High copeptin levels are linked to a poor prognosis in heart failure (HF). Studies of copeptin levels in elderly HF patients with normal left ventricular ejection fraction (HFNEF) have reported conflicting results.

The aim is to study the relationship between copeptin levels and HF in the elderly.

In a prospective cohort of 261 patients with a mean age of 70±11 years, referred for echocardiography due to suspected HF. Electrocardiography, blood sampling and clinical examination were performed within approximately 24hours after echocardiography. The study group was categorised according to the following definitions: systolic HF (SHF) (39%), HFNEF (previously called diastolic HF) (19%), uncertain HFNEF (19%), where only symptoms and partial echocardiography signs supported the diagnosis and a group in which HF was excluded (Non-HF) (23%).

Copeptin levels were higher in patients with SHF and HFNEF compared with non-HF patients. Patients with uncertain HFNEF had similar copeptin levels as the non-HF group. Copeptin across quartiles was related to an increased proportion of SHF, low ejection fraction (LVEF), high pulmonary artery pressure (PA) (all P<0.01), signs of increased preload (LVDD) (P<0.05), and higher levels of a panel of biomarkers (P<0.01), but not to the incidence of HFNEF. In a stepwise multiple linear regression analysis there was a positive relationship between copeptin and cystatin C, high-sensitivity troponin T (both P<0.001) and male gender (P<0.05).

Copeptin levels are elevated in both SHF and HFNEF in the elderly but not in patients in whom the HFNEF diagnosis is based only on symptoms and partial echocardiography findings.