AIM To investigate the prognostic value of fibroblast growth factor 23 (FGF23) in heart failure patients (HF) with different ejection fraction (EF).
METHODS Two hundred and eight HF patients hospitalized in the Department of Cardiology in Hebei General hospital in 2019-2020 were selected and divided into the heart failure with reduced ejection fraction (HFrEF) group (n=72), heart failure with mid-range ejection fraction (HFmrEF) group (n=58) and heart failure with preserved ejection fraction (HFpEF) group (n=78) according to their EF, with a median follow-up of 3 years. Clinical characteristics and FGF23 levels were detected. COX survival analysis was used to analyze the relationship between FGF23 and prognosis.
RESULTS Compared to HFpEF, The systolic blood pressure in the HFmrEF group and HFrEF group decreased (both P<0.01), and the HFrEF group was lower than the HFmrEF group (P<0.01), The proportion of smoking history was higher in the HFrEF group (P<0.05) The proportion of alcohol consumption history in the HFmrEF group and HFrEF group was higher (both P<0.05) The D-dimer in HFrEF group increased (P<0.05); The NT proBNP levels in both HFpEF and HFmrEF groups were lower than those in HFrEF group (both P<0.01); Compared to HFpEF, LVEDD of HFmrEF group and HFrEF group LVESD elevation LVEF decreased (both P<0.01), and LVEDD and LVESD values were higher in the HFrEF group than in the HFmrEF group LVEF values were lower in the HFrEF group than in the HFmrEF group (both P<0.01); Compared with HFpEF after discharge, The proportion of β - receptor blockers in the HFmrEF group and HFrEF group was high (both P<0.01). The ACEI/ARBy and diuretics in the HFrEF group were higher than those in the other two groups (both P<0.01), The proportion of sacubitril and valsartan in the HFrEF group was higher than that in the HFpEF group (P<0.05). There was no statistically significant difference in FGF23 concentration and endpoint event incidence among the three groups. FGF23 is HFpEF The influencing factors of cardiogenic and all-cause mortality in HFmrEF and HFrEF patients. Higher concentrations of FGF-23 are risk factors for all-cause mortality in HFpEF and HFmrEF patients. After comprehensive adjustment for demographic, renal function, and cardiovascular risk factors, HFpEF patients with high concentrations of FGF-23 have an increased risk of all-cause mortality compared to the low concentration group (HR 4.520, 95% CI: 1.379~14.810, P<0.05), However, there was no correlation between FGF23 and all-cause mortality in the HFmrEF group.
CONCLUSION High levels of FGF23 are an independent risk factor for all-cause mortality in HFpHF.
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