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Al‐Atta A, Spray L, Mohammed A, Shmeleva E, Spyridopoulos I. Arginine Vasopressin Plays a Role in Microvascular Dysfunction After ST-Elevation Myocardial Infarction. J Am Heart Assoc 2023; 12:e030473. [PMID: 37681545 PMCID: PMC10547306 DOI: 10.1161/jaha.123.030473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
Background Coronary microvascular dysfunction (CMD) predicts mortality after ST-elevation-myocardial infarction (STEMI). Arginine vasopressin (AVP) may be implicated, but data in humans are lacking, and no study has investigated the link between arginine vasopressin and invasive measures of CMD. Methods and Results We invasively assessed CMD in 55 patients with STEMI treated with primary percutaneous coronary intervention (PPCI), by measuring the index of microcirculatory resistance after PPCI. In a separate group of 45 patients with STEMI/PPCI, recruited for a clinical trial, we measured infarct size and microvascular obstruction with cardiac magnetic resonance (CMR) imaging at 1 week and 12 weeks post-STEMI. Serum copeptin was measured at 4 time points before and after PPCI in all patients with STEMI. Plasma copeptin levels fell from 92.5 pmol/L before reperfusion to 6.4 pmol/L at 24 hours. Copeptin inversely correlated with diastolic, but not systolic, blood pressure (r=-0.431, P=0.001), suggesting it is released in response to myocardial ischemia. Persistently raised copeptin at 24 hours was correlated with higher index of microcirculatory resistance (r=0.372, P=0.011). Patients with microvascular obstruction on early CMR imaging showed a trend toward higher admission copeptin, which was not statistically significant. Copeptin levels were not associated with infarct size on either early or late CMR. Conclusions Patients with CMD after STEMI have persistently elevated copeptin at 24 hours, suggesting arginine vasopressin may contribute to microvascular dysfunction. Arginine vasopressin receptor antagonists may represent a novel therapeutic option in patients with STEMI and CMD.
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Affiliation(s)
- Ayman Al‐Atta
- Freeman HospitalNewcastle upon TyneUnited Kingdom
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUnited Kingdom
| | - Luke Spray
- Freeman HospitalNewcastle upon TyneUnited Kingdom
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUnited Kingdom
| | | | | | - Ioakim Spyridopoulos
- Freeman HospitalNewcastle upon TyneUnited Kingdom
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUnited Kingdom
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El Amrousy D, Abdelhai D, Nassar M. Predictive Value of Plasma Copeptin Level in Children with Acute Heart Failure. Pediatr Cardiol 2022; 43:1737-1742. [PMID: 35532808 PMCID: PMC9587970 DOI: 10.1007/s00246-022-02909-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/04/2022] [Indexed: 02/08/2023]
Abstract
We investigated the ability of copeptin level to predict adverse outcome in pediatric heart failure (HF) and correlated copeptin level with various clinical and echocardiographic data. This cohort study was carried out on forty children with clinical picture of acute HF as the patient group and forty healthy children of matched age and sex as the control group. Echocardiographic examination and plasma copeptin level were performed for all included children at admission. Patients were followed up for 6 months for mortality or readmission. Plasma copeptin level was significantly higher in the patient group (16.2 ± 5) pmol/L compared to the control group (4.1 ± 2.3) pmol/L, P ˂0.001. Moreover, copeptin level was positively correlated with Ross classification, being the highest in patients with class IV (19.6 ± 3.9) pmol/L compared to those with class III (15.2 ± 4) pmol/L and class II (10.4 ± 1.5) pmol/L. Copeptin levels were significantly higher in patients with bad prognosis (21.2 ± 4.1) pmol/L compared to those with good prognosis (14.5 ± 4.1) pmol/L, P ˂0.001. Copeptin level had a significant positive correlation with age, heart rate, respiratory rate, and ROSS classification. On the contrary, copeptin level had a significant negative correlation with left ventricular fraction shortening and diastolic function. Copeptin at cut-off value of ≥ 19.5 pmol/L yielded a sensitivity of 75% and a specificity of 93% to predict adverse outcome in children with HF. Plasma copeptin level has a good prognostic value to predict adverse outcome in pediatric heart failure. Moreover, copeptin correlate well with the severity of pediatric HF.
