The Associations Of Serum Osteocalcin And Fibroblast Growth Factor 21 Levels With Left Ventricular Systolic Function And Major Adverse Cardiovascular Events

Objective: This study was aimed to investigate the associations of serum osteocalcin and fibroblast growth factor 21(FGF21)levels with left ventricular systolic function and major adverse cardiovascular events(MACEs).Methods: The study subjects were from the Department of Cardiology of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital.All of the subjects underwent coronary angiography.Serum osteocalcin levels and serum FGF21 levels were measured with electrochemiluminescent immunoassay and enzyme-linked immunosorbent assay kit,respectively.Echocardiographic parameters were determined using the ultrasonic device.We recorded MACEs during 2-96 months follow-up.MACEs included cardiovascular death,nonfatal myocardial infarction,repeat coronary revascularization,hospitalization for unstable angina,and nonfatal stroke.Kaplan-Meier analysis was used to plot the survival curves and the event-free survival rates for subjects with differernt serum osteocalcin or FGF21 levels were compared using the log-rank test.Results:(1)The median left ventricular ejection fraction(LVEF)was 62% in 158 men.In men with LVEF > 62%,the serum osteocalcin levels were significantly higher than in those with LVEF ≤ 62%(P = 0.042).Receiver operating characteristic curve analysis in men showed that serum osteocalcin levels(P = 0.007),serum NT-pro-BNP levels(P = 0.018)were all significant in identifying left ventricular systolic dysfunction at baseline with non-significance in the pairwise comparison of the areas under the curves(AUCs)(P > 0.05).Men in the lower osteocalcin levels group at baseline tended to suffer more risks of future cardiac death(P = 0.016).(2)During a median follow-up time of 4.3 years in a total of 247 subjects(164 men and 83 women),MACEs occurred in 175 cases.Relatively lower serum osteocalcin levels were associated with a higher risk of MACEs in men with coronary artery disease(CAD)(P = 0.005).(3)In 218 subjects(143 men and 75 women),AUCs were non-significant among FGF21,NT-pro-BNP,and FGF21 + NT-pro-BNP as determined by pairwise comparisons(all P > 0.05).Both a higher serum level of FGF21 and a higher serum level of NT-pro-BNP were independent risk factors for left ventricular systolic dysfunction,with which those also tended to suffer greater risks of cardiac death(all P < 0.05).(4)One hundred and sixty nine out of 229 subjects(150 men and 79 women)were diagnosed with CAD at baseline.Among patients with CAD,serum FGF21 levels were significantly higher in patients with MACEs than in those without MACEs(P = 0.001).Conclusions: Lower serum osteocalcin levels in men could identify left ventricular systolic dysfunction and risks of cardiac death.Relatively lower serum osteocalcin levels were associated with higher risks of MACEs in men with CAD.Serum FGF21 levels were significantly correlated with left ventricular systolic dysfunction at baseline.Patients with higher serum levels of FGF21 tended to suffer greater risks of cardiac death.In patients with CAD at baseline,an elevated serum FGF21 level was associated with the development of MACEs in the future.