New Cardiovascular Biomarkers in Ischemic Heart Disease—GDF-15, A Probable Predictor for Ejection Fraction

Abstract

Background: Various biomarkers have been associated with coronary artery disease (CAD) and ischemic heart failure. The aim of this study was to investigate the correlation of serum levels of soluble urokinase-type plasminogen activator receptor (suPAR), growth differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), and soluble suppression of tumorigenicity 2 (sST2) with left ventricular ejection fraction (EF) in CAD patients and controls. Methods and Results: CAD patients were divided into three groups according to their EF as measured by the biplane Simpson method (53–84%, 31–52%, ≤30%). Overall, 361 subjects were analyzed. In total, 155 CAD patients had an EF of 53–84%, 71 patients had an EF of 31–52%, and 23 patients had an EF of ≤30% as compared to 112 healthy controls (age 51.3 ± 9.0 years, 44.6% female). Mean ages according to EF were 62.1 ± 10.9, 65.2 ± 10.1, and 66.6 ± 8.2 years, respectively, with females representing 29.0, 29.6, and 13.0%. suPAR, GDF-15, H-FABP, and sST2 values were significantly higher in CAD patients and showed an exponential increase with decreasing EF. In a multiple logistic regression model, GDF-15 (p = 0.009), and NT-brain natriuretic peptide (p = 0.003) were independently associated with EF. Conclusion: Biomarkers such as suPAR, GDF-15, H-FABP, and sST2 are increased in CAD patients, especially in highly impaired EF. Besides NT-proBNP as a well-known marker for risk prediction, GDF-15 may be an additional tool for diagnosis and clinical follow-up.

The Endocrine Function of the Heart: Physiology and Involvements of Natriuretic Peptides and Cyclic Nucleotide Phosphodiesterases in Heart Failure

“…Moreover, even if ESC and ACC/AHA guidelines confirm the clinical utility of serum BNP or NT-proBNP for establishing disease and prognostic in chronic and acute HF, biomarker-“guided” therapy has produced inconsistent results in randomized controlled trials for the purpose of reducing hospitalizations or mortality [109]. In addition to NPs, other plasmatic biomarkers dosages as GDF-15 (growth differentiation factor 15) in ischemic HF, a heart-derived hormone that regulates pediatric body growth and would coordinate cardiac function with NPs [110], might be an interesting complementary tool in HF diagnosis and clinical follow-up [111].…”

Soluble urokinase-type plasminogen activator receptor represents exercise tolerance and predicts adverse cardiac events in patients with heart failure

“…For instance, previous reports suggested that circulating suPAR levels are independently associated with severity of chronic kidney disease [ 8 ], and suPAR levels are specifically elevated in patients with focal segmental glomerulosclerosis (FSGS), and have an important role in the pathogenesis of FSGS [ 9 ]. In the cardiovascular field, previous studies have reported that circulating suPAR levels are associated with an increased incidence of atherosclerosis and coronary artery disease [ 10,11 ]. Moreover, Koller et al recently reported that suPAR is a strong and independent predictor of mortality in patients with heart failure (HF) [ 12 ].…”

Heart-Type Fatty Acid-Binding Protein (H-FABP) and Its Role as a Biomarker in Heart Failure: What Do We Know So Far?

“…Another application of H-FABP as a biomarker might be in highly specialized areas. Dalos et al observed an exponential increase of H-FABP levels, with decreasing left ventricular ejection fraction in patients with coronary artery disease, reflecting chronic myocardial ischemia [80]. As a strong and independent correlation of H-FABP with individual prognosis was shown in several studies, it may, therefore, be used in mid-to long-term treatment planning.…”