September 21, 2010Circulation
Serial Measurement of Growth-Differentiation Factor-15 in Heart Failure
Key result
Higher baseline GDF-15 linked to ~1% greater mortality risk per 100 ng/L in HF.
- HR 1.007
- 95% CI 1.001 to 1.014
- P=0.02
- n=1,734
Why the study?
Little is known about growth-differentiation factor-15 (GDF-15) as a biomarker in patients with heart failure.
Does the circulating concentration of GDF-15 predict mortality and first morbid event in patients with heart failure?
Population
1734 patients with heart failure randomized in the Valsartan Heart Failure Trial (Val-HeFT)
Comparison
GDF-15 levels at baseline and at 12 months
Design
Randomized controlled trial with biomarker measurement
Follow-up
12 months
Authors
Discussion
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Implication
GDF-15 may refine mortality risk stratification in heart failure beyond standard markers; leaves open whether it guides therapy or warrants prospective validation.
Key Points
- To investigate the clinical correlates, longitudinal changes, and prognostic value of circulating growth-differentiation factor-15 (GDF-15) in patients with heart failure.
- Measured circulating GDF-15 concentrations at baseline (n=1734) and at 12 months (n=1517) in patients randomized in the Valsartan Heart Failure Trial (Val-HeFT).
- Evaluated associations with all-cause mortality and first morbid events using multivariable Cox regression models adjusted for clinical variables, BNP, hs-CRP, and hs-TnT.
- Baseline GDF-15 was abnormally high (>1200 ng/L) in 85% of patients and independently predicted mortality (HR 1.007 per 100 ng/L; 95% CI, 1.001 to 1.014; P=0.02) after adjustment for clinical variables, BNP, hs-CRP, and hs-TnT.
- GDF-15 levels increased similarly at 12 months in the placebo and valsartan arms (P=0.94).
- Increases in GDF-15 over 12 months were independently associated with future mortality and first morbid events, even after adjusting for prognostic biomarkers and their longitudinal changes.
Study Design
Type
RCT (n=1,734)
Randomization
randomized
Structured PICO
Does the circulating concentration of GDF-15 predict mortality and first morbid event in patients with heart failure?
P
Population
1,734 patients with heart failure from the Val-HeFT trial, evaluated for the prognostic value of GDF-15 levels at baseline and 12 months.
I
Intervention
Measurement of Growth-Differentiation Factor-15 (GDF-15) at baseline and 12 months
O
Outcome
Mortality and first morbid eventhard clinical
Main Result
Hazard Ratio: 1.007 (95% CI 1.001–1.014)
p-value: p=0.02
GDF-15 provides independent prognostic information for mortality in heart failure patients, even after adjusting for established clinical variables and other biomarkers like BNP, hs-CRP, and hs-TnT.
Cite This Study
Anand et al. (2010) conducted an RCT in Heart failure (n=1,734). Baseline GDF-15 levels (per 100 ng/L) was evaluated on Mortality (HR 1.007, 95% CI 1.001 to 1.014, p=0.02). In patients with heart failure, higher baseline GDF-15 levels were independently associated with an increased risk of mortality (HR 1.007 per 100 ng/L; 95% CI 1.001-1.014; P=0.02).