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Growth Differentiation Factor 15 as a Marker for Chronic Ventricular Pacing
Christoph Edlinger1,2,3, Marwin Bannehr1,2, Michael Lichtenauer3
1Department of Cardiology, Heart Center Brandenburg, 16321 Bernau bei Berlin, Germany.
Insights
Growth differentiation factor 15 (GDF-15) may serve as a valuable biomarker for chronic right ventricular pacing. Elevated GDF-15 levels were observed in patients with significant right ventricular pacing, indicating potential cardiac stress.
Area of Science:
- Cardiology
- Biomarker Discovery
- Cardiac Electrophysiology
Background:
- Right ventricular pacing is crucial for symptomatic bradycardia but can lead to left ventricular dysfunction.
- Growth differentiation factor 15 (GDF-15) is upregulated in cardiomyocytes under stress.
- A healthy adult heart typically does not express GDF-15.
Purpose of the Study:
- To investigate the potential of GDF-15 as a biomarker for chronic right ventricular pacing.
- To assess the correlation between GDF-15 levels and pacing burden.
Main Methods:
- A single-center, cross-sectional study of 265 patients with pacemakers and no pre-existing heart failure.
- Serum GDF-15 levels were measured using immunoassay.
- Statistical analysis included Student's t-test and receiver operating characteristic (ROC) analysis.
Main Results:
- GDF-15 levels were significantly higher in patients with >40% right ventricular pacing (1186 ± 592 pg/mL) compared to those with ≤40% (789 ± 293 pg/mL; p < 0.001).
- ROC analysis demonstrated GDF-15 as a marker for chronic right ventricular pacing with an area under the curve of 0.713 (p < 0.001).
Conclusions:
- GDF-15 shows promise as a valuable biomarker for identifying chronic right ventricular pacing.
- This finding could aid in monitoring patients at risk for pacing-induced cardiac dysfunction.
Abstract:
Background/Objectives: Right ventricular pacing is an effective and safe treatment option for patients experiencing symptomatic bradycardia. However, some individuals may develop left ventricular dysfunction as a consequence. Growth differentiation factor 15 (GDF-15), which is not present in a healthy adult heart, is upregulated in cardiomyocytes in response to various stress stimuli. This study aimed to explore the potential of GDF-15 as a biomarker for chronic right ventricular pacing. Methods: This single-center cross-sectional cohort study analyzed data from 265 consecutive patients (60.4% male) with either single- or dual-chamber pacemakers, all lacking pre-existing heart failure, who attended the outpatient department for routine follow-up. Chronic right ventricular (RV) pacing was defined as pacing exceeding 40% over the past year. Serum samples were collected, and GDF-15 levels were measured using a commercially available immunoassay (R&D Systems Inc., Minneapolis, MN, USA). Student's t-test was utilized to assess group differences, and receiver operating characteristic (ROC) analysis was employed to evaluate diagnostic performance. Results: When stratifying patients by pacing burden, GDF-15 levels were significantly higher in those with pacing over 40% compared to those with 40% or less (789 ± 293 pg/mL vs. 1186 ± 592 pg/mL; p < 0.001). The ROC analysis indicated that GDF-15 serves as a marker for chronic RV pacing, yielding an area under the curve of 0.713 (95% confidence interval 0.650-0.776; p < 0.001). Conclusions: This study suggests that GDF-15 may be a valuable biomarker for chronic right ventricular pacing.
