Predictive Value Of Serum Levels Of Growth Differentiation Factor15to Recently Left Ventricular Remodeling In Acute Myocardial Infarction

Background and Objective: Heart failure is the terminal stage of variouscardiovascular diseases and ventricular remodeling run through all the stages of itsdevelopment. After the myocardial ischemia of coronary artery disease and (or) acutemyocardial infarction (AMI), the persistent influence of ischemia, hypoxia and heartoverload cause damage to the ventricular myocardial, leading to the change of the size,shape and function of the heart. It will further develop to ischemic cardiomyopathy andlead to heart failure eventually, which is the most common reason of heart failure and aserious threat to the patient’s quality of life and life safety. Therefore, it’s very importantto predict ventricular remodeling early and terminate or delay its occurrence anddevelopment. It has been reported that the serum levels of N-terminal probrainnatriuretic peptide (NT-proBNP) within early phase of AMI is associated with thedevelopment of left ventricular remodeling(LVR), however there is certain limitation ofits predictive value of left ventricular remodeling. So finding a more specific andsensitive biomarker is imminent. In recent years, multiple multicenter clinical studiesfound that GDF-15, as a biomarker associated with cardiovascular disease hasimportant clinical meaning. Its levels are related to the prognosis of acute coronarysyndrome (ACS). In animals models, Growth differentiation factor-15(GDF-15) wasinduced during heart failure development and might influence the different processesinvolved in cardiac remodeling. Clinical studies have reported that there was positivecorrelation between the serum levels of GDF-15within the first24hours of ST-segmentelevation myocardial infarction and the development of subsequent LVR at1year offollow-up, but now such research is rare. The aim of the present investigation was toassess the relationship between the serum levels of GDF-15within the first24hours ofAMI and the development of subsequent LVR at3months of follow-up.Methods:59cases were selected from the acute myocardial infarction patients in the cardiovascular department of the second affiliated hospital of Dalian MedicalUniversity from June2012to December2012. We collected baseline data (includingage, gender, height, weight, smoking history, hypertension history, diabetes history andso on), measured the serum levels of GDF-15and the NT-proBNP and performedother related laboratory tests. Real-time three-dimensional echocardiography (RT-3DE)was used to measure the related parameters of left ventricular remodeling for all thepatients at1week,1month and3months, and left ventricular remodelingindex(LVRI)was calculate by total volume method according to those parameters.Furthermore, according to the formula LVRIproportion=(LVRI1week or1month-LVRIxmonth)/LVRI1week or1month,we calculate LVRI proportion of1week to1month,1week to3months and1month to3mouths. Statistical analysis was performedby Using SPSS17.0software, P<0.05was of statistical difference and P<0.01was ofstatistically significant difference.Results:1.The LVRI of the patients with acute myocardial infarction were different at1week,1month and3months. The LVRI of1month and3months were significantlylower than that of1week (1.30±0.17vs1.46±0.14, P<0.01and1.15±0.20vs1.46±0.14, P<0.01), similarly, the LVRI of3months is lower than that of1month(1.15±0.20vs1.30±0.17, P <0.01).2.The median of LVRIproportion(1week to3months) was20%. According to themedian, all patients were divided into mild group(LVRIproportion<20%) and severegroup(LVRIproportion≥20%). The levels of GDF-15and NT-ProBNP in severe group aresignificant higher than that in mild group(P<0.05).3.Correlation analysis showed that, the levels of GDF-15and NT-proBNP werepositively correlated with LVRI proportion (r=0.726, P=0.000and r=0.500, P=0.000), and GDF-15was positively related with NT-proBNP (r=0.544, P=0.544).Linear regression analysis showed that GDF-15is independent correlated with LVRIproportion(P <0.01), while, NT-proBNP is not independent correlated with LVRIproportion(P>0.05).4. Compare the diagnosis efficiency of left ventricular remodeling between thelevels of NT-proBNP and GDF-15in patients with AMI within three months byreceiving operating characteristics(ROC) analysis, the former is more sensitive, specificand accurate than the latter, with higher Youden index and area under curve(AUC). (AUC=0.817, P=0.817; AUC=0.680, P=0.017).Conclusions:1. Different degrees of left ventricular remodeling will occur within3month ofacute myocardial infarction.2. The high serum level of GDF-15is an independent predictor for recent leftventricular remodeling of AMI patients.3. The serum levels of GDF-15and NT-proBNP have certain predictive diagnosticsvalue on left ventricular remodeling of AMI patients,but the former is much moreefficient than the latter.