Browsing by Author "Bahl, Ajay"

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    18F-fluorodeoxyglucose positron emission tomography-based evaluation of systemic and vascular inflammation and assessment of the effect of systemic treatment on inflammation in patients with moderate-to-severe psoriasis: A randomized placebo-controlled pilot study
    (Indian Association of Dermatologists, Venereologists & Leprologists, 2018-11) Kaur, Sharonjeet; Shafiq, Nusrat; Dogra, Sunil; Mittal, BR; Attri, Savita Verma; Bahl, Ajay; Narang, Tarun; Vinay, Keshavamurthy; Rajagopalan, Sujit; Malhotra, Samir
    Background: Psoriasis is a systemic inflammatory disorder associated with an increased risk of cardiovascular disease. Objective: To evaluate the utility of [[18]F]-fluorodeoxyglucose positron emission tomography/computed tomography in identifying vascular and systemic inflammation in psoriasis patients with moderate-to-severe disease and to analyze its usefulness in assessing the effect of systemic treatment. Methods: This was a randomized, double-blind pilot study conducted in a tertiary care center. Baseline standardized uptake value score was estimated by18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with moderate-to-severe psoriasis and compared with historical controls. Patients were then randomized using computer-generated randomization list into methotrexate or placebo (with or without pioglitazone) groups.18F-fluorodeoxyglucose positron emission tomography/computed tomography was repeated at 12 weeks and composite standardized uptake value score determined. The correlation between Psoriasis Activity and Severity Index and SUVmax was assessed. Results: A total of 16 patients were randomized to different treatment groups. Significant increase in mean SUVmax was observed in the ascending aorta in psoriasis patients as compared to historical controls (2.03 ± 0.53 vs 1.51 ± 0.36, P < 0.03). There was no difference in composite standardized uptake value score after 12 weeks of treatment in any of the treatment groups (P = 0.82), although an improvement in Psoriasis Activity and Severity Index score in the methotrexate arm was observed. No correlation was found between mean SUVmax and Psoriasis Activity and Severity Index scores in various aortic segments (r = 0.3–0.7). Limitations: Small sample size, short follow-up, historical controls, exclusion of patients with comorbid conditions and lack of surrogate markers of systemic inflammation. Conclusion: 18F-fluorodeoxyglucose positron emission tomography imaging showed higher vascular inflammation in ascending aorta of psoriasis patients as compared to historical controls. Systemic treatment with methotrexate and pioglitazone did not influence the vascular inflammation in the short term.
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    Cardiac evaluation in patients awaiting kidney transplant-position statement of the Cardiological Society of India and Indian Society of Nephrology
    (Elsevier, 2025-06) Bahl, Ajay; Prasad, Narayan; Sinha, Dhurjati Prasad; Ganguly, Kajal; Roy, Sandipta; Roy, Debabrata; Rakshit, Sumit; Kumar, Dilip; Das, Saurav; Bhasin, Dinkar; Raju, Sree Bhushan; Trivedi, Mayuri; Rathi, Manish; Gulati, Sanjeev; Agstam, Sourabh; Bhargava, Vinant; Bhalla, Anil Kumar; Bansal, Shyam Bihari; Varughese, Santosh; Patel, Manas Ranjan; Yadav, Rakesh; Naik, Nitish; Bang, Vijay Harikisan; Dastidar, Dipankar Ghosh; Banerjee, Partha Sarathi
    Cardiovascular diseases are a major cause of death after kidney transplantation. This statement addresses pre- operative cardiac decision-making and management with the aim of assessing and reducing the risk of the kidney transplant surgery. Important issues from a clinician’s perspective include the basic cardiovascular workup of these patients, coronary evaluation and management of coronary artery disease, valvular heart disease and left ventricular systolic dysfunction. Recovery left ventricular function after kidney transplant is discussed. In addition, the use of cardiovascular drugs in patients with special emphasis on antiplatelets and anticoagulants in patients planned for kidney transplant is also discussed.
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    Efficacy of stem cell in improvement of left ventricular function in acute myocardial infarction - MI3 Trial.
