GDF-15 and hs-cTnI levels independently predicted incident major adverse cardiovascular events with HRs 1.47 and 1.26 per SD after adjusting for risk factors.
Do cardiovascular biomarkers (hs-cTnI, hs-CRP, NT-proBNP, GDF-15) predict pathological stress test results and incident MACE in patients with suspected coronary artery disease?
In patients with suspected CAD undergoing stress testing, baseline GDF-15 and hs-cTnI predict incident MACE despite having poor diagnostic discrimination for a pathological stress test.
Abstract Background Cardiovascular biomarkers may be helpful to guide diagnostic and prognostic evaluation of patients with suspected coronary artery disease. The aim of this study was to investigate the diagnostic and predictive value of cardiovascular biomarkers in patients with suspected coronary artery disease undergoing cardiac stress testing. Methods Patients undergoing cardiac stress testing for suspected coronary artery disease were recruited in a prospective cohort study. Measurements of high-sensitivity cardiac troponin (hs-cTnI), high-sensitivity C-reactive protein (hs-CRP), natriuretic peptides (NT-proBNP) and Growth differentiation factor 15 (GDF-15) were obtained before the stress test. Hs-cTnI concentrations were also measured one hour after the stress test. The diagnostic performance of each biomarker in predicting a pathological stress test was evaluated by calculating the area under the receiver operating characteristic curve. Cox regression analysis was conducted to identify predictors of incident major adverse cardiovascular events (MACE). Results 778 participants (median age 70 years) were included in the final analysis, of which 240 had a pathological stress test and 558 a non-pathological stress test. During follow-up of 33 months (IQR 32-34), an event rate of 17.8 % was reported for MACE. Baseline hs-cTnI, NT-proBNP and GDF-15 concentrations were significantly higher in participants with a pathological stress test (8.0 ng/L vs. 4.5 ng/L, 398.9 vs. 261.6 ng/L and 1583.3 vs. 1840.9 ng/L respectively). Hs-cTnI concentrations after one hour showed a slight decrease from the baseline concentration. All biomarker concentrations showed poor performance in discriminating between pathological and non-pathological stress tests. Concentrations of GDF-15 and hs-cTnI were significantly associated with incident MACE after adjusting for conventional cardiovascular risk factors (1.47 per SD 95%CI 1.10, 1.97) and 1.26 per SD [95%CI 1.10, 1.44 respectively). Conclusion In patients undergoing cardiac stress testing, concentrations of hs-cTnI, NT-proBNP, hs-CRP and GDF-15 demonstrated limited ability in discriminating between pathological and non-pathological test results. However, GDF-15 and hs-cTnI concentrations were predictors of incident MACE beyond established cardiovascular risk factors suggesting their potential to improve cardiovascular risk assessment in high-risk populations.Cox regression analysis
Abdennadher et al. (2025) studied this question. GDF-15 and hs-cTnI levels independently predicted incident major adverse cardiovascular events with HRs 1.47 and 1.26 per SD after adjusting for risk factors.