Baylor Heart and Vascular Institute

McCullough, P. A., J. Zhang and C. Ronco (2017). “Volume expansion and contrast-induced acute kidney injury.” Lancet: 2017 Feb [Epub ahead of print].

Full text of this article.

There is an ever-increasing population at risk of being exposed to intravascular iodinated contrast because of the increasingly popular practice of imaging techniques in medicine and surgery. Despite efforts to improve the safety of these agents, there has been no fundamental improvement in contrast product development since the introduction of iso-osmolar contrast more than 20 years ago.1; 2 ; 3 Thus, clinicians have focused on strategies to decrease the risk of contrast-induced acute kidney injury by limiting contrast volume, giving adjuvant agents, and providing supportive care once the renal damage has occurred. It has been suggested that intravascular volume expansion with isotonic crystalloid solution can decrease the incidence and the severity of contrast-induced acute kidney injury.4 This approach is attractive because the short-term administration of intravenous fluid results in an increase in renal blood flow, glomerular filtration, and increased volume of urine flow through the tubular segments of the nephron. Forced diuresis has been associated with a lesser rise in serum creatinine especially when higher rates (>150 ml/h) of urine flow have been achieved.5

Cedars, A., L. Benjamin, S. V. Burns, E. Novak and A. Amin (2017). “Clinical predictors of length of stay in adults with congenital heart disease.” Heart: 2017 Feb [Epub ahead of print].

Full text of this article.

OBJECTIVE: Length of stay (LOS) is a major driver of inpatient care costs. To date, few studies have investigated risk factors associated with increased LOS in patients with adult congenital heart disease (ACHD). In the present work, we sought to address this knowledge gap. METHODS: We conducted an analysis of the State Inpatient Databases from Arkansas, California, Florida, Hawaii, Nebraska and New York. We analysed data on admissions in patients with ACHD and constructed a series of hierarchical regression models to identify the clinical factors having the greatest effects on LOS. RESULTS: We identified 99 103 inpatient hospitalisations meeting criteria for inclusion. Diagnoses associated with the longest LOS were septicaemia (LOS=14.2 days in patients atrial septal defect, and 11.7 days among all other ACHD) and pericarditis, endocarditis and myocarditis (LOS=13.6 days and 10.0 days, respectively). When separated by underlying anatomy, the variables most consistently associated with longer LOS were bacterial infection, complications of surgeries or medical care, acute renal disease and anaemia. CONCLUSIONS: In the present study, we identified risk factors associated with longer LOS in ACHD. These data may be used to identify at-risk patients for targeted intervention to decrease LOS and thereby cost.

Blackbourne, B. D., A. Vasudevan and W. C. Roberts (2017). “Comparison at necropsy of heart weight in women aged 20 to 29 years with fatal trauma or chemical intoxication versus fatal natural cause (a search for the normal adult heart weight).” Am J Cardiol 119(5): 808-812.

Full text of this article.

The present obesity epidemic makes determining the normal heart weight in adults difficult. This study examines the heart weight at autopsy in 104 women aged 20 to 29 years who died in 1978 to 1980 before the overweight epidemic ensued. Of the 104 cases, the hearts weighed 300 g in 18 (17%). Of the 67 cases dying from an unnatural cause (trauma or chemical intoxication), only 3 (4%) had hearts weighing >300 g; of the 37 patients dying from a variety of natural causes, 15 (41%) had hearts weighing >300 g (p <0.001). The body mass index (BMI) was 25 kg/m2, the hearts ranged from 230 to 850 g (mean 351 +/- 142; median 300 g). In conclusion, the cases dying from an unnatural cause had smaller mean heart weights than those women dying from a natural cause and those with a normal BMI (25 kg/m2. The normal heart weight in young women dying from an unnatural cause with few exceptions is <300 g.

Cedars, A., L. Benjamin, S. V. Burns, E. Novak and A. Amin (2017). “Clinical predictors of length of stay in adults with congenital heart disease.” Heart: 2017 Feb [Epub ahead of print].

Full text of this article.

OBJECTIVE: Length of stay (LOS) is a major driver of inpatient care costs. To date, few studies have investigated risk factors associated with increased LOS in patients with adult congenital heart disease (ACHD). In the present work, we sought to address this knowledge gap. METHODS: We conducted an analysis of the State Inpatient Databases from Arkansas, California, Florida, Hawaii, Nebraska and New York. We analysed data on admissions in patients with ACHD and constructed a series of hierarchical regression models to identify the clinical factors having the greatest effects on LOS. RESULTS: We identified 99 103 inpatient hospitalisations meeting criteria for inclusion. Diagnoses associated with the longest LOS were septicaemia (LOS=14.2 days in patients atrial septal defect, and 11.7 days among all other ACHD) and pericarditis, endocarditis and myocarditis (LOS=13.6 days and 10.0 days, respectively). When separated by underlying anatomy, the variables most consistently associated with longer LOS were bacterial infection, complications of surgeries or medical care, acute renal disease and anaemia. CONCLUSIONS: In the present study, we identified risk factors associated with longer LOS in ACHD. These data may be used to identify at-risk patients for targeted intervention to decrease LOS and thereby cost.

Corzo, G. and G. P. Espino-Solis (2017). “Selected scorpion toxin exposures induce cytokine release in human peripheral blood mononuclear cells.” Toxicon 127: 56-62.

Full text of this article.

A cytokine screening on human peripheral blood mononuclear cells (PBMCs) stimulated with selected scorpion toxins (ScTx’s) was performed in order to evaluate their effect on human immune cells. The ScTx’s chosen for this report were three typical buthid scorpion venom peptides, one with lethal effects on mammals Centruroides suffussus suffusus toxin II (CssII), another, with lethal effects on insects and crustaceans Centruroides noxius toxin 5 (Cn5), and one more without lethal effects Tityus discrepans toxin (Discrepin). A Luminex multiplex analysis was performed in order to determine the amounts chemokines and cytokines IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12-p40, IL-13, interferon alpha (IFN-alpha), interferon gamma (IFN-gamma), tumor necrosis factor alpha TNF-alpha, and interferon-inducible protein-10 (IP-10) secreted from human PBMCs exposed to these toxins. Although, the ScTx Cn5 is not lethal for mammals, it was able to induce the secretion of cytokines IL-1beta, IL-6, and TNF-alpha, IL-10 and IP-10 in comparison to the lethal CssII, which was able to induce only IP-10 secretion. Discrepin also was able to induce only IP-10. Interestingly, only low amounts of interferons alpha and beta were induced in the presence of the ScTx’s assayed. In a synergic experiment, the combination of Discrepin and Cn5 displayed considerable reverse effects on induction of IL-1beta, IL-6, IL-10 and TNF-alpha, but they had a slight synergic effect on IP-10 cytokine production in comparison with the single effect obtained with the Cn5 alone. Thus, the results obtained suggest that the profile of secreted cytokines promoted by ScTx Cn5 is highly related with a cytokine storm event, and also it suggests that the mammalian lethal neurotoxins are not solely responsible of the scorpion envenomation symptomatology.