BACKGROUND Early outcome prediction in out-of-hospital cardiac arrest is still a challenge. End-tidal carbon dioxide (ETCO₂) has been shown to be a reliable parameter to reflect the quality of cardiopulmonary resuscitation and the chance of return of spontaneous circulation (ROSC). OBJECTIVES This study assessed the validity of early capnography as a predictive factor for ROSC and survival in out-of-hospital cardiac arrest victims with an underlying nonshockable rhythm. DESIGN Retrospective observational study. SETTING/PATIENTS During a 2-year observational period, data from 2223 out-of-hospital cardiac arrest victims within the city of Vienna were analysed. The focus was on the following patients: age more than 18 years, an underlying nonshockable rhythm, and advanced airway management within the first 15 min of advanced life support with subsequent capnography. INTERVENTION No specific intervention was set in this observational study. MAIN OUTCOME MEASURES The first measured ETCO₂, assessed immediately after placement of an advanced airway, was used for further analysis. The primary outcome was defined as sustained ROSC, and the secondary outcome was 30-day survival. RESULTS A total of 526 patients met the inclusion criteria. These were stratified into three groups according to initial ETCO₂ values (45 mmHg). Baseline data and resuscitation factors were similar among all groups. The odds of sustained ROSC and survival were significantly higher for patients presenting with higher values of initial ETCO₂ (>45 mmHg): 3.59 [95% CI, 2.19 to 5.85] P = 0.001 and 5.02 [95% CI, 2.25 to 11.23] P = 0.001, respectively. On the contrary ETCO₂ levels less than 20 mmHg were associated with significantly poorer outcomes. CONCLUSION Patients with a nonshockable out-of-hospital cardiac arrest who presented with higher values of initial ETCO₂ had an increased chance of sustained ROSC and survival. This finding could help decision making as regards continuation of resuscitation efforts.

Left ventricular (LV) ejection fraction (LVEF) is the most widely used prognostic marker in cardiovascular diseases. LV global function index (LVGFI) is a novel marker which incorporates the total LV structure in the assessment of LV cardiac performance. We evaluated the prognostic significance of LVGFI, measured by cardiovascular magnetic resonance (CMR), in predicting mortality and ICD therapies in a real-world (ICD) population with secondary ICD prevention indication, to detect a high-risk group among these patients. In total, 105 patients with cardiac MRI prior to the ICD implantation were included (mean age 56 ± 16 years old; 76% male). Using the MRI data for each patient LVGFI was determined and a cut-off for the LVGFI value was calculated. Patients were followed up every four to six months in our or clinics in proximity. Data on the occurrence of heart failure symptoms and or mortality, as well as device therapies and other vital parameters, were collected. Follow up duration was 37 months in median. The mean LVGFI was 24.5%, the cut off value for LVGFI 13.5%. According to the LVGFI Index patient were divided into 2 groups, 86 patients in the group with the higher LVGFI und 19 patients in the lower group. The LVGFI correlates significantly with the LVEF (r = 0.642, p < 0.001). In Kaplan–Meier analysis, a lower LVGFI ( I, the initial device or a medication (each p = n.s.). Further, in Kaplan–Meier analysis no association was evident between the LVGFI and adequate ICD therapy (p = n.s.). In secondary prevention ICD patients reduced LVGFI was shown as an independent predictor for mortality and rehospitalization, but not for ICD therapies. We were able to identify a high-risk collective among these patients, but further investigation is needed to evaluate LVGFI compared to ejection fraction, especially in patients with an elevated risk for adverse cardiac events.

Background: Aim of the study was a better characterization of heart failure (HF) with recovered ejection fraction (HFrecEF) and undulating EF (HFuEF) with regard to re‐hospitalization due to congestive HF (CHF), adequate electric therapies (AETs) and mortality compared to HF with reduced EF (HFrEF), mid‐range EF (HFmrEF) and preserved EF (pEF).Methods: Retrospective study of 342 participants with an implantable cardioverter defibrillator (ICD) for primary or secondary prevention. Type of HF was classified according to left ventricular EF with 4.7 ± 3.1 investigations for each patient.Results: Re‐hospitalization due to CHF was similar in HFrecEF (7 (9.5%)), HFmrEF (2(9.0%)) and pEF (8(12.9%); p = n.s.) and significantly higher in HFrEF (62(38.0%)) and HFuEF (6(28.6%); p < .001 compared to HFrecEF and HFrEF). AETs were significantly lower in HFrecEF (13(17.6%)) compared to HFrEF (57(35.0%)), HFmrEF (7(31.8%)), pEF (18(29.0%)) and HFuEF (6(28.6%); each p < .01 compared to HFrecEF). Mortality was similar in HFrecEF (6(8.1%)) compared to HFuEF (0(0%)), pEF (4(6.5%)) and HFmrEF (2(9.0%), p = n.s.) and significantly lower compared to HFrEF (52(31.9%), p < .001). HFrEF was the strongest predictor for mortality besides age and chronic renal insufficiency according to Cox Regression (each p < .05) opposite to arterial hypertension, diabetes, type of cardiomyopathy and secondary prevention ICD indication (each p = n.s.).Conclusions: HFrecEF indicates as a new entity of HF with similar prognosis as pEF and HFmrEF with regard to re‐hospitalization due to CHF and mortality and even better prognosis with regard to AETs. HFuEF showed similar rates of re‐hospitalization due to CHF and AETs compared to HFrEF, but lower rates of mortality.

