Diagnosis Value Of Plasma Growth Differentiation Factor-15 For Chronic Heart Failure

Background:Chronic heart failure (CHF) is a terminal phase caused in a variety of heart diseases. But, so far, the CHF treatment is still not ideal and mortality is still high. Once the CHF patents are diagnosed, the re-hospitalization rate is high and the prognosis is poor. Therefore, it attaches great importance to the early diagnosis and the confirmed diagnosis. Therefore, it attaches great importance to the early diagnosis and the confirmed diagnosis. When the patient is in CHF especially in the early stage, the signs and symptoms of the patient is lack of specific clinical manifestations. Adopt the easy, rapid and accurate methods to diagnose CHF would be of great significance. However, the current diagnose methods cannot satisfy such need.. BNP is the most established biochemical index that most tightly associates with the CHF. Since it cannot be used alone for confirming or ruling out the diagnosis, the other valuable markers of CHF should be discovered continually to overcome one, s weakness by acquiring others strong points .Use these markers jointly to achieve the clinical purpose. The present studies show the GDF-15 is related to the heart diseases, which is the protective factor for the heart. The study of the relation between the GDF-15 and the CHF is relatively less.Objective:To explore the diagnosis value of plasma GDF-15 for CHF by comparing with BNP.Methods:A total of 110 patients with CHF in-hospital patients which from department of cardiology of the Second affiliated Hospital of Guangzhou Medical College during Nov 2009 to Sep 2010 was recruited to this study. After admission, the patients have been asked the detailed history, noted the BP,gender and age. Venous blood was collected after more than fasting 12 hours and the conventional serum biochemical indexes were measured. Plasma GDF-15 levels were measured by Enzyme Linked Immunosorbent Assay kit (R&D). All subjects were check of chest radiography, meanwhile underwent common ECG and echocardiography during 48 hours after admission. According to the Framingham CHF diagnostic criteria, all the cases were classified as CHF group (n=110), including the NYHA I to IV. According to the cause of HF, they were classified as the ischemic heart failure group (IHF) (n=69) and the non-ischemic heart failure group (NIHF) (n=41). According to the left ventricular ejection fraction, they were classified as heart failure with the left ventricular ejection fraction (LVEF)≤45% (n=29) and heart failure with the LVEF>45% (n=81), normal control group (n=36).Results:1. In chronic heart failure group, the plasma concentration of GDF-15 was significantly higher than in control group (P<0.01). In IHF and NIHF groups, their plasma concentrations of GDF-15 was significantly higher than in control group (P<0.01). There were no difference between the IHF and NIHF (P=0.635). In LVEF>45% and LVEF≤45% groups, their plasma concentrations of GDF-15 was significantly higher than in control group (P<0.01). There were no difference between the LVEF>45% and LVEF≤45% groups (P>0.05).2. The plasma GDF-15 of chronic heart failure patients were gradually and significantly increased with the NYHA functional class except to the patients between NYHA I and control group ,NYHA I and NYHA II.3. In univariant analysis,GDF-15 was positively related to NYHA (r=0.567,P=0.00),LVEDD(r=0.209,P=0.030) ,and negatively related to LVEF(r=-0.226,P=0.019).In multivariate stepwise regression analysis, only NYHA (B=0.576 ,P=0.000)were independent correlative maker for GDF-15.4. With ROC curves analysis shows: Both GDF-15 and BNF can be used for CHF diagnosis. To GDF-15 and BNP, there were no differences in the specific diagnosis between the In LVEF≤45% and LVEF>45% ,In IHF and NIHF. In each group, the diagnosis value was not significant different between BNP-only and GDF-15 plus BNP. Conclusion1. In chronic heart failure group, the plasma concentration of GDF-15 was significantly higher than in control group. It can well reflect severity of heart failure, and can be used for clinical assessment of the condition of patients with heart failure.2 the plasma concentration of GDF-15 was no difference between the IHF /NIHF and LVEF≤45% /LVEF>45% .3. In each subgroup, the diagnosis value was not significant difference between GDF-15 and BNP,and was not significant different between BNP-only and GDF-15 plus BNP...