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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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Formiga F, Nuñez J, Castillo Moraga MJ, Cobo Marcos M, Egocheaga MI, García-Prieto CF, Trueba-Sáiz A, Matalí Gilarranz A, Fernández Rodriguez JM. Diagnosis of heart failure with preserved ejection fraction: a systematic narrative review of the evidence. Heart Fail Rev 2024; 29:179-189. [PMID: 37861854 PMCID: PMC10904432 DOI: 10.1007/s10741-023-10360-z] [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] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a common condition in clinical practice, affecting more than half of patients with HF. HFpEF is associated with morbidity and mortality and with considerable healthcare resource utilization and costs. Therefore, early diagnosis is crucial to facilitate prompt management, particularly initiation of sodium-glucose co-transporter 2 inhibitors. Although European guidelines define HFpEF as the presence of symptoms with or without signs of HF, left ventricular EF ≥ 50%, and objective evidence of cardiac structural and/or functional abnormalities, together with elevated natriuretic peptide levels, the diagnosis of HFpEF remains challenging. First, there is no clear consensus on how HFpEF should be defined. Furthermore, diagnostic tools, such as natriuretic peptide levels and resting echocardiogram findings, are significantly limited in the diagnosis of HFpEF. As a result, some patients are overdiagnosed (i.e., elderly people with comorbidities that mimic HF), although in other cases, HFpEF is overlooked. In this manuscript, we perform a systematic narrative review of the diagnostic approach to patients with HFpEF. We also propose a comprehensible algorithm that can be easily applied in daily clinical practice and could prove useful for confirming or ruling out a diagnosis of HFpEF.
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Affiliation(s)
- Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, Spain.
| | - Julio Nuñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia-España, Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, Fundación de Investigación INCLIVA, Valencia, Spain
| | | | - Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Angel Trueba-Sáiz
- Medical Affairs Department, Eli Lilly and Company España, Alcobendas, Madrid, Spain
| | | | - José María Fernández Rodriguez
- Área Cardiorrenometabólica del Servicio de Medicina Interna del Hospital Universitario Ramon y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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Cobo Marcos M, de la Espriella R, Gayán Ordás J, Llàcer P, Pomares A, Fort A, Ponz de Antonio I, Méndez A, Blázquez-Bermejo Z, Caravaca Pérez P, Rubio Gracia J, Recio-Mayoral A, Zegrí I, García Pinilla JM, Montero Hernández E, Castro A, Soler MJ, Górriz JL, Bascompte Claret R, Fluvià-Brugués P, Manzano L, Núñez J. Prevalence and clinical profile of kidney disease in patients with chronic heart failure. Insights from the Spanish cardiorenal registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:50-59. [PMID: 37217135 DOI: 10.1016/j.rec.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with combined heart failure (HF) and chronic kidney disease (CKD) have been underrepresented in clinical trials. The prevalence of CKD in these patients and their clinical profile require constant evaluation. This study aimed to analyze the prevalence of CKD, its clinical profile, and patterns of use of evidence-based medical therapies in HF across CKD stages in a contemporary cohort of ambulatory patients with HF. METHODS From October 2021 to February 2022, the CARDIOREN registry included 1107 ambulatory HF patients from 13 HF clinics in Spain. RESULTS The median age was 75 years, 63% were male, and 48% had heart failure with reduced left ventricular ejection fraction (HFrEF). A total of 654 (59.1%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and 122 (11%) patients with eGFR ≥ 60 mL/min/1.73 m2 had a urine albumin-creatinin ratio ≥ 30 mg/g. The most important variables associated with lower eGFR were age (R2=61%) and furosemide dose (R2=21%). The proportion of patients receiving an angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blockers (ARB), an angiotensin receptor-neprilysin inhibitor (ARNi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), or a mineralocorticoid receptor antagonist (MRA) progressively decreased with lower eGFR categories. Notably, 32% of the patients with HFrEF and an eGFR <30 mL/min/1.73 m2 received the combination of ACEI/ARB/ARNi+beta-blockers+MRA+SGLT2i. CONCLUSIONS In this contemporary HF registry, 70% of patients had kidney disease. Although this population is less likely to receive evidence-based therapies, structured and specialized follow-up approaches within HF clinics may facilitate the adoption of these life-saving drugs.
