Publications by authors named "Richard Krasuski"
Importance: In the US, there are more than 1.5 million adults living with congenital heart disease (CHD). The Congenital Heart Initiative (CHI) is a digital, online, patient-empowered registry that was created to advance multicenter research and improve clinical care by gathering patient-reported outcomes (PROs) in adults with CHD.
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- The study examines the characteristics and outcomes of adult congenital heart disease (ACHD) patients admitted to cardiac intensive care units (CICUs) in North America from 2017 to 2022, revealing limited previous knowledge in this area.
- Out of 23,299 CICU admissions, only 441 (1.9%) were for ACHD, which tended to be younger patients who had more admissions related to heart failure and medical issues compared to non-ACHD patients.
- Despite longer hospital stays for ACHD patients, their in-hospital mortality rates were similar to those of non-ACHD patients, indicating the need for more focused research on managing specific complexities related to ACHD in the CICU.*
Article Synopsis
- The foramen ovale is important for blood flow when a baby is still in the womb, but if it stays open after birth (called PFO), it can cause health problems like strokes or migraines.
- These health issues usually affect different age groups, with migraines common in young adults and strokes more seen in older people.
- The article explains how PFO causes these problems by allowing blood to flow in the wrong direction and emphasizes the need to better understand this condition and how it affects people.
Article Synopsis
- COVID-19 significantly affects coagulation in adult patients with congenital heart disease (ACHD), making them more susceptible to thromboembolic (TE) and bleeding complications.
- In a study from May 2020 to November 2021 involving nearly 2,000 ACHD patients, 1.5% experienced severe TE or bleeding events, which were linked to higher mortality rates and more advanced health conditions.
- Key risk factors for these complications included prior anticoagulation treatment, incidents of cardiac injury, and severity of the COVID-19 infection, with logistic regression confirming their independent associations with TE and bleeding risks.
Atrial fibrillation/flutter (AF) is the most common dysrhythmia in patients with hypertrophic cardiomyopathy (HCM). Unexplained left ventricular hypertrophy and left ventricular outflow tract obstruction are integral components of HCM pathology which can cause increased left atrial pressure and atrial myopathy contributing to the substrate for AF. We aimed to determine the impact of AF on hospital readmissions in patients with HCM.
View Article and Find Full Text PDFPulmonary Hypertension in Adult Congenital Heart Disease-Related Heart Failure.
Heart Fail Clin
April 2024
Already a challenging condition to define, adult congenital heart disease (ACHD) -associated heart failure (HF) often incorporates specific anatomies, including intracardiac and extracardiac shunts, which require rigorous diagnostic characterization and heighten the importance of clinicians proactively considering overall hemodynamic impacts of using specific therapies. The presence of elevated pulmonary vascular resistance dramatically increases the complexity of managing patients with ACHD-HF. Total circulatory management in patients with ACHD-HF requires input from multidisciplinary care teams and thoughtful and careful utilization of medical, interventional, and surgical approaches.
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- Congenital heart disease (CHD) is a wide range of structural heart issues and is the leading cause of serious birth defects.
- Advances in pediatric care have resulted in more adults surviving with CHD than there are children currently living with the condition.
- Adults with CHD face significant health risks from their heart conditions and previous surgeries, necessitating regular check-ups and targeted care plans for better health outcomes.
Pulmonary arterial hypertension (PAH) is a progressive, life-limiting disease. Despite significant medical progress over the last three decades, the prognosis of PAH remains poor. PAH is associated with sympathetic nervous system over-stimulation and baroreceptor-mediated vasoconstriction, leading to pathologic pulmonary artery (PA) and right ventricular remodeling.
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- An increasing number of adult Fontan patients are needing heart or combined heart-liver transplants, but there is limited data on their outcomes and ideal referral timing.
- This study analyzed 131 adult Fontan patients who underwent transplantation between 1995 and 2021, finding a 79% survival rate at one year and 66% at five years post-transplant, with improved outcomes noted in patients transplanted after 2010.
- Late referrals and certain health indicators like poor functional status and specific vascular issues were linked to lower survival rates, highlighting the importance of timely evaluations.
Article Synopsis
- - The study investigates the effects of Fontan-associated liver disease (FALD) on post-transplant outcomes, specifically looking at heart transplant (HT) versus combined heart-liver transplant (CHLT) in adult Fontan patients.
- - Results showed that CHLT patients were generally older and had higher FALD scores, but they exhibited better survival rates compared to HT, particularly in those with higher FALD scores.
- - The research indicates a correlation between higher FALD scores and increased mortality post-transplant, suggesting that CHLT may offer improved survival outcomes for patients with significant liver disease.
Background: Balloon pulmonary angioplasty (BPA) was introduced as a treatment modality for patients with inoperable, medically refractory chronic thromboembolic pulmonary hypertension decades ago; however, reports of high rates of pulmonary vascular injury have led to considerable refinement in procedural technique.
Objectives: The authors sought to better understand the evolution of BPA procedure-related complications over time.
Methods: The authors conducted a systematic review of original articles published by pulmonary hypertension centers globally and performed a pooled cohort analysis of procedure-related outcomes with BPA.
Background: The pharmacologic treatment of non-alcoholic fatty liver disease (NAFLD) remains unclear.
Methods: Two reviewers searched PubMed, SCOPUS, Cochrane Central and clinicaltrials.gov for randomized controlled trials (RCTs) of patients with NAFLD with or without type 2 diabetes mellitus (T2DM) receiving TZDs vs SGLT2 inhibitors.
