Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Graduate Program in Cardiovascular Science and Cardiology, Universidade Federal do Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil..
Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Graduate Program in Cardiovascular Science and Cardiology, Universidade Federal do Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil.
J Electrocardiol. 2022 Jan-Feb;70:19-23. doi: 10.1016/j.jelectrocard.2021.10.002. Epub 2021 Oct 8.
Cardiac biomarkers have been proposed as a new tool to improve risk stratification of serious arrhythmic events in patients with heart failure (HF) beyond estimates of left ventricular ejection fraction. Growth differentiation factor (GDF)-15, a stress-induced cytokine, has been found to correlate with markers of myocardial fibrosis and adverse clinical outcomes, but its role as a predictor of arrhythmic events in patients with nonischemic HF is uncertain.
A prospective observational study was conducted in 148 nonischemic patients with HF who underwent comprehensive clinical and laboratory evaluation, including measurement of serum GDF-15. The study endpoints were serious arrhythmic events (which included appropriate implantable cardioverter-defibrillator therapy and sudden cardiac death) and all-cause mortality. Mean age of the cohort was 54.8 ± 12.7 years, and mean left ventricular ejection fraction (LVEF) was 27.4% ± 7.5%. During a mean follow-up time of 42 months, arrhythmic events occurred in 28 patients (19%), and 40 patients (27%) died. An increase in serum GDF-15 (log-transformed) correlated linearly with a higher risk of serious arrhythmic events (HR 1.14, 95% CI 1.01-1.28, p = 0.03) even after adjustment for other potential clinical predictors (HR 1.16, 95% CI 1.02-1.32, p = 0.02). GDF-15 was also strongly and independently associated with all-cause mortality (HR 1.17, 1.05-1.31, p = 0.004).
In this cohort of nonischemic HF patients on optimized medical treatment, serum GDF-15 levels were independently associated with major arrhythmic events and overall mortality. This biomarker may add prognostic information to better stratify the risk of sudden death in this particular population.
心脏生物标志物被提议作为一种新工具，以改善心力衰竭（HF）患者严重心律失常事件的风险分层，超出左心室射血分数（LVEF）的估计。生长分化因子（GDF）-15 是一种应激诱导的细胞因子，已被发现与心肌纤维化和不良临床结局的标志物相关，但它作为非缺血性 HF 患者心律失常事件预测因子的作用尚不确定。
对 148 名接受综合临床和实验室评估的非缺血性 HF 患者进行了前瞻性观察研究，包括血清 GDF-15 的测量。研究终点是严重心律失常事件（包括适当的植入式心脏复律除颤器治疗和心脏性猝死）和全因死亡率。队列的平均年龄为 54.8±12.7 岁，平均 LVEF 为 27.4%±7.5%。在平均 42 个月的随访期间，28 名患者（19%）发生心律失常事件，40 名患者（27%）死亡。血清 GDF-15（对数转换）的增加与严重心律失常事件的风险呈线性相关（HR 1.14，95%CI 1.01-1.28，p=0.03），即使在调整其他潜在临床预测因素后（HR 1.16，95%CI 1.02-1.32，p=0.02）。GDF-15 也与全因死亡率强烈且独立相关（HR 1.17，1.05-1.31，p=0.004）。
在接受优化药物治疗的非缺血性 HF 患者队列中，血清 GDF-15 水平与主要心律失常事件和总死亡率独立相关。该生物标志物可能为更好地分层该特定人群的猝死风险提供预后信息。
