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Combined corrected QT interval and growth differentiation factor-15 level has synergistic predictive value for
Kuan-Hung Yeh1,2, Yao-Ting Chang1, Jyh-Ming Jimmy Juang3,4
1Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Insights
Combining ECG corrected QT interval (QTc) and Growth Differentiation Factor-15 (GDF-15) levels significantly improves prediction of mortality in coronary artery disease (CAD) patients. This combined approach also correlates with CAD severity.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- Corrected QT interval (QTc) predicts prognosis in general and coronary artery disease (CAD) populations.
- Growth Differentiation Factor-15 (GDF-15) indicates myocardial fibrosis and left ventricular remodeling.
- The relationship between QTc and GDF-15 in CAD patients was previously unknown.
Purpose of the Study:
- To investigate the interaction between QTc and GDF-15.
- To evaluate their combined predictive power for mortality and adverse cardiovascular events in CAD patients.
- To assess the correlation of these parameters with CAD severity.
Main Methods:
- Study included 487 patients with confirmed CAD.
- QTc was measured using Bazett's formula.
- GDF-15 levels and other biomarkers were analyzed.
- Primary endpoint was total mortality; secondary endpoints included major adverse cardiovascular events.
Main Results:
- Both QTc and GDF-15 were significant predictors of mortality and adverse events.
- A positive correlation was found between QTc and GDF-15 levels (r=0.216, P<1.0x10^-6).
- Combining QTc and GDF-15 demonstrated synergistic predictive power for both primary and secondary endpoints (P<2.31x10^-7 and P<1.26x10^-8, respectively).
- The combined strategy correlated significantly with CAD severity (P<0.001).
Conclusions:
- In Chinese patients with CAD, a combined strategy using QTc and GDF-15 improves mortality prediction.
- This combined approach shows a strong correlation with CAD severity.
- Utilizing both ECG and biomarker data offers enhanced prognostic value.
Background:
The corrected QT interval (QTc) predicts prognosis for the general population and patients with coronary artery disease (CAD). Growth differentiation factor-15 (GDF-15) is a biomarker of myocardial fibrosis and left ventricular (LV) remodelling. The interaction between these two parameters is unknown.
Subjects And Methods:
This study included 487 patients with angiographically confirmed CAD. QTc was calculated using the Bazett formula. Multiple biochemistries and GDF-15 levels were measured. The primary endpoint was total mortality, and the secondary endpoints comprised the combination of total mortality, myocardial infarction and hospitalisation for heart failure and stroke.
Results:
The mean follow-up period was 1029 ± 343 days (5-1692 days), during which 21 patients died and 47 had secondary endpoints. ROC curve analysis for the optimal cut-off value of primary endpoint is 1.12 ng/mL for GDF-15 (AUC = 0.787, P = 9.0 × 10-6 ) and 438.5 msec for QTc (AUC = 0.698, P = .002). Utilising linear regression, QTc has a positive correlation with Log-GDF-15 (r = .216, P = 1.0 × 10-6 ). Utilising Kaplan-Meier analysis, both QTc interval and GDF-15 level are significant predictors for primary end point (P = .000194, P = 2.0 × 10-6 , respectively) and secondary endpoint (P = .00028, P = 6.15 × 10-8 , respectively). When combined these two parameters together, a significant synergistic predictive power was noted for primary and secondary endpoint (P = 2.31 × 10-7 , P = 1.26 × 10-8 , respectively). This combined strategy also showed significant correlation with the severity of CAD (P < .001).
Conclusion:
In Chinese patient with angiographically confirmed CAD, a combined strategy utilising an ECG parameter (QTc) and a circulating biomarker (GDF-15) has good correlation with the severity of CAD, and improves the predictive power for total mortality.
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