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Rico-Mesa JS, Haloot J, Anupama BK, Atluri S, Liu J, Khalid U. The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure. Curr Heart Fail Rep 2024:10.1007/s11897-024-00677-7. [PMID: 39042238 DOI: 10.1007/s11897-024-00677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE OF REVIEW This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients. RECENT FINDINGS Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.
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Affiliation(s)
| | - Justin Haloot
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - B K Anupama
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Suman Atluri
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jing Liu
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Umair Khalid
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
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2
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Sato R, Vatic M, Peixoto da Fonseca GW, Anker SD, von Haehling S. Biological basis and treatment of frailty and sarcopenia. Cardiovasc Res 2024:cvae073. [PMID: 38828887 DOI: 10.1093/cvr/cvae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/23/2022] [Accepted: 12/20/2022] [Indexed: 06/05/2024] Open
Abstract
In an ageing society, the importance of maintaining healthy life expectancy has been emphasized. As a result of age-related decline in functional reserve, frailty is a state of increased vulnerability and susceptibility to adverse health outcomes with a serious impact on healthy life expectancy. The decline in skeletal muscle mass and function, also known as sarcopenia, is key in the development of physical frailty. Both frailty and sarcopenia are highly prevalent in patients not only with advanced age but also in patients with illnesses that exacerbate their progression like heart failure (HF), cancer, or dementia, with the prevalence of frailty and sarcopenia in HF patients reaching up to 50-75% and 19.5-47.3%, respectively, resulting in 1.5-3 times higher 1-year mortality. The biological mechanisms of frailty and sarcopenia are multifactorial, complex, and not yet fully elucidated, ranging from DNA damage, proteostasis impairment, and epigenetic changes to mitochondrial dysfunction, cellular senescence, and environmental factors, many of which are further linked to cardiac disease. Currently, there is no gold standard for the treatment of frailty and sarcopenia, however, growing evidence supports that a combination of exercise training and nutritional supplement improves skeletal muscle function and frailty, with a variety of other therapies being devised based on the underlying pathophysiology. In this review, we address the involvement of frailty and sarcopenia in cardiac disease and describe the latest insights into their biological mechanisms as well as the potential for intervention through exercise, diet, and specific therapies.
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Affiliation(s)
- Ryosuke Sato
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Mirela Vatic
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Guilherme Wesley Peixoto da Fonseca
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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Tang Y, Liu T, Sun S, Peng Y, Huang X, Wang S, Zhou Z. Role and Mechanism of Growth Differentiation Factor 15 in Chronic Kidney Disease. J Inflamm Res 2024; 17:2861-2871. [PMID: 38741613 PMCID: PMC11090192 DOI: 10.2147/jir.s451398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
GDF-15 is an essential member of the transforming growth factor-beta superfamily. Its functions mainly involve in tissue injury, inflammation, fibrosis, regulation of appetite and weight, development of tumor, and cardiovascular disease. GDF-15 is involved in various signaling pathways, such as MAPK pathway, PI3K/AKT pathway, STAT3 pathway, RET pathway, and SMAD pathway. In addition, several factors such as p53, ROS, and TNF-α participate the regulation of GDF-15. However, the specific mechanism of these factors regulating GDF-15 is still unclear and more research is needed to explore them. GDF-15 mainly improves the function of kidneys in CKD and plays an important role in the prediction of CKD progression and cardiovascular complications. In addition, the role of GDF-15 in the kidney may be related to the SMAD and MAPK pathways. However, the specific mechanism of these pathways remains unclear. Accordingly, more research on the specific mechanism of GDF-15 affecting kidney disease is needed in the future. In conclusion, GDF-15 may be a therapeutic target for kidney disease.
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Affiliation(s)
- Yifang Tang
- Department of Nephrology, the First Affiliated Hospital, Kunming Medical University, Kunming, People’s Republic of China
| | - Tao Liu
- Organ Transplantation Center, the First Affiliated Hospital, Kunming Medical University, Kunming, People’s Republic of China
| | - Shibo Sun
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital, Kunming Medical University, Kunming, People’s Republic of China
| | - Youbo Peng
- Department of Nephrology, the First Affiliated Hospital, Kunming Medical University, Kunming, People’s Republic of China
| | - Xiaoxiao Huang
- Department of Nephrology, Xishuangbanna Dai Autonomous Prefecture People’s Hospital, Xishuangbanna, People’s Republic of China
| | - Shuangquan Wang
- Department of Nephrology, Xishuangbanna Dai Autonomous Prefecture People’s Hospital, Xishuangbanna, People’s Republic of China
| | - Zhu Zhou
- Department of Nephrology, the First Affiliated Hospital, Kunming Medical University, Kunming, People’s Republic of China
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Garofalo M, Corso R, Tomasoni D, Adamo M, Lombardi CM, Inciardi RM, Gussago C, Di Mario C, Metra M, Pagnesi M. Inflammation in acute heart failure. Front Cardiovasc Med 2023; 10:1235178. [PMID: 38045909 PMCID: PMC10690826 DOI: 10.3389/fcvm.2023.1235178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Acute heart failure (AHF) represents a common clinical scenario that requires prompt evaluation and therapy and that is characterized by a high risk of mortality or subsequent rehospitalizations. The pathophysiology leading to AHF decompensation is still not fully understood. Significant activation of inflammatory pathways has been identified in patients with AHF, particularly in its most severe forms, and it has been hypothesized that systemic inflammation has a role in AHF pathogenesis. Several inflammatory mediators and cytokines, such as high sensitivity C-reactive protein, tumor necrosis factor-α, interleukin-6, interleukin-1, soluble suppression of tumorigenicity 2 and galectin-3, have been shown to play a role in the pathogenesis, development and worsening of this condition with an independent prediction of adverse outcomes. This manuscript reviews the prevalence and prognostic value of systemic inflammation in AHF, as well as the potential role of anti-inflammatory therapies, focusing on available evidence from clinical trials and ongoing studies.
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Affiliation(s)
- Manuel Garofalo
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Rossana Corso
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M. Lombardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M. Inciardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Cristina Gussago
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Di Mario
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
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Sawalha K, Norgard NB, Drees BM, López-Candales A. Growth Differentiation Factor 15 (GDF-15), a New Biomarker in Heart Failure Management. Curr Heart Fail Rep 2023; 20:287-299. [PMID: 37289373 DOI: 10.1007/s11897-023-00610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
The emergence of biomarkers across medicine's subspecialties continues to evolve. In essence, a biomarker is a biological observation that clearly substitutes a clinical endpoint or intermediate outcome not only are more difficult to observe but also, biomarkers are easier, less expensive and could be measured over shorter periods. In general, biomarkers are versatile and not only used for disease screening and diagnosis but, most importantly, for disease characterization, monitoring, and determination of prognosis as well as individualized therapeutic responses. Obviously, heart failure (HF) is no exception to the use of biomarkers. Currently, natriuretic peptides are the most used biomarkers for both diagnosis and prognostication, while their role in the monitoring of treatment is still debatable. Although several other new biomarkers are currently under investigation regarding diagnosis and determination of prognosis, none of them are specific for HF, and none are recommended for routine clinical use at present. However, among these emerging biomarkers, we would like to highlight the potential for growth differentiation factor (GDF)-15 as a plausible new biomarker that could be helpful in providing prognostic information regarding HF morbidity and mortality.
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Affiliation(s)
- Khalid Sawalha
- Cardiometabolic Medicine Fellowship, University of Missouri-Kansas City, Kansas City, MO, USA.
