Document Detail

Growth-differentiation factor-15 improves reclassification for the diagnosis of heart failure with normal ejection fraction in morbid obesity.
MedLine Citation:
PMID:  22843563     Owner:  NLM     Status:  MEDLINE    
AIMS: This study aimed to examine the incremental value of growth-differentiation factor-15 (GDF-15) to N-terminal pro brain natriuretic hormone (NT-proBNP) levels for the diagnosis of left ventricular diastolic dysfunction (LVDD) and possible heart failure (HF) in morbidly obese patients. Method and results We analysed data from 207 obese subjects [body mass index (BMI) 41 ± 8 kg/m(2)] with normal ejection fraction, LVDD, and symptoms and/or signs of HF (referred to as 'LVDD with possible HF', n = 88) and with normal left ventricular function (n = 119) before participating in a medical weight loss programme, in addition to the study of healthy lean subjects (n = 51). Median NT-proBNP (interquartile range) for obese subjects with 'LVDD and possibe HF' and with normal LV function was 52 (29-96) and 42 (25-66) pg/mL, respectively (P = 0.12). There was no correlation of NT-proBNP with parameters of left ventricular filling pressure, i.e. E/E' (r(2) = 0.002, P = 0.63) or E' velocity (r(2) = 0.02, P = 0.24). In contrast, GDF-15 was 665 (496-926) with 'LVDD and possible HF' and 451 (392- 679) pg/mL without (P < 0.0001). GDF-15 was significantly correlated to E/E', E' velocity, E/A ratio, isovolumetric relaxation time, duration of reversed pulmonary vein atrial systolic flow, and left atrial size. The area under the receiver operating characteristic curve that defines LVDD with possible HF was 0.56 for NT-proBNP and 0.74 for GDF-15 (P < 0.0001). The addition of GDF-15 to a multivariate predicition model increased the net reclassification improvement (NRI) by 9% (P= 0.022).
CONCLUSION: In morbidly obese individuals, GDF-15 levels seem to better correlate with diastolic dysfunction than NT-proBNP levels. GDF-15 significantly improves reclassification for the diagnosis of 'LVDD with possible HF' and, thus, adds incremental value to NT-proBNP.
Andrea Baessler; Christina Strack; Elena Rousseva; Florian Wagner; Janine Bruxmeier; Martin Schmiedel; Günter Riegger; Claas Lahmann; Thomas Loew; Gerd Schmitz; Marcus Fischer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-07-26
Journal Detail:
Title:  European journal of heart failure     Volume:  14     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-22     Completed Date:  2013-04-01     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1240-8     Citation Subset:  IM    
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany.
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MeSH Terms
Analysis of Variance
Biological Markers
Growth Differentiation Factor 15 / diagnostic use*
Health Status Indicators
Heart Failure, Diastolic / diagnosis*,  pathology,  ultrasonography
Middle Aged
Natriuretic Peptide, Brain / diagnostic use*
Obesity, Morbid / complications,  pathology*
Peptide Fragments / diagnostic use*
Predictive Value of Tests
Statistics as Topic
Ventricular Dysfunction, Left / diagnosis*,  pathology,  ultrasonography
Young Adult
Reg. No./Substance:
0/Biological Markers; 0/Growth Differentiation Factor 15; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain

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