Release of growth-differentiation factor 15 and associations with cardiac function in adult patients with congenital heart disease

Background: Growth-differentiation factor-15 (GDF-15), a cytokine with broad cardiac and non-cardiac activity, has diagnostic and prognostic value in various diseases, including heart failure. We aimed to investigate the release of GDF-15 in adults with congenital heart disease (ConHD), and assess the association with cardiac function and functional capacity.
Methods: A total of 587 consecutive adults with ConHD underwent electrocardiography, echocardiography, venepuncture and were seen by a cardiologist. A subset of 143 patients underwent bicycle ergometry on the same day.
Results: Median plasma GDF-15 was 618 ng/L. In 87 patients, GDF-15 was above the reference value of normal. GDF-15 levels were higher in older patients. GDF-15 was higher in patients with elevated pulmonary pressure. In multivariate analysis adjusting for age, sex, and NT-proBNP, hs-TnT and hs-CRP, GDF-15 above the reference value was associated with NYHA class, and decreased exercise capacity, but not with systolic ventricular function or ECG rhythm.
Conclusions: GDF-15 is elevated in a substantial number of patients and higher in those with elevated pulmonary pressures, regardless of underlying congenital diagnosis. GDF-15 is associated with NYHA class, NT-proBNP and exercise capacity, suggesting the marker has diagnostic and potential prognostic value in adults with ConHD.