Complementary Role of Copeptin and High-Sensitivity Troponin in Predicting Outcome in Patients with Stable Chronic Heart Failure

AIMS: Copeptin, the C-terminal part of the vasopressin pro-hormone, is elevated after myocardial infarction and predicts adverse outcome. In the present study we investigated whether the complementary role of copeptin and cardiac troponin T (cTnT) could be used for identification of high-risk patients with chronic stable heart failure. METHODS AND RESULTS: We measured copeptin and high-sensitivity cTnT (hs-cTnT) levels in 172 consecutive patients with stable chronic heart failure. Patients were followed for all-cause mortality and hospitalization due to heart failure for a median of 1301 days (interquartile range: 707-1636). In univariate analysis, plasma copeptin showed a moderate but significant correlation with hs-cTnT (r= 0.40 P< 0.001), age (r= 0.36 P< 0.001), creatinine (r= 0.52 P< 0.001), and amino-terminal pro-B type natriuretic peptide (NT-proBNP; r= 0.42 P< 0.001). Both copeptin (P= 0.002) and hs-cTnT (P= 0.005) concentrations were significantly increased in patients with higher New York Heart Association classes. While 109 (58%) patients had hs-cTnT concentrations above normal (>14 pg/mL) 104 patients (55%) had copeptin concentrations above normal (16.4 pmol/L). In survival analysis, both elevated copeptin and hs-cTnT concentrations were significant predictors of outcome (P< 0.001 for both). The combination of both markers showed a graded and highly significant association with impaired clinical outcome, which was independent of plasma NT-proBNP levels (adjusted hazard ratios 1.40, 95% CI, 1.20-1.70; P< 0.001). Adding copeptin concentrations to a prediction model with NT-proBNP and hs-cTnT resulted in significant improvement in model performance (net reclassification improvement 0.208; P< 0.05). CONCLUSION: Our data suggest that the combined use of hs-cTnT and copeptin might predict clinical outcome of patients with chronic stable heart failure.