What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with preserved ejection fraction (HFpEF) (n=181). Intervention: Growth differentiation factor 15 (GDF15). Primary outcome: Composite of all-cause death and hospitalisation for HF (adjusted HR 13.67, 95% CI 2.78 to 67.22, p=0.001).

What does this research mean for the field?

Elevated levels of growth differentiation factor 15 (GDF15) are significantly associated with an increased risk of all-cause death and heart failure hospitalization, providing incremental prognostic value beyond the MAGGIC risk score in elderly, multimorbid patients with HFpEF. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2025Open Heart9 citationsOpen Access

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

DSDaisuke SakamotoHokkaido University of Science YMYuki MatsuokaUniversity of Tsukuba DNDaisaku NakataniOsaka Gakuin University

Key Result

Log-transformed GDF15 was significantly associated with increased risk of all-cause death and heart failure hospitalization in elderly HFpEF patients (adjusted HR 13.67; 95% CI 2.78-67.22; p=0.001).

Study Design

Type

Observational (n=181)

Multicenter

Yes

Structured PICO

Does GDF15 level predict the composite of all-cause death and hospitalisation for HF in elderly multimorbid patients with HFpEF?

Population

181 elderly multimorbid patients with acute decompensated heart failure with preserved ejection fraction (HFpEF), median age 81, 48% male, from the prospective multicentre PURSUIT-HFpEF registry.

Intervention

Growth differentiation factor 15 (GDF15) biomarker measurement

Outcome

Composite of all-cause death and hospitalisation for HFcomposite

GDF15 is a significant prognostic marker for all-cause death and heart failure hospitalization in elderly multimorbid patients with HFpEF, adding incremental value to the MAGGIC risk score.

Main Result

Effect estimate: adjusted HR 13.67 (95% CI 2.78 to 67.22)

p-value: p=0.001

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.

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