    (2015-08) Nair, Velu; Madan, Hemant; Sofat, Sunil; Ganguli, Prosenjit; Jacob, M J; Datta, Rajat; Bharadwaj, Prashant; Sarkar, R S; Pandit, A J; Nityanand, Soniya; Goel, Pravin K; Garg, Naveen; Gambhir, Sanjay; George, Paul V; Chandy, Sunil; Mathews, Vikram; George, Oomen K; Talwar, K K; Bahl, Ajay; Marwah, Neelam; Bhatacharya, Anish; Bhargava, Balram; Airan, Balram; Mohanty, Sujata; Patel, Chetan D; Sharma, Alka; Bhatnagar, Shinjini; Mondal, A; Jose, Jacob; Srivastava, A; MI3 Trial
    Background & objectives: Acute myocardial infarction (AMI) is characterized by irreparable and irreversible loss of cardiac myocytes. Despite major advances in the management of AMI, a large number of patients are left with reduced left ventricular ejection fraction (LVEF), which is a major determinant of short and long term morbidity and mortality. A review of 33 randomized control trials has shown varying improvement in left ventricular (LV) function in patients receiving stem cells compared to standard medical therapy. Most trials had small sample size and were underpowered. This phase III prospective, open labelled, randomized multicenteric trial was undertaken to evaluate the efficacy in improving the LVEF over a period of six months, after injecting a predefined dose of 5-10 × 108 autologous mononuclear cells (MNC) by intra-coronary route, in patients, one to three weeks post ST elevation AMI, in addition to the standard medical therapy. Methods: In this phase III prospective, multicentric trial 250 patients with AMI were included and randomized into stem cell therapy (SCT) and non SCT groups. All patients were followed up for six months. Patients with AMI having left ventricular ejection fraction (LVEF) of 20-50 per cent were included and were randomized to receive intracoronary stem cell infusion after successfully completing percutaneous coronary intervention (PCI). Results: On intention-to-treat analysis the infusion of MNCs had no positive impact on LVEF improvement of ≥ 5 per cent. The improvement in LVEF after six months was 5.17 ± 8.90 per cent in non SCT group and 4.82 ± 10.32 per cent in SCT group. The adverse effects were comparable in both the groups. On post hoc analysis it was noted that the cell dose had a positive impact when infused in the dose of ≥ 5 X 108 (n=71). This benefit was noted upto three weeks post AMI. There were 38 trial deviates in the SCT group which was a limitation of the study. Interpretation & conclusions: Infusion of stem cells was found to have no benefit in ST elevation AMI. However, the procedure was safe. A possible benefit was seen when the predefined cell dose was administered which was noted upto three weeks post AMI, but this was not significant and needs confirmation by larger trials.
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    Genetic testing of cardiomyopathies: Position statement of the Cardiological Society of India
    (Elsevier, 2025-06) Bahl, Ajay; Seth, Sandeep; Dhandapany, Perundurai S.; Mittal, Anupam; Chockalingam, Priya; Ahamed, Hisham; Subramanian, Muthiah; Nampoothiri, Sheela; Namboodiri, Narayanan; Das, Soumi; Vaidya, Vanya; Anantharaman, Rajaram; Khullar, Madhu; Rani, Deepa Selvi; Thangaraj, Kumarasamy; Naik, Nitish; Sivasubbu, Sridhar; Roy, Debabrata; Bang, Vijay Harikisan; Banerjee, Partha Sarathi; Rath, Pratap Chandra; Sinha, Dhurjati Prasad; Yadav, Rakesh; Dastidar, Dipankar Ghosh
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    Implantable cardioverter defibrillators for primary prevention in cardiomyopathies
    (Elsevier, 2024-04) Kanneganti, Vineetha; Bahl, Ajay; Rohit, Manoj Kumar; Mehrotra, Saurabh
    Background: Implantable cardioverter defibrillators (ICD) are often used as primary prevention strategy for sudden cardiac death (SCD) in young individuals. This study analyzed appropriate therapies, complications and inappropriate shocks in the real-world Indian population. Methods: All patients in the cardiomyopathy cohort under follow up who had ICD implanted as a primary pre- vention strategy were studied. The objective was to assess the incidence of appropriate ICD therapies, inap- propriate therapies and complications. ICD was interrogated and stored electrograms analyzed. Underlying arrhythmia or conditions resulting in appropriate or inappropriate ICD therapy were studied. Correlation and regression studies was done to assess for the predictors of appropriate therapy. Results: Fifty patients were followed up for a mean follow-up duration of 4.4 3.1 years with total follow up of 220.2 patient years. Appropriate ICD therapy was delivered in 16 out of 50 (32%) patients, with 65 appropriate therapies (median 2 per patient, range: 020). Inappropriate therapy delivered in 7 of the 50 (14%) patients, with 44 inappropriate therapies (median 5 per patient, range: 020). Complications occurred in 8 of the 50 (16%) patients. Overall, the rate of appropriate therapy was 29.5 per 100 patient years, that of inappropriate therapy was 19.9 per 100 patient years and the rate of complications was 3.6 per 100 patient years. Conclusions: When implanted for primary prevention in patients with cardiomyopathies over a mean period of 4.4 3.1 years, appropriate ICD therapy was delivered in 32% patients. However, inappropriate therapy (14% patients) and complications (16% patients) were also common.
