Background : Acute respiratory distress syndrome (ARDS) is considered the main cause of COVID-19 associated morbidity and mortality. Early and reliable risk stratification is of crucial clinical importance in order to identify persons at risk for developing a severe course of disease. Deceleration capacity (DC) of heart rate as a marker of cardiac autonomic function predicts outcome in persons with myocardial infarction and heart failure. We hypothesized that reduced modulation of heart rate may be helpful in identifying persons with COVID-19 at risk for developing ARDS. Methods : We prospectively enrolled 60 consecutive COVID-19 positive persons presenting at the University Hospital of Tuebingen. Arterial blood gas analysis and 24h-Holter ECG recordings were performed and analyzed at admission. The primary end point was defined as development of ARDS with regards to the Berlin classification. Results : 61.7% (37 of 60 persons) developed an ARDS. In persons with ARDS DC was significantly reduced when compared to persons with milder course of infection (3.2 ms vs. 6.6 ms, p < 0.001). DC achieved a good discrimination performance (AUC = 0.76) for ARDS in COVID-19 persons. In a multivariate analysis, decreased DC was associated with the development of ARDS. Conclusion : Our data suggest a promising role of DC to risk stratification in COVID-19.

Background Risk prediction in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) is challenging. Development of novel markers for patient risk assessment is of great clinical value. Deceleration capacity (DC) of heart rate is a strong risk predictor in post‐infarction patients. Hypothesis DC provides prognostic information in patients undergoing TAVI. Methods We enrolled 374 consecutive patients with severe AS undergoing TAVI. All patients received 24‐hour Holter recording or continuous heart‐rate monitoring to assess DC before intervention. Primary endpoint was all‐cause mortality after 1 year. Results Forty‐nine patients (13.1%) died within 1 year. DC was significantly lower in nonsurvivors than in survivors (1.2 ± 4.8 ms vs 3.3 ± 2.9 ms; P < 0.001), whereas the logistic EuroSCORE and EuroSCORE II were comparable between groups (logistic EuroSCORE: 27.3% ± 17.0% vs 22.9% ± 14.2%; P = 0.122; EuroSCORE II: 8.0% ± 6.9% vs 6.7% ± 4.8%, P = 0.673). One‐year mortality in the 116 patients with impaired DC (<2.5 ms) was significantly higher than in patients with normal DC (23.3% vs 8.5%; P < 0.001). In multivariate Cox regression analysis that included DC, sex, paroxysmal atrial fibrillation, hemoglobin level before TAVI, and logistic EuroSCORE, DC was the strongest predictor of 1‐year mortality (hazard ratio: 0.88, 95% confidence interval: 0.85‐0.94, P < 0.001). DC yielded an AUC in the ROC analysis of 0.645. Conclusions DC of heart rate is a strong and independent predictor of 1‐year mortality in patients with severe AS undergoing TAVI.

Background Cardiac autonomic dysfunction after myocardial infarction identifies patients at high risk despite only moderately reduced left ventricular ejection fraction. We aimed to show that telemedical monitoring with implantable cardiac monitors in these patients can improve early detection of subclinical but prognostically relevant arrhythmic events. MethodsWe did a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial at 33 centres in Germany and Austria. Survivors of acute myocardial infarction with left ventricular ejection fraction of 36-50% had biosignal analysis for assessment of cardiac autonomic function. Patients with abnormal periodic repolarisation dynamics (≥5•75 deg²) or abnormal deceleration capacity (≤2•5 ms) were randomly assigned (1:1) to telemedical monitoring with implantable cardiac monitors or conventional follow-up. Primary endpoint was time to detection of serious arrhythmic events defined by atrial fibrillation 6 min or longer, atrioventricular block class IIb or higher and fast non-sustained (>187 beats per min; ≥40 beats) or sustained ventricular tachycardia or fibrillation. This study is registered with ClinicalTrials.gov, NCT02594488.

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BackgroundPatients with acute coronary syndrome (ACS) are at risk especially in the period shortly after the event. Alterations in respiratory control have been associated with adverse prognosis. The aim of our study was to assess if the nocturnal respiratory rate (NRR) is a predictor of mortality in patients with ACS presenting in the emergency department.MethodsClinically stable consecutive patients with ACS aged ≥ 18 years were prospectively enrolled. The Global Registry of Acute Coronary Events (GRACE) score and left ventricular ejection fraction (LVEF) were assessed for all patients. The average NRR over a period of 6  hours was determined by the records of the surveillance monitors in the first night after admission. Primary and secondary endpoints were intrahospital and 2  years all-cause mortality, respectively.ResultsOf the 860 patients with ACS, 21 (2.4%) died within the intrahospital phase and 108 patients (12.6%) died within the subsequent 2 years. The NRR was a significant predictor of both endpoints and was independent from the GRACE score and LVEF. Implementing the NRR into the GRACE risk model leads to a significant increase of the C-statistics especially for prediction of intrahospital mortality.ConclusionThe NRR is an independent predictor of mortality in patients with ACS.