{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:01:57Z","timestamp":1760148117019,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Background: In light of overlapping symptoms, discrimination between non-ST-elevation (NSTE) acute coronary syndrome (ACS) and acute heart failure (HF) is challenging, particularly in patients with equivocal clinical presentation for suspected ACS. We sought to evaluate the diagnostic and prognostic properties of copeptin in this scenario. Methods: Data from 1088 patients from a single-center observational registry were used to test the ability of serial high sensitivity cardiac troponin T (hs-cTnT)\u2014compared to copeptin, or a combination of copeptin with hs-cTnT\u2014to discriminate acute HF from uncomplicated non-ST-elevation myocardial infarction (NSTEMI) and to evaluate all-cause mortality after 365 days. Patients with STEMI, those with unstable angina and either normal or undetectable hs-cTnT concentrations were excluded. The findings were validated in an independent external NSTE-ACS cohort. Results: A total of 219 patients were included in the analysis. The final diagnosis was acute HF in 56 and NSTE-ACS in 163, with NSTEMI in 78 and unstable angina having stable elevation of hs-cTnT &gt;ULN in 85. The rate of all-cause death at 1 year was 9.6% and occurred significantly more often in acute HF than in NSTE-ACS (15 vs. 6%, p &lt; 0.001). In the test cohort, the area under the receiver operator curve (AUC) for the discrimination of acute HF vs. NSTE-ACS without HF was 0.725 (95% confidence interval [CI] 0.625\u20130.798) for copeptin and significantly higher than for hs-cTnT at 0 h (AUC = 0.460, 0.370\u20130.550) or at 3 h (AUC = 0.441, 0.343\u20130.538). Copeptin and hs-cTnT used either as continuous values or at cutoffs optimized to yield 90% specificity for acute HF were associated with significantly higher age- and sex-adjusted risk for all-cause mortality at 365 days. The findings from the test cohort were consistently replicated in the independent external NSTE-ACS validation cohort. Conclusions: High concentrations of copeptin in patients with suspected NSTE-ACS and equivocal clinical presentation suggest the presence of acute HF compared to uncomplicated NSTE-ACS and are associated with higher rates of all-cause death at 365 days.<\/jats:p>","DOI":"10.3390\/cells12071062","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T08:27:27Z","timestamp":1680251247000},"page":"1062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Role of Copeptin and hs-cTnT to Discriminate AHF from Uncomplicated NSTE-ACS with Baseline Elevated hs-cTnT\u2014A Derivation and External Validation Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Stephan","family":"von Haehling","sequence":"first","affiliation":[{"name":"Department of Cardiology and Pneumology, University of G\u00f6ttingen Medical Center, 37075 G\u00f6ttingen, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen, 37075 G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"M\u00fcller-Hennessen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania","family":"Garfias-Veitl","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University of G\u00f6ttingen Medical Center, 37075 G\u00f6ttingen, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen, 37075 G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5211-5593","authenticated-orcid":false,"given":"Alina","family":"Go\u00dfling","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-2757","authenticated-orcid":false,"given":"Johannes T.","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, 10115 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7571-4847","authenticated-orcid":false,"given":"Nils A.","family":"S\u00f6rensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, 10115 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul M.","family":"Haller","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, 10115 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tau","family":"Hartikainen","sequence":"additional","affiliation":[{"name":"University Heart Center Freiburg Bad Krozingen, Department of Cardiology and Angiology, University Freiburg, 79110 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rn Ole","family":"Vollert","sequence":"additional","affiliation":[{"name":"BRAHMS GmbH Deutschland, 10785 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"M\u00f6ckel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Campus Charit\u00e9 Mitte, Virchow-Klinikum and Department of Cardiology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Blankenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, 10115 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"University Heart Center Freiburg Bad Krozingen, Department of Cardiology and Angiology, University Freiburg, 79110 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-2872","authenticated-orcid":false,"given":"Evangelos","family":"Giannitsis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.gheart.2018.08.004","article-title":"Fourth Universal Definition of Myocardial Infarction (2018)","volume":"13","author":"Thygesen","year":"2018","journal-title":"Glob. 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