Abstract 9920: Growth Differentiation Factor 15, ST2 and Natriuretic Peptides in Heart Failure with Preserved versus Reduced Ejection Fraction
Background: Growth differentiation factor 15 (GDF15) is part of the TGF-β superfamily and a marker of cell injury and inflammation. ST2 is part of the interleukin-1 receptor family and a marker of mechanical stress and ventricular remodeling. While each of these novel markers is elevated in heart failure (HF), little is known regarding their differential levels in HF with preserved vs reduced ejection fraction (HFPEF vs HFREF respectively) or relative to the established marker of wall stretch, amino terminal pro B type natriuretic peptide (NTproBNP).
Aim: To compare circulating GDF15, ST2, NTproBNP and their ratios in HFPEF vs HFREF
Hypotheses: Since GDF15, ST2 and NTproBNP are markers of distinct mechanistic processes that may be differentially involved in HFPEF vs HFREF, we hypothesized that a combination of markers may better distinguish between HFPEF and HFREF than a single marker.
Methods and Results: GDF15, ST2 and NTproBNP were measured in consecutive patients hospitalized with HFREF (N=20, 58±5 y, 85% men) and HFPEF (EF≥50%, N=12, 68±11 y, 58% men). Despite similarly raised filling pressures (E/e’ 20±11 in HFREF vs 19±9 in HFPEF; p=0.8), NTproBNP was lower in HFPEF than HFREF, whereas GDF15 and ST2 were similar raised in both HFPEF and HFREF (Table). The ratio GDF15:NTproBNP was higher in HFPEF than HFREF, even after adjusting for age, sex and body size (p=0.025), and distinguished HFPEF from HFREF with the largest area under receiver operating curve. Among the biomarkers, only NTproBNP correlated with left ventricular mass (r=0.44; p=0.012).
Conclusions: This pilot study suggests that at similarly high filling pressures, myocardial injury/ inflammation (as measured by GDF15) relative to wall stretch (GDF:NTproBNP ratio) is dominant in HFPEF compared to HFREF. Future studies in larger samples of HF patients and including non-HF controls are needed to further delineate the relationships of these novel biomarkers with ventricular remodeling.
- © 2011 by American Heart Association, Inc.