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

Author:

Menghoum Nassiba12,Badii Maria Chiara12,Deltombe Matthieu3,Lejeune Sibille12,Roy Clotilde1,Vancraeynest David12,Pasquet Agnes12,Gerber Bernhard L.12,Horman Sandrine2,Gruson Damien3,Beauloye Christophe12,Pouleur Anne‐Catherine12

Affiliation:

1. Cardiovascular Department Cliniques universitaires Saint‐Luc Brussels Belgium

2. Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain (UCLouvain) Brussels Belgium

3. Department of Laboratory Medicine Cliniques universitaires Saint‐Luc Brussels Belgium

Abstract

AbstractAimsHeart 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.

Funder

Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung

Fondation Saint Luc

Publisher

Wiley

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