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Alexander Opotowsky

Fred M Wu, Alexander R Opotowsky, Erica R Denhoff, Russell Gongwer, Michelle Z Gurvitz, Michael J Landzberg, Keri M Shafer, Anne Marie Valente, Ahmet Z Uluer, Jonathan Rhodes
BACKGROUND: While the Fontan procedure has improved life expectancy, patients with single ventricle physiology have impaired exercise capacity due to limited increase in pulmonary blood flow during activity. Enhancing the "thoracic pump" using inspiratory muscle training (IMT) may ameliorate this impairment. METHODS: Adult non-smokers with Fontan physiology were recruited through Boston Children's Hospital's outpatient clinic. Participants underwent cardiopulmonary exercise testing and pulmonary function testing, followed by 12 weeks of IMT and then repeat testing...
July 28, 2018: Seminars in Thoracic and Cardiovascular Surgery
Shankar Baskar, Gruschen R Veldtman, Philip R Khoury, Alexander R Opotowsky, Ari M Cedars
BACKGROUND: Characteristics of hospitalizations including healthcare utilization for adult patients with congenital heart disease (ACHD) at the time of implantable cardioverter defibrillator (ICD) placement has not been well studied. METHODS: We analyzed data from the 2002-2014 United States National Inpatient Sample (NIS). ICD implantation, CHD, complications, and indications for admissions were determined based on diagnostic codes among adults. Propensity score matching was performed, based on age, sex and in-hospital mortality index with a 10:1 ratio between adults without CHD and those with CHD, to determine relative healthcare utilization attributable to CHD...
July 24, 2018: International Journal of Cardiology
Alexander R Opotowsky, Anne Marie Valente, Laith Alshawabkeh, Susan Cheng, Allison Bradley, Eric B Rimm, Michael J Landzberg
Aims: Despite the well-defined association of high-sensitivity hsCRP with cardiovascular outcomes in apparently healthy adults and those with acquired heart disease, the relevance of this inflammatory marker in adults with congenital heart disease (ACHD) remains unclear. We aimed to examine the clinical correlates and prognostic value of high-sensitivity C-reactive protein levels in ACHD. Methods and results: We conducted a prospective cohort study of (n = 707) outpatient ACHD (age 39 ± 14 years, 49% women), enrolled mainly at a referral centre, who had serum hsCRP measured in conjunction with a clinical assessment between 2012 and 2016...
July 12, 2018: European Heart Journal
Konstantinos Dimopoulos, Gerhard-Paul Diller, Alexander R Opotowsky, Michele D'Alto, Hong Gu, George Giannakoulas, Werner Budts, Craig S Broberg, Gruschen Veldtman, Lorna Swan, Maurice Beghetti, Michael A Gatzoulis
No abstract text is available yet for this article.
July 4, 2018: Journal of the American Heart Association
Stephen P Wright, Alexander R Opotowsky, Tayler A Buchan, Sam Esfandiari, John T Granton, Jack M Goodman, Susanna Mak
Aims: The assumption of equivalence between right ventricular and pulmonary arterial systolic pressure is fundamental to several assessments of right ventricular or pulmonary vascular hemodynamic function. Our aims were to 1) determine whether systolic pressure gradients develop across the right ventricular outflow tract in healthy adults during exercise, 2) examine the potential correlates of such gradients, and 3) consider the effect of such gradients on calculated indices of right ventricular function...
June 6, 2018: Cardiovascular Research
Sarah S Pickard, Kimberlee Gauvreau, Michelle Gurvitz, Joshua J Gagne, Alexander R Opotowsky, Kathy J Jenkins, Ashwin Prakash
BACKGROUND: Adults with repaired coarctation of the aorta (CoA) have reduced long-term survival compared with the general population. This study aimed to determine whether CoA is independently associated with premature ischemic and hemorrhagic stroke in the contemporary era. METHODS AND RESULTS: This was a cross-sectional study utilizing the National Inpatient Sample database from 2005 to 2014. We hypothesized that patients with CoA are hospitalized with ischemic and hemorrhagic stroke at a younger age compared with the general population...
June 1, 2018: Journal of the American Heart Association
Michele D'Alto, Eduardo Bossone, Alexander R Opotowsky, Stefano Ghio, Lawrence G Rudski, Robert Naeije
Doppler echocardiography is extensively used in clinical practice for the screening and detection of pulmonary hypertension (PH). It allows for accurate estimates of pulmonary artery pressures, but with moderate precision, which explains why it is more appropriate for population studies than for definitive diagnosis of PH in individual patients. Moreover, echocardiography allows one to distinguish different patterns of right ventricular remodelling in various forms of PH and enables clinically satisfactory differentiation between pre- and post-capillary PH...
