Comparative diagnostic and predictive utilities of N-Terminal Pro-B-Type natriuretic peptide and copeptin in assessing heart failure and systolic dysfunction severity

Objective: To evaluate and compare the diagnostic and predictive capacities of N-terminal pro-B-type natriuretic peptide (NT proBNP) and copeptin in heart failure (HF), and to determine their respective associations with the severity of systolic dysfunction. Methods: A case-control study enrolled 60 patients with diagnosed HF and 60 healthy controls. Serum NT proBNP and copeptin were quantified using enzyme-linked immunosorbent assays. Diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis. Binary and ordinal logistic regression models identified independent predictors of HF and its severity. Results: Both biomarkers showed good diagnostic accuracy. NT proBNP yielded an area under the curve (AUC) of 0.87 (specificity 99.0%, sensitivity 64.0%), while copeptin produced an AUC of 0.84 (sensitivity 81.9%, specificity 74.0%). Binary logistic regression confirmed both markers as significant independent predictors of HF (NT proBNP: odds ratio [OR] 3.23, p=0.007; copeptin: OR 2.33, p=0.001). Ordinal logistic regression revealed that only NT proBNP maintained a statistically significant association with the severity of systolic dysfunction (OR 2.12, p=0.001), whereas copeptin did not (OR 0.99, p=0.87). Conclusions: NT proBNP and copeptin provide complementary diagnostic information. NT proBNP correlates strongly with cardiac dysfunction severity, whereas copeptin offers enhanced sensitivity to neurohormonal stress. A multimarker strategy may optimise clinical evaluation in HF.