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Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study

INTRODUCTION: Underlying mechanisms of heart failure (HF) with preserved ejection fraction (HFPEF) remain unknown. We explored copeptin, a biomarker of the arginine vasopressin system, hypothesising that copeptin in HFPEF is elevated, associated with diastolic dysfunction and N-terminal pro-brain na...

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Autores principales: Hage, Camilla, Lund, Lars H, Donal, Erwan, Daubert, Jean-Claude, Linde, Cecilia, Mellbin, Linda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636678/
https://www.ncbi.nlm.nih.gov/pubmed/26568833
http://dx.doi.org/10.1136/openhrt-2015-000260
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author Hage, Camilla
Lund, Lars H
Donal, Erwan
Daubert, Jean-Claude
Linde, Cecilia
Mellbin, Linda
author_facet Hage, Camilla
Lund, Lars H
Donal, Erwan
Daubert, Jean-Claude
Linde, Cecilia
Mellbin, Linda
author_sort Hage, Camilla
collection PubMed
description INTRODUCTION: Underlying mechanisms of heart failure (HF) with preserved ejection fraction (HFPEF) remain unknown. We explored copeptin, a biomarker of the arginine vasopressin system, hypothesising that copeptin in HFPEF is elevated, associated with diastolic dysfunction and N-terminal pro-brain natriuretic peptide (NT-proBNP) and predictive of HF hospitalisation and mortality. METHODS AND ANALYSIS: In a prospective observational substudy of the The Karolinska Rennes (KaRen) 86 patients with symptoms of acute HF and ejection fraction (EF) ≥45% were enrolled. After 4–8 weeks, blood sampling and echocardiography was performed. Plasma-copeptin was analysed in 86 patients and 62 healthy controls. Patients were followed in median 579 days (quartile 1; quartile 3 (Q1;Q3) 276;1178) regarding the composite end point all-cause mortality or HF hospitalisation. ETHICS AND DISSEMINATION: The patients with HFPEF had higher copeptin levels, median 13.56 pmol/L (Q1;Q3 8.56;20.55) than controls 5.98 pmol/L (4.15;9.42; p<0.001). Diastolic dysfunction, assessable in 75/86 patients, was present in 45 and absent in 30 patients. Copeptin did not differ regarding diastolic dysfunction and did not correlate with cardiac function but with NT-proBNP (r=0.223; p value=0.040). In univariate Cox regression analysis log copeptin predicted the composite end point (HR 1.56 (95% CI 1.03 to 2.38; p value=0.037)) but not after adjusting for NT-proBNP (HR 1.39 (95% CI 0.91 to 2.12; p value=0.125)). CONCLUSIONS: In the present patients with HFPEF, copeptin is elevated, correlates with NT-proBNP but not markers of diastolic dysfunction, and has prognostic implications, however blunted after adjustment for NT-proBNP. The HFPEF pathophysiology may be better reflected by markers of neurohormonal activation than by diastolic dysfunction. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT00774709.
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spelling pubmed-46366782015-11-13 Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study Hage, Camilla Lund, Lars H Donal, Erwan Daubert, Jean-Claude Linde, Cecilia Mellbin, Linda Open Heart Heart Failure and Cardiomyopathies INTRODUCTION: Underlying mechanisms of heart failure (HF) with preserved ejection fraction (HFPEF) remain unknown. We explored copeptin, a biomarker of the arginine vasopressin system, hypothesising that copeptin in HFPEF is elevated, associated with diastolic dysfunction and N-terminal pro-brain natriuretic peptide (NT-proBNP) and predictive of HF hospitalisation and mortality. METHODS AND ANALYSIS: In a prospective observational substudy of the The Karolinska Rennes (KaRen) 86 patients with symptoms of acute HF and ejection fraction (EF) ≥45% were enrolled. After 4–8 weeks, blood sampling and echocardiography was performed. Plasma-copeptin was analysed in 86 patients and 62 healthy controls. Patients were followed in median 579 days (quartile 1; quartile 3 (Q1;Q3) 276;1178) regarding the composite end point all-cause mortality or HF hospitalisation. ETHICS AND DISSEMINATION: The patients with HFPEF had higher copeptin levels, median 13.56 pmol/L (Q1;Q3 8.56;20.55) than controls 5.98 pmol/L (4.15;9.42; p<0.001). Diastolic dysfunction, assessable in 75/86 patients, was present in 45 and absent in 30 patients. Copeptin did not differ regarding diastolic dysfunction and did not correlate with cardiac function but with NT-proBNP (r=0.223; p value=0.040). In univariate Cox regression analysis log copeptin predicted the composite end point (HR 1.56 (95% CI 1.03 to 2.38; p value=0.037)) but not after adjusting for NT-proBNP (HR 1.39 (95% CI 0.91 to 2.12; p value=0.125)). CONCLUSIONS: In the present patients with HFPEF, copeptin is elevated, correlates with NT-proBNP but not markers of diastolic dysfunction, and has prognostic implications, however blunted after adjustment for NT-proBNP. The HFPEF pathophysiology may be better reflected by markers of neurohormonal activation than by diastolic dysfunction. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT00774709. BMJ Publishing Group 2015-11-03 /pmc/articles/PMC4636678/ /pubmed/26568833 http://dx.doi.org/10.1136/openhrt-2015-000260 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Heart Failure and Cardiomyopathies
Hage, Camilla
Lund, Lars H
Donal, Erwan
Daubert, Jean-Claude
Linde, Cecilia
Mellbin, Linda
Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study
title Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study
title_full Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study
title_fullStr Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study
title_full_unstemmed Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study
title_short Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study
title_sort copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective karen-study
topic Heart Failure and Cardiomyopathies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636678/
https://www.ncbi.nlm.nih.gov/pubmed/26568833
http://dx.doi.org/10.1136/openhrt-2015-000260
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