Elevation of the Tumor Marker CA125 in Right Heart Failure

Mathew, Boban; Bhatia, Vineet; Mahy, I R; Ahmed, Imad Awwad; Francis, Lisa

doi:10.1097/01.smj.0000141306.20265.1e

Cited by 14 publications

(7 citation statements)

References 5 publications

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“…In a different study by Yilmaz et al [5], elevated levels of CA 125 reflected right ventricle dysfunction in patients with COPD even before corpulmonale to be evident [5]. Our report adds to the literature a unique case that describe CA 125 elevation in a patient with isolated right heart failure in the setting of rheumatic heart disease [6,7]. Though the exact mechanism remains unclear, the production of CA 125 is hypothesized to be increased secretion by the peritoneal mesothelium, either via a direct stretch activation due to the as cites from the right heart failure or via an indirect activation through inflammatory cytokines such as interleukin-6 [8].…”

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confidence: 54%

Elevated Carbohydrate Antigen 125 Level in a Patient with Right Heart Failure

2015

JCCR

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A 55-year-old woman with history of rheumatic heart disease, mitral valve and aortic valve replacement four months ago was admitted with dyspnea, abdominal distention and swelling in her lower extremities. Her physical examination was remarkable for ascites and bilateral pedal edema. A chest roentogram showed a small right pleural effusion. Her electrocardiogram was consistent with sinus bradycardia. Her echocardiogram showed a normal left ventricular function with an ejection fraction of 55-60%, moderate pulmonary hypertension, moderately dilated right ventricle with moderately decreased function, moderate tricuspid regurgitation, moderate to severe pulmonic regurgitation, moderate right atrial enlargement and mild left atrial enlargement. Her right heart catheterization showed a right atrial pressure of 28 mmHg, a right ventricular end diastolic pressure of 31 mmHg, a pulmonary artery pressure of 92/36 mmHg, a mean pulmonary artery pressure of 68 mmHg, pulmonary capillary wedge pressure of 22 mmHg, a pulmonary artery saturation of 33% and a cardiac index of 1.7 L/min/m 2 . During initial investigation, it was found that her carbohydrate antigen (CA) 125 was markedly elevated to 871 U/ml (upper normal level is 35 U/ml). Investigation for gynecological malignancy by ultrasonography and computer tomography of the abdomen and pelvis was negative. Her ascites was tapped and the analysis did not show any malignant cells. She was started on diuretics and ionotropes with clinical improvement. Her symptoms were resolved and there was no evidence of abdominal distention on exam after few days of hospitalization. Since no obvious malignancy could be identified, her CA 125 was repeated and it was 35 U/ml. DiscussionThe CA 125 is a high molecular weight (approximately 2-5 million daltons) glycoprotein synthesized by epithelial serosal cells, such as the pleura, pericardium and peritoneum [1]. Inflammation or stretch of the serosal surface may be responsible for elevation of CA 125. The biological role of CA 125 in humans is not clearly understood. CA 125 is a tumor marker that is used in ovarian cancer. It has been shown to be useful for diagnosis of suspected cases, to monitor the efficacy of treatment and for early detection of recurrence. Increased CA 125 has also been noted in other neoplastic diseases like lung, breast, uterine and gastrointestinal tract cancer and non-neoplastic diseases like liver cirrhosis, serosal effusion and renal impairment [1]. Nagele et al. [2], while measuring various biomarkers in HF patients, were the first to identify this strong correlation between elevated CA 125 level and the severity of the clinical picture of patients [2]. Other studies investigated the evidence of this correlation in acute failure cases and right-sided failure cases [3,4]. D' Aloia et al. [4] showed a significant correlation of CA 125 levels with the right atrial and systolic pulmonary artery pressure. In a different study by Yilmaz et al. [5], elevated levels of CA 125 reflected right ventricle dysfunction in patie...

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confidence: 54%

Elevated Carbohydrate Antigen 125 Level in a Patient with Right Heart Failure

2015

JCCR

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“…In the multiple regression analysis, CA-125 was independently associated with RV dilatation, pericardial effusion and left ventricular EF. Though, there were few reports in the literature mentioning such possible association between CA-125 level and right heart chambers [14,15], there was no study showing that relationship in those without depressed EF and demonstrating such independent relationship of these parameters influencing plasma levels of CA-125 in a group of all comers. Mechanical stress on the venous system up on decreased unloading effect of RV, inflammatory stimuli involving pulmonary bed could all be potential sources of explanation such effect.…”

Section: Discussionmentioning

confidence: 95%

Plasma CA-125 level is related to both sides of the heart: A retrospective analysis

Yilmaz

Zorlu

Tandoğan

2011

International Journal of Cardiology

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“…Besides, RV dilatation and tricuspid regurgitation were not separated from other potential confounders. Actually, potential role of right side of the heart in the plasma levels of CA-125 has not been searched in detail so far except case reports [15][16]. In a very recent study enrolling all comers, it was shown that presence of depressed ejection fraction, presence of right ventricular dilatation and presence of pericardial effusion were independent predictors of high CA-125 levels [17] further supporting the notion that RV dilatation could be responsible for elevations of CA-125.…”

Section: Discussionmentioning

confidence: 99%

Cancer antigen 125 level is determined by tricuspid regurgitation among patients with stable systolic heart failure

Kaya¹,

Yücel²,

Zorlu³

2014

Cumhuriyet Med J

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Aim. Cancer antigen 125 (CA-125) is a soluble glycoprotein with high molecular weight. Recently, increased serum CA-125 levels were also documented in patients with heart failure (HF). We aimed to show what factors influence serum levels of CA-125 among patients with chronic systolic HF. Method. Patients, who had chronic systolic HF with echocardiographically determined ejection fraction (EF) <45% were enrolled into final analysis (n=56). CA-125 levels were classified into two as those with normal (<35 U/mL) and high levels (≥35 U/mL). Results. Patients with Right ventricular (RV) dilatation had significantly higher CA-125 levels compared to those without RV dilatation. Besides, patients with RV dilatation had higher systolic pulmonary artery pressure (SPAP) levels compared to those without. Patients with high CA-125 levels had more frequent RV dilatation, higher pulmonary artery pressure, more severe tricuspid regurgitation. Tricuspid regurgitation was the only significant predictor of high CA-125 levels in patients with stable chronic systolic HF. Conclusion. It was shown in this study that tricuspid regurgitation was the only independent predictor of high CA-125 levels among patients with chronic stable systolic HF.

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Elevation of the Tumor Marker CA125 in Right Heart Failure

Cited by 14 publications

References 5 publications

Elevated Carbohydrate Antigen 125 Level in a Patient with Right Heart Failure

Elevated Carbohydrate Antigen 125 Level in a Patient with Right Heart Failure

Plasma CA-125 level is related to both sides of the heart: A retrospective analysis

Cancer antigen 125 level is determined by tricuspid regurgitation among patients with stable systolic heart failure

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