Copeptin – a novel biomarker for early diagnosis of myocardial infarction

Copeptin – a novel biomarker for early diagnosis of myocardial infarction

Copeptin – a novel biomarker for early diagnosis of myocardial infarction: Copeptin is the c-terminal fragment of provasopressin. Provasopressin is the precursor of arginine vasopressin (antidiuretic hormone) released from the neurohypophysis (posterior pituitary). Copeptin is a 39 amino acid glycopeptide with no known function in the circulation. It has a molecular weight of about 5 kilo Daltons. Though vasopressin is released in shock and heart failure, the estimation of vasopressin has limitations due to the unstable nature of that peptide. But copeptin is stable and can be measured easily. It is also secreted in equal amounts to vasopressin from the neurohypophysis. Since the vasopressin system is activated after acute myocardial infarction, copetin levels may predict adverse prognosis, especially if associated with an elevated NTproBNP [1].

A study by Till Keller, Stergios Tzikas, Tanja Zeller, Ewa Czyz, Lars Lillpopp, Francisco M Ojeda, Alexander Roth, Christoph Bickel, Stephan Baldus, Christoph R Sinning, Philipp S Wild, Edith Lubos, Dirk Peetz, Jan Kunde, Oliver Hartmann, Andreas Bergmann, Felix Post, Karl J Lackner, Sabine Genth-Zotz, Viviane Nicaud, Laurence Tiret, Thomas F Münzel and Stefan Blankenberg in the Journal of American College of Cardiology [2] found that copeptin estimation improves the early diagnosis of myocardial infarction. They evaluated about 1400 patients with suspected acute coronary syndrome in this multicentric study. Copeptin, troponin T, myoglobin and creatine kinase-myocardial band were the biomarkers estimated at 0, 3 and 6 hours of admission. They concluded that copeptin determination improves the diagnostic performance in the triage of patients presenting with chest pain, especially early after the onset of pain. They also found a good negative predictive value in ruling out myocardial infarction by the combined determination of troponin and copeptin.

References

1. Sohail Q Khan, Onkar S Dhillon, Russell J O’Brien, Joachim Struck, Paulene A Quinn, Nils G Morgenthaler, Iain B Squire, Joan E Davies, Andreas Bergmann, Leong L Ng. C-terminal provasopressin (copeptin) as a novel and prognostic marker in acute myocardial infarction: Leicester Acute Myocardial Infarction Peptide (LAMP) study. Circulation. 2007 Apr 24;115(16):2103-10.
2. Till Keller, Stergios Tzikas, Tanja Zeller, Ewa Czyz, Lars Lillpopp, Francisco M Ojeda, Alexander Roth, Christoph Bickel, Stephan Baldus, Christoph R Sinning, Philipp S Wild, Edith Lubos, Dirk Peetz, Jan Kunde, Oliver Hartmann, Andreas Bergmann, Felix Post, Karl J Lackner, Sabine Genth-Zotz, Viviane Nicaud, Laurence Tiret, Thomas F Münzel, Stefan Blankenberg. Copeptin improves early diagnosis of acute myocardial infarction. J Am Coll Cardiol. 2010 May 11;55(19):2096-106.