July 15, 2018: International Journal of Cardiology
Anand Vaidya, Shahida K Flores, Zi-Ming Cheng, Marlo Nicolas, Yilun Deng, Alexander R Opotowsky, Delmar M Lourenço, Justine A Barletta, Huma Q Rana, M Adelaide Pereira, Rodrigo A Toledo, Patricia L M Dahia
New England Journal of Medicine, Volume 378, Issue 13, Page 1259-1261, March 2018.
March 29, 2018: New England Journal of Medicine
Alexander R Opotowsky, Jonathan Rhodes, Michael J Landzberg, Ami B Bhatt, Keri M Shafer, Doreen DeFaria Yeh, Scott E Crouter, Ana Ubeda Tikkanen
BACKGROUND: Cardiac rehabilitation (CR) improves exercise capacity and quality of life while reducing mortality in adults with acquired heart disease. Cardiac rehabilitation has not been extensively studied in adults with congenital heart disease (CHD). METHODS: We performed a prospective, randomized controlled trial (NCT01822769) of a 12-week clinical CR program compared with standard of care (SOC). Participants were ≥16 years old, had moderate or severe CHD, had O2 saturation ≥92%, and had peak O2 consumption ([Formula: see text]) < 80% predicted...
March 2018: World Journal for Pediatric & Congenital Heart Surgery
Saurabh Rajpal, Laith Alshawabkeh, Nureddin Almaddah, Caroline M Joyce, Keri Shafer, Michelle Gurvitz, Sushrut S Waikar, Finnian R Mc Causland, Michael J Landzberg, Alexander R Opotowsky
Importance: Albuminuria is associated with adverse outcomes in diverse groups of patients, but the importance of albuminuria in the emerging population of increasingly complex adults with congenital heart disease (ACHD) remains unknown. Objective: To assess the prevalence, risk factors, and prognostic implications of albuminuria in ACHD. Design, Setting, and Participants: This prospective study assessed a cohort of ambulatory patients aged 18 years and older who were examined at an ACHD referral center and enrolled in the Boston ACHD Biobank between May 17, 2012, to August 5, 2016...
April 1, 2018: JAMA Cardiology
William M Oldham, Rudolf K F Oliveira, Rui-Sheng Wang, Alexander R Opotowsky, David M Rubins, Jon Hainer, Bradley M Wertheim, George A Alba, Gaurav Choudhary, Adrienn Tornyos, Calum A MacRae, Joseph Loscalzo, Jane A Leopold, Aaron B Waxman, Horst Olschewski, Gabor Kovacs, David M Systrom, Bradley A Maron
RATIONALE: Current methods assessing clinical risk because of exercise intolerance in patients with cardiopulmonary disease rely on a small subset of traditional variables. Alternative strategies incorporating the spectrum of factors underlying prognosis in at-risk patients may be useful clinically, but are lacking. OBJECTIVE: Use unbiased analyses to identify variables that correspond to clinical risk in patients with exercise intolerance. METHODS AND RESULTS: Data from 738 consecutive patients referred for invasive cardiopulmonary exercise testing at a single center (2011-2015) were analyzed retrospectively (derivation cohort)...
March 16, 2018: Circulation Research
Alexander R Opotowsky, Gary D Webb
No abstract text is available yet for this article.
March 21, 2018: European Heart Journal
Gary D Webb, Alexander R Opotowsky
No abstract text is available yet for this article.
November 13, 2017: JACC. Cardiovascular Interventions
Brandon S Hays, Michael Baker, Annie Laib, Wei Tan, Sebastian Udholm, Bryan H Goldstein, Stephen P Sanders, Alexander R Opotowsky, Gruschen R Veldtman
OBJECTIVE: Fontan circulations have obligatory venous hypertension, depressed cardiac output and abnormal arterial elastance. Ventriculovascular coupling is known to be abnormal, but the underlying mechanisms are poorly defined. We aim to describe the histopathological features of vascular remodelling encountered in the central arteries and veins in the Fontan circulation as a possible underlying pathological representation of abnormal ventriculovascular coupling. METHODS: Postmortemvasculature (inferior vena cava (IVC), superior vena cava (SVC), pulmonary artery (PA), pulmonary vein (PV) and aorta) of 13 patients with a Fontan circulation (mean age 29...
