Critical Care and Shock

Role of growth differentiation factor-15 and left ventricular global longitudinal strain in predicting major adverse cardiovascular events following acute myocardial infarction

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Background: Acute myocardial infarction (AMI) remains the leading cause of death worldwide. High serum levels of growth differentiation factor-15 (GDF-15) are associated with apoptosis and post-AMI inflammation. Increased left ventricular global longitudinal strain (GLS) is correlated with a worse prognosis and reflects the extent of the post-AMI ventricular injury. We compared the abilities of GDF-15 and GLS in predicting major adverse cardiovascular events (MACEs) during hospitalization.

Methods: This cross-sectional study included 40 patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) who were admitted to Dr. Moewardi Hospital, Indonesia. Serum GDF-15 levels were estimated in the Emergency Department, and GLS was assessed on the third day of hospitalization.

Results: Of the 40 patients (mean age 58±12 years), 29 (72.5%) had STEMI, and 11 (27.5%) had NSTEMI. Among patients with MACEs, the mean GDF-15 level was 4013.48±1979.09 pg/ml, and the mean GLS was -8.45%±3.53%. In-hospital MACEs in 22 (55%) patients included acute heart failure (n=12, 30%), stroke (n=2, 5%), major bleeding (n=1, 2.5%), and in-hospital death (n=7, 17. 5%). The area under the receiver operating characteristic curve (AUC) for GDF-15 level and MACEs was 0.744, and the optimal cut-off GDF-15 level was 2830.50 pg/ml. The AUC for GLS was 0.672 with an optimal cut-off of 8.65%.

Conclusions: GDF-15 can be used as a predictor of short-term MACEs during hospitalization in patients with AMI and is a better predictor than left ventricular GLS.