Wei Ying, Cui Ming, Liu Shuwang, Yu Haiyi, Gao Wei, Li Lei
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Aug 18;56(4):715-721. doi: 10.19723/j.issn.1671-167X.2024.04.027.
To measure the concentration of growth differentiation factor-15 (GDF-15) in the serum of patients with atrial fibrillation (AF), to study the correlations between the levels of GDF-15 and different factors including basic clinical information, biochemical examinations, and atrial structure, and further to explore the association between GDF-15 and AF types and structural remodeling.
AF patients who were admitted to the ward of the Department of Cardiology at Peking University Third Hospital between October 2017 and October 2019 were prospectively enrolled. Patients admitted to the ward at the same time with sinus rhythm and no prior AF history were enrolled in the control group. Clinical information and blood samples of the patients were collected. Enzyme-linked immunosorbent assay was used to measure the concentration of GDF-15. SPSS 23.0 was used for statistical analysis.
In the study, 156 AF patients (64 persistent AF and 92 paroxysmal AF) and 38 patients of the control group were included. Serum GDF-15 levels in the AF group were significantly higher than in the control group [1 112 (723, 1 525) ng/L . 697 (499, 825) ng/L, < 0.001]. Serum GDF-15 levels in the persistent AF group were significantly higher than in the paroxysmal AF group [1 140 (858, 1 708) ng/L . 1 090 (662, 1 374) ng/L, =0.047]. The area under the curve (AUC) of serum GDF-15 levels for prediction of AF was 0.736 (95%: 0.651-0.822, < 0.001). The cut-off value was 843.2 ng/L with a sensitivity of 68.2% and a specificity of 78.9%. The AUC of serum GDF-15 levels for prediction of persistent AF was 0.594 (95% 0.504-0.684, =0.047). The cut-off va-lue was 771.5 ng/L with a sensitivity of 82.8% and a specificity of 35.9%. Spearman rank correlation analysis showed that the serum GDF-15 levels were positively correlated with age (=0.480, < 0.001), left atrial pressure (LAP, =0.300, < 0.001), and also negatively correlated with left atrial appendage flow velocity (LAAV, =-0.252, =0.002). Multiple linear regression analysis showed that age and LAP affected the GDF-15 levels significantly ( < 0.05). Logistic regression analysis suggested GDF-15 (=1.002, 95%: 1.001-1.003, =0.004) and left atrial diameter (LAD, =1.400, 95%: 1.214-1.616, < 0.001) were independent predictors of AF.
Serum GDF-15 levels are higher in AF patients. Meanwhile, serum GDF-15 levels are higher in persistent AF patients than paroxysmal AF patients. GDF-15 is associated with AF and atrial structural remodeling.
检测心房颤动（AF）患者血清中生长分化因子15（GDF-15）的浓度，研究GDF-15水平与包括基本临床信息、生化检查及心房结构等不同因素之间的相关性，并进一步探讨GDF-15与AF类型及结构重塑之间的关联。
前瞻性纳入2017年10月至2019年10月北京大学第三医院心内科病房收治的AF患者。同时将同期入院的窦性心律且无既往AF病史的患者纳入对照组。收集患者的临床信息和血样。采用酶联免疫吸附测定法检测GDF-15的浓度。使用SPSS 23.0进行统计分析。
本研究共纳入156例AF患者（64例持续性AF和92例阵发性AF）及38例对照组患者。AF组血清GDF-15水平显著高于对照组[1112（723，1525）ng/L对697（499，825）ng/L，P<0.001]。持续性AF组血清GDF-15水平显著高于阵发性AF组[1140（858，1708）ng/L对1090（662，1374）ng/L，P=0.047]。血清GDF-15水平预测AF的曲线下面积（AUC）为0.736（95%CI：0.651-0.822，P<0.001）。截断值为843.2 ng/L，灵敏度为68.2%，特异度为78.9%。血清GDF-15水平预测持续性AF的AUC为0.594（95%CI 0.504-0.684，P=0.047）。截断值为771.5 ng/L，灵敏度为82.8%，特异度为35.9%。Spearman等级相关分析显示，血清GDF-15水平与年龄呈正相关（r=0.480，P<0.001），与左心房压力（LAP，r=0.300，P<0.001）呈正相关，与左心耳流速（LAAV，r=-0.252，P=0.002）呈负相关。多元线性回归分析显示，年龄和LAP对GDF-15水平有显著影响（P<0.05）。Logistic回归分析提示GDF-15（β=1.002，95%CI：1.001-1.003，P=0.004）和左心房直径（LAD，β=1.400，95%CI：1.214-1.616，P<0.001）是AF的独立预测因素。
AF患者血清GDF-15水平较高。同时，持续性AF患者血清GDF-15水平高于阵发性AF患者。GDF-15与AF及心房结构重塑有关。
