Heart failure in patients with aortic stenosis: Clinical and prognostic significance of carbohydrate antigen 125 and brain natriuretic peptide measurement

Background: Brain natriuretic peptide (BNP) is related to symptomatic status and outcome in aortic stenosis (AS) patients. Carbohydrate antigen 125 (CA125) demonstrated recently a BNP-like behaviour in patients with congestive heart failure (CHF) but has never been studied in AS patients. We aimed to assess the role of CA125 and BNP in AS patients. Methods: CA125 and BNP blood levels, transthoracic echocardiography and independent evaluation of CHF symptoms were obtained in 64 consecutive patients (76 +/- 9 years; 35 males) with AS (valve area 0.9 +/- 0.3 cm(2)). A pre-specified combined end-point consisting of cardiac mortality, urgent aortic valve replacement and hospitalization for CHF was considered. The median follow-up was 8 months (interquartile range 4.5-10 months). Results: Both CA125 and BNP have accurately identified patients with III-IV NYHA class: area under the ROC curve was 0.85 for CA125 and 0.78 for BNP (best cut-offs of 10.3 U/mL and 254.64 pg/mL respectively) and were independently correlated to left ventricular ejection fraction. Fifty-two percent of patients with CA125 >= 10.3 U/mL vs. 13% with CA125<10.3 U/mL (p<0.01) and 65% patients with BNP >= 254 pg/mL vs. 7% with BNP<254 pg/mL (p<0.001) have reached the end-point. Conclusions: Both CA125 and BNP levels are significantly correlated with NYHA class and outcome in patients with AS. CA125 blood level assessment (less expensive) may improve the clinical management in this setting. (C) 2007 Elsevier Ireland Ltd. All rights reserved.