title: Growth differentiation factor-15 as a prognostic marker in patients with acute myocardial infarction.
abstract: OBJECTIVE
  Our aim was to assess the long-term prognostic value of growth differentiation factor-15 (GDF-15) in patients post-acute myocardial infarction (AMI). Growth differentiation factor-15 is a member of the transforming growth factor beta family. Growth differentiation factor-15 is expressed in the myocardium and upregulated due to 'stress' and has been shown to have antiapoptotic actions. Its role in the cardiovascular system however is not well defined. We were interested to see if GDF-15 could provide long-term prognostic value in post-AMI patients. We compared GDF-15 with N-terminal pro-B-type natriuretic peptide (NT-proBNP).
  
  
  RESULTS
  We recruited 1142 consecutive post-AMI patients [820 men, median (range) age 67 (24-97) years] in a prospective study with a follow-up period of 505 (range 1-2837) days. Growth differentiation factor-15 levels increased with increasing Killip class (P < 0.001) and were correlated with NT-proBNP (r = 0.47, P < 0.001). Using a multivariable Cox proportional hazards model, log GDF-15 (HR 1.77), log NT-proBNP (HR 2.06), age (HR 1.03) Killip class above 1, (HR 1.62), use of beta-blockers (HR 0.54) and past history of MI (HR 1.44) were significant independent predictors of death or heart failure (HF). Predictors of death were log NT-proBNP, log GDF-15, age, eGFR, past history of MI, use of beta-blockers, and use of ACE inhibitors or angiotensin receptor blockers. The C-statistic for GDF-15 for predicting death or HF at 1 year was 0.73 (95% CI: 0.70-0.76, P < 0.001) and was 0.76 (95% CI: 0.70-0.80, P < 0.001) for NT-proBNP. Combining these markers yielded an AUC of 0.81 (95% CI: 0.77-0.85), which exceeded that of GDF-15 (P < 0.001) and NT-proBNP (P = 0.004) alone. The Kaplan-Meier analysis revealed that those patients with above median GDF-15 and NT-proBNP had the highest event rate for death and HF (log rank 50.22, P < 0.001).
  
  
  CONCLUSIONS
  Growth differentiation factor-15 is a new marker for predicting death and HF in post-AMI patients. GDF-15 provides prognostic information over and above clinical factors and the established biomarker NT-proBNP. Combined levels of GDF-15 with NT-proBNP can identify a high-risk group of patients.
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK. sqk1@le.ac.uk
authors.forename: Sohail Q
authors.initials: SQ
authors.lastname: Khan
authors.forename: Kelvin
authors.initials: K
authors.lastname: Ng
authors.forename: Onkar
authors.initials: O
authors.lastname: Dhillon
authors.forename: Dominic
authors.initials: D
authors.lastname: Kelly
authors.forename: Paulene
authors.initials: P
authors.lastname: Quinn
authors.forename: Iain B
authors.initials: IB
authors.lastname: Squire
authors.forename: Joan E
authors.initials: JE
authors.lastname: Davies
authors.forename: Leong L
authors.initials: LL
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D055436:Growth Differentiation Factor 15; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain