The GDF‐15 assay is intended as an aid in risk stratification of patients with Acute Coronary Syndrome (ACS) or Chronic Heart Failure (CHF).
GDF‐15 is a member of the transforming growth factor β (TGF‐β) cytokine superfamily.
GDF‐15 levels increase sharply in response to pathological or physiological stress associated with inflammation, oxygen deficiency, tissue injury and remodelling as observed in cardiovascular diseases, as well as in some tumors and pregnancy. Induction of GDF‐15 in response to cardiac injury has been shown to be cardioprotective to ischemia/reperfusion injury.
Levels of GDF‐15 increase with the severity of cardiovascular diseases: elevated serum levels are found in stable coronary artery disease, ACS and heart failure (HF). Increasing evidence indicates that GDF‐15 levels predict adverse outcomes of cardiovascular disease, independently from traditional risk factors such as previous myocardial infarction (MI), age, elevated levels of cardiac troponin T, N‐terminal pro B‐type natriuretic peptide, or high‐sensitivity C‐reactive protein. Increased GDF‐15 levels are indicative of high mortality in patients with ST-segment elevation ACS (STE‐ACS), non‐ST‐elevation ACS (NSTE‐ACS) and HF. Higher levels of GDF‐15 also identify NSTE‐ACS patients at an elevated risk of recurrent MI or stroke.
Studies have suggested a relationship between elevated GDF‐15 levels and stroke mortality in atrial fibrillation. GDF‐15 levels have been shown to correlate independently with a subsequent risk of serious bleeding complications in patients with atrial fibrillation treated with oral anticoagulants.
GDF‐15 provides prognostic information additional to that provided by established clinical risk scores. Adding GDF‐15 levels to a troponin- modified Global Registry of Acute Coronary Events (GRACE) score further improves the prediction of 6‐month all-cause mortality and non-fatal MI in patients with NSTE‐ACS. GDF‐15 levels may also assist in guiding therapeutic intervention: GDF‐15 levels in patients with NSTE‐ACS at admission predict those likely to benefit most from an intensive treatment regime. High levels of GDF‐15 are also associated with increased risk of developing HF following an episode of ACS. Therefore GDF‐15 levels potentially allow to identify which ACS patients will benefit from more aggressive therapies aimed at reducing HF‐related admissions.