Disparities in Loss to Follow-Up Among Adults With Congenital Heart Disease in North Carolina.
World J Pediatr Congenit Heart Surg
November 2022
Article Synopsis
- - The study analyzed follow-up care for adults with congenital heart disease (CHD) in North Carolina, revealing that 39% of patients did not receive the recommended follow-up within two years after their initial healthcare encounter.
- - Among the 2822 patients studied, those with severe CHD had better follow-up rates (72%) compared to those with less severe conditions (55%), while follow-up was notably lower among Black patients (56%) than White patients (64%).
- - Younger age, having non-severe CHD, and being from a minority background were identified as factors that increased the likelihood of inadequate follow-up, suggesting a need for targeted health interventions to improve care retention in these groups.
Article Synopsis
- - Current cardiac output (CO) and hemodynamic parameter measurements are underused in cardiovascular management due to technology limitations, especially in outpatient settings, where tracking changes over time is difficult.
- - The study aimed to validate a non-invasive cardiac output measurement method called NICaS against the standard cardiac magnetic resonance (CMR) technique by comparing stroke volume (SV) in 41 patients undergoing CMR.
- - Results showed a strong correlation between NICaS and CMR SV measurements, indicating potential for NICaS to consistently assess hemodynamic changes over time without invasive procedures, aligning with FDA standards for medical devices.
The population of adults with congenital heart disease (ACHD) is rapidly increasing. There is limited understanding of location of death and associated disparities in these patients. From 2005-2018, a trend-level analysis was performed using death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Database, with individual-level mortality data obtained from National Center for Health Statistics.
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- Women with congenital heart disease (CHD) have a higher prevalence of hypertensive disorders of pregnancy (HDP) compared to those without CHD, with rates of 11.2% vs 8.1% respectively.
- Chronic hypertension and diabetes mellitus are significant risk factors for HDP in women with CHD, along with coarctation of the aorta as a specific condition linked to increased risk.
- HDP was found to be more strongly associated with complications like difficult deliveries and preterm births, indicating that HDP poses more substantial risks than the presence of CHD itself.
Novel oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta-analysis.
Catheter Cardiovasc Interv
June 2022
Article Synopsis
- A meta-analysis was conducted to compare the effectiveness and safety of novel oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) for patients with atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR).
- The analysis included 12 studies with over 12,000 patients and found no significant differences in major outcomes such as stroke, major bleeding, and mortality between the two drug classes.
- Factors like gender, age, and risk scores were identified as significant contributors to variations in all-cause mortality in the meta-regression analysis, but overall, NOACs and VKAs showed similar outcomes in this patient population.
Arrhythmias are the leading cause of morbidity and mortality in repaired tetralogy of Fallot (TOF), and over 20% of these patients will develop a sustained atrial arrhythmia during their lifetimes. Cardiac magnetic resonance imaging (cMRI) is frequently performed in TOF, although its ability to identify patients at risk of atrial arrhythmias is uncertain. Adult TOF patients (n = 175) with no history of atrial arrhythmia who underwent cMRI between 2003 and 2020 at a single tertiary care center were identified.
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- The Fontan circulation has improved survival rates for patients with complex congenital heart disease, but it leads to long-term complications due to low cardiac output and high central venous pressure.
- Current hemodynamic parameters for this specific patient group have not been clearly defined, which makes it difficult to manage their health effectively.
- Establishing a clear range of normal hemodynamic parameters for Fontan patients could help physicians determine when interventions are needed, reducing variability in treatment and possibly enhancing long-term outcomes.
Purpose Of Review: Arrhythmias are a leading cause of morbidity and mortality following repair of tetralogy of Fallot (TOF). This review will highlight current understanding of arrhythmia pathogenesis in this patient population and review novel therapeutic options.
Recent Findings: Risk factors for developing ventricular arrhythmias in repaired TOF have thus far been better defined than for atrial arrhythmias.
Article Synopsis
- Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5-10% of adults with congenital heart disease and is linked to serious health risks.
- It develops due to abnormal blood flow between the heart and lungs, leading to harmful changes in pulmonary blood vessels, similar to other types of PAH.
- The most extreme form, called Eisenmenger syndrome, results in high pulmonary pressure and can cause serious symptoms like low oxygen levels; treatment usually involves medication, with surgery considered for some patients.
Interventional Management of Chronic Thromboembolic Pulmonary Hypertension.
Cardiol Clin
February 2022
Article Synopsis
- * The preferred first treatment is pulmonary thromboendarterectomy, but patients who can't have surgery can benefit from balloon pulmonary angioplasty (BPA).
- * BPA can improve patients' functioning, symptoms, and heart and lung mechanics, but requires careful technique and quick handling of any complications for the best outcomes.
A multiscale model of vascular function in chronic thromboembolic pulmonary hypertension.
Am J Physiol Heart Circ Physiol
August 2021
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by recurrent or unresolved pulmonary thromboemboli, leading to perfusion defects and increased arterial wave reflections. CTEPH treatment aims to reduce pulmonary arterial pressure and reestablish adequate lung perfusion, yet patients with distal lesions are inoperable by standard surgical intervention. Instead, these patients undergo balloon pulmonary angioplasty (BPA), a multisession, minimally invasive surgery that disrupts the thromboembolic material within the vessel lumen using a catheter balloon.
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