Association between serum CA125 and echocardiographic congestion markers in heart failure patients

Background CA125, a high-molecular-weight glycoprotein widely used as a diagnostic marker for ovarian cancer, has recently emerged as a congestion biomarker in heart failure (HF). Although classicaly associated with serosal effusion and right-sided pressure overload, its relevance to broader echocardiographic markers—including left ventricular (LV) stiffness—has not been fuly characterized. Methods We retrospectively analyzed 2,584 transthoracic echocardiographic (TTE) studies with matched CA125 values colected between March 2015 and March 2024 at a single tertiary center. CA125 was measured in 2,499 women and 220 men, with no significant difference in mean CA125 levels between sexes (65.4 vs. 68.6 U/mL, p = 0.78). Patients were stratified by CA125 quartiles (Q1–Q4). Associations with TTE parameters—including LVEF, LV mass, E/E′ septal, E′, LAVI, LADs (LV-related), and TAPSE, TV S′, RVSP (RV-related)—were assessed using spline regression and quartile-based comparisons (Figure 1). In a longitudinal subset (n = 762), change in LVEF (ΔLVEF) was analyzed by baseline CA125 quartile. Results Higher CA125 quartiles were significantly associated with worse echocardiographic markers: elevated RVSP (Q4 vs. Q1: 47 vs. 38 mmHg, p < 0.001), increased LAVI (45.8 vs. 34.1 mL/m², p < 0.001), lower TAPSE (14.8 vs. 17.2 mm, p = 0.003), and reduced TV S′ (8.1 vs. 10.2 cm/s, p < 0.001). LV mass (p = 0.004), LADs (p = 0.002), E/E′ (18.6 vs. 11.4, p < 0.001), and E′ were al significantly worse in Q4. Patients in Q4 showed greater LVEF decline (−5.6% vs. +1.4%, p < 0.001). Conclusion Beyond its oncologic role, CA125 reflects not only effusion and RV dysfunction but also markers of LV stiffness and adverse cardiac remodeling. It may serve as a practical biomarker of biventricular congestion in HFFigure 1