Balram Bhargava | All India Institute of Medical Sciences, New Delhi (original) (raw)

Papers by Balram Bhargava

Research paper thumbnail of Vascular repair after balloon overstretch injury in porcine model effects of intracoronary radiation

Journal of The American College of Cardiology, 2000

OBJECTIVESThe purpose of this study was to evaluate the effect of IR on thrombus formation and di... more OBJECTIVESThe purpose of this study was to evaluate the effect of IR on thrombus formation and dissection repair following overstretch balloon injury in porcine coronary arteries.BACKGROUNDExposure of blood to the injured arterial wall after percutaneous transluminal coronary angioplasty (PTCA) induces thrombus formation and inflammation in the dissection plane. Neointima formation is related to smooth muscle cell (SMC) proliferation and migration

Research paper thumbnail of Delayed re-endothelialization and T-cell infiltration following intracoronary radiation therapy in the porcine model

International Journal of Radiation Oncology Biology Physics, 2001

Purpose: To evaluate the late induction of apoptosis following intracoronary radiation (IR) and t... more Purpose: To evaluate the late induction of apoptosis following intracoronary radiation (IR) and the effects of IR on inflammatory cells.Methods and Materials: Porcine coronaries were injured by balloon overstretch followed by either 0 or 15 Gy of 192Ir prescribed to 2 mm from the center of the source. Swine were euthanized at 3, 7, and 14 days posttreatment, and arteries

Research paper thumbnail of Edge stenosis and geographical miss following intracoronary gamma radiation therapy for in-stent restenosis

Journal of The American College of Cardiology, 2001

OBJECTIVESWe sought to determine the relationship between geographical miss (GM) and edge resteno... more OBJECTIVESWe sought to determine the relationship between geographical miss (GM) and edge restenosis (ERS) following intracoronary radiation therapy.BACKGROUNDEdge restenosis may be a limitation of intracoronary irradiation to prevent in-stent restenosis (ISR). Inadequate radiation source coverage of the injured segment (GM) has been proposed as a cause of ERS. We studied the relationship between GM and ERS following 192Ir treatment of

Research paper thumbnail of Late thrombosis following intracoronary brachytherapy

Catheterization and Cardiovascular Interventions, 2000

Vascular brachytherapy has been the subject of an extensive ongoing investigation into the safety... more Vascular brachytherapy has been the subject of an extensive ongoing investigation into the safety and efficacy of this technique for preventing restenosis. Preclinical studies have demonstrated reduction of the neointimal proliferation and the late vascular constriction with radiation therapy. However, radiation is also known to delay the healing process and may contribute to a new phenomenon of late thrombosis. We report on two cases of patients with in-stent restenosis who underwent intervention followed by intracoronary vascular radiation therapy (utilizing beta and gamma radiation) and presented with acute onset of unstable angina. Angiographic study demonstrated late thrombosis, which were treated successfully with the Angiojet thrombectomy device.

Research paper thumbnail of Differential remodeling after balloon overstretch injury and either β- or γ-intracoronary radiation of porcine coronary arteries

Cardiovascular Radiation Medicine, 2001

Background: Restenosis is a consequence of both neointimal hyperplasia and vessel remodeling. Pri... more Background: Restenosis is a consequence of both neointimal hyperplasia and vessel remodeling. Prior studies have shown that intracoronary radiation (IR) prevents neointima accumulation, but its contribution to vessel remodeling is unknown. The purpose of this study was to evaluate the effect of IR on differential vascular remodeling after balloon angioplasty in porcine coronary arteries. Methods: A total of 20 juvenile swine (30 coronary arteries) were subjected to overstretch balloon injury (BI) followed by IR with either b-or g-radiation ( 90 Y or 192 Ir). After 2 weeks following treatment, serial tissue sections were perfusion fixed and stained by hematoxylin and eosin (H&E), Verhoeff von Giesson (VVG), or Masson Trichrome. Adventitial area (AA), lumen area (LA), vessel area (VA), intimal area (IA), and IA corrected for medial fracture length (IA/FL) were quantified by digital image analysis. The vessel circumference was divided into two regions containing (1) the undisrupted region (UReg) with the undisrupted arc of media and internal elastic lamina (IEL) and (2) the disrupted region (DReg) with the disrupted arc between the medial tears. Quantitative regional analysis was performed by (1) measuring the IEL to define the UReg, (2) calculating the area of the UReg with the perimeter value derived from measurement of the IEL, and (3) calculating the DReg as follows: LA + IA À UReg. Immunohistochemical smooth muscle cell a-actin and Masson Trichrome were quantified by digital image analysis. Results: The IA/FL was significantly smaller following treatment with 90 Y or 192 Ir vs. control ( P < .01). A smaller AA was obtained following IR with both b-and g-sources vs. control ( P < .01). The UReg calculation was smaller in the irradiated arteries as compared to control (b: 2.3 0.4 mm 2 , g: 2.1 0.5 mm 2 , P < .01 vs. control; control: 3.6 0.7 mm 2 ). In contrast, the DReg was increased following IR, as demonstrated by the FL and the calculated area of the injured segment (control: 2.7 0.5 mm 2 ; b: 5.5 1.1 mm 2 , g: 5.5 1.1 mm 2 , P < .01 vs. control). Adventitial a-actin positive cell density (CD) was decreased after IR; however, the collagen density was similar. In contrast, the neointimal collagen density in the injured segment was significantly decreased following IR. Conclusion: We consider that the global arterial remodeling after IR is a heterogeneous process that includes the absence of retraction in an UReg and a positive remodeling in the DReg as shown in the porcine coronary model. These changes in adventitia and neointima appear to contribute to differential vascular remodeling caused by IR in injured vessels. D

