Fibroblast Growth Factor 23 and Outcome Prediction in Patients with Acute Myocardial Infarction

Abstract

(1) Background: Fibroblast growth factor 23 (FGF23) is associated with mortality in patients with heart failure (HF); however, less is known about mortality associations in patients with myocardial infarction (MI). (2) Methods: FGF23 was assessed in 180 patients with acute MI, 99 of whom presented with concomitant acute HF. Patients were followed up for one year, and outcome estimates by FGF23 were compared to GRACE score estimates. (3) Results: Log-transformed serum levels of intact FGF23 (logFGF23) did not differ between MI patients with and without HF, and no difference in logFGF23 was observed between 14 MI patients who died and those who survived. However, when only MI patients with concomitant HF were considered, logFGF23 was significantly higher among non-survivors compared to that in survivors. While logFGF23 was not associated with the outcome in the entire cohort, logFGF23 was fairly predictive for one-year mortality in patients with concomitant HF (AUC 0.78; 95%CI 0.61–0.95), where it outperformed GRACE score estimates (AUC 0.70; 95%CI 0.46–0.94). (4) Conclusions: FGF23 was associated with one-year mortality only in MI patients who concomitantly presented with HF, surpassing the predictive ability of GRACE score estimates. No associations were observed in patients without HF despite similar FGF23 levels at admission. Further studies are warranted to investigate whether FGF23 is causal for dismal outcome of HF.

Fibroblast growth factor 23 in children with or without heart failure: a prospective study

“…FGF23, however, lacked any discriminative capacity for predicting survival in patients without acute HF. 40 They demonstrated that in patients with acute HF caused by myocardial infarction, logFGF23 levels of 1.71 pg/mL accurately predicted death at 1 year with a sensitivity of 75% and a specificity of 74%.…”

“…In addition, a later study by the same authors showed that, in patients with acute myocardial infarction and concomitant HF, FGF23 levels outperformed the Global Registry of Acute Coronary Events (GRACE) score in 1-year mortality prediction. FGF23, however, lacked any discriminative capacity for predicting survival in patients without acute HF 40. They demonstrated that in patients with acute HF caused by myocardial infarction, logFGF23 levels of 1.71 pg/mL accurately predicted death at 1 year with a sensitivity of 75% and a specificity of 74%.…”

“…FGF23, however, lacked any discriminative capacity for predicting survival in patients without acute HF. 40 They demonstrated that in patients with acute HF caused by myocardial infarction, logFGF23…”

Fibroblast Growth Factor 23 and Cardiovascular Risk in Diabetes Patients—Cardiologists Be Aware

“…Numerous studies have shown a clear association between FGF23 level and CV morbidity and mortality in patients with HF rather than MI. German researchers conducted a study that indicated that FGF23 was linked to one-year mortality in patients with MI and concomitant acute HF [ 30 ]. Thorsen et al demonstrated that during the acute phase of MI, the level of FGF23 began to decline, with its normalization at seven days following revascularization.…”

Direct and indirect effects of fibroblast growth factor 23 on the heart

“…Several previous studies have shown an association between high serum concentrations of FGF23 and cardiovascular mortality (37,45,(59)(60)(61)(62)(63)(64). Furthermore, the circulating concentrations of FGF23 are significantly higher in non-surviving patients with myocardial infarction and heart failure (65). A linear dose-response relationship between FGF23 concentration and cardiovascular mortality for concentrations of FGF23 of >50 pg/mL has been demonstrated (37,59).…”