title: Growth-differentiation factor-15 and major cardiac events.
abstract: BACKGROUND
  Growth-differentiation factor (GDF)-15 is a strong predictor of cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). However, the effects of GDF-15 on left ventricular (LV) remodeling have not been clearly elucidated. The aim of this study is to investigate whether GDF-15 will be of benefit in predicting LV remodeling, heart failure and death in patients with STEMI.
  
  
  METHODS
  The authors enrolled 216 patients with STEMI who received measurement of GDF-15 level on day 2 of hospitalization. Echocardiographic studies were performed at baseline and were repeated 6 months later. Clinical events, including all-cause death and readmission for heart failure, were followed up for a maximum of 3 years.
  
  
  RESULTS
  Patients with GDF-15 levels above the median had lower LV ejection fraction at baseline (43.9% versus 48.0%, P = 0.041) and at 6 months (51.5% versus 56.9%, P = 0.025). In univariable regression model, log-transformed GDF-15 level was not a predictor of increase in LV end-diastolic volume index at 6 months (P = 0.767). Kaplan-Meier survival curves showed that the combination of high GDF-15 and high N-terminal pro-B-type natriuretic peptide was a strong predictor of death and heart failure (P < 0.001). In multivariable Cox regression model, the independent predictors of death and heart failure were age, GDF-15 level and diabetes mellitus.
  
  
  CONCLUSIONS
  High GDF-15 level is a strong predictor of death and heart failure in patients with STEMI. Although patients with higher GDF-15 levels tend to have lower LV ejection fraction, they have similar degree of the increase in LV end-diastolic volume index at 6 months.
authors: Division of Cardiology (JFL, SYH, KHY, HHC, STC, TYW, WTH, YLK), Department of Internal Medicine, Buddhist Tzu-Chi Hospital, Taipei Branch, Taiwan; School of Medicine (JFL, SYH, KHY, YLK), Tzu Chi University, Hualien, Taiwan; Department of Laboratory Medicine (CCY), Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan; Department of Research (SW), Buddhist Tzu-Chi Hospital, Taipei Branch, Taiwan; and Department of Life Science (SW), Chinese Culture University, Taipei, Taiwan.
authors: Jeng-Feng
authors: JF
authors: Lin
authors: Semon
authors: S
authors: Wu
authors: Shun-Yi
authors: SY
authors: Hsu
authors: Kuan-Hung
authors: KH
authors: Yeh
authors: Hsin-Hua
authors: HH
authors: Chou
authors: Shih-Tsung
authors: ST
authors: Cheng
authors: Tien-Yu
authors: TY
authors: Wu
authors: Wen-Tze
authors: WT
authors: Hsu
authors: Chun-Chun
authors: CC
authors: Yang
authors: Yu-Lin
authors: YL
authors: Ko
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006333:Heart Failure / Q000097:blood / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain