DOI: 10.1161/circ.148.suppl_1.16679 ISSN: 0009-7322

Abstract 16679: Growth Differentiation Factor 15 in the Initial Evaluation of Suspected Coronary Artery Disease

Iman Karaji, Ole-Thomas Steiro, Gard Myrmel, Torbjorn Omland, Joerund Langoergen, Rune Bjoerneklett, Oyvind Skadberg, Vernon V Bonarjee, Oeistein Mjelva, Paul O Collinson, Kjell Vikenes, Eva Pedersen, Kristin Moberg M Aakre
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: The cytokine growth differentiation factor 15 (GDF-15) is expressed in several tissues including cardiomyocytes, and is up-regulated in conditions of tissue injury and stress.

Hypothesis: We hypothesized that serum GDF-15 can predict obstructive CAD and need of revascularization among acutely admitted chest pain patients. Further, we assessed whether the combination of GDF-15 and coronary artery calcium (CAC) scoring could identify a subgroup with low risk of obstructive CAD, in whom a full coronary CT angiography (CCTA) could be avoided.

Methods: GDF-15 was measured, using the assay on Cobas e801 (Roche Diagnostics), in 537 patients with chest pain and high-sensitivity cardiac troponin T concentrations ≤99th percentile. All participants underwent CAC scoring and CCTA. Obstructive CAD was defined as >50% lumen diameter narrowing. Associations of GDF-15 with obstructive CAD and 30-days revascularization were calculated by multivariable logistic regression adjusting for age, sex, smoking, hypertension, HbA1c, LDL-cholesterol, GFR and prior AMI. We also evaluated whether GDF-15 could improve sensitivity and negative predictive value (NPV) of CAC=0 for ruling out the presence of obstructive CAD.

Results: The median (25th-75th percentile) age was 56 (49-65) years, 217 (40.4%) of the patients were women, 83 (15.5%) had obstructive CAD, and 49 (9.1%) had revascularization within 30 days. After multivariable adjustment, elevated GDF-15 (≥1200pg/mL) predicted obstructive CAD at baseline with OR (95%CI) of 2.23 (1.14-4.36), p=0.02. The OR (95%CI) for 30-days revascularization was 2.33 (1.08-5.03), p=0.03. For CAC=0, we observed a sensitivity (95%CI) and NPV (95%CI) of 94.0% (86.5%-98.0%) and 98.0% (95.3%-99.3%) in ruling out obstructive CAD. For patients having both CAC=0 and GDF-15 levels below median (<730pg/mL), sensitivity (95%CI) and NPV (95%CI) for obstructive CAD were 97.6% (91.6%-99.7%) and 98.7 (95.2%-99.8%), respectively.

Conclusions: Elevated serum GDF-15 predicts obstructive CAD and 30 days revascularization among patients with chest pain, but without AMI. The combination of low GDF-15 levels and CAC=0 appears promising for the identification of low-risk patients, who can possibly be discharged without a full CCTA.

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