Carbohydrate Antigen 125 Predicts Long-Term Mortality in African American Patients With Acute Decompensated Heart Failure

Carbohydrate antigen 125 in congestive heart failure: ready for clinical application?

Congestion is the permanent mechanism driving disease progression in patients with acute heart failure (AHF) and also is an important treatment target. However, distinguishing between the two different phenotypes (intravascular congestion and tissue congestion) for personalized treatment remains challenging. Historically, carbohydrate antigen 125 (CA125) has been a frequently used biomarker for the screening, diagnosis, and prognosis of ovarian cancer. Interestingly, CA125 is highly sensitive to tissue congestion and shows potential for clinical monitoring and optimal treatment of congestive heart failure (HF). Furthermore, in terms of right heart function parameters, CA125 levels are more advantageous than other biomarkers of HF. CA125 is expected to become a new biological alternative marker for congestive HF and thereby is expected be widely used in clinical practice.

Novel Biomarkers of Renal Dysfunction and Congestion in Heart Failure

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.

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

Because heart failure (HF) is more lethal than some of the common malignancies in the general population, such as prostate cancer in men and breast cancer in women, there is a need for a cost-effective prognostic biomarker in HF beyond natriuretic peptides, especially concerning congestion, the most common reason for the hospitalisation of patients with worsening of HF. Furthermore, despite diuretics being the mainstay of treatment for volume overload in HF patients, no randomised trials have shown the mortality benefits of diuretics in HF patients, and appropriate diuretic titration strategies in this population are unclear. Recently, carbohydrate antigen (CA) 125, a well-established marker of ovarian cancer, emerged as both a prognostic indicator and a guide in tailoring decongestion therapy for patients with HF. Hence, in this review the authors present the molecular background regarding the role of CA125 in HF and address valuable clinical aspects regarding the relationship of CA125 with both prognosis and therapeutic management in HF.

Serum levels of carbohydrate antigen 125 in combination with N-terminal pro-brain natriuretic peptide in patients with acute decompensated heart failure

BACKGROUND/AIMS

Carbohydrate antigen 125 (CA-125) is an emerging prognostic biomarker for heart failure. We aimed to test the long-term prognostic value of CA-125 in combination with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure (ADHF).

METHODS

This observational study included a total of 413 patients (64.1 ± 15.6 yearold, 214 men) with ADHF. All-cause mortality during the 2-year follow-up was investigated for the prognosis.

RESULTS

During the follow-up (mean follow-up, 591 ± 233 days), 109 deaths (26.0%) were recorded. In the multivariable analysis model, CA-125 was an independent factor associated with all-cause mortality (log CA-125: hazard ratio, 1.23; 95% confidence interval, 1.02 to 1.48; p = 0.030) together with age, sex, New York Heart Association class, β-blocker, and NT-proBNP. The Kaplan-Meier survival analysis demonstrated that the group with both low marker levels showed the best 2-year survival (87.9%) followed by the group with low NT-proBNP and high CA-125 (76.1%), high NT-proBNP and low CA-125 (64.7%) and high NT-proBNP and high CA-125 levels (54.3%) (p < 0.001). Addition of CA-125 in combination with NT-proBNP and established risk factors further increased the predictive power for mortality in patients with ADHF.

CONCLUSION

CA-125 was an independent factor associated with all-cause mortality in patients with ADHF. Combination of CA-125 with NT-proBNP significantly improved the prediction of mortality in patients with ADHF.

Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis

Background

Carbohydrate antigen-125 (CA125) is an ovarian cancer marker, but recent work has examined its role in risk stratification in heart failure. A recent meta-analysis examined its prognostic value in heart failure generally. However, there has been no systematic evaluation of its role specifically in acute heart failure (AHF).

Methods

PubMed and EMBASE databases were searched until 11 May 2018 for studies that evaluated the prognostic value of CA125 in AHF.

