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Abstract
Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9–14.8, HR = 7.8 95% CI 2.4–25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6–52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE.
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1 University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy (GRID:grid.10796.39) (ISNI:0000000121049995); Bonomo Hospital, Department of Cardiology, Andria, Italy (GRID:grid.10796.39)
2 University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy (GRID:grid.10796.39) (ISNI:0000000121049995)
3 Montefiore Medical Center, Department of Medicine, Bronx, USA (GRID:grid.240283.f) (ISNI:0000 0001 2152 0791)
4 Caduti Di Guerra Hospital, Department of Cardiology, Canosa, Italy (GRID:grid.240283.f)
5 University of Bari, Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine “Baccelli”, Bari, Italy (GRID:grid.7644.1) (ISNI:0000 0001 0120 3326); IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy (GRID:grid.7644.1)
6 University of Bari, Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine “Baccelli”, Bari, Italy (GRID:grid.7644.1) (ISNI:0000 0001 0120 3326)
7 Bonomo Hospital, Department of Cardiology, Andria, Italy (GRID:grid.10796.39)