Carbohydrate Antigen 125: A Biomarker at the Crossroads of Congestion and Inflammation in Heart Failure

Kumrić, Marko; Kurir, Tina Tičinović; Božić, Joško; Glavaš, Duška; Šarić, Tina; Marcelius, Bjørnar; D’Amario, Domenico; Borovac, Josip Anđelo

doi:10.15420/cfr.2021.22

Cited by 10 publications

(13 citation statements)

References 75 publications

(93 reference statements)

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“…Another parameter currently used to determine the degree of congestion in heart failure is the CA-125 level. In this study, CA-125 levels were significantly associated with less IVC collapsibility and were, therefore, more predictive of the degree of congestion [ 13 , 14 , 15 , 16 ]. This association between decreased inferior vena cava collapsibility values and elevated CA-125 values suggests that these parameters are more elevated in those subjects with a higher degree of pulmonary hypertension and right HF.…”

Section: Discussionmentioning

confidence: 92%

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Pérez-Herrero

Lorenzo-Villalba

Urbano

et al. 2022

JCM

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Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139–0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.

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Section: Discussionmentioning

confidence: 92%

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Pérez-Herrero

Lorenzo-Villalba

Urbano

et al. 2022

JCM

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“…CA-125-guided diuretic therapy was associated with a significant reduction in death and readmission for AHF at 30 days. The CA-125-guided group exhibited a considerably greater improvement in renal function (increase in GFR) in comparison to the standard treatment group [ 133 ]. Given the long half-life (over a week) of CA-125, it does not provide any information about acute response to therapy [ 132 ].…”

Section: Congestionsmentioning

confidence: 99%

“…CA-125 is associated with congestion, right-sided HF parameters, and an increased risk of adverse clinical events in AHF, beyond standard prognostic factors such as natriuretic peptides [ 133 ]. Broad availability, standardized measurement, and low cost make it a compelling candidate for routine use in decompensated HF.…”

Section: Congestionsmentioning

confidence: 99%

“…Broad availability, standardized measurement, and low cost make it a compelling candidate for routine use in decompensated HF. Variations in CA-125 concentrations according to the clinical situation make it a potential tool for both monitoring and guiding HF treatment following a decompensated HF event [ 133 ]. There are several limitations that currently prevent CA-125 from being used in the HF setting.…”

Section: Congestionsmentioning

confidence: 99%

“…There are several limitations that currently prevent CA-125 from being used in the HF setting. These include an insufficient understanding of CA-125 biology, a lack of an optimal cutoff value, and indefinitive data from large multicenter trials [ 133 ]. Hence, future large-scale research is required to validate the role of CA-125 in heart failure.…”

Section: Congestionsmentioning

confidence: 99%

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Novel Biomarkers of Renal Dysfunction and Congestion in Heart Failure

Zdanowicz

Urban

Ponikowska

et al. 2022

JPM

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Heart failure is a major public health problem and, despite the constantly emerging, new, effective treatments, it remains a leading cause of morbidity and mortality. Reliable tools for early diagnosis and risk stratification are crucial in the management of HF. This explains a growing interest in the development of new biomarkers related to various pathophysiological mechanisms of HF. In the course of this review, we focused on the markers of congestion and renal dysfunction in terms of their interference with cardiovascular homeostasis. Congestion is a hallmark feature of heart failure, contributing to symptoms, morbidity, and hospitalizations of patients with HF and has, therefore, become a therapeutic target in AHF. On the other hand, impaired renal function by altering the volume status contributes to the development and progression of HF and serves as a marker of an adverse clinical outcome. Early detection of congestion and an adequate assessment of renal status are essential for the prompt administration of patient-tailored therapy. This review provides an insight into recent advances in the field of HF biomarkers that could be potentially implemented in diagnosis and risk stratification of patients with HF.

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Carbohydrate antigen 125: a useful marker of congestion, fibrosis, and prognosis in heart failure with preserved ejection fraction

Menghoum,

Badii,

Deltombe

et al. 2024

ESC Heart Failure

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AimsHeart failure (HF) with preserved ejection fraction (HFpEF) is a disease associated with high morbidity and mortality, for which it is difficult to identify patients with the poorest prognosis in routine clinical practice. Carbohydrate antigen 125 (CA 125) has been shown to be a potential marker of congestion and prognosis in HF. We sought to better characterize HFpEF patients with high CA 125 levels by using a multimodal approach.Methods and resultsWe prospectively enrolled 139 HFpEF patients (78 ± 8 years; 60% females) and 25 controls matched for age and sex (77 ± 5 years; 60% females). They underwent two‐dimensional echocardiography, cardiac magnetic resonance with late gadolinium enhancement [including extracellular volume (ECV) measurement], and serum measurements of CA 125 level. The primary endpoint of the study was a composite of all‐cause mortality or first HF hospitalization. The prognostic impact of CA 125 was determined using Cox proportional hazard models. Median CA 125 levels were significantly higher in HFpEF patients compared with controls [CA 125: 23.5 (14.5–44.7) vs. 14.6 (10.3–21.0) U/mL, P = 0.004]. CA 125 levels were positively correlated with a congestion marker [N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels, Pearson's r = 0.37, P < 0.001] and markers of cardiac fibrosis estimated by both ECV (Pearson's r = 0.26, P = 0.003) and fibroblast growth factor 23 levels (Pearson's r = 0.50, P < 0.001). Over a median follow‐up of 49 (22–64) months, 97 HFpEF patients reached the composite endpoint. Even after adjustment for the Meta‐Analysis Global Group in Chronic risk score, a CA 125 level ≥35 U/mL was still a significant predictor of the composite endpoint [hazard ratio (HR): 1.58 (1.04–2.41), P = 0.032] and more particularly of HF hospitalization [HR: 1.81 (1.13–2.92), P = 0.014]. In contrast, NT‐proBNP levels were not an independent predictor.ConclusionsCA 125 levels were significantly higher in HFpEF patients compared with controls matched for age and sex and were associated with markers of congestion and cardiac fibrosis. CA 125 levels were a strong and independent predictor of HF hospitalization in HFpEF patients. These data suggest a potential value of CA 125 as a biomarker for staging and risk prediction in HFpEF.

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Carbohydrate Antigen 125: A Biomarker at the Crossroads of Congestion and Inflammation in Heart Failure

Cited by 10 publications

References 75 publications

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis

Novel Biomarkers of Renal Dysfunction and Congestion in Heart Failure

Carbohydrate antigen 125: a useful marker of congestion, fibrosis, and prognosis in heart failure with preserved ejection fraction

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