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CLINICAL RESEARCH

Serum levels of carbohydrate antigen 125 in patients with chronic heart failure

Relation to clinical severity, hemodynamic and Doppler echocardiographic abnormalities, and short-term prognosis

Antonio D’Aloia, MD^*, Pompilio Faggiano, MD^,*, Gerard Aurigemma, MD, FACC, Luca Bontempi, MD^*, Giuseppina Ruggeri, MD, Marco Metra, MD^*, Savina Nodari, MD^* and Livio Dei Cas, MD^*

^* Cattedra di Cardiologia, Università di Brescia, Brescia, Italy
Unità Operativa di Policardiografia, Brescia, Italy
III Laboratorio di Analisi, Spedali Civili, Brescia, Italy
Cardiology Division, University of Worcester, Worcester, Massachusetts, USA

Manuscript received November 4, 2002; revised manuscript received January 18, 2003, accepted February 6, 2003.

^* Reprint requests and correspondence: Dr. Pompilio Faggiano, Spedali Civili, Unità Operativa di Policardiografia, Via S. Antonio 6, Brescia, Italy 25133.
faggiano{at}numerica.it

OBJECTIVES: The aim of this study was to evaluate the serum levels of carbohydrate antigen 125 (CA125) in patients with congestive heart failure (CHF).

BACKGROUND: CA125 is a glycoprotein produced by serosal epithelium, found to be increased in ovarian cancer.

METHODS: Serum levels of CA125 were obtained in 286 patients (122 males and 164 females; age 69 ± 13 years) with CHF (left ventricular ejection fraction 30 ± 11%). A non-invasive evaluation was obtained by Doppler echocardiography; right heart catheterization was performed in 88 patients. An attempt to adjust medical therapy to maximally tolerated doses was done, and CA125 was repeated after 18 days (range 7 to 40) in 80 patients. The mean follow-up duration was 6 ± 3 months in 240 patients.

RESULTS: The mean value of CA125 was 68 ± 83 U/ml (range 3 to 537): 71 ± 85 in men and 56 ± 64 U/ml in women (p = NS). CA125 above the normal value (<35 U/ml) was found in 152 (53%) of 286 patients; it was higher in patients with advanced New York Heart Association (NYHA) functional class (n = 140 in class I/II: 15 ± 9 U/ml; n = 63 in class III: 57 ± 18 U/ml; n = 83 in class IV: 167 ± 94 U/ml; p < 0.005). CA125 was related to the deceleration time of early filling on transmitral Doppler (r = –0.63, p < 0.05) and to pulmonary artery wedge pressure (r = 0.66, p < 0.05) and right atrial pressure (r = 0.69, p < 0.05). During 6 ± 3 months of follow-up, a combined end point of mortality and CHF hospitalization was observed in 16 of 127 patients with CA125 <35 U/ml, compared with 70 of 113 patients with CA125 >35 U/ml (p < 0.01). After medical treatment optimization, NYHA class decreased by more than one grade in 56 of 80 patients and was unchanged or increased in 24 patients: CA125 decreased from 125 ± 98 to 53 ± 61 U/ml (p < 0.001) in the former and changed from 130 ± 81 to 153 ± 61 U/ml (p = NS) in the latter.

CONCLUSIONS: Our data suggest that CA125 is related to CHF severity and short-term prognosis. Furthermore, fluctuations of CA125 serum levels over time may reflect changes induced by therapy. Therefore, measurements of CA 125 serum levels might be proposed for the serial assessment of CHF patients.

Abbreviations and Acronyms   BNP   brain natriuretic peptide   CA125   carbohydrate antigen 125   CHF   congestive heart failure   DT   deceleration time of early filling   LVEDD   left ventricular end-diastolic diameter   LVEF   left ventricular ejection fraction   NYHA   New York Heart Association   PAWP   pulmonary artery wedge pressure   RAP   right atrial pressure   RHC   right heart catheterization

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