European Journal of Molecular & Clinical Medicine

Background:Congenital heart diseases (CHD) are lesions caused by abnormal development of
the structure of the heart.heart failure(HF) is a common complication of CHD.Elevated
Fibroblast growth factor 23 (FGF-23) levels were associated with increased risk of
cardiovascular diseases (CVD) and mortality in general population.
Aim of the study: The aim of this study wasto assess serum FGF-23 levels among pediatric
heart failure patients to demonstrate relationship between its levels and cardiac function and
severity of the disease.
Patients and methods: In our study we have evaluated 60 children. They were divided into two
groups: A case group: Included 30 patient with HF secondary to CHD and A control group:
Included 30 age and sex matched apparently healthy children.The diagnosis of cases was
established from the history, clinical examination investigation. All patients were subjected to
full history taking, a complete clinical examination including Ross Score for detection of the
degree of heart failure, Complete blood count ,kidney function tests, chest X ray, ECHO was
performed and serum level of FGF-23was also measured.
Results:There were statistical significant decrease in Ejection fraction (EF) and Fractional
Shortening (FS) of HF group compared to control group. There was significant increase in
LVEDD, LVESD and ESPAP in HF group compared to control group. There was a statistical
significant increase in serum FGF-23 level in HF group compared to healthy one. According to
correlation analysis there was significant positive correlation between FGF-23 and Heart rate,
respiratory rate, HB and Modified Ross score, also there was significant negative correlation
between FGF-23 and FS, EF, while there was no significant correlation between FGF-23 and
age, ESPAP, phosphorous and creatinine. The best cut-off value for FGF-23in HF patients was
141.5 ng/dl with sensitivity 88.3%, specificity 89.7%, positive predictive value 80.2%, negative
predictive value 91.5%, accuracy 88% and area under curve 0.982. So, FGF-23 can be a good
sensitive and specific marker for HF.
Conclusion:This study demonstrated that FGF23 is diagnostic for heart failure with good
sensitivity and specificity and related to severity of heart failure and correlate significantly with
left ventricular function.

A congenital heart disease (CHD) is a defect in the structure of the heart and great vessels
which is present at birth. Many types of CHD exist, most of which either obstruct blood flow in
the heart or vessels near it, or cause blood to flow through the heart in an abnormal pattern.
Other diseases, such as long QT syndrome, affect the heart's rhythm. CHDs are among the most
common birth defects and are the leading cause of birth defect-related deaths. Approximately 9
people in 1000 are born with CHD. Many diseases do not need treatment, but some complex
CHD require medication or surgery. Heart failure in children is a clinical and
pathophysiological syndrome that results from ventricular dysfunction, volume or pressure
overload, either alone or in combination. Salbutamol is generally given via pressurized metered
dose inhaler (pMDI) with a large volume spacer, this is a highly efficient delivery system and
ensures good delivery particularly to the small-sized to moderate-sized airways. However, it can
also be inhaled via a dry powder inhaler or nebuliser or given orally or intravenously Inhaled
furosemide affects the respiratory system by inhibiting the movement of chlorine through the
membrane of the epithelial cell , also increases the synthesis and release of the bronchodilators
prostaglandin E2 (PGE2) in the airway epithelium and prostacycline (PGI2) in the vascular
endothelium.