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Affiliation(s)
- Doaa El Amrousy
- grid.412258.80000 0000 9477 7793Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina Abdelhai
- grid.412258.80000 0000 9477 7793Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammed Nassar
- grid.412258.80000 0000 9477 7793Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Mu D, Cheng J, Qiu L, Cheng X. Copeptin as a Diagnostic and Prognostic Biomarker in Cardiovascular Diseases. Front Cardiovasc Med 2022; 9:901990. [PMID: 35859595 PMCID: PMC9289206 DOI: 10.3389/fcvm.2022.901990] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022] Open
Abstract
Copeptin is the carboxyl-terminus of the arginine vasopressin (AVP) precursor peptide. The main physiological functions of AVP are fluid and osmotic balance, cardiovascular homeostasis, and regulation of endocrine stress response. Copeptin, which is released in an equimolar mode with AVP from the neurohypophysis, has emerged as a stable and simple-to-measure surrogate marker of AVP and has displayed enormous potential in clinical practice. Cardiovascular disease (CVD) is currently recognized as a primary threat to the health of the population worldwide, and thus, rapid and effective approaches to identify individuals that are at high risk of, or have already developed CVD are required. Copeptin is a diagnostic and prognostic biomarker in CVD, including the rapid rule-out of acute myocardial infarction (AMI), mortality prediction in heart failure (HF), and stroke. This review summarizes and discusses the value of copeptin in the diagnosis, discrimination, and prognosis of CVD (AMI, HF, and stroke), as well as the caveats and prospects for the application of this potential biomarker.
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Affiliation(s)
- Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Baumann P, Gotta V, Atkinson A, Deisenberg M, Hersberger M, Roggia A, Schmid K, Cannizzaro V. Copeptin Release in Arterial Hypotension and Its Association with Severity of Disease in Critically Ill Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060794. [PMID: 35740731 PMCID: PMC9222164 DOI: 10.3390/children9060794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/05/2022]
Abstract
Low copeptin levels may indicate inadequate arginine-vasopressin release promoting arterial hypotension, whereas high copeptin concentrations may reflect disease severity. This single-center prospective non-randomized clinical trial analyzed the course of blood copeptin in critically ill normo- and hypotensive children and its association with disease severity. In 164 patients (median age 0.5 years (interquartile range 0.1, 2.9)), the mean copeptin concentration at baseline was 43.5 pmol/L. Though not significantly different after 61 h (primary outcome, mean individual change: −12%, p = 0.36, paired t-test), we detected 1.47-fold higher copeptin concentrations during arterial hypotension when compared to normotension (mixed-effect ANOVA, p = 0.01). In total, 8 out of 34 patients (23.5%) with low copeptin concentrations <10 pmol/L were hypotensive. Copeptin was highest in the adjusted mixed-effect regression analysis within the first day (+20% at 14 h) and decreased significantly at 108 h (−27%) compared to baseline (p = 0.002). Moreover, we found a significant association with vasopressor-inotrope treatment intensity, infancy (1−12 months) and cardiopulmonary bypass (all p ≤ 0.001). In conclusion, high copeptin values were associated with arterial hypotension and severity of disease in critically ill children. This study does not support the hypothesis that low copeptin values might be indicative of arginine-vasopressin deficiency.
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Affiliation(s)
- Philipp Baumann
- Department of Intensive Care and Neonatology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.D.); (A.R.); (K.S.)
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.H.); (V.C.)
- Correspondence:
| | - Verena Gotta
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, 4056 Basel, Switzerland; (V.G.); (A.A.)
| | - Andrew Atkinson
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, 4056 Basel, Switzerland; (V.G.); (A.A.)
| | - Markus Deisenberg
- Department of Intensive Care and Neonatology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.D.); (A.R.); (K.S.)
- Department of Anaesthesia, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Martin Hersberger
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.H.); (V.C.)
- Clinical Chemistry and Biochemistry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Adam Roggia
- Department of Intensive Care and Neonatology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.D.); (A.R.); (K.S.)
| | - Kevin Schmid
- Department of Intensive Care and Neonatology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.D.); (A.R.); (K.S.)
| | - Vincenzo Cannizzaro
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (M.H.); (V.C.)
