Introduction: Described for the first time in 1972 by Holwerda, copeptin represents the terminal segment of pre-pro-vasopressin. It is synthetized in stoichiometric quantities with vasopressin (AVP), directly reflecting the seric level of AVP. Given that AVP is extremely un-stable in human plasma and routine measuring is not possible, copeptin can stand for a surrogate biomarker of the vasopressinergic system. We hereby present the main clinical applications of copeptin in cardiovascular diseases.
Methods: Secreted in response to endogenous/exoge-nous stress or baroreceptor stimulation, elevated levels of copeptin are found in different cardiovascular disea-ses. During an acute myocardial infarction, the redu-ced cardiac output and the endogenous stress activates the vasopressinergic system. Therefore, copeptin levels rise even before other necrosis markers, but its positive predictive value is scarce because it lacks cardiac spe-cificity. Still, its negative predictive value is important. That’s why a dual-marker strategy using hsTn and co-peptin to rule out an MI has been developed, being the only guideline indication for the use of copeptin.
Results: In heart failure, the activation of the vasopre-ssinergic system causes water retention and edema, which leads to stimulation of the V1 and V2 receptors. This increases the myocardial wall stress, inducing ven-tricular remodeling and hypertrophy. The seric level of copeptin increases in heart failure up to 3-7 times the normal value, being independently associated with all-cause mortality, both in acute and chronic setting. A recently published meta-analysis showed that the pre-dictive value of copeptin is similar to that of NT pro BNP. The Molitor study, published in 2018 showed that copeptin is the strongest predictor of re-hospitalization and mortality at 90 days. In resistant hypertension, co-peptin levels are extremely high and correlate to BMI and albuminuria. Also, copeptin level is an indepen-dent predictor of preeclampsia in pregnancy.
Conclusions: During the past few years, there has been an increasing interest in finding modern biomarkers that could be useful and guide the clinical practice. Through its pathophysiological correlations, copeptin represents a promising biomarker, both by itself or as part of a multimarker strategy.