Growth Differentiation Factor 15 in Severe Aortic Valve Stenosis: Relationship with Left Ventricular Remodeling and Frailty.
Iacopo FabianiTatiana SantoniMarco AngelillisSerena PetricciuoloAndrea ColliGiovanni PellegriniDeborah MazzeiNicola Riccardo PuglieseAnna Sonia PetronioRaffaele De CaterinaPublished in: Journal of clinical medicine (2020)
Background: Frailty is an important outcome predictor in patients with aortic stenosis who are candidates for transcatheter or surgical aortic valve replacement (AVR). Growth/differentiation factor 15 (GDF15) is a cytokine playing a role in the pathophysiology of ventricular remodeling. We assessed its potential role as an independent soluble biomarker of frailty in these patients. Methods: We studied 62 patients (age, mean 79 years, 95% confidence interval (CI) 77-81; 54.8% female) with severe aortic valve stenosis and candidates for AVR. We systematically assessed pre-intervention GDF15 levels for their relationship with frailty (Katz score) and echocardiographic parameters of left ventricular dysfunction/remodeling. Fifteen hypertensive patients with left ventricular (LV) hypertrophy served as controls. Results: Patients with aortic valve stenosis featured higher GDF15 levels than controls (1773, 95% CI 1574-1971 pg/mL vs. 775, 95% CI 600-950 pg/mL, respectively, p < 0.0001). Subjects in the upper GDF15 tertile were older (p = 0.004), with a more advanced NYHA functional class (p = 0.04) and a higher prevalence of impaired renal function (p = 0.004). Such patients also showed a higher frailty score (p = 0.04) and higher indices of LV dysfunction, including reduced global longitudinal strain (p = 0.01) and a higher left ventricular mass (p = 0.001). GDF15 was significantly related to the Katz score, and predicted (OR 1.05; 95% CI 0.9-1.1; p = 0.03) a low (<5) Katz score, independent of the relationship with LV mass, age, renal function or indices of LV dysfunction. Conclusions: GDF15 is increased in patients with severe aortic stenosis and appears to be a soluble correlate of patients' frailty, independent of indices of left ventricular dysfunction.
Keyphrases
- aortic stenosis
- ejection fraction
- aortic valve
- aortic valve replacement
- left ventricular
- transcatheter aortic valve replacement
- transcatheter aortic valve implantation
- end stage renal disease
- heart failure
- newly diagnosed
- chronic kidney disease
- oxidative stress
- mitral valve
- prognostic factors
- coronary artery disease
- blood pressure
- acute myocardial infarction
- peritoneal dialysis
- hypertrophic cardiomyopathy
- randomized controlled trial
- early onset
- left atrial
- community dwelling
- cross sectional
- atrial fibrillation