Carbohydrate antigen 125 for predicting right ventricular dysfunction and right ventricular to pulmonary artery uncoupling in acute heart failure: a cardiac magnetic resonance study

BACKGROUND: Right ventricular dysfunction (RVD) and right ventricular to pulmonary artery (RV-PA) uncoupling predict outcomes in heart failure, but accurate assessment relies on cardiac magnetic resonance (CMR). We evaluated whether serum carbohydrate antigen 125 (CA125) identifies CMR-derived RVD and RV-PA uncoupling in acute heart failure (AHF). METHODS: This retrospective single-center study included 479 consecutive AHF patients who underwent CMR. RVD was defined as RV ejection fraction <45% and RV-PA uncoupling as RV stroke volume/RV end-systolic volume < 1. Discriminatory accuracy was assessed by ROC analysis and multivariable logistic regression. RESULTS: Mean age was 67.7 ± 12.3 years, 65.6% were men, and 78.5% had LVEF<50%. RVD was present in 178 patients (37.2%) and RV-PA uncoupling in 221 (46.1%). Median CA125 levels were significantly higher in both RVD (121.5 vs. 53.5 U/mL, p < 0.001) and RV-PA uncoupling (114 vs. 49 U/mL, p < 0.001). CA125 showed moderate discriminatory ability for RVD (AUC 0.684, 95% CI 0.635-0.734) and RV-PA uncoupling (AUC 0.682, 95% CI 0.634-0.730), outperforming N-terminal pro B-type natriuretic peptide (NT-proBNP) (AUC 0.605 and 0.593; p < 0.05). In multivariable analysis, CA125 remained the only independent predictor associated with both CMR indices (p < 0.001). Adding CA125 to tricuspid annular plane systolic excursion (TAPSE) or NT-proBNP significantly improved reclassification (continuous NRI 31-38%, IDI 3-4%; all p < 0.05). CONCLUSIONS: In AHF patients undergoing CMR, serum CA125 levels were independently associated with RVD and RV-PA uncoupling, outperforming NT-proBNP and adding value beyond conventional markers. CA125 may help identify RV dysfunction in AHF.