Association between Venous Excess Ultrasound (VExUS) Score and Serum CA-125 Levels in Patients with Heart Failure and Left Ventricular Systolic Dysfunction: A Prospective Pilot Study

Introduction: Heart failure (HF) remains a major cause of morbidity and mortality worldwide. Accurate assessment of congestion is fundamental in patients with worsening HF, yet physical examination and chest radiography may underestimate its severity. Carbohydrate antigen 125 (CA-125) has emerged as a biomarker associated with congestion severity and prognosis in HF. However, its relationship with ultrasound-defined systemic venous congestion using the Venous Excess Ultrasound (VExUS) score has not been evaluated. Material and methods: We conducted a prospective, cross-sectional, single-center pilot study including ambulatory patients with previously diagnosed chronic HF with reduced ejection fraction and with clinical suspicion of worsening heart failure. At inclusion, blood samples were obtained for CA-125 measurement and transthoracic echocardiography with VExUS assessment was performed during the same visit, prior to treatment adjustment. The primary objective was to determine the association between VExUS score and CA-125 levels. Results: Fifty-four patients were included. A moderate positive correlation was observed between VExUS grade and CA-125 (Spearman ρ=0.46, p<0.001). In multivariable analysis adjusting for age, ejection fraction and serum creatinine, VExUS grade remained independently associated with CA-125 (β = 0.387, p = 0.001). Discussion: In patients with HF and left ventricular systolic dysfunction, CA-125 levels correlate with ultrasound-defined systemic venous congestion. CA-125 may represent an accessible biomarker reflecting congestion severity in ambulatory clinical settings.