Effect of a Strategy of Comprehensive Vasodilation vs Usual Care on Mortality and Heart Failure Rehospitalization Among Patients With Acute Heart Failure: The GALACTIC Randomized Clinical Trial.

Importance: Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF).

Objective: To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF.

Design, Setting, And Participants: Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100 mm Hg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain.

Incremental value of multiplex real-time PCR for the early diagnosis of sepsis in the emergency department.

Background: Delayed recognition of sepsis and inappropriate initial antibiotic therapy are associated with increased mortality and morbidity. The early detection of the causative organism in sepsis is an unmet clinical need. A novel multiplex real-time polymerase chain reaction (MRT-PCR) (SeptiFast®) technique may provide the microbiological diagnosis within six hours.

Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure.

Introduction: The accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of AKI.

Methods: A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled.

Quantifying cardiac hemodynamic stress and cardiomyocyte damage in ischemic and nonischemic acute heart failure.

Background: The early and noninvasive differentiation of ischemic and nonischemic acute heart failure (AHF) in the emergency department (ED) is an unmet clinical need.

Methods And Results: We quantified cardiac hemodynamic stress using B-type natriuretic peptide (BNP) and cardiomyocyte damage using 2 different cardiac troponin assays in 718 consecutive patients presenting to the ED with AHF (derivation cohort). The diagnosis of ischemic AHF was adjudicated using all information, including coronary angiography.

Value of arterial blood gas analysis in patients with acute dyspnea: an observational study.

Introduction: The diagnostic and prognostic value of arterial blood gas analysis (ABGA) parameters in unselected patients presenting with acute dyspnea to the Emergency Department (ED) is largely unknown.

Methods: We performed a post-hoc analysis of two different prospective studies to investigate the diagnostic and prognostic value of ABGA parameters in patients presenting to the ED with acute dyspnea.

Results: We enrolled 530 patients (median age 74 years).

Increasing B-type natriuretic peptide levels predict mortality in unselected haemodialysis patients.

Aims: Cardiac disease is the major cause of death in patients undergoing chronic haemodialysis. Recent studies have found that B-type natriuretic peptide (BNP) levels accurately reflect the cardiovascular burden of dialysis patients. However, the prognostic potential of BNP measurements in dialysis patients remains unknown.

Effect and clinical prediction of worsening renal function in acute decompensated heart failure.

We aimed to establish the prevalence and effect of worsening renal function (WRF) on survival among patients with acute decompensated heart failure. Furthermore, we sought to establish a risk score for the prediction of WRF and externally validate the previously established Forman risk score. A total of 657 consecutive patients with acute decompensated heart failure presenting to the emergency department and undergoing serial creatinine measurements were enrolled.

Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure.

Introduction: Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome.

Methods: This was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge.

Copeptin and risk stratification in patients with acute dyspnea.

Introduction: The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of Copeptin, the C-terminal part of the vasopressin prohormone alone and combined to N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea.

Methods: We conducted a prospective, observational cohort study in the emergency department of a university hospital and enrolled 287 patients with acute dyspnea.

Central venous pressure and impaired renal function in patients with acute heart failure.

Aims: To determine the relationship between central venous pressure (CVP) and renal function in patients with acute heart failure (AHF) presenting to the emergency department.

Methods And Results: Central venous pressure was determined non-invasively using compression sonography in 140 patients with AHF at presentation. Worsening renal function (WRF) was defined as an increase in serum creatinine ≥ 0.

Effect of oral β-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study.

Introduction: Acute respiratory failure (ARF) is responsible for about one-third of intensive care unit (ICU) admissions and is associated with adverse outcomes. Predictors of short- and long-term outcomes in unselected ICU-patients with ARF are ill-defined. The purpose of this analysis was to determine predictors of in-hospital and one-year mortality and assess the effects of oral beta-blockers in unselected ICU patients with ARF included in the BASEL-II-ICU study.

Use of B-type natriuretic peptide in the management of hypoxaemic respiratory failure.

Aims: Evaluation and management of patients with hypoxaemic respiratory failure in the intensive care unit (ICU) are difficult. The use of B-type natriuretic peptide (BNP), a quantitative marker of cardiac stress and heart failure (HF), may be helpful. The purpose of this study is to describe the prevalence of causative disorders of hypoxaemic respiratory failure in the ICU and to determine the impact of a BNP-guided diagnostic strategy.

Use of myeloperoxidase for risk stratification in acute heart failure.

Background: Myeloperoxidase (MPO) is a biomarker of inflammation and oxidative stress produced by neutrophils, monocytes, and endothelial cells. Concentrations of MPO predict mortality in patients with chronic heart failure. This study sought to investigate the diagnostic accuracy and prognostic value of MPO in patients with acute heart failure (AHF).

Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure.

Aims: To investigate the relationship between central venous pressure (CVP) at presentation to the emergency room (ER) and the risk of cardiac rehospitalization and mortality in patients with decompensated heart failure (DHF).