Plasma NT-proBNP is an established marker of heart failure. Previous studies suggested urinary NT-proBNP has potential as marker of chronic heart failure as well. The objective of this study was to compare urinary NT-proBNP to plasma NT-proBNP in a real-life collective of patients with an ICD, especially regarding ICD-therapies. NT-proBNP was assessed in plasma and fresh spot urine (the latter related to urinary creatinine) from 322 patients of our ICD outpatient clinic. 54 healthy individuals served as a control group. Follow-up regarding mortality and ICD therapies was performed after 32 months (IQR 5-35 months). Plasma and urinary NT-proBNP was positively correlated (r = 0.89, p < 0,001). According to ROC analysis urinary NT-proBNP detected LV dysfunction (EF<35 % vs. healthy CTRL) with very satisfying predictive values (AUC 0.95), but plasma NT-proBNP showed slightly better values (AUC 0.99). Patients who received appropriate ICD-shock-therapies showed significantly higher plasma (p < 0.001) as well as urinary NT-proBNP levels (p = 0.011) compared to patients without shock-therapy. In Kaplan-Meier analysis, plasma as well as urinary NT-proBNP levels > Youden-Index showed significantly higher event rates for appropriate ICD-shock therapies (p < 0.001 and p = 0.016) and the combined endpoint of all-cause-mortality and shock therapies (each p < 0.001). Urinary and plasma NT-proBNP were independent predictors for appropriate ICD-shock-therapies and for the combined endpoint of all-cause mortality and appropriate ICD-shock-therapies (each p < 0.001). Urinary NT-proBNP as a marker for LV dysfunction and symptomatic heart failure showed promising predictive values. Associations between plasma as well as urinary NT-proBNP and ICD shock-therapies could be shown.

Introduction The goal of the current study was to evaluate the prognostic value of the potential cardiorenal biomarkers kidney injury molecule-1 (u-KIM-1), N-acteyl-ß-D-glucosaminidase (NAG) and urinary Neutrophil gelatinase-associated lipocalin (u-NGAL) regarding mortality and major adverse cardiac events in patients presenting with acute chest pain in the emergency department. Methods The study cohort consisted of 294 patients who presented themselves with acute chest pain in the emergency department of the university hospital Regensburg. The urinary concentrations of NAG, KIM-1 and NGAL were measured alongside Troponin I and NT-proBNP. The patients were followed for 60 months regarding the primary endpoints mortality of any cause and major adverse cardiac events, consisting of mortality, stroke, congestive heart failure and ACS with the necessity of PCI was gathered (MACE). Results 54 patients died during the follow-up and 97 suffered from MACE. Regarding ROC-analysis NAG as well as u-KIM-1 showed promising predictive values (all-cause mortality: AUCNAG 0.821, AUCKIM-1 0.745, MACE: AUCNAG 0.778, AUCKIM-1 0.692). u-NGAL showed less promising AUCs regarding mortality (AUC 0.69) as well as MACE (AUC 0.66). According to Kaplan-Meier analysis, patients with concentrations of u-NAG, u-KIM-1 or u-NGAL > median showed a significant worse outcome regarding MACE as well as all-cause mortality (each p< 0.05). Furthermore, Cox regression analysis revealed NAG as independent predictor beside NT-proBNP and older age for mortality due to any cause and MACE (each p< 0.001), opposite to u-KIM-1, hypertension and diabetes (each p=n.s.). Conclusion Urinary N-acteyl-ß-D-glucosaminidase and, to a lesser extent, kidney injury molecule-1 showed significant value in prediction major adverse cardiac events and mortality due to any cause in patients with acute chest pain. But the clinical useability is still not certain and further studies are required.