Faculty Bibliography

BACKGROUND: Insulin resistance and endothelial dysfunction share a reciprocal relationship that links the metabolic and cardiovascular sequelae of obesity. We characterized the brachial artery reactivity testing (BART) and carotid artery-intima media thickness (CIMT) in adolescents categorized as obese insulin resistant (OIR) and obese not insulin resistant (ONIR). Lipoprotein particle (p) analysis and inflammatory cytokines in OIR and ONIR groups were also analyzed. METHODS: Obese adolescents (n=40; mean body mass index [BMI] 35.6) were categorized as ONIR and OIR based on their homeostatic model assessment of insulin resistance (HOMA-IR) calculation ( than 3.4). Ultrasound measured conduit arterial function BART, microvascular function (post-ischemic hyperemia) and conduit artery structure CIMT. RESULTS: BART did not differ according to IR status (mean+/-SD: 7.0+/-4.3% vs. 5.9+/-3.4% in ONIR and OIR, respectively, p=0.3, but post-ischemic hyperemia was significantly greater in the ONIR group (4.5+/-2.2 vs. 3.5+/-3, p=0.04). Atherogenic lipoprotein particles; large VLDL particles and small LDL particles were higher in the OIR compared to ONIR group. CONCLUSIONS: OIR adolescents demonstrate an inflamed atherogenic milieu compared to the ONIR adolescents. Microvascular function, but not conduit vessel structure or function, was impaired in association with IR.

PURPOSE: The primary aim of this study was to assess the feasibility of an exercise counseling intervention for adults of diverse race/ethnicity with heart failure (HF) and to assess its potential for improving overall physical activity, functional capacity, and HF self-care. DESIGN: This study was a quasi-experimental, prospective, longitudinal cohort design. METHODS: Twenty adults were enrolled and completed the 6-minute walk and standardized instruments, followed by exercise counseling using motivational interviewing. Each received an accelerometer, hand weights, and a diary to record self-care behaviors. Participants were followed via phone for 12 weeks to collect step-counts, review symptoms, and plan the following week's step-goal. FINDINGS: Results indicate this intervention was feasible for most participants, and resulted in improvements in physical activity, functional capacity, and self-care behaviors. CONCLUSION/CLINICAL RELEVANCE: Brief exercise counseling may be an appropriate option to improve outcomes for stable patients with HF, and may be tailored to fit different settings.

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study (N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

OBJECTIVES: To determine the relationship between caregiver status and outcomes after durable left ventricular assist device (LVAD) implantation. BACKGROUND: The absence of a caregiver is a relative contraindication to durable LVAD support. METHODS: Forty-three patients that underwent primary LVAD implantation were divided into three groups: those with caregivers that retained their roles for the duration of LVAD support (CG group), those with caregivers that resigned their roles (CG-QUIT group), and those implanted without an assigned caregiver (No-CG group). Group-specific characteristics and post-implant outcomes were compared. RESULTS: In the CG-QUIT group, caregivers did not live in the same home (0.0% vs. 80.6% of CG group) and none were spouses (0.0% vs. 64.5% for CG group). Thirty-day readmission rate was highest in the CG-QUIT group (83.3% vs. 25.8% in CG group and 16.7% in No-CG group). CONCLUSIONS: Caregiver relationships were more likely to be maintained for the duration of LVAD support when the caregiver was a spouse and resided in the same home as the patient. Carefully selected patients implanted without a designated caregiver had comparable outcomes to those who retained their original caregiver.