Fluctuations of tumor markers in heart failure patients pre and post hearttransplantation

Background: Elevated plasma levels of tumor makers may be caused by disease s other than malignancy, Le; kidney, liver or circulatory disturbances. The se conditions are not well defined, especially sinve there are only sparse reports on fluctuations of tumor markers related to cardiac function. Patie nts and Methods: During our routine pre- and postoperative follow-up tumor marker determinations in heart failure patients were made in order to scree n for possible occult neoplasm's which may either be a contraindication or a sequela of heart transplantation. The markers CA 12-5, CEA, CA 19-9, CA 7 2-4, TPA, TPS and CYFRA 21-1 were determined at three month intervals besid es clinical examination and hemodynamic measurements in a total of n=118 pa tients pre- and n=74 patients post heart transplantation. Results: The resu lts were grouped according the clinical status (NYHA-stage 1-4): CA12-5 (29 ,4 +/- 40, 63 omega, 151, 174 +/- 345 and 491 +/- 633 U/ml, p<0.001 between all groups) and TPS (64 +/- 32, 118 +/- 153, 163 +/- 311 and 181 +/- 232 U /ml, p=0.06 between all groups) were increasingly elevated in NYHA stages 1 , 2, 3 or 4 respectively. A direct correlation to right atrial pressure (r= 0.41, p<0.0001) and pulmonary capillary wedge pressure (r=0.27, p<0.001) wa s only found for CA 12-5. After heart transplantation a normalization of el evated pre-OF levels could be found. Comparable to heart failure patients p oor graft function was also associated with elevated levels of CA 12-5 (113 +/- 99 vs 21,6 +/- 31 U/ml, p<0.0001), CA 72-4 (8.4 +/-3 vs 3.6 +/- 4, U/m l p=0.03) and TPS (154 +/- 133 vs 66 +/- 28 U/ml, p<0.001). The individual time course of the markers, especially of CA 12-5, correlated nicely to cli nical events and hemodynamic measurements in some patients. Another finding was that CYFRA 21-1 levels were correlated to renal function. CEA, CA 19-9 and CYFRA 21-1 serum levels were not influenced by circulatory disturbance s. Conclusion: We concluded that the tumor markers CA 12-5 and TPS (but not CEA, CA 19-9 and CYFRA 21-1) are associated with congestion and the clinic al course of heart failure and HTx patients. These "nonspecific" changes ha ve to be considered when tumor markers are determined in cancer patients wi th heart failure. Whether CA 12-5 blood levels may yield additional prognos tic information in the management of cardiovascular patients has to be dete rmined in further studies.