Research paper thumbnail of NT pro B type natriuretic peptide levels in constrictive pericarditis and restrictive cardiomyopathy

Indian Heart Journal, 2015

The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) may b... more The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) may be clinically difficult and may require multiple investigations. Even though brain natriuretic peptide (BNP) is shown to be higher in patients with RCM as compared to CP, the clinical utility is not fully established especially in Indian patients known to have advanced CP and myocardial involvement. We measured NT-pro-BNP levels in 49 patients suspected of having either CP or RCM, diagnosed on the basis of echocardiography, computed tomography, magnetic resonance imaging, endomyocardial biopsy and cardiac catheterization data as needed. Twenty nine patients (Mean age - 26 yrs, 24 males) had CP and 20 patients (Mean age - 39 yrs, 14 males) had RCM. The median plasma NT-pro-BNP levels were significantly higher in RCM as compared to CP [1775 (208-7500) pg/ml vs 124 (68-718) pg/ml, respectively; p = 0.001]. A cut off value of 459 pg/ml had sensitivity, specificity and overall accuracy of 90%, 86% and 88% respectively, for differentiating CP from RCM. The NT-pro-BNP levels are significantly elevated in RCM as compared to CP.

Research paper thumbnail of Percutaneous transvenous mitral commissurotomy for rheumatic mitral stenosis with impaired left ventricular function: an echocardiographic follow-up study

International Journal of Cardiology, 1996

Sixty consecutive patients of rheumatic mitral stenosis who underwent percutaneous transvenous mi... more Sixty consecutive patients of rheumatic mitral stenosis who underwent percutaneous transvenous mitral commissurotomy were evaluated and followed up for 3 months in order to study the effect of the procedure on left ventricular ejection fraction and to elucidate the pathophysiology of impaired left ventricular function. The response in 16 patients (26.7%) with left ventricular dysfunction (ejection fraction less than 50%)

Research paper thumbnail of Long-term outcome of intracoronary microstent implantation: Lesion matched comparison with Palmaz-Schatz stent

Catheterization and Cardiovascular Diagnosis, 1998

We performed a lesion matched comparison of AVE Microstent and Palmaz-Schatz stent implants with ... more We performed a lesion matched comparison of AVE Microstent and Palmaz-Schatz stent implants with 6 month follow-up angiography to compare the occurrence of restenosis. Thirty-three pairs of lesions were matched for lesion location, ACC/AHA lesion type, reference diameter, lesion length, and angiographic descriptors. Age, sex, clinical profile, and indication for stenting were comparable. Quantitative coronary analysis before and after the procedure was comparable in the two groups but minimum lumen diameter (MLD) at follow-up was less with Microstent--2.01 +/- 1.01 mm than Palmaz-Schatz stent--2.43 +/- 0.96 mm (P = 0.05). Binary restenosis was present in 33% and 21% and was diffuse in 55% and 29% of the two groups, respectively. Typical angina at follow-up was more frequent with Microstent (36%) than Palmaz-Schatz stent (15%; P = 0.038). When implanted in lesions of similar complexity, Microstent yields similar post procedure angiographic results but smaller MLD at follow-up and more frequent angina than Palmaz-Schatz stent.

Research paper thumbnail of Extrasupport guidewire as primary wire for percutaneous transluminal coronary angioplasty

Catheterization and Cardiovascular Diagnosis, 1998

Avariety of guidewires are available for percutaneous translumi- nal coronary angioplasty (PTCA) ... more Avariety of guidewires are available for percutaneous translumi- nal coronary angioplasty (PTCA) [1]. Extrasupport guidewires are very useful (though not mandatory) during intracoronary stent deployment but are generally not ...

