Author + information
- Martin Reindla,b,
- Sebastian Reinstadlera,b,
- Hans-Josef Feistritzera,b,
- Lukas Muellera,b,
- Constantin Kocha,b,
- Agnes Mayra,b,
- Markus Theurla,b,
- Rudolf Kirchmaira,b,
- Gert Kluga,b and
- Bernhard Metzlera,b
Background: Adverse left ventricular remodeling (LVR) is the major determinant of heart failure and mortality in survivors of ST-elevation myocardial infarction (STEMI). The role of fibroblast growth factor 23 (FGF-23) for LVR prediction after STEMI is unknown. We therefore aimed to investigate the relation between circulating FGF-23 and LVR following revascularized STEMI.
Methods: In this prospective observational study, we included 88 consecutive STEMI patients treated by primary percutaneous coronary intervention. FGF-23 concentrations were measured 2 [IQR: 2-2] days after symptom onset. Cardiac magnetic resonance was performed 2 [1-3] days as well as 4 [4-5] months after infarction to evaluate LVR, defined as ≥20% increase in LV end-diastolic volume. Clinical outcome as secondary endpoint (major adverse cardiac events (MACE)) was defined as a composite of death, re-infarction and new congestive heart failure within 12 months after infarction.
Results: Concentrations of FGF-23 were significantly higher in patients who developed LVR (n=11, 13%) as compared to those without LVR (152.6 [102.5-241.3] vs. 75.8 [58.6-105.4] RU/ml, p=0.002). The association between increased FGF-23 (>124 RU/ml, best cutoff by C-statistics) and LVR remained significant (odds ratio: 14.1, 95% confidence interval (CI) 2.8-70.9; p=0.001) after adjustment for biomarkers reflecting myocardial necrosis (high-sensitivity cardiac Troponin-T, hs-cTnT), myocardial stress (N-terminal pro B-type natriuretic peptide, NT-proBNP) and inflammation (high-sensitivity C-reactive protein, hs-CRP). Furthermore, the addition of FGF-23 to the established LVR-predictive biomarkers (hs-cTnT, NT-proBNP, hs-CRP) led to a net reclassification improvement of 0.92 (95%CI: 0.44-1.41, p<0.001) and to an integrated discrimination improvement of 0.16 (95%CI: 0.08-0.24, p<0.001). Increased FGF-23 concentrations were also associated with lower MACE-free survival (p=0.008).
Conclusions: Circulating FGF-23 is independently associated with LVR after reperfused STEMI. Moreover, a comprehensive multimarker strategy that includes FGF-23 provides incremental prognostic validity.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: MR Heart Failure and Pulmonary Hypertension
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1158-204
- 2017 American College of Cardiology Foundation