The Association Between Carbohydrate Antigen 125 and Clinical Severity of Heart Failure

Öz

Carbohydrate antigen (CA) 125 and brain natriuretic peptide (BNP) levels increase in patients with heart failure (HF). In this study, we aimed to investigate CA 125 and pro-BNP levels in patients with HF and evaluate possible relationship between these biomarkers and functional capacity. A total of 48 patients were involved in the study (28 men, 20 women). They were aged 67.6 years on average. HF was diagnosed based on medical history, physical examination, electrocardiography, telecardiography and transthoracic echocardiography. The clinical statuses of all patients were assigned by being used NYHA classification. Patients with HF were categorized into two groups according to NYHA classification: Group B was with mild-moderate HF (I and II) (a total of 20 patients, 12 men and 8 women, aged 65 on average) and Group A was with severe HF (III and IV) (a total of 28 patients, 16 men and 12 women, aged 70.2 on average). The mean age was 70.2 years and 65 years in Group A and Group B, (p = 0.078). The mean EF was 28±10% in Group A, while the mean EF was 32±11% in Group B (p=0.0012). Serum CA 125 and Pro BNP levels in group A (CA 125=176.38 U/ml, and Pro BNP=36465.06 pg/ml) were found significantly higher than those in group B (CA 125=50.7 U/ml and Pro BNP=122.65 pg/ml) (p<0.001). CA 125 and pro BNP are a promising biomarker in the assessment of heart failure patients. There was a statistically significant relationship between CA 125 serum level and HF stage.

Anahtar Kelimeler

• CA 125,Pro BNP,Heart failure,Left ventricle,Markers

Karbonhidrat Antijen 125 ve Kalp Yetersizliğinin Klinik Şiddeti Arasındaki İlişki

Öz

Kalp yetmezliği (KY) olan hastalarda karbonhidrat antijeni (CA) 125 ve brain natriüretik peptidi (BNP) seviyeleri artar. Bu çalışmada KY'li hastalarda CA 125 ve BNP düzeylerini araştırmayı ve bu biyomarkerlar ile fonksiyonel kapasite arasındaki olası ilişkiyi değerlendirmeyi amaçladık. Çalışmaya toplam 48 hasta dahil edildi (28 erkek, 20 kadın). Ortalama yaş 67.6.  KY tanısı, anamnez, fizik muayene, elektrokardiyografi, telekardiyografi ve transtorasik ekokardiyografi ile konuldu. Tüm hastaların klinik durumları NYHA sınıflandırması kullanılarak belirlendi. KY'li hastalar NYHA sınıflamasına göre iki gruba ayrıldı: B grubu hafif-orta KY' li (I ve II)   hastalar (toplam 20 hasta, 12 erkek ve 8 kadın, ortalama 65 yaş) ve A grubu ağır KY' li ( III ve IV) (toplam 28 hasta, 16 erkek ve 12 kadın, ortalama 70,2). Ortalama yaş Grup A ve Grup B'de 70.2 ve 65 idi (p=0.078). Ortalama EF, Grup A'da %28±10 iken, Ortalama EF, Grup B'de %32±11 idi (p=0.0012). Grup A'daki serum CA 125 ve Pro BNP düzeyleri (CA 125=176.38 U/ml ve Pro BNP=36465.06 pg/ml), B grubunda (CA 125=50.7 U/ml ve Pro BNP=122.65  pg/ml) anlamlı derecede yüksek bulundu. (p<0.001). CA 125 ve pro BNP, kalp yetmezliği hastalarının degerlendirmesinde umut verici bir biyobelirteçtir. CA 125 serum seviyesi ile HF evresi arasınsa istatistiksel anlamlı ilişki vardır.

