title: Copeptin in Heart Failure, Post-Left Ventricular Assist Device and Post-Heart Transplantation.
abstract: BACKGROUND
  Heart failure (HF) is associated with pathological activation of arginine vasopressin, measured in plasma by the pre-hormone fragment copeptin. We hypothesised that copeptin is elevated and associated with worse prognosis in HF, and that left ventricular assist device (LVAD) therapy and heart transplantation (HTx) are associated with lower levels of copeptin.
  
  
  METHODS
  We measured copeptin in groups of 49 patients with advanced HF, 13 patients one year post-LVAD and 22 patients one year post-HTx and correlated with clinical data and cardiac output. In HF we also assessed the prognostic role of copeptin with Kaplan-Meier analysis and multivariate Cox regression.
  
  
  RESULTS
  In HF, median (interquartile range) copeptin was 28 (18-45) pmol/L, after LVAD 16 (6-27) pmol/L, and after HTx 12 (5-20) pmol/L (p overall <0.001). In HF, copeptin was an independent predictor of death, LVAD or HTx (hazard ratio for log copeptin, 3.28 [95% confidence interval: 1.66-6.50], p=0.001).
  
  
  CONCLUSIONS
  Copeptin was elevated in, and independently predicted prognosis in, HF. Copeptin was progressively lower after LVAD and HTx. This suggests that improvement in cardiac output with LVAD and HTx may induce progressively reduced activation of vasopressin, which may be a marker for the beneficial effects of LVAD and HTx.
authors: Karolinska Institute, Department of Medicine, Stockholm, Sweden; Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden. Electronic address: stasia.zab@gmail.com.
authors: Stanislava
authors: S
authors: Zabarovskaja
authors: Karolinska Institute, Department of Medicine, Stockholm, Sweden; Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
authors: Camilla
authors: C
authors: Hage
authors: Karolinska Institute, Department of Medicine, Stockholm, Sweden.
authors: Anders
authors: A
authors: Gabrielsen
authors: Karolinska Institute, Department of Medicine, Stockholm, Sweden; Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
authors: Linda
authors: L
authors: Mellbin
authors: Karolinska Institute, Department of Medicine, Stockholm, Sweden; Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
authors: Lars H
authors: LH
authors: Lund
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate
chemical_list: D006020:Glycopeptides; C048197:copeptins
keywords: Copeptin; Heart assist device; Heart failure; Heart transplantation