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Combined measurement of copeptin, high-sensitivity troponin T, and N-terminal proBNP improves the identification of patients at risk of cardiovascular death

Alehagen, Urbana,b; Dahlström, Ulfa,b; Carstensen, Johnc; Rehfeld, Jens F.d; Goetze, Jens P.d

doi: 10.1097/XCE.0b013e32835bfb42
Original articles

Objectives A multimarker strategy for the handling of patients with heart failure has been suggested in the literature. Therefore, the potential prognostic relevance of combined copeptin, high-sensitivity troponin T (HS-TnT), and N-terminal proBNP (NT-proBNP) measurement in plasma from elderly patients with symptoms of heart failure was evaluated.

Methods This study included 470 elderly patients (mean age 73 years) from a rural municipality with symptoms of heart failure. Clinical examination, echocardiography, and biomarker measurements were performed. All patients were followed for 13 years and all mortality was registered. Cardiovascular mortality was evaluated using Kaplan–Meier plots and multivariate Cox proportional hazard regression analyses.

Results Copeptin, HS-TnT, and NT-proBNP measurements provided independent prognostic information in a multivariate setting over 5 years (hazard ratio, HR: 3.66; 95% confidence interval, CI 1.27–10.53, HR: 2.52; 95% CI 1.20–5.28, HR: 2.73; 95% CI 1.19–6.26, respectively). Also, the group with all three biomarkers below cut-off values had a low risk for cardiovascular death (1.8% of the patients in this group died in the 5-year follow-up period). In the 13-year follow-up, combined copeptin and HS-TnT measurement did not provide independent prognostic information.

Conclusion Combined copeptin, HS-TnT, and NT-proBNP plasma measurements provide prognostic information on cardiovascular mortality that is superior to single biomarker use.

aDepartment of Cardiology UHL, County Council of Östergötland

bDivision of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences

cDivision of Health and Society, Department of Medical and Health Sciences, Faculty of Arts and Science, Linköping University, Linköping, Sweden

dDepartment of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Correspondence to Urban Alehagen, MD, PhD, Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping SE-581 31, Sweden Tel: +46 10 103 0000; fax: +46 10 1032294; e-mail:

Received August 25, 2012

Accepted October 9, 2012

© 2012Wolters Kluwer Health Lippincott Williams Wilkins