Results

A total of 129 and 179 entries were retrieved from PubMed and EMBASE. Sixteen studies (15 cohort studies, 1 randomised trial) including 8401 subjects with AHF (mean age 71 years old, 52% male, mean follow-up 13 months, range of patients 525.1±598.2) were included. High CA125 levels were associated with a 68% increase in all-cause mortality (8 studies, HRs: 1.68, 95% CI 1.36 to 2.07; p<0.0001; I²: 74%) and 77% increase in heart failure-related readmissions (5 studies, HRs: 1.77, 95% CI 1.22 to 2.59; p<0.01; I²: 73%). CA125 levels were higher in patients with fluid overload symptoms and signs compared with those without them, with a mean difference of 54.8 U/mL (5 studies, SE: 13.2 U/mL; p<0.0001; I²: 78%).

Conclusion

Our meta-analysis found that high CA125 levels are associated with AHF symptoms, heart failure-related hospital readmissions and all-cause mortality. Therefore, CA125 emerges as a useful risk stratification tool for identifying high-risk patients with more severe fluid overload, as well as for monitoring following an AHF episode.

Carbohydrate antigen 125: a promising tool for risk stratification in heart diseases

All patients with heart diseases should undergo risk stratification to predict those who are at high risk for short- and long-term adverse outcomes. Carbohydrate antigen 125 (CA125) is a glycoprotein produced by mesothelium that has clinical role in ovarian cancer monitoring. However, as it is not specific for ovarian cells, CA125 could also be used in heart diseases to monitor congestion and inflammation. Pericarditis, atrial fibrillation, heart failure and coronary artery disease are some scenarios in which this biomarker was studied.CA125 identifies patients at high risk of rehospitalizations and death, in addition to being associated with hemodynamic data (ejection fraction and right atrial pressure). Hence, CA125 is a tool for risk stratification in heart diseases.

Cancer antigen-125 and risk of atrial fibrillation: a systematic review and meta-analysis

Background

Cancer antigen-125 (Ca-125) is traditionally recognised as a tumour marker and its role in cardiovascular diseases has been studied only in recent years. Whether Ca-125 is elevated in patients with atrial fibrillation (AF) and its levels predict the risk of AF remains controversial. Therefore, we conducted a systematic review and meta-analysis of the association between Ca-125 levels and AF.

Methods

PubMed and EMBASE databases were searched until 1 June 2017 for studies that evaluated the association between Ca-125 and AF. Inclusion criteria included studies that compare Ca-125 in patients with and without AF, or those reporting HRs/ORs for risk of AF stratified by Ca-125 levels.

Results

A total of 39 entries were retrieved from the databases, of which 10 studies were included in the final meta-analysis. Ca-125 was significantly higher in patients with AF compared with those in sinus rhythm (mean difference=16 U/mL, 95% CI 2 to 30 U/mL, P<0.05; I²: 98%). Ca-125 significantly increased the risk of AF (HR: 1.39, 95% CI 1.06 to 1.82, P<0.05; I²: 84%).

Conclusion

Ca-125 was significantly higher in patients with AF than in those in sinus rhythm, and high Ca-125 is predictive of AF occurrence. However, the high heterogeneity observed means there is an uncertainty in the relationship between Ca-125 and AF, which needs to be confirmed by larger prospective studies.

Acute heart failure in the African American patient

BACKGROUND

African Americans (AAs) are disproportionately affected by acute heart failure (AHF) compared with other racial/ethnic groups. Disparities in AHF risk factors among AAs are attributed to higher rates of hypertension and diabetes mellitus, lower socioeconomic status, higher dietary caloric and salt intake, and biologic/genetic differences. However, AAs are frequently underrepresented in AHF clinical trials, and race-related differences in risks and clinical outcomes are not well understood.

OBJECTIVE

The aim of this work was to review published data on AHF in the AA population, including management strategies that may differ based on race and common barriers to optimal care.

METHODS

Publications were identified in Pubmed (through June 10, 2013) with the use of the search strategy terms (acute heart failure) AND (black OR African American OR racial).

RESULTS

Racial disparities in the quality of AHF care are relatively uncommon; however, racial differences in pathophysiology have resulted in differing pharmacologic recommendations (eg, isosorbide dinitrate plus hydralazine is indicated only in AAs). Various socioeconomic factors influence disease progression, treatment compliance, and hospitalization/rehospitalization rates.