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA.
| | - Nicholas B Norgard
- Department of Medicine, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Betty M Drees
- Department(s) of Internal Medicine, Biomedical and Health Informatics, Section of Endocrinology, UMKC School of Medicine, Kansas City, MO, USA
| | - Angel López-Candales
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA
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6
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Maimaiti Y, Cheng H, Guo Z, Yu X, Tuohuti A, Li G. Correlation between serum GDF-15 level and pulmonary vascular morphological changes and prognosis in patients with pulmonary arterial hypertension. Front Cardiovasc Med 2023; 10:1085122. [PMID: 37288264 PMCID: PMC10241999 DOI: 10.3389/fcvm.2023.1085122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/12/2023] [Indexed: 06/09/2023] Open
Abstract
Objective To investigate how serum GDF-15 concentration affects pulmonary artery hemodynamics and pulmonary vascular morphological changes in patients with pulmonary arterial hypertension. Methods A total of 45 patients admitted to our hospital from December 2017 to December 2019, were selected for the study. Pulmonary vascular hemodynamics and pulmonary vascular morphology were detected by RHC and IVUS. Serum GDF-15 levels were detected by enzyme-linked immunosorbent assay (ELISA). Based on the concentration of GDF-15, the patients were divided into two groups-the normal GDF-15 group (GDF-15 <1,200 pg/ml, 12 cases) and the elevated GDF-15 group (GDF-15 ≥1,200 pg/ml, 33 cases). A statistical analysis was performed to compare the effects of normal blood GDF-15 levels and high serum GDF-15 levels on hemodynamics and pulmonary vascular morphology in each group of patients. Results The average levels of RVP, sPAP, dPAP, mPAP, and PVR in patients with elevated GDF-15 levels were higher than those in patients with normal GDF-15 levels. The difference between the two groups was statistically significant (P < 0.05). The average levels of Vd, elastic modulus, stiffness index β, lesion length, and PAV in the normal GDF-15 group were lower than those in the elevated GDF-15 group. The average levels of compliance, distensibility, and minimum l umen area were higher than those in the elevated GDF-15 group. The difference between the two groups was statistically significant (P < 0.05). The survival analysis results showed that the 1-year survival rate of patients with normal GDF-15 levels and elevated GDF-15 levels was 100% and 87.9%, respectively, and that the 3-year survival rate of patients with normal GDF-15 levels and elevated GDF-15 levels was 91.7% and 78.8%, respectively. The survival rates of the two groups were compared by the Kaplan Meier method, and the difference was not statistically significant (P > 0.05). Conclusion Patients with pulmonary arterial hypertension with elevated GDF-15 levels have higher pulmonary arterial pressure, higher pulmonary vascular resistance, and more serious pulmonary vascular lesions, which are potentially more harmful. There was no statistically significant difference in survival rates among patients with different serum GDF-15 levels.
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Affiliation(s)
- Yasenjiang Maimaiti
- Gerontology Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hui Cheng
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zitong Guo
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xiaolin Yu
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Adilijiang Tuohuti
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Guoqing Li
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Yin D, Yan X, Bai X, Tian A, Gao Y, Li J. Prognostic value of Growth differentiation factors 15 in Acute heart failure patients with preserved ejection fraction. ESC Heart Fail 2022; 10:1025-1034. [PMID: 36519216 PMCID: PMC10053169 DOI: 10.1002/ehf2.14271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS There is an increasing proportion of hospitalized heart failure (HF) patients classified as HF with preserved ejection fraction (HFpEF) around the world. Growth differentiation factor 15 (GDF-15) is a promising biomarker in HFpEF prognostication; however, the majority of the existing data has been derived from the research on undifferentiated HF, whereas the studies focusing on HFpEF are still limited. This study aimed to determine the prognostic power of GDF-15 in the hospitalized patients with HFpEF in a Chinese cohort. METHODS AND RESULTS We analysed the levels of serum GDF-15 in 380 patients hospitalized for acute onset of HFpEF measured by heart ultrasound at admission in a prospective cohort. The associations of GDF-15 with 1 year risk of all-cause death and 1 year HF readmission were assessed by the Cox proportional hazards model. Area under the receiver operating characteristic curves was used to compare predictive accuracy. GDF-15 was strongly correlated with 1 year HF readmission and 1 year all-cause death, with event rates of 24.8%, 40.0%, and 50.0% for 1 year HF readmission (P < 0.001), respectively, and with 11.2%, 13.6%, and 24.6% for 1 year all-cause death (P = 0.004) in the corresponding tertile, respectively. In the multivariate linear regression model, GDF-15 had a significantly negative correlation with haemoglobin (P = 0.01) and a positive correlation with creatinine (P = 0.01), alanine transaminase (P = 0.001), and therapy of aldosterone antagonist (P = 0.018). The univariate Cox regression model of GDF-15 showed that c-statistic was 0.632 for 1 year HF readmission and 0.644 for 1 year all-cause death, which were superior to the N-terminal pro-brain natriuretic peptide (NT-proBNP) model with c-statistics of 0.595 and 0.610, respectively. In the multivariable Cox regression model, GDF-15 tertiles independently predicted 1 year HF readmission (hazard ratio 2.25, 95% confidence interval: 1.43-3.54, P < 0.001) after adjusting for baseline Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) risk score, history of HF, NT-proBNP, and high-sensitivity cardiac troponin T. Compared with the model including all the adjusted variables, the model with the addition of GDF-15 improved predictive power, with c-statistic increasing from 0.643 to 0.657 for 1 year HF readmission and from 0.638 to 0.660 for 1 year all-cause death. CONCLUSIONS In hospitalized patients with HFpEF, GDF-15 measured within 48 h of admission is a strong independent biomarker for 1 year HF readmission and even better than NT-proBNP. GDF-15 combined with the traditional indicators provided incremental prognostic value in this population.
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Affiliation(s)
- Dan Yin
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College 167 Beilishi Road Beijing 100037 People's Republic of China
| | - Xiaofang Yan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College 167 Beilishi Road Beijing 100037 People's Republic of China
| | - Xueke Bai
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College 167 Beilishi Road Beijing 100037 People's Republic of China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College 167 Beilishi Road Beijing 100037 People's Republic of China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College 167 Beilishi Road Beijing 100037 People's Republic of China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College 167 Beilishi Road Beijing 100037 People's Republic of China
- Fuwai Hospital Chinese Academy of Medical Sciences 12 Langshan Road, Nanshan District Shenzhen China
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Gürgöze MT, van Vark LC, Baart SJ, Kardys I, Akkerhuis KM, Manintveld OC, Postmus D, Hillege HL, Lesman-Leegte I, Asselbergs FW, Brunner-la-Rocca HP, van den Bos EJ, Orsel JG, de Ridder SP, Pinto YM, Boersma E. Multimarker Analysis of Serially Measured GDF-15, NT-proBNP, ST2, GAL-3, cTnI, Creatinine, and Prognosis in Acute Heart Failure. Circ Heart Fail 2022; 16:e009526. [PMID: 36408685 PMCID: PMC9833118 DOI: 10.1161/circheartfailure.122.009526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies on serially measured GDF-15 (growth differentiation factor 15) in acute heart failure (HF) are limited. Moreover, several pathophysiological pathways contribute to HF. Therefore, we aimed to explore the (additional) prognostic value of serially measured GDF-15 using a multi-marker approach to more accurately predict HF risk. METHODS TRIUMPH (Translational Initiative on Unique and Novel Strategies for Management of Patients With Heart Failure) is a prospective cohort of 496 patients with acute HF who were enrolled in 14 hospitals in the Netherlands between 2009 and 2014. Blood sampling was scheduled at 7 moments during 1-year follow-up. GDF-15, NT-proBNP (N-terminal pro-B-type natriuretic peptide), ST2 (suppression of tumorigenicity 2), galectin-3, troponin I, and creatinine were measured in a central laboratory. We associated repeated measurements of these biomarkers with the composite primary end point of all-cause mortality and HF rehospitalization, using multivariable joint modeling. RESULTS Median age was 74 years, and 37% were women. Median baseline GDF-15 was 4632 pg/mL. The primary end point was reached in 188 (40%) patients. The average estimated GDF-15 level increased weeks before the primary end point was reached. The hazard ratio per 1 SD difference in log-GDF-15 was 2.14 (95% CI, 1.78-2.57) unadjusted, 1.96 (1.49-2.53) after adjustment for clinical confounders and 1.44 (1.05-1.91) when jointly modeled with all biomarkers. The adjusted HRs for NT-proBNP were 2.38 (1.78-3.33) and 1.52 (1.15-2.08), respectively. The multimarker model combining GDF-15, NT-proBNP, and troponin I provided a favorable risk discrimination (area under the curve=0.785). CONCLUSIONS Sequentially measured GDF-15 independently and dynamically predicts risk of adverse outcomes during 1-year follow-up after index admission for acute HF. NT-proBNP remains a robust predictor among potential candidates. Multiple biomarkers should be considered for stratification in clinical practice. REGISTRATION URL: https://www.trialregister.nl/trial/1783; Unique Identifier: NTR1893. (The trial can be found temporarily at https://trialsearch.who.int/Trial2.aspx?TrialID=NTR1893.).
