Congestion Biomarker CA125 Signals Worse Outcomes in Ambulatory HFrEF

5 Jul 2023 • Carbohydrate antigen 125 (CA125), a biomarker that initially emerged in the setting of ovarian cancer and has since been studied in acute heart failure(HF) as a marker of congestion, appears to provide important prognostic information in patients with chronic ambulatory heart failure with reduced ejection fraction (HFrEF), according to a post hoc analysis of the DAPA-HF trial published in the Journal of the American College of Cardiology.

Patients with high levels of CA125 at baseline were more likely to have a first episode of worsening HF or cardiovascular death (primary outcome) than were those with lower levels, even after adjustment for NT-proBNP and other biomarkers.

  • Overall, 3,123 of the 4,774 trial participants had available data on CA125 measured at baseline and/or 12 months. The median CA125 level at baseline was 13.04 U/mL, with 12.2% coming in above 35 U/mL (upper limit of normal).
  • As anticipated, an elevated CA125 level was associated with findings suggestive of more-severe HF, including higher natriuretic peptide levels and more-frequent reports of peripheral edema.
  • In addition, higher CA125 levels were associated with worse clinical outcomes regardless of how the analysis was performed
  • As for the beneficial impact of dapagliflozin over the course of the DAPA-HF trial, it remained consistent regardless of baseline CA125 level for the primary outcome, secondary morbidity/mortality outcomes, and the total symptom score.

CA125 or NT-proBNP? Asked about the relative utility of CA125 versus NT-proBNP, study authors said the latter is a good marker of elevated left-sided filling pressures, whereas there is some evidence to suggest that CA125 is a better marker of elevated right-sided filling pressures.

Using CA125 in Daily Practice The study provides evidence that CA125 is a good biomarker of congestion that can be used to monitor worsening heart failure or monitor patients as they transition home after discharge. It may also improve the assessment of prognosis in these patients, even on top of information on natriuretic peptides.

Source: tctMD | Read full story

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