Anahtar Kelimeler

• CA 125,Pro BNP,Kalp Yetmezliği,Sol Ventrikül,Marker

Kaynakça

1. 1. Bates SE. Clinical applications of serum tumor markers. Ann Intern Med. 1991;115:623-38.
2. 2. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol. 1996;14(10):2843-77.
3. 3. Antony W. Burch, Nicole A. Massol, Alex A. Pappas. Tumor markers in Clinical Chemistry. Principles, procedures, correlations. Michael L. Bishop Janet L. Duben, Engel Kirk Edward P. Fody, Eds. Lippincott Williams and Wilkins, Phledelphia, USA, 4th ed. 2000:522-36.
4. 4. Faggiano P, D’Aloia A, Brentana L, et al. Serum levels of different tumour markers in patients with cronic heart failure. Eur J Heart Fail. 2005;7(1):57-61.
5. 5. Faggiano P, D’Aloia A, Bignotti T, Dei Cas L. One biologic marker (carbohydrate antigen-CA 125), two different disease (ovarian cancer and congestive heart failure): practical implications of monitoring CA 125 serum levels. A case report. Ital Heart J. 2003;4(7):497-9.
6. 6. Hopman EH, Helmerhorst TJ, Bunfrer JM, Ten Bukkel Huinink WW. Highly elevated ± serum CA 125 levels in a patient with cardiac failure. Eur J Obstet Gynecol Reprod Biol. 1993;48:71-3.
7. 7. Nagele H, Bahlu M, Klapdor R, Schaeperkoeter D, Rfdiger W. CA 125 and its relation to cardiac function. Am Heart J. 1999;137:1044-9.
8. 8. Kouris N.T, Zcharos I. D,Kontogianni D. et al. The significance of CA 125 levels in patients with chronic congestive heart failure. Correlation with clinical and achocardiographic parameters. Eur J Heart Fail. 2005;7(2):199-203.

9. 9. Varol E, Özaydın M, Doğan A, Kaşar F. Tumour marker levels in patients with chronic heart failure. Eur J Heart Fail. 2005;7(5):840-3.
10. 10. Vizzardi E, D'Aloia A, Pezzali N, Bugatti S, Curnis A, Dei Cas L. Long-term prognostic value of CA 125 serum levels in mild to moderate heart failure patients. J Card Fail. 2012;18(1):68-73.
11. 11. Karaca O, Guler GB, Guler E. et al. Serum carbohydrate antigen 125 levels in nonischemic dilated cardiomyopathy: a useful biomarker for prognosis and functional mitral regurgitation. Congest Heart Fail. 2012;18(3):144-50.
12. 12. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440.
13. 13. Lavin PT, Knapp RC, Malkasion G, Whitney CW, Berek JC, Bast Jr RC. CA 125 for the monitoring of ovarian carcinoma during primary therapy. Obstet Gynecol. 1987;69:223-7.
14. 14. Seo T, Ikeda Y, Onaka H, et al. Usefulness of serum CA 125 measurement for monitoring pericardial effusion. Jpn Circ J. 1993;57(6):489-94.
15. 15. Spann JF, Bove AA, Natarajan G, Kreulen T. Ventricular performance, pump function and compensatory mechanisms in patients with aortic stenosis. Circulation. 1990;82:2075-82.
16. 16. Zacharos ID, Efstathiou SP, Petreli E, Georgiou G, Tsioulos DI, Mastorantonakis SE, Christakopoulou I, Rousou PP. The prognostic significance of CA 125 in patients with non-Hodgkin’s lymphoma. Eur J Haematol. 2002;69(4):221-6.
17. 17. Duman C, Ercan E, Tengiz I, Bozdemir H, Ercan HE, Nalbantgil I. Elevated serum CA 125 levels in mitral stenotic patients with heart failure. Cardiology. 2003;100(1):7-10.
18. 18. De Gennaro L, Brunetti ND, Bungara R, et al. CA- 125:additional accuray in identifing patients at risk of acute heart failure in acute coronary syndrome. Coron Artery Dis. 2009;20(4):274-80.
19. 19. D’Aloia A, Faggiano P, Aurigemma GP, et al. Serum levels of carbohydrate antigen 125 (CA 125) in patients with chronic heart failure. Relation with clinical severity, hemodynamic and Doppler echocardiographic abnormalities and short term prognosis. J Am Coll Cardiol. 2003;41(10):1805-11.
20. 20. Zhuang J, Faggiano P, Li Q, et al. Insights into the clinical implications of carbohydrate antigen 125 as a biomarker of heart failure: a meta-analysis and systematic review of published studies. J Cardiovasc Med (Hagerstown). 2014;15(12):864-72.
21. 21. Folga A, Filipiak KJ, Mamcarz A, Obrebska-Tabaczka E, Opolski G. Simultaneous predictive value of NT-proBNP and CA-125 in patients newly diagnosed with advanced heart failure: preliminary results. Arch Med Sci. 2012;8(4):637-43.
22. 22. Núñez J, Merlos P, Fácila L, et al. CHANCE-HF Investigators. Prognostic effect of carbohydrate antigen 125-guided therapy in patients recently discharged for acute heart failure (CHANCE-HF). Study design. Rev Esp Cardiol (Engl Ed). 2015;68(2):121-8.