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Affiliation(s)
- Muhammed T. Gürgöze
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Laura C. van Vark
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Sara J. Baart
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.J.B.)
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - K. Martijn Akkerhuis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Olivier C. Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Douwe Postmus
- Department of Epidemiology (D.P., H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hans L. Hillege
- Department of Epidemiology (D.P., H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands,Department of Cardiology (H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands,University Medical Center Groningen, University of Groningen, the Netherlands (H.L.H.)
| | - Ivonne Lesman-Leegte
- Department of General Practice and Elderly Care Medicine (I.L.-L.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Folkert W. Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands (F.W.A.).,Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.), University College London, United Kingdom.,Health Data Research UK and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | | | - Ewout J. van den Bos
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (E.J.v.d.B.)
| | - Joke G. Orsel
- Philips Healthcare, Eindhoven, the Netherlands (J.G.O.)
| | - Stijn P.J. de Ridder
- Department of Cardiology, St. Anna Hospital, Geldrop, the Netherlands (S.P.J.d.R.)
| | - Yigal M. Pinto
- Department of Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands (Y.M.P.)
| | - Eric Boersma
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
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Mohan IK, Baba KSSS, Iyyapu R, Thirumalasetty S, Satish OS. Advances in congestive heart failure biomarkers. Adv Clin Chem 2022; 112:205-248. [PMID: 36642484 DOI: 10.1016/bs.acc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Congestive heart failure (CHF) is the leading cause of morbidity and mortality in the elderly worldwide. Although many biomarkers associated with in heart failure, these are generally prognostic and identify patients with moderate and severe disease. Unfortunately, the role of biomarkers in decision making for early and advanced heart failure remains largely unexplored. Previous studies suggest the natriuretic peptides have the potential to improve the diagnosis of heart failure, but they still have significant limitations related to cut-off values. Although some promising cardiac biomarkers have emerged, comprehensive data from large cohort studies is lacking. The utility of multiple biomarkers that reflect various pathophysiologic pathways are increasingly being explored in heart failure risk stratification and to diagnose disease conditions promptly and accurately. MicroRNAs serve as mediators and/or regulators of renin-angiotensin-induced cardiac remodeling by directly targeting enzymes, receptors and signaling molecules. The role of miRNA in HF diagnosis is a promising area of research and further exploration may offer both diagnostic and prognostic applications and phenotype-specific targets. In this review, we provide insight into the classification of different biochemical and molecular markers associated with CHF, examine clinical usefulness in CHF and highlight the most clinically relevant.
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Affiliation(s)
| | - K S S Sai Baba
- Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Telangana, India
| | - Rohit Iyyapu
- Katuri Medical College & Hospital, Guntur, Andhra Pradesh, India
| | | | - O Sai Satish
- Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Telangana, India
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Rabkin SW. Evaluating the adverse outcome of subtypes of heart failure with preserved ejection fraction defined by machine learning: A systematic review focused on defining high risk phenogroups. EXCLI JOURNAL 2022; 21:487-518. [PMID: 35391918 PMCID: PMC8983850 DOI: 10.17179/excli2021-4572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
The ability to distinguish clinically meaningful subtypes of heart failure with preserved ejection fraction (HFpEF) has recently been examined by machine learning techniques but studies appear to have produced discordant results. The objective of this study is to synthesize the types of HFpEF by examining their features and relating them to phenotypes with adverse prognosis. A systematic search was conducted using the search terms "Diastolic Heart Failure" OR "heart failure with preserved ejection fraction" OR "heart failure with normal ejection fraction" OR "HFpEF" AND "machine learning" OR "artificial intelligence" OR 'computational biology'. Ten studies were identified and they varied in their prevalence of ten clinical variables: age, sex, body mass index (BMI) or obesity, hypertension, diabetes mellitus, coronary artery disease, atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease or symptom severity (NYHA class or BNP). The clinical findings associated with the different phenotypes in > 85 % of studies were age, hypertension, atrial fibrillation, chronic kidney disease and worse symptoms severity; an adverse outcome was in 65 % to 85 % of studies identified diabetes mellitus and female sex and in less than 65 % of studies was body mass index or obesity, and coronary artery disease. COPD was a relevant factor in only 33 % of studies. Adverse clinical outcome - death or admission to hospital (for heart failure) defined phenogroups with the worst outcome. Combining the 4 studies that calculated the MAGGIC score showed a significant (p<0.05) linear relationship between MAGGIC score and outcome, using the one-year event rate. A new score based on strength of the evidence of the HFpEF studies analyzed here, using 9 variables (eliminating COPD), showed a significant (p<0.009) linear relationship with one-year event rate. Three studies examined biomarkers in detail and the ones most prominently related to outcome or consistently found in the studies were GDF15, FABP4, FGF23, sST2, renin and TNF. The dominant factors that identified phenotypes of HFpEF with adverse outcome were hypertension, atrial fibrillation, chronic kidney disease and worse symptoms severity. A new simplified score, based on clinical factors, was proposed to assess prognosis in HFpEF. Several biomarkers were consistently elevated in phenogroups with adverse outcomes and may indicate the underlying mechanism or pathophysiology specific for phenotypes with an adverse prognosis.
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Affiliation(s)
- Simon W. Rabkin
- University of British Columbia,*To whom correspondence should be addressed: Simon W. Rabkin, University of British Columbia, 9th Floor 2775 Laurel St., Vancouver, B.C., Canada V5Z 1M9; Phone: (604) 875 5847, Fax: (604) 875 5849, E-mail:
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11
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Cooper LB, Bruce S, Psotka M, Mentz R, Bell R, Seliger SL, O'Connor C, deFilippi C. Proteomic differences among patients with heart failure taking furosemide or torsemide. Clin Cardiol 2022; 45:265-272. [PMID: 35014074 PMCID: PMC8922525 DOI: 10.1002/clc.23733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/13/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Loop diuretics are commonly used for patients with heart failure (HF) but it remains unknown if one loop diuretic is clinically superior. HYPOTHESIS Biomarkers and proteomics provide insight to how different loop diuretics may differentially affect outcomes. METHODS Blood and urine were collected from outpatients with HF who were taking torsemide or furosemide for >30 days. Differences were assessed in cardiac, renal, and inflammatory biomarkers and soluble protein panels using the Olink Cardiovascular III and inflammation panels. RESULTS Of 78 subjects, 55 (71%) were treated with furosemide and 23 (29%) with torsemide, and 25 provided a urine sample (15 treated with furosemide, 10 with torsemide). Patients taking torsemide were older (68 vs 64 years) with a lower mean eGFR (46 vs 54 ml/min/1.73 m2 ), a higher proportion were women (39% vs 24%) and Black (43% vs 27%). In plasma, levels of hs-cTnT, NT-proBNP, and hsCRP were not significantly different between groups. In urine, there were significant differences in urinary albumin, β-2M, and NGAL, with higher levels in the torsemide-treated patients. Of 184 proteins testing in Olink panels, in plasma, 156 (85%) were higher in patients taking torsemide but none were significantly different after correcting for false discovery. CONCLUSIONS We show differences in urinary biomarkers but few differences in plasma biomarkers among HF patients on different loop diuretics. Olink technology can detect differences in plasma protein levels from multiple biologic domains. These findings raise the importance of defining differences in mechanisms of action of each diuretic in an appropriately powered study.
