Limited role for fibroblast growth factor 23 in assessing prognosis in heart failure patients: data from the TIME‐CHF trial

Abstract

Aim Fibroblast growth factor 23 (FGF23) is an intensively studied biomarker at the crossroads of cardiovascular disease, heart failure (HF) and chronic kidney disease. Independent associations between increasing FGF23 levels and cardiovascular events were found in many, but not all studies. By analysing data from the TIME‐CHF cohort, we sought to investigate the prognostic value of FGF23 in an elderly, multimorbid HF patient cohort. We determined differences between intact (iFGF23) and C‐terminal FGF23 (cFGF23) regarding their prognostic value and their levels over time in different HF subgroups according to left ventricular ejection fraction (LVEF). Methods and results In this multicentre trial of 622 patients with symptomatic HF aged ≥60 years, we determined iFGF23 and cFGF23 at baseline, 3, 6 and 12‐month follow‐up. In unadjusted analyses, cFGF23 significantly predicted all HF‐related outcomes at all time points. The predictive value of iFGF23 was less and not statistically significant at baseline. After multivariable adjustments, the association between both cFGF23 and iFGF23 and outcome lost statistical significance apart from cFGF23 at month 3. Overall, patients with preserved and mid‐range LVEF had higher levels of iFGF23 and cFGF23 than those with reduced LVEF. Levels decreased significantly during the first 3 months in mid‐range and reduced LVEF patients, but did not significantly change over time in those with preserved LVEF. Conclusions Fibroblast growth factor 23 is of limited value regarding risk prediction in this elderly HF population. Potentially heterogeneous roles of FGF23 in different LVEF groups deserve further investigation.

Fibroblast‐growth‐factor‐23 in heart failure with preserved ejection fraction: relation to exercise capacity and outcomes

“…In the TIME CHF study, FGF23 was found to be higher in HFpEF than in HFrEF but was not associated with risk of death or HF hospitalization. 21 Similarly, FGF23 was not associated with mortality risk in patients undergoing coronary angiography in the Ludwigshafen Risk and Cardiovascular (LURIC) Health Study. 22 While our observations of increased risk of adverse outcome in association with elevated FGF23 appear to contrast with those of TIME CHF and LURIC, 21,22 the former included only 73 patients with HFpEF, and neither was a specific study of HFpEF.…”

The Prognostic Value of Plasma Galectin 3 in HFrEF Depends on the Etiology of Heart Failure: a Cohort Study and Animal Experiment

“…Thus, as indicators of pathological processes and responses to therapeutic interventions, circulating blood biomarkers have been increasingly studied due to their noninvasive determinations that tend to be su ciently sensitive and accurate. Although there many different available biomarkers (e.g., NT-proBNP [3] , GDF-15 [4] ), there are also multiple factors that affect the prognostic values of these biomarkers.…”

CKD-MBD: Was gibt es Neues?

“…gerade zur Früherkennung von CKD und deren myokardialen Risikenin die Routine einzuschleusen, hat sich nicht bewahrheitet. Aktuelle Studiendaten zu FGF23 stellen seine Aussagekraft als kardialen Biomarker wieder infrage [13].…”