Growth-differentiation factor 15 as predictor of mortality in acute reperfused ST-elevation myocardial infarction: insights from cardiovascular magnetic resonance
Authors:
- Ingo EitelIngo Eitel
- Patrick BlasePBPatrick Blase
- Volker AdamsVAVolker Adams
- Lysann HildebrandLHLysann Hildebrand
- Steffen DeschSDSteffen Desch
- Gerhard SchulerGSGerhard Schuler
- Holger ThieleHTHolger Thiele
Abstract
Objective Growth-differentiation factor 15 (GDF-15), a stress-responsive member of the transforming growth factor beta cytokine superfamily, has emerged as a biomarker of increased mortality in cardiovascular disease. However, the exact pathophysiological mechanisms of GDF-15 in the cardiovascular system and in acute ST-elevation myocardial infarction (STEMI) are not well defined. The aim of this study was to determine the relation between GDF-15 and myocardial damage assessed by cardiovascular magnetic resonance (CMR) imaging and to evaluate the prognostic value of GDF-15 in a high-risk STEMI population exclusively reperfused by primary angioplasty. Design, setting, patients GDF-15 concentrations were determined by an ELISA in 238 consecutive patients undergoing primary angioplasty in STEMI less than 12 h after symptom onset. Patients were categorised into two groups defined by the median GDF-15 value on admission. CMR was performed 3 days (IQR 2–4) after infarction for assessment of infarct size, myocardial salvage and microvascular obstruction. The primary clinical endpoint was mortality within 6 months after the index event. Results Elevated GDF-15 concentrations over and above the median on admission were a strong predictor of mortality (19 vs one death, pConclusions GDF-15 on admission is a strong predictor of mortality in patients with STEMI reperfused by primary angioplasty, which is associated with decreased myocardial salvage and subsequent adverse clinical outcome. Clinical trail registration number http://www.clinicaltrials.gov/ NCT00463749.Keywords
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