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The novel biomarker growth differentiation factor 15 in heart failure with normal ejection fraction.

Stahrenberg R, Edelmann F, Mende M, Kockskämper A, Düngen HD, Lüers C, Binder L, Herrmann-Lingen C, Gelbrich G, Hasenfuss G, Pieske B, Wachter R - Eur. J. Heart Fail. (2010)

Bottom Line: In multivariate analysis, factors significantly associated with GDF-15 levels were age, sex, estimated glomerular filtration rate (eGFR), presence of HFrEF and HFnEF.When using a classification for HFnEF that did not employ N-terminal pro brain natriuretic peptide (NT-proBNP) as a diagnostic criterion, the diagnostic properties of GDF-15 for detecting HFnEF tended to be superior to those of NT-proBNP, and a combination significantly improved diagnostic accuracy.It is independently associated with impairment in exercise capacity and in physical components of quality of life.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Pneumology, University of Goettingen, 37075 Goettingen, Germany.

ABSTRACT

Aims: Heart failure with normal ejection fraction (HFnEF) is an important clinical entity that remains incompletely understood. The novel biomarker growth differentiation factor 15 (GDF-15) is elevated in systolic heart failure (HFrEF) and is predictive of an adverse outcome. We investigated the clinical relevance of GDF-15 plasma levels in HFnEF.

Methods and results: A subgroup of patients from the ongoing DIAST-CHF observational trial, with a history of chronic heart failure (CHF) or positive Framingham criteria at presentation, was selected. Patients were classified as having either HFrEF (n=86) or HFnEF (n=142) and compared with healthy elderly controls (n=188) from the same cohort. Growth differentiation factor 15 levels in HFnEF were significantly higher than in controls and similar to those in HFrEF. In multivariate analysis, factors significantly associated with GDF-15 levels were age, sex, estimated glomerular filtration rate (eGFR), presence of HFrEF and HFnEF. Growth differentiation factor 15 correlated with multiple echocardiographic markers of diastolic function and was associated with 6 min walk test performance and SF-36 physical score on multivariate analysis in all patients. When using a classification for HFnEF that did not employ N-terminal pro brain natriuretic peptide (NT-proBNP) as a diagnostic criterion, the diagnostic properties of GDF-15 for detecting HFnEF tended to be superior to those of NT-proBNP, and a combination significantly improved diagnostic accuracy.

Conclusion: Growth differentiation factor 15 is elevated in HFnEF to a similar degree as in HFrEF. It is independently associated with impairment in exercise capacity and in physical components of quality of life. Diagnostic precision of GDF-15 is at least as good as that of NT-proBNP and combining both markers improves diagnostic accuracy.

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ROC curves for growth differentiation factor 15, NT-proBNP or their combination for discrimination of (A) HFnEFESC from controls or (B) HFnEFNew from controls.
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HFQ151F5: ROC curves for growth differentiation factor 15, NT-proBNP or their combination for discrimination of (A) HFnEFESC from controls or (B) HFnEFNew from controls.

Mentions: As NT-proBNP is considered a valuable biomarker for the diagnosis of HFnEFESC,4 we compared GDF-15 with NT-proBNP for the discrimination of HFnEFESC from healthy controls. ROC curves for both markers were very similar (Figure 5A) with an AUC of 0.882 (0.842; 0.922) for NT-proBNP and 0.891 (0.850; 0.932) for GDF-15 (P = 0.37), while the combination of both markers exhibited a significantly larger AUC of 0.942 (0.912; 0.972) compared with NT-proBNP (P < 0.01) or GDF-15 (P < 0.05) alone. For cut-off levels of 1.16 ng/mL (GDF-15) and 199 ng/L (NT-proBNP), the respective sum of sensitivity and specificity was maximal. A cut-off value of 1.20 ng/mL has been proposed for GDF-15 for a diagnosis of HFrEF.15 At this value, sensitivity reached 81.7% and specificity 85.5% with an odds ratio (OR) of 18.1 for having HFnEFESC. Sinilarly, an NT-proBNP >220 ng/L is recommended for a positive diagnosis of HFnEFESC,4 which gives a sensitivity of 65.1%, a specificity of 96.8% and an OR of 46, respectively.Figure 5


The novel biomarker growth differentiation factor 15 in heart failure with normal ejection fraction.

