title: Growth differentiation factor-15 in Takotsubo cardiomyopathy: diagnostic and prognostic value.
abstract: BACKGROUND
  Growth differentiation factor-15 (GDF-15), a stress responsive cytokine, has emerged as a marker of adverse outcome in various cardiovascular diseases. Since GDF-15 has not been evaluated in patients with Takotsubo cardiomyopathy (TTC), the present study sought to investigate the diagnostic and prognostic value in this patient cohort.
  
  
  METHODS
  A total of 22 patients presenting with TTC were matched for age and gender with 22 ST-segment elevation myocardial infarction (STEMI) patients. GDF-15 concentrations were measured at admission and 1 day thereafter. The primary clinical endpoint of the TTC cohort was the composite of death, cardiogenic shock, or new congestive heart failure within 6 months.
  
  
  RESULTS
  TTC patients showed significantly higher GDF-15 values on admission compared to patients presenting with STEMI (median 3047 ng/l [interquartile range 2256-7572] versus median 1527 ng/l [interquartile range 1152-2677]; p=0.002). TTC patients with a biventricular ballooning pattern and patients experiencing major adverse cardiac events during the first 6 months after acute presentation showed significantly higher GDF-15 concentrations on admission (p=0.008 and p=0.005, respectively). Biventricular ballooning was identified as a predictor for elevated GDF-15 values on admission (p=0.03). High GDF-15 levels on admission were the only significant predictor for the combined clinical endpoint in multivariable regression analysis (p=0.02).
  
  
  CONCLUSIONS
  TTC patients showed markedly high, but transient elevation of GDF-15 levels. Biventricular ballooning was associated with particularly high GDF-15 concentrations. Elevated GDF-15 values on admission were a strong predictor of adverse clinical outcome.
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Stiermaier
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Adams
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Just
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Blazek
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Desch
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schuler
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Thiele
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine-Cardiology, Leipzig, Germany. Electronic address: ingoeitel@gmx.de.
authors.forename: I
authors.initials: I
authors.lastname: Eitel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000097:blood* / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15
keywords: Apical ballooning syndrome; GDF-15; Infarction; Prognosis; Stress cardiomyopathy; Takotsubo