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Aims: Heart failure (HF) with preserved ejection fraction (HFpEF) is a disease associated with high morbidity and mortality, for which it is difficult to identify patients with the poorest prognosis in routine clinical practice. Carbohydrate antigen 125 (CA 125) has been shown to be a potential marker of congestion and prognosis in HF. We sought to better characterize HFpEF patients with high CA 125 levels by using a multimodal approach. Methods and results: We prospectively enrolled 139 HFpEF patients (78 ± 8 years; 60% females) and 25 controls matched for age and sex (77 ± 5 years; 60% females). They underwent two‐dimensional echocardiography, cardiac magnetic resonance with late gadolinium enhancement [including extracellular volume (ECV) measurement], and serum measurements of CA 125 level. The primary endpoint of the study was a composite of all‐cause mortality or first HF hospitalization. The prognostic impact of CA 125 was determined using Cox proportional hazard models. Median CA 125 levels were significantly higher in HFpEF patients compared with controls [CA 125: 23.5 (14.5–44.7) vs. 14.6 (10.3–21.0) U/mL, P = 0.004]. CA 125 levels were positively correlated with a congestion marker [N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels, Pearson's r = 0.37, P < 0.001] and markers of cardiac fibrosis estimated by both ECV (Pearson's r = 0.26, P = 0.003) and fibroblast growth factor 23 levels (Pearson's r = 0.50, P < 0.001). Over a median follow‐up of 49 (22–64) months, 97 HFpEF patients reached the composite endpoint. Even after adjustment for the Meta‐Analysis Global Group in Chronic risk score, a CA 125 level ≥35 U/mL was still a significant predictor of the composite endpoint [hazard ratio (HR): 1.58 (1.04–2.41), P = 0.032] and more particularly of HF hospitalization [HR: 1.81 (1.13–2.92), P = 0.014]. In contrast, NT‐proBNP levels were not an independent predictor. Conclusions: CA 125 levels were significantly higher in HFpEF patients compared with controls matched for age and sex and were associated with markers of congestion and cardiac fibrosis. CA 125 levels were a strong and independent predictor of HF hospitalization in HFpEF patients. These data suggest a potential value of CA 125 as a biomarker for staging and risk prediction in HFpEF. [ABSTRACT FROM AUTHOR]

The method for assaying the chosen EV cargo(s) must be accessible in most clinical laboratories, not be a specific technique devoted to basic research as is often the case and have a sufficient dynamic range and resolution. Most of the studies related to EV profiling in MS are small-scale pre-clinical studies comparing MS patients versus healthy controls, indicating that we are only at the beginning of the development process leading to implementation of this potential biomarker. [Extracted from the article]

Indeed, many studies and case reports point in the same direction and claim that in patients suffering from chronic skeletal muscle disorders, elevations in hs-cTnT are not always due to myocardial injury but can be linked to the injured skeletal muscle [[3]], [[4]], [[5]], [[6]], [[7]], [[8]]. Keywords: interference; re-expression; skeletal muscle; specificity; troponin T EN interference re-expression skeletal muscle specificity troponin T e11 e12 2 11/28/22 20230101 NES 230101 To the Editor, Troponin testing is a cornerstone in the diagnosis of myocardial infarction [[1]]. Despite the fact that there is no formal evidence of the re-expression of the cTnT protein in diseased human skeletal muscle, it is time to admit that the cardio-specificity of hs-cTnT assay is clearly challenged. [Extracted from the article]