Reindl Martin, Reinstadler Sebastian Johannes, Feistritzer Hans-Josef, Mueller Lukas, Koch Constantin, Mayr Agnes, Theurl Markus, Kirchmair Rudolf, Klug Gert, Metzler Bernhard
University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Heart. 2017 Jun;103(11):856-862. doi: 10.1136/heartjnl-2016-310520. Epub 2016 Dec 15.
Adverse left ventricular (LV) remodelling is the major determinant of heart failure and mortality in survivors of ST-elevation myocardial infarction (STEMI). The role of fibroblast growth factor 23 (FGF-23) for LV remodelling prediction after STEMI is unknown. We therefore aimed to investigate the relation between circulating FGF-23 and LV remodelling following revascularised STEMI.
In this prospective observational study, we included 88 consecutive patients with STEMI treated by primary percutaneous coronary intervention. FGF-23 concentrations were measured 2 (IQR: 2-2) days after symptom onset. Cardiac magnetic resonance was performed 2 (IQR: 1-3) days as well as 4 (IQR: 4-5) months after infarction to evaluate LV remodelling, defined as ≥20% increase in LV end-diastolic volume.
Levels of FGF-23 were significantly higher in patients who developed LV remodelling (n=11, 13%) as compared with those without LV remodelling (152.6 (102.5-241.3) vs 75.8 (58.6-105.4) relative units per millilitre, p=0.002). The association between FGF-23 and LV remodelling remained significant (OR: 14.1, 95% CI 2.8 to 70.9; p=0.001) after adjustment for biomarkers reflecting myocardial necrosis (high-sensitivity cardiac troponin T (hs-cTnT)), myocardial stress (N-terminal pro B-type natriuretic peptide (NT-proBNP)) and inflammatory state (high-sensitivity C reactive protein (hs-CRP)). Moreover, a multimarker approach adding FGF-23 to the established LV remodelling-predictive biomarkers (hs-cTnT, NT-proBNP and hs-CRP) led to a net reclassification improvement of 0.92 (95% CI 0.44 to 1.41, p<0.001) and to an integrated discrimination improvement of 0.16 (95% CI 0.08 to 0.24, p<0.001).
Circulating FGF-23 is independently associated with LV remodelling after reperfused STEMI. A comprehensive multimarker strategy that includes FGF-23 provides incremental prognostic value for prediction of LV remodelling.
左心室（LV）不良重塑是ST段抬高型心肌梗死（STEMI）幸存者发生心力衰竭和死亡的主要决定因素。成纤维细胞生长因子23（FGF - 23）在STEMI后左心室重塑预测中的作用尚不清楚。因此，我们旨在研究血管再通的STEMI后循环FGF - 23与左心室重塑之间的关系。
在这项前瞻性观察研究中，我们纳入了88例连续接受直接经皮冠状动脉介入治疗的STEMI患者。在症状发作后2（四分位间距：2 - 2）天测量FGF - 23浓度。在心肌梗死后2（四分位间距：1 - 3）天以及4（四分位间距：4 - 5）个月进行心脏磁共振成像，以评估左心室重塑，左心室重塑定义为左心室舒张末期容积增加≥20%。
发生左心室重塑的患者（n = 11，13%）的FGF - 23水平显著高于未发生左心室重塑的患者（每毫升相对单位为152.6（102.5 - 241.3）对比75.8（58.6 - 105.4），p = 0.002）。在调整反映心肌坏死的生物标志物（高敏心肌肌钙蛋白T（hs - cTnT））、心肌应激（N末端B型利钠肽原（NT - proBNP））和炎症状态（高敏C反应蛋白（hs - CRP））后，FGF - 23与左心室重塑之间的关联仍然显著（比值比：14.1，95%置信区间2.8至70.9；p = 0.001）。此外，将FGF - 23添加到已确立的左心室重塑预测生物标志物（hs - cTnT、NT - proBNP和hs - CRP）中的多标志物方法导致净重新分类改善为0.92（95%置信区间0.44至1.41，p < 0.001），综合判别改善为0.16（95%置信区间0.08至0.24，p < 0.001）。
循环FGF - 23与再灌注STEMI后的左心室重塑独立相关。包含FGF - 23的综合多标志物策略为左心室重塑的预测提供了额外的预后价值。
