What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with mid-range or preserved ejection fraction (HFmrEF or HFpEF) (n=311). Intervention: GDF-15 vs. NT-proBNP. Primary outcome: All-cause mortality (p=0.01).

What does this research mean for the field?

Growth differentiation factor 15 (GDF-15) is an independent predictor of all-cause mortality and is superior to NT-proBNP for assessing prognosis in patients with heart failure with mid-range or preserved ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 26, 2020Open Access

Growth Differentiation Factor 15 as Mortality Predictor in Heart Failure Patients with Non-Reduced Ejection Fraction

Key Result

Growth differentiation factor 15 independently predicted all-cause mortality, with 5-year survival of 16% in the highest versus 78% in the lowest tertile (P<0.001).

Study Design

Type

Cohort (n=311)

Structured PICO

Does GDF-15 concentration predict all-cause mortality better than NT-proBNP in patients with HFmrEF or HFpEF?

Population

311 patients with heart failure and mid-range (HFmrEF, n=90, 29%) or preserved ejection fraction (HFpEF, n=221, 71%), mean age 72 ± 13 years, 136 (44%) women.

Intervention

Measurement of serum Growth Differentiation Factor 15 (GDF-15) concentration

Comparator

Measurement of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration

Outcome

All-cause mortalityhard clinical

GDF-15 is superior to NT-proBNP as an independent predictor of all-cause mortality in patients with HFmrEF and HFpEF.

Main Result

p-value: p=0.01

Abstract

AIMS: The prognostic value of biomarkers in patients with heart failure (HF) and mid-range (HFmrEF) or preserved ejection fraction (HFpEF) has not been widely addressed. The aim of this study was to assess whether the prognostic value of growth differentiation factor 15 (GDF-15) is superior to that of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with HFmrEF or HFpEF. METHODS AND RESULTS: Heart failure patients with either HFpEF or HFmrEF were included in the study. During their first visit to the HF unit, serum samples were obtained and stored for later assessment of GDF-15 and NT-proBNP concentrations. Patients were followed up by the HF unit. The main endpoint was all-cause mortality. A total of 311 patients, 90 (29%) HFmrEF and 221 (71%) HFpEF, were included. Mean age was 72 ± 13 years, and 136 (44%) were women. No differences were found in GDF-15 or NT-proBNP concentrations between both HF groups. During a median follow-up of 15 months (Q1-Q3: 9-30 months), 98 patients (32%) died, most (71%) of cardiovascular causes. Patients who died had higher median concentrations of GDF-15 (4085 vs. 2270 ng/L, P 65 years (P 4330 ng/L), and survival curves were evaluated using the Kaplan-Meier technique. Patients in the highest tertile had the poorest 5 year survival, at 16%, whereas the lowest tertile had the best survival, of 78% (P < 0.001). CONCLUSIONS: Growth differentiation factor 15 was superior to NT-proBNP for assessing prognosis in patients with HFpEF and HFmrEF. GDF-15 emerges as a strong, independent biomarker for identifying HFmrEF and HFpEF patients with worse prognosis.