title: Elevated growth differentiation factor 15 levels predict outcome in patients undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has emerged as a treatment of aortic stenosis in patients at high surgical risk. However, risk stratification in this elderly population is challenging, as patients at extreme risk might not benefit from TAVI. While several clinical criteria have been proposed for estimating the outcome, prediction of individual risk remains difficult. Therefore, our aim was to assess the prognostic value of the biomarker growth differentiation factor 15 (GDF15).
  
  
  RESULTS
  Over a 2.9-year period, we prospectively enrolled 217 patients undergoing TAVI. Clinical parameters, risk scores, and biomarkers (NT-proBNP and GDF15) were measured at baseline. The primary endpoint was survival time; prognostic factors were analysed by Cox regression analysis. Mean age of study participants was 81.8 ± 6.0 years. Median Logistic EuroSCORE was 20.1 (Q1-Q3 13.6-32.6). Thirty-day mortality was 6.9%; 30.4% of the patients died during follow-up [median 349 days (Q1-Q3 106-660)]. Median pre-procedural GDF15 values were 2256 pg/mL (1585-3082). High GDF15 levels were associated with numerous factors that could contribute to poor outcome. Analyses comparing the upper quartile with the lower three quartiles for biomarker levels revealed a hazard ratio (HR) of increased GDF15 for adverse outcome of 2.4 [95% confidence interval (CI) 1.5-3.9, P < 0.001]. Of note, in multiple analyses, elevated GDF15 levels were superior to NT-proBNP for predicting negative outcome (adjusted HR of GDF15 1.97, 95% CI 1.2-3.3; P = 0.009).
  
  
  CONCLUSIONS
  Elevated GDF15 levels were superior to NT-proBNP for TAVI risk stratification and provided additional prognostic information. Thus, patient selection for TAVI may benefit from measurement of GDF15.
authors.affiliation: Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Nora-Christina
authors.initials: NC
authors.lastname: Krau
authors.affiliation: Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Nina-Sophie
authors.initials: NS
authors.lastname: Lünstedt
authors.affiliation: Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Freitag-Wolf
authors.affiliation: Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Doreen
authors.initials: D
authors.lastname: Brehm
authors.affiliation: Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Petzina
authors.affiliation: Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Lutter
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Mahlow, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.affiliation: Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Dempfle
authors.affiliation: Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Frey
authors.affiliation: Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
authors.forename: Derk
authors.initials: D
authors.lastname: Frank
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000401:mortality / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006801:Humans; D008297:Male; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D015415:Biomarkers; D055436:Growth Differentiation Factor 15
keywords: Biomarker; Growth differentiation factor 15 (GDF15); N-terminal pro brain natriuretic peptide (NT-proBNP); Transcatheter aortic valve implantation (TAVI)