title: Inorganic phosphate and FGF-23 predict outcome in stable systolic heart failure.
abstract: BACKGROUND
  Recent studies show associations between inorganic phosphate and risk of heart failure in the general population as well as between fibroblast growth factor 23 (FGF-23) and outcome in coronary heart disease. This study was carried out to assess whether circulating levels of inorganic phosphate and FGF-23, a new central hormone in mineral bone metabolism, predict outcome in systolic heart failure.
  
  
  METHODS
  Ninety-nine consecutive outpatients with systolic heart failure were enrolled. Mean (SD) age was 61 years (11), mean left ventricular ejection fraction (LVEF) was 33% (10), 82 patients were men, median estimated creatinine clearance was 83 mL/min (Q(1) -Q(3) 58-106), median NTproBNP level was 803 pg/mL (Q(1) -Q(3) 404-2757), median inorganic phosphate was 1·12 mM (Q(1) -Q(3) 1·02-1·22), median FGF-23 was 39·02 pg/mL (Q(1) -Q(3) 32·45-55·86) and median follow-up was 35 months. Associations between inorganic phosphate, FGF-23 and endpoints were assessed using Cox regression analyses.
  
  
  RESULTS
  Inorganic phosphate and FGF-23 levels were significantly higher (P < 0·001 and P = 0·009) in patients reaching the combined endpoint of cardiac hospitalization or death. FGF-23 (ln) predicted all-cause mortality (hazard ratio (HR) 5·042, P = 0·032) in a model adjusted for age, gender, estimated creatinine clearance, LVEF, New York Heart Association (NYHA) stage and NTproBNP level. Inorganic phosphate predicted heart failure hospitalization (HR 26·944, P = 0·021), cardiac hospitalization (HR 16·016, P = 0·017) and the combined endpoint (HR 13·294, P = 0·015) in models adjusted for the same co-variables.
  
  
  CONCLUSIONS
  The results of this study demonstrate the independent prognostic value of inorganic phosphate and FGF-23 in heart failure even in the context of established risk markers.
authors.affiliation: Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Max
authors.initials: M
authors.lastname: Plischke
authors.forename: Stephanie
authors.initials: S
authors.lastname: Neuhold
authors.forename: Christopher
authors.initials: C
authors.lastname: Adlbrecht
authors.forename: Bernhard
authors.initials: B
authors.lastname: Bielesz
authors.forename: Sascha
authors.initials: S
authors.lastname: Shayganfar
authors.forename: Christian
authors.initials: C
authors.lastname: Bieglmayer
authors.forename: Thomas
authors.initials: T
authors.lastname: Szekeres
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Guido
authors.initials: G
authors.lastname: Strunk
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
mesh_terms: D015331:Cohort Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D054143:Heart Failure, Systolic / Q000097:blood* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: C000717427:FGF23 protein, human; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23