title: Calciotropic and Phosphaturic Hormones in End-Stage Heart Failure Patients Supported by a Left-Ventricular Assist Device.
abstract: BACKGROUND
  Calcium and phosphate are central for myocardial contractility and energy metabolism, and low levels of the calciotropic hormone 1,25-dihydroxyvitamin D (1,25(OH)2D), as well as high levels of the phosphaturic hormone fibroblast growth factor (FGF)-23, are independently associated with poor clinical outcome in heart failure (HF) patients. We therefore aimed to investigate the postoperative time course of the aforementioned hormones in HF patients supported with a left-ventricular assist device (LVAD) implant.
  
  
  METHODS
  For the present study, stored biobank plasma samples of 69 patients, collected before LVAD implantation (t0) and 12 days (t1), 30 days (t2), 83 days (t3), and 300 days (t4) post-intervention, were used to measure circulating FGF-23, parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), 1,25(OH)2D, and kidney function.
  
  
  RESULTS
  Most patients were male and had baseline INTERMACS levels and cardiac index values ≤ 3 and ≤ 2.7 L/min/m2, respectively. There were significant time effects on estimated glomerular filtration rate (eGFR), FGF-23 and 1,25(OH)2D, but not on PTH or 25OHD. Notably, eGFR values increased and FGF-23 levels decreased only transiently, whereas 1,25(OH)2D increased continuously until t4. The rise in 1,25(OH)2D was largely influenced by those patients who survived the first post-implant year, and was not seen in non-survivors. Variations in 1,25(OH)2D levels could only partly be explained by eGFR values or FGF-23, 25OHD, and PTH levels (multiple R2 = 0.305;P<0.001).
  
  
  CONCLUSIONS
  The present study indicates that LVAD implantation has only transient effects on circulating FGF-23 levels, but is associated with a continuous increase in circulating 1,25(OH)2D levels, especially in survivors.
authors: Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Armin
authors: A
authors: Zittermann
authors: Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Jana B
authors: JB
authors: Ernst
authors: Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Stefan
authors: S
authors: Pilz
authors: Institute for Laboratory and Transfusion Medicine, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Jens
authors: J
authors: Dreier
authors: Institute for Laboratory and Transfusion Medicine, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Joachim
authors: J
authors: Kuhn
authors: Institute for Laboratory and Transfusion Medicine, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Cornelius
authors: C
authors: Knabbe
authors: Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Jan F
authors: JF
authors: Gummert
authors: Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Michiel
authors: M
authors: Morshuis
authors: Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors: Hendrik
authors: H
authors: Milting
mesh_terms: D000368:Aged; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood / Q000502:physiology*; D060730:Glomerular Filtration Barrier; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood / Q000502:physiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood / Q000502:physiology
chemical_list: C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D014807:Vitamin D; D005346:Fibroblast Growth Factors; C097949:1,25-dihydroxyvitamin D; D000089703:Fibroblast Growth Factor-23; C104450:25-hydroxyvitamin D