Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine.
Faculty of Medicine, Yamagata University School of Medicine.
Circ J. 2023 Jul 25;87(8):1120-1129. doi: 10.1253/circj.CJ-23-0088. Epub 2023 Mar 23.
Heart failure (HF) is an increasing health problem associated with a high mortality rate. Growth differentiation factor (GDF) 15, a stress response cytokine belonging to the transforming growth factor-β superfamily, is associated with poor clinical outcomes in a broad spectrum of cardiovascular diseases. However, the prognostic usefulness of GDF15 in Japanese patients with HF remains unclear.
We measured serum concentrations of GDF15 and B-type natriuretic peptide (BNP) in 1,201 patients with HF. All patients were prospectively followed for a median period of 1,309 days. In all, 319 HF-related events and 187 all-cause deaths occurred during the follow-up period. Kaplan-Meier analysis demonstrated that, among GDF15 tertiles, the highest tertile group had the greatest risk of HF-related events and all-cause mortality. Multivariate Cox proportional hazard regression analysis demonstrated that the serum GDF15 concentration was an independent predictor of HF-related events and all-cause deaths after adjusting for confounding risk factors. Serum GDF15 improved the prediction capacity for all-cause deaths and HF-related events with a significant net reclassification index and integrated discrimination improvement. Subgroup analysis in patients with HF with preserved ejection fraction also showed the prognostic usefulness of GDF15.
Serum GDF15 concentrations were associated with HF severity and clinical outcomes, indicating that GDF15 could provide additional clinical information to track the health status of patients with HF.
心力衰竭（HF）是一种日益严重的健康问题，与高死亡率相关。生长分化因子（GDF）15 是转化生长因子-β超家族中的一种应激反应细胞因子，与广泛的心血管疾病的不良临床结局相关。然而，GDF15 在日本 HF 患者中的预后价值仍不清楚。
我们测量了 1201 例 HF 患者的血清 GDF15 和 B 型利钠肽（BNP）浓度。所有患者均前瞻性随访中位数为 1309 天。在随访期间，共发生 319 例 HF 相关事件和 187 例全因死亡。Kaplan-Meier 分析表明，在 GDF15 三分位组中，最高三分位组 HF 相关事件和全因死亡率的风险最高。多变量 Cox 比例风险回归分析表明，在调整混杂风险因素后，血清 GDF15 浓度是 HF 相关事件和全因死亡的独立预测因子。血清 GDF15 改善了全因死亡和 HF 相关事件的预测能力，具有显著的净重新分类指数和综合判别改善。在射血分数保留的 HF 患者亚组分析中也显示了 GDF15 的预后价值。
血清 GDF15 浓度与 HF 严重程度和临床结局相关，表明 GDF15 可以提供额外的临床信息来跟踪 HF 患者的健康状况。
