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Menghoum N, Badii MC, Deltombe M, Lejeune S, Roy C, Vancraeynest D, Pasquet A, Gerber BL, Horman S, Gruson D, Beauloye C, Pouleur A. Carbohydrate antigen 125: a useful marker of congestion, fibrosis, and prognosis in heart failure with preserved ejection fraction. ESC Heart Fail 2024; 11:1493-1505. [PMID: 38339764 PMCID: PMC11098669 DOI: 10.1002/ehf2.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
AIMS Heart 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 RESULTS We 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. CONCLUSIONS CA 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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Affiliation(s)
- Nassiba Menghoum
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Maria Chiara Badii
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Matthieu Deltombe
- Department of Laboratory MedicineCliniques universitaires Saint‐LucBrusselsBelgium
| | - Sibille Lejeune
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Clotilde Roy
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
| | - David Vancraeynest
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Agnes Pasquet
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Bernhard L. Gerber
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Sandrine Horman
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Damien Gruson
- Department of Laboratory MedicineCliniques universitaires Saint‐LucBrusselsBelgium
| | - Christophe Beauloye
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Anne‐Catherine Pouleur
- Cardiovascular DepartmentCliniques universitaires Saint‐LucBrusselsBelgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC)Université Catholique de Louvain (UCLouvain)BrusselsBelgium
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Marinescu MC, Oprea VD, Munteanu SN, Nechita A, Tutunaru D, Nechita LC, Romila A. Carbohydrate Antigen 125 (CA 125): A Novel Biomarker in Acute Heart Failure. Diagnostics (Basel) 2024; 14:795. [PMID: 38667440 PMCID: PMC11048787 DOI: 10.3390/diagnostics14080795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Heart failure is a global major healthcare problem with millions of hospitalizations annually and with a very high mortality. There is an increased interest in finding new and reliable biomarkers for the diagnostic, prognostic and therapeutic guidance of patients hospitalized for acute heart failure; Our review aims to summarize in an easy-to-follow flow recent relevant research evaluating the possible use and the clinical value of measuring CA 125 serum levels in acute HF. METHODS A thorough search in the main international databases identified a relevant pool of 170 articles, providing recently published data for this narrative review that used PRISMA guidelines. RESULTS There are data to sustain the role of carbohydrate antigen 125 (CA 125), a worldwide used marker of ovarian cancer, in patients with heart failure. Several studies have shown links between CA 125 levels and congestion seen in acute heart failure, high mortality and readmission rates at 6 months follow-up after discharge from acute heart failure and also a role of CA 125 in the guidance of heart failure therapy. There are also clinical trials that showed that several particularities of CA 125 make it even better than N-terminal pro b-type natriuretic peptide (NT-pro BNP)-a classical and more utilized marker of heart failure) in several scenarios of acute heart failure. CONCLUSIONS Although the mechanism behind the upregulation of serum CA 125 in patients with congestive HF has not been confirmed nor fully understood.
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Affiliation(s)
- Mihai Cristian Marinescu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University in Galați, 800216 Galați, Romania; (S.N.M.); (A.N.); (D.T.); (L.C.N.); (A.R.)
- St. Apostle Andrei Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Violeta Diana Oprea
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University in Galați, 800216 Galați, Romania; (S.N.M.); (A.N.); (D.T.); (L.C.N.); (A.R.)
- St. Apostle Andrei Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Sorina Nicoleta Munteanu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University in Galați, 800216 Galați, Romania; (S.N.M.); (A.N.); (D.T.); (L.C.N.); (A.R.)
- St. Apostle Andrei Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University in Galați, 800216 Galați, Romania; (S.N.M.); (A.N.); (D.T.); (L.C.N.); (A.R.)
- St. Ioan Emergency Clinical Hospital for Children, 800487 Galați, Romania
| | - Dana Tutunaru
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University in Galați, 800216 Galați, Romania; (S.N.M.); (A.N.); (D.T.); (L.C.N.); (A.R.)
- St. Apostle Andrei Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Luiza Camelia Nechita
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University in Galați, 800216 Galați, Romania; (S.N.M.); (A.N.); (D.T.); (L.C.N.); (A.R.)
- St. Apostle Andrei Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurelia Romila
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University in Galați, 800216 Galați, Romania; (S.N.M.); (A.N.); (D.T.); (L.C.N.); (A.R.)
