Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w

Diagnostic Value of Copeptin in Right Heart Failure

M. Harbrücker1, M. Natale1, T. Bertsch2, S. Lindner1, S.-H. Kim1, J. Müller1, M. Borggrefe1, S. Lang1, I. Akin1, M. Behnes1

1I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; 2Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg;

Purpose: Appropriate assessment of right heart failure – often underestimated – is more regarded as a mere bystander and victim of pathological cardiovascular processes. However, the communicative role of right ventricular function between pulmonary and systemic circulation demands further investigation. Copeptin, a novel biomarker, might aid early diagnosis of right heart failure and thus lead to better clinical outcomes. This study aims to evaluate the association between copeptin and right ventricular function (RVF) assessed by echocardiography. Methods: Patients undergoing routine echocardiography were prospectively enrolled in the present monocentric study. Patients with left ventricular dysfunction (LVEF <50 %) or moderate or severe aortic or mitral valvular heart diseases were excluded. Blood samples for measurements of copeptin and NT-proBNP were collected at the day of echocardiographic examination. Subgroups of RVF based on tricuspid annular plane systolic excursion (TAPSE) were defined (I: TAPSE > 24 mm (n=23); II: TAPSE 18-24 mm (n=53); III: TAPSE < 18 (n=13)). Results: A total of 89 patients were included. Levels of copeptin as well as NT-proBNP increased significantly according to decreasing RVF (copeptin: p=0.001, NT-proBNP: p=0.002). Furthermore, copeptin correlated significantly with TAPSE (p=0.0001). In multivariable linear regression models adjusted for clinical characteristics and cardiac comorbidities (age, sex, creatinine, NT-proBNP, arterial hypertension, coronary artery disease and RVF), RVF was significantly associated with copeptin (RVF: Beta -0.19, T -2.281, p=0.025). Both, copeptin and NT-proBNP were able to discriminate patients with RVF grade III (copeptin: AUC=0.793, p=0.001; NT-proBNP: AUC=0.805, p=0.0001). In multivariable logistic regression models only copeptin was still associated significantly with severe right ventricular dysfunction RVF III (copeptin: OR=0.943; p=0.001) after adjusting with age, sex, creatinine and NT-proBNP. Conclusions: This study demonstrates that copeptin is able to reflect RVF assessed by echocardiography and might thus be a useful marker for detecting right heart failure at early stages.

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