Congestive Heart Failure (CHF) is a serious medical condition that results in the heart not being able to pump to meet the body's demands successfully. CHF is generally caused by long-standing chronic diseases such as diabetes, high blood pressure, and ischemic heart disease. Notably, it is associated with significant mortality and consumption of healthcare resources. Between 2000 and 2010, it was estimated that 1 million hospitalizations were related to CHF in the United States. Due to the serious nature of CHF, it is necessary to have a reliable biomarker to estimate the outcome of this disease. Traditionally laboratory markers such as B-type Natriuretic Peptide (BNP) have been used to diagnose and predict outcomes in heart failure. Although valuable, BNP is impacted by other factors such as age and certain medical conditions, limiting its clinical usefulness.
Previous animal studies have demonstrated that Growth Differentiation Factor-15 (GDF-15) is upregulated in response to cardiac stress. Certain studies have also indicated that levels are higher in human patients with CHF. As such, investigators have performed a meta-analysis to determine whether GDF-15 can serve as a reliable biomarker in the prognostic evaluation of CHF.
The meta-analysis included ten studies with over 6 thousand participants. Rigorous bias assessment was performed, and publication bias was controlled using various methods. In addition, all included studies were deemed high quality based on Newcastle-Ottawa-Scale methodology. Results indicated that all-cause mortality significantly increased with increasing levels of GDF-15 in patients with ischemic CHF. The risk of death was also more strongly associated with patients that had CHF with reduced ejection fraction. Limitations of this analysis include heterogeneity across eligible studies, possibly due in part to factors such as comorbidities among study participants and different assay methods for measuring GDF-15.
This evidence strongly suggests that GDF-15 may serve as a useful biomarker in the prognostication of CHF. Further studies should focus on factors such as GDF-15 levels for stratifying patients into different risk categories. In addition, the impact of age and medical comorbidities on the prognostic utility of GDF-15 should also be evaluated.
Sources: CDC, Circulation Research, Frontiers in Cardiovascular Medicine