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Inorganic phosphate and FGF‐23 predict outcome in stable systolic heart failure
Author(s) -
Plischke Max,
Neuhold Stephanie,
Adlbrecht Christopher,
Bielesz Bernhard,
Shayganfar Sascha,
Bieglmayer Christian,
Szekeres Thomas,
Hörl Walter H.,
Strunk Guido,
Vavken Patrick,
Pacher Richard,
Hülsmann Martin
Publication year - 2012
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2011.02631.x
Subject(s) - cardiology , heart failure , phosphate , medicine , fibroblast growth factor 23 , outcome (game theory) , chemistry , biochemistry , mathematics , calcium , parathyroid hormone , mathematical economics
Eur J Clin Invest 2012; 42 (6): 649–656 Abstract Background Recent studies show associations between inorganic phosphate and risk of heart failure in the general population as well as between fibroblast growth factor 23 (FGF‐23) and outcome in coronary heart disease. This study was carried out to assess whether circulating levels of inorganic phosphate and FGF‐23, a new central hormone in mineral bone metabolism, predict outcome in systolic heart failure. Materials and methods Ninety‐nine consecutive outpatients with systolic heart failure were enrolled. Mean (SD) age was 61 years (11), mean left ventricular ejection fraction (LVEF) was 33% (10), 82 patients were men, median estimated creatinine clearance was 83 mL/min (Q 1 –Q 3 58–106), median NTproBNP level was 803 pg/mL (Q 1 –Q 3 404–2757), median inorganic phosphate was 1·12 mM (Q 1 –Q 3 1·02–1·22), median FGF‐23 was 39·02 pg/mL (Q 1 –Q 3 32·45–55·86) and median follow‐up was 35 months. Associations between inorganic phosphate, FGF‐23 and endpoints were assessed using Cox regression analyses. Results Inorganic phosphate and FGF‐23 levels were significantly higher ( P < 0·001 and P = 0·009) in patients reaching the combined endpoint of cardiac hospitalization or death. FGF‐23 (ln) predicted all‐cause mortality (hazard ratio (HR) 5·042, P = 0·032) in a model adjusted for age, gender, estimated creatinine clearance, LVEF, New York Heart Association (NYHA) stage and NTproBNP level. Inorganic phosphate predicted heart failure hospitalization (HR 26·944, P = 0·021), cardiac hospitalization (HR 16·016, P = 0·017) and the combined endpoint (HR 13·294, P = 0·015) in models adjusted for the same co‐variables. Conclusion The results of this study demonstrate the independent prognostic value of inorganic phosphate and FGF‐23 in heart failure even in the context of established risk markers.