Role of carbohydrate antigen 125 in predicting right ventricular dysfunction and right ventricular to pulmonary artery uncoupling in acute heart failure
J Montiel Perez, E Valero, R De La Espriella, G Minana, E Santas, E Rumiz, G Nunez, M Lorenzo, A Mollar, A Bayes-Genis, V Bodi, J Sanchis, J NunezAbstract
Background
Right ventricular dysfunction (RVD) and right ventricular to pulmonary artery (RV-PA) uncoupling predict outcomes in heart failure, but accurate assessment relies on cardiac magnetic resonance (CMR). We evaluated whether serum carbohydrate antigen 125 (CA125) identifies CMR-derived RVD and RV-PA uncoupling in acute heart failure (AHF).
Methods
This retrospective single-center study included 479 consecutive AHF patients who underwent CMR. RVD was defined as RV ejection fraction <45% and RV-PA uncoupling as RV stroke volume/RV end-systolic volume <1. Discriminatory accuracy was assessed by ROC analysis and multivariable logistic regression.
Results
Mean age was 67.7±12.3 years, 65.6% were men, and 78.5% had LVEF<50%. RVD was present in 178 patients (37.2%) and RV-PA uncoupling in 221 (46.1%). Median CA125 levels were significantly higher in both RVD (121.5 vs. 53.5 U/mL, p<0.001) and RV-PA uncoupling (114 vs. 49 U/mL, p<0.001). CA125 showed moderate discriminatory ability for RVD (AUC 0.684, 95% CI 0.635–0.734) and RV-PA uncoupling (AUC 0.682, 95% CI 0.634-0.730), outperforming NT-proBNP (AUC 0.605 and 0.593; p<0.05). In multivariable analysis, CA125 remained the only independent predictor associated with both CMR indices (p<0.001). Adding CA125 to TAPSE or NT-proBNP significantly improved reclassification (continuous NRI 31-38%, IDI 3-4%; all p<0.05).
Conclusions
In AHF patients undergoing CMR, serum CA125 levels were independently associated with RVD and RV-PA uncoupling, outperforming NT-proBNP and adding value beyond conventional markers. CA125 may help identify RV dysfunction in AHF.Diagnostic accuracy for RVD & RV-PA uncFor image description, please refer to the figure legend and surrounding text.Association of CA125 with RVD % RV-PA unFor image description, please refer to the figure legend and surrounding text.