生长分化因子15在射血分数保留的心力衰竭患者中的作用及预后价值：来自PURSUIT-HFpEF注册研究的见解

Role and prognostic value of growth differentiation factor 15 in patient of heart failure with preserved ejection fraction: insights from the PURSUIT-HFpEF registry.

作者信息

Sakamoto Daisuke, Matsuoka Yuki, Nakatani Daisaku, Okada Katsuki, Sunaga Akihiro, Kida Hirota, Sato Taiki, Kitamura Tetsuhisa, Tamaki Shunsuke, Seo Masahiro, Yano Masamichi, Hayashi Takaharu, Nakagawa Akito, Nakagawa Yusuke, Yasumura Yoshio, Yamada Takahisa, Hikoso Shungo, Sotomi Yohei, Sakata Yasushi

机构信息

Osaka University Graduate School of Medicine Department of Cardiovascular Medicine, Suita, Japan.

Department of Medical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan.

出版信息

Open Heart. 2025 Jan 19;12(1):e003008. doi: 10.1136/openhrt-2024-003008.

DOI:10.1136/openhrt-2024-003008

PMID:39832941

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11784240/

Abstract

BACKGROUND

Growth differentiation factor 15 (GDF15) is a cytokine responding to oxidative stress and inflammation, and it regulates appetite and energy balance. The association between GDF15 and clinical factors and its prognostic value in elderly multimorbid patients with heart failure with preserved ejection fraction (HFpEF) have not been well unknown.

METHODS

This exploratory analysis is part of the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction study (N=1231), an ongoing, prospective, multicentre observational study of acute decompensated HFpEF (UMIN000021831). A predefined subcohort of 212 patients underwent multi-biomarker testing. Of these, we analysed 181 patients with available GDF15 data. The primary endpoint was a composite of all-cause death and hospitalisation for HF.

RESULTS

In this analysis population, the median age was 81 (75-85) years, with 48% male patients. GDF15 significantly correlated with cardiac burden, anaemia, renal dysfunction and inflammation. Notably, poor nutritional status was significantly associated with GDF15. GDF15 was linked to poor prognosis in this elderly multimorbid cohort with HFpEF (adjusted HR for log-transformed GDF15: 13.67, 95% CI: 2.78 to 67.22, p=0.001). Furthermore, GDF15 added significant incremental value to the MAGGIC risk score (net reclassification improvement=0.4955 (95% CI: 0.1367 to 0.8543), p=0.007; integrated discrimination improvement=0.0278 (95% CI: 0.0013 to 0.0543), p=0.040).

CONCLUSIONS

GDF15 was associated with anaemia, inflammation, renal dysfunction, cardiac burden and malnutrition. It demonstrated prognostic value in elderly multimorbid HFpEF patients, suggesting its potential role as a complementary marker for the prognostic risk assessment of HFpEF patients.

TRIAL REGISTRATION NUMBER

UMIN-CTR ID: UMIN000021831.

摘要

背景

生长分化因子15（GDF15）是一种对氧化应激和炎症有反应的细胞因子，它调节食欲和能量平衡。GDF15与临床因素之间的关联及其在老年射血分数保留的心力衰竭（HFpEF）多病共存患者中的预后价值尚不明确。

方法

这项探索性分析是射血分数保留的心力衰竭患者前瞻性多中心观察性研究（N = 1231）的一部分，该研究是一项正在进行的急性失代偿性HFpEF前瞻性多中心观察性研究（UMIN000021831）。一个预先定义的212例患者的亚队列进行了多种生物标志物检测。其中，我们分析了181例有可用GDF15数据的患者。主要终点是全因死亡和因心力衰竭住院的复合终点。

结果

在这个分析人群中，中位年龄为81（75 - 85）岁，男性患者占48%。GDF15与心脏负担、贫血、肾功能不全和炎症显著相关。值得注意的是，营养状况差与GDF15显著相关。在这个老年多病共存的HFpEF队列中，GDF15与不良预后相关（对数转换后的GDF15调整后HR：13.67，95%CI：2.78至67.22，p = 0.001）。此外，GDF15为MAGGIC风险评分增加了显著的增量价值（净重新分类改善 = 0.4955（95%CI：0.1367至0.8543），p = 0.007；综合判别改善 = 0.0278（95%CI：0.0013至0.0543），p = 0.040）。