AIM Fibroblast growth factor 23 (FGF23) is an intensively studied biomarker at the crossroads of cardiovascular disease, heart failure (HF) and chronic kidney disease. Independent associations between increasing FGF23 levels and cardiovascular events were found in many, but not all studies. By analysing data from the TIME-CHF cohort, we sought to investigate the prognostic value of FGF23 in an elderly, multimorbid HF patient cohort. We determined differences between intact (iFGF23) and C-terminal FGF23 (cFGF23) regarding their prognostic value and their levels over time in different HF subgroups according to left ventricular ejection fraction (LVEF). METHODS AND RESULTS In this multicentre trial of 622 patients with symptomatic HF aged ≥60 years, we determined iFGF23 and cFGF23 at baseline, 3, 6 and 12-month follow-up. In unadjusted analyses, cFGF23 significantly predicted all HF-related outcomes at all time points. The predictive value of iFGF23 was less and not statistically significant at baseline. After multivariable adjustments, the association between both cFGF23 and iFGF23 and outcome lost statistical significance apart from cFGF23 at month 3. Overall, patients with preserved and mid-range LVEF had higher levels of iFGF23 and cFGF23 than those with reduced LVEF. Levels decreased significantly during the first 3 months in mid-range and reduced LVEF patients, but did not significantly change over time in those with preserved LVEF. CONCLUSIONS Fibroblast growth factor 23 is of limited value regarding risk prediction in this elderly HF population. Potentially heterogeneous roles of FGF23 in different LVEF groups deserve further investigation.

中文翻译：

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成纤维细胞生长因子23在评估心力衰竭患者的预后中作用有限：来自TIME-CHF试验的数据。

AIM成纤维细胞生长因子23（FGF23）是在心血管疾病，心力衰竭（HF）和慢性肾脏病的十字路口进行的深入研究的生物标志物。在许多但并非全部研究中都发现了FGF23水平升高与心血管事件之间的独立关联。通过分析来自TIME-CHF队列的数据，我们试图研究FGF23在老年多发性HF患者队列中的预后价值。根据左心室射血分数（LVEF），我们确定了完整的（iFGF23）和C端FGF23（cFGF23）的预后价值及其随时间的变化在不同的HF亚组中的差异。方法和结果在这项多中心试验中，对622名≥60岁的有症状HF患者进行了研究，我们在基线，3、6和12个月的随访中确定了iFGF23和cFGF23。在未经调整的分析中，cFGF23在所有时间点均能显着预测所有与HF相关的结果。在基线时，iFGF23的预测值较小且无统计学意义。经过多变量调整后，在第3个月，cFGF23和iFGF23与结局之间的关联除cFGF23以外均失去统计学意义。总的来说，LVEF保持中和范围的患者比LVEF降低的患者具有更高的iFGF23和cFGF23水平。LVEF患者在中档和头3个月的前三个月中水平显着下降，但LVEF保留者未随时间变化。结论关于老年HF人群的风险预测，成纤维细胞生长因子23的价值有限。FGF23在不同LVEF组中的潜在异质作用值得进一步研究。