Baylor Heart and Vascular Institute

Cedars, A. and A. R. Opotowsky (2016). “Sustaining happiness in adult congenital heart disease.” World J Pediatr Congenit Heart Surg 7(5): 635-637.

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Patients with ACHD appear to have a distinct psychological adaptation to their lifelong heart disease. Although there is some inconsistency in the results of published studies, most data indicate that QOL among patients with ACHD is similar to the healthy general population, with the exception of the physical functioning domain.3 Furthermore, despite marked variability in objectively measured physical capacity between lesions,4 QOL in ACHD is not clearly related to lesion severity or complexity.3,5 This phenomenon appears to be consistent between countries with dramatically different health-care systems.6 The present study by Steele et al in a group of patients with CHD of high complexity provides further evidence for this observation. The apparent mental resilience among patients with ACHD is in stark contrast to adults with acquired heart failure (HF) in whom QOL is notably impaired compared to healthy controls.7 Although the reasons for preserved QOL in ACHD remain unknown, it has been proposed that patients with ACHD have a unique ‘‘sense of coherence.’’8 This concept, first introduced by Aaron Antonovsky as a metric of individual optimism and sense of control, may insulate patients with ACHD against health-related stressors.9

Packer, M. (2016). “Heart failure’s dark secret: Does anyone really care about optimal medical therapy?” Circulation 134(9): 629-631.

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Today, most heart failure physicians focus on devices and transplantation; hospital-based management teams devoted only to achieving optimal medical therapy are scarce. The financial demands on heart failure specialists are enormous. A viable business plan can no longer be based on the misguided hope that payers will reimburse generously for prescriptions of digitalis and diuretics; in contrast, cardiac procedures generate meaningful revenues. A growing advocacy now encourages the use of ventricular assist devices in ambulatory patients on the basis of the dual misconceptions that the hazards are readily managed and that the clinical responses to medical therapy are poor. The biases in favor of performing procedures are so great that a National Institutes of Health–sponsored randomized trial comparing left ventricular assistance and optimal medical therapy in ambulatory patients was closed because of slow recruitment.

Han, E., G. Kim, N. Hong, Y. H. Lee, D. W. Kim, H. J. Shin, B. W. Lee, E. S. Kang, I. K. Lee and B. S. Cha (2016). “Association between dietary acid load and the risk of cardiovascular disease: Nationwide surveys (knhanes 2008-2011).” Cardiovasc Diabetol 15(1): 122.

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BACKGROUND: Acid-base imbalance has been reported to increase incidence of hypertension and diabetes. However, the association between diet-induced acid load and cardiovascular disease (CVD) risk in the general population has not been fully investigated. METHODS: This was a population-based, retrospectively registered cross-sectional study using nationally representative samples of 11,601 subjects from the Korea National Health and Nutrition Examination Survey 2008-2011. Individual CVD risk was evaluated using atherosclerotic cardiovascular disease (ASCVD) risk equations according to 2013 ACC/AHA guideline assessment in subjects aged 40-79 without prior CVD. Acid-base status was assessed with both the potential renal acid load (PRAL) and the dietary acid load (DAL) scores derived from nutrient intake. RESULTS: Individuals in the highest PRAL tertile had a significant increase in 10 year ASCVD risks (9.6 vs. 8.5 %, P < 0.01) and tended to belong to the high-risk (10 year risk >10 %) group compared to those in the lowest PRAL tertile (odds ratio [OR] 1.23, 95 % confidence interval [CI] 1.22-1.35). The association between higher PRAL score and high CVD risk was stronger in the middle-aged group. Furthermore, a multiple logistic regression analysis also demonstrated this association (OR 1.20 95 % CI 1.01-1.43). Subgroup analysis stratified obesity or exercise status; individuals in unhealthy condition with lower PRAL scores had comparable ASCVD risk to people in the higher PRAL group that were in favorable physical condition. In addition, elevated PRAL scores were associated with high ASCVD risk independent of obesity, exercise, and insulin resistance, but not sarcopenia. Similar trends were observed with DAL scores. CONCLUSION: Diet-induced acid load was associated with increased risk of CVD, independent of obesity and insulin resistance.

