1. The phosphatonin fibroblast growth factor 23 links calcium–phosphate metabolism with left-ventricular dysfunction and atrial fibrillation
- Author
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Bruno Scheller, Kyrill S. Rogacev, Jana Jeken, Charlotte Steimle, Michael Böhm, Bodo Cremers, Sarah Seiler, Danilo Fliser, Florian Hornof, Gunnar H. Heine, Sylvie Kersting, Philipp Ege, Michael Fehrenz, and Niko M. Rebling
- Subjects
Calcium Phosphates ,Male ,Fibroblast growth factor 23 ,medicine.medical_specialty ,Heart disease ,Population ,Coronary Artery Disease ,Serum Phosphate Measurement ,Coronary artery disease ,Electrocardiography ,Ventricular Dysfunction, Left ,Internal medicine ,Atrial Fibrillation ,Natriuretic Peptide, Brain ,medicine ,Humans ,cardiovascular diseases ,education ,education.field_of_study ,Ejection fraction ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Peptide Fragments ,Fibroblast Growth Factors ,Fibroblast Growth Factor-23 ,Cross-Sectional Studies ,Endocrinology ,Heart failure ,cardiovascular system ,Cardiology ,Hypertrophy, Left Ventricular ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Glomerular Filtration Rate - Abstract
High serum phosphate is linked to cardiovascular morbidity and mortality in the general population. Fibroblast growth factor 23 (FGF-23) is a critical phosphate regulating hormone, potentially reflecting phosphate load better than a single serum phosphate measurement. Recent pioneering echocardiographic studies associated FGF-23 with left-ventricular morphology. However, the association between FGF-23 and left-ventricular function is unknown, prompting us to investigate this relationship in our HOM SWEET HOMe study.We studied the association between C-terminal FGF-23, coronary artery disease, and left-ventricular function in 885 subjects undergoing elective coronary angiography. Left-ventricular function was assessed with ventriculography. More, pro-brain natriuretic peptide (pro-BNP) plasma levels were measured. The presence of left-ventricular hypertrophy and atrial fibrillation was assessed by electrocardiography. Patients with an ejection fraction40% had significantly higher FGF-23 levels compared with patients with the ejection fraction40% (P0.001). In multivariable regression analysis, the observed relationship between FGF-23 and left-ventricular function remained significant after adjustment for estimated glomerular filtration rate, presence of left-ventricular hypertrophy, and other confounding variables. In accordance, FGF-23 significantly correlated with pro-BNP plasma levels (r = 0.31; P0.001). Prevalent atrial fibrillation was associated with elevated FGF-23 levels, while the presence of coronary artery disease was not.Fibroblast growth factor 23 levels are associated with left-ventricular function and atrial fibrillation even in the absence of renal function impairment. Of note, these cross-sectional data cannot prove causality; therefore, future studies will have to discern whether FGF-23 exerts a direct untoward effect on the myocardium, or rather represents an 'innocent bystander' which reflects a high phosphate burden.
- Published
- 2011