The association of serum GDF-15 level with the improvement of left ventricular ejection fraction in patients with heart failure and reduced ejection fraction

Background: Heart failure with improved ejection fraction (HFimpEF) is a distinct subtype of heart failure. Growth differentiation factor-15 (GDF-15), a biomarker linked to adverse cardiovascular outcomes, could help predict left ventricular ejection fraction (LVEF) improvement in patients with heart failure with reduced ejection fraction (HFrEF). Methods: A prospective cohort study was conducted with 162 HFrEF patients admitted to the First Affiliated Hospital of Nanjing Medical University between October 2017 and December 2021, with follow-up until December 2022. Patients were divided into three groups based on serum GDF-15 tertiles: high (≥2474 ng/L), medium (1439–2474 ng/L), and low (<1439 ng/L). Logistic and Cox regression analyses assessed predictors of HFimpEF at one year, heart failure readmission, and cardiovascular mortality. Results: The median age of patients was 57 years, with 39 females. The median GDF-15 level was 1915 ng/L. High GDF-15 levels were associated with a 73% reduced likelihood of HFimpEF (OR=0.27, P=0.003), and medium levels with a 60% reduction (OR=0.40, P=0.037). Over a median follow-up of 41 months, 72 heart failure readmissions and 40 cardiovascular deaths occurred. High GDF-15 levels were independently associated with increased risk of readmission (HR=2.70, P=0.004) and mortality (HR=3.85, P=0.017). HFimpEF was linked to significantly lower risks of readmission (HR=0.33, P<0.001) and mortality (HR=0.25, P<0.001). Conclusion: Serum GDF-15 levels could positively predict LVEF improvement in HFrEF patients and are associated with higher risks of heart failure readmission and cardiovascular mortality. Achieving HFimpEF provides significant protection against these outcomes.