Folia Med (Plovdiv). 2025 Nov 28;67(6). doi: 10.3897/folmed.67.e153542.
ABSTRACT
Heart failure (HF) poses a major global health burden due to its high prevalence, complexity, and poor prognosis. Although biomarkers such as B-type natriuretic peptides (BNP, NT-proBNP) are widely used for diagnosis and risk stratification, additional biomarkers are needed to refine prognostication. Copeptin, a stable fragment of pre-provasopressin, reflects vasopressin system activity and has emerged as a promising prognostic tool. Elevated copeptin levels correlate with increased mortality, hospitalizations, and disease progression in both acute and chronic HF. It offers early detection of hemodynamic stress and complements traditional markers, especially in multimarker strategies. This review explores copeptin's physiological role, its predictive value in various HF phenotypes, and its integration into clinical risk models. Evidence supports its utility in identifying high-risk patients, guiding therapy, and monitoring disease evolution. Challenges to clinical adoption include assay standardization, cost-effectiveness, and establishing universally accepted cutoffs. Future directions focus on copeptin-guided therapies, AI-driven predictive models, and its role in precision medicine. Continued research may solidify copeptin's role in optimizing heart failure management through individualized risk assessment and tailored interventions.
PMID:41467274 | DOI:10.3897/folmed.67.e153542