Table 2: Studies on Monitoring and Carbohydrate Antigen 125-guided Therapy in Heart Failure.
| Reference | Design | Population | Intervention (CA125-guided) | Control | Endpoints | Key Results |
|---|---|---|---|---|---|---|
| Núñez et al. 201656 (CHANCE-HF) | RCT | 380 post-AHF with CA125 >35 | Diuretic/statin intensification until ≤35 U/ml | Usual care | Death or HF readmission (1 year) | The guided group had a lower risk, driven by fewer rehospitalisations. |
| Núñez et al. 202057 | RCT | 160 AHF + renal dysfunction | Loop diuretics titrated by CA125 (>35: higher doses) | Usual care | eGFR at 72 h; decongestion | Better renal outcomes with guided approach. |
| Núñez et al. 201253 | Serial measurement | 293 post-AHF patients | Serial CA125 measurement from discharge to early outpatient follow-up | – | Mortality | Persistent elevation or failure of CA125 to normalise was associated with a higher risk of mortality. |
| Miñana Escrivá et al. 201254 | Serial measurement | 293 post-AHF patients | Serial CA125 measurement from discharge to early outpatient follow-up | – | Early HF readmission | Persistent elevation or an increase in CA125 was associated with a higher risk of early HF readmission. |
| Lourenço et al. 20225 | Cohort | AHF | Paired CA125 at admission and discharge | – | Mortality at 1 year | Decline is associated with 68% lower mortality, but only if LOS >10 days. |
| de la Espriella et al. 202158 | Observational | CHF + T2D | Empagliflozin | Pre-initiation levels | CA125 trajectory | Significant decline in CA125, consistent with decongestion. |
| Amiguet et al. 202360 (DAPA-VO₂) | RCT sub-analysis | 87 stable HFrEF | Dapagliflozin | Placebo | VO₂, CA125 change | Dapagliflozin reduced CA125; mediation analysis linked the reduction with improved VO₂. |
| Miñana et al. 202559 | Observational | 956 AHF | Dapagliflozin at discharge | No dapagliflozin | CA125 change, 6-month outcomes | Greater CA125 reduction and fewer events. |
| Núñez et al. 201861 | Observational | Refractory CHF | Acetazolamide | – | Decongestion | Useful adjunct in refractory congestion. |
| Núñez et al. 201262 | Observational | Advanced CHF | CAPD | – | Clinical outcomes | CAPD was associated with a marked reduction in CA125 at 6 and 24 weeks, improved functional status and fewer days hospitalised for AHF. |
| Lorenzo et al. 202163 | Cohort | AHF | CA125-based discharge planning | – | Readmission | Elevated discharge CA125 identified patients needing longer stay. |
| Núñez et al. 201264 | Observational | Post-AHF | BUN × CA125 stratification | – | Mortality | Identified patients tolerating high diuretic doses with survival benefit. |
AHF = acute heart failure; BUN = blood urea nitrogen; CA125 = carbohydrate antigen 125; CAPD = continuous ambulatory peritoneal dialysis; CHF = chronic heart failure; eGFR = estimated glomerular filtration rate; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; LOS = length of stay; RCT = randomised controlled trial; T2D = type 2 diabetes; VO₂ = peak oxygen consumption. Thresholds of 23 U/ml and 35 U/ml represent the most widely used cut-offs in therapeutic algorithms.