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Affiliation(s)
- Lauren B Cooper
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.,Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Scott Bruce
- Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, Virginia, USA
| | - Mitchell Psotka
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Robert Mentz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel Bell
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Stephen L Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christopher O'Connor
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Christopher deFilippi
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
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12
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Aleksova A, Sinagra G, Beltrami AP, Pierri A, Ferro F, Janjusevic M, Gagno G. Biomarkers in the management of acute heart failure: state of the art and role in COVID-19 era. ESC Heart Fail 2021; 8:4465-4483. [PMID: 34609075 PMCID: PMC8652929 DOI: 10.1002/ehf2.13595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/07/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022] Open
Abstract
Acute heart failure (AHF) affects millions of people worldwide, and it is a potentially life‐threatening condition for which the cardiologist is more often brought into play. It is crucial to rapidly identify, among patients presenting with dyspnoea, those with AHF and to accurately stratify their risk, in order to define the appropriate setting of care, especially nowadays due to the coronavirus disease 2019 (COVID‐19) outbreak. Furthermore, with physical examination being limited by personal protective equipment, the use of new alternative diagnostic and prognostic tools could be of extreme importance. In this regard, usage of biomarkers, especially when combined (a multimarker approach) is beneficial for establishment of an accurate diagnosis, risk stratification and post‐discharge monitoring. This review highlights the use of both traditional biomarkers such as natriuretic peptides (NP) and troponin, and emerging biomarkers such as soluble suppression of tumourigenicity (sST2) and galectin‐3 (Gal‐3), from patients' emergency admission to discharge and follow‐up, to improve risk stratification and outcomes in terms of mortality and rehospitalization.
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Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | - Antonio P Beltrami
- Clinical Pathology Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) and Department of Medicine (DAME), University of Udine, Udine, 33100, Italy
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | | | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
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13
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Chen Y, Zhou S, Zhang A, Huang J, Zhang G, Cui L. Temporal changes and prognostic value of plasma ghrelin level in patients with acute heart failure: a prospective study. Heart Vessels 2021; 37:419-425. [PMID: 34533592 DOI: 10.1007/s00380-021-01935-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Plasma ghrelin levels can be elevated in patients with acute heart failure (AHF). This study aimed to analyze the temporal changes and prognostic value of ghrelin levels in patients with AHF. METHODS This prospective study included patients with AHF at the Cardiology Department, Weifang People's Hospital (May 2018-October 2019), and age- and sex-matched healthy controls. Plasma ghrelin levels were measured. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate whether ghrelin levels could predict major cardiac adverse events (MACEs) during a 1-year follow-up. RESULTS Finally, 92 patients with AHF and 50 healthy controls were enrolled. Ghrelin levels were higher in patients with AHF at 1, 3, 12, and 24 h compared with controls (all P < 0.01). Ghrelin levels in the AHF group were higher at 3 and 12 h than at 1 and 24 h (P < 0.001). Ghrelin level at 3 h in patients with AHF was negatively correlated with the left ventricular end-diastolic diameter and left ventricular ejection fraction (both P < 0.05). MACEs occurred in 48 patients with AHF. Ghrelin levels were higher in the MACE group than in the non-MACE group at 1 (P = 0.011) and 3 h (P = 0.034). Multivariable regression showed that ghrelin level at 3 h was independently associated with MACEs [OR = 0.629, 95% confidence interval (CI): 0.515-0.742, P = 0.010], but the area under the ROC curve was only 0.629 (95% CI 0.515-0.742). CONCLUSIONS Plasma ghrelin levels are elevated in AHF and patients with MACEs during follow-up.
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Affiliation(s)
- Yanbo Chen
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.,Department of Cardioangiology, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Sani Zhou
- Central Sterile Supply Department, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Aiyuan Zhang
- Department of Cardioangiology, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Jing Huang
- Department of Cardioangiology, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Guangfang Zhang
- Department of Cardioangiology, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Lianqun Cui
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
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14
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Al-Sadawi M, Saad M, Ayyadurai P, Shah NN, Bhandari M, Vittorio TJ. Biomarkers in Acute Heart Failure Syndromes: An Update. Curr Cardiol Rev 2021; 18:e090921196330. [PMID: 34503430 DOI: 10.2174/1573403x17666210909170415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022] Open
Abstract
Heart failure is one of the leading healthcare problems in the world. Clinical data lacks sensitivity and specificity in the diagnosis of heart failure. Laboratory biomarkers are a non-invasive method of assessing suspected decompensated heart failure. Biomarkers such as natriuretic peptides have shown promising results in the management of heart failure. The literature does not provide comprehensive guidance in the utilization of biomarkers in the setting of acute heart failure syndrome. Many conditions that manifest with similar pathophysiology as acute heart failure syndrome may demonstrate positive biomarkers. The following is a review of biomarkers in heart failure, enlightening their role in diagnosis, prognosis and management of heart failure.
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Affiliation(s)
- Mohammed Al-Sadawi
- Cardiovascular Medicine Department, SUNY Stony Brook Medicine, Stony Brook, NY. United States
| | - Muhammad Saad
- Division of Internal Medicine, BronxCare Hospital Center, Bronx, NY. United States
| | | | - Niel N Shah
- Division of Internal Medicine, BronxCare Hospital Center, Bronx, NY. United States
| | - Manoj Bhandari
- Division of Cardiology, BronxCare Hospital Center, Bronx, NY. United States
| | - Timothy J Vittorio
- Division of Cardiology, BronxCare Hospital Center, Bronx, NY. United States
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15
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di Candia AM, de Avila DX, Moreira GR, Villacorta H, Maisel AS. Growth differentiation factor-15, a novel systemic biomarker of oxidative stress, inflammation, and cellular aging: Potential role in cardiovascular diseases. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 9:100046. [PMID: 38559370 PMCID: PMC10978141 DOI: 10.1016/j.ahjo.2021.100046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 04/04/2024]
Abstract
Growth differentiation factor-15 (GDF-15) is a cytokine upregulated in multiple pathological conditions where oxidative stress, endothelial dysfunction, tissue aging, and chronic inflammation are the hallmarks. GDF-15 has many sources of production, including cardiac and vascular myocytes, endothelial cells, adipocytes and macrophages in response to metabolic stress, oncogenic transformation and the burden of proinflammatory cytokines or reactive oxygen species. Although the main sources of GDF-15 are extracardiac tissues, it has been shown to be elevated in many cardiac disorders. In experimental models of heart disease, GDF-15 release is induced after an ischemic insult and in pressure overload scenarios. Likewise, in recent years, an increasing body of evidence has emerged linking GDF-15 to the risk of mortality in acute coronary syndromes, atrial fibrillation and heart failure. Additionally, GDF-15 has been shown to add prognostic information beyond other conventional biomarkers such as natriuretic peptides and cardiac troponins. Further studies are needed to assess whether the incorporation of GDF-15 into clinical practice can improve cardiovascular outcomes.