Research paper thumbnail of Yttrium90 delivered via a centering catheter and afterloader, given both before and after stent implantation, inhibits neointima formation in porcine coronary arteries

Cardiovascular Radiation Medicine, 2001

Background: Intracoronary radiation (IR) studies have shown reduction of neointima formation (NF)... more Background: Intracoronary radiation (IR) studies have shown reduction of neointima formation (NF). Extrapolation of animal studies with β-radiation to clinical trials have shown variable results, which may be related to dosimetry, centering issues, and/or shielding of β-rays by the stent metal. We examined the effect of yttrium-90 (90Y), a pure β-emitter delivered via an automatic afterloader to a centering catheter,

Research paper thumbnail of Antistreptokinase antibodies and outcome of fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis

American heart journal, 2015

Left-sided prosthetic valve thrombosis (PVT) is a serious complication of valve replacement. In d... more Left-sided prosthetic valve thrombosis (PVT) is a serious complication of valve replacement. In developing countries, fibrinolysis with streptokinase (SK) is often used as the first line of treatment. Anti-streptokinase (anti-SK) antibodies are widely prevalent in the general population, but their effect on the efficacy and outcome of fibrinolysis with SK in patients with PVT is not known. Patients with rheumatic heart disease and prosthetic valve replacement presenting with a first episode of left-sided PVT were enrolled. All patients underwent fibrinolysis with SK. An indirect enzyme-linked immunosorbent assay was used to detect anti-SK antibodies before fibrinolysis. Relationship of these antibodies to the outcome of fibrinolysis was evaluated. Forty-four patients treated for left-sided PVT were included. Thrombosis affected 33 mitral and 11 aortic prosthetic valves. On fibrinolysis with SK, 32 (73%) patients achieved complete success, whereas it was unsuccessful in the remaining 12 patients. There were 3 bleeding events, 1 stroke, and 3 deaths. Mean anti-SK antibody levels were not significantly different between patients who had complete success and those who did not (8.81 ± 2.43 vs 7.67 ± 1.26 Au/mL; P = .13) and did not correlate with the outcome after adjustment with other variables. Patients in New York Heart Association class III or IV had a greater chance of failed fibrinolytic therapy, even after adjustment for other prognostic variables (odds ratio 9.0; 95% CI 1.29-63.02; P = .027). Anti-SK antibody titers are not associated with success of fibrinolytic therapy using SK in patients with left-sided PVT.

Research paper thumbnail of Stress-Rest Thallium-201 Myocardial Perfusion SPECT Pattern in Patients with Exercise Induced Left Bundle Branch Block

Nuclear medicine and molecular imaging, 2014

Research paper thumbnail of A simple algorithm: Reply to the letter to the editor by Tejas Patel et al

Catheterization and Cardiovascular Diagnosis, 1997

It is also possible that your web browser is not configured or not able to display style sheets. ... more It is also possible that your web browser is not configured or not able to display style sheets. In this case, although the visual presentation will be degraded, the site should continue to be functional. We recommend using the ...

Research paper thumbnail of mammary artery graft? Radial artery in CABG: could the early results be comparable to internal

Research paper thumbnail of Intracoronary b-Radiation Therapy Inhibits Recurrence of In-Stent Restenosis

Background—Intracoronary g-radiation therapy reduces recurrent in-stent restenosis (ISR). This st... more Background—Intracoronary g-radiation therapy reduces recurrent in-stent restenosis (ISR). This study, BETA WRIST (Washington Radiation for In-Stent restenosis Trial) was designed to examine the efficacy and safety of the b-emitter 90-yttrium for the prevention of recurrent ISR. Methods and Results—A total of 50 consecutive patients with ISR in native coronaries underwent percutaneous transluminal coronary angioplasty, laser angioplasty, rotational atherectomy, and/or stent

Research paper thumbnail of Intracoronary g-Radiation Therapy After Angioplasty Inhibits Recurrence in Patients With In-Stent Restenosis

were then blindly randomized to receive either intracoronary g-radiation with 192Ir (15 Gy) or pl... more were then blindly randomized to receive either intracoronary g-radiation with 192Ir (15 Gy) or placebo. Four independent core laboratories blinded to the treatment protocol analyzed the angiographic and intravascular ultrasound end points of restenosis. Procedural success and in-hospital and 30-day complications were similar among the groups. At 6 months, patients assigned to radiation therapy required less target lesion revascularization and

Research paper thumbnail of Late total occlusion after intracoronary brachytherapy for patients with in-stent restenosis

Journal of the American College of Cardiology, 2000

The study sought to determine the incidence and predictors of late total occlusion (LTO, Ͼ30 days... more The study sought to determine the incidence and predictors of late total occlusion (LTO, Ͼ30 days) in-patients with in-stent restenosis who were treated with intracoronary radiation. BACKGROUND Intracoronary radiation both with beta and gamma emitters has been shown to reduce recurrent in-stent restenosis.

