Growth differentiation factor 15 and arterial remodeling in adult patients after succesful repair of aortic coarctation (RCD code: IV-5.A.1)

Abstract

Background: Coarctation of aorta (CoAo) is a congenital heart anomaly associated with high cardiovascular morbidity and mortality attributable to vascular remodeling in adult survivors following surgical management of aortic stenosis. This study sought to adjudicate the significance of novel stress-responsive biomarker, growth differentiation factor 15 (GDF-15), as an indicator of vascular remodeling and its correlation with numerous laboratory and vascular parameters in patients after successful CoAo repair. Methods and results:This research is a case-control study comprising 33 consecutive patients (19 men, 57.58%; mean age 33.9 ±9.3 years; mean age at surgery: 9.1 ±7 years; mean follow-up duration 24.8 ±6.8 years) admitted to outpatient clinic for routine follow-up after repair of CoAo (mainly Dacron patch technique) and matched with 20 healthy controls (10 men, 50%; mean age 34.8 ±9.9 years). Laboratory (GDF-15, high-sensitivity C-reactive protein) and vascular parameters (intima-media thickness, flow-and nitrate-mediated dilation, pulse-wave velocity, central arterial pressure) were assessed. Significant aortic residual gradient was present in 24 (72.7%). The circulating GDF-15 level was lower in CoAo survivors than in control group (539.56 vs. 744.98 pg/ml respectively; p < 0.001). GDF-15 concentration <550 pg/ml successfully differentiated patients after CoA repair (odds ratio [OR] = 9.2; 95%CI: 2.45-34.56, p = 0.0005). There was no difference in GDF-15 level depending on the presence of significant residual gradient (p = 0.19). No significant correlation between GDF-15 and other variables was observed. Conclusions: Low concentration of GDF-15 is characteristic of asymptomatic patients following CoAo repair, however, its clinical significance and relationship with vascular remodeling substantiates further investigation. JRCD 2013; 1 (2): 41-48