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Affiliation(s)
- Angelo Michele di Candia
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Diane Xavier de Avila
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Gustavo Rodolfo Moreira
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Humberto Villacorta
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Alan S. Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, United States of America
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16
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Janssen E, Jukema JW, Beeres SLMA, Schalij MJ, Tops LF. Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review. Front Cardiovasc Med 2021; 8:699492. [PMID: 34307507 PMCID: PMC8292668 DOI: 10.3389/fcvm.2021.699492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/01/2021] [Indexed: 12/04/2022] Open
Abstract
Aims: Major adverse event (MAE) rates during left ventricular assist device (LVAD) therapy in advanced heart failure (HF) patients are high, and impair quality of life and survival. Prediction and risk stratification of MAEs in order to improve patient selection and thereby outcome during LVAD therapy is therefore warranted. Circulating natriuretic peptides (NPs) are strong predictors of MAEs and mortality in chronic HF patients. However, whether NPs can identify patients who are at risk of MAEs and mortality or tend toward myocardial recovery after LVAD implantation is unclear. The aim of this systematic review is to analyze the prognostic value of circulating NP levels before LVAD implantation for all-cause mortality, MAEs and myocardial recovery after LVAD implantation. Methods and Results: Electronic databases were searched for studies analyzing circulating NP in adults with advanced HF before LVAD implantation in relation to mortality, MAEs, or myocardial recovery after LVAD implantation. Twenty-four studies published between 2008 and 2021 were included. Follow-up duration ranged from 48 hours to 5 years. Study sample size ranged from 14 to 15,138 patients. Natriuretic peptide levels were not predictive of all-cause mortality. However, NPs were predictive of right ventricular failure (RVF) and MAEs such as ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization. No relation between NPs and myocardial recovery was found. Conclusion: This systematic review found that NP levels before LVAD implantation are not predictive of all-cause mortality after LVAD implantation. Thus, NP levels may be of limited value in patient selection for LVAD therapy. However, NPs help in risk stratification of MAEs and may be used to identify patients who are at risk for RVF, ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization after LVAD implantation.
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Affiliation(s)
- Eva Janssen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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17
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Yeh KH, Chang YT, Juang JMJ, Chiang FT, Teng MS, Wu S, Lin JF, Ko YL. Combined corrected QT interval and growth differentiation factor-15 level has synergistic predictive value for long-term outcome of angiographically confirmed coronary artery disease. Int J Clin Pract 2021; 75:e14180. [PMID: 33759309 DOI: 10.1111/ijcp.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The corrected QT interval (QTc) predicts prognosis for the general population and patients with coronary artery disease (CAD). Growth differentiation factor-15 (GDF-15) is a biomarker of myocardial fibrosis and left ventricular (LV) remodelling. The interaction between these two parameters is unknown. SUBJECTS AND METHODS This study included 487 patients with angiographically confirmed CAD. QTc was calculated using the Bazett formula. Multiple biochemistries and GDF-15 levels were measured. The primary endpoint was total mortality, and the secondary endpoints comprised the combination of total mortality, myocardial infarction and hospitalisation for heart failure and stroke. RESULTS The mean follow-up period was 1029 ± 343 days (5-1692 days), during which 21 patients died and 47 had secondary endpoints. ROC curve analysis for the optimal cut-off value of primary endpoint is 1.12 ng/mL for GDF-15 (AUC = 0.787, P = 9.0 × 10-6 ) and 438.5 msec for QTc (AUC = 0.698, P = .002). Utilising linear regression, QTc has a positive correlation with Log-GDF-15 (r = .216, P = 1.0 × 10-6 ). Utilising Kaplan-Meier analysis, both QTc interval and GDF-15 level are significant predictors for primary end point (P = .000194, P = 2.0 × 10-6 , respectively) and secondary endpoint (P = .00028, P = 6.15 × 10-8 , respectively). When combined these two parameters together, a significant synergistic predictive power was noted for primary and secondary endpoint (P = 2.31 × 10-7 , P = 1.26 × 10-8 , respectively). This combined strategy also showed significant correlation with the severity of CAD (P < .001). CONCLUSION In Chinese patient with angiographically confirmed CAD, a combined strategy utilising an ECG parameter (QTc) and a circulating biomarker (GDF-15) has good correlation with the severity of CAD, and improves the predictive power for total mortality.
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Affiliation(s)
- Kuan-Hung Yeh
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yao-Ting Chang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fu-Tien Chiang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Center and Division of Cardiology, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Ming-Sheng Teng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Semon Wu
- Department of Life Science, Chinese Culture University, Taipei, Taiwan
| | - Jeng-Feng Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Lin Ko
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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18
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Lourenço P, Cunha FM, Ferreira-Coimbra J, Barroso I, Guimarães JT, Bettencourt P. Dynamics of growth differentiation factor 15 in acute heart failure. ESC Heart Fail 2021; 8:2527-2534. [PMID: 33938154 PMCID: PMC8318469 DOI: 10.1002/ehf2.13377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/21/2021] [Accepted: 04/08/2021] [Indexed: 01/09/2023] Open
Abstract
Aims Risk stratification in acute heart failure (HF) patients can help to decide therapies and time for discharge. The potential of growth differentiation factor 15 (GDF‐15) in HF has been previously shown. We aimed to study the importance of GDF‐15‐level variations in acute HF patients. Methods and results We retrospectively evaluated a cohort of patients hospitalized due to acute HF. GDF‐15 was measured both at admission and on the discharge day. Patients were followed‐up during a 3 year period. The endpoint under analysis was all‐cause mortality. GDF‐15 variation is equal to [(admission GDF‐15 − discharge GDF‐15)∕admission GDF‐15] × 100. Variation was categorized in levels of increase or decrease of GDF‐15. Patients were cross‐classified according to admission and discharge GDF‐15 cut‐off points. A Cox regression analysis was used to assess the prognostic impact of GDF‐15 variation and the impact of both admission and discharge GDF‐15 according to the cross‐classification. We studied a group of 249 patients with high co‐morbidity burden. Eighty‐one patients died at 1 year and 147 within 3 years. There was a modest decrease in GDF‐15 during hospitalization from a median value of 4087 to 3671 ng/mL (P = 0.02). No association existed between GDF‐15 variation and mortality. In multivariate analysis, patients with admission GDF‐15 ≥ 3500 ng/mL and discharge GDF‐15 ≥ 3000 ng/mL had a significantly higher 1 year death risk when compared with the remaining—hazard ratio = 2.59 (95% confidence interval: 1.41–4.76)—and a 3 year 1.76 (95% confidence interval: 1.08–2.87) higher death risk compared with those with both values below the cut‐off. Conclusions Growth differentiation factor 15 decreased during an acute HF hospitalization, but its variation had no prognostic implications. The knowledge of both admission and discharge GDF‐15 added meaningful information to patients' risk stratification.
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Affiliation(s)
- Patrícia Lourenço
- Internal Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Heart Failure Clinic of the Internal Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Cardiovascular R&D Unit (UnIC), University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Filipe M Cunha
- Endocrinology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - João Ferreira-Coimbra
- Internal Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Isaac Barroso
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Serviço de Medicina Interna, Hospital CUF Porto, Porto, Portugal
| | - João-Tiago Guimarães
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal.,Clinical Pathology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Paulo Bettencourt
- Cardiovascular R&D Unit (UnIC), University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal.,Serviço de Medicina Interna, Hospital CUF Porto, Porto, Portugal
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19
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Sipos B, Jirak P, Paar V, Rezar R, Mirna M, Kopp K, Hoppe UC, Berezin AE, Lichtenauer M. Promising Novel Biomarkers in Cardiovascular Diseases. APPLIED SCIENCES 2021; 11:3654. [DOI: 10.3390/app11083654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Cardiovascular diseases remain the most common causes of death globally, according to the World Health Organization. In recent years, a great number of biomarkers have been investigated, whereas only some have gained value in the diagnosis, prognosis, and risk stratification of different cardiovascular illnesses. As numerous studies have investigated the diagnostic yield of novel biomarkers in various disease entities every year, this review aims to provide an overview of the current status of four promising representatives. In particular, this manuscript refers to soluble suppression of tumorigenicity 2 (sST2), heart-type fatty acid binding protein (H-FABP), growth differentiation factor (GDF-15) and soluble urokinase-type plasminogen activator receptor (suPAR). These markers are of special interest as they are thought to provide an accurate estimate of cardiovascular risk in certain patient populations, especially those with pre-existing diseases, such as obesity or diabetes mellitus. We sought to give an overview of their function, individual diagnostic and predictive value and determination in the laboratory. A review of the literature regarding the aforementioned cardiovascular biomarkers yielded manifold results with respect to their individual diagnostic and prognostic value. Yet, the clinical relevance of these findings remains unclear, warranting further studies to identify their optimal use in clinical routine.
