Elevated CA125 values predict adverse outcomes in acute heart failure.
Valores elevados de CA125 predicen resultados adversos en la insuficiencia cardíaca aguda.
Palabras clave:
antígeno carbohidrato 125, predicción del riesgo, péptido natriurético tipo pro-B N-terminal, insuficiencia cardíaca aguda
Resumen
En la insuficiencia cardíaca aguda, se ha demostrado que el antígeno de carbohidratos 125 (CA125) elevado y el péptido natriurético tipo B N-terminal (NTproBNP) se correlacionan con eventos adversos. Intentamos cuantificar su utilidad pronóstica al predecir el punto final combinado de 6 meses de readmisión por muerte/insuficiencia cardíaca. El estudio incluyó a 352 pacientes ingresados por insuficiencia cardíaca aguda. El punto final principal fue el punto final combinado de 6 meses de muerte/rehospitalización aguda. CA125 y NTPROBNP se dicotomizaron de acuerdo con los mejores límites para predecir el punto final primario de 6 meses. La asociación independiente de CA125 y NTPROBNP con el punto final primario se evaluó mediante análisis multivariado de regresión de Cox, y su utilidad pronóstica incremental se evaluó mediante la mejora de la reclasificación neta (NRI) y el índice de mejora de la discriminación integrada (IDI). En el seguimiento a los 6 meses se identificaron un total de 47 (13,4%) muertes y 113 (32,1%) rehospitalizaciones por insuficiencia cardíaca aguda. Los sujetos con CA125≥39,7 U/mL y NTproBNP≥3900 pg/mL presenta-ron tasas de acontecimientos acumulativos significativamente más altas (56,1% frente a 33,3% y 53,3% frente a 33,8%, p<0,001 en ambos casos). CA125 elevado (HR: 1,93; IC del 95% [1,32-2,83]; p = 0,001) se asoció con un HR superior al NTproBNP ≥3900 pg/mL (HR 1,71; IC del 95% [1,19-2,48]; p = 0,004) después del ajuste por los factores de riesgo establecidos. CA125 elevado aún predijo de forma independiente los acontecimientos adversos cuando tanto CA125 como NTproBNP se introdujeron juntos en el mismo modelo multivariante. Además, los análisis de reclasificación del riesgo demostraron mejoras significativas en el NRI del 22,3% (p = 0,014) y en el IDI del 2,7% (p = 0,012) al añadir CA125 al modelo base + NTproBNP. Los niveles elevados de CA125 y NTproBNP predijeron los resultados adversos en los pacientes con insuficiencia cardíaca aguda. CA125 añadió valor pronóstico al NTproBNP y, por lo tanto, su combinación confirió una mayor capacidad predictiva.
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Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, Testani JM, Tang WHW, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ. The use of diuretics in heart failure with congestion a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(2):137-155. doi:10.1002/ejhf.1369.
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Zhang J, Li W, Xiao J, Hui J, Li Y. Prognostic significance of carbohydrate antigen 125 in stage D heart failure. BMC Cardiovasc Disord 2023; 23:108. Published 2023 Feb 25. doi:10.1186/s12872-023-03139-5.
Núñez J, Llàcer P, García-Blas S, Bonanad C, Ventura S, Núñez JM, Sánchez R, Fácila L, de la Espriella R, Vaquer JM, Cordero A, Roqué M, Chamorro C, Bodi V, Valero E, Santas E, Moreno MDC, Miñana G, Carratalá A, Rodríguez E, Mollar A, Palau P, Bosch MJ, Bertomeu-González V, Lupón J, Navarro J, Chorro FJ, Górriz JL, Sanchis J, Voors AA, Bayés-Genís A. CA125-guided diuretic treatment versus usual care in patients with acute heart failure and renal dysfunction. Am J Med 2020; 133:370-380.e4. doi:10.1016/j.amj-med.2019.07.041
Felker GM, Anstrom KJ, Adams KF, Eze-kowitz JA, Fiuzat M, Houston-Miller N, Januzzi JL Jr, Mark DB, Piña IL, Passmore G, Whellan DJ, Yang H, Coo-per LS, Leifer ES, Desvigne-Nickens P, O’Connor CM. Effect of natriuretic pep-tide-guided therapy on hospitalization or cardiovascular mortality in high-risk pa-tients with heart failure and reduced ejec-tion fraction: A randomized clinical trial. JAMA 2017; 318:713-720. doi:10.1001/jama.2017.10565.