Research paper thumbnail of Intramural coronary delivery of advanced antisense oligonucleotides reduces neointimal formation in the porcine stent restenosis model

Journal of the American College of Cardiology, 2002

We evaluated the long-term influence of intramural delivery of advanced c-myc neutrally charged a... more We evaluated the long-term influence of intramural delivery of advanced c-myc neutrally charged antisense oligonucleotides (Resten-NG) on neointimal hyperplasia after stenting in a pig model. BACKGROUND Neointimal hyperplasia after percutaneous coronary interventions is one of the key components of the restenotic process. The c-myc is a critical cell division cycle protein involved in the formation of neointima.

Research paper thumbnail of Procedural results and intermediate clinical outcomes after multiple saphenous vein graft stenting

Journal of the American College of Cardiology, 2000

We evaluated the early and mid-term (18-month) clinical events in a consecutive series of patient... more We evaluated the early and mid-term (18-month) clinical events in a consecutive series of patients undergoing a nonstaged multiple saphenous vein grafting (SVG) intervention with stents as compared with a single SVG stent procedure. Saphenous vein graft angioplasty has been limited by high rates of distal embolization, myocardial infarction, restenosis and late mortality. It is unknown whether stenting of multiple, different SVGs at the same setting is associated with higher risk. We evaluated in-hospital and mid-term clinical outcomes (death, Q wave myocardial infarction [MI] and repeat revascularization rates up to 18 months) in 70 consecutive patients treated with coronary stents in 2 (93% of patients) or 3 SVGs, as compared with 649 patients undergoing stenting of a single SVG between January 1, 1994 and December 31, 1997. Overall procedural success was obtained in 97% of patients with 2 or 3 SVGs and 97% of patients with a single SVG (p = 0.94). Procedural complications were also similar (2.8% for multiple SVGs vs. 2.7% for a single SVG, p = 0.94). There was a higher prevalence of periprocedural non-Q wave MI (28% vs. 16%, p = 0.009) in the multiple SVG group. During follow-up (18 months), target lesion revascularization was 11% in multiple SVG and 15% in single SVG interventions (p = 0.19), and repeat revascularization (calculated per treated patient) was also similar for both groups (19% vs. 18%, p = 0.94). There was no difference in death (5.6% vs. 5.3%, p = 0.92) and Q wave MI rate (4.3% vs. 2.9%, p = 0.55) after the multiple SVG intervention. Overall cardiac event-free survival was similar for both groups (62% vs. 60%, p = 0.75). The study was powered to detect a clinically meaningful difference of 10% in mortality; smaller differences could not be evaluated on the basis of this sample size. Simultaneous stenting of multiple SVGs in carefully selected patients has similar in-hospital procedural success and major complications rates, as well as mid-term (18-month) clinical outcomes, as compared with single SVG stenting. Thus, multiple SVG interventions using stents may be a viable revascularization strategy for carefully selected patients and suitable lesions in multiple SVG disease.

Research paper thumbnail of Stem cell niche is partially lost during follicular plucking: A preliminary pilot study

International Journal of Trichology, 2013

Clinical hair transplant studies have revealed that follicular unit extraction (FUE) is superior ... more Clinical hair transplant studies have revealed that follicular unit extraction (FUE) is superior in terms of stable hair growth in comparison to follicular plucking (FP). Various reasons have been cited for this clinical outcome. FUE and FP are employed to obtain the hair follicle units for hair transplant and recently for cell based therapies in vitiligo. However, there is no scientific data available on the comparison of stem cell fraction in the cell suspension obtained by FUE and FP. Therefore, we undertook this study to compare the percentage of stem cells in the hair follicle obtained by FUE and FP. The purpose of the following study is to evaluate the quantitative stem cell pool in the hair follicle obtained by FUE and FP. A total of 3 human subjects were enrolled with age groups of 17-25 years. Both methods of tissue harvest: FUE and FP; were employed on each subject. There was no vitiligo lesion on the scalp in any of the patients. Hair follicles were incubated with trypsin-EDTA solution at 37°C for 90 min to separate outer root sheath cells. The cell suspension was passed through a 70 μm cell strainer; filtrate was centrifuged to obtain the cell pellet. Cells were labeled with cluster of differentiation (CD200) antibody and acquired with flowcytometry. The mean percentage of CD200 positive cells in FUE and FP method come out to be 8.43 and 1.63 respectively (P = 0.0152). FUE is a better method of the hair follicle harvesting for cell based applications as the stem cell fraction is significantly higher in comparison to FP.

