BACKGROUND In acute heart failure (AHF) with right ventricular dysfunction, the roles of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) are poorly understood, and functional tricuspid regurgitation (TR) severity is thought to indicate a poor prognosis. We examined the prognostic abilities of NT-proBNP and CA125 according to TR status among patients with AHF. METHODS TR severity was assessed during index hospitalization (108 ± 24 h after admission) and classified as none/trivial, mild, moderate, or severe. Multivariable Cox regression analysis was performed to assess how pre-discharge CA125 and NT-proBNP were associated with long-term all-cause mortality relative to TR severity. RESULTS We prospectively included 2961 patients discharged following hospitalization for AHF (mean age 74 ± 11 years; 49.0% women; 51.8% with left ventricular ejection fraction >50%). Median NT-proBNP was 4823 ng/L (IQR: 2086-9183) and CA125 was 58.1 U/mL (IQR: 25-129). Severe TR was present in 300 patients (10.1%), and 1821 patients (61.5%) died (mean follow-up, 3.3 ± 3.2 years). Multivariate analysis revealed a differential prognostic effect across TR status for both biomarkers (p-value for both interactions<0.05). NT-proBNP was significantly linearly associated with mortality in non-severe TR (p < 0.001), but not in severe TR (p = 0.308). Higher CA125 values were significantly associated with mortality risk in all patients (HR: 1.09; 95% CI:1.03-1.14; p = 0.001), with a greater effect in those with severe TR (HR: 1.28; 98% CI:1.11-1.48; p = 0.001). CONCLUSIONS In patients with AHF and severe TR, CA125 outperforms NT-proBNP in predicting long-term mortality. In AHF with right ventricular involvement, CA125 may be the preferred biomarker for risk stratification.

中文翻译：

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在伴有严重三尖瓣反流的急性心力衰竭中，CA125 优于 NT-proBNP。

背景 在伴有右心室功能障碍的急性心力衰竭 (AHF) 中，氨基末端脑钠肽前体 (NT-proBNP) 和碳水化合物抗原 125 (CA125) 的作用知之甚少，人们认为功能性三尖瓣反流 (TR) 的严重程度表示预后不良。我们根据 AHF 患者的 TR 状态检查了 NT-proBNP 和 CA125 的预后能力。方法 在首次住院期间（入院后 108 ± 24 小时）评估 TR 严重程度，并将其分为无/轻微、轻度、中度或重度。进行多变量 Cox 回归分析以评估出院前 CA125 和 NT-proBNP 与长期全因死亡率相对于 TR 严重程度的相关性。结果 我们前瞻性纳入了 2961 名因 AHF 住院后出院的患者（平均年龄 74 ± 11 岁；49. 0% 女性；51.8% 左心室射血分数 >50%）。中位 NT-proBNP 为 4823 ng/L (IQR: 2086-9183)，CA125 为 58.1 U/mL (IQR: 25-129)。300 名患者 (10.1%) 出现严重 TR，1821 名患者 (61.5%) 死亡（平均随访时间为 3.3 ± 3.2 年）。多变量分析揭示了两种生物标志物在 TR 状态下的不同预后效应（两种相互作用的 p 值<0.05）。NT-proBNP 与非严重 TR 的死亡率呈显着线性相关（p < 0.001），但与严重 TR 无关（p = 0.308）。较高的 CA125 值与所有患者的死亡风险显着相关（HR：1.09；95% CI：1.03-1.14；p = 0.001），对严重 TR 患者的影响更大（HR：1.28；98% CI：1.11- 1.48；p = 0.001）。结论 在 AHF 和严重 TR 患者中，CA125 在预测长期死亡率方面优于 NT-proBNP。在右心室受累的 AHF 中，CA125 可能是风险分层的首选生物标志物。