Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany.
Eur J Heart Fail. 2012 Nov;14(11):1240-8. doi: 10.1093/eurjhf/hfs116. Epub 2012 Jul 26.
This study aimed to examine the incremental value of growth-differentiation factor-15 (GDF-15) to N-terminal pro brain natriuretic hormone (NT-proBNP) levels for the diagnosis of left ventricular diastolic dysfunction (LVDD) and possible heart failure (HF) in morbidly obese patients. Method and results We analysed data from 207 obese subjects [body mass index (BMI) 41 ± 8 kg/m(2)] with normal ejection fraction, LVDD, and symptoms and/or signs of HF (referred to as 'LVDD with possible HF', n = 88) and with normal left ventricular function (n = 119) before participating in a medical weight loss programme, in addition to the study of healthy lean subjects (n = 51). Median NT-proBNP (interquartile range) for obese subjects with 'LVDD and possibe HF' and with normal LV function was 52 (29-96) and 42 (25-66) pg/mL, respectively (P = 0.12). There was no correlation of NT-proBNP with parameters of left ventricular filling pressure, i.e. E/E' (r(2) = 0.002, P = 0.63) or E' velocity (r(2) = 0.02, P = 0.24). In contrast, GDF-15 was 665 (496-926) with 'LVDD and possible HF' and 451 (392- 679) pg/mL without (P < 0.0001). GDF-15 was significantly correlated to E/E', E' velocity, E/A ratio, isovolumetric relaxation time, duration of reversed pulmonary vein atrial systolic flow, and left atrial size. The area under the receiver operating characteristic curve that defines LVDD with possible HF was 0.56 for NT-proBNP and 0.74 for GDF-15 (P < 0.0001). The addition of GDF-15 to a multivariate predicition model increased the net reclassification improvement (NRI) by 9% (P= 0.022).
In morbidly obese individuals, GDF-15 levels seem to better correlate with diastolic dysfunction than NT-proBNP levels. GDF-15 significantly improves reclassification for the diagnosis of 'LVDD with possible HF' and, thus, adds incremental value to NT-proBNP.
本研究旨在探讨生长分化因子 15（GDF-15）对 N 末端脑钠肽前体（NT-proBNP）水平在诊断病态肥胖患者左心室舒张功能障碍（LVDD）和可能心力衰竭（HF）方面的增量价值。
我们分析了 207 名肥胖受试者的数据，这些受试者的体重指数（BMI）为 41 ± 8 kg/m²，射血分数正常，左心室舒张功能障碍（LVDD），以及有或无症状和/或体征的 HF（称为“可能 HF 的 LVDD”，n = 88）和左心室功能正常（n = 119），在参加医疗减肥计划之前，以及健康瘦受试者（n = 51）的研究。患有“LVDD 和可能 HF”和左心室功能正常的肥胖受试者的中位数 NT-proBNP（四分位距）分别为 52（29-96）和 42（25-66）pg/mL（P = 0.12）。NT-proBNP 与左心室充盈压的参数（E/E'（r² = 0.002，P = 0.63）或 E'速度（r² = 0.02，P = 0.24）之间没有相关性。相比之下，GDF-15 为 665（496-926），而无“LVDD 和可能 HF”时为 451（392-679）pg/mL（P < 0.0001）。GDF-15 与 E/E'、E'速度、E/A 比值、等容舒张时间、反向肺静脉心房收缩血流持续时间和左心房大小显著相关。定义可能存在 HF 的 LVDD 的接收器操作特征曲线下面积（AUC）为 NT-proBNP 的 0.56 和 GDF-15 的 0.74（P < 0.0001）。将 GDF-15 添加到多变量预测模型中可将净重新分类改善（NRI）提高 9%（P= 0.022）。
在病态肥胖个体中，GDF-15 水平似乎与舒张功能障碍比 NT-proBNP 水平更好地相关。GDF-15 显著改善了“可能存在 HF 的 LVDD”的诊断再分类，因此为 NT-proBNP 提供了增量价值。
