Heart Health Clinical Studies

A targeted metabolic protocol with D-ribose for off-pump coronary artery bypass procedures: a retrospective analysis (Therapeutic Advances in Cardiovascular Disease, 2011)

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David J. Perkowski, Susan Wagner, Joseph R. Schneider and J. A. St. Cyr

Therapeutic Advances in Cardiovascular Disease, 21 June 2011

Objectives: 
Coronary revascularization using cardiopulmonary bypass is an effective surgical procedure for ischemic coronary artery disease. Complications associated with cardiopulmonary bypass have included cerebral vascular accidents, neurocognitive disorders, renal dysfunction, and acute systemic inflammatory responses. Within the last two decades off-pump coronary artery bypass has emerged as an approach to reduce the incidence of these complications, as well as shorten hospital stays and recovery times. Many patients with coronary artery disease have insulin resistance and altered energy metabolism, which can exacerbate around the time of coronary revascularization. D-ribose has been shown to enhance the recovery of high-energy phosphates following myocardial ischemia. We hypothesized that patient outcomes could improve using a perioperative metabolic protocol with D-ribose.

Methods:
A perioperative metabolic protocol was used in 366 patients undergoing off-pump coronary artery bypass during 2004_2008. D-ribose was added in 308 of these 366 patients. Data were collected prospectively as part of the Society of Thoracic Surgeons database and retrospectively analyzed.

Results:
D-ribose patients were generally similar to those who did not receive D-ribose. There was one death, two patients suffered strokes and renal failure requiring dialysis occurred in two patients postoperatively among the entire group of patients. D-ribose patients enjoyed a greater improvement in cardiac index postrevascularization compared with non-D-ribose patients (37% vs. 17%, respectively, p<0.001).

Conclusions:
This metabolic protocol was associated with very low mortality and morbidity with a significant early postoperative improvement in cardiac index using D-ribose supplementation. These preliminary results support a prospective randomized trial using this protocol and D-ribose.

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D-RIBOSE AIDS ADVANCED ISCHEMIC HEART FAILURE PATIENTS (International Journal of Cardiology, 2008)

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Dean MacCarter, PhD; Nampalli Vijay, MD; Melinda Washam, MS; Linda Shecterle, PhD; Helen Sierminski, BA; J.A. St. Cyr, MD, PhD; Aurora Denver Cardiology Associates, P.C.; Denver, CO

International Journal of Cardiology, July 2008

Abstract

Patients with advanced heart failure are exercise intolerant. Low cellular energy levels in the failing heart have been proposed. Energy enhancing substrates have revealed mixed results. Ribose, a pentose monosaccharide, has shown to replenish low myocardial energy levels, improving cardiac dysfunction following ischemia, and improving ventilation efficiency in patients with heart failure. As current pharmaceuticals do not address cellular energy levels, this study was designed to investigate the role of ribose on ventilation at anaerobic threshold in congestive heart failure patients. D-ribose (5gms/dose, tid) was assessed in 16 NYHA class III-IV, heart failure patients with VO2, tidal volume/VCO2, heart rate/tidal volume evaluated at 8 weeks. All patients had a significant improvement in ventilator parameters at anaerobic threshold, along with a 44% Weber class improvement. Ribose improved the ventilator exercise status in advanced heart failure patients.

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Energizing Diastole (Heart Failure Clin 4, 2008)

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Ragavendra R. Baliga, MD, MBA
James B. Young, MD

Heart Failure Clin 4 (2008) ix–xiii

 

Epidemiologic studies suggest that diastolic dysfunction is present in more than half of the patients admitted to the hospital with congestive heart failure [1], and the mortality rate in these patients appears comparable to that of patients with depressed left ventricular ejection fraction.  As there are few randomized clinical trials that include patients who have diastolic heart failure, current therapies have focused on the management of factors that exacerbate the clinical manifestations, such as lowering systolic and diastolic blood pressure, controlling ventricular rate in atrial fibrillation, and decreasing volume overload [2]. Unfortunately, the impact of available therapies on diastolic heart failure has been, at best, moderate, making the search for a more effective treatment urgent [3,4]. Recent work suggests that modulating myocardial energetics merit attention in this quest [5–7].

Intuitively, it is well recognized that sarcomeric relaxation is an active process because skeletal muscle goes into contracture (rigor mortis) rather than relaxation when metabolism stops.Abundant evidence exists that ventricular diastole is also an active process [8,9], because adenosine triphosphate (ATP) is required for the dissociation of actin and myosin in the cardiac myocyte [10–12]. Agents such as D-ribose that enhance recovery of depressed myocardial ATP levels improve diastolic compliance [13,14]. ‘‘Runningout-of-gas,’’ or energy depletion, in the cardiac myocyte [10] was described in heart failure more than three decades ago [15,16], and several studies have characterized the impaired myocardial metabolism in diastolic dysfunction [17–22] and left ventricular hypertrophy (LVH), which often precedes diastolic dysfunction [23–28].

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D-Ribose Benefits COPD (The Internet Journal of Pulmonary Medicine, 2007)

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Dean J. MacCarter Ph.D., Aurora Denver Cardiology Associates, Denver, CO, USA

L. M. Shecterle Ph.D., Jacqmar, Inc., Minneapolis, MN, USA

J. A. St. Cyr M.D., Ph.D., Jacqmar, Inc., Minneapolis, MN, USA

The Internet Journal of Pulmonary MedicineTM, 2007; Volume 7, Number 2

Abstract

Patients with COPD have exercise limitations due to pulmonary function restrictions and heart stress, potentially producing alterations in energy levels. Adenosine triphosphate (ATP), a highenergy phosphate molecule, provides energy for the maintenance of cellular processes. D-ribose (DR), a natural occurring pentose carbohydrate, has shown to enhance ATP levels and improve cardiac function in ischemic cardiovascular disease2 and shown benefits in lung mechanics along with ventilation in congestive heart failure patients. 3

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On the Hypothesis that the Failing Heart Is Energy Starved: Lessons Learned from the Metabolism of ATP and Creatine

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Corresponding author Joanne S. lngwall, PhD 

NMR Laboratory for Physiological Chemistry, Brigham and Women's Hospital, 221 Longwood Avenue, Room 247, Boston, MA 02115, USA.

Current Hypertension Reports
2006, 8:457-464

Current Science Inc. ISSN 1522-6417
Copyright© 2006 by Current Science Inc.

Adenosine triphosphate (ATP) and phosphocreatine fall in the failing heart. New insights into the control of ATP synthesis, supply, and utilization, and how this changes in the failing heart, have emerged. In this article, we address four questions: What are the mechanisms explaining loss of ATP and creatine from the failing heart? What are the consequences of these changes? Can metabolism be manipulated to restore a normal ATP supply? Does increasing energy supply have physiologic consequences (ie, does it lead to improved contractile [systolic and/or diastolic] performance)? In part 1 we focus on ATP, in part 2 on creatine, and in part 3 on the relationship between creatine and purine metabolism and purine nucleotide signaling.

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