Stahrenberg R, Edelmann F, Mende M, Kockskämper A, Düngen HD, Lüers C, Binder L, Herrmann-Lingen C, Gelbrich G, Hasenfuss G, Pieske B, Wachter R - Eur. J. Heart Fail. (2010)

ROC curves for growth differentiation factor 15, NT-proBNP or their combination for discrimination of (A) HFnEFESC from controls or (B) HFnEFNew from controls.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2990410&req=5

HFQ151F5: ROC curves for growth differentiation factor 15, NT-proBNP or their combination for discrimination of (A) HFnEFESC from controls or (B) HFnEFNew from controls.
Mentions: As NT-proBNP is considered a valuable biomarker for the diagnosis of HFnEFESC,4 we compared GDF-15 with NT-proBNP for the discrimination of HFnEFESC from healthy controls. ROC curves for both markers were very similar (Figure 5A) with an AUC of 0.882 (0.842; 0.922) for NT-proBNP and 0.891 (0.850; 0.932) for GDF-15 (P = 0.37), while the combination of both markers exhibited a significantly larger AUC of 0.942 (0.912; 0.972) compared with NT-proBNP (P < 0.01) or GDF-15 (P < 0.05) alone. For cut-off levels of 1.16 ng/mL (GDF-15) and 199 ng/L (NT-proBNP), the respective sum of sensitivity and specificity was maximal. A cut-off value of 1.20 ng/mL has been proposed for GDF-15 for a diagnosis of HFrEF.15 At this value, sensitivity reached 81.7% and specificity 85.5% with an odds ratio (OR) of 18.1 for having HFnEFESC. Sinilarly, an NT-proBNP >220 ng/L is recommended for a positive diagnosis of HFnEFESC,4 which gives a sensitivity of 65.1%, a specificity of 96.8% and an OR of 46, respectively.Figure 5

Bottom Line: In multivariate analysis, factors significantly associated with GDF-15 levels were age, sex, estimated glomerular filtration rate (eGFR), presence of HFrEF and HFnEF.When using a classification for HFnEF that did not employ N-terminal pro brain natriuretic peptide (NT-proBNP) as a diagnostic criterion, the diagnostic properties of GDF-15 for detecting HFnEF tended to be superior to those of NT-proBNP, and a combination significantly improved diagnostic accuracy.It is independently associated with impairment in exercise capacity and in physical components of quality of life.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Pneumology, University of Goettingen, 37075 Goettingen, Germany.

ABSTRACT

Aims: Heart failure with normal ejection fraction (HFnEF) is an important clinical entity that remains incompletely understood. The novel biomarker growth differentiation factor 15 (GDF-15) is elevated in systolic heart failure (HFrEF) and is predictive of an adverse outcome. We investigated the clinical relevance of GDF-15 plasma levels in HFnEF.

Methods and results: A subgroup of patients from the ongoing DIAST-CHF observational trial, with a history of chronic heart failure (CHF) or positive Framingham criteria at presentation, was selected. Patients were classified as having either HFrEF (n=86) or HFnEF (n=142) and compared with healthy elderly controls (n=188) from the same cohort. Growth differentiation factor 15 levels in HFnEF were significantly higher than in controls and similar to those in HFrEF. In multivariate analysis, factors significantly associated with GDF-15 levels were age, sex, estimated glomerular filtration rate (eGFR), presence of HFrEF and HFnEF. Growth differentiation factor 15 correlated with multiple echocardiographic markers of diastolic function and was associated with 6 min walk test performance and SF-36 physical score on multivariate analysis in all patients. When using a classification for HFnEF that did not employ N-terminal pro brain natriuretic peptide (NT-proBNP) as a diagnostic criterion, the diagnostic properties of GDF-15 for detecting HFnEF tended to be superior to those of NT-proBNP, and a combination significantly improved diagnostic accuracy.

Conclusion: Growth differentiation factor 15 is elevated in HFnEF to a similar degree as in HFrEF. It is independently associated with impairment in exercise capacity and in physical components of quality of life. Diagnostic precision of GDF-15 is at least as good as that of NT-proBNP and combining both markers improves diagnostic accuracy.

Show MeSH
Related in: MedlinePlus