Research Spotlight

Posted August 15th 2019

Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression.

Ann M. Warren Ph.D.

Ann M. Warren Ph.D.

deRoon-Cassini, T. A., J. C. Hunt, T. J. Geier, A. M. Warren, K. J. Ruggiero, K. Scott, J. George, M. Halling, G. Jurkovich, S. M. Fakhry, D. Zatzick and K. J. Brasel (2019). “Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression.” J Trauma Acute Care Surg 87(2): 440-450.

Full text of this article.

Traumatic injury affects over 2.6 million U.S. adults annually and elevates risk for a number of negative health consequences. This includes substantial psychological harm, the most prominent being posttraumatic stress disorder (PTSD), with approximately 21% of traumatic injury survivors developing the disorder within the first year after injury. Posttraumatic stress disorder is associated with deficits in physical recovery, social functioning, and quality of life. Depression is diagnosed in approximately 6% in the year after injury and is also a predictor of poor quality of life. The American College of Surgeons Committee on Trauma suggests screening for and treatment of PTSD and depression, reflecting a growing awareness of the critical need to address patients’ mental health needs after trauma. While some trauma centers have implemented screening and treatment or referral for treatment programs, the majority are evaluating how to best address this recommendation, and no standard approach for screening and treatment currently exists. Further, guidelines are not yet available with respect to resources that may be used to effectively screen and treat these disorders in trauma survivors, as well as who is going to bear the costs. The purpose of this review is: (1) to evaluate the current state of the literature regarding evidence-based screens for PTSD and depression in the hospitalized trauma patient and (2) summarize the literature to date regarding the treatments that have empirical support in treating PTSD and depression acutely after injury. This review also includes structural and funding information regarding existing postinjury mental health programs. Screening of injured patients and timely intervention to prevent or treat PTSD and depression could substantially improve health outcomes and improve quality of life for this high-risk population. LEVEL OF EVIDENCE: Review, level IV.


Posted August 15th 2019

Anxiety, depression, and healthcare utilization 1 year after cardiac surgery

Ann M. Warren Ph.D.

Ann M. Warren Ph.D.

Curcio, N., L. Philpot, M. Bennett, J. Felius, M. B. Powers, J. Edgerton and A. M. Warren (2019). “Anxiety, depression, and healthcare utilization 1 year after cardiac surgery.” Am J Surg 218(2): 335-341.

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BACKGROUND: While it is known that depression and anxiety influence cardiac surgery recovery, the mechanisms of such remain unclear. We examined the influence of anxiety and/or depression on health care utilization and quality of life (QOL) in the 12 months following cardiac surgery. METHODS: (N=306) patients at two North Texas hospitals were assessed pre-operatively, at 30 days, and one year post-operatively using the Hospital Anxiety and Depression Scale and Kansas City Cardiomyopathy Quality of Life measures. Patient healthcare utilization metrics included length of stay, outpatient visits, hospital stays, emergency department (ED) visits, and home healthcare. RESULTS: At 12 months post-surgery, anxious patients sustained more outpatient visits (p = 0.0129) than those without anxiety. Depressed patients differed significantly from non-depressed patients with significantly lower QOL (p<0.01), as well as more readmissions, ED visits, home healthcare use, and a longer length of stay (all p<0.05). CONCLUSIONS: Depressed patients utilized more expensive healthcare services and had lower QOL at 12 months follow up compared to non-depressed patients. Targeting depressed patients for intervention may foster a faster recovery and reduce excessive healthcare burden.


Posted August 15th 2019

Institutional Experience With Transcatheter Mitral Valve Repair and Clinical Outcomes: Insights From the TVT Registry.

Michael J. Mack M.D.

Michael J. Mack M.D.

Chhatriwalla, A. K., S. Vemulapalli, D. R. Holmes, Jr., D. Dai, Z. Li, G. Ailawadi, D. Glower, S. Kar, M. J. Mack, J. Rymer, A. S. Kosinski and P. Sorajja (2019). “Institutional Experience With Transcatheter Mitral Valve Repair and Clinical Outcomes: Insights From the TVT Registry.” JACC Cardiovasc Interv 12(14): 1342-1352.

Full text of this article.

