Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
J Cell Mol Med. 2018 Apr;22(4):2422-2429. doi: 10.1111/jcmm.13540. Epub 2018 Feb 4.
Growth differentiation factor (GDF)-15 and soluble ST2 (sST2) are established prognostic markers in acute and chronic heart failure. Assessment of these biomarkers might improve arrhythmic risk stratification of patients with non-ischaemic, dilated cardiomyopathy (DCM) based on left ventricular ejection fraction (LVEF). We studied the prognostic value of GDF-15 and sST2 for prediction of arrhythmic death (AD) and all-cause mortality in patients with DCM. We prospectively enrolled 52 patients with DCM and LVEF ≤ 50%. Primary end-points were time to AD or resuscitated cardiac arrest (RCA), and secondary end-point was all-cause mortality. The median follow-up time was 7 years. A cardiac death was observed in 20 patients, where 10 patients had an AD and 2 patients had a RCA. One patient died a non-cardiac death. GDF-15, but not sST2, was associated with increased risk of the AD/RCA with a hazard ratio (HR) of 2.1 (95% CI = 1.1-4.3; P = .031). GDF-15 remained an independent predictor of AD/RCA after adjustment for LVEF with adjusted HR of 2.2 (95% CI = 1.1-4.5; P = .028). Both GDF-15 and sST2 were independent predictors of all-cause mortality (adjusted HR = 2.4; 95% CI = 1.4-4.2; P = .003 vs HR = 1.6; 95% CI = 1.05-2.7; P = .030). In a model including GDF-15, sST2, LVEF and NYHA functional class, only GDF-15 was significantly associated with the secondary end-point (adjusted HR = 2.2; 95% CI = 1.05-5.2; P = .038). GDF-15 is superior to sST2 in prediction of fatal arrhythmic events and all-cause mortality in DCM. Assessment of GDF-15 could provide additional information on top of LVEF and help identifying patients at risk of arrhythmic death.
生长分化因子 15（GDF-15）和可溶性 ST2（sST2）是急性和慢性心力衰竭的既定预后标志物。评估这些生物标志物可能会改善非缺血性扩张型心肌病（DCM）患者基于左心室射血分数（LVEF）的心律失常风险分层。我们研究了 GDF-15 和 sST2 对 DCM 患者预测心律失常死亡（AD）和全因死亡率的预后价值。我们前瞻性纳入了 52 例 LVEF≤50%的 DCM 患者。主要终点为 AD 或复苏性心脏骤停（RCA）的时间，次要终点为全因死亡率。中位随访时间为 7 年。20 例患者发生心脏性死亡，其中 10 例发生 AD，2 例发生 RCA，1 例发生非心脏性死亡。GDF-15 但不是 sST2 与 AD/RCA 的风险增加相关，风险比（HR）为 2.1（95%CI=1.1-4.3；P=0.031）。在调整 LVEF 后，GDF-15 仍然是 AD/RCA 的独立预测因子，调整后的 HR 为 2.2（95%CI=1.1-4.5；P=0.028）。GDF-15 和 sST2 均为全因死亡率的独立预测因子（调整后的 HR=2.4；95%CI=1.4-4.2；P=0.003 与 HR=1.6；95%CI=1.05-2.7；P=0.030）。在包含 GDF-15、sST2、LVEF 和纽约心脏协会（NYHA）功能分级的模型中，只有 GDF-15 与次要终点显著相关（调整后的 HR=2.2；95%CI=1.05-5.2；P=0.038）。在 DCM 中，GDF-15 预测致命性心律失常事件和全因死亡率的能力优于 sST2。评估 GDF-15 可以在 LVEF 的基础上提供额外的信息，并帮助识别心律失常死亡风险患者。