Dunlay SM, Roger VL, Killian JM, Weston SA, Schulte PJ, Subramaniam AV, Blecker SB, Redfield MM. Advanced heart failure epidemiology and outcomes: a population-based study. JACC Heart Fail 2021; 9:722-732. doi: 10.1016/j.jchf.2021.05.009.
Lorenzo M, Palau P, Llàcer P, Domín-guez E, Ventura B, Núñez G, Miñana G, Solsona J, Santas E, De La Espriella R, Bodí V, Núñez E, Sanchis J, Bayés-Genís A, Núñez J. Clinical utility of antigen carbohydrate 125 for planning the optimal length of stay in acute heart failure. Eur J Intern Med 2021; 92:94-99. doi: 10.1016/j.ejim.2021.05.037.
Clerico A, Carlo Zucchelli G, Pilo A, Pas-sino C, Emdin M. Clinical relevance of biological variation: the lesson of brain na-triuretic peptide (BNP) and NT-proBNP as-say. Clin Chem Lab Med 2006; 44:366-378. doi:10.1515/CCLM.2006.063.
Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Challenging the two concepts in determining the appropriate pre-discharge N-terminal pro-brain natriuretic peptide treatment target in acute decompensated heart failure patients: absolute or relative discharge levels? Eur J Heart Fail 2015; 17:936-44. doi:10.1002/ejhf.320.
Kociol RD, Horton JR, Fonarow GC, Reyes EM, Shaw LK, O’Connor CM, Felker GM, Hernandez AF. Admission, discharge, or change in B-type natriuretic peptide and long-term outcomes: data from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) linked to Medicare claims. Circ Heart Fail 2011; 4:628-36. doi:10.1161/CIRCHEARTFAILU RE.111.962290.
Aleksova A, Paldino A, Beltrami AP, Padoan L, Iacoviello M, Sinagra G, Emdin M, Maisel AS. Cardiac biomarkers in the emergency department: the role of soluble ST2 (sST2) in acute heart failure and acute coronary syndrome-There is meat on the bone. J Clin Med 2019; 8:270. doi:10.3390/jcm8020270.
van Vark LC, Lesman-Leegte I, Baart SJ, Postmus D, Pinto YM, Orsel JG, Westenbrink BD, Brunnerla Rocca HP, van Miltenburg AJM, Boersma E, Hillege HL, Akkerhuis KM; TRIUMPH Investigators. Prognostic value of Serial ST2 measure-ments in patients with acute heart failure. J Am Coll Cardiol 2017; 70:2378-2388. doi:10.1016/j.jacc.2017.09.026.
Morrow DA, Velazquez EJ, DeVore AD, Prescott MF, Duffy CI, Gurmu Y, McCague K, Rocha R, Braunwald E. Cardiovascular biomarkers in patients with acute decompensated heart failure randomized to sacubitril-valsartan or enalapril in the PIONEER-HF trial. Eur Heart J 2019; 40:3345- 3352. doi:10.1093/eurheartj/ehz240.
Peacock WF 4th, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, Wu AH; ADHERE Investigators. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008; 358:2117-1126. doi:10.1056/NEJMoa0706824.
Felker GM, Mentz RJ, Teerlink JR, Voors AA, Pang PS, Ponikowski P, Greenberg BH, Filippatos G, Davison BA, Cotter G, Prescott MF, Hua TA, Lopez-Pintado S, Severin T, Metra M. Serial high sensitivity cardiac troponin T measurement in acute heart failure: insights from the RELAX- AHF study. Eur J Heart Fail 2015; 17:1262- 1670. doi:10.1002/ejhf.341.
