TY - JOUR
T1 - Increased 90-day mortality in patients with Acute Heart Failure with elevated copeptin secondary results from the Biomarkers in Acute Heart Failure (BACH) study
AU - Maisel, Alan
AU - Xue, Yang
AU - Shah, Kevin
AU - Mueller, Christian
AU - Nowak, Richard
AU - Peacock, W. Frank
AU - Ponikowski, Piotr
AU - Mockel, Martin
AU - Hogan, Christopher
AU - Wu, Alan H B
AU - Richards, Mark
AU - Clopton, Paul
AU - Filippatos, Gerasimos S.
AU - Somma, Salvatore Di
AU - Anand, Inder S.
AU - Ng, Leong
AU - Daniels, Lori B.
AU - Neath, Sean Xavier
AU - Christenson, Robert
AU - Potocki, Mihael
AU - Mccord, James
AU - Terracciano, Garret
AU - Kremastinos, Dimitrios
AU - Hartmann, Oliver
AU - Von Haehling, Stephan
AU - Bergmann, Andreas
AU - Morgenthaler, Nils G.
AU - Anker, Stefan D.
PY - 2011/9/1
Y1 - 2011/9/1
N2 - Background: In patients with heart failure (HF), increased arginine vasopressin concentrations are associated with more severe disease, making arginine vasopressin an attractive target for therapy. However, AVP is difficult to measure due to its in vitro instability and rapid clearance. Copeptin, the C-terminal segment of preprovasopressin, is a stable and reliable surrogate biomarker for serum arginine vasopressin concentrations. Methods and Results: The Biomarkers in Acute Heart Failure (BACH) trial was a 15-center, diagnostic and prognostic study of 1641 patients with acute dyspnea; 557 patients with acute HF were included in this analysis. Copeptin and other biomarker measurements were performed by a core laboratory at the University of Maryland. Patients were followed for up to 90 days after initial evaluation for the primary end point of all-cause mortality, HF-related readmissions, and HF-related emergency department visits. Patients with copeptin concentrations in the highest quartile had increased 90-day mortality (P<0.001; hazard ratio, 3.85). Mortality was significantly increased in patients with elevated copeptin and hyponatremia (P<0.001; hazard ratio, 7.36). Combined end points of mortality, readmissions, and emergency department visits were significantly increased in patients with elevated copeptin. There was no correlation between copeptin and sodium (r=0.047). Conclusions: This study showed significantly increased 90-day mortality, readmissions, and emergency department visits in patients with elevated copeptin, especially in those with hyponatremia. Copeptin was highly prognostic for 90-day adverse events in patients with acute HF, adding prognostic value to clinical predictors, ser um sodium, and natriuretic peptides.
AB - Background: In patients with heart failure (HF), increased arginine vasopressin concentrations are associated with more severe disease, making arginine vasopressin an attractive target for therapy. However, AVP is difficult to measure due to its in vitro instability and rapid clearance. Copeptin, the C-terminal segment of preprovasopressin, is a stable and reliable surrogate biomarker for serum arginine vasopressin concentrations. Methods and Results: The Biomarkers in Acute Heart Failure (BACH) trial was a 15-center, diagnostic and prognostic study of 1641 patients with acute dyspnea; 557 patients with acute HF were included in this analysis. Copeptin and other biomarker measurements were performed by a core laboratory at the University of Maryland. Patients were followed for up to 90 days after initial evaluation for the primary end point of all-cause mortality, HF-related readmissions, and HF-related emergency department visits. Patients with copeptin concentrations in the highest quartile had increased 90-day mortality (P<0.001; hazard ratio, 3.85). Mortality was significantly increased in patients with elevated copeptin and hyponatremia (P<0.001; hazard ratio, 7.36). Combined end points of mortality, readmissions, and emergency department visits were significantly increased in patients with elevated copeptin. There was no correlation between copeptin and sodium (r=0.047). Conclusions: This study showed significantly increased 90-day mortality, readmissions, and emergency department visits in patients with elevated copeptin, especially in those with hyponatremia. Copeptin was highly prognostic for 90-day adverse events in patients with acute HF, adding prognostic value to clinical predictors, ser um sodium, and natriuretic peptides.
KW - Copeptin
KW - Death
KW - Heart failure
KW - Sodium
KW - Vasopressin
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U2 - 10.1161/CIRCHEARTFAILURE.110.960096
DO - 10.1161/CIRCHEARTFAILURE.110.960096
M3 - Article
C2 - 21765124
AN - SCOPUS:80054914995
SN - 1941-3289
VL - 4
SP - 613
EP - 620
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 5
ER -