ArticleESC heart failure2026
High CA125 levels as a red flag for ATTR cardiac amyloidosis.
Article in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionRecognition of transthyretin cardiac amyloidosis (ATTR-CA) remains challenging. In heart failure, plasmatic carbohydrate antigen 125 (CA125) is an established biomarker, reflecting inflammation and volume overload, common issues in ATTR-CA. Our aim was to evaluate the potential utility of CA125 as a 'rule-in' biomarker for suspected ATTR-CA. METHODS AND
resultsThis is a retrospective, multicentre, case-control study that included 626 consecutive ambulatory patients (median age 79 years, 74.8% male) from three tertiary centres. All individuals underwent 99mTc-DPD scintigraphy for suspected cardiac amyloidosis and had a CA125 determination available at the time of the evaluation. Following diagnostic workup, 451 (72%) patients were diagnosed with ATTR-CA, while 175 (28%) were ruled out for the disease. Patients with ATTR-CA showed a non-significant trend towards higher CA125 levels (16.2 [10.2-29.7] vs 14 [8-26.3] U/mL, P = .065). A CA125 cut-off of 40 U/mL yielded a positive predictive value of 81.7% (95% confidence interval: 78.6%-84.7%). In a multivariate logistic regression model, CA125 was an independent predictor for the diagnosis of ATTR-CA (odds ratio 2.109; 95% confidence interval: 1.197-3.717; P = .01). Combining CA125 (>40 U/mL) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (>2500 pg/mL) significantly improved the diagnostic accuracy of the model. Patients with both biomarkers above their respective cut-offs had a three-fold higher likelihood of ATTR-CA (odds ratio: 3.38; 1.704-6.719; P < .001).
conclusionsIn ambulatory patients with suspected ATTR-CA, a CA125 > 40 U/mL, particularly when combined with elevated NT-proBNP, supports the clinical suspicion of the disease. High CA125 levels may be useful in ATTR-CA recognition.
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