{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T09:47:48Z","timestamp":1785577668449,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>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. Methods: 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. Results: In the multivariate logistic regression, preoperative FGF23 level was found to be a predictor of postoperative RHF (OR: 1.37, 95-CI: 0.78\u20132.38; p = 0.031), mortality (OR: 1.10, 95%-CI: 0.90\u20131.60; p = 0.025) and the need for postoperative dialysis (OR: 1.09, 95%-CI: 0.91\u20131.44; 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. Conclusions: FGF23 improves the prediction of clinically significant patient outcomes\u2014such as need for dialysis, RHF and mortality\u2014after HM3 and HMII implantation, as adding FGF23 to established risk scores increased their predictive value.<\/jats:p>","DOI":"10.3390\/jcdd12080290","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T16:16:10Z","timestamp":1753805770000},"page":"290","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Fibroblast Growth Factor 23 Is a Strong Predictor of Adverse Events After Left Ventricular Assist Device Implantation"],"prefix":"10.3390","volume":"12","author":[{"given":"Wissam","family":"Yared","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"},{"name":"Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine, Hospital of the Barmherzige Brueder Trier, 54292 Trier, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyla","family":"Dogan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahsannullah Madad","family":"Fassli","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Moza","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Goetzenich","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"},{"name":"Medical Affairs, Abiomed GmbH, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2028-2039","authenticated-orcid":false,"given":"Christian","family":"Stoppe","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed F. A.","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2958-843X","authenticated-orcid":false,"given":"Sandra","family":"Kraemer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lachmandath","family":"Tewarie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Abugameh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Klinikum Dortmund gGmbH, 44137 Dortmund, Germany"},{"name":"Faculty of Medicine, Witten\/Herdecke University, 58455 Witten, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2243-8743","authenticated-orcid":false,"given":"Rachad","family":"Zayat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/MAT.0000000000000910","article-title":"Risk Assessment in Patients with a Left Ventricular Assist Device Across INTERMACS Profiles Using Bayesian Analysis","volume":"65","author":"Kanwar","year":"2019","journal-title":"Asaio J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102437","DOI":"10.1016\/j.rpth.2024.102437","article-title":"Performance of risk scores in predicting major bleeding in left ventricular assist device recipients: A comparative external validation","volume":"8","author":"Jukema","year":"2024","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1161\/CIRCULATIONAHA.114.011983","article-title":"Biomarkers and risk models in cardiac surgery","volume":"130","author":"Shahian","year":"2014","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1016\/j.athoracsur.2018.06.052","article-title":"Utility of Biomarkers to Improve Prediction of Readmission or Mortality After Cardiac Surgery","volume":"106","author":"Brown","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s13054-015-0925-6","article-title":"A single preoperative FGF23 measurement is a strong predictor of outcome in patients undergoing elective cardiac surgery: A prospective observational study","volume":"19","author":"Speer","year":"2015","journal-title":"Crit. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e027875","DOI":"10.1161\/JAHA.122.027875","article-title":"Relationship of Fibroblast Growth Factor 23 with Hospitalization for Heart Failure and Cardiovascular Outcomes in Patients Undergoing Cardiac Surgery","volume":"12","author":"Hofer","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1146\/annurev-physiol-030212-183727","article-title":"Fibroblast growth factor 23 and Klotho: Physiology and pathophysiology of an endocrine network of mineral metabolism","volume":"75","author":"Hu","year":"2013","journal-title":"Annu. Rev. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.mce.2008.10.052","article-title":"The Klotho gene family as a regulator of endocrine fibroblast growth factors","volume":"299","author":"Kurosu","year":"2009","journal-title":"Mol. Cell Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e12902","DOI":"10.1111\/eci.12902","article-title":"PTH, vitamin D, and the FGF-23-klotho axis and heart: Going beyond the confines of nephrology","volume":"48","author":"Delgado","year":"2018","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s00394-015-0847-8","article-title":"Vitamin D metabolites and fibroblast growth factor-23 in patients with left ventricular assist device implants: Association with stroke and mortality risk","volume":"55","author":"Zittermann","year":"2016","journal-title":"Eur. J. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Vazquez-Sanchez, S., Poveda, J., Navarro-Garcia, J.A., Gonzalez-Lafuente, L., Rodriguez-Sanchez, E., Ruilope, L.M., and Ruiz-Hurtado, G. (2021). An Overview of FGF-23 as a Novel Candidate Biomarker of Cardiovascular Risk. