title: Growth-differentiation factor 15 as predictor of mortality in acute reperfused ST-elevation myocardial infarction: insights from cardiovascular magnetic resonance.
abstract: OBJECTIVE
  Growth-differentiation factor 15 (GDF-15), a stress-responsive member of the transforming growth factor beta cytokine superfamily, has emerged as a biomarker of increased mortality in cardiovascular disease. However, the exact pathophysiological mechanisms of GDF-15 in the cardiovascular system and in acute ST-elevation myocardial infarction (STEMI) are not well defined. The aim of this study was to determine the relation between GDF-15 and myocardial damage assessed by cardiovascular magnetic resonance (CMR) imaging and to evaluate the prognostic value of GDF-15 in a high-risk STEMI population exclusively reperfused by primary angioplasty.
  
  
  METHODS
  GDF-15 concentrations were determined by an ELISA in 238 consecutive patients undergoing primary angioplasty in STEMI less than 12 h after symptom onset. Patients were categorised into two groups defined by the median GDF-15 value on admission. CMR was performed 3&emsp14;days (IQR 2-4) after infarction for assessment of infarct size, myocardial salvage and microvascular obstruction. The primary clinical endpoint was mortality within 6 months after the index event.
  
  
  RESULTS
  Elevated GDF-15 concentrations over and above the median on admission were a strong predictor of mortality (19 vs one death, p<0.001) and major adverse cardiac events (27 vs nine events, p=0.001) at 6 months follow-up. Myocardial salvage was an inverse multivariable predictor of GDF-15 concentrations.
  
  
  CONCLUSIONS
  GDF-15 on admission is a strong predictor of mortality in patients with STEMI reperfused by primary angioplasty, which is associated with decreased myocardial salvage and subsequent adverse clinical outcome. Clinical trail registration number http://www.clinicaltrials.gov/ NCT00463749.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Strümpellstrasse 39, Leipzig 04289, Germany. ingoeitel@gmx.de
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Patrick
authors.initials: P
authors.lastname: Blase
authors.forename: Volker
authors.initials: V
authors.lastname: Adams
authors.forename: Lysann
authors.initials: L
authors.lastname: Hildebrand
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D004812:Epidemiologic Methods; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000378:metabolism*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D055436:Growth Differentiation Factor 15