New prognostic biomarkers show great potential in acute heart failure

The aim of Jacob Andreas Winter’s PhD thesis has been to find out if hyponatremia, copeptin and mid-regional-proANP have diagnostic and prognostic value in acute dyspnea.


MAIN RESULTS:

  1. Acute heart failure patients with low Na+ concentrations are at increased risk of early death.
  2. Copeptin and mid-regional pro-atrial natriuretic peptide are linked to mortality in patients with acute dyspnea.
  3. The diagnostic and prognostic accuracy of mid-regional pro-atrial natriuretic peptide in acute heart failure is comparable to NT-proBNP.

THESIS DEFENCE:

Thesis: Prognostic and diagnostic biomarkers linked to water and sodium regulation in acute dyspnea
Candidate: Jacob Andreas Winther
Time: June 17, 2019 at 13:15
Place: Akershus University Hospital, Frontbygg: Auditorium
Link to university website


SUMMARY:

(1) Hyponatremia at admission is associated with 85 % increased risk of dying within the next 2-3 years in patients admitted to hospital with acute heart failure. The association was attenuated and no longer statistically significant in adjusted analysis.

The study includes 313 patients admitted to Akershus University Hospital with dyspnea in 2009 and 2010, of which 143 were diagnosed with acute heart failure. 20 % of the heart failure patients were hyponatremic. Half of the patients died during follow-up. In patients with acute exacerbation of chronic obstructive pulmonary disease, there were no significant relation between hyponatremia and mortality.

(2) The levels of copeptin in blood are higher in patients with acute heart failure than in patients with acute exacerbations of chronic obstructive pulmonary disease. Increased levels predict mortality in both groups of patients.

When compared to the established heart failure marker N-terminal pro-B-type natriuretic peptide (NT-proBNP), copeptin performed equally well as a prognostic biomarker. However, NT-proBNP was a more accurate diagnostic marker to discriminate acute heart failure from other causes of dyspnea.

(3) Mid-regional pro-atrial natriuretic peptide (MR-proANP) seems to be an equally strong diagnostic and prognostic biomarker as NT-proBNP in acute heart failure. In contrast to NT-proBNP, MR-proANP also provides independent prognostic information in acute exacerabation of chronic obstructive pulmonary disease.


REFERENCES:

(1) Winther, J. A., Brynildsen, J., Høiseth, A. D., Følling, I., Brekke, P. H., Christensen, G., Hagve, T.-A., Verbalis, J. G., Omland, T., & Røsjø, H. (2016). Prevalence and prognostic significance of Hyponatremia in patients with acute exacerbation of chronic obstructive pulmonary disease: data from the Akershus cardiac examination (ACE) 2 study. PloS one11(8), e0161232.

(2) Winther, J. A., Brynildsen, J., Høiseth, A. D., Strand, H., Følling, I., Christensen, G., Nygård, S., Røsjø, H., & Omland, T. (2017). Prognostic and diagnostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 study. Respiratory research18(1), 184.

(3) Pervez, M. O., Winther, J. A., Brynildsen, J., Strand, H., Christensen, G., Høiseth, A. D., Røysland, R., Lyngbakken, M. N., Omland, T., & Røsjø, H. (2018). Prognostic and diagnostic significance of mid-regional pro-atrial natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 Study. Biomarkers23(7), 654-663.