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.632260"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1001\/jamacardio.2018.0653","article-title":"Association of Fibroblast Growth Factor 23 with Recurrent Cardiovascular Events in Patients After an Acute Coronary Syndrome: A Secondary Analysis of a Randomized Clinical Trial","volume":"3","author":"Bergmark","year":"2018","journal-title":"JAMA Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2734","DOI":"10.1253\/circj.CJ-10-0355","article-title":"Association between fibroblast growth factor 23 and left ventricular hypertrophy in maintenance hemodialysis patients. Comparison with B-type natriuretic peptide and cardiac troponin T","volume":"74","author":"Negishi","year":"2010","journal-title":"Circ. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.1161\/CIRCULATIONAHA.108.844506","article-title":"Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease","volume":"119","author":"Januzzi","year":"2009","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1007\/s00392-023-02162-y","article-title":"Fibroblast growth factor 23 as a biomarker of right ventricular dysfunction in pulmonary hypertension","volume":"112","author":"Widmann","year":"2023","journal-title":"Clin. Res. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4393","DOI":"10.1172\/JCI46122","article-title":"FGF23 induces left ventricular hypertrophy","volume":"121","author":"Faul","year":"2011","journal-title":"J. Clin. Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/ajh\/hpy142","article-title":"Fibroblast Growth Factor-23, Heart Failure Risk, and Renin-Angiotensin-Aldosterone-System Blockade in Hypertension: The MESA Study","volume":"32","author":"Akhabue","year":"2019","journal-title":"Am. J. Hypertens."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.athoracsur.2021.12.011","article-title":"Twelfth Interagency Registry for Mechanically Assisted Circulatory Support Report: Readmissions After Left Ventricular Assist Device","volume":"113","author":"Shah","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2994","DOI":"10.1681\/ASN.2021070988","article-title":"A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease","volume":"32","author":"Delgado","year":"2021","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1001\/jama.2015.18202","article-title":"Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis","volume":"315","author":"Tangri","year":"2016","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jacc.2012.09.055","article-title":"Predicting survival in patients receiving continuous flow left ventricular assist devices: The HeartMate II risk score","volume":"61","author":"Cowger","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.jchf.2022.08.002","article-title":"Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device","volume":"10","author":"Mehra","year":"2022","journal-title":"JACC Heart Fail."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ejcts\/ezs043","article-title":"EuroSCORE II","volume":"41","author":"Nashef","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1016\/j.jacc.2008.03.009","article-title":"The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates","volume":"51","author":"Matthews","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.athoracsur.2013.03.099","article-title":"Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era","volume":"96","author":"Atluri","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1161\/CIRCULATIONAHA.117.030543","article-title":"Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices: The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) Right-Sided Heart Failure Risk Score","volume":"137","author":"Soliman","year":"2018","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ornitz, D.M., and Itoh, N. (2001). Fibroblast growth factors. Genome Biol., 2.","DOI":"10.1186\/gb-2001-2-3-reviews3005"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Rodelo-Haad, C., Santamaria, R., Mu\u00f1oz-Casta\u00f1eda, J.R., Pend\u00f3n-Ruiz de Mier, M.V., Martin-Malo, A., and Rodriguez, M. (2019). FGF23, Biomarker or Target?. Toxins, 11.","DOI":"10.3390\/toxins11030175"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1093\/ckj\/sfad093","article-title":"Is there a role in acute kidney injury for FGF23 and Klotho?","volume":"16","author":"Mattinzoli","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1161\/CIRCHEARTFAILURE.115.002341","article-title":"Fibroblast Growth Factor 23 Is an Independent and Specific Predictor of Mortality in Patients With Heart Failure and Reduced Ejection Fraction","volume":"8","author":"Koller","year":"2015","journal-title":"Circ. Heart Fail."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ijcard.2017.10.010","article-title":"Fibroblast growth factor 23 is related to profiles indicating volume overload, poor therapy optimization and prognosis in patients with new-onset and worsening heart failure","volume":"253","author":"Voors","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1093\/ndt\/gfy392","article-title":"Fibroblast growth factor-23 promotes rhythm alterations and contractile dysfunction in adult ventricular cardiomyocytes","volume":"34","author":"Delgado","year":"2019","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2045894019895446","DOI":"10.1177\/2045894019895446","article-title":"Higher plasma fibroblast growth factor 23 levels are associated with a higher risk profile in pulmonary arterial hypertension","volume":"9","author":"Bouzina","year":"2019","journal-title":"Pulm. Circ."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/8\/290\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:18:22Z","timestamp":1760033902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/8\/290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcdd12080290"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12080290","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,29]]}}}