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Heart failure is a leading cause of premature death in patients with established cardiovascular (CV) disease [1]. The prevalence of chronic HF regardless of left ventricular (LV) pump function increases worldwide that leads to shape hard economic burden of medical care of health systems in different countries [2]. In the developed countries the prevalence of chronic HF with reduced LV ejection fraction (EF) < 40% (HFrEF) especially due to ischemic and inflammatory reasons demonstrates a steadily decrease, while the prevalence of HF with preserved LVEF = 50-59% (HFpEF) in general population continues to progressively rise [3]. In contrast, in the developing countries new diagnosed cases of both phenotypes of chronic HF reveal a tendency to growth and associate with an increased risk of all-cause mortality and CV mortality [4]. The clinical presentation of chronic HF appears to be distinguished depending on age and a prevalence of the etiology causes including coronary artery disease (CAD), cardiomyopathies, myocarditis, diabetes mellitus, hypertension, chronic obstructive pulmonary disease etc. [5]. Although clinical entity of chronic HF with reduced LV ejection fraction (EF) < 40% (HFrEF) and preserved LVEF = 50-59% (HFpEF) respectively has defined, there is not completely clear whether HF (HFmrEF) related to mid-range LVEF=40-49% could associate with clinical outcomes and prognosis similar other phenotypes of chronic HF [6]. The analysis of the TIME-CHF (Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure) trail yielded that clinical status, profile of comorbidities including CAD and impaired quality of life of individuals with HFmrEF were comparable to patients with HFrEF, but these patients were not similar HFpEF in these fields [7]. In the Swedish Heart Failure Registry a higher adjusted risk of all-cause death and CV death in patients with HFmrEF and HFrEF versus HFpEF was defined [8]. Interestingly, there is overlapping in clinical and biomarker-based prediction of outcomes in different HF phenotypes [9, 10]. Indeed, natriuretic peptides (NPs) and cardiac troponins strongly Abstract: Heart failure (HF) is a major factor contributing to premature death in patients with established cardiovascular (CV) disease. There is a large body of evidence that biological markers presumably natriuretic peptides, galectin-3, soluble ST2 and cardiac troponins could be the best tool for prediction of poor clinical outcomes in general population as well as in individuals with suspected or established CV diseases including HF. However, recent clinical trials have shown that abilities of these biomarkers regarding identification of morbidity and mortality risks distinguished in wide range and depended on numerous factors, i.e. age, sex, comorbidities, treatment regime and phenotypes of HF. Additionally, not all of these biomarkers except natriuretic peptides were best fitted to guided therapy of HF and consequently serial measures of them did not warrant improving of predictive value in follow-up especially in patients with preserved left ventricular ejection fraction. Growth-differentiation factor-15 (GDF-15) belongs to the transforming growth factor-β superfamily that regulates mitochondrial function of wide range of cells that involve in inflammation, oxidative stress, apoptosis, immune reaction, fibrosis, reparation and malignancy. This mini review is depicted the possibilities to extrapolate the predictive capabilities of GDF-15 from metabolic and tumor diseases to CV diseases including HF.

Prediction of Cardiovascular Clinical Outcomes with Novel Biomarker: the Focus on Growth Differentiation Factor 15