Davies R G, Fiorini F, Bailey D M
Department of Anaesthesia University Hospital of Wales Cardiff UK.
Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales Pontypridd UK.
Anaesth Rep. 2025 Aug 27;13(2):e70023. doi: 10.1002/anr3.70023. eCollection 2025 Jul-Dec.
Heart failure is a major peri-operative risk factor associated with significant postoperative morbidity and mortality. Traditional biomarkers used in heart failure management include natriuretic peptides. Carbohydrate antigen 125 biomarker is well known to be elevated in ovarian cancer but can also be elevated in heart failure, particularly right-sided heart failure and heart failure with preserved ejection fraction. We report the management of a 71-year-old woman with a presumed diagnosis of ovarian cancer based on imaging and an elevated carbohydrate antigen 125, who underwent cardiopulmonary exercise testing as part of the pre-operative assessment. Exercise testing, despite being sub-maximal, identified significant but asymptomatic heart failure. Surgery was deferred and cardiology-led optimisation resulted in normalisation of her carbohydrate antigen biomarker, refuting her ovarian cancer diagnosis and avoidance of a major intra-abdominal surgery. This case highlights the role of biomarkers, such as carbohydrate antigen 125, in heart failure treatment and the use of exercise testing in heart failure diagnosis and management. Cardiopulmonary exercise testing facilitated the identification of hidden comorbidities leading to better pre-operative risk stratification, optimisation and collaborative decision making.
心力衰竭是一种主要的围手术期风险因素，与显著的术后发病率和死亡率相关。用于心力衰竭管理的传统生物标志物包括利钠肽。碳水化合物抗原125生物标志物在卵巢癌中升高是众所周知的，但在心力衰竭中也可能升高，特别是右心衰竭和射血分数保留的心力衰竭。我们报告了一名71岁女性的治疗情况，该女性基于影像学检查和碳水化合物抗原125升高被推测诊断为卵巢癌，作为术前评估的一部分，她接受了心肺运动试验。尽管运动试验未达到最大负荷，但发现了严重但无症状的心力衰竭。手术被推迟，由心脏病学主导的优化治疗使她的碳水化合物抗原生物标志物恢复正常，推翻了她的卵巢癌诊断，并避免了一次大型腹部手术。该病例突出了碳水化合物抗原125等生物标志物在心力衰竭治疗中的作用，以及运动试验在心力衰竭诊断和管理中的应用。心肺运动试验有助于识别隐藏的合并症，从而实现更好的术前风险分层、优化和协作决策。
