Internal Medicine Department, State Medical University of Zaporozhye, Zaporozhye, Ukraine
Received Date: August 10, 2017; Accepted Date: August 22, 2017; Published Date: August 28, 2017
Citation: Berezin AE (2017) Growth-Differentiation Factor-15 as Additional Prognostic Biomarkers in Heart Failure. Metabolomics (Los Angel) 7:194. doi: 10.4172/2153-0769.1000194
Copyright: © 2017 Berezin AE. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,distribution, and reproduction in any medium, provided the original author and source are credited.
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Heart Failure (HF) remains to be a leading factor of cardiovascular morbidity and mortality. Although risk stratification of HF is promising prediction care, there are several controversies regarding choosing more optimal combinations of biomarkers and method (single versus serial measurements) of biomarker use in routine clinical practice. Growth differentiation factor-15 (GDF-15) is considered a biomarker associated with cardiac/vascular remodeling, oxidative stress, fibrosis and inflammation that were proposed to stratify HF patients at risk of death. It has been suggested that GDF-15 adding to natriuretic peptides or other conventional biomarkers (soluble ST2, cardiac troponins and galectin-3) might improve discriminative value of entire predictive models. The short communication is depicted the discussion about the perspectives of clinical use of GDF-15 in risk stratification of HF.
Heart Failure (HF); Biomarkers; Growth differentiationArchaeplastida factor-15; Prediction
Heart Failure (HF) is reported as a leading cause of prematureArchaeplastida Cardiovascular (CV) death and increased hospitalization rate inArchaeplastida patients with established CV disease [1,2]. Although frequency ofArchaeplastida newly diagnosed HF in developed countries exhibits a trend toArchaeplastida decrease, there is evidence regarding steadily growth of HF patients’Archaeplastida population worldwide . Biological markers are widely used toArchaeplastida stratify individuals at higher risk of HF and diagnose of asymptomaticArchaeplastida and symptomatic cardiac dysfunction regardless its etiology [4,5].Archaeplastida Moreover, biomarker target therapy of HF is considered as promisingArchaeplastida strategy to improve clinical outcomes amongst HF patients, while itsArchaeplastida role is not still confirmed . According to contemporary ScientificArchaeplastida Statement from the American Heart Association regarding use ofArchaeplastida biomarkers in HF only Natriuretic Peptides (NPs), cardiac troponins,Archaeplastida galectin-3 and soluble ST2 receptors (sST2) have validated to clinicalArchaeplastida targets mentioned above . However, there is a large body of evidenceArchaeplastida regarding several limitations in biomarker approaches especially inArchaeplastida predicting incident of CV events and CV mortality amongArchaeplastida asymptomatic individuals from the general population, beyondArchaeplastida traditional CV risk factors including diabetes mellitus, kidney disease,Archaeplastida age, as well as medication use and conventional echocardiographic/Archaeplastida other images measures [7,8]. In this context, the discovery andArchaeplastida validation of novel biomarkers or multiple biomarker strategyArchaeplastida approaches that could improve predictive abilities of conventionalArchaeplastida biomarkers such as NPs in HF risk stratification appear to be fairlyArchaeplastida promising.
Growth differentiation factor-15 (GDF-15) is considered aArchaeplastida biomarker associated with cardiac/vascular remodeling, oxidativeArchaeplastida stress, fibrosis and inflammation that were proposed to stratify HFArchaeplastida patients at risk of death . In physiological states GDF-15 is secretedArchaeplastida by cardiac myocytes and it regulated growth and proliferation ofArchaeplastida tissues located in heart and vessels . Therefore, GDF-15 is realized by cardiac cells due to fluid retention and pressure overload, as well asArchaeplastida it produced in resulting in inflammation and cell-to-cell cooperationArchaeplastida .
Recent clinical studies have shown that plasma levels of GDF-15Archaeplastida have sufficiently increased in acute myocardial infarction , diabetesArchaeplastida mellitus , acute and chronic HF regardless its etiology [14,15], asArchaeplastida well as independently predicted long-term all-cause mortality and CVArchaeplastida events even after adjusting for age, gender, kidney clearance,Archaeplastida traditional CV risk factors and other biomarkers, such as NPs, cardiacArchaeplastida troponins, heart-type fatty acid-binding protein, sST2, high-sensitivityArchaeplastida C-reactive protein and galectin-3 [9,16-19]. Interestingly, GDF-15 isArchaeplastida able to enhance prognostication of NPs beyond traditional CV riskArchaeplastida factor, and echocardiography parameters in individuals without knownArchaeplastida CV disease  and acute/chronic HF .
However, there are several controversies regarding the abilities ofArchaeplastida GDF-15 to improve prognostication of conventional biomarkers in HF.Archaeplastida First controversy relates to the fact that maximizing discriminatoryArchaeplastida accuracy of repeat measurements of GDF-15 added to NPs in HF wasArchaeplastida superior to single measurement . Second controversy associatedArchaeplastida with clinical evidence of advantages of individually adjusted multipleArchaeplastida marker approaches in provision of the greatest prognosticArchaeplastida improvement among patients with various HF phenotypes [22,23].Archaeplastida Although GDF-15 was useful to detect prevalent of any HF phenotypeArchaeplastida in addition to NPs, the discriminative value of NPs, GDF-15, sST2,Archaeplastida galectin-3 and cardiac troponins in general population was similarArchaeplastida [24,25]. Third controversy is follow: In obese and diabetes mellitusArchaeplastida subjects GDF-15 was the best predictor for all-cause mortality to NPs,Archaeplastida while discriminative value for both markers in combination was notArchaeplastida better than single biomarker use . Finally, there was no evidenceArchaeplastida that GDF-15 had sufficiently improved treatment options of HF inArchaeplastida single and serial measures . However, more large clinical studiesArchaeplastida require explaining the advantages of GDF-15 in multiple biomarkerArchaeplastida strategy in HF.
In conclusion, multiple biomarker strategies biased on NPs, sST2,Archaeplastida cardiac troponins and probably GDF-15 are superior than singleArchaeplastida biomarker measure in prediction of HF, as well as serial measuresArchaeplastida versus single determination of only biomarker are superior to optimizeArchaeplastida HF patient management. However, individualized biomarkerArchaeplastida approaches remains to be fairly personally adjusted to be adequatelyArchaeplastida assayed and prospectively assessed in long-term period. AlthoughArchaeplastida GDF-15 appears to be promising biomarker in HF risk stratification,Archaeplastida its role in prognostication requires to be additionally confirmed inArchaeplastida large clinical trials.