TY - JOUR
TI - 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, J.M.
AU - Voors, A.A.
AU - Damman, K.
AU - van der Meer, P.
AU - Anker, S.D.
AU - Cleland, J.G.
AU - Dickstein, K.
AU - Filippatos, G.
AU - van der Harst, P.
AU - Hillege, H.L.
AU - Lang, C.C.
AU - Metra, M.
AU - Navis, G.
AU - Ng, L.
AU - Ouwerkerk, W.
AU - Ponikowski, P.
AU - Samani, N.J.
AU - van Veldhuisen, D.J.
AU - Zannad, F.
AU - Zwinderman, A.H.
AU - de Borst, M.H.
JO - International Journal of Cardiology
PY - 2018
VL - 253
TODO - null
SP - 84-90
PB - Elsevier Ireland Ltd
SN - 0167-5273
TODO - 10.1016/j.ijcard.2017.10.010
TODO - angiotensin receptor antagonist;  beta adrenergic receptor blocking agent;  brain natriuretic peptide;  dipeptidyl carboxypeptidase inhibitor;  fibroblast growth factor 23;  furosemide;  biological marker;  fibroblast growth factor;  fibroblast growth factor 23, aged;  all cause mortality;  Article;  atrial fibrillation;  cardiovascular mortality;  confounding variable;  controlled study;  drug dose titration;  edema;  estimated glomerular filtration rate;  female;  general condition deterioration;  heart failure;  hospitalization;  human;  hypervolemia;  independent variable;  major clinical study;  male;  observational study;  priority journal;  prognosis;  prospective study;  protein blood level;  treatment outcome;  very elderly;  blood;  clinical trial;  disease exacerbation;  follow up;  heart failure;  heart stroke volume;  international cooperation;  middle aged;  mortality;  multicenter study;  physiology;  prognosis;  treatment outcome;  trends, Aged;  Aged, 80 and over;  Biomarkers;  Disease Progression;  Female;  Fibroblast Growth Factors;  Follow-Up Studies;  Heart Failure;  Hospitalization;  Humans;  Internationality;  Male;  Middle Aged;  Mortality;  Prognosis;  Prospective Studies;  Stroke Volume;  Treatment Outcome
TODO - 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 3 months, 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. © 2017 Elsevier B.V.
ER -