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Atrial Fibrillation (AF), a dysrhythmia with negative consequences on mortality and morbidity, is noted in approximately 30% of patients with Heart Failure (HF). Permanent AF is a situation in which the sinus rhythm can't be restored with the usual therapy. Paroxysmal and persistent atrial fibrillations eventually yield in permanent AF, particularly in patients with HF. An association of CA-125 with poor prognosis in patients with HF has been demonstrated previously by a number of studies. The purpose of the present study was to investigate the relationship between CA- 125 levels and permanent AF in patients with systolic HF.
The study included 216 patients (152 males and 64 females) with stable systolic HF (EF ≤45%). The patients were classified into two groups: those with permanent AF (n=76) and those without permanent AF (all in sinus rhythm on index ECG, hence called patients in sinus rhythm) (n=140). Patients were followed up for HF related hospitalization and mortality for 21 months.
Patients with permanent AF had higher levels of CA-125 compared to those with sinus rhythm (113.1 U/ml vs. 34.5 U/ml; p<0.001). Patients with permanent AF had larger left atrial diameter compared to those with sinus rhythm (4.6±0.6 vs 4.4±0.7 cm, p=0.025). There were more patients with moderate-severe mitral regurgitation (50.0 vs. 26.6%; p=0,001), moderate-severe tricuspid regurgitation (53.9 vs. 25.7%; p<0.001) in the group with permanent AF compared to those with sinus rhythm. Number of HF related hospitalizations was also significantly higher among the patients with permanent AF than in those with sinus rhythm on follow up (63.2 vs. 47.9%; p=0.031). CA-125 levels predicted presence of permanent AF in patients with stable HF (AUC: 0.742, 95% CI 0.673-0.812, p<0.001). Furthermore, CA-125 level of more than 150 U/ml predicted presence of permanent AF with a sensitivity of 37% and specificity of 91% in a group of patients with systolic HF, and associated with 5.699 times more likelihood of permanent AF (Odds ratio, 95% CI 2.727-11.907, p<0.001).
CA-125 levels were significantly higher among the stable systolic HF patients with permanent AF compared to those with sinus rhythm and there was a higher rate of hospitalizations in patients with permanent AF due to HF on follow up. It seems a high CA-125 level (>150 U/ml) can rule-in (high specificity) the presence of permanent AF in patients with HF.