Yared Wissam, Dogan Leyla, Fassli Ahsannullah Madad, Moza Ajay, Goetzenich Andreas, Stoppe Christian, Mohammed Ahmed F A, Kraemer Sandra, Tewarie Lachmandath, Abugameh Ahmad, Zayat Rachad
Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany.
Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine, Hospital of the Barmherzige Brueder Trier, 54292 Trier, Germany.
J Cardiovasc Dev Dis. 2025 Jul 29;12(8):290. doi: 10.3390/jcdd12080290.
Heart failure (HF) and left ventricular hypertrophy (LVH) are linked to fibroblast growth factor 23 (FGF23). This study aims to analyze whether FGF23 can predict postoperative outcomes in unselected left ventricular assist device (LVAD) candidates.
We conducted a prospective observational study that included 27 patients (25 HeartMate3 and 2 HeartMateII) with a median follow-up of 30 months. We measured preoperative FGF23 plasma levels and computed the HeartMateII risk score (HMRS), the HeartMate3 risk score (HM3RS) and the EuroSCOREII with respect to postoperative mortality, as well as the Michigan right heart failure risk score (MRHFS), the Euromacs RHF risk score (EURORHFS), the CRITT score with respect to RHF prediction and the kidney failure risk equation (KFRE) with respect to kidney failure. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed.
In the multivariate logistic regression, preoperative FGF23 level was found to be a predictor of postoperative RHF (OR: 1.37, 95-CI: 0.78-2.38; = 0.031), mortality (OR: 1.10, 95%-CI: 0.90-1.60; = 0.025) and the need for postoperative dialysis (OR: 1.09, 95%-CI: 0.91-1.44; = 0.032). In the ROC analysis, FGF23 as a predictor of post-LVAD RHF had an area under the curve (AUC) of 0.81.
FGF23 improves the prediction of clinically significant patient outcomes-such as need for dialysis, RHF and mortality-after HM3 and HMII implantation, as adding FGF23 to established risk scores increased their predictive value.
心力衰竭（HF）和左心室肥厚（LVH）与成纤维细胞生长因子23（FGF23）有关。本研究旨在分析FGF23能否预测未经筛选的左心室辅助装置（LVAD）候选者的术后结局。
我们进行了一项前瞻性观察性研究，纳入了27例患者（25例HeartMate3和2例HeartMateII），中位随访时间为30个月。我们测量了术前FGF23血浆水平，并计算了HeartMateII风险评分（HMRS）、HeartMate3风险评分（HM3RS）和欧洲心脏手术风险评估系统II（EuroSCOREII）以评估术后死亡率，以及密歇根右心衰竭风险评分（MRHFS）、欧洲人工心脏辅助装置注册研究右心衰竭风险评分（EURORHFS）、用于预测右心衰竭的CRITT评分和用于预测肾衰竭的肾衰竭风险方程（KFRE）。进行了多因素逻辑回归和受试者工作特征（ROC）分析。
在多因素逻辑回归中，术前FGF23水平被发现是术后右心衰竭（OR：1.37，95%置信区间：0.78 - 2.38；P = 0.031）、死亡率（OR：1.10，95%置信区间：0.90 - 1.60；P = 0.025）和术后透析需求（OR：1.09，95%置信区间：0.91 - 1.44；P = 0.032）的预测指标。在ROC分析中，FGF23作为LVAD术后右心衰竭的预测指标，曲线下面积（AUC）为0.81。
FGF23改善了对临床上重要患者结局的预测，如透析需求、右心衰竭和死亡率，在植入HM3和HMII后，将FGF23添加到既定风险评分中可提高其预测价值。
