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Fibroblast growth factor 23 is associated with cardiac disease severity in transthyretin amyloid cardiomyopathy

Mahshid Eslami1, Nikita Ermolaev1, Christina Kronberger1

  • 1Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.

Scientific Reports
|May 4, 2026
PubMed

Insights

Fibroblast growth factor 23 (FGF23) is linked to cardiac and kidney markers in transthyretin amyloid cardiomyopathy (ATTR-CM). Higher FGF23 levels correlate with advanced disease stages, suggesting its potential as a complementary biomarker for ATTR-CM risk stratification.

Area of Science:

  • Cardiology
  • Endocrinology
  • Biomarker Discovery

Background:

  • Fibroblast growth factor 23 (FGF23) is a hormone primarily produced by bone cells.
  • FGF23 is increasingly recognized for its role in cardiovascular disease.
  • The significance of FGF23 in transthyretin amyloid cardiomyopathy (ATTR-CM) is not well understood.

Purpose of the Study:

  • To investigate the association between circulating FGF23 levels and markers of cardiac and renal function in patients with ATTR-CM.
  • To explore the relationship between FGF23 levels and disease severity in ATTR-CM.

Main Methods:

  • Intact FGF23 levels were measured in 114 patients with confirmed ATTR-CM using a chemiluminescent immunoassay.
  • Associations between FGF23 levels, cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], troponin T), and National Amyloidosis Centre (NAC) stages were analyzed.
  • Statistical analyses included evaluation across FGF23 tertiles and adjustments for estimated glomerular filtration rate (eGFR).

Main Results:

  • Elevated FGF23 levels were significantly associated with higher NT-proBNP and troponin T levels.
  • Higher FGF23 levels correlated with advanced NAC stages, indicating a link to disease progression.
  • FGF23 remained significantly associated with NT-proBNP after adjusting for eGFR, though the association with troponin T showed a non-significant trend.

Conclusions:

  • This study provides the first evidence of a significant association between FGF23 and cardiac injury markers in ATTR-CM.
  • FGF23 may serve as a valuable complementary biomarker for risk stratification in patients with ATTR-CM.
  • Further research is warranted to elucidate the precise role of FGF23 in the pathophysiology and progression of ATTR-CM.

Keywords:
BiomarkersDisease severityFibroblast growth factor 23NT-proBNPRenal functionTransthyretin amyloid cardiomyopathy (ATTR-CM)Troponin T

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