Paradox of Low CA-125 in Patients with Decompensated Congestive Heart Failure

Aims: Patients diagnosed with decompensated congestive heart failure (HF) often have elevated CA-125 levels, attributed to systemic congestion. However, a subgroup presents with normal CA-125 levels. The primary objective of this study was to characterize the clinical, analytical, and echocardiographic profile of patients admitted for decompensated congestive HF according to CA-125 levels. The secondary objective was to analyze mortality after discharge. Methods: A retrospective study of patients hospitalized for a decompensated congestive HF episode. Recruitment was consecutive over more than 4 years (December 2019 – June 2024), with 3,151 patients. Scheduled admissions, transfers from other hospitals, pulmonary congestion patterns, mixed patterns, and low output were excluded. The final number of patients included was 166, all with an isolated systemic congestion pattern: CA-125 ≤50 U/mL: 38 and CA-125 >50 U/mL: 128. The diagnosis of decompensated congestive HF was defined as the presence of fluid retention manifested by significant weight gain, reduced diuresis, and severe edema, without evidence of orthopnea or signs of low cardiac output. Pulmonary congestion was required to be absent. In cases of doubt, patients were evaluated by a multidisciplinary team. Results: The comparative analysis between the groups showed that patients with CA-125 ≤50 U/mL were more often women (p50 U/mL group, it was around 25% (p< 0.05). Conclusions: The proportion of patients with decompensated congestive HF and systemic congestion who present with a low CA-125 level is close to 25%. These patients are mostly women with preserved ejection fraction and inspiratory collapse of the IVC >50%. Moreover, they have a higher survival rate, so a low CA-125 could help identify a subgroup of patients with a better prognosis.