Association between Venous Excess Ultrasound (VExUS) Score and Serum CA-125 Levels in Patients with Heart Failure and Left Ventricular Systolic Dysfunction: A Prospective Pilot Study
Asociación entre la puntuación de ultrasonido de exceso venoso (VExUS) y los niveles séricos de CA-125 en pacientes con insuficiencia cardíaca y disfunción sistólica del ventrículo izquierdo: un estudio piloto prospectivo
Louis Fernando Robles-Fernandes, Gabriela Rodríguez-Guzmán, Genaro Hiram Mendoza-Zavala, Eduardo Almeida-Gutierrez, Karina Lupercio-Mora, Diana Romero-Zertuche, Rosalba Carolina García-Méndez, Jesús Salgado-Campos, Amor Yanira Cazares-Avendaño, Juan Betuel Ivey-Miranda
Abstract
Introduction: Heart failure (HF) remains a major cause of morbidity and mortality worldwide. Accurate assessment of congestion is fundamental in patients with worsening HF, yet physical examination and chest radiography may underestimate its severity. Carbohydrate antigen 125 (CA-125) has emerged as a biomarker associated with congestion severity and prognosis in HF. However, its relationship with ultrasound-defined systemic venous congestion using the Venous Excess Ultrasound (VExUS) score has not been evaluated.
Material and methods: We conducted a prospective, cross-sectional, single-center pilot study including ambulatory patients with previously diagnosed chronic HF with reduced ejection fraction and with clinical suspicion of worsening heart failure. At inclusion, blood samples were obtained for CA-125 measurement and transthoracic echocardiography with VExUS assessment was performed during the same visit, prior to treatment adjustment. The primary objective was to determine the association between VExUS score and CA-125 levels.
Results: Fifty-four patients were included. A moderate positive correlation was observed between VExUS grade and CA-125 (Spearman ρ=0.46, p<0.001). In multivariable analysis adjusting for age, ejection fraction and serum creatinine, VExUS grade remained independently associated with CA-125 (β = 0.387, p = 0.001).
Discussion: In patients with HF and left ventricular systolic dysfunction, CA-125 levels correlate with ultrasound-defined systemic venous congestion. CA-125 may represent an accessible biomarker reflecting congestion severity in ambulatory clinical settings.
Keywords
Resumen
Introducción: La insuficiencia cardíaca (IC) sigue siendo una de las principales causas de morbilidad y mortalidad a nivel mundial. La evaluación precisa de la congestión es fundamental en pacientes con IC progresiva; sin embargo, la exploración física y la radiografía de tórax pueden subestimar su gravedad. El antígeno carbohidrato 125 (CA-125) ha surgido como un biomarcador asociado a la gravedad de la congestión y al pronóstico en la IC. No obstante, su relación con la congestión venosa sistémica definida por ecografía mediante la puntuación de exceso venoso por ultrasonido (VExUS) no se ha evaluado.
Material y métodos: Realizamos un estudio piloto prospectivo, transversal y unicéntrico que incluyó pacientes ambulatorios con IC crónica previamente diagnosticada, con fracción de eyección reducida y con sospecha clínica de empeoramiento de la insuficiencia cardíaca. Al inicio del estudio, se obtuvieron muestras de sangre para la medición de CA-125 y se realizó una ecocardiografía transtorácica con evaluación VExUS durante la misma visita, antes del ajuste del tratamiento. El objetivo principal fue determinar la asociación entre la puntuación VExUS y los niveles de CA-125.
Resultados: Se incluyeron cincuenta y cuatro pacientes. Se observó una correlación positiva moderada entre el grado VExUS y el CA-125 (Spearman ρ=0,46, p<0,001). En el análisis multivariante, ajustando por edad, fracción de eyección y creatinina sérica, el grado VExUS se mantuvo asociado de forma independiente con el CA-125 (β = 0,387, p = 0,001).
Discusión: En pacientes con insuficiencia cardíaca y disfunción sistólica del ventrículo izquierdo, los niveles de CA-125 se correlacionan con la congestión venosa sistémica definida por ecografía. El CA-125 podría representar un biomarcador accesible que refleje la gravedad de la congestión en entornos clínicos ambulatorios.
Palabras clave
References
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Submitted date:
02/28/2026
Reviewed date:
04/09/2026
Accepted date:
04/23/2026
Publication date:
04/23/2026
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