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20
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Sánchez-Infantes D, Nus M, Navas-Madroñal M, Fité J, Pérez B, Barros-Membrilla AJ, Soto B, Martínez-González J, Camacho M, Rodriguez C, Mallat Z, Galán M. Oxidative Stress and Inflammatory Markers in Abdominal Aortic Aneurysm. Antioxidants (Basel) 2021; 10:602. [PMID: 33919749 PMCID: PMC8070751 DOI: 10.3390/antiox10040602] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is increasing due to aging of the population and is a major cause of death among the elderly. Ultrasound screening programs are useful in early diagnosis, but aneurysm size is not always a good predictor of rupture. Our aim was to analyze the value of circulating molecules related to oxidative stress and inflammation as new biomarkers to assist the management of AAA. The markers were quantified by ELISA, and their expression in the aneurysmal wall was studied by real-time PCR and by immunostaining. Correlation analysis of the studied markers with aneurysm diameter and peak wall stress (PWS), obtained by finite element analysis, and multivariate regression analysis to assess potential confounding factors were performed. Our study shows an extensive inflammatory infiltration in the aneurysmal wall, mainly composed by T-cells, macrophages and B-cells and altered levels of reactive oxygen species (ROS), IgM, IgG, CD38, GDF15, S100A4 and CD36 in plasma and in the aneurysmal tissue of AAA patients compared with controls. Circulating levels of IgG, CD38 and GDF15 positively correlated with abdominal aortic diameter, and CD38 was correlated with PWS. Our data show that altered levels of IgG, CD38 and GDF15 have potential diagnostic value in the assessment of AAA.
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Affiliation(s)
- David Sánchez-Infantes
- Department of Basic Sciences of Health, Area of Biochemistry and Molecular Biology, University Rey Juan Carlos, 28922 Alcorcón, Spain;
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, 28029 Madrid, Spain
| | - Meritxell Nus
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (M.N.); (Z.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
| | - Miquel Navas-Madroñal
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
| | - Joan Fité
- Servicio de Angiología, Cirugía Vascular y Endovascular, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.F.); (B.S.)
| | - Belén Pérez
- Faculty of Medicine, Universidad Autónoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
| | - Antonio J. Barros-Membrilla
- Unidad Funcional de Patología de la Aorta (UPA), Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Begoña Soto
- Servicio de Angiología, Cirugía Vascular y Endovascular, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.F.); (B.S.)
| | - José Martínez-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
- Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036 Barcelona, Spain
| | - Mercedes Camacho
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
| | - Cristina Rodriguez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
| | - Ziad Mallat
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (M.N.); (Z.M.)
| | - María Galán
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
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21
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Boriani G, Vitolo M, Lane DA, Potpara TS, Lip GY. Beyond the 2020 guidelines on atrial fibrillation of the European society of cardiology. Eur J Intern Med 2021; 86:1-11. [PMID: 33518403 DOI: 10.1016/j.ejim.2021.01.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/03/2021] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Abstract
The most recent atrial fibrillation (AF) guidelines delivered by European Society of Cardiology (ESC) offer an updated approach to AF management, with the perspective of improved characterization of the arrhythmia, the cardiac substrate and the patients profile in terms of associated risk factors and comorbidities. Recommendations were based on careful scrutiny and assessment of all available evidence with the final aim to offer to practitioners a lower level of uncertainty in the complex process of decision making for patients with AF. The 2020 ESC guidelines on AF propose a paradigm shift in the clinical approach to AF patients, moving from a single-domain AF classification to comprehensive characterization of AF patients. Given the complex nature of AF, an integrated holistic management of AF patients is suggested by the guidelines for improving patients outcomes through the formal introduction of the CC (Confirm AF and Characterize AF) to ABC (Atrial fibrillation Better Care) pathway. In line with this concept, these new guidelines underline the importance of a more comprehensive management of AF patients which should not be limited to simply prescribe oral anticoagulation or decide between a rhythm or rate control strategy. Indeed, each step of the ABC pathway represents one of the pivotal pillars in the management of AF and only a holistic approach has the potential to improve patients' outcomes. In this review we will discuss the background that supports some of the new recommendations of 2020 ESC guidelines, with important implications for daily management of AF patients.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; School of Medicine, University of Belgrade, Belgrade, Serbia
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22
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May BM, Pimentel M, Zimerman LI, Rohde LE. GDF-15 as a Biomarker in Cardiovascular Disease. Arq Bras Cardiol 2021; 116:494-500. [PMID: 33566936 PMCID: PMC8159541 DOI: 10.36660/abc.20200426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
In the last years, several diagnostic and prognostic biomarkers have been studied in cardiovascular disease. Growth differentiation factor-15 (GDF-15), a cytokine belonging to the transforming growth factor- (TGF-) family, is highly up-regulated in stress and inflammatory conditions and has been correlated to myocardial injury and pressure cardiac overload in animal models. This new biomarker has been positively correlated with increased risk of cardiovascular events in population studies and shown an independent predictor of mortality in patients with coronary artery disease and heart failure. This review aimed to summarize the current evidence on the diagnostic and prognostic value of GDF-15 in different settings in cardiology.
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Affiliation(s)
- Bruna Miers May
- Universidade Federal do Rio Grande do SulPrograma de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências CardiovascularesPorto AlegreRSBrasil Universidade Federal do Rio Grande do Sul
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Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares
,
Porto Alegre
,
RS
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Brasil
| | - Mauricio Pimentel
- Hospital de Clinicas de Porto AlegreHospital de Clinicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clinicas de Porto Alegre
,
Porto Alegre
,
RS
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Brasil
| | - Leandro Ioschpe Zimerman
- Hospital de Clinicas de Porto AlegreHospital de Clinicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clinicas de Porto Alegre
,
Porto Alegre
,
RS
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Brasil
| | - Luis Eduardo Rohde
- Hospital de Clinicas de Porto AlegreHospital de Clinicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clinicas de Porto Alegre
,
Porto Alegre
,
RS
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Brasil
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23
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Evaluation of left atrial remodeling in kidney transplant patients using cardiac magnetic resonance imaging. J Nephrol 2020; 34:851-859. [PMID: 32910428 DOI: 10.1007/s40620-020-00853-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Increased left atrial (LA) size predicts cardiovascular events in patients with end-stage kidney disease. There is a paucity of data on LA changes after kidney transplantation (KT). Accordingly, we used cardiac magnetic resonance imaging (CMR) to evaluate LA remodeling after KT, and examined its relationship with left ventricular (LV) measurements, blood pressure and cardiac biomarkers. METHODS In this prospective multi-center cohort study, 39 pre-transplant dialysis patients underwent KT and 42 eligible transplant recipients remained on dialysis. CMR, blood pressure and serum measurements for N-terminal pro b-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hsCRP), and growth differentiation factor-15 (GDF-15) were performed at baseline and 12 months. RESULTS After 12 months, there were no significant changes in LA end-systolic volume index, LA end-diastolic volume index, or LA ejection fraction (LAEF) within the KT or dialysis group; changes over time did not differ between the 2 groups (all p > 0.25). At baseline and over 12 months, LA volumes and LAEF positively correlated with LV volumes and mass while LAEF positively correlated with LV function. Changes in LA volumes also positively correlated with NT-proBNP and systolic blood pressure (sBP) while LAEF negatively correlated with NT-proBNP. GDF-15 correlated with LA measurements at baseline but not in 12-month changes. hsCRP did not correlate with any LA measurements. CONCLUSIONS LA volumes and function as measured by CMR did not change significantly over 12 months post-KT. There were significant associations between LA and LV remodeling, NT-proBNP and sBP, suggesting common underlying pathophysiological mechanisms.