- Department of Neonatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Mu D, Ma C, Cheng J, Zou Y, Qiu L, Cheng X. Copeptin in fluid disorders and stress. Clin Chim Acta 2022; 529:46-60. [PMID: 35143773 DOI: 10.1016/j.cca.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Abstract
Copeptin, a glycosylated peptide of 39 amino acids, is the C-terminal segment of arginine vasopressin (AVP) precursor peptide, which is consisted of two other fragments, vasopressin and neurophysin Ⅱ. The main physiological functions of AVP are fluid and osmotic balance, cardiovascular homeostasis and regulation of the endocrine stress response. Numerous studies have demonstrated that the endogenous AVP in plasma is a meaningful biomarker to guide diagnosis and therapy of diseases associated with fluids disorders and stress. However, due to its instability, short half-time life in circulation and lack of readily available AVP assays, clinical measurement of AVP is restricted. In contrast to AVP, copeptin which is released in an equimolar mode with AVP from the pituitary, has emerged as a stable and simple-to-measure surrogate marker of AVP and displays excellent potential in diagnosis, differentiation and prognosis of various diseases. This review will discuss the studies on the clinical value of copeptin in different diseases, especially in AVP-dependent fluids disorders, as well as issues and prospects of the application of this potential biomarker.
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Affiliation(s)
- Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Yutong Zou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
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Schill F, Timpka S, Nilsson PM, Melander O, Enhörning S. Copeptin as a predictive marker of incident heart failure. ESC Heart Fail 2021; 8:3180-3188. [PMID: 34056865 PMCID: PMC8318511 DOI: 10.1002/ehf2.13439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Heart failure (HF) is a common disease with increasing prevalence and poor prognosis. The vasopressin (VP) marker copeptin predicts development of diabetes mellitus, diabetic heart disease, coronary artery disease, and premature mortality. Copeptin is elevated in HF patients and predicts a worse outcome. This study aims to investigate whether copeptin can predict HF development. Methods Copeptin was analysed in 5297 individuals (69.6% men) without prevalent HF from the Malmö Preventive Project, a population‐based prospective cohort. Cox proportional hazards models were used to analyse risk of incident HF by copeptin levels after adjusting for conventional cardiovascular risk factors. Results During a median follow‐up time of 11.1 years, 350 subjects (6.6%) were diagnosed with HF. Of these events, 99 were classified as myocardial infarction (MI) related HF and 251 as non‐MI‐related HF. Individuals in the top quartile of copeptin had, after multivariate adjustment for conventional risk factors (age, sex, systolic blood pressure, diabetes mellitus, body mass index, antihypertensive therapy, smoking, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol), a significantly increased risk of developing HF by 1.63 [confidence interval (CI) 1.20–2.21] for HF compared with the reference quartile 1. After adjustment for conventional risk factors, the hazard ratio (HR) per standard deviation increase of log‐transformed copeptin for any HF was 1.30 (95% CI 1.17–1.46), whereas it was 1.39 (CI 1.13–1.71) for MI‐related HF and 1.26 (CI 1.11–1.44) for non‐MI‐related HF. The associations remained after additional adjustment for estimated glomerular filtration rate [HR 1.24 (95% CI: 1.10–1.40)] and for pro atrial natriuretic peptide on top of conventional risk factors [HR 1.14 (95% CI: 1.02–1.28)]. Conclusions Elevated copeptin predicts development of HF in older adults. Copeptin is a risk marker of VP‐driven HF susceptibility and a candidate to guide prevention efforts of HF targeting the VP system.
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Affiliation(s)
- Fredrika Schill
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Simon Timpka
- Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Sofia Enhörning
- Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Yildirim E, Cabbar AT. Association between copeptin and contrast-induced nephropathy in patients with ST-elevation myocardial infarction. Rev Port Cardiol 2020; 38:873-879. [PMID: 32165078 DOI: 10.1016/j.repc.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/16/2019] [Accepted: 06/22/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the predictive value of copeptin levels in the development of contrast-induced nephropathy (CIN). METHODS A total of 274 patients diagnosed with ST-elevation myocardial infarction (STEMI) and who had undergone primary percutaneous coronary intervention were included in the study. The patients were divided into two groups according to the presence (CIN+) or absence (CIN-) of CIN. These groups were compared in terms of demographic characteristics, laboratory findings and risk factors. RESULTS Copeptin levels (10.68±6.43 vs. 7.07±05.53 pmol/l; p<0.001) and peak creatinine (1.46±1.20 vs. 1.03±0.20 mg/dl; p=0.005) were significantly higher in the CIN+ group than in the CIN- group. Female gender was significantly more prevalent in the CIN- group compared to the CIN+ group (19% vs. 8.6%; p<0.05). Copeptin level at hospital admission (OR: 2.36, p=0.005) was found to be an independent predictor for CIN development. CONCLUSION Copeptin level is an independent predictor of CIN development in patients with acute STEMI that can be detected rapidly and easily. This result indicates that physicians should be aware of the possibility of CIN development in patients with high copeptin levels and preventive measures should start early.
