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Alexander Opotowsky

Sarah S Pickard, Kimberlee Gauvreau, Michelle Gurvitz, Joshua J Gagne, Alexander R Opotowsky, Kathy J Jenkins, Ashwin Prakash
Adults with repaired coarctation of the aorta (CoA) suffer reduced long-term survival compared with the general population, in part due to coronary artery disease (CAD). There is conflicting evidence as to whether or not CoA is an independent risk factor for CAD. The primary aim was to determine if CoA is independently associated with premature myocardial infarction (MI) in the contemporary era. The secondary aim was to determine if CoA is independently associated with early coronary intervention. In a cross-sectional study using the National Inpatient Sample database from 2005 to 2014, we compared the age at MI and the age at coronary intervention (coronary artery bypass grafting or percutaneous coronary intervention, in the absence of MI diagnosis) in patients with and without CoA using weighted linear regression...
September 21, 2018: American Journal of Cardiology
Laith Alshawabkeh, Alexander R Opotowsky, Knute D Carter, Michael M Givertz, Michael J Landzberg, Marcus A Urey, Heather Bartlett
Medical and surgical advances in the late 20th century that allowed the majority of children born with congenital heart disease (CHD) to survive have resulted in a shift of the burden of morbidity and mortality into adulthood. Heart failure is the leading cause of death in adults with CHD. This study aimed to address the gap in understanding of outcomes of adults with CHD who have heart failure and are listed for heart transplantation compared with those without CHD. The study analyzed data from the US Scientific Registry of Transplant Recipients database, categorized by the listing era (on/before or after January 19, 1999)...
August 21, 2018: American Journal of Cardiology
Alexander R Opotowsky, Bradley M Wertheim, Ryan J Tedford
No abstract text is available yet for this article.
September 6, 2018: JACC. Cardiovascular Imaging
Laith Alshawabkeh, Saurabh Rajpal, Michael J Landzberg, Sitaram Emani, Georges Ephrem, Catherine Gray, Michael N Singh, Fred Wu, Alexander R Opotowsky
Red cell distribution width (RDW), a measure of variability in red cell size, predicts adverse outcomes in acquired causes of heart failure. We examined the relation of RDW and outcomes in adults with congenital heart disease. We performed a prospective cohort study on 696 ambulatory patients ≥18 years old enrolled in the Boston Adult Congenital Heart Disease Biobank between 2012 and 2016 (mean age 38.7 ± 13.5 years; 49.9% women). The combined outcome was all-cause mortality or nonelective cardiovascular hospitalization...
August 3, 2018: American Journal of Cardiology
Keri M Shafer, Alexander R Opotowsky, Jonathan Rhodes
OBJECTIVE: Risk prediction using cardiopulmonary exercise testing (CPET) in complex congenital heart disease tends to either focus on single diagnoses or complete cohorts. We aimed to evaluate patients with two distinct anatomies cared for at a single institution over the same time period to determine CPET variables associated with mortality. DESIGN: All Fontan and tetralogy of Fallot (TOF) subjects with CPET between November 1, 2002 and December 31, 2014 and subsequently died were identified (cases)...
September 14, 2018: Congenital Heart Disease
Anna R Hemnes, Alexander R Opotowsky, Tufik R Assad, Meng Xu, Laura N Doss, Eric Farber-Eger, Quinn S Wells, Evan L Brittain
BACKGROUND: The measurements used to define pulmonary hypertension (PH) etiology, pulmonary arterial wedge pressure (PAWP), and left ventricular end-diastolic pressure (LVEDP) vary in clinical practice. We aimed to identify clinical features associated with measurement discrepancy between PAWP and LVEDP in patients with PH. METHODS: We extracted clinical data and invasive hemodynamics from consecutive patients undergoing concurrent right and left heart catheterization at Vanderbilt University between 1998 and 2014...
August 24, 2018: Chest
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 nonsmokers 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 29, 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...
October 15, 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...
September 7, 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
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