Fibroblast Growth Factor 23 Is a Strong Predictor of Adverse Events After Left Ventricular Assist Device Implantation

Heart failure (HF) and left ventricular hypertrophy (LVH) are linked to fibroblast growth factor 23 (FGF23). This study aims to analyze whether FGF23 can predict postoperative outcomes in unselected left ventricular assist device (LVAD) candidates.

We conducted a prospective observational study that included 27 patients (25 HeartMate3 and 2 HeartMateII) with a median follow-up of 30 months. We measured preoperative FGF23 plasma levels and computed the HeartMateII risk score (HMRS), the HeartMate3 risk score (HM3RS) and the EuroSCOREII with respect to postoperative mortality, as well as the Michigan right heart failure risk score (MRHFS), the Euromacs RHF risk score (EURORHFS), the CRITT score with respect to RHF prediction and the kidney failure risk equation (KFRE) with respect to kidney failure. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed.

In the multivariate logistic regression, preoperative FGF23 level was found to be a predictor of postoperative RHF (OR: 1.37, 95-CI: 0.78-2.38; p = 0.031), mortality (OR: 1.10, 95%-CI: 0.90-1.60; p = 0.025) and the need for postoperative dialysis (OR: 1.09, 95%-CI: 0.91-1.44; p = 0.032). In the ROC analysis, FGF23 as a predictor of post-LVAD RHF had an area under the curve (AUC) of 0.81.

FGF23 improves the prediction of clinically significant patient outcomes-such as need for dialysis, RHF and mortality-after HM3 and HMII implantation, as adding FGF23 to established risk scores increased their predictive value.