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    Incidence of infective endocarditis in patients with hypertrophic cardiomyopathy
    (Elsevier, 2024-12) Somendra, Somyata; Mehrotra, Saurabh; Barwad, Parag; Gupta, Himanshu; Bahl, Ajay
    Background: Data on the incidence of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM) is sparse. This study evaluated a HCM cohort with aim to study the incidence of IE in these patients. Methods: All patients entering the HCM cohort from May 2003 to June 2022 of a tertiary care hospital with at least one follow-up visit were included and followed up till June 2023. This was a retrospective cohort analysis. Only individuals who were diagnosed with IE after entry into the cohort were included. Results: The study cohort consisted of 529 HCM patients with a total follow up duration of 3244.6 years. The mean and median follow-up durations were 6.1 4.7 and 5.3 (range 31 days to 20.1) years respectively. Three (0.57 %) patients in the cohort developed IE. Incidence of IE in HCM patients was 0.92/1000 patient years. Two patients had left ventricular outflow tract obstruction while one had non-obstructive HCM. None of the patients with isolated mid-cavity gradients developed IE. The incidence of IE in the obstructive and nonobstructive groups was 1.39 and 0.55 per 1000 patient years respectively. Two had vegetations on mitral valve while one had vegetations on aortic valve. Both patients with mitral valve endocarditis developed severe residual mitral regurgitation and heart failure. Conclusions: IE is a rare complication in HCM patients with an incidence of 0.92/1000 patient years. However, when it occurs, IE is associated with high morbidity and mortality.
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    Rotablation in complex ACS versus Non-ACS patients: Prospective follow up study from tertiary care centre in North India
    (Cardiological Society of India, 2022-12) Ary, Kunwer Abhishek; Barward, Parag; Bahl, Ajay; Sharma, Yashpaul; Gupta, Himanshu
    The purpose of this study is to compare short term outcome of rotablation in ACS versus non-ACS patients. 60 Consecutive patients who underwent rotational atherectomy were followed prospectively. The mean duration of follow up was 13.05 ± 5.2 months. The mean ejection fraction was 52.41% ± 9.4%. 45% patients had diagnosis of CSA and 55% were ACS. The mean syntax score was 29.23 ± 7.99. LAD was the most common vessel treated by RA in 76.6%. Rotablation of LM was done in 30%. IVUS guided procedure was done in 66.7%. RA can be done with comparable safety and success in both non-ACS and ACS patients
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    Serial electrocardiographic changes in patients with idiopathic dilated cardiomyopathy
    (Elsevier, 2025-04) Choudhary, Anil Kumar; Bahl, Ajay; Sharma, Yash Paul; Mehrotra, Saurabh; Gupta, Himanshu; Somendra, Somyata
    Broad QRS and bundle-branch blocks are associated with poor outcomes in patients with DCM, however, studies on changes in QRS duration and morphology over long-term are limited. We retrospectively analyzed changes in ventricular activation and AV conduction in serial ECGs of 165 DCM patients with a follow-up of at least 5 years from 2003 to 2022. The mean QRS duration at the last follow-up was 114.2 ± 29 vs 106.2 ± 25.3 msec at the baseline(p < 0.0001). Individuals who showed ?10msec increase in QRS duration also had a higher prevalence of ventricular conduction defects (68%). 13.8% of patients developed broadening of QRS, with an LBBB pattern in over 50%.
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    Transcatheter closure of aortopulmonary window.
    (2005-03-15) Rohit, Manojkumar; Nandakumar, S; Bahl, Ajay; Kubba, S; Talwar, K K
    Aortopulmonary window is an uncommon congenital cardiac defect. Most infants presenting with aortopulmonary window will require conventional surgical repair. Experience with transcatheter closure of aortopulmonary window is limited. We report the case of a 9-year-old girl with aortopulmonary window, in whom transcatheter closure was performed successfully using Amplatzer ductal occluder device.