Introduction

Cardiac biomarkers have been proposed as a new tool to improve risk stratification of serious arrhythmic events in patients with heart failure (HF) beyond estimates of left ventricular ejection fraction. Growth differentiation factor (GDF)-15, a stress-induced cytokine, has been found to correlate with markers of myocardial fibrosis and adverse clinical outcomes, but its role as a predictor of arrhythmic events in patients with nonischemic HF is uncertain.

Methods and results

A prospective observational study was conducted in 148 nonischemic patients with HF who underwent comprehensive clinical and laboratory evaluation, including measurement of serum GDF-15. The study endpoints were serious arrhythmic events (which included appropriate implantable cardioverter-defibrillator therapy and sudden cardiac death) and all-cause mortality. Mean age of the cohort was 54.8 ± 12.7 years, and mean left ventricular ejection fraction (LVEF) was 27.4% ± 7.5%. During a mean follow-up time of 42 months, arrhythmic events occurred in 28 patients (19%), and 40 patients (27%) died. An increase in serum GDF-15 (log-transformed) correlated linearly with a higher risk of serious arrhythmic events (HR 1.14, 95% CI 1.01–1.28, p = 0.03) even after adjustment for other potential clinical predictors (HR 1.16, 95% CI 1.02–1.32, p = 0.02). GDF-15 was also strongly and independently associated with all-cause mortality (HR 1.17, 1.05–1.31, p = 0.004).

Conclusion

In this cohort of nonischemic HF patients on optimized medical treatment, serum GDF-15 levels were independently associated with major arrhythmic events and overall mortality. This biomarker may add prognostic information to better stratify the risk of sudden death in this particular population.

中文翻译：

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生长/分化因子 15 (GDF-15) 作为非缺血性扩张型心肌病患者严重心律失常事件的预测因子

介绍

心脏生物标志物已被提议作为一种新工具，用于改善心力衰竭 (HF) 患者严重心律失常事件的风险分层，超出左心室射血分数的估计值。生长分化因子 (GDF)-15 是一种应激诱导的细胞因子，已被发现与心肌纤维化标志物和不良临床结果相关，但其作为非缺血性 HF 患者心律失常事件预测因子的作用尚不确定。

方法和结果

对 148 名非缺血性心力衰竭患者进行了一项前瞻性观察研究，这些患者接受了全面的临床和实验室评估，包括血清 GDF-15 的测量。研究终点是严重心律失常事件（包括适当的植入式心脏复律除颤器治疗和心源性猝死）和全因死亡率。该队列的平均年龄为 54.8 ± 12.7 岁，平均左心室射血分数 (LVEF) 为 27.4% ± 7.5%。在 42 个月的平均随访时间内，28 名患者 (19%) 发生心律失常事件，40 名患者 (27%) 死亡。血清 GDF-15（对数转换）的增加与严重心律失常事件的较高风险呈线性相关（HR 1.14, 95% CI 1.01–1.28, p = 0.03)，即使在调整了其他潜在的临床预测因素后 (HR 1.16, 95% CI 1.02–1.32, p  = 0.02)。GDF-15 也与全因死亡率强烈且独立地相关（HR 1.17, 1.05–1.31, p  = 0.004）。

结论

在这个接受优化药物治疗的非缺血性心衰患者队列中，血清 GDF-15 水平与主要心律失常事件和总死亡率独立相关。这种生物标志物可能会增加预后信息，以更好地对这一特定人群的猝死风险进行分层。