Methods And Results: Central venous pressure was determined non-invasively using high-resolution compression sonography at presentation in 100 patients with DHF. Cardiac hospitalizations and cardiac and all-cause mortality were assessed as a function of continuous CVP levels and predefined CVP categories (low <6 cm H(2)O, intermediate 6-23 cm H(2)O, and high >23 cm H(2)O).

Midregional pro-A-type natriuretic peptide for the evaluation of exercise intolerance.

The aim of this study was to determine the accuracy of midregional pro-A-type natriuretic peptide (MR-proANP) for the identification of a cardiocirculatory exercise limitation (CL) as assessed by cardiopulmonary exercise testing (CPET) and to compare it to B-type natriuretic peptide (BNP). Among 94 patients with CPET data fulfilling criteria for appropriate effort and sufficient diagnostic certainty, 27 (29%) had CL. The areas under the receiver-operator-characteristic curve for MR-proANP and BNP to identify CL were 0.

Determinants of absolute and relative exercise-induced changes in B-type natriuretic peptides.

Background: Exercise is associated with changes in circulating B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP). However, the biological relevance of this phenomenon is poorly examined. We sought to assess determinants of absolute (Δ) and relative (Δ%) exercise-induced changes in BNP and NT-proBNP.

Diagnostic and prognostic value of uric acid in patients with acute dyspnea.

Background: Uric acid was shown to predict outcome in patients with stable chronic heart failure. Its impact in patients admitted in the Emergency Department with acute dyspnea, however, remains unknown.

Methods: We prospectively investigated the diagnostic and prognostic value of uric acid in 743 unselected patients presenting to the Emergency Department with acute dyspnea.

Natriuretic peptides and their evolving clinical applications.

Natriuretic peptides (NP) are quantitative plasma biomarkers of heart failure, which are widely used in clinical practice in many countries. NP levels are accurate in the diagnosis of heart failure in patients presenting with dyspnea. The use of NP improves patient management and reduces total treatment costs in patients with dyspnea.

Early diagnosis of myocardial infarction with sensitive cardiac troponin assays.

Background: The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need.

Methods: We conducted a multicenter study to examine the diagnostic accuracy of new, sensitive cardiac troponin assays performed on blood samples obtained in the emergency department from 718 consecutive patients who presented with symptoms suggestive of acute myocardial infarction. Cardiac troponin levels were determined in a blinded fashion with the use of four sensitive assays (Abbott-Architect Troponin I, Roche High-Sensitive Troponin T, Roche Troponin I, and Siemens Troponin I Ultra) and a standard assay (Roche Troponin T).

B-type natriuretic peptide-guided management and outcome in patients with obesity and dyspnea--results from the BASEL study.

Background: Obesity may reduce diagnostic accuracy of B-type natriuretic peptide (BNP) and affect long-term outcome.

Methods: This study evaluated patients included in the BASEL study (N = 452). We compared BNP levels in patients with (n = 86) and without (n = 366) obesity (body mass index <30 and >30 kg/m(2)) and determined sensitivities and specificities of BNP in both patient groups by receiver-operating characteristic analysis.

Haemodynamic and arrhythmic effects of moderately cold (22 degrees C) water immersion and swimming in patients with stable coronary artery disease and heart failure.

Aims: Data on moderately cold water immersion and occurrence of arrhythmias in chronic heart failure (CHF) patients are scarce.

Methods And Results: We examined 22 male patients, 12 with CHF [mean age 59 years, ejection fraction (EF) 32%, NYHA class II] and 10 patients with stable coronary artery disease (CAD) without CHF (mean age 65 years, EF 52%). Haemodynamic effects of water immersion and swimming in warm (32 degrees C) and moderately cold (22 degrees C) water were measured using an inert gas rebreathing method.

Midregional pro-adrenomedullin in addition to b-type natriuretic peptides in the risk stratification of patients with acute dyspnea: an observational study.

Introduction: The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of the newly described midregional fragment of the pro-Adrenomedullin molecule (MR-proADM) alone and combined to B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) in patients with acute dyspnea.

Methods: We conducted a prospective, observational cohort study in the emergency department of a University Hospital and enrolled 287 unselected, consecutive patients (48% women, median age 77 (range 68 to 83) years) with acute dyspnea.

Cardiovascular biomarkers in the ICU.

Purpose Of Review: Natriuretic peptides are markers of heart failure and/or cardiac dysfunction that provide useful diagnostic and prognostic information in patients with dyspnea and/or respiratory failure in the emergency department. Cardiac troponins (cTn) have markedly simplified the diagnosis of myocardial infarction. In critically ill patients, conditions like coexisting organ dysfunction multiorgan involvement or altered synthesis/clearance may confound interpretation of designated biomarkers, including natriuretic peptides and cTn.

Incremental value of copeptin for rapid rule out of acute myocardial infarction.

Objectives: The purpose of this study was to examine the incremental value of copeptin for rapid rule out of acute myocardial infarction (AMI).

Background: The rapid and reliable exclusion of AMI is a major unmet clinical need. Copeptin, the C-terminal part of the vasopressin prohormone, as a marker of acute endogenous stress may be useful in this setting.