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Cancer antigen 125 levels and increased risk of new-onset atrial fibrillation

Cancer-Antigen-125-Werten und erhöhtem Risiko eines neu auftretenden Vorhofflimmerns

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Abstract

Objective

Elevated cancer antigen 125 (CA-125) levels are associated with cardiopulmonary disorders such as acute and chronic heart failure (HF), coronary artery disease, chronic obstructive pulmonary disease, and atrial fibrillation (AF). The development of atrial fibrillation (AF) is related to morbidity and mortality in patients with HF: therefore, it is important to identify patients with increased risk for development of AF. We investigated whether plasma CA-125 levels in patients with hospitalized systolic HF could predict the development of AF.

Patients and methods

A total of 149 consecutive patients with sinus rhythm who were admitted to the emergency department with hospitalized systolic HF were evaluated prospectively. Serum CA-125 levels were obtained after initial stabilization during their hospital stay.

Results

AF developed in 36 (% 24.2) patients during a follow-up period of 22.1 ± 11  months (range 3–61). CA-125 levels were significantly higher in patients who developed AF than in patients with sinus rhythm [99 U/ml (48–172) vs. 47 U/ml (18–108), p = 0.001]. The optimal cut-off level of CA-125 to predict development of AF was found to be > 68.49 U/ml. CA-125 > 68.49 U/ml, left atrial diameter, right ventricular dilatation, moderate to severe mitral and tricuspid regurgitations were found to have prognostic significance in univariate analysis. In a multivariate Cox proportional hazards model with the backward stepwise method, CA-125 > 68.49 U/ml (HR = 2.693, % 95 CI = 1.285–5.641, p = 0.009) and moderate to severe mitral regurgitation (HR = 2.708, % 95 CI = 1.295–5.663, p = 0.008) were associated with an increased risk of new-onset AF after adjustment for variables found to be statistically significant in univariate analysis and correlated with CA-125 level.

Conclusion

CA-125 level is associated with the development of AF in patients with hospitalized systolic HF.

Zusammenfassung

Ziel

Erhöhte Werte für Cancer Antigen 125 (CA-125) stehen mit der Prognose kardiopulmonaler Erkrankungen wie akute und chronische Herzinsuffizienz, koronare Herzkrankheit (KHK), chronisch obstruktive Lungenerkrankung (COPD) und Vorhofflimmern (VF) in Zusammenhang. Das Auftreten eines VF ist mit der Morbidität und Mortalität bei Patienten mit Herzinsuffizienz verknüpft; daher ist es wichtig, Patienten mit einem erhöhten Risiko für das Auftreten eines VF zu erkennen. Die Autoren untersuchten, ob anhand der CA-125-Werte im Plasma bei Patienten mit stationärer Behandlung einer systolischen Herzinsuffizienz die Entwicklung eines VF abgeschätzt werden konnte.

Patienten und Methoden

Es wurden 149 konsekutive Patienten mit Sinusrhythmus prospektiv untersucht, die sich in der Notaufnahme vorstellten und wegen systolischer Herzinsuffizienz stationär behandelt wurden. Die CA-125-Werte im Serum wurden während des stationären Aufenthalts nach initialer Stabilisierung bestimmt.

Ergebnisse

Ein VF trat bei 36 (24,2 %) Patienten während der Nachbeobachtungsphase von 22,1 ± 11 Monaten auf (Spannbreite: 3–61). Die Werte für CA-125 waren bei Patienten, bei denen ein VF auftrat, signifikant höher als bei Patienten mit Sinusrhythmus [99 (48–172) U/ml vs. 47 (18–108) U/ml; p = 0,001]. Es stellte sich heraus, dass der optimale Grenzwert für CA-125 zur Vorhersage eines VF bei > 68,49 U/ml lag. Für einen CA-125-Wert > 68,49 U/ml, den Durchmesser des linken Vorhofs, eine rechtsventrikuläre Dilatation sowie mittel- bis schwergradige Mitral- und Trikuspidalinsuffizienzen stellte sich heraus, dass sie in der univariaten Analyse von prognostischer Bedeutung waren. Im multivariaten Proportional-Hazards-Modell nach Cox mit schrittweiser Rückwärtsselektion blieben CA-125 > 68,49 U/ml (HR: 2,693; 95%-KI: 1,285–5,641; p = 0,009) und mittel- bis schwergradige Mitralinsuffizienz (HR: 2,708; 95%-KI: 1,295–5,663; p = 0,008) mit einem erhöhten Risiko für das Neuauftreten eines VF verknüpft – nach Adjustierung im Hinblick auf Variablen, die sich in der univariaten Analyse als statistisch signifikant und mit dem CA-125-Wert korreliert erwiesen hatten.

Schlussfolgerung

Der CA-125-Wert ist mit dem Auftreten eines VF bei Patienten mit stationärer Behandlung einer systolischen Herzinsuffizienz verknüpft.

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Compliance with ethical guidelines

Conflict of interest. H. Kaya, A. Zorlu, K. Yıldırımlı, E. Sancakdar, H. Gunes, R. Kurt, U. Ozgul, O.O. Turgut, and M.B. Yilmaz state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey

    H. Yucel, H. Kaya,  A. Zorlu, K. Yıldırımlı, H. Gunes, R. Kurt, U. Ozgul, O.O. Turgut & M.B. Yilmaz

  2. Department of Biochemistry, Cumhuriyet University Medical School, Sivas, Turkey

    E. Sancakdar

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  1. H. Yucel
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  2. H. Kaya
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  3. A. Zorlu
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  4. K. Yıldırımlı
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  5. E. Sancakdar
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  7. R. Kurt
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  8. U. Ozgul
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  9. O.O. Turgut
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  10. M.B. Yilmaz
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Correspondence to A. Zorlu.

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Yucel, H., Kaya, H., Zorlu, A. et al. Cancer antigen 125 levels and increased risk of new-onset atrial fibrillation. Herz 40 (Suppl 2), 119–124 (2015). https://doi.org/10.1007/s00059-014-4148-4

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  • DOI: https://doi.org/10.1007/s00059-014-4148-4

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