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Affiliation(s)
- Ersin Yildirim
- Istanbul Umraniye Education and Research Hospital, University of Health Sciences, Department of Cardiology, Turkey.
| | - Ayca Turer Cabbar
- Yeditepe University Faculty of Medicine, Department of Cardiology, Turkey
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Buttà C, Roberto M, Tuttolomondo A, Petrantoni R, Miceli G, Zappia L, Pinto A. Old and New Drugs for Treatment of Advanced Heart Failure. Curr Pharm Des 2019; 26:1571-1583. [PMID: 31878852 DOI: 10.2174/1381612826666191226165402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/23/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Advanced heart failure (HF) is a progressive disease with high mortality and limited medical therapeutic options. Long-term mechanical circulatory support and heart transplantation remain goldstandard treatments for these patients; however, access to these therapies is limited by the advanced age and multiple comorbidities of affected patients, as well as by the limited number of organs available. METHODS Traditional and new drugs available for the treatment of advanced HF have been researched. RESULTS To date, the cornerstone for the treatment of patients with advanced HF remains water restriction, intravenous loop diuretic therapy and inotropic support. However, many patients with advanced HF experience loop diuretics resistance and alternative therapeutic strategies to overcome this problem have been developed, including sequential nephron blockade or use of the hypertonic saline solution in combination with high-doses of furosemide. As classic inotropes augment myocardial oxygen consumption, new promising drugs have been introduced, including levosimendan, istaroxime and omecamtiv mecarbil. However, pharmacological agents still remain mainly short-term or palliative options in patients with acute decompensation or excluded from mechanical therapy. CONCLUSION Traditional drugs, especially when administered in combination, and new medicaments represent important therapeutic options in advanced HF. However, their impact on prognosis remains unclear. Large trials are necessary to clarify their therapeutic potential and prognostic role in these fragile patients.
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Affiliation(s)
- Carmelo Buttà
- Unità Operativa Complessa, Cardiologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy
| | - Marco Roberto
- Servizio di Cardiologia, Cardiocentro Ticino Lugano, Lugano, Switzerland
| | - Antonino Tuttolomondo
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
| | - Rossella Petrantoni
- Pronto Soccorso, Fondazione Istituto G. Giglio di Cefalù, 90015 Cefalù PA, Italy
| | - Giuseppe Miceli
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Zappia
- Unità Operativa Complessa, Cardiologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy
| | - Antonio Pinto
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
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Yildirim E, Cabbar AT. Association between copeptin and contrast-induced nephropathy in patients with ST-elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Heart failure (HF) is the end result of many different cardiac and non-cardiac abnormalities leading to a complex clinical entity. In this view, the use of biomarkers in HF should be deeply reconsidered; indeed, the same biomarker may carry a different significance in patients with preserved or reduced EF. The aim of this review is to reconsider the role of biomarkers in HF, based on the different clinical characteristics of this syndrome. The role of cardiac and non-cardiac biomarkers will be reviewed with respect of the different clinical manifestations of this syndrome.
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Effect of Chronic Kidney Disease on Changes in Vasopressin System Expression in the Kidney Cortex in Rats with Nephrectomy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2607928. [PMID: 30013980 PMCID: PMC6022316 DOI: 10.1155/2018/2607928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/18/2018] [Accepted: 05/21/2018] [Indexed: 02/01/2023]
Abstract
It is believed that the vasopressinergic system plays an important role in the pathogenesis of chronic kidney disease (CKD). The aim of this study was to evaluate the effect of CKD on changes in vasopressin system expression in the kidney cortex in rats with nephrectomy. The study was performed on 4 groups of Sprague Dawley (SPRD) rats: a control group (CN), 1/2 nephrectomy (N1/2), 2/3 nephrectomy (N2/3), and 5/6 nephrectomy (N5/6). Blood and the kidney cortex were collected to evaluate plasma copeptin concentrations and mRNA expressions of V1a vasopressin receptors (V1aR) and V2 vasopressin receptors (V2R) and V1aR, V2R, and aquaporin 2 (AQP2) protein levels. V1aR and V2R mRNA expression in the kidney cortex was significantly lower in the CN group compared with the other groups. In contrast, the V1aR, V2R, and AQP2 protein levels were significantly higher in the CN group compared with all of the nephrectomized groups. Plasma copeptin concentration was significantly lower in the CN group than in the nephrectomized groups. CKD caused significant changes in the expression of the vasopressinergic system. Further research is needed to explain the mechanisms of the impact of the vasopressinergic system on the kidney in CKD.