- St. Apostle Andrei Clinical Emergency County Hospital, 800578 Galați, Romania
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Ferreira JP, Packer M, Sattar N, Butler J, Pocock SJ, Anker SD, Maldonado SG, Panova-Noeva M, Sumin M, Masson S, Zannad F, Januzzi JL. Carbohydrate antigen 125 concentrations across the ejection fraction spectrum in chronic heart failure: The EMPEROR programme. Eur J Heart Fail 2024; 26:788-802. [PMID: 38439582 DOI: 10.1002/ejhf.3166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
AIM Vascular congestion may lead to an increase of carbohydrate antigen 125 (CA-125). The role of CA-125 as a biomarker of congestion or for prognosis across the full ejection fraction (EF) spectrum of chronic heart failure (HF) remains unknown. METHODS AND RESULTS Serum CA-125 was measured in 1111 study participants from the EMPEROR-Reduced and EMPEROR-Preserved trials. Congestive signs and symptoms were evaluated across CA-125 tertiles. Cox regression was used to study the association with outcomes. The primary outcome was a composite of first HF hospitalization or cardiovascular (CV) death. No significant association was present between baseline CA-125 levels and congestive signs or symptoms. In the overall population, higher CA-125 levels were not associated with an increased risk of primary outcome (tertile 3 vs. tertile 1: hazard ratio [HR] 1.34; 95% confidence interval [CI] 0.91-1.96; p-trend = 0.11). However, higher CA-125 levels were associated with an increased risk of primary outcome in patients with HF and reduced EF (HFrEF; tertile 3 vs. tertile 1: HR 2.25 [95% CI 1.30-3.89]), but not among patients with preserved EF (HFpEF; tertile 3 vs. tertile 1: HR 0.68 [95% CI 0.38-1.21]); interaction-p = 0.02). Patients in the upper CA-125 tertile also showed the steepest estimated glomerular filtration rate decline over time (p-trend = 0.03). The effect of empagliflozin to reduce the risk of CV death or HF hospitalization appeared to be attenuated in those with lower baseline CA-125 levels (interaction-p-trend = 0.09). CONCLUSION Across the range of EF in patients with chronic HF enrolled in the EMPEROR trials, the majority of whom did not have clinical evidence of congestion, CA-125 concentrations were not significantly associated with congestive signs or symptoms. CA-125 concentrations may predict HF hospitalization/CV death in patients with HFrEF, but not those with HFpEF. CLINICAL TRIAL REGISTRATION EMPEROR-Reduced (NCT03057977), EMPEROR-Preserved (NCT03057951).
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Affiliation(s)
- João Pedro Ferreira
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
- Centre d'Investigations Cliniques Plurithématique 14-33, Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Cardiovascular Research and Development Center, Université de Lorraine, Nancy, France
| | - Milton Packer
- Imperial College London, London, UK
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Stefan D Anker
- Center for Regenerative Therapies, Berlin Institute of Health, Department of Cardiology, German Centre for Cardiovascular Research, partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Mikhail Sumin
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Serge Masson
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
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Morillas H, Núñez J, Moliner P. Circulating levels of carbohydrate antigen 125 in chronic heart failure: Useful or futile? Eur J Heart Fail 2024; 26:803-805. [PMID: 38562007 DOI: 10.1002/ejhf.3212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Herminio Morillas
- Community Heart Failure Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Pedro Moliner
- Community Heart Failure Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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Fuster V. Editor-in-Chief's Top Picks From 2023. J Am Coll Cardiol 2024; 83:961-1026. [PMID: 38448128 DOI: 10.1016/j.jacc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Each week, I record audio summaries for every paper in JACC, as well as an issue summary. This process has become a true labor of love due to the time they require, but I am motivated by the sheer number of listeners (16M+), and it has allowed me to familiarize myself with every paper that we publish. Thus, I have selected the top 100 papers (Original Investigations, Review Articles, Society Documents, and the Global Burden of Diseases) from distinct specialties each year. In addition to my personal choices, I have included papers that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these abstracts in this issue of JACC, as well as their Central Illustrations∗ and podcasts. The highlights comprise the following sections: Aorta; Basic and Translational Science; Cardiac Failure, Myocarditis, and Pericarditis; Cardiomyopathies and Genetics; Congenital Heart Disease; Coronary, Peripheral, and Structural Interventions; Coronavirus; Health Promotion and Preventive Cardiology; Imaging; Metabolic and Lipid Disorders; Neurovascular Disease and Dementia; Rhythm Disorders and Thromboembolism; and Valvular Heart Disease.1-104 ∗ To view the full manuscript, including the full-sized Central Illustration, please refer to the original publication in JACC.
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Bayes-Genis A, de la Espriella R, Núñez J. CA125 for Fluid Overload Monitoring: A New Life for an Old Tool. J Am Coll Cardiol 2023; 82:158-160. [PMID: 37407114 DOI: 10.1016/j.jacc.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; Center for Biomedical Research in Cardiovascular Diseases Network (CIBERCV), Carlos III Institute of Health, Madrid, Spain.
| | - Rafael de la Espriella
- Center for Biomedical Research in Cardiovascular Diseases Network (CIBERCV), Carlos III Institute of Health, Madrid, Spain; Department of Cardiology, University Clinical Hospital, Institute of Health Research (INCLIVA), University of Valencia, Valencia, Spain
| | - Julio Núñez
- Center for Biomedical Research in Cardiovascular Diseases Network (CIBERCV), Carlos III Institute of Health, Madrid, Spain; Department of Cardiology, University Clinical Hospital, Institute of Health Research (INCLIVA), University of Valencia, Valencia, Spain
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