Τίτλος:
Increased 90-Day Mortality in Patients With Acute Heart Failure With
Elevated Copeptin Secondary Results From the Biomarkers in Acute Heart
Failure (BACH) Study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00537628.(Circ Heart Fail. 2011;4:613-620.)
Συγγραφείς:
Maisel, Alan
Xue, Yang
Shah, Kevin
Mueller, Christian and
Nowak, Richard
Peacock, W. Frank
Ponikowski, Piotr
Mockel,
Martin
Hogan, Christopher
Wu, Alan H. B.
Richards, Mark and
Clopton, Paul
Filippatos, Gerasimos S.
Di Somma, Salvatore and
Anand, Inder S.
Ng, Leong
Daniels, Lori B.
Neath,
Sean-Xavier
Christenson, Robert
Potocki, Mihael
McCord,
James
Terracciano, Garret
Kremastinos, Dimitrios
Hartmann,
Oliver
von Haehling, Stephan
Bergmann, Andreas
Morgenthaler,
Nils G.
Anker, Stefan D.
Περιοδικό:
Circulation: Heart Failure
Εκδότης:
Lippincott, Williams & Wilkins
Λέξεις-κλειδιά:
heart failure; sodium; death; copeptin; vasopressin
DOI:
10.1161/CIRCHEARTFAILURE.110.960096
