Purpose: Heart failure with preserved ejection fraction (HFpEF) affects half of all heart failure patients with an increasing prevalence. The accurate diagnosis of HFpEF is based on a complex echocardiographic algorithm. Novel biomarkers, such as copeptin, might improve diagnostic capacity in heart failure patients. Therefore, this study aims to evaluate the association between copeptin levels and heart failure with preserved ejection fraction (HFpEF)/diastolic dysfunction assessed by echocardiography.

Methods: Patients undergoing routine echocardiography were prospectively enrolled in the present monocentric study. Patients with left ventricular dysfunction (LVEF <50 %), right ventricular dysfunction (TAPSE < 17 mm) or moderate to severe valvular heart diseases were excluded. Blood samples for measurements of copeptin and NT-proBNP were collected at the day of echocardiographic examination. Subgroups based on HFpEF grades were defined (no diastolic dysfunction (n=14); grade I (n=14); grade II (n=29); grade III (n=11)).

Results: A total of 68 patients were included. Copeptin levels increased significantly alongside decreasing grades of HFpEF. In contrast, NT-proBNP did not (copeptin: p=0.026, NT-proBNP: p=0.38). Furthermore, copeptin correlated significantly with E/E’ (p<0.001). In multivariable linear regression models adjusted for age, sex, creatinine, NT-proBNP, arterial hypertension, coronary artery disease and HFpEF, only grades of HFpEF, NT-proBNP and creatinine sustained significantly associated with copeptin levels (HFpEF: Beta 0.199, T 2.13, p=0.037; NT-proBNP: Beta 0.549, T 5.86, p=0.0001; creatinine: Beta 0.196, T 2.1, p=0.04). Both, copeptin and NT-proBNP were able to discriminate patients with severe HFpEF grade III (copeptin: AUC=0.755, p=0.008; NT-proBNP: AUC=0.800, p=0.001). In multivariable logistic regression models only copeptin and not NT-proBNP was still associated with severe HFpEF grade III (copeptin: OR=1.06; p=0.016) after adjusting with age, sex, creatinine.

Conclusion: This study demonstrates that copeptin is able to reflect HFpEF of advanced stages assessed by echocardiography and might thus serve as a novel biomarker for early diagnosis of left ventricular diastolic dysfunction.