TY - JOUR
T1 - Fibroblast growth factor 23 is related to profiles indicating volume overload, poor therapy optimization and prognosis in patients with new-onset and worsening heart failure
AU - Ter Maaten, Jozine M.
AU - Voors, Adriaan A.
AU - Damman, Kevin
AU - van der Meer, Peter
AU - Anker, Stefan D.
AU - Cleland, John G.
AU - Dickstein, Kenneth
AU - Filippatos, Gerasimos
AU - van der Harst, Pim
AU - Hillege, Hans L.
AU - Lang, Chim C.
AU - Metra, Marco
AU - Navis, Gerjan
AU - Ng, Leong
AU - Ouwerkerk, Wouter
AU - Ponikowski, Piotr
AU - Samani, Nilesh J.
AU - van Veldhuisen, Dirk J.
AU - Zannad, Faiez
AU - Zwinderman, Aeilko H.
AU - de Borst, Martin H.
N1 - This project was funded by a grant from the European Commission: FP7-242209-BIOSTAT-CHF. This study was supported by the Dutch Heart Foundation, CVON 2014-11 RECONNECT.
PY - 2018/2/15
Y1 - 2018/2/15
N2 - BACKGROUND: Fibroblast growth factor (FGF) 23 is a hormone that increases urinary phosphate excretion and regulates renal sodium reabsorption and plasma volume. We studied the role of plasma FGF23 in therapy optimization and outcomes in patients with new-onset and worsening heart failure (HF).METHODS: We measured plasma C-terminal FGF23 levels at baseline in 2399 of the 2516 patients included in the BIOlogy Study to Tailored Treatment in Chronic HF (BIOSTAT-CHF) trial. The association between FGF23 and outcome was evaluated by Cox regression analysis adjusted for potential confounders.RESULTS: Median FGF23 was 218.0 [IQR: 117.1-579.3] RU/ml; patients with higher FGF23 levels had a worse NYHA class, more signs of congestion, and were less likely to use an ACE-inhibitor (ACEi) or angiotensin receptor blocker (ARBs) at baseline (all P<0.01). Higher FGF23 levels were independently associated with higher BNP, lower eGFR, the presence of oedema and atrial fibrillation (all P<0.001). In addition, higher FGF23 was independently associated with impaired uptitration of ACEi/ARBs after 3months, but not of beta-blockers. In multivariable Cox regression analysis, FGF23 was independently associated with all-cause mortality (hazard ratio: 1.17 (1.09-1.26) per log increase, P<0.001), and the combined endpoint of all-cause mortality and HF hospitalization (1.15 (1.08-1.22) per log increase, P<0.001).CONCLUSIONS: In patients with new-onset and worsening HF, higher plasma FGF23 levels were independently associated with volume overload, less successful uptitration of ACEi/ARBs and an increased risk of all-cause mortality and HF hospitalization.
AB - BACKGROUND: Fibroblast growth factor (FGF) 23 is a hormone that increases urinary phosphate excretion and regulates renal sodium reabsorption and plasma volume. We studied the role of plasma FGF23 in therapy optimization and outcomes in patients with new-onset and worsening heart failure (HF).METHODS: We measured plasma C-terminal FGF23 levels at baseline in 2399 of the 2516 patients included in the BIOlogy Study to Tailored Treatment in Chronic HF (BIOSTAT-CHF) trial. The association between FGF23 and outcome was evaluated by Cox regression analysis adjusted for potential confounders.RESULTS: Median FGF23 was 218.0 [IQR: 117.1-579.3] RU/ml; patients with higher FGF23 levels had a worse NYHA class, more signs of congestion, and were less likely to use an ACE-inhibitor (ACEi) or angiotensin receptor blocker (ARBs) at baseline (all P<0.01). Higher FGF23 levels were independently associated with higher BNP, lower eGFR, the presence of oedema and atrial fibrillation (all P<0.001). In addition, higher FGF23 was independently associated with impaired uptitration of ACEi/ARBs after 3months, but not of beta-blockers. In multivariable Cox regression analysis, FGF23 was independently associated with all-cause mortality (hazard ratio: 1.17 (1.09-1.26) per log increase, P<0.001), and the combined endpoint of all-cause mortality and HF hospitalization (1.15 (1.08-1.22) per log increase, P<0.001).CONCLUSIONS: In patients with new-onset and worsening HF, higher plasma FGF23 levels were independently associated with volume overload, less successful uptitration of ACEi/ARBs and an increased risk of all-cause mortality and HF hospitalization.
KW - FGF23
KW - Heart failure
KW - Prognosis
KW - Volume overload
UR - http://www.scopus.com/inward/record.url?scp=85039949075&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2017.10.010
DO - 10.1016/j.ijcard.2017.10.010
M3 - Article
C2 - 29306478
SN - 0167-5273
VL - 253
SP - 84
EP - 90
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -