The Correlation Of Fibroblast Growth Factor 23 And Natriuretic Peptide With Cardiac Remodeling In Essential Hypertension

Background: Fibroblast growth factor 23(FGF23)is secreted mainly by bone osteocytes.Atrial natriuretic peptide(ANP)and brain natriuretic peptide(BNP)which are mainly component of cardiac hormone system are synthetized in the heart(atria and ventricles,respectively).All of them are related to the occurrence and development of cardiac remodeling in patients with essential hypertension.Although previous studies have shown that circulating concentrations of ANP,BNP,and FGF23 have diagnostic value in hypertensive cardiac remodeling,no studies have directly evaluated the relative value of these biomarkers.Objective: In this study we compared plasma FGF23,ANP and BNP levels in patients with essential hypertension and investigated the correlation of human plasma FGF23 and ANP concentrations with cardiac remodeling.Moreover,we also explored the diagnostic values of FGF23,ANP and BNP in cardiac remodeling of the essential hypertension.Method: A total of 146 consecutive essential hypertension patients aged between 18 and 75 who were hospitalized in the Hypertension and Heart Failure Department of the First Affiliated Hospital of Dalian Medical University were enrolled in our study from July 2019 to December 2019.According to the left ventricular mass index(LVMI),the participating patients were divided into EH+LVH(essential hypertension + left ventricular hypertrophy,n=54)group.Then,according to left atrial diameter index(LAI),patients with normal LVMI were divided into EH+LAE(essential hypertension + left atrial enlargement,n=53)group and EH(essential hypertension,n=39)group.40 healthy volunteers were enrolled as Control group.General clinical data and blood biochemical indicators of all people enrolled were collected including age,gender,FPG,TC,HDL-C,LDL-C and so on.Relevant echocardiographic parameters were also measured and recorded.Enzyme-linked immunosorbent assay(ELISA)was used to determine human plasma FGF23 and ANP concentrations.Statistical Analysis: All the data were presented as mean ± standard deviation or median(interquartile range)for continuous variables and as percentages for categorical variables.Differences among continuous variables conforming to normal distribution were assessed using a one-way analysis of variance(ANOVA),otherwise,Kruskal-Wallis H test was used.Chi-square test is needed for categorical variables.Univariate and multivariate Logistic regression were used to analyze the factors involving cardiac remodeling.Multivariate regression analysis was performed on the indicators of P<0.05 in the single factor to determine independent predictors of LVH and left atrial enlargement.Further apply the ROC curve to analyze the diagnostic value of the related index.P< 0.05 was considered statistically significant for all the analyses.All statistical analyses were performed with SPSS software v.23.0?Graph Pad Prism v.8.0and Med Calc v.19.1.3.P<0.05 is statistically significant.Result: Compared with the control group,the concentration of FGF23 was significantly higher in the EH group(P<0.001),and increased further in the EH + LAE group(both P<0.001 compared with the Control and the EH group).FGF23 was the highest is in the EH + LVH group(compared with all other groups,P<0.001).The trend of ANP level was similar to FGF23.Compared with the control group,the concentration of ANP was significantly higher in the EH group(P<0.001),and increased further in the EH + LAE group(both P<0.001 compared with the Control and the EH group).ANP was the highest is in the EH + LVH group(compared with all the other groups,P<0.001).Univariate Logistic regression analysis was used to evaluate the related factors for LVH and left atrial enlargement,and P<0.05 was included in multivariate Logistic regression analysis.The final results showed that FGF23 and ANP were correlative factors of LVH and left atrial enlargement.We further explored the diagnostic values of these biomarkers in cardiac remodeling including LVH and left atrial enlargement.The Area under ROC curve of FGF23 was similar to ANP(P>0.05)for both LVH and leftatrial enlargement,which were significantly higher than that of BNP(P<0.05).It indicated that the diagnostic values of FGF23 and ANP in LVH and left atrial enlargement were similar(P>0.05),and both were significantly higher than BNP(P>0.05).Conclusion: Plasma FGF23 and ANP levels increase significantly with the progress of cardiac remodeling in essential hypertension.Plasma FGF23 and ANP levels are independently related to hypertensive LVH and left atrial enlargement.For LVH and left atrial enlargement,FGF23 has the similar diagnostic value with ANP,and better than BNP.