Higher copeptin levels are associated with worse outcome in patients with hypertrophic cardiomyopathy

Abstract

Background: Correlation of increased copeptin levels with various cardiovascular diseases has been described. The clinical use of copeptin levels in patients with hypertrophic cardiomyopathy (HCM) has not been investigated before.

Hypothesis: In this study, we aimed to investigate the prognostic value of copeptin levels in patients with hypertrophic cardiomyopathy (HCM).

Methods: HCM was defined as presence of left ventricular wall thickness ≥15 mm in a subject without any concomitant disease that may cause left ventricular hypertrophy. Levels of copeptin and plasma N-terminal probrain natriuretic peptide (NT-proBNP) were evaluated prospectively in 24 obstructive HCM patients, 36 nonobstructive HCM patients, and 36 age- and sex-matched control subjects. Blood samples were collected in the morning between 7 and 9 am after overnight fasting. Patients were followed for 24 months. Hospitalization with diagnosis of heart failure/arrhythmia, implantable cardioverter-defibrillator implantation, and cardiac mortality were accepted as adverse cardiac events.

Results: Copeptin and NT-proBNP levels were higher in the HCM group compared with controls (14.1 vs 8.4 pmol/L, P < 0.01; and 383 vs 44 pg/mL, P < 0.01, respectively). Copeptin and NT-proBNP levels were higher in the obstructive HCM subgroup compared with the nonobstructive HCM subgroup (18.3 vs 13.1 pmol/L, P < 0.01; and 717 vs 223 pg/mL, P < 0.01, respectively). In multivariable logistic regression analysis, copeptin and NT-proBNP levels remained as independent predictors of heart failure (P < 0.01 for both) and adverse cardiac events (P < 0.01 for both).

Conclusions: Copeptin and NT-proBNP levels were significantly higher in patients with obstructive HCM, and higher levels were associated with worse outcome.

Keywords: Cardiovascular; Heart failure/cardiac transplantation/cardiomyopathy/myocarditis; Imaging; biochemistry; echocardiography.

Figure 1

Box‐plot graph showing the copeptin (left side) and NT‐proBNP (right side) levels in obstructive HCM, nonobstructive HCM, and control groups. Abbreviations: HCM, hypertrophic cardiomyopathy; NT‐proBNP, N‐terminal probrain natriuretic peptide.

Figure 2

ROC curve analysis of copeptin and NT‐proBNP levels for diagnosis of HCM in the study population. Abbreviations: AUC, area under the curve; HCM, hypertrophic cardiomyopathy; NT‐proBNP, N‐terminal probrain natriuretic peptide; ROC, receiver operating characteristic.