Role of CA-125 in identification of right ventricular failure in chronic obstructive pulmonary disease

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating disease. Cor pulmonale, characterized by right ventricular (RV) failure, can severely influence prognosis in these patients. Hence, early recognition might be important for tailoring therapy. An old biomarker, CA-125, seems to be associated with the right heart. We aimed to show the relationship between CA-125 levels and RV failure in patients with COPD.

Hypothesis: CA-125 might be a useful biomarker in identification of RV failure in patients with COPD.

Methods: Forty patients with recent exacerbation of COPD were enrolled into the study. Another 40 age- and sex-matched individuals were enrolled for comparison. Levels of CA-125 were measured in the patients during the hospital stay. The COPD patients underwent echocardiographic study on the same day. Right-ventricular parameters were evaluated, and RV failure was identified via transthoracic echocardiography.

Results: Patients with COPD had significantly higher CA-125 levels compared with controls (median 33.94 U/mL vs 9.76 U/mL, respectively; P < 0.001). Levels of CA-125 were correlated with systolic pulmonary artery pressure (r = 0.550, P < 0.001), tricuspid annular plane systolic excursion (r = - 0.496, P = 0.001), and tricuspid lateral annulus S velocity (r = - 0.549, P = 0.002). High CA-125 levels, obtained in hospitalized patients with COPD before echocardiography, enabled identification of RV failure with a sensitivity of 89.5% and specificity of 85.7%.

Conclusions: The CA-125 biomarker can be used to identify COPD patients with RV failure.

Figure 1

Graphic representation of median levels of CA‐125 in the control group and patients with 3 different stages of COPD in the study. Vertical axis denotes CA‐125 levels in U/mL. Abbreviations: COPD, chronic obstructive pulmonary disease.

Figure 2

An ROC curve to identify RV failure with CA‐125 in patients with COPD (AUC: 0.902, P < 0.001). Abbreviations: AUC, area under the curve; COPD, chronic obstructive pulmonary disease; ROC, receiver operating characteristic; RV, right ventricular.

Figure 3

An ROC curve to identify RV dilation with CA‐125 in patients with COPD (AUC: 0.775, P = 0.003). Abbreviations: AUC, area under the curve; COPD, chronic obstructive pulmonary disease; ROC, receiver operating characteristic; RV, right ventricular.