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Nymo SH, Aukrust P, Kjekshus J, McMurray JJV, Cleland JGF, Wikstrand J, Muntendam P, Wienhues-Thelen U, Latini R, Askevold ET, Gravning J, Dahl CP, Broch K, Yndestad A, Gullestad L, Ueland T. Limited Added Value of Circulating Inflammatory Biomarkers in Chronic Heart Failure. JACC-HEART FAILURE 2018; 5:256-264. [PMID: 28359413 DOI: 10.1016/j.jchf.2017.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/09/2017] [Accepted: 01/21/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study sought to evaluate whether a panel of biomarkers improved prognostication in patients with heart failure (HF) and reduced ejection fraction of ischemic origin using a systematized approach according to suggested requirements for validation of new biomarkers. BACKGROUND Modeling combinations of multiple circulating markers could potentially identify patients with HF at particularly high risk and aid in the selection of individualized therapy. METHODS From a panel of 20 inflammatory and extracellular matrix biomarkers, 2 different biomarker panels were created and added to the Seattle HF score and the prognostic model from the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) study (n = 1,497), which included conventional clinical characteristics and C-reactive protein and N-terminal pro-B-type natriuretic peptide. Interactions with statin treatment were also assessed. RESULTS The two models-model 1 (endostatin, interleukin 8, soluble ST2, troponin T, galectin 3, and chemokine [C-C motif] ligand 21) and model 2 (troponin T, soluble ST2, galectin 3, pentraxin 3, and soluble tumor necrosis factor receptor 2)-significantly improved the CORONA and Seattle HF models but added only modestly to their Harrell's C statistic and net reclassification index. In addition, rosuvastatin had no effect on the levels of a wide range of inflammatory and extracellular matrix markers, but there was a tendency for patients with a lower level of biomarkers in the 2 panels to have a positive effect from statin treatment. CONCLUSIONS In the specific HF patient population studied, a multimarker approach using the particular panel of biomarkers measured was of limited clinical value for identifying future risk of adverse outcomes.
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Affiliation(s)
- Ståle H Nymo
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - John Kjekshus
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - John G F Cleland
- Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston-upon-Hull, United Kingdom
| | | | | | | | - Roberto Latini
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Erik Tandberg Askevold
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jørgen Gravning
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Christen P Dahl
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
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Kerbert AJC, Verspaget HW, Navarro ÀA, Jalan R, Solà E, Benten D, Durand F, Ginès P, van der Reijden JJ, van Hoek B, Coenraad MJ. Copeptin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:321. [PMID: 29268760 PMCID: PMC5740749 DOI: 10.1186/s13054-017-1894-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022]
Abstract
Background Acute-on-chronic liver failure (ACLF) is characterized by the presence of acute decompensation (AD) of cirrhosis, organ failure, and high short-term mortality rates. Hemodynamic dysfunction and activation of endogenous vasoconstrictor systems are thought to contribute to the pathogenesis of ACLF. We explored whether copeptin, a surrogate marker of arginine vasopressin, is a potential marker of outcome in patients admitted for AD or ACLF and whether it might be of additional value to conventional prognostic scoring systems in these patients. Methods All 779 patients hospitalized for AD of cirrhosis from the CANONIC database with at least one serum sample available for copeptin measurement were included. Presence of ACLF was defined according to the CLIF-consortium organ failure (CLIF-C OF) score. Serum copeptin was measured in samples collected at days 0–2, 3–7, 8–14, 15–21, and 22–28 when available. Competing-risk regression analysis was applied to evaluate the impact of serum copeptin and laboratory and clinical data on short-term survival. Results Serum copeptin concentration was found to be significantly higher in patients with ACLF compared with those without ACLF at days 0–2 (33 (14–64) vs. 11 (4–26) pmol/L; p < 0.001). Serum copeptin at admission was shown to be a predictor of mortality independently of MELD and CLIF-C OF scores. Moreover, baseline serum copeptin was found to be predictive of ACLF development within 28 days of follow-up. Conclusions ACLF is associated with significantly higher serum copeptin concentrations at hospital admission compared with those with traditional AD. Copeptin is independently associated with short-term survival and ACLF development in patients admitted for AD or ACLF. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1894-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annarein J C Kerbert
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands.
