Intact fibroblast growth factor 23 in heart failure with reduced and mildly reduced ejection fraction.

BACKGROUND: Fibroblast growth factor-23 (FGF23) has been associated to left ventricular (LV) hypertrophy and heart failure (HF) severity. We aimed to investigate the clinical correlates and prognostic value of intact FGF23 (iFGF23) in HF patients. METHODS: Patients with stable HF and left ventricular ejection fraction (LVEF) < 50% were prospectively enrolled, managed according to current recommendations and followed over time. iFGF23 was measured at baseline with a fully automated immuno-chemiluminescent assay. RESULTS: We enrolled 150 patients (82% males; median age 65 years). First, second, and third iFGF23 tertiles were < 35.2 pg/mL, 35.2-50.9 pg/mL, and > 50.9 pg/mL. LVEF decreased from the first iFGF23 tertile to the third tertile (p = 0.014). N-terminal pro-B-type natriuretic peptide (NT-proBNP) increased from the first to the third tertile (p = 0.001), while peak oxygen consumption decreased (p < 0.001). Thirty-five patients (23%) experienced the primary endpoint (all-cause death or HF hospitalization at 5 years), and 26 (17%) the secondary endpoint (all-cause death at 5 years). On multivariable analysis, iFGF23 independently predicted the primary endpoint on top of age, gender and LVEF (HR 4.6 [95% CI 2.1-10.3], p < 0.001), age, gender and eGFR (HR 4.1 [95% CI 1.6-10.3], p = 0.003), as well as age, gender and NT-proBNP (HR 3.6 [95% CI 1.6-8.2], p = 0.002). iFGF23 even reclassified patient risk on top of all the 3 models, with NRI values of 0.65 (95% CI 0.30-1.01), 0.55 (95% CI 0.25-0.88), and 0.60 (95% CI 0.24-0.96), respectively (both p < 0.001). CONCLUSIONS: Circulating iFGF23 is associated with disease severity and outcome in HF patients with reduced and mildly reduced ejection fraction.

Reconstruction of the Extensor Apparatus Using a Hybrid Augment with Polyethylene Mesh and Fascia Lata Allograft: Report of a Case with Patellar Gigant Cell Tumor of the Bone.

Introduction: The extensor apparatus of the knee can be thought of a chain that transmits the muscular strength developed by the quadriceps muscles to the proximal tibia. This complex is essential to allow the extension of the tibia over the femur, being essential to provide knee mobility and stability. In case of lesions which irreparably damage the patella, such as a locally aggressive bone tumor, it is necessary to restore both the apparatus' anatomical continuity and its strength. Case Report: A 67-years-old Caucasian woman developed atraumatic swelling and soreness in her left knee. X-rays and MRI images evidenced an osteolytic degeneration of the patella. A diagnosis of Gigant cell tumor of bone was made with a needle biopsy. We performed an en bloc resection of the patella and replaced it with a composite augment made with a polypropylene mesh and a fascia lata allograft. No complication was observed. In her latest follow-up, our patient did not have any extension lag and quadriceps strength was completely restored. Conclusion: The combination of internal layers of polypropylene surgical mesh and a surface allogenic graft can provide good mechanical performances for patients who underwent patellectomy due to a locally aggressive tumor.