Research paper thumbnail of Vascular repair after balloon overstretch injury in porcine model effects of intracoronary radiation

Journal of The American College of Cardiology, 2000

OBJECTIVESThe purpose of this study was to evaluate the effect of IR on thrombus formation and di... more OBJECTIVESThe purpose of this study was to evaluate the effect of IR on thrombus formation and dissection repair following overstretch balloon injury in porcine coronary arteries.BACKGROUNDExposure of blood to the injured arterial wall after percutaneous transluminal coronary angioplasty (PTCA) induces thrombus formation and inflammation in the dissection plane. Neointima formation is related to smooth muscle cell (SMC) proliferation and migration

Research paper thumbnail of Delayed re-endothelialization and T-cell infiltration following intracoronary radiation therapy in the porcine model

International Journal of Radiation Oncology Biology Physics, 2001

Purpose: To evaluate the late induction of apoptosis following intracoronary radiation (IR) and t... more Purpose: To evaluate the late induction of apoptosis following intracoronary radiation (IR) and the effects of IR on inflammatory cells.Methods and Materials: Porcine coronaries were injured by balloon overstretch followed by either 0 or 15 Gy of 192Ir prescribed to 2 mm from the center of the source. Swine were euthanized at 3, 7, and 14 days posttreatment, and arteries

Research paper thumbnail of Edge stenosis and geographical miss following intracoronary gamma radiation therapy for in-stent restenosis

Journal of The American College of Cardiology, 2001

OBJECTIVESWe sought to determine the relationship between geographical miss (GM) and edge resteno... more OBJECTIVESWe sought to determine the relationship between geographical miss (GM) and edge restenosis (ERS) following intracoronary radiation therapy.BACKGROUNDEdge restenosis may be a limitation of intracoronary irradiation to prevent in-stent restenosis (ISR). Inadequate radiation source coverage of the injured segment (GM) has been proposed as a cause of ERS. We studied the relationship between GM and ERS following 192Ir treatment of

Research paper thumbnail of Late thrombosis following intracoronary brachytherapy

Catheterization and Cardiovascular Interventions, 2000

Vascular brachytherapy has been the subject of an extensive ongoing investigation into the safety... more Vascular brachytherapy has been the subject of an extensive ongoing investigation into the safety and efficacy of this technique for preventing restenosis. Preclinical studies have demonstrated reduction of the neointimal proliferation and the late vascular constriction with radiation therapy. However, radiation is also known to delay the healing process and may contribute to a new phenomenon of late thrombosis. We report on two cases of patients with in-stent restenosis who underwent intervention followed by intracoronary vascular radiation therapy (utilizing beta and gamma radiation) and presented with acute onset of unstable angina. Angiographic study demonstrated late thrombosis, which were treated successfully with the Angiojet thrombectomy device.

Research paper thumbnail of Differential remodeling after balloon overstretch injury and either β- or γ-intracoronary radiation of porcine coronary arteries

Cardiovascular Radiation Medicine, 2001

Background: Restenosis is a consequence of both neointimal hyperplasia and vessel remodeling. Pri... more Background: Restenosis is a consequence of both neointimal hyperplasia and vessel remodeling. Prior studies have shown that intracoronary radiation (IR) prevents neointima accumulation, but its contribution to vessel remodeling is unknown. The purpose of this study was to evaluate the effect of IR on differential vascular remodeling after balloon angioplasty in porcine coronary arteries. Methods: A total of 20 juvenile swine (30 coronary arteries) were subjected to overstretch balloon injury (BI) followed by IR with either b-or g-radiation ( 90 Y or 192 Ir). After 2 weeks following treatment, serial tissue sections were perfusion fixed and stained by hematoxylin and eosin (H&E), Verhoeff von Giesson (VVG), or Masson Trichrome. Adventitial area (AA), lumen area (LA), vessel area (VA), intimal area (IA), and IA corrected for medial fracture length (IA/FL) were quantified by digital image analysis. The vessel circumference was divided into two regions containing (1) the undisrupted region (UReg) with the undisrupted arc of media and internal elastic lamina (IEL) and (2) the disrupted region (DReg) with the disrupted arc between the medial tears. Quantitative regional analysis was performed by (1) measuring the IEL to define the UReg, (2) calculating the area of the UReg with the perimeter value derived from measurement of the IEL, and (3) calculating the DReg as follows: LA + IA À UReg. Immunohistochemical smooth muscle cell a-actin and Masson Trichrome were quantified by digital image analysis. Results: The IA/FL was significantly smaller following treatment with 90 Y or 192 Ir vs. control ( P < .01). A smaller AA was obtained following IR with both b-and g-sources vs. control ( P < .01). The UReg calculation was smaller in the irradiated arteries as compared to control (b: 2.3 0.4 mm 2 , g: 2.1 0.5 mm 2 , P < .01 vs. control; control: 3.6 0.7 mm 2 ). In contrast, the DReg was increased following IR, as demonstrated by the FL and the calculated area of the injured segment (control: 2.7 0.5 mm 2 ; b: 5.5 1.1 mm 2 , g: 5.5 1.1 mm 2 , P < .01 vs. control). Adventitial a-actin positive cell density (CD) was decreased after IR; however, the collagen density was similar. In contrast, the neointimal collagen density in the injured segment was significantly decreased following IR. Conclusion: We consider that the global arterial remodeling after IR is a heterogeneous process that includes the absence of retraction in an UReg and a positive remodeling in the DReg as shown in the porcine coronary model. These changes in adventitia and neointima appear to contribute to differential vascular remodeling caused by IR in injured vessels. D