OBJECTIVES: The aim of this study was to examine the relation between institutional experience and procedural results of transcatheter mitral valve repair. BACKGROUND: Transcatheter mitral valve repair for the treatment of mitral regurgitation (MR) is a complex procedure requiring navigation of the left atrium, left ventricle, and mitral valve apparatus using echocardiographic guidance. METHODS: MitraClip procedures from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were stratified into tertiles on the basis of site-specific case sequence (1 to 18, 19 to 51, and 52 to 482). In-hospital outcomes of procedural success, procedural time, and procedural complications were examined. To evaluate the learning curve for the procedure, generalized linear mixed models were developed using case sequence number as a continuous variable. RESULTS: MitraClip procedures (n = 12,334) performed at 275 sites between November 2013 and September 2017 were analyzed. Optimal procedural success (less-than-or-equal-to 1+ residual MR without mortality or need for cardiac surgery) increased across tertiles of case experience (62.0%, 65.5%, and 72.5%; p < 0.001), whereas procedural time and procedural complications decreased. Acceptable procedural success (less-than-or-equal-to2+ residual MR without death or need for cardiac surgery) also increased across tertiles of case experience, but the differences were smaller (91.2%, 91.2%; and 92.9%; p = 0.006). In the learning-curve analysis, visual inflection points for procedural time, procedural success, and procedural complications were evident after about 50 cases, with continued improvements observed up to 200 cases. CONCLUSIONS: For transcatheter mitral valve repair with the MitraClip, increasing institutional experience was associated with improvements in procedural success, procedure time, and procedural complications. The impact of institutional experience was larger when considering the goal of achieving optimal MR reduction.


Posted August 15th 2019

Smeloff-Cutter Mechanical Prosthesis in the Aortic Position for 49 Years.

Jeffrey M. Schussler M.D.

Jeffrey M. Schussler M.D.

Chalkley, R. A., C. W. Kim, J. W. Choi, W. C. Roberts and J. M. Schussler (2019). “Smeloff-Cutter Mechanical Prosthesis in the Aortic Position for 49 Years.” Am J Cardiol 124(3): 457-459.

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We describe a 76-year-old male physician who at age 27 underwent replacement of his stenotic aortic valve with a Smeloff-Cutter mechanical prosthesis which functioned normally for 49 years. He died of a noncardiac condition. A normally functioning substitute cardiac valve for this length of time has not been previously reported.


Posted August 15th 2019

Gamma-Hydroxybutyrate content in dried bloodspots facilitates newborn detection of succinic semialdehyde dehydrogenase deficiency.

Teodoro Bottiglieri, Ph.D.

Teodoro Bottiglieri, Ph.D.

Brown, M., P. Ashcraft, E. Arning, T. Bottiglieri, J. B. Roullet and K. M. Gibson (2019). “Gamma-Hydroxybutyrate content in dried bloodspots facilitates newborn detection of succinic semialdehyde dehydrogenase deficiency.” Mol Genet Metab Jul 18. [Epub ahead of print].

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Increased gamma-hydroxybutyric acid in urine and blood are metabolic hallmarks of succinic semialdehyde dehydrogenase deficiency, a defect of 4-aminobutyric acid metabolism. Here, we examined the hypothesis that succinic semialdehyde dehydrogenase deficiency could be identified via measurement of gamma-hydroxybutyric acid in newborn and post-newborn dried bloodspots. Quantitation of gamma-hydroxybutyric acid using liquid chromatography-tandem mass spectrometry in twelve archival newborn patient dried bloodspots was 360+/-57muM (mean, standard error; range 111-767), all values exceeding the previously established cutoff for newborn detection of 78 muMu established from 2831 dried bloodspots derived from newborns, neonates and children. Gamma-hydroxybutyric acid in post-newborn dried bloodspots (n=19; ages 0.8-38years) was 191+/-65muM (mean, standard error; range 20-1218), exceeding the aforementioned GHB cutoff for patients approximately 10years of age or younger. Further, gamma-hydroxybutyric acid in post-newborn dried bloodspots displayed a significant (p<.0001) inverse correlation with age. This preliminary study suggests that succinic semialdehyde dehydrogenase deficiency may be identified in newborn and post-newborn dried bloodspots via quantitation of gamma-hydroxybutyric acid, while forming the platform for more extensive studies in affected and unaffected dried bloodspots.