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Copeptin in Heart Failure, Post-Left Ventricular Assist Device and Post-Heart Transplantation
Stanislava Zabarovskaja1, Camilla Hage1, Anders Gabrielsen2
1Karolinska Institute, Department of Medicine, Stockholm, Sweden; Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
Insights
Elevated copeptin indicates poor prognosis in heart failure (HF). Treatments like left ventricular assist device (LVAD) and heart transplantation (HTx) significantly lower copeptin levels, reflecting improved outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Biomarker Research
Background:
- Heart failure (HF) is linked to increased arginine vasopressin activity, indicated by elevated copeptin levels.
- Copeptin, a pre-hormone fragment, is a potential biomarker for HF severity and prognosis.
Purpose of the Study:
- To investigate copeptin levels in patients with advanced heart failure.
- To determine if copeptin predicts prognosis in heart failure patients.
- To assess the impact of left ventricular assist device (LVAD) therapy and heart transplantation (HTx) on copeptin levels.
Main Methods:
- Copeptin levels were measured in 49 advanced HF patients, 13 post-LVAD patients, and 22 post-HTx patients.
- Correlations with clinical data and cardiac output were analyzed.
- Prognostic value of copeptin in HF was evaluated using Kaplan-Meier analysis and Cox regression.
Main Results:
- Median copeptin was significantly higher in HF (28 pmol/L) compared to post-LVAD (16 pmol/L) and post-HTx (12 pmol/L) groups (p < 0.001).
- Copeptin independently predicted mortality, LVAD, or HTx in HF patients (HR 3.28, p=0.001).
Conclusions:
- Elevated copeptin is a significant independent predictor of prognosis in heart failure.
- LVAD therapy and HTx lead to progressively lower copeptin levels.
- Reduced copeptin post-intervention suggests improved cardiac output and reduced vasopressin activation, marking beneficial treatment effects.
Background:
Heart failure (HF) is associated with pathological activation of arginine vasopressin, measured in plasma by the pre-hormone fragment copeptin. We hypothesised that copeptin is elevated and associated with worse prognosis in HF, and that left ventricular assist device (LVAD) therapy and heart transplantation (HTx) are associated with lower levels of copeptin.
Methods:
We measured copeptin in groups of 49 patients with advanced HF, 13 patients one year post-LVAD and 22 patients one year post-HTx and correlated with clinical data and cardiac output. In HF we also assessed the prognostic role of copeptin with Kaplan-Meier analysis and multivariate Cox regression.
Results:
In HF, median (interquartile range) copeptin was 28 (18-45) pmol/L, after LVAD 16 (6-27) pmol/L, and after HTx 12 (5-20) pmol/L (p overall <0.001). In HF, copeptin was an independent predictor of death, LVAD or HTx (hazard ratio for log copeptin, 3.28 [95% confidence interval: 1.66-6.50], p=0.001).
Conclusions:
Copeptin was elevated in, and independently predicted prognosis in, HF. Copeptin was progressively lower after LVAD and HTx. This suggests that improvement in cardiac output with LVAD and HTx may induce progressively reduced activation of vasopressin, which may be a marker for the beneficial effects of LVAD and HTx.
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