Use of copeptin in the detection of myocardial ischemia.
BACKGROUND
The role of the arginine-vasopressin (AVP) system in the response to myocardial ischemia is unclear. Copeptin, the C-terminal part of the AVP prohormone is secreted stoichiometrically with AVP.


METHODS
A total of 253 consecutive patients with suspected myocardial ischemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography (SPECT) were enrolled. We evaluated the response of copeptin during exercise and determined whether measurement of copeptin may be helpful in the detection of myocardial ischemia.


RESULTS
Myocardial ischemia on perfusion images was detected in 127 patients (50%). Median copeptin levels increased significantly with exercise in patients with ischemia as well as in patients without ischemia (from 3.8 [IQR 2.8-6.6] to 12.3 [IQR 5.2-39.6] pmol/l, P<0.001; and from 3.6 [IQR 2.6-5.7] to 10.8 [IQR 5.0-24.5] pmol/l, P<0.001). Median exercise-induced changes in copeptin (Deltacopeptin) were similar in both groups (7.7 versus 5.1 pmol/l, P=0.150). The area under the ROC curve for the ability of Deltacopeptin to detect myocardial ischemia was 0.552.


CONCLUSIONS
Copeptin levels increased threefold with exercise, irrespective of the presence or absence of myocardial ischemia. Therefore, myocardial ischemia does not seem to be a major trigger of the AVP system. Measurement of copeptin does not seem helpful in the detection of exercise-induced myocardial ischemia.
Department of Internal Medicine, University Hospital Basel, Switzerland.
Daniel
D
Staub
Nils G
NG
Morgenthaler
Claudia
C
Buser
Tobias
T
Breidthardt
Mihael
M
Potocki
Markus
M
Noveanu
Tobias
T
Reichlin
Andreas
A
Bergmann
Christian
C
Mueller
D000368:Aged; D001127:Arginine Vasopressin / Q000097:blood*; D015444:Exercise / Q000502:physiology*; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D012372:ROC Curve; D015899:Tomography, Emission-Computed, Single-Photon; D014662:Vasoconstrictor Agents / Q000097:blood
D006020:Glycopeptides; D014662:Vasoconstrictor Agents; C048197:copeptins; D001127:Arginine Vasopressin