Thompson, R. W., C. Dawkins, C. Vemuri, M. W. Mulholland, T. D. Hadzinsky and G. J. Pearl (2016). “Performance metrics in professional baseball pitchers before and after surgical treatment for neurogenic thoracic outlet syndrome.” Ann Vasc Surg: 2016 Aug [Epub ahead of print].

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BACKGROUND: High-performance throwing athletes may be susceptible to the development of neurogenic thoracic outlet syndrome (NTOS). This condition can be career-threatening but the outcomes of treatment for NTOS in elite athletes have not been well characterized. The purpose of this study was to utilize objective performance metrics to evaluate the impact of surgical treatment for NTOS in Major League Baseball (MLB) pitchers. METHODS: Thirteen established MLB pitchers underwent operations for NTOS between July 2001 and July 2014. For those returning to MLB, traditional and advanced (PitchF/x) MLB performance metrics were acquired from public databases for various time-period scenarios before and after surgery, with comparisons made using paired t-tests, Wilcoxon matched-pair signed rank tests, and Kruskal-Wallis analysis of variance. RESULTS: Ten of 13 pitchers (77%) achieved a sustained return to MLB, with a mean age of 30.2 +/- 1.4 years at the time of surgery and 10.8 +/- 1.5 months of postoperative rehabilitation before the return to MLB. Pre- and post-operative career data revealed no significant differences for 15 traditional pitching metrics, including earned-run-average (ERA), fielding-independent-pitching (FIP), walks-plus-hits-per-inning-pitched (WHIP), walks-per-9-innings (BB/9), and strikeouts-to-walks-ratio (SO/BB). There were also no significant differences between the 3 years before and the 3 years after surgical treatment. Using PitchF/x data for 72 advanced metrics and 25 different time-period scenarios, the highest number of significant relationships (n = 18) was observed for the 8-weeks-before/12-weeks-after scenario. In this analysis, 54 (75%) measures were unchanged (including ERA, WHIP, and SO/BB) and 14 (19%) were significantly improved, while only 4 (6%) were significantly decreased (including hard pitch maximal velocity, 93.1 +/- 1.0 vs 92.5 +/- 0.9 miles per hour, P = 0.047). Six pitchers remained active in MLB during the study period, while the other 4 had retired due to factors or injuries unrelated to NTOS. CONCLUSIONS: Objective performance metrics demonstrate that pitchers returning to MLB after surgery for NTOS have had capabilities equivalent to or better than before treatment. Thoracic outlet decompression coupled with an ample period of postoperative rehabilitation can provide effective treatment for professional baseball pitchers with career-threatening NTOS.

Zhang, J. and P. A. McCullough (2016). “Lipoic acid in the prevention of acute kidney injury.” Nephron 134(3): 133-140.

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Hypoxia, reactive oxygen species (ROS) and oxidative stress contribute to contrast-induced acute kidney injury (CI-AKI) and ischemic reperfusion injury (IRI) in the kidney and heart. Imbalance between the increased formation of ROS by hypoxia in the cardiac and renal tissue and the low availability of endogenous antioxidants is a common cause of cellular and tissue damage. Therefore, a strategy to inhibit ROS generation or to scavenger free radicals becomes an important intervention to prevent CI-AKI and myocardial IRI. Evidence has shown that a naturally occurring cellular antioxidant lipoic acid (LA) (1,2-dithilane-3-pentanoic acid) acts as a free radical scavenger of ROS and reactive nitrogen oxide species for cardioprotection and renoprotection. The mechanisms whereby LA exerts its protective effects are not entirely understood, but may be related to the phosphatidylinositol 3-kinase/Akt/Nrf2 pathway and the PI3-kinase/Akt pathways. This review will provide the current information of LA as an exogenous antioxidant for cardioprotection and renoprotection, with emphasis on antioxidant functions of LA and multiple signaling pathways underlying protective effects of LA on CI-AKI as well as cardiac and renal IRI.