| | - Hein W Verspaget
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands
| | - Àlex Amorós Navarro
- Liver Unit/EASL-CLIF Data Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rajiv Jalan
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK
| | - Elsa Solà
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Daniel Benten
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - François Durand
- Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France
| | - Pere Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Johan J van der Reijden
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, PO Box 9600, Leiden, The Netherlands
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Advances in heart failure: a review of biomarkers, emerging pharmacological therapies, durable mechanical support and telemonitoring. Clin Sci (Lond) 2017; 131:553-566. [PMID: 28302916 DOI: 10.1042/cs20160196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/14/2016] [Accepted: 01/05/2017] [Indexed: 01/14/2023]
Abstract
The purpose of this review is to provide an overview of diagnosis, prognosis and management of heart failure (HF) with reduced ejection fraction (HFrEF). Specifically, this review is divided into three sections. The first section will address biomarkers. The discovery of biomarkers has allowed further understanding of the pathophysiology of HF and provides insight into potential therapeutic targets. This review will focus on novel applications of natriuretic peptides (NPs) in clinical trials. Next, emerging biomarkers of HF, such as ST2, galectin-3 and copeptin, will be discussed. The second section aims to highlight HF therapies, including novel drugs and durable devices. The last section will review home haemodynamic monitoring and mobile health. We aim to provide context for the understanding of novel diagnostic and therapeutic advances in HF that are still in phase II or III trials, and have yet to become widely available.
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Abstract
Despite the introduction of multiple new pharmacological agents over the past three decades in the field of heart failure (HF), overall prognosis remains poor. Hyponatremia is prevalent in HF patients and has been suggested as a contributor to poor response to standard therapy. Elevated levels of arginine vasopressin (AVP), a peptide hormone produced in the hypothalamus, play a role in development of hyponatremia, and AVP and its surrogate, copeptin, are related to changes in osmolality, hemodynamics, neuro-hormones as well as in overall outcome in HF patients. Of current pharmacological interest are the selective and non-selective vasopressin receptor antagonists (VRAs), which inhibit vasoconstriction and cardiac remodeling mediated by the V1a receptors in smooth blood vessels, and water retention (increased urine osmolality and decreased water excretion) by increasing aquaporin-2 water channels mediated by the V2 receptors in the renal collecting tubules. The optimal use of VRAs is yet to be determined, especially in patients with congestive HF. Although long-term effects on improvement in mortality have not been shown in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, the only long-term outcome trial to date, many short-term studies indicate beneficial aquaretic- and hemodynamic-effects of the VRAs. In contrast to loop diuretics, these new agents tend to increase urine flow and the excretion of electrolyte-free water (so-called aquaresis) in patients with HF, without substantial changes in sodium or potassium excretion. This chapter reviews the role of AVP and copeptin in HF, and the treatment potential of VRAs in HF.
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Calmarza P, Lapresta C, García-Castañón S, López-Perales C, Pérez-Guerrero A, Portolés A. [Usefulness of copeptin in the diagnosis of acute coronary syndrome in the emergency department of a tertiary hospital]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:209-215. [PMID: 27650658 DOI: 10.1016/j.arteri.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was conducted in order to evaluate the usefulness of copeptin (a stable fragment of the precursor of arginine vasopressin) in the differential diagnosis of acute chest pain of probable coronary origin. MATERIAL AND METHODS The study includes 82 patients who were initially evaluated according to the protocol of a patient with suspected acute coronary syndrome (ACS) in our Emergency Department, including the determination of troponin and copeptin with specimens taken on admission (time 0) and at 6h. RESULTS Statistically significant differences were observed in copeptin concentrations at time 0 among patients diagnosed with non-ST-segment elevation (NTEACS): 42.1±38.7pmol/L and non-NSTEACS patients: 15.6±21.2pmol/L (P<. 01). However, the differences did not reach statistical significance at 6h (P=.093). The analysis of the area under the ROC curve for Copeptin in NSTEACS patients at time 0 was 0.713, with a confidence interval of 95% from 0.592 to 0.834 and a significance level of P=.001. CONCLUSIONS The concentration of copeptin represents an additional value in the differentiation between NSTEACS patients and non-NSTEACS patients, as well as between ACS patients and patients with stable angina. The cut-off point of 10pmol/L provides the best values for sensitivity, negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) in the diagnosis of NSTEACS patients.
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Affiliation(s)
- Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Carlos Lapresta
- Servicio de Medicina Preventiva, Hospital de Barbastro, Zaragoza, España
| | | | | | | | - Ana Portolés
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, España
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