Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany.
Clin Res Cardiol. 2023 Oct;112(10):1382-1393. doi: 10.1007/s00392-023-02162-y. Epub 2023 Feb 15.
Fibroblast growth factor 23 (FGF-23) has been associated with left ventricular hypertrophy (LVH) and heart failure. However, its role in right ventricular (RV) remodeling and RV failure is unknown. This study analyzed the utility of FGF-23 as a biomarker of RV function in patients with pulmonary hypertension (PH).
In this observational study, FGF-23 was measured in the plasma of patients with PH (n = 627), dilated cardiomyopathy (DCM, n = 59), or LVH with severe aortic stenosis (n = 35). Participants without LV or RV abnormalities served as controls (n = 36).
Median FGF-23 plasma levels were higher in PH patients than in healthy controls (p < 0.001). There were no significant differences between PH, DCM, and LVH patients. Analysis across tertiles of FGF-23 levels in PH patients revealed an association between higher FGF-23 levels and higher levels of NT-proBNP and worse renal function. Furthermore, patients in the high-FGF-23 tertile had a higher pulmonary vascular resistance (PVR), mean pulmonary artery pressure, and right atrial pressure and a lower cardiac index (CI) than patients in the low tertile (p < 0.001 for all comparisons). Higher FGF-23 levels were associated with higher RV end-diastolic diameter and lower tricuspid annular plane systolic excursions (TAPSE) and TAPSE/PASP. Receiver operating characteristic analysis revealed FGF-23 as a good predictor of RV maladaptation, defined as TAPSE < 17 mm and CI < 2.5 L/min/m. Association of FGF-23 with parameters of RV function was independent of the glomerular filtration rate in regression analysis.
FGF-23 may serve as a biomarker for maladaptive RV remodeling in patients with PH.
成纤维细胞生长因子 23（FGF-23）与左心室肥厚（LVH）和心力衰竭有关。然而，其在右心室（RV）重构和 RV 衰竭中的作用尚不清楚。本研究分析了 FGF-23 作为肺动脉高压（PH）患者 RV 功能生物标志物的效用。
在这项观察性研究中，测量了 PH（n=627）、扩张型心肌病（DCM，n=59）或伴严重主动脉瓣狭窄的 LVH（n=35）患者的血浆 FGF-23。无 LV 或 RV 异常的参与者作为对照组（n=36）。
PH 患者的 FGF-23 血浆水平中位数高于健康对照组（p<0.001）。PH、DCM 和 LVH 患者之间无显著差异。PH 患者按 FGF-23 水平三分位分析显示，较高的 FGF-23 水平与较高的 NT-proBNP 水平和更差的肾功能相关。此外，高 FGF-23 三分位组的患者肺动脉阻力（PVR）、平均肺动脉压和右心房压较高，心指数（CI）较低（所有比较的 p<0.001）。较高的 FGF-23 水平与 RV 舒张末期直径增加和三尖瓣环平面收缩期位移（TAPSE）降低和 TAPSE/PASP 比值降低相关。ROC 分析显示 FGF-23 是 RV 适应不良的良好预测指标，定义为 TAPSE<17mm 和 CI<2.5L/min/m。回归分析中，FGF-23 与 RV 功能参数的相关性独立于肾小球滤过率。
FGF-23 可能作为 PH 患者 RV 适应性重构的生物标志物。
