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Heart Asia. 2018 Oct 26;10(2):e011044. doi: 10.1136/heartasia-2018-011044. eCollection 2018.

Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis.

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Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China.
Faculty of Medicine, Newcastle University, England, UK.
Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, china.
Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.
Departamento de Medicina, Universitat de València, Valencia, Spain.
CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.



Carbohydrate antigen-125 (CA125) is an ovarian cancer marker, but recent work has examined its role in risk stratification in heart failure. A recent meta-analysis examined its prognostic value in heart failure generally. However, there has been no systematic evaluation of its role specifically in acute heart failure (AHF).


PubMed and EMBASE databases were searched until 11 May 2018 for studies that evaluated the prognostic value of CA125 in AHF.


A total of 129 and 179 entries were retrieved from PubMed and EMBASE. Sixteen studies (15 cohort studies, 1 randomised trial) including 8401 subjects with AHF (mean age 71 years old, 52% male, mean follow-up 13 months, range of patients 525.1±598.2) were included. High CA125 levels were associated with a 68% increase in all-cause mortality (8 studies, HRs: 1.68, 95% CI 1.36 to 2.07; p<0.0001; I2: 74%) and 77% increase in heart failure-related readmissions (5 studies, HRs: 1.77, 95% CI 1.22 to 2.59; p<0.01; I2: 73%). CA125 levels were higher in patients with fluid overload symptoms and signs compared with those without them, with a mean difference of 54.8 U/mL (5 studies, SE: 13.2 U/mL; p<0.0001; I2: 78%).


Our meta-analysis found that high CA125 levels are associated with AHF symptoms, heart failure-related hospital readmissions and all-cause mortality. Therefore, CA125 emerges as a useful risk stratification tool for identifying high-risk patients with more severe fluid overload, as well as for monitoring following an AHF episode.


heart failure; heart failure treatment; systolic heart failure

Conflict of interest statement

Competing interests: JN reports personal fees from Novartis, personal fees from Vifor, personal fees from Abbott, personal fees from Rovi, personal fees from Boehringer Ingelheim and personal fees from Novo Nordisk, outside the submitted work.

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