(Press-News.org) Munich, Germany – Copeptin predicts prognosis in patients with heart failure, according to research presented at the ESC Congress today, August 25, by Professor Stefan Störk from Germany.
Increased levels of copeptin were associated with increased frequencies of typical co-morbidities of heart failure, increased severity of heart failure, and increased risk of all-cause death.
"Knowledge on the prognosis of patients with a chronic condition enables the physician to tailor the speed and intensity of treatment options to the individual patient," said Professor Störk. "Copeptin, a stress hormone involved in water and sodium balance holds promise to improve the prediction of prognosis in patients with heart failure."
Heart failure has become one of the most frequent hospital discharge diagnoses and represents one of the most cost-intensive conditions of industrialized countries. The aging population and improved treatment strategies of coronary heart disease further contribute to the steep rise of heart failure prevalence. "Prognosis in heart failure very much depends on the early success of treatment tailored to the individual patient," said Professor Störk. "In clinical practice, it is crucial to get a reliable estimate of the prognosis of an individual patient since prognosis determines the urgency and intensity of treatment. Depending on the success of treatment, prognosis may be modified.
This estimate of prognosis may be drawn from clinical information describing the patient´s general condition, dedicated diagnostic examinations, or laboratory measurements."
Heart failure is a condition associated with fluid overload. It leads to congestion of the lungs, other internal organs, and peripheral oedema. So far, only natriuretic peptides that are markers of cardiac muscle stretch have been established as simple-to-use prognostic markers. Vasopressin is a hormone that is centrally involved in the regulation of sodium and water balance and renal function. Direct measurement of vasopressin is not possible in clinical routine, but its prohormone copeptin (i.e., the C-terminal fragment of the vasopressin precursor peptide) is very stable and reliably to measure.
Professor Störk said: "Copeptin is viewed as a general marker of stress; recently, it was shown that copeptin can be used to improve the speed of diagnosing or ruling out myocardial infarction."
For the study, the association of copeptin with clinical characteristics, laboratory parameters, comorbidities and outcome were investigated in 926 patients of the Interdisciplinary Network Heart Failure Study. Subjects with reduced cardiac pump function (i.e., left ventricular ejection fraction below 40%) were enrolled into the study prior to discharge after a hospitalisation for cardiac decompensation. All patients underwent a very detailed clinical assessment and diagnostic work-up. Patients were seen for a series of follow-up visits at six month intervals at the outpatients' clinic or were monitored via a structured telephone call.
Heart failure is a disorder of the elderly. Accordingly, the mean age of subjects was 68 years, and 71% were male. About half of the patients suffered from advanced heart failure (44% were in NYHA functional class III or IV). Important comorbidities such as diabetes, poor kidney function and anaemia were frequent.
The table shows relevant differences in relation to increasing steps (i.e., quartiles) of copeptin levels measured at baseline. Higher copeptin levels were linked with higher patient age, and more advanced heart failure (NYHA functional class III/IV). Patients in all quartiles had similar blood sodium levels and similar rates of heart failure caused by ischaemia.
As copeptin levels rose, patients were more likely to have a low glomerular filtration rate. "This indicates that a higher copeptin level predicts poorer kidney function," said Professor Störk. The proportion of patients with diabetes mellitus and anaemia also increased as copeptin levels rose.
Left ventricular ejection fraction decreased as copeptin levels increased. Professor Störk said: "This shows that copeptin measurements are linked with the strength of cardiac contractility. Patients with higher copeptin levels had lower left ventricular ejection fraction, which indicates that their heart was pumping less effectively."
The risk of mortality from all causes increased with rising copeptin levels. Patients in the lowest quartile of copeptin (40.61). "The risk of all-cause death strongly depended on the copeptin levels," said Professor Störk. "It was about four-fold higher in the highest quartile compared to the lowest quartile.
Table: Association between quartiles of baseline copeptin levels and clinical characteristics or mortality
Copeptin at baseline (pmol/L)
Copeptin at baseline (pmol/L)
≤ 10.10 10.11 – 20.35 20.36 – 40.60 > 40.61 P for trend
Median age, years
(interquartile range) 63
(53; 72) 69
(57; 76) 71
(64; 77) 76
(69; 80) END
Copeptin predicts prognosis in HF patients
2012-08-27
ELSE PRESS RELEASES FROM THIS DATE:
Sudden death less likely in exercise related cardiac arrests
2012-08-27
Munich, Germany – People who have a cardiac arrest during or shortly after exercise are three times more likely to survive than those who have a cardiac arrest that is not exercise related, according to research presented at the ESC Congress 2012 today, August 26. The findings from the Amsterdam Resuscitation Study (ARREST) were presented by Dr Arend Mosterd from the Netherlands.
"Although physical activity is the best way to promote cardiovascular health, exercise can also trigger an acute cardiac event leading to death," said Dr Mosterd. "These dramatic and often high ...
