First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Neurology (M.F.), University Medical Centre Mannheim, Mannheim, Germany.
Ann Clin Biochem. 2021 Jul;58(4):270-279. doi: 10.1177/0004563221989364. Epub 2021 Feb 11.
Data is limited evaluating novel biomarkers in right ventricular dysfunction. Normal right heart function improves the prognosis of patients with heart failure. Therefore, this study investigates the association between the novel biomarker copeptin and right heart function compared to NT-proBNP.
Patients undergoing routine echocardiography were enrolled prospectively. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE) and further right ventricular and atrial parameters. Exclusion criteria were age under 18 years, left ventricular ejection fraction < 50% and moderate to severe valvular heart disease. Blood samples were taken for biomarker measurements within 72 h of echocardiography.
Ninety-one patients were included. Median values of copeptin increased significantly according to decreasing values of TAPSE ( = 0.001; right heart function grade I: tricuspid annular plane systolic excursion; TAPSE > 24 mm: 5.20 pmol/L; grade II: TAPSE 18-24 mm: 8.10 pmol/L; grade III: TAPSE < 18 mm: 26.50 pmol/L). Copeptin concentrations were able to discriminate patients with decreased right heart function defined as TAPSE < 18 mm (area under the curves [AUC]: copeptin: 0.793; = 0.001; NT-proBNP: 0.805; = 0.0001). Within a multivariable linear regression model, copeptin was independently associated with TAPSE (copeptin: T: -4.43; = 0.0001; NT-proBNP: T: -1.21; = 0.23). Finally, copeptin concentrations were significantly associated with severely reduced right heart function (TAPSE < 18 mm) within a multivariate logistic regression model (copeptin: odds ratio: 0.94; 95% confidence interval: 0.911-0.975; = 0.001).
This study demonstrates that the novel biomarker copeptin reflects longitudinal right heart function assessed by standardized transthoracic echocardiography compared with NT-proBNP.
目前有关新型生物标志物在右心功能障碍中的评估数据十分有限。正常右心功能可改善心力衰竭患者的预后。因此，本研究旨在比较新型生物标志物 copeptin 与 NT-proBNP 对右心功能的相关性。
前瞻性纳入接受常规超声心动图检查的患者。通过三尖瓣环平面收缩期位移（TAPSE）及其他右心和心房参数评估右心功能。排除标准为年龄<18 岁、左心室射血分数<50%以及中重度瓣膜性心脏病。在超声心动图检查后 72 小时内采集血样进行生物标志物检测。
共纳入 91 例患者。 copeptin 中位数随 TAPSE 值降低而显著升高（ = 0.001；右心功能分级 I：TAPSE>24mm：5.20pmol/L；分级 II：TAPSE 18-24mm：8.10pmol/L；分级 III：TAPSE<18mm：26.50pmol/L）。 copeptin 浓度能够区分 TAPSE<18mm 定义的右心功能降低患者（曲线下面积 [AUC]：copeptin：0.793； = 0.001；NT-proBNP：0.805； = 0.0001）。在多变量线性回归模型中，copeptin 与 TAPSE 独立相关（copeptin：T：-4.43； = 0.0001；NT-proBNP：T：-1.21； = 0.23）。最后，在多变量逻辑回归模型中，copeptin 浓度与严重右心功能降低（TAPSE<18mm）显著相关（copeptin：比值比：0.94；95%置信区间：0.911-0.975； = 0.001）。
本研究表明，与 NT-proBNP 相比，新型生物标志物 copeptin 反映了经标准化经胸超声心动图评估的纵向右心功能。
