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09-01-2012 | Cardiology | Article

MR-proANP, copeptin combined with cTnT could identify high-risk HF outpatients


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MedWire News: Serial monitoring of midregional proatrial natriuretic peptide (MR-proANP) and copeptin combined with cardiac troponin T (cTnT) could identify high-risk heart failure (HF) outpatients, say researchers.

This could offer more effective risk stratification, which is the key to success in the long-term management of HF, particularly for outpatients, write Wayne Miller (Mayo Clinic, Rochester, Minnesota, USA) and co-authors in the journal Heart.

Their analysis included 187 patients with New York Heart Association class III-IV HF who were prospectively enrolled between June 2001 and January 2004. Levels of MR-proANP, copeptin, and cTnT were collected every 3 months over 2 years and analyzed in relation to death or transplantation rates.

At enrolment, MR-proANP and copeptin levels were raised (>95th centile of normal population adjusted for age and gender; >7.1 pmol/L for women and >9.4 pmol/L for men, respectively) among 157 (84%) and 133 (71%) patients, respectively. Elevated cTnT (≥0.01 n/ml) was evident in 103 (55%) patients.

Univariate time-dependent analyses over 2 years revealed that serial measurements of MR-proANP and copeptin were highly predictive for prediction for death or transplantation, at respective hazard ratios (HRs) of 7.6 and 2.7 (p<0.01).

However, in multivariate analysis adjusted for elevated cTnT, only raised MR-proANP remained an independent predictor for death or transplantation, at a hazard ratio of 5.5 (p=0.02).

Meanwhile, a combined increase in MR-proANP and copeptin was associated with a significant nine-fold increased risk (p=0.03).

In addition, a combined increase in MR-proANP, copeptin, and cTnT predicted a substantial increase in risk, at a hazard ratio of 11.1 (p=0.02). This, however, was not much greater than the combined increase in MR-proANP and cTnT, ie, when copeptin was excluded (HR=10.3, p=0.0013), note the authors.

"These findings suggest that the periodic monitoring of MR-proANP, either separately or in combination with copeptin or particularly with cTnT, after an initial increase may be an effective means of detecting meaningful changes in risk and better stratifying outpatients HF," say the authors.

They add: "Results in both this study and other analyses of other biomarkers should be helpful to physicians in following patients with systolic HF."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Piriya Mahendra

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