Growth differentiation factor 15: An additional diagnostic tool for the risk stratification of developing heart failure in patients with operated congenital heart defects?

Background Many young adults who have congenital heart defects develop heart failure despite corrective surgeries. Growth differentiation factor 15 (GDF-15) has an established role as a marker for risk stratification and mortality both in patients after acute myocardial infarction and in patients with heart failure. Our aim was to establish a role for GDF-15 for monitoring heart failure in operated congenital heart defects (ACHD). This potential biomarker was validated through comparison with maximal oxygen uptake (VO2max) and to another biomarker, N-terminal pro-brain natriuretic peptide (NT-proBNP). Methods A total of 317 ACHD patients (129 females) with an average age of 26.5 +/- 8.5 years (mean +/- SD) enrolled in the study. We studied the relation between GDF-15 and NT-proBNP and VO2max% (percent predicted for age and gender). The cutoffs for the groups were as follows: NT-proBNP <100, 100 to 300, and >300 pg/mL; VO2max% <65%, 65% to 85%, and >85% of predicted normal. Results Significant differences in mean GDF-15 levels were found between the NT-proBNP <100 and NT-proBNP >300 groups, as well as between the 100 to 300 and the >300 groups. For VO2max%, significant differences were found in GDF-15 levels between <65% and >85% and between <65% and 65% to 85%, respectively. The lowest mean GDF-15 was found in groups with NT-proBNP <100 pg/mL and VO2max% >85%. The highest mean GDF-15 was found in the groups with NT-proBNP >300 pg/mL and VO2max% <65%. A subgroup analysis, including 82 patients with operated tetralogy of Fallot, showed that patients in the New York Heart Association I class have significantly lower NT-proBNP and GDF-15 level and markedly higher VO2max compared with the patients in higher New York Heart Association class. Conclusion Growth differentiation factor 15 might be used as a surrogate marker for latent heart failure and could help to identify patients with ACHD who are at risk for developing heart failure, even if they are clinically asymptomatic. (Am Heart J 2011;162:131-5.)