CONCLUSIONS

Further research would enhance understanding of pathophysiologic heart failure differences between racial groups. Programs are needed that incorporate known clinical and cultural differences to improve quality of care and reduce the disease burden of AHF for all patients.

Tumor marker levels in patients aged 85 years and older with chronic heart failure

BACKGROUND

Recent studies have suggested that carbohydrate antigen 125 (CA 125) serum levels are remarkably elevated in patients with heart failure. We hypothesized that there was a relationship between serum levels of tumor markers and the four stages of chronic heart failure (CHF) in patients aged 85 years and older with CHF.

METHODS

The retrospective study enrolled 2115 patients aged 85 years and older suffering from CHF between January 2004 and January 2011. The levels of various tumor markers, N-terminal proB-type natriuretic peptide (NT-proBNP) in the different stages of CHF, and clinical risk factors were analyzed. All patients were followed for 180 days, and major cardiovascular events were recorded.

RESULTS

Only the CA 125 level increased as the stage of CHF increased (p<0.05) among the tumor markers. Significantly higher CA 125 serum levels were found in patients with pleural fluids or peripheral edema, compared with patients without pericardial effusion or peripheral edema (p<0.01). During 180 days of follow-up, CA 125 values were significantly higher in patients who died or were rehospitalized, compared with those who remained alive or did not undergo rehospitalization. Linear regression analysis between CA 125 and NT-proBNP serum levels showed a statistically significant relation (r=0.5103, p<0.05).

CONCLUSIONS

Among the tumor markers evaluated, only CA 125 appeared to be related to the severity of CHF and NT-proBNP, along with the presence of pleural fluid or peripheral edema in patients aged 85 years and older with CHF.

Long-term prognostic value of CA 125 serum levels in mild to moderate heart failure patients

BACKGROUND

Plasma levels of tumor marker carbohydrate 125 antigen (CA 125) have been found elevated among patients with advanced heart failure (HF). We evaluated the prognostic value of CA125 in a population of patients with mild to moderate HF.

METHODS AND RESULTS

Serum levels of CA 125 were obtained in 102 patients with mild to moderate HF from idiopathic (48%) or ischemic (52%) dilated cardiomyopathy (age 64 ± 10.4 years, left ventricular ejection fraction: 34.4 ± 8.5%), under optimized medical therapy. During follow-up (43 ± 15 months), 16 (15.7%) cardiovascular deaths and 23 (22.5%) cardiovascular deaths + HF hospitalizations were recorded. Considering cardiac death, comparison of Kaplan-Meier survival curves by the log-rank test showed that patients with CA 125 levels higher than the cut-off value (30 U/mL) had a worse survival (P < .0001). This was observed also when considering cardiovascular death+ HF hospitalizations as the secondary end point (P = .0003). Event-free survival was assessed by Kaplan-Meier method and log-rank test. Multivariable Cox proportional stepwise hazards regression analysis was performed and showed that CA 125 and systolic pulmonary artery pressure (sPAP) were significantly associated with the risk of cardiovascular deaths + HF hospitalizations (HR 1.01, 95% CI 1.02-1.06, and HR 1.07, 95% CI 1.02-1.1, P < .001, respectively).

CONCLUSIONS

In mild-to-moderate HF patients under optimized therapy, higher plasma CA 125 levels are an effective long-term prognostic marker in forecasting cardiovascular events and HF hospitalization and may contribute to a better risk stratification.

Tumour biomarkers in heart failure: is there a role for CA-125?

Tumour markers are used for the screening, diagnosis, and stratification of cancer disease. Recently, the potential role of some tumour markers has also been explored in the context of heart failure. These include CA-125, CA 15-3, CA 19-9, carcinoembryonic antigen, alpha-feto protein, tissue polypeptide antigen, tissue polypeptide specific antigen, cytokeratin 19 fragment, and chromogranins. Of these markers, CA-125, a tumour antigen that is expressed on the surface of ovarian cancer cells and which is a well-established biomarker for monitoring ovarian cancer growth, has been investigated most extensively. Trials have consistently indicated that CA-125 could serve as both a diagnostic and prognostic biomarker of heart failure, although the pathophysiology remains to be established. In this review paper we discuss the potential role of tumour markers in heart failure with a special focus on CA-125 within the context of recent trials.