FGF23 is associated with disease severity and prognosis in chronic heart failure

BackgroundElevated 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. Materials and methodsSerum levels of C-term FGF23 (Ct-FGF23) concentrations, inorganic phosphate (P-i), parathormone (PTH) and 25-hydroxyvitamin D (25(OH)D) were measured in 208 patients with nonischaemic heart failure (age 4815years; 70% male; NYHA Class I 278%, NYHA Class II 434%, NYHA Class III/IV 288%; LV-EF 3415%; eGFR 60mL/min/173m(2) in 86%). ResultsMedian Ct-FGF23 levels were 182RU/mL (75-408RU/mL). A dose-response relationship was found between median Ct-FGF23 levels and increasing NYHA class (I: 119RU/mL, II: 158RU/mL, III/IV: 388RU/mL; P<0001). Ct-FGF23 correlated with NTproBNP (r=0307, P<0001), central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and inversely correlated with cardiac output after adjustment for renal function (eGFR) and P-i. LnCt-FGF23 was related with the combined endpoint of death or heart transplantation (hazard ratio 1452 [1029-2048]; P=0034) independent of P-i, PTH, 25(OH)D, age and sex. ConclusionThe 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.