Research paper thumbnail of NT pro B type natriuretic peptide levels in constrictive pericarditis and restrictive cardiomyopathy

Indian Heart Journal, 2015

The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) may b... more The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) may be clinically difficult and may require multiple investigations. Even though brain natriuretic peptide (BNP) is shown to be higher in patients with RCM as compared to CP, the clinical utility is not fully established especially in Indian patients known to have advanced CP and myocardial involvement. We measured NT-pro-BNP levels in 49 patients suspected of having either CP or RCM, diagnosed on the basis of echocardiography, computed tomography, magnetic resonance imaging, endomyocardial biopsy and cardiac catheterization data as needed. Twenty nine patients (Mean age - 26 yrs, 24 males) had CP and 20 patients (Mean age - 39 yrs, 14 males) had RCM. The median plasma NT-pro-BNP levels were significantly higher in RCM as compared to CP [1775 (208-7500) pg/ml vs 124 (68-718) pg/ml, respectively; p = 0.001]. A cut off value of 459 pg/ml had sensitivity, specificity and overall accuracy of 90%, 86% and 88% respectively, for differentiating CP from RCM. The NT-pro-BNP levels are significantly elevated in RCM as compared to CP.

Research paper thumbnail of Percutaneous transvenous mitral commissurotomy for rheumatic mitral stenosis with impaired left ventricular function: an echocardiographic follow-up study

International Journal of Cardiology, 1996

Sixty consecutive patients of rheumatic mitral stenosis who underwent percutaneous transvenous mi... more Sixty consecutive patients of rheumatic mitral stenosis who underwent percutaneous transvenous mitral commissurotomy were evaluated and followed up for 3 months in order to study the effect of the procedure on left ventricular ejection fraction and to elucidate the pathophysiology of impaired left ventricular function. The response in 16 patients (26.7%) with left ventricular dysfunction (ejection fraction less than 50%)

Research paper thumbnail of Long-term outcome of intracoronary microstent implantation: Lesion matched comparison with Palmaz-Schatz stent

Catheterization and Cardiovascular Diagnosis, 1998

We performed a lesion matched comparison of AVE Microstent and Palmaz-Schatz stent implants with ... more We performed a lesion matched comparison of AVE Microstent and Palmaz-Schatz stent implants with 6 month follow-up angiography to compare the occurrence of restenosis. Thirty-three pairs of lesions were matched for lesion location, ACC/AHA lesion type, reference diameter, lesion length, and angiographic descriptors. Age, sex, clinical profile, and indication for stenting were comparable. Quantitative coronary analysis before and after the procedure was comparable in the two groups but minimum lumen diameter (MLD) at follow-up was less with Microstent--2.01 +/- 1.01 mm than Palmaz-Schatz stent--2.43 +/- 0.96 mm (P = 0.05). Binary restenosis was present in 33% and 21% and was diffuse in 55% and 29% of the two groups, respectively. Typical angina at follow-up was more frequent with Microstent (36%) than Palmaz-Schatz stent (15%; P = 0.038). When implanted in lesions of similar complexity, Microstent yields similar post procedure angiographic results but smaller MLD at follow-up and more frequent angina than Palmaz-Schatz stent.

Research paper thumbnail of Extrasupport guidewire as primary wire for percutaneous transluminal coronary angioplasty

Catheterization and Cardiovascular Diagnosis, 1998

Avariety of guidewires are available for percutaneous translumi- nal coronary angioplasty (PTCA) ... more Avariety of guidewires are available for percutaneous translumi- nal coronary angioplasty (PTCA) [1]. Extrasupport guidewires are very useful (though not mandatory) during intracoronary stent deployment but are generally not ...

