title: FGF23 is associated with disease severity and prognosis in chronic heart failure.
abstract: BACKGROUND
  Elevated levels of fibroblast growth factor 23 (FGF23) are associated with incident heart failure in individuals with or without chronic kidney disease. We aimed to investigate the association between serum FGF23 concentrations and disease severity and long-term outcome in patients with stable heart failure.
  
  
  METHODS
  Serum levels of C-term FGF23 (Ct-FGF23) concentrations, inorganic phosphate (Pi ), parathormone (PTH) and 25-hydroxyvitamin D (25(OH)D) were measured in 208 patients with nonischaemic heart failure (age 48 ± 15 years; 70% male; NYHA Class I 27·8%, NYHA Class II 43·4%, NYHA Class III/IV 28·8%; LV-EF 34 ± 15%; eGFR ≥60 mL/min/1·73 m(2) in 86%).
  
  
  RESULTS
  Median Ct-FGF23 levels were 18·2 RU/mL (7·5-40·8RU/mL). A dose-response relationship was found between median Ct-FGF23 levels and increasing NYHA class (I: 11·9 RU/mL, II: 15·8 RU/mL, III/IV: 38·8 RU/mL; P < 0·001). Ct-FGF23 correlated with NTproBNP (r = 0·307, P < 0·001), central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and inversely correlated with cardiac output after adjustment for renal function (eGFR) and Pi . LnCt-FGF23 was related with the combined endpoint of death or heart transplantation (hazard ratio 1·452 [1·029-2·048]; P = 0·034) independent of Pi , PTH, 25(OH)D, age and sex.
  
  
  CONCLUSIONS
  The phosphatonin FGF23 is strongly associated with disease severity and long-term outcome in patients with nonischaemic heart failure and preserved renal function. Further studies are needed to evaluate the pathophysiologic role of FGF23 and its potential as a biomarker in heart failure.
authors.affiliation: Clinical Division of Cardiology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Poelzl
authors.forename: Christian
authors.initials: C
authors.lastname: Trenkler
authors.forename: Johannes
authors.initials: J
authors.lastname: Kliebhan
authors.forename: Philipp
authors.initials: P
authors.lastname: Wuertinger
authors.forename: Christoph
authors.initials: C
authors.lastname: Seger
authors.forename: Susanne
authors.initials: S
authors.lastname: Kaser
authors.forename: Gert
authors.initials: G
authors.lastname: Mayer
authors.forename: Markus
authors.initials: M
authors.lastname: Pirklbauer
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Andrea
authors.initials: A
authors.lastname: Griesmacher
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000378:metabolism*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D010710:Phosphates / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000378:metabolism
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; C104450:25-hydroxyvitamin D
keywords: Chronic heart failure; FGF23; metabolic bone disorders; prognosis