Impact of Mechanical Circulatory Support on Exercise Capacity in Patients With Advanced Heart Failure.

Approximately 6 million individuals have heart failure in the United States alone and 15 million in Europe. Left ventricular assist devices (LVAD) improve survival in these patients, but functional capacity may not fully improve. This article examines the hypothesis that patients supported by LVAD experience persistent reductions in functional capacity and explores mechanisms accounting for abnormalities in exercise tolerance.

Cardiac Emergencies in Patients with Left Ventricular Assist Devices.

Continuous-flow left ventricular assist devices are frequently used for management of patients with advanced heart failure with reduced ejection fraction. Although technologic advancements have contributed to improved outcomes, several complications arise over time. These complications result from several factors, including medication effects, physiologic responses to chronic exposure to circulatory support that is minimally/entirely nonpulsatile, and dysfunction of the device itself. Clinical presentation can range from chronic and indolent to acute, life-threatening emergencies. Several areas of uncertainty exist regarding best practices for managing complications; however, growing awareness has led to development of new guidelines to reduce risk and improve outcomes.

Cardiopulmonary Performance Among Heart Failure Patients Before and After Left Ventricular Assist Device Implantation.

BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) have persistent impairments in functional capacity after continuous-flow left ventricular assist device (CF-LVAD) implantation. OBJECTIVES: This study aims to characterize longitudinal changes in exercise hemodynamics and functional capacity among patients with HFrEF before and after CF-LVAD implantation. METHODS: Ten patients underwent 3 invasive cardiopulmonary exercise tests on upright cycle ergometry with pulmonary artery catheterization: 1) Visit 1 before CF-LVAD implantation; 2) Visit 2 after device implantation with CF-LVAD pump speed held constant at baseline speed; and 3) Visit 3 with increases in pump speed during exercise (median: 1,050 rpm [IQR: 750-1,150 rpm] and 220 rpm [IQR: 120-220 rpm] for HeartMate 3 and HeartWare VAD, respectively). Hemodynamics and direct Fick cardiac output were monitored using pulmonary artery catheterization. Gas exchange metrics were determined using indirect calorimetry. RESULTS: Maximal oxygen uptake (Visits 1, 2, and 3: 10.8 ± 2.5 mL/kg/min, 10.7 ± 2.2 mL/kg/min, and 11.5 ± 1.7 mL/kg/min; P = 0.92) did not improve after device implantation. Mean pulmonary arterial and pulmonary capillary wedge pressures increased significantly during submaximal and peak exercise on preimplantation testing (P < 0.01 for rest vs peak exercise) and remained elevated, with minimal change on Visits 2 and 3 regardless of whether pump speed was fixed or increased. CONCLUSIONS: Among patients with HFrEF, cardiovascular hemodynamics and exercise capacity were similar after CF-LVAD implantation, regardless of whether patients exercised at fixed or adjusted pump speeds during exercise. Further research is needed to determine methods by which LVADs may alleviate the HFrEF syndrome after device implantation. (Effect of mechanIcal circulatoRy support ON exercise capacity aMong pAtieNts with heart failure [IRONMAN]; NCT03078972).

Lactococcus garvieae in Rural Alabama: A Case Report.

Lactococcus (L.) garvieae is a gram-positive coccus that has been found in various aquatic and terrestrial animals, as well as in dairy products, and is considered a potential zoonotic bacterium. The pathogen has been recognized as an emerging opportunistic human pathogen, often associated with the ingestion of raw seafood. The most common presentation of L. garvieae infection in humans is infective endocarditis, but it has also been found to have associations with other clinical manifestations. The following is a case report of a 6-year-old male with infected bilateral leg abrasions that occurred after playing in a local creek near his home in northern Alabama, which had livestock including goats, cows, and horses. Wound culture indicated that the bacteria was L. garvieae, which was found to be sensitive to ceftriaxone, levofloxacin, linezolid, tetracycline, tigecycline, and vancomycin and resistant to clindamycin. The patient was treated with oral cephalexin and topical gentamicin for ten days, after which there appeared to be an overall improvement in wound healing.

Cognitive functioning as a predictor of response to comprehensive cognitive remediation.

Cognitive remediation is aimed at reducing cognitive impairments in severe mental illnesses such as schizophrenia, but little is known about whether severity of cognitive impairment predicts benefit from this intervention. To address this question, this study aggregated data from five randomized controlled trials (N = 300) of a standardized comprehensive, multimodal outpatient cognitive remediation program, the Thinking Skills for Work program, and evaluated whether baseline level of cognitive impairment differentially predicted improvement in cognitive functioning following cognitive remediation vs. usual services. Using standardized scores of neuropsychological functioning to designate "low average," "moderate," and "severe" levels of cognitive impairment, participants with greater cognitive impairment were found to benefit differentially more from cognitive remediation than usual services compared to less cognitively impaired participants. The findings were unaffected by statistically controlling for participant demographic and clinical characteristics. The findings suggest that individuals with the greatest cognitive impairment, for whom cognitive remediation was developed, are also most likely to benefit from this intervention.

Electrochemiluminescence of dipicolinic acid (DPA) and (bpy)(2)Ru(DPA)(+) (bpy = 2,2'-bipyridine).

The spectroscopic and electrochemiluminescence (ECL) properties of dipicolinic acid (DPA), (bpy)(2)Ru(2+) (bpy = 2,2'-bipyridine) and the species formed when DPA and (bpy)(2)Ru(2+) [abbreviated to (bpy)(2)Ru(DPA)(+)] are allowed to react are reported. The UV-Vis absorption maxima for (bpy)(2)Ru(2+) and (bpy)(2)Ru(DPA)(+) are 493 and 475 nm, respectively, indicating the in situ formation of a complex between DPA and (bpy)(2)Ru(2+). DPA, (bpy)(2)Ru(2+) and (bpy)(2)Ru(DPA)(+) display ECL upon oxidation in the presence of the oxidative-reductive co-reactant tri-n-propylamine (TPrA). The ECL of (bpy)(2)Ru(DPA)(+) is at least two-fold higher than either of the parent species. An ECL spectrum of (bpy)(2)Ru(DPA)(+) displays a peak maximum 40 nm red-shifted from the photoluminescence peak maximum, suggesting that the excited state formed electrochemically is different from that formed spectroscopically.