Research paper thumbnail of Yttrium90 delivered via a centering catheter and afterloader, given both before and after stent implantation, inhibits neointima formation in porcine coronary arteries

Cardiovascular Radiation Medicine, 2001

Background: Intracoronary radiation (IR) studies have shown reduction of neointima formation (NF)... more Background: Intracoronary radiation (IR) studies have shown reduction of neointima formation (NF). Extrapolation of animal studies with β-radiation to clinical trials have shown variable results, which may be related to dosimetry, centering issues, and/or shielding of β-rays by the stent metal. We examined the effect of yttrium-90 (90Y), a pure β-emitter delivered via an automatic afterloader to a centering catheter,

Research paper thumbnail of Antistreptokinase antibodies and outcome of fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis

American heart journal, 2015

Left-sided prosthetic valve thrombosis (PVT) is a serious complication of valve replacement. In d... more Left-sided prosthetic valve thrombosis (PVT) is a serious complication of valve replacement. In developing countries, fibrinolysis with streptokinase (SK) is often used as the first line of treatment. Anti-streptokinase (anti-SK) antibodies are widely prevalent in the general population, but their effect on the efficacy and outcome of fibrinolysis with SK in patients with PVT is not known. Patients with rheumatic heart disease and prosthetic valve replacement presenting with a first episode of left-sided PVT were enrolled. All patients underwent fibrinolysis with SK. An indirect enzyme-linked immunosorbent assay was used to detect anti-SK antibodies before fibrinolysis. Relationship of these antibodies to the outcome of fibrinolysis was evaluated. Forty-four patients treated for left-sided PVT were included. Thrombosis affected 33 mitral and 11 aortic prosthetic valves. On fibrinolysis with SK, 32 (73%) patients achieved complete success, whereas it was unsuccessful in the remaining 12 patients. There were 3 bleeding events, 1 stroke, and 3 deaths. Mean anti-SK antibody levels were not significantly different between patients who had complete success and those who did not (8.81 ± 2.43 vs 7.67 ± 1.26 Au/mL; P = .13) and did not correlate with the outcome after adjustment with other variables. Patients in New York Heart Association class III or IV had a greater chance of failed fibrinolytic therapy, even after adjustment for other prognostic variables (odds ratio 9.0; 95% CI 1.29-63.02; P = .027). Anti-SK antibody titers are not associated with success of fibrinolytic therapy using SK in patients with left-sided PVT.

Research paper thumbnail of Stress-Rest Thallium-201 Myocardial Perfusion SPECT Pattern in Patients with Exercise Induced Left Bundle Branch Block

Nuclear medicine and molecular imaging, 2014

Research paper thumbnail of A simple algorithm: Reply to the letter to the editor by Tejas Patel et al

Catheterization and Cardiovascular Diagnosis, 1997

It is also possible that your web browser is not configured or not able to display style sheets. ... more It is also possible that your web browser is not configured or not able to display style sheets. In this case, although the visual presentation will be degraded, the site should continue to be functional. We recommend using the ...

Research paper thumbnail of mammary artery graft? Radial artery in CABG: could the early results be comparable to internal

Research paper thumbnail of Intracoronary b-Radiation Therapy Inhibits Recurrence of In-Stent Restenosis

Background—Intracoronary g-radiation therapy reduces recurrent in-stent restenosis (ISR). This st... more Background—Intracoronary g-radiation therapy reduces recurrent in-stent restenosis (ISR). This study, BETA WRIST (Washington Radiation for In-Stent restenosis Trial) was designed to examine the efficacy and safety of the b-emitter 90-yttrium for the prevention of recurrent ISR. Methods and Results—A total of 50 consecutive patients with ISR in native coronaries underwent percutaneous transluminal coronary angioplasty, laser angioplasty, rotational atherectomy, and/or stent

Research paper thumbnail of Intracoronary g-Radiation Therapy After Angioplasty Inhibits Recurrence in Patients With In-Stent Restenosis

were then blindly randomized to receive either intracoronary g-radiation with 192Ir (15 Gy) or pl... more were then blindly randomized to receive either intracoronary g-radiation with 192Ir (15 Gy) or placebo. Four independent core laboratories blinded to the treatment protocol analyzed the angiographic and intravascular ultrasound end points of restenosis. Procedural success and in-hospital and 30-day complications were similar among the groups. At 6 months, patients assigned to radiation therapy required less target lesion revascularization and

Research paper thumbnail of Late total occlusion after intracoronary brachytherapy for patients with in-stent restenosis

Journal of the American College of Cardiology, 2000

The study sought to determine the incidence and predictors of late total occlusion (LTO, Ͼ30 days... more The study sought to determine the incidence and predictors of late total occlusion (LTO, Ͼ30 days) in-patients with in-stent restenosis who were treated with intracoronary radiation. BACKGROUND Intracoronary radiation both with beta and gamma emitters has been shown to reduce recurrent in-stent restenosis.

