Repeated measurement of growth-differentiation factor-15 in Chinese Han patients with post-myocardial infarction chronic heart failure

• 来源期刊: 老年心脏病学杂志（英文版）
• 年，卷（期）: 2018,（10）
• 页码范围: 618-627
• 页数: 10页
• 语种: 英文
• DOI: 10.11909/j.issn.1671-5411.2018.10.002

摘要

Background Growth-differentiation factor-15 (GDF-15) is a promising prognostic biomarker in patients with chronic heart failure (CHF).Comparatively little is known about the value of repeated measurement of GDF-15 with CHF in Chinese Han population.This study sought to identify the clinical value of repeated measurement of GDF-15 in Chinese Han patients with post-myocardial infarction CHF.Methods In total,232 consecutive Chinese Han patients with post-myocardial infarction CHF were enrolled prospectively from January 2014 to June 2016.The plasma concentration of GDF-15 was determined on admission and over 12 months.Patients were followed up for all-cause death and a composite outcome of major adverse cardiac events (MACE) included all-cause death,myocardial infarction and first heart failure (HF) re-hospitalization.Association with other clinical variables and adverse outcomes of repeated measurement of GDF-15 was explored.Results The median baseline GDF-15 level was 2025 ng/L.Baseline GDF-15 was moderately associated with baseline N-terminal pro-B type natriuretic peptide (NT-proBNP) (coefficient 0.561,P ＜ 0.001).During a median follow-up of 20 months,there were 53 deaths and 100MACE.GDF-15 remained an independent predictor of all-cause death (adjusted hazard ratio 1.826 per 1 Ln U,95％ CI:1.037-8.360;P =0.037) and MACE (adjusted hazard ratio 2.243 per 1 Ln U,95％ CI:1.181-1.775;P ＜ 0.001) adjusted for established risk factors.Repeated measurement of GDF-15 was performed in 173 survivals over 12months.Increase of GDF-15 over 12 months was associated with dilatation of left ventricle and acted as an independent predictor of subsequent all-cause death (adjusted HR =3.164,95％ CI:1.245-0.041;P =0.015).In the joint model,GDF-15 was also shown to be a risk factor for all-cause death (HR =2.749,95％ CI:1.667-3.831;P ＜ 0.001) and MACE (HR =2.434,95％ CI:1.425-3.443;P ＜ 0.001).Conclusions Repeated measurements of GDF-15 have promising prognostic value of the risk of all-cause death in Chinese Han patients with CHF post-myocardial infarction.GDF-15 may influence the post-myocardial infarction CHF through the path physiological pathway of myocardial remodeling.