Diagnostic Value Of Growth Differentiation Factor-15 With B-type Natriuretic Peptide In Chronic Heart Failure

Background Heart failure?HF?is a complex clinical syndrome and a global medical and public health problem associated with high morbidity and high mortality.Contemporary HF classification is often based on left ventricular ejection fraction?LVEF?.Patients of HF with different LVEF vary in population characteristics,pathophysiology,treatment and prognosis.Natriuretic peptides are clinically the most widely used and accepted diagnostic markers,but their detection is affected by many factors,and their diagnostic value for heart failure with preserved ejection fraction?HFpEF?is limited.Growth differentiation factor-15?GDF-15?is one of the new markers of HF in recent years and is anti-apoptotic,anti-cardiac hypertrophic and anti-ventricular remodeling in function.GDF-15is involved in different pathophysiological processes in the development of HF,and it is of great significance in diagnosis,differential diagnosis,risk stratification and prognosis prediction of HF.The expression of GDF-15 in patients of HF with different LVEF and the diagnostic value and differential diagnosis of GDF-15 combined with B-type natriuretic peptide?BNP?for patients of HF with different LVEF need further study.Objective To evaluate the diagnostic value of GDF-15 and GDF-15 combined with BNP in patients of HF with different LVEF,compared with that of BNP.Methods The study enrolled 90 patients of HF in Southeast University affiliated Zhongda Hospital from January 2017 to October 2017.Routine echocardiographic measurements of echocardiographic data such as LVEF were performed.Out of the 90 patients,30 were of HFpEF?LVEF?50%?,30 were of heart failure with mid-range ejection fraction?HFmrEF,40%?LVEF<50%?,while 30 were of heart failure with reduced ejection fraction?HFrEF,LVEF<40%?.And 30 cases without HF were in the control group during the same period.Plasma GDF-15 levels were measured by enzyme-linked immunosorbent assay?ELISA?and plasma BNP levels were measured by Triage.To analyze the expression and diagnostic value of GDF-15 and BNP in patients of HF with different LVEF.Data analysis was performed using SPSS 21.0.P?0.05 was considered statistically significant difference.Results?1?The concentrations of BNP in HFpEF group,HFmrEF group and HFrEF group were180.29±21.92pg/ml,1005.51±184.55pg/ml and 1258.73±116.78pg/ml,respectively.The levels of BNP in HFmrEF group and HFrEF group were both higher than those in the control group?102.91±23.13pg/ml?,both with statistical differences?P?0.05 in both?,but there was no significant difference of BNP concentration between HFpEF group and the control group?P>0.05?.?2?The concentrations of GDF-15 in HFpEF group,HFmrEF group and HFrEF group were51.32±2.87ng/L,52.86±6.20ng/L and 45.15±1.67ng/L,respectively.The levels of GDF-15 in the three groups were all higher than those in the control group?32.18±1.18ng/L?,with statistical difference?P?0.05?,but there was no significant difference in GDF-15 among the three groups of HF with different LVEF?P>0.05?.?3?BNP levels in chronic heart failure?CHF,LVEF<50%?combined with coronary artery disease,percutaneous coronary intervention?PCI?history,previous myocardial infarction,atrial fibrillation were significantly higher,with statistical differences?P?0.05?,and possessed the highest diagnostic value in CHF?LVEF<40%?combined with coronary artery disease and the area under the curve(AUC^ROC)was 0.879.?4?GDF-15 levels in CHF?LVEF?50%?combined with coronary artery disease,PCI history,atrial fibrillation were significantly higher,with statistical differences?P?0.05?,and possessed the highest diagnostic value?AUC^ROCOC was 0.796?in CHF?LVEF?50%?combined with coronary artery disease.?5?The AUC^ROCOC for the diagnosis of HF by GDF-15 was 0.930?95%CI 0.882 to 0.979?,and the AUC^ROCOC for BNP in diagnosis of HF was 0.890?95%CI 0.829⁰.950?.The AUC^ROCOC for the diagnosis of HFpEF,HFmrEF,and HFrEF by GDF-15 was 0.746?95%CI 0.661 to 0.831?,0.633?95%CI 0.514to 0.752?,and 0.551?95%CI 0.445 to 0.658?,respectively.The AUC^ROCOC for the diagnosis of HFpEF,HFmrEF,and HFrEF by BNP was 0.300?95%CI 0.211 to 0.389?,0.712?95%CI 0.613 to 0.811?,and0.878?95%CI 0.817 to 0.939?,respectively.Conclusions?1?BNP can be used as a biomarker for the diagnosis of CHF with LVEF<50%?HFmrEF and HFrEF?,and has a higher diagnostic value in CHF with LVEF<40%?HFrEF?.?2?GDF-15 can be used as a biomarker for the diagnosis of CHF,and has the same diagnostic significance for HF with different LVEF?HFpEF,HFmrEF and HFrEF?.The diagnostic value in CHF with LVEF?50%?HFpEF?is higher.?3?CHF?LVEF<50%?combined with coronary artery disease,previous PCI,previous myocardial infarction,or atrial fibrillation can be diagnosed with BNP.When LVEF<40%,the diagnostic ability of BNP is better,and BNP possesses the highest diagnostic value in CHF?LVEF<40%?combined with coronary artery disease.?4?CHF?LVEF?50%?combined with coronary artery disease,previous PCI,or atrial fibrillation can be diagnosed with GDF-15,and GDF-15 possesses the highest diagnostic value in CHF?LVEF?50%?combined with coronary artery disease.?5?The diagnostic value of GDF-15 combined with BNP in HF is better than BNP or GDF-15 alone.The diagnostic value of BNP and the combination of both in HFrEF is higher than GDF-15,and the diagnostic value of GDF-15 and the combination of both in HFpEF is higher than BNP.GDF-15,BNP and their combination have some guiding significance in diagnosis and differential diagnosis of HF and HF with different LVEF.