CA125 outperforms NT-proBNP in acute heart failure with severe tricuspid regurgitation.

Fecha de publicación: 01/01/2020

Autores de INCLIVA

Meritxell Soler Costa

Autor
Gema Miñana Escriva

Autor
Enrique Santas Olmeda

Autor
Rafael De La Espriella Juan

Autor
Ernesto Valero Picher

Autor
Vicent Bodí Peris

Autor
Francisco Javier Chorro Gascó

Autor
Agustín Fernández Cisnal

Autor
Juan Sanchis Fores

Autor
Julio Nuñez Villota

Autor

Participantes ajenos a INCLIVA

Nunez, Eduardo
D'Ascoli, Giulio
Marti-Cervera, Jorge
Bayes-Genis, Antoni

Grupos y Plataformas de I+D+i

Grupo de investigación en Cardiología Clínica

Leading Researcher

Juan Sanchis Fores
Grupo de Investigación en Electrofisiología cardiaca experimental

Leading Researcher

Antonio M. Alberola Aguilar
Grupo de Investigación en Insuficiencia Cardiaca

Established Researcher

Julio Nuñez Villota
Grupo de Investigación Traslacional en Cardiopatía Isquémica

Leading Researcher

Vicent Bodí Peris

Abstract

BACKGROUND: In acute heart failure (AHF) with right ventricular dysfunction, the roles of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) are poorly understood, and functional tricuspid regurgitation (TR) severity is thought to indicate a poor prognosis. We examined the prognostic abilities of NT-proBNP and CA125 according to TR status among patients with AHF.; METHODS: TR severity was assessed during index hospitalization (108±24h after admission) and classified as none/trivial, mild, moderate, or severe. Multivariable Cox regression analysis was performed to assess how pre-discharge CA125 and NT-proBNP were associated with long-term all-cause mortality relative to TR severity.; RESULTS: We prospectively included 2961 patients discharged following hospitalization for AHF (mean age 74±11years; 49.0% women; 51.8% with left ventricular ejection fraction >50%). Median NT-proBNP was 4823ng/L (IQR: 2086-9183) and CA125 was 58.1U/mL (IQR: 25-129). Severe TR was present in 300 patients (10.1%), and 1821 patients (61.5%) died (mean follow-up, 3.3±3.2years). Multivariate analysis revealed a differential prognostic effect across TR status for both biomarkers (p-value for both interactions<0.05). NT-proBNP was significantly linearly associated with mortality in non-severe TR (p<0.001), but not in severe TR (p=0.308). Higher CA125 values were significantly associated with mortality risk in all patients (HR: 1.09; 95% CI:1.03-1.14; p=0.001), with a greater effect in those with severe TR (HR: 1.28; 98% CI:1.11-1.48; p=0.001).; CONCLUSIONS: In patients with AHF and severe TR, CA125 outperforms NT-proBNP in predicting long-term mortality. In AHF with right ventricular involvement, CA125 may be the preferred biomarker for risk stratification. Copyright © 2020 Elsevier B.V. All rights reserved.