[Benefits of statin therapy based on plasma carbohydrate antigen 125 values following an admission for acute heart failure]

Carbohydrate Antigen 125 Is a Biomarker of the Severity and Prognosis of Pulmonary Hypertension

Background: Emerging evidence has showed that serum carbohydrate antigen 125 (CA 125) levels are associated with the severity and prognosis of heart failure. However, its role in pulmonary hypertension remains unclear. This study aimed to investigate the clinical, echocardiographic, hemodynamic, and prognostic associations of CA 125 in pulmonary hypertension. Methods and Results: We conducted a retrospective cohort study of all idiopathic pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension patients receiving CA 125 measurement in Fuwai Hospital (January 1, 2014-December 31, 2018). The primary end-point was cumulative 1-year clinical worsening-free survival rate. Linear regression was performed to assess the association between CA 125 and clinical, echocardiographic, and hemodynamic parameters. Cox proportional hazards models were used to assess the association between CA 125 and clinical worsening events. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive performance of CA 125. A total of 231 patients were included. After adjustment, CA 125 still positively correlated with World Health Organization functional class, NT-proBNP, right ventricular end-diastolic diameter, pericardial effusion, mean right atrial pressure and pulmonary arterial wedge pressure; negatively correlated with 6-min walk distance, left ventricular end-diastolic diameter, mixed venous oxygen saturation, and cardiac index. After adjustment, CA 125 > 35 U/ml was associated with over 2 folds increased risk of 1-year clinical worsening. Further, ROC analysis showed that CA 125 provided additional predictive value in addition to the established pulmonary hypertension biomarker NT-proBNP. Conclusion: CA 125 was associated with functional status, echocardiography, hemodynamics and prognosis of pulmonary hypertension.

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.

Long-term serial kinetics of N-terminal pro B-type natriuretic peptide and carbohydrate antigen 125 for mortality risk prediction following acute heart failure

AIM

Baseline values of N-terminal pro B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) predict all-cause mortality in acute heart failure (AHF). However, there is limited information about the added prognostic benefit of using longitudinal values, and how this predictive ability is modified when modelling together. The aim of this study was to determine the mutually-adjusted association between the longitudinal trajectories of NT-proBNP and CA125 with all-cause mortality after an episode of AHF.

METHODS AND RESULTS

We included 946 consecutive patients discharged for AHF. NT-proBNP and CA125 were measured at each physician-patient encounter (median (interquartile range (IQR)):3 (2-4)). The effect on mortality (time-dependent modelling) was assessed using joint modelling (JM) and multi-state Markov. The mean age was 71±11 years and 51% exhibited left ventricular systolic dysfunction. At a median follow-up of 2.64 years (IQR=1.20-5.36), 498 patients died (52.6%). The observed trajectories of both biomarkers markedly differed over survival status, with sustained higher values in patients who died. After being adjusted by established risk factors and by each other, the baseline absolute change in CA125 and NT-proBNP were significantly associated to mortality (hazard ratio (HR)=1.05 (1.01-1.09); p=0.011 (area under the curve (AUC)=0.76) and HR=1.04 (1.02-1.06); p<0.001 (AUC=0.75), respectively). After merging the binary version of NT-proBNP (⩾1000 pg/ml) and CA125 (>35 U/ml) into a four-level variable, we found the highest risk when both were elevated, intermediate risk when either one was low, and lowest risk when both were low.

CONCLUSION

The combination of long-term longitudinal trajectories of CA125 and NT-proBNP improves risk stratification for all-cause mortality after a hospitalization for AHF.

Prognostic value of the interaction between galectin-3 and antigen carbohydrate 125 in acute heart failure

Aims

Galectin-3 (Gal-3) and carbohydrate antigen 125 (CA125) have emerged as robust prognostic biomarkers in heart failure. Experimental data have also suggested a potential molecular interaction between CA125 and Gal-3; however, the biological and clinical relevance of this interaction is still uncertain. We sought to evaluate, in patients admitted for acute heart failure, the association between plasma Gal-3 with all-cause mortality and the risk for rehospitalizations among high and low levels of CA125.

Methods and Results

We included 264 consecutive patients admitted for acute heart failure to the Cardiology Department in a third-level center. Both biomarkers were measured on admission. Negative binomial and Cox regression models were used to evaluate the prognostic effect of the interaction between Gal-3 and CA125 (dichotomized by its median) with hospital readmission and all-cause mortality, respectively. During a median follow-up of 2 years (IQR = 1-2.8), 108 (40.9%) patients deaths and 365 rehospitalizations in 171 (69.5%) patients were registered. In a multivariable setting, the effect of Gal-3 on mortality and rehospitalization was differentially mediated by CA125 (p = 0.007 and p<0.001, respectively). Indeed, in patients with CA125 above median (>67 U/ml), values across the continuum of Gal-3 showed a positive and almost linear relationship with either the risk of death or rehospitalization. Conversely, when CA125 was below median (≤67 U/ml), Gal-3 lacked any prognostic effect on both endpoints.

Conclusion

In patients with acute heart failure, Gal-3 was strongly associated with higher risk of long-term mortality and repeated rehospitalizations, but only in those patients exhibiting higher values of CA125 (above 67 U/ml).

Prognostic effect of carbohydrate antigen 125-guided therapy in patients recently discharged for acute heart failure (CHANCE-HF). Study design

INTRODUCTION AND OBJECTIVES

Morbidity and mortality after admission for acute heart failure remain prohibitively high. In that setting, plasma levels of antigen carbohydrate 125 have shown to correlate with the severity of fluid overload and the risk of mortality and readmission. Preliminary data suggests a potential role of antigen carbohydrate 125 to guide therapy. The objective of this study is to evaluate the prognostic effect of an antigen carbohydrate 125-guided management strategy vs standard therapy in patients recently discharged for acute heart failure.

METHODS

This is a multicenter, randomized, single-blind, efficacy trial study of patients recently discharged from acute heart failure (< 180 days), New York Heart Association functional class II-IV and antigen carbohydrate 125 > 35 U/ml. A randomization scheme was used to allocate participants (in a 1:1 ratio) to receive therapy guided by antigen carbohydrate 125 (aiming to keep normal values) or standard treatment. Mainly, antigen carbohydrate 125-guided therapy is focused on the frequency of monitoring and titration of decongestive therapies and statins. As of December 10, 2013, there were 383 patients enrolled. The primary outcome was the composite of 1-year all-cause mortality or rehospitalization for acute heart failure. Analysis was planned to be intention-to-treat.

CONCLUSIONS

Discovering novel therapeutic strategies or finding better ways of optimizing established treatments have become a health care priority in heart failure. This study will add important knowledge about the potential of antigen carbohydrate 125 as a management tool for monitoring and titration of therapies where optimal utilization has not been well defined, such as diuretics and statins.

TRIAL REGISTRATION

ClinicalTrials.gov number: NCT02008110.