Clinical InvestigationC-Terminal Provasopressin (Copeptin) is Associated With Left Ventricular Dysfunction, Remodeling, and Clinical Heart Failure in Survivors of Myocardial Infarction
Section snippets
Methods
We studied 274 consecutive AMI patients admitted to the coronary care unit of Leicester Royal Infirmary. The study complied with the declaration of Helsinki and was approved by the local ethics committee; written consent was obtained from all patients before inclusion. Diagnosis was based on symptoms consistent with AMI in conjunction with appropriate, dynamic electrocardiogram changes (ST segment elevation MI [STEMI], n = 230) or ST segment/T wave changes, non–ST-elevation myocardial infarction
Patient Demographic
Patient demographics for our study population are shown in Table 1. Approximately 75% of the population were male, ST-elevation was evident on the admission electrocardiogram in more than 84%, and median creatine kinase was >900 IU. Of the 230 patients presenting with STEMI, 149 (65%) received thrombolytic therapy. No patient received primary percutaneous revascularization, which was unavailable in our unit at the time. Adequate echocardiographic assessment was available in 248 (91%) subjects
Discussion
The present study has several important findings. First, association is seen between Copeptin and LV dysfunction in the very early stages post-AMI. Second, in those subjects who survive the acute event, this relationship is maintained, and hence Copeptin predicts LV dysfunction at follow-up. In addition, Copeptin is associated with the degree of LV remodeling after the acute event and is associated with clinical heart failure events.
One of the most prognostically significant consequences of AMI
Conclusions
The present study demonstrates the association between Copeptin and LV dysfunction in the post-AMI period, Moreover our study shows that Copeptin predicts LV dysfunction and clinical heart failure distant from the infarct period in survivors of the acute event. This study is the first to demonstrate an association between Copeptin and the degree of LV remodeling post-AMI. Pharmacologic manipulation of the AVP system may be a potential therapeutic target in the post-AMI period, and we suggest
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2017, Advances in Clinical ChemistryCitation Excerpt :Its superiority in comparison to BNP and NT-proBNP was further confirmed in a study which showed association of copeptin with severity of HF, as well as proved copeptin as a potent independent predictor of mortality [190]. Copeptin was also associated to LVEF, remodeling, and clinical HF in survivor of MI [201]. In patients with acute HF, elevated copeptin indicated increased 90-day mortality [126], while its excellent predictive value was also found in patients with chronic, stable coronary disease [186,202].
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D. Kelly was supported by a BHF project grant; S.Q. Khan was supported by British Heart Foundation Junior Fellowship.
This study was supported by research grants from the Brandenburg Ministry of Economics, Germany and the European Regional Development Fund (EFRE/ERDF). Drs. Struck and Morgenthaler are employees of BRAHMS, which holds patent rights on and manufactures the Copeptin assay.