Núñez J, Bayés-Genís A, Revuelta-López E, Ter Maaten JM, Miñana G, Barallat J, Cserkóová A, Bodi V, Fernández-Cisnal A, Núñez E, Sanchis J, Lang C, Ng LL, Metra M, Voors AA. Clinical role of CA125 in worsening heart failure: A BIOSTAT-CHF Study Subanalysis. JACC Heart Fail 2020; 8:386-397. doi:10.1016/j.jchf.2019.12.005.
Núñez J, Sanchis J, Bodí V, Fonarow GC, Núñez E, Bertomeu-González V, Miñana G, Consuegra L, Bosch MJ, Carratalá A, Chorro FJ, Llàcer A. Improvement in risk stratification with the combination of the tumour marker antigen carbohydrate 125 and brain natriuretic peptide in patients with acute heart failure. Eur Heart J 2010; 31:1752-1763. doi:10.1093/eurheartj/ehq142.
Marcus CS, Maxwell GL, Darcy KM, Hamilton CA, McGuire WP. Current approaches and challenges in managing and monitoring treatment response in ovarian cancer. J Cancer 2014; 5:25-30. doi:10.7150/jca.7810.
Núñez J, Llàcer P, Bertomeu-González V, Bosch MJ, Merlos P, García-Blas S, Montagud V, Bodí V, Bertomeu-Martínez V, Pedrosa V, Mendizábal A, Cordero A, Gallego J, Palau P, Miñana G, Santas E, Morell S, Llàcer A, Chorro FJ, Sanchis J, Fácila L; CHANCE-HF Investigators. Carbohydrate Antigen-125-Guided Therapy in Acute Heart Failure: CHANCE-HF: A Randomized Study. JACC Heart Fail 2016; 4:833-843. doi:10.1016/j.jchf.2016.06.007.
Rheude T, Pellegrini C, Schmid H, Trenkwalder T, Mayr NP, Joner M, Kasel AM, Holdenrieder S, Nunez J, Sanchis J, Bodi V, Schunkert H, Kastrati A, Hengstenberg C, Husser O. Comparison of carbohydrate antigen 125 and N-Terminal pro-brain natriuretic peptide for risk prediction after transcatheter aortic valve implantation. Am J Cardiol 2018; 121:461-468. doi:10.1016/j.amjcard.2017.11.020.
Falcão F, Oliveira F, Cantarelli F, Cantarelli R, Brito Júnior P, Lemos H, Silva P, Camboim I, Freire MC, Carvalho O, Sobral Filho DC. Carbohydrate antigen 125 for mortality risk prediction following acute myocardial infarction. Sci Rep 2020; 10:11016. doi:10.1038/s41598-020-67548-8.
Falcão F, de Oliveira FRA, da Silva MCFC, Sobral Filho DC. Carbohydrate antigen 125: a promising tool for risk stratification in heart diseases. Biomark Med 2018; 12:367-381. doi:10.2217/bmm-2017-0452.
Núñez J, Miñana G, Núñez E, Chorro FJ, Bodí V, Sanchis J. Clinical utility of antigen carbohydrate 125 in heart failure. Heart Fail Rev 2014; 19:575-584. doi:10.1007/s10741-013-9402-y.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. doi:10.1093/eurheartj/eh w128.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 2017; 136:e137-e161. doi:10.1161/CIR.0000000000000509.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39:119-177. doi:10.1093/eurheartj/ ehx393.
Rubio-Gracia J, Demissei BG, Ter Maaten JM, Cleland JG, O’Connor CM, Metra M, Ponikowski P, Teerlink JR, Cotter G, Davison BA, Givertz MM, Bloomfield DM, Dittrich H, Damman K, Pérez-Calvo JI, Voors AA. Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure. Int J Cardiol 2018; 258:185-191. doi:10.1016/j.ijcard.2018.01.067.
Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, Testani JM, Tang WHW, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ. The use of diuretics in heart failure with congestion a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(2):137-155. doi:10.1002/ejhf.1369.
Parrinello G, Torres D, Paterna S, di Pasquale P, Licata G. The pathophysiology of acute heart failure: the key role of fluid accumulation. Am Heart J 2008; 156:e19. doi:10.1016/j.ahj.2008.04.031.
Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JE, Cleland JG, Dickstein K, Drazner MH, Fonarow GC, Jaarsma T, Jondeau G, Sendon JL, Mebazaa A, Metra M, Nieminen M, Pang PS, Seferovic P, Stevenson LW, van Veldhuisen DJ, Zannad F, Anker SD, Rhodes A, McMurray JJ, Filippatos G; European Society of Cardiology; European Society of Intensive Care Medicine. Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 2010; 12:423-433. doi:10.1093/eurjhf/hfq045.
Zhang J, Li W, Xiao J, Hui J, Li Y. Prognostic significance of carbohydrate antigen 125 in stage D heart failure. BMC Cardiovasc Disord 2023; 23:108. Published 2023 Feb 25. doi:10.1186/s12872-023-03139-5.
Núñez J, Llàcer P, García-Blas S, Bonanad C, Ventura S, Núñez JM, Sánchez R, Fácila L, de la Espriella R, Vaquer JM, Cordero A, Roqué M, Chamorro C, Bodi V, Valero E, Santas E, Moreno MDC, Miñana G, Carratalá A, Rodríguez E, Mollar A, Palau P, Bosch MJ, Bertomeu-González V, Lupón J, Navarro J, Chorro FJ, Górriz JL, Sanchis J, Voors AA, Bayés-Genís A. CA125-guided diuretic treatment versus usual care in patients with acute heart failure and renal dysfunction. Am J Med 2020; 133:370-380.e4. doi:10.1016/j.amj-med.2019.07.041
Felker GM, Anstrom KJ, Adams KF, Eze-kowitz JA, Fiuzat M, Houston-Miller N, Januzzi JL Jr, Mark DB, Piña IL, Passmore G, Whellan DJ, Yang H, Coo-per LS, Leifer ES, Desvigne-Nickens P, O’Connor CM. Effect of natriuretic pep-tide-guided therapy on hospitalization or cardiovascular mortality in high-risk pa-tients with heart failure and reduced ejec-tion fraction: A randomized clinical trial. JAMA 2017; 318:713-720. doi:10.1001/jama.2017.10565.
Dunlay SM, Roger VL, Killian JM, Weston SA, Schulte PJ, Subramaniam AV, Blecker SB, Redfield MM. Advanced heart failure epidemiology and outcomes: a population-based study. JACC Heart Fail 2021; 9:722-732. doi: 10.1016/j.jchf.2021.05.009.
Lorenzo M, Palau P, Llàcer P, Domín-guez E, Ventura B, Núñez G, Miñana G, Solsona J, Santas E, De La Espriella R, Bodí V, Núñez E, Sanchis J, Bayés-Genís A, Núñez J. Clinical utility of antigen carbohydrate 125 for planning the optimal length of stay in acute heart failure. Eur J Intern Med 2021; 92:94-99. doi: 10.1016/j.ejim.2021.05.037.
Clerico A, Carlo Zucchelli G, Pilo A, Pas-sino C, Emdin M. Clinical relevance of biological variation: the lesson of brain na-triuretic peptide (BNP) and NT-proBNP as-say. Clin Chem Lab Med 2006; 44:366-378. doi:10.1515/CCLM.2006.063.
Publicado
2024-08-20
Cómo citar
Zhang, J., Li, W., Hui, J., & Xiao, J. (2024). Elevated CA125 values predict adverse outcomes in acute heart failure.: Valores elevados de CA125 predicen resultados adversos en la insuficiencia cardíaca aguda. Investigación Clínica, 65(3), 308-320. https://doi.org/10.54817/IC.v65n3a04
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