Novel blood test predicts sudden death risk patients who would benefit from ICDs
2012-08-27
Munich, Germany – A novel blood test that predicts sudden death risk in heart failure patients is set to help physicians decide which patients would benefit from implantable cardioverter defibrillators (ICDs). The findings were presented at the ESC Congress 2012 today, August 26, by Professor Samuel Dudley from Chicago, IL, US.
Approximately 5 million patients in the US have heart failure, a condition where the heart is unable to pump blood adequately, and nearly 550,000 people are diagnosed annually. Heart failure is the single most common cause of admission to hospitals ...
ECG is a cost effective method for diagnosing cardiac abnormalities in young athletes
2012-08-27
Munich, Germany – Cardiovascular screening with ECG in young athletes is a cost effective way of diagnosing cardiac abnormalities, at just 138 Swiss Francs (about €115) per athlete. The findings were presented today, August 26, at the ESC Congress 2012 by Dr Andrea Menafoglio from Switzerland.
Sport is beneficial for health in most people. But for the small minority of the population who has cardiovascular abnormalities, sport can cause harm and very rarely – in one to three per 100,000 athletes per year – it can lead to sudden cardiac death.
"The cardiac arrest of ...
Electrical storm is a potent risk factor for mortality and morbidity
2012-08-27
Munich, Germany – Electrical storm (ES) is a potent risk factor for mortality and morbidity, according to research presented today, August 26, at the ESC Congress 2012 by Dr Federico Guerra from Italy. Data was also presented on which patients are prone to developing ES and how effective current treatments are.
Sustained ventricular arrhythmias, such as ventricular tachycardia (VT) or ventricular fibrillation (VF), are often seen as serious and devastating events, given their ability to lead to cardiac arrest and death if not treated promptly. Dr Guerra said: "The cluster ...
How ocean currents affect global climate is a question oceanographer may be close to answering
2012-08-27
TALLAHASSEE, Fla. - Kevin Speer has a "new paradigm" for describing how the world's oceans circulate — and with it he may help reshape science's understanding of the processes by which wind, water, sunlight and other factors interact and influence the planet's climate.
A Florida State University professor of oceanography with a passion for teaching, Speer and a colleague recently published a significant paper in the respected journal Nature Geoscience.
Working with John Marshall, an oceanography professor at the Massachusetts Institute of Technology, Speer reviewed ...
Compounds activate key cancer enzyme to interfere with tumor formation
2012-08-27
Scientists have known for decades that cancer cells use more glucose than healthy cells, feeding the growth of some types of tumors. Now, a team that includes researchers from the National Institutes of Health's new National Center for Advancing Translational Sciences (NCATS) has identified compounds that delay the formation of tumors in mice, by targeting a key enzyme that governs how cancer cells use glucose and its metabolites.
The study, published August 26 in the advance online publication of Nature Chemical Biology, was led by researchers from the Koch Institute ...
JCI early table of contents for Aug. 27, 2012
2012-08-27
New model of muscular dystrophy provides insight into disease development
Muscular dystrophy is a complicated set of genetic diseases in which genetic mutations affect the various proteins that contribute to a complex that is required for a structural bridge between muscle cells and the extracellular matrix (ECM) that provides the physical and chemical environment required for their development and function. The affects of these genetic mutations in patients vary widely, even when the same gene is affected. In order to develop treatments for this disease, it is important ...
New model of muscular dystrophy provides insight into disease development
2012-08-27
Muscular dystrophy is a complicated set of genetic diseases in which genetic mutations affect the various proteins that contribute to a complex that is required for a structural bridge between muscle cells and the extracellular matrix (ECM) that provides the physical and chemical environment required for their development and function. The affects of these genetic mutations in patients vary widely, even when the same gene is affected. In order to develop treatments for this disease, it is important to have an animal model that accurately reflects the course of the disease ...
The role of genes in political behavior
2012-08-27
Politics and genetics have traditionally been considered non-overlapping fields, but over the past decade it has become clear that genes can influence political behavior, according to a review published online August 27th in Trends in Genetics. This paradigm shift has led to novel insights into why people vary in their political preferences and could have important implications for public policy.
"We're seeing an awakening in the social sciences, and the wall that divided politics and genetics is really starting to fall apart," says review author Peter Hatemi of the ...
Review of new evidence to treat colonic diverticulitis may help doctors
2012-08-27
Recent evidence and new treatments for colonic diverticulitis that may help clinicians manage and treat the disease are summarized in a review in CMAJ (Canadian Medical Association Journal).
Diverticular disease, in which sac-like protrusions form in the wall of the colon, is common in developed countries, although it is increasing throughout the world, likely because of lifestyle changes. In people with the disease, about 25% will develop symptoms, which include abdominal pain and changed bowel habits, often leading to a diagnosis of irritable bowel syndrome. The widespread ...