February 2018: Heart: Official Journal of the British Cardiac Society
Alexander R Opotowsky, Edward Hess, Bradley A Maron, Evan L Brittain, Anna E Barón, Thomas M Maddox, Laith I Alshawabkeh, Bradley M Wertheim, Meng Xu, Tufik R Assad, Jonathan D Rich, Gaurav Choudhary, Ryan J Tedford
Importance: Thermodilution (Td) and estimated oxygen uptake Fick (eFick) methods are widely used to measure cardiac output (CO). They are often used interchangeably to make critical clinical decisions, yet few studies have compared these approaches as applied in medical practice. Objectives: To assess agreement between Td and eFick CO and to compare how well these methods predict mortality. Design, Setting, and Participants: This investigation was a retrospective cohort study with up to 1 year of follow-up...
October 1, 2017: JAMA Cardiology
Fabien Labombarda, Robert Hamilton, Azadeh Shohoudi, Jamil Aboulhosn, Craig S Broberg, Marie A Chaix, Scott Cohen, Stephen Cook, Annie Dore, Susan M Fernandes, Anne Fournier, Joseph Kay, Laurent Macle, Blandine Mondésert, François-Pierre Mongeon, Alexander R Opotowsky, Anna Proietti, Lena Rivard, Jennifer Ting, Bernard Thibault, Ali Zaidi, Paul Khairy
BACKGROUND: Atrial arrhythmias are the most common complication encountered in the growing and aging population with congenital heart disease. OBJECTIVES: This study sought to assess the types and patterns of atrial arrhythmias, associated factors, and age-related trends. METHODS: A multicenter cohort study enrolled 482 patients with congenital heart disease and atrial arrhythmias, age 32.0 ± 18.0 years, 45.2% female, from 12 North American centers...
August 15, 2017: Journal of the American College of Cardiology
Gruschen R Veldtman, Alexander R Opotowsky, Samuel G Wittekind, Jack Rychik, Daniel J Penny, Mark Fogel, Bradley S Marino, Marc Gewillig
Although medium-term survival following Fontan operations in the modern era has improved dramatically, late cardiovascular and extracardiac morbidity are common and are associated with impaired quality of life and premature late mortality. This serves as a reminder of the extraordinary adaptations required of the cardiovascular system when the systemic arterial, systemic venous and pulmonary circulations are placed in series coupled to a single ventricular pump. This article reviews the key features and principles that govern interactions between the ventricle, systemic arterial circulation, the systemic venous and pulmonary circulatory compartments, the microcirculation, and lymphatic circulations...
December 2017: Congenital Heart Disease
Annelieke C M J van Riel, David M Systrom, Rudolf K F Oliveira, Michael J Landzberg, Barbara J M Mulder, Berto J Bouma, Bradley A Maron, Amil M Shah, Aaron B Waxman, Alexander R Opotowsky
BACKGROUND: We recently reported a novel observation that many patients with equal resting supine right ventricular(RV) and pulmonary artery(PA) systolic pressures develop an RV outflow tract(RVOT) pressure gradient during upright exercise. The current work details the characteristics of patients who develop such an RVOT gradient. METHODS: We studied 294 patients (59.7±15.5 years-old, 49% male) referred for clinical invasive cardiopulmonary exercise testing, who did not have a resting RVOT pressure gradient defined by the simultaneously measured peak-to-peak difference between RV and PA systolic pressures...
2017: PloS One
Jonathan W Cunningham, Ashwin S Nathan, Jonathan Rhodes, Keri Shafer, Michael J Landzberg, Alexander R Opotowsky
Peak oxygen consumption (pVO2 ) measured by cardiopulmonary exercise test (CPET) predicts mortality in adults with a Fontan circulation. The purpose of this study was to assess the additive prognostic value of change in pVO2 over time. METHODS: We analyzed a cohort of adults (≥18 years old) with a Fontan circulation who underwent at least 2 maximal CPETs separated by 6-30 months at Boston Children's Hospital between 2000 and 2015. Survival analysis was performed to determine whether changes in CPET variables, including pVO2 between consecutive tests, were associated with subsequent clinical events...
July 2017: American Heart Journal
Sergio A Segrera, Laurie Lawler, Alexander R Opotowsky, David Systrom, Aaron B Waxman
A growing body of evidence suggests that exercise pulmonary hypertension (ePH) is an early form of pulmonary arterial hypertension (PAH). Identifying the disease at an early, potentially more responsive phase, and initiating treatment may improve functional status and prevent progression to severe forms of PAH. This was a single-center, open-label six-month treatment trial to evaluate the effect of ambrisentan on pulmonary hemodynamics and exercise capacity in ePH utilizing invasive cardiopulmonary exercise testing (iCPET)...
April 2017: Pulmonary Circulation
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