title: Elevation of circulating but not myocardial FGF23 in human acute decompensated heart failure.
abstract: Elevated plasma fibroblast growth factor 23 (FGF23) is a prognostic marker in chronic kidney disease. Recently, FGF23 was reported to also be a predictive factor in chronic congestive heart failure (HF). To date however, plasma levels in acute decompensated HF (ADHF) have not been reported and myocardial production and distribution of FGF23 in HF is poorly defined. We aimed to determine plasma levels and myocardial production of FGF23 in ADHF.
  
  
  
  Plasma FGF23, N-terminal pro B-type natriuretic peptide (NT-proBNP) and estimated glomerular filtration rate (eGFR) were assessed in 21 ADHF patients and 19 controls. Myocardial gene expression and distribution of FGF23 was determined on left ventricular samples from HF patients and normal controls.
  
  
  
  Plasma FGF23 was markedly higher in ADHF patients compared with controls (1498 ± 1238 versus 66 ± 27 RU/mL, P < 0.0001). There were no correlations between FGF23 and eGFR, NT-proBNP, ejection fraction or age. ADHF subjects with eGFR >60 mL/min/1.73 m(2) had FGF23 levels of 1526 ± 1601 RU/mL versus 55 ± 20 RU/mL in controls (P = 0.007). Quantified myocardial FGF23 gene expression was similar between HF patients and controls. Myocardial FGF23 immunostaining was similar between HF patients and controls, with equal distribution throughout cardiomyocytes.
  
  
  
  Patients with ADHF had markedly elevated plasma FGF23 levels. Myocardial FGF23 gene expression was present in HF at a similar level as normal controls, and immunohistochemistry showed similar cellular distribution of FGF23 in HF and controls, suggesting that the myocardium does not contribute to the elevated circulating FGF23 in HF.
authors.affiliation: Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Andersen
authors.affiliation: Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Huntley
authors.affiliation: Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sharon S
authors.initials: SS
authors.lastname: Sandberg
authors.affiliation: Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Heublein
authors.affiliation: Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Burnett
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000378:metabolism*; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D020097:Natriuretic Peptide, Brain / Q000097:blood
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D020097:Natriuretic Peptide, Brain; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: FGF23; GFR; biomarkers; gene expression; heart failure; myocardium