| ObjectiveThis study aimed to investigate the expression level of serum fibroblast growth factor 23(FGF23)in patients with heart failure with preserved ejection fraction(HFpEF,LVEF≥50%)and to assess the predictive value of FGF23 for poor prognosis in heart failure with preserved ejection fraction in the medium to long term.MethodsOne hundred and twenty-nine HFpEF patients hospitalized in the Department of Cardiology of XX People’s Hospital from December 2020 to May 2021,45 heart failure with reduced ejection fraction(HFrEF,LVEF<40%)patients and 27 controls with healthy physical examination were collected of similar gender and age to HFpEF from December 2021 to May 2022.Basic clinical information,laboratory indices,and echocardiographic parameters were collected from all subjects,and the differences between the three groups in C-terminal fibroblast growth factor 23(cFGF23),intact fibroblast growth factor 23(iFGF23)and each clinical index were compared.Patients in the HFpEF group were then singled out for analysis and followed up for 1-year all-cause death and readmission for heart failure,and the relationship between cFGF23 and iFGF23 and New York Heart Association(NHYA)was compared according to the NYHA classification of patients in this group into NYHA Ⅱ(n=39),NYHA Ⅲ(n=53),and NYHA Ⅳ(n=37);then the relationship between cFGF23 and iFGF23 was based on serum cFGF23 and iFGF23 levels were divided into the low-level group(n=65)and high-level group(n=64)for HFpEF patients,and into endpoint event group(n=65)and no event group(n=64)according to the presence or absence of endpoint events,respectively,to compare the differences of each index between different groups.Kaplan-Meier curves were used to analyze the predictive value of cFGF23 and iFGF23 on the adverse prognosis of HFpEF,and finally,one-way and multi-way Cox regression methods were used to analyze the influencing factors affecting the adverse prognosis of HFpEF patients.Results(1)Clinical data of HFpEF,HFrEF,and control group:compared with the control group,the proportion of HFpEF combined with hypertension was higher,with a statistically significant difference(P<0.05),hemoglobin(Hb),high-density lipoprotein cholesterol(HDLC)and left ventricular ejection fraction(LVEF)levels were lower,with a statistically significant difference(P<0.05),uric acid(UA),left ventricular end-systolic internal diameter(LVESD),and left ventricular mass index(LVMI)levels were higher,with statistically significant differences(P<0.05);compared with the HFrEF group,the HFpEF group had lower proportions of β-blocker,spironolactone,and collaterals diuretic drugs,with statistically significant differences(P<0.05),and Hb,UA,HDL-C,LVEDD,LVESD,and LVMI levels were lower,with statistically significant differences(P<0.05),and LVEF levels were higher,with statistically significant differences(P<0.05).(2)HFpEF,HFrEF,and control group cFGF23,iFGF23,N-terminal brain natriuretic peptide precursor(NT-proBNP):compared with the control group,cFGF23,iFGF23,NTproBNP was significantly higher in the HFpEF group and HFrEF group,and the difference was statistically significant(P<0.05);the HFpEF group and HFrEF group showed no significant difference in cFGF23,NT proBNP,and iFGF23 in HFrEF group was significantly higher than that in HFpEF group,and the difference was statistically significant(P<0.05).(3)NHYA grouping:compared with the NYHA Ⅱ group,there were statistically significant differences in cFGF23,iFGF23,and NT-proBNP in the NYHA Ⅳ group(P<0.05);the higher the concentration of cFGF23,iFGF23 and NT-proBNP,the worse the cardiac function.(4)Correlation analysis of cFGF23 and iFGF23 with each clinical variable(HFpEF group):higher cFGF23 was positively correlated with age,UA,Serum creatinine(Scr),NHYA,NT-proBNP,LAD,LVEDD,LVESD,Interventricular septal thickness(IVS),LVMI,and negatively correlated with Hb,Albumin(ALB),and estimated Glomerular filtration rate(eGFR);higher iFGF23 was positively correlated with age,CRP,UA,Scr,NHYA,NT-proBNP,LVEDD,IVS,LVMI,and Left ventricular posterior wall thickness(LVPW),and negatively correlated with ALB and eGFR.(5)Low cFGF23 level group and high cFGF23 level group(HFpEF group):higher cFGF23 level combination and a higher percentage of hypertension,higher Scr,UA,NTproBNP,LAD,LVEDD,LVESD,LVMI levels,and lower eGFR levels,and the difference was statistically significant(P<0.05).(6)Low iFGF23 level group and high iFGF23 level group(HFpEF group):the high iFGF23 level group had lower admission diastolic blood pressure,more patients on β-blockers,higher Scr,UA,NT-proBNP,IVS,LVEDD,LVESD,LVMI levels,and lower eGFR levels,and the differences were statistically significant(P<0.05).(7)Endpoint event group and no-event group(HFpEF group):admission diastolic blood pressure and eGFR were lower and Scr,UA,NT-proBNP,cFGF23,and iFGF23 were higher in the endpoint event group,with statistically significant differences(P<0.05).(8)Kaplan-Meier curves(HFpEF group):the endpoint event rate in HFpEF patients with iFGF23>533 pg/ml exceeded that in patients with ≤533 pg/ml,and the endpoint event rate in HFpEF patients with cFGF23>606 pg/ml exceeded that in patients with ≤606 pg/ml,with statistically significant differences(log-rank P<0.001).(9)Cox regression analysis(HFpEF group):NT-proBNP(HR=1.926,95%CI=1.0613.498,P=0.031),cFGF23(HR=2.306,95%CI=1.232-4.318,P=0.009),iFGF23(HR=2.057,95%CI=1.085-3.901,P=0.027)were independent risk factors for poor patient prognosis(P<0.05).(10)Endpoint event group versus no-event group(HFrEF group):NT-proBNP levels were higher in the endpoint event group than in the no-event group,and the difference was statistically significant(P<0.05).cFGF23 and iFGF23 levels were lower in the endpoint event group than in the no-event group,and the difference was not statistically significant(P>0.05).Conclusion(1)Serum cFGF23 and iFGF23 levels are higher in patients with heart failure than in healthy controls;(2)Serum cFGF23 and iFGF23 are independent predictors of 1-year all-cause mortality or risk of rehospitalization for heart failure in patients with HFpEF. |
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