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Affiliation(s)
- Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jara Gayán Ordás
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Antonia Pomares
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aleix Fort
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | - Ana Méndez
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | - Jorge Rubio Gracia
- Servicio de Medicina Interna, Hospital Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | | | - Isabel Zegrí
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Esther Montero Hernández
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain
| | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - María José Soler
- Servicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Ramón Bascompte Claret
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
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Amiguet M, Palau P, Domínguez E, Seller J, Pinilla JMG, de la Espriella R, Miñana G, Valle A, Sanchis J, Górriz JL, Bayés-Genís A, Núñez J. Dapagliflozin and short-term changes on circulating antigen carbohydrate 125 in heart failure with reduced ejection fraction. Sci Rep 2023; 13:10591. [PMID: 37391470 PMCID: PMC10313805 DOI: 10.1038/s41598-023-37491-5] [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: 10/26/2022] [Accepted: 06/22/2023] [Indexed: 07/02/2023] Open
Abstract
Circulating antigen carbohydrate 125 (CA125) has emerged as a proxy of fluid overload in heart failure. This study aimed to evaluate the effect of dapagliflozin on short-term CA125 levels in patients with stable heart failure with reduced ejection fraction (HFrEF) and whether these changes mediated the effects on peak oxygen consumption (peakVO2). This study is a post-hoc sub-analysis of a randomized, double-blinded clinical trial in which 90 stable patients with HFrEF were randomly assigned to receive either dapagliflozin or placebo to evaluate change in peakVO2 (NCT04197635). We used linear mixed regression analysis to compare changes in the natural logarithm of CA125 (logCA125) and percent changes from baseline (Δ%CA125). We used the "rwrmed" package to perform mediation analyses. CA125 was available in 87 patients (96.7%). LogCA125 significantly decreased in patients on treatment with dapagliflozin [1-month: Δ - 0.18, (CI 95% = - 0.33 to - 0.22) and 3-month: Δ - 0.23, (CI 95% = - 0.38 to - 0.07); omnibus p-value = 0.012]. Δ%CA125 decreased by 18.4% and 31.4% at 1 and 3-month, respectively (omnibus p-value = 0.026). Changes in logCA125 mediated the effect on peakVO2 by 20.4% at 1 month (p < 0.001). We did not find significant changes for natural logarithm of NTproBNP (logNT-proBNP) [1-month: Δ - 0.03, (CI 95% = - 0.23 to 0.17; p = 0.794), and 3-month: Δ 0.73, (CI 95% = - 0.13 to 0.28; p-value 0.489), omnibus p-value = 0.567]. In conclusion, in patients with stable HFrEF, dapagliflozin resulted in a significant reduction in CA125. Dapagliflozin was not associated with short-term changes in natriuretic peptides. These changes mediated the effects on peakVO2.
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Affiliation(s)
| | - Patricia Palau
- Cardiology Department, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.
| | | | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Jose Manuel Garcia Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Malaga, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Rafael de la Espriella
- Cardiology Department, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Juan Sanchis
- Cardiology Department, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Jose Luis Górriz
- Nephrology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain
- Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.
- CIBER Cardiovascular, Madrid, Spain.
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Núñez-Marín G, Iraola D, Lorenzo M, de la Espriella R, Villar S, Santas E, Miñana G, Sanchis J, Carratalá A, Miró Ò, Bayés-Genís A, Núñez J. An update on utilising brain natriuretic peptide for risk stratification, monitoring and guiding therapy in heart failure. Expert Rev Mol Diagn 2023:1-13. [PMID: 37216616 DOI: 10.1080/14737159.2023.2216386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Heart failure (HF) is a dominant health problem with an overall poor prognosis. Natriuretic peptides (NPs) are upregulated in HF as a compensatory mechanism. They have extensively been used for diagnosis and risk stratification. AREAS COVERED This review addresses the history and physiology of NPs in order to understand their current role in clinical practice. It further provides a detailed and updated narrative review on the utility of those biomarkers for risk stratification, monitoring, and guiding therapy in HF. EXPERT OPINION NPs show excellent predictive ability in heart failure patients, both in acute and chronic settings. Understanding their pathophysiology and their modifications in specific situations is key for an adequate interpretation in specific clinical scenarios in which their prognostic value may be weaker or less well evaluated. To better promote risk stratification in HF, NPs should be integrated with other predictive tools to develop multiparametric risk models. Both inequalities of access to NPs and evidence caveats and limitations will need to be addressed by future research in the coming years.
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Affiliation(s)
- Gonzalo Núñez-Marín
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Diego Iraola
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Arturo Carratalá
- Clinical Chemistry Department, Hospital Clínico Universitario, INCLIVA
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germas Trias i Pujol. Badalona, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Zhang J, Li W, Xiao J, Hui J, Li Y. Prognostic significance of carbohydrate antigen 125 in stage D heart failure. BMC Cardiovasc Disord 2023; 23:108. [PMID: 36841766 PMCID: PMC9960178 DOI: 10.1186/s12872-023-03139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND The predictive value of carbohydrate antigen 125 (CA125) has not been examined in stage D heart failure (HF) patients, regardless of left ventricular ejection fraction (LVEF). We sought to quantify the prognostic usefulness in predicting death and HF readmission in this cohort. METHODS According to CA125 levels above and below the median (65.7 U/ml), 176 stage D HF patients including more than half (50.6%) had LVEF > 40% were divided into 2 groups. RESULTS A total of 106 (60.2%) deaths and 102 deaths due to the cardiovascular disease were identified. All-cause death/HF readmission and MACE occurred in 157 patients (89.2%) during 18 months (16-20) of follow-up. By the Kaplan-Meier method, subjects with CA125 ≥ 65.7 U/ml exhibited higher 1-year mortality rate (59.3% vs. 31.0%, P < 0.001) and 1-year death/HF rehospitalization rate (94.2% vs. 80.6%, P < 0.001). In univariate Cox analysis, CA125 (categorized) was a significant prognostic factor for all-cause death, cardiovascular mortality, death/HF readmission and MACE. Based on multivariate Cox analysis, elevated CA125 was still significant for all-cause death, cardiovascular mortality, death/HF readmission and MACE. CONCLUSIONS In stage D HF patients, elevated CA125 levels were highly predictive of all-cause death, cardiovascular mortality, all-cause death/HF readmission and MACE, which can be used for better risk stratification.
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Affiliation(s)
- Ji Zhang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, No. 2, Yongning Road, Changzhou, Jiangsu Province, China.
| | - Wenhua Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, No. 2, Yongning Road, Changzhou, Jiangsu Province, China
| | - Jianqiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, No. 2, Yongning Road, Changzhou, Jiangsu Province, China
| | - Jie Hui
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Li
- School of Math and Statistics, Nanjing Audit University, Nanjing, China
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