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Updated: Oct 30, 2025
A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Propensity for Calcification in Serum Associates With 2-Year Cardiovascular Mortality in Ischemic Heart Failure With
Marija Bojic1, Lorenz Koller2, Daniel Cejka3
1Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Insights
Serum calcification propensity (T50) is linked to 2-year cardiovascular mortality in patients with ischemic heart failure with reduced ejection fraction (HFrEF). This association was not observed in non-ischemic HFrEF patients.
Area of Science:
- Cardiology
- Nephrology
- Biochemistry
Background:
- Serum calcification propensity, measured by the T50-test, is a known mortality predictor in chronic kidney disease.
- Phosphate and fibroblast growth factor-23 (FGF-23) are implicated in vascular calcification and survival in chronic heart failure.
- The prognostic value of T50 in heart failure with reduced ejection fraction (HFrEF) remains under investigation.
Purpose of the Study:
- To investigate the association between serum calcification propensity (T50) and overall/cardiovascular survival in HFrEF patients.
- To explore the role of FGF-23 in HFrEF mortality.
Main Methods:
- T50, intact FGF-23, and C-terminal FGF-23 levels were measured in 306 HFrEF patients.
- Survival analysis and Cox regression models were used to assess associations with mortality.
- Patients were stratified by ischemic and non-ischemic HFrEF.
Main Results:
- A median follow-up of 3.2 years revealed 37.3% all-cause and 24.8% cardiovascular mortality.
- In ischemic HFrEF, the lowest T50 tertile was associated with significantly higher 2-year cardiovascular mortality (p=0.011).
- T50 independently predicted cardiovascular mortality in ischemic HFrEF (p=0.046), but not in non-ischemic HFrEF. FGF-23 associations were not significant after adjustments.
Conclusions:
- Serum calcification propensity (T50) is a significant predictor of 2-year cardiovascular mortality specifically in patients with ischemic HFrEF.
- The prognostic value of T50 differs between ischemic and non-ischemic HFrEF.
- Further research into T50 measurements in coronary artery disease is warranted.
Abstract:
Background: The propensity of serum to calcify, as assessed by the T50-test, associates with mortality in patients with chronic kidney disease. In chronic heart failure, phosphate and fibroblast growth factor-23 (FGF-23), which are important components of the vascular calcification pathway, have been linked to patient survival. Here, we investigated whether T50 associates with overall and cardiovascular survival in patients with chronic heart failure with reduced ejection fraction (HFrEF). Methods: We measured T50, intact and c-terminal FGF-23 levels in a cohort of 306 HFrEF patients. Associations with overall and cardiovascular mortality were analyzed in survival analysis and Cox-regression models. Results: After a median follow-up time of 3.2 years (25th-75th percentile: 2.0-4.9 years), 114 patients (37.3%) died due to any cause and 76 patients (24.8%) died due to cardiovascular causes. 139 patients (45.4%) had ischemic and 167 patients (54.6%) had non-ischemic HFrEF. Patients with ischemic HFrEF in the lowest T50-tertile had significantly greater 2-year cardiovascular mortality compared to patients in higher tertiles (p = 0.011). In ischemic but not in non-ischemic HFrEF, T50 was significantly associated with cardiovascular mortality in univariate (p = 0.041) and fully adjusted (p = 0.046) Cox regression analysis. Significant associations of intact and c-terminal FGF-23 with all-cause and cardiovascular mortality in univariate Cox regression analysis did not remain significant after adjustment for confounding factors. Conclusion: T50 is associated with 2-year cardiovascular mortality in patients with ischemic HFrEF but not in non-ischemic HFrEF. More research on the role of T50 measurements in coronary artery disease is warranted.
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