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Growth differentiation factor 15, ST2, high‐sensitivity troponin T, and N‐terminal pro brain natriuretic peptide in heart failure with preserved vs. reduced ejection fraction
Author(s) -
Santhanakrishnan Rajalakshmi,
Chong Jenny P.C.,
Ng Tze P.,
Ling Lieng H.,
Sim David,
Toh G. Leong Kui,
Shuan D. Yeo Poh,
Ong Hean Y.,
Jaufeerally Fazlur,
Wong Raymond,
Chai Ping,
Low Adrian F.,
Richards Arthur Mark,
Lam Carolyn S.P.
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs130
Subject(s) - gdf15 , medicine , cardiology , ejection fraction , heart failure , natriuretic peptide , troponin t , troponin , heart failure with preserved ejection fraction , pathophysiology , brain natriuretic peptide , myocardial infarction
Aims Growth differentiation factor 15 (GDF15), ST2, high‐sensitivity troponin T (hsTnT), and N‐terminal pro brain natriuretic peptide (NT‐proBNP) are biomarkers of distinct mechanisms that may contribute to the pathophysiology of heart failure (HF) [inflammation (GDF15); ventricular remodelling (ST2); myonecrosis (hsTnT); and wall stress (NT‐proBNP)]. Methods and results We compared circulating levels of GDF15, ST2, hsTnT, and NT‐proBNP, as well as their combinations, in compensated patients with clinical HF with reduced ejection fraction (HFREF) ( n = 51), HF with preserved ejection fraction (HFPEF) ( n = 50), and community‐based controls ( n = 50). Compared with controls, patients with HFPEF and HFREF had higher median levels of GDF15 (540 pg/mL vs. 2529 and 2672 pg/mL, respectively), hsTnT (3.7 pg/mL vs. 23.7 and 35.6 pg/mL), and NT‐proBNP (69 pg/mL vs. 942 and 2562 pg/mL), but not ST2 (27.6 ng/mL vs. 31.5 and 35.3 ng/mL), adjusting for clinical covariates. In receiver operating characteristic curve analyses, NT‐proBNP distinguished HFREF from controls with an area under the curve (AUC) of 0.987 ( P < 0.001); GDF15 distinguished HFPEF from controls with an AUC of 0.936 ( P < 0.001); and the combination of NT‐proBNP and GDF15 distinguished HFPEF from controls with an AUC of 0.956 ( P < 0.001). NT‐proBNP and hsTnT levels were higher in HFREF than in HFPEF (adjusted P < 0.04). The NT‐proBNP:GDF15 ratio distinguished between HFPEF and HFREF with the largest AUC (0.709; P < 0.001). Conclusions Our study provides comparative data on physiologically distinct circulating biomarkers in HFPEF, HFREF, and controls from the same community. These data suggest a prominent role for myocardial injury (hsTnT) with increased wall stress (NT‐proBNP) in HFREF, and systemic inflammation (GDF15) in HFREF