Research paper thumbnail of Intramural coronary delivery of advanced antisense oligonucleotides reduces neointimal formation in the porcine stent restenosis model

Journal of the American College of Cardiology, 2002

We evaluated the long-term influence of intramural delivery of advanced c-myc neutrally charged a... more We evaluated the long-term influence of intramural delivery of advanced c-myc neutrally charged antisense oligonucleotides (Resten-NG) on neointimal hyperplasia after stenting in a pig model. BACKGROUND Neointimal hyperplasia after percutaneous coronary interventions is one of the key components of the restenotic process. The c-myc is a critical cell division cycle protein involved in the formation of neointima.

Research paper thumbnail of Procedural results and intermediate clinical outcomes after multiple saphenous vein graft stenting

Journal of the American College of Cardiology, 2000

We evaluated the early and mid-term (18-month) clinical events in a consecutive series of patient... more We evaluated the early and mid-term (18-month) clinical events in a consecutive series of patients undergoing a nonstaged multiple saphenous vein grafting (SVG) intervention with stents as compared with a single SVG stent procedure. Saphenous vein graft angioplasty has been limited by high rates of distal embolization, myocardial infarction, restenosis and late mortality. It is unknown whether stenting of multiple, different SVGs at the same setting is associated with higher risk. We evaluated in-hospital and mid-term clinical outcomes (death, Q wave myocardial infarction [MI] and repeat revascularization rates up to 18 months) in 70 consecutive patients treated with coronary stents in 2 (93% of patients) or 3 SVGs, as compared with 649 patients undergoing stenting of a single SVG between January 1, 1994 and December 31, 1997. Overall procedural success was obtained in 97% of patients with 2 or 3 SVGs and 97% of patients with a single SVG (p = 0.94). Procedural complications were also similar (2.8% for multiple SVGs vs. 2.7% for a single SVG, p = 0.94). There was a higher prevalence of periprocedural non-Q wave MI (28% vs. 16%, p = 0.009) in the multiple SVG group. During follow-up (18 months), target lesion revascularization was 11% in multiple SVG and 15% in single SVG interventions (p = 0.19), and repeat revascularization (calculated per treated patient) was also similar for both groups (19% vs. 18%, p = 0.94). There was no difference in death (5.6% vs. 5.3%, p = 0.92) and Q wave MI rate (4.3% vs. 2.9%, p = 0.55) after the multiple SVG intervention. Overall cardiac event-free survival was similar for both groups (62% vs. 60%, p = 0.75). The study was powered to detect a clinically meaningful difference of 10% in mortality; smaller differences could not be evaluated on the basis of this sample size. Simultaneous stenting of multiple SVGs in carefully selected patients has similar in-hospital procedural success and major complications rates, as well as mid-term (18-month) clinical outcomes, as compared with single SVG stenting. Thus, multiple SVG interventions using stents may be a viable revascularization strategy for carefully selected patients and suitable lesions in multiple SVG disease.

Research paper thumbnail of Stem cell niche is partially lost during follicular plucking: A preliminary pilot study

International Journal of Trichology, 2013

Clinical hair transplant studies have revealed that follicular unit extraction (FUE) is superior ... more Clinical hair transplant studies have revealed that follicular unit extraction (FUE) is superior in terms of stable hair growth in comparison to follicular plucking (FP). Various reasons have been cited for this clinical outcome. FUE and FP are employed to obtain the hair follicle units for hair transplant and recently for cell based therapies in vitiligo. However, there is no scientific data available on the comparison of stem cell fraction in the cell suspension obtained by FUE and FP. Therefore, we undertook this study to compare the percentage of stem cells in the hair follicle obtained by FUE and FP. The purpose of the following study is to evaluate the quantitative stem cell pool in the hair follicle obtained by FUE and FP. A total of 3 human subjects were enrolled with age groups of 17-25 years. Both methods of tissue harvest: FUE and FP; were employed on each subject. There was no vitiligo lesion on the scalp in any of the patients. Hair follicles were incubated with trypsin-EDTA solution at 37°C for 90 min to separate outer root sheath cells. The cell suspension was passed through a 70 μm cell strainer; filtrate was centrifuged to obtain the cell pellet. Cells were labeled with cluster of differentiation (CD200) antibody and acquired with flowcytometry. The mean percentage of CD200 positive cells in FUE and FP method come out to be 8.43 and 1.63 respectively (P = 0.0152). FUE is a better method of the hair follicle harvesting for cell based applications as the stem cell fraction is significantly higher in comparison to FP.