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Beyond NT-proBNP: Ca-125
Session:
Sessão de Posters 21 - Insuficiência cardíaca aguda
Speaker:
Joana Sousa Varela
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
11. Acute Heart Failure
Subtheme:
11.7 Acute Heart Failure - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Joana De Sousa Varela; Nazar Ilchyshyn; Otília Simões; Ana Catarina Gomes; Bruno Sousa; Catarina Valadão; Mário Amaro; Maria Francisca Delerue; Hélder Pereira
Abstract
<p style="text-align:justify"><strong>Introduction: </strong>Recent studies have identified Ca-125 as a biomarker for congestion and prognosis. Ca-125 demonstrates a correlation with serosal effusions and peripheral edema, potentially holding greater significance compared to NT-pro-BNP in cases involving right heart predominant heart failure (HF).</p> <p style="text-align:justify"><strong>Purpose: </strong>The objective was to assess the potential correlation with right versus left-dominant congestion, the association with the severity of tricuspid regurgitation (TR) and the association with the risk of hospital readmission and mortality.</p> <p style="text-align:justify"><strong>Methods: </strong>A prospective study involving 89 hospitalized patients with the diagnosis of HF in hemodynamic profile B between February and November 2023. Demographic, clinical, analytic, echocardiographic and outcome data were collected. Serum levels of Ca-125 and NTproBNP were obtained within the initial 3 days of admission. Elevated Ca-125 levels were defined as > 35 U/mL, while NT-proBNP levels were interpreted according to the 2021 ESC guidelines. We investigated the association between Ca-125 and NT-proBNP with HF predominance patterns, TR severity and other relevant parameters.</p> <p style="text-align:justify"><strong>Results: </strong>The analyzed group presented a median age of 75 (IQR: 15.5) years and 64% were male. Half of patients (50.6%) had a preserved left ventricle ejection fraction (LVEF), 36% had moderate to severe LVEF depression and 13.6% had mildly reduced LVEF.</p> <p style="text-align:justify">Elevated Ca-125 was significantly associated with right heart predominant HF (211.5 (IQR: 325.3) vs 58.4 (IQR:103.7) in non-right HF, p< 0.001), the presence of moderate and severe TR (Ca-125 – 93.7 (IQR: 207.1) vs 39.6 (IQR: 88) U/mL in mild TR, p < 0.001) and peripheral edema above the the knees (135.7 (IQR:137.3) vs 26.1 (IQR: 54.3) U/mL below the knees, p < 0.001). Lower levels were associated with left heart predominant HF (25.9 (IQR: 26.7) U/mL vs 132.5 (IQR: 137.3) in non-left HF, p< 0.001).</p> <p style="text-align:justify">The predictive accuracy analysis demonstrated superior performance of Ca-125 compared to NT-proBNP for right heart HF (AUC 0.83 vs. 0.61, p = 0.02 – image.1). Both biomarkers exhibited robust negative predictive accuracy for left heart HF (AUC 0.11 and 0.18, respectively) and positive predictive accuracy for moderate or severe TR (AUC 0.71 and 0.73, respectively).</p> <p style="text-align:justify">Unlike NT-proBNP, Ca-125 elevation exhibited a statistical trend towards increase in hospital readmissions and all-cause mortality at follow-up (94.5 (QRS: 152.3) vs 67.1 (IQR: 132) U/mL, p= 0.072). Elevated CA125 and NTproBNP independently associated with both right (p = 0.001 and p < 0.001, respectively) and left HF (p = 0.001 and p < 0.001, respectively).</p> <p style="text-align:justify"><strong>Conclusion:</strong> Ca-125 demonstrated superior predictive accuracy for right heart HF compared to NT-pro-BNP. The findings suggest Ca-125 potential as a valuable biomarker in assessing ventricular involvement and TR severity, paving the way for improved prognostication.</p>
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