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24
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Lockhart SM, Saudek V, O’Rahilly S. GDF15: A Hormone Conveying Somatic Distress to the Brain. Endocr Rev 2020; 41:bnaa007. [PMID: 32310257 PMCID: PMC7299427 DOI: 10.1210/endrev/bnaa007] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/02/2020] [Indexed: 12/27/2022]
Abstract
GDF15 has recently gained scientific and translational prominence with the discovery that its receptor is a GFRAL-RET heterodimer of which GFRAL is expressed solely in the hindbrain. Activation of this receptor results in reduced food intake and loss of body weight and is perceived and recalled by animals as aversive. This information encourages a revised interpretation of the large body of previous research on the protein. GDF15 can be secreted by a wide variety of cell types in response to a broad range of stressors. We propose that central sensing of GDF15 via GFRAL-RET activation results in behaviors that facilitate the reduction of exposure to a noxious stimulus. The human trophoblast appears to have hijacked this signal, producing large amounts of GDF15 from early pregnancy. We speculate that this encourages avoidance of potential teratogens in pregnancy. Circulating GDF15 levels are elevated in a range of human disease states, including various forms of cachexia, and GDF15-GFRAL antagonism is emerging as a therapeutic strategy for anorexia/cachexia syndromes. Metformin elevates circulating GDF15 chronically in humans and the weight loss caused by this drug appears to be dependent on the rise in GDF15. This supports the concept that chronic activation of the GDF15-GFRAL axis has efficacy as an antiobesity agent. In this review, we examine the science of GDF15 since its identification in 1997 with our interpretation of this body of work now being assisted by a clear understanding of its highly selective central site of action.
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Affiliation(s)
- Samuel M Lockhart
- MRC Metabolic Diseases Unit, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Vladimir Saudek
- MRC Metabolic Diseases Unit, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen O’Rahilly
- MRC Metabolic Diseases Unit, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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25
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Adverse Cardiac Remodelling after Acute Myocardial Infarction: Old and New Biomarkers. DISEASE MARKERS 2020; 2020:1215802. [PMID: 32626540 PMCID: PMC7306098 DOI: 10.1155/2020/1215802] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/06/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022]
Abstract
The prevalence of heart failure (HF) due to cardiac remodelling after acute myocardial infarction (AMI) does not decrease regardless of implementation of new technologies supporting opening culprit coronary artery and solving of ischemia-relating stenosis with primary percutaneous coronary intervention (PCI). Numerous studies have examined the diagnostic and prognostic potencies of circulating cardiac biomarkers in acute coronary syndrome/AMI and heart failure after AMI, and even fewer have depicted the utility of biomarkers in AMI patients undergoing primary PCI. Although complete revascularization at early period of acute coronary syndrome/AMI is an established factor for improved short-term and long-term prognosis and lowered risk of cardiovascular (CV) complications, late adverse cardiac remodelling may be a major risk factor for one-year mortality and postponded heart failure manifestation after PCI with subsequent blood flow resolving in culprit coronary artery. The aim of the review was to focus an attention on circulating biomarker as a promising tool to stratify AMI patients at high risk of poor cardiac recovery and developing HF after successful PCI. The main consideration affects biomarkers of inflammation, biomechanical myocardial stress, cardiac injury and necrosis, fibrosis, endothelial dysfunction, and vascular reparation. Clinical utilities and predictive modalities of natriuretic peptides, cardiac troponins, galectin 3, soluble suppressor tumorogenicity-2, high-sensitive C-reactive protein, growth differential factor-15, midregional proadrenomedullin, noncoding RNAs, and other biomarkers for adverse cardiac remodelling are discussed in the review.
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26
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The utility of growth differentiation factor-15, galectin-3, and sST2 as biomarkers for the diagnosis of heart failure with preserved ejection fraction and compared to heart failure with reduced ejection fraction: a systematic review. Heart Fail Rev 2020; 26:799-812. [PMID: 32472523 DOI: 10.1007/s10741-020-09913-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective was to evaluate the diagnosis of heart failure with preserved ejection fraction (HFpEF) using the biomarkers, growth differentiation factor-15 (GDF-15), galectin-3 (Gal-3), and soluble ST2 (sST2), and to determine whether they can differentiate HFpEF from heart failure with reduced ejection fraction (HFrEF). Medline and Embase databases were searched with the terms diastolic heart failure or HFpEF, biomarkers, and diagnosis, limited to years 2000 to 2019. There were significantly and consistently higher levels of GDF-15, Gal-3, and sST2 in HFpEF compared to no heart failure. Importantly, the magnitude of the increase in GDF-15 or Gal-3 and possibly sST2,correlated with a greater degree of diastolic dysfunction. There were no significant differences between GDF-15, Gal-3, and sST2 in patients with HFpEF vs HFrEF. In the studies assessing these three biomarkers, BNP was significantly greater in heart failure than controls. Furthermore, BNP was significantly higher in HFrEF compared to HFpEF. The diagnostic utility of GDF-15, Gal-3, and sST2 compared to BNP was evaluated by comparing ROC curves. The data supports the contention that to distinguish HFpEF from HFrEF, an index is needed that incorporates GDF-15, Gal-3, or sST2 as well as BNP. The three biomarkers GDF-15, Gal-3, or sST2 can identify patients with HFpEF compared to individuals without heart failure but cannot differentiate HFpEF from HFrEF. BNP is higher in and is better at differentiating HFrEF from HFpEF. Indices that incorporate GDF-15, Gal-3, or sST2 as well as BNP show promise in differentiating HFpEF from HFrEF.
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27
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Sachinidis A. Cardiotoxicity and Heart Failure: Lessons from Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes and Anticancer Drugs. Cells 2020; 9:cells9041001. [PMID: 32316481 PMCID: PMC7226145 DOI: 10.3390/cells9041001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
Human-induced pluripotent stem cells (hiPSCs) are discussed as disease modeling for optimization and adaptation of therapy to each individual. However, the fundamental question is still under debate whether stem-cell-based disease modeling and drug discovery are applicable for recapitulating pathological processes under in vivo conditions. Drug treatment and exposure to different chemicals and environmental factors can initiate diseases due to toxicity effects in humans. It is well documented that drug-induced cardiotoxicity accelerates the development of heart failure (HF). Until now, investigations on the understanding of mechanisms involved in HF by anticancer drugs are hindered by limitations of the available cellular models which are relevant for human physiology and by the fact that the clinical manifestation of HF often occurs several years after its initiation. Recently, we identified similar genomic biomarkers as observed by HF after short treatment of hiPSCs-derived cardiomyocytes (hiPSC-CMs) with different antitumor drugs such as anthracyclines and etoposide (ETP). Moreover, we identified common cardiotoxic biological processes and signal transduction pathways which are discussed as being crucial for the survival and function of cardiomyocytes and, therefore, for the development of HF. In the present review, I discuss the applicability of the in vitro cardiotoxicity test systems as modeling for discovering preventive mechanisms/targets against cardiotoxicity and, therefore, for novel HF therapeutic concepts.
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Affiliation(s)
- Agapios Sachinidis
- Faculty of Medicine, Institute of Neurophysiology, University of Cologne, Robert-Koch-Str. 39, 50931 Cologne, Germany;
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
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28
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Cardiac Biomarkers in Advanced Heart Failure: How Can They Impact Our Pre-transplant or Pre-LVAD Decision-making. Curr Heart Fail Rep 2019; 16:274-284. [PMID: 31741231 DOI: 10.1007/s11897-019-00447-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Decision-making in advanced heart failure (HF) is a complex process that involves careful consideration of competing tradeoffs of risks and benefits in regard to heart transplantation (HT) or left ventricular assist device (LVAD) placement. The purpose of this review is to discuss how biomarkers may affect decision-making for HT or LVAD implantation. RECENT FINDINGS N-Terminal probrain natriuretic peptide, soluble suppression of tumorigenicity-2, galectin-3, copeptin, and troponin T levels are associated with HF survival and can help identify the appropriate timing for advanced HF therapies. Patients at risk of right ventricular failure after LVAD implantation can be identified with preimplant biomarkers of extracellular matrix turnover, neurohormonal activation, and inflammation. There is limited data on the adoption of biomarker measurement for decision-making in the allocation of advanced HF therapies. Nonetheless, biomarkers can improve risk stratification and prognostication thereby optimizing patient selection for HT and LVAD implantation.
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29
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Connelly PW, Yan AT, Nash MM, Lok CE, Gunaratnam L, Prasad GVR. Growth differentiation factor 15 is decreased by kidney transplantation. Clin Biochem 2019; 73:57-61. [PMID: 31361994 DOI: 10.1016/j.clinbiochem.2019.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Growth differentiation factor 15 (GDF15) is markedly increased in end-stage kidney disease and has been related to increased mortality in patients on dialysis. We hypothesized that kidney transplantation would decrease both GDF15 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and that GDF-15 decrease relates to post-kidney transplantation allograft function. METHODS End-stage kidney disease patients on dialysis awaiting a living donor kidney transplantation (n = 39), and those expected to be on the deceased donor waitlist for at least 12 months (n = 43) were enrolled at three transplant centers. Serum GDF15 and NT-proBNP were measured at 0, 3, and 12 months post-kidney transplantation or post-enrollment. Change in serum GDF15 and NT-proBNP concentrations, and their relation to estimated glomerular filtration rate (eGFR) were assessed by non-parametric tests and regression analyses. RESULTS Median baseline GDF15 was 4744 pg/ml and 5451 pg/ml for the kidney transplantation and dialysis groups, respectively (p = 0.09). Kidney transplantation resulted in a significant decrease in GDF15 (month 12 median 1631 pg/ml, p < 0.0001 vs. baseline), whereas there was no change for the dialysis group (month 12 median 5658 pg/ml, p = 0.31). Post-kidney transplantation NT-proBNP highly correlated with GDF15 (ρ = 0.64, p < 0.0001). GDF15 inversely correlated with post-transplant eGFR for the kidney transplantation group (ρ = -0.42, p = 0.0081). Month 12 NT-proBNP explained 15.8% and 40.1% of the variance in month 12 GDF15 in the dialysis and kidney transplantation groups, respectively. The relationship of GDF15 with eGFR was no longer significant when NT-proBNP was included in the models. CONCLUSIONS Kidney transplantation significantly decreases serum GDF15 concentrations. The post-kidney transplantation association of GDF15 with NT-proBNP is consistent with a gradient of post- kidney transplantation cardiovascular risk.
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Affiliation(s)
- Philip W Connelly
- Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto and Keenan Research Centre for Biomedical Sciences of St. Michael's Hospital, Toronto, Canada.
| | - Andrew T Yan
- University of Toronto, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Michelle M Nash
- Renal Transplant Program, St. Michael's Hospital, Toronto, Canada
| | - Charmaine E Lok
- Department of Medicine, University of Toronto, Division of Nephrology, Toronto General Hospital, Toronto, Canada
| | - Lakshman Gunaratnam
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - G V Ramesh Prasad
- University of Toronto, Division of Nephrology, St. Michael's Hospital, Toronto, Canada
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30
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Lainscak M, Omersa D, Sedlar N, Anker SD, Farkas J. Heart failure prevalence in the general population: SOBOTA-HF study rationale and design. ESC Heart Fail 2019; 6:1077-1084. [PMID: 31347289 PMCID: PMC6816073 DOI: 10.1002/ehf2.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/02/2019] [Accepted: 06/25/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Epidemiological heart failure (HF) data in the era of natriuretic peptides and echocardiography are scarce. The primary aim of this study is to evaluate the HF prevalence in the general population. We will also investigate natriuretic peptide cut‐off for diagnosis of HF. Finally, we will be able to identify left ventricular function phenotypes and study relations between cardiac function, clinical presentation, and health‐related quality of life. Methods and results Screening Of adult urBan pOpulation To diAgnose Heart Failure (SOBOTA‐HF) is a cross‐sectional prevalence study in a representative sample of Murska Sobota residents aged 55 years or more. Individuals will be invited to attend screening visit with point‐of‐care N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) testing. All subjects with NT‐proBNP ≥ 125 pg/mL will be invited for a diagnostic visit that will include history and physical examination, electrocardiogram, echocardiography, blood and urine sampling, ankle brachial index, pulmonary function tests, body composition measurement, physical performance tests, and questionnaires. To validate the screening procedure, a control group (NT‐proBNP < 125 pg/mL) will undergo the same diagnostic evaluation. An external centre will validate echocardiography results, and the HF diagnosis will be adjudicated within an international HF expert panel. Overall and age‐specific HF prevalence will be calculated in individuals ≥ 55 years and extrapolated to the whole population. Conclusions The SOBOTA‐HF study will test the latest HF guideline diagnostic criteria in the general population sample. Next to HF prevalence, it will provide insight into left ventricular function and general patient phenotype; we will also extend current understanding of natriuretic peptides for HF screening.
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Affiliation(s)
- Mitja Lainscak
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel Omersa
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,General Hospital Jesenice, Jesenice, Slovenia
| | - Natasa Sedlar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jerneja Farkas
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,National Institute of Public Health, Ljubljana, Slovenia
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Bettencourt P, Ferreira-Coimbra J, Rodrigues P, Marques P, Moreira H, Pinto MJ, Guimarães JT, Lourenço P. Towards a multi-marker prognostic strategy in acute heart failure: a role for GDF-15. ESC Heart Fail 2018; 5:1017-1022. [PMID: 30144302 PMCID: PMC6301153 DOI: 10.1002/ehf2.12301] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 02/22/2018] [Accepted: 04/08/2018] [Indexed: 01/05/2023] Open
Abstract
Aims Growth differentiation factor (GDF)‐15 mirrors inflammation and oxidative stress in cardiovascular diseases. Brain natriuretic peptide (BNP) is associated with cardiomyocyte stretch in heart failure (HF). The objective of this study was to evaluate the prognostic impact of plasma GDF‐15 and BNP in acute HF. Methods and results We studied a subgroup of patients prospectively recruited in an acute HF registry (follow‐up: 2 years; endpoint: all‐cause mortality). Cox regression multivariate models were built to study the association of GDF‐15 and mortality. Further cross‐classification according to discharge GDF‐15 (mean) and BNP (mean) and association with mortality was studied. We studied 158 patients: seventy‐nine were male, mean age was 75 years, 55.1% had left ventricular ejection fraction < 40%, mean discharge BNP was 1000 pg/mL, and mean GDF‐15 was 3013 ng/mL. Higher BNP and GDF‐15 predicted 2‐year mortality. Patients with GDF‐15 ≥ 3000 ng/mL had a multivariate adjusted 2‐year death risk of 1.86 (1.08–3.18). Patients discharged with both BNP and GDF‐15 above the mean had an adjusted hazard ratio of 4.33 (2.07–9.06) when compared with those with both <mean. Conclusions Higher GDF‐15 associated with worse prognosis in acute HF independently of BNP. When both biomarkers GDF‐15 and BNP were elevated at discharge, the 2‐year mortality risk increased over four‐fold. Biomarkers related to different pathophysiological pathways can provide incremental prognostic information in acute HF.
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Affiliation(s)
- Paulo Bettencourt
- Faculty of Medicine, University of Porto, Porto, Portugal.,Internal Medicine Department, Hospital CUF, Porto, Portugal
| | | | - Pedro Rodrigues
- Internal Medicine Department, São João Hospital Center, Porto, Portugal
| | - Pedo Marques
- Internal Medicine Department, São João Hospital Center, Porto, Portugal
| | - Helena Moreira
- Internal Medicine Department, São João Hospital Center, Porto, Portugal
| | - Maria João Pinto
- Faculty of Medicine, University of Porto, Porto, Portugal.,Clinical Pathology Department, São João Hospital Center, Porto, Portugal
| | - João Tiago Guimarães
- Faculty of Medicine, University of Porto, Porto, Portugal.,Clinical Pathology Department, São João Hospital Center, Porto, Portugal
| | - Patrícia Lourenço
- Faculty of Medicine, University of Porto, Porto, Portugal.,Internal Medicine Department, São João Hospital Center, Porto, Portugal
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