Consider the polyhedron represented by the dual of the LP formulation of the maximum s-t flow pro... more Consider the polyhedron represented by the dual of the LP formulation of the maximum s-t flow problem. It is well known that the vertices of this polyhedron are integral, and can be viewed as s-t cuts in the given graph. In this paper we show that not all s-t cuts appear as vertices, and we give a characterization. We also characterize pairs of cuts that form edges of this polyhedron. Finally, we show a set of inequalities such that the corresponding polyhedron has as its vertices all s-t cuts.
Texas Heart Institute Journal from the Texas Heart Institute of St Luke S Episcopal Hospital Texas Children S Hospital, 2011
Malignant metastases to the heart and pericardium, which occur far more often than do primary car... more Malignant metastases to the heart and pericardium, which occur far more often than do primary cardiac neoplasms, typically lead to fatal outcomes. The phyllodes tumor is a rare, predominantly benign fibroepithelial breast neoplasm with variable malignancy potential. Herein, we describe the case of a 35-year-old woman who, 3 years after undergoing a simple mastectomy for a rapidly enlarging breast neoplasm, presented with cardiogenic shock and was found to have a large right ventricular tumor that obstructed the right ventricular outflow tract. Despite successful resection of the ventricular mass and a right atrial mass of organized thrombus, the patient died 8 days postoperatively of multiorgan failure due to severe right ventricular dysfunction. Histopathologic analysis determined that the right ventricular mass was a malignant, metastatic phyllodes tumor. To our knowledge, this is only the 2nd reported case of a phyllodes tumor that metastasized to the heart and presented as an intracavitary mass with cardiogenic shock. In addition to discussing our patient's case, we review the pertinent medical literature.
BACKGROUND AND METHODS: Vitamin D deficiency has been linked to an increased risk of coronary art... more BACKGROUND AND METHODS: Vitamin D deficiency has been linked to an increased risk of coronary artery disease (CAD) and cardiovascular (CV) death. Endothelial dysfunction plays an important role in pathogenesis of CAD and vitamin D deficiency is postulated to promote endothelial dysfunction. Despite rising trends of CAD in Asians, only limited data are available on the relationship between vitamin D, CAD, and endothelial dysfunction.RESULTS: In a study of 100 patients undergoing coronary angiography, mean 25(OH)D level was 14.8 ± 9.1 ng/mL; vitamin D deficiency was present in 80% and only 7% had optimal 25(OH)D levels. Nearly one-third (36%) were severely deficient, with 25(OH)D levels <10 ng/mL. Those with vitamin D deficiency had significantly higher prevalence of double- or triple-vessel CAD (53% vs 38%), diffuse CAD (56% vs 34%), and higher number of coronary vessels involved as compared to those with higher 25(OH)D levels. Those with lower 25(OH)D levels had significantly lower brachial artery flow-mediated dilation (FMD; 4.57% vs 10.68%: P<.001) and significantly higher prevalence of impaired FMD (values <4.5%; 50.6% vs 7%; P<.002). A graded relationship between 25(OH)D levels and FMD was observed; impaired FMD was noted in 62.2%, 38.6%, and 13.3% in those with 25(OH)D levels <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively.CONCLUSION: Indian patients with angiographically documented CAD frequently have vitamin D deficiency. Patients with lower 25(OH)D levels had higher prevalence of double- or triple-vessel CAD and diffuse CAD. Endothelial dysfunction as assessed by brachial artery FMD was also more frequently observed in those with low 25(OH)D levels.
This thesis is about multicommodity ows and their use in designing approximation algorithms for p... more This thesis is about multicommodity ows and their use in designing approximation algorithms for problems involving cuts in graphs. In a ground-breaking work Leighton and Rao 34] showed an approximate max-ow min-cut theorem for uniform multicommodity ow and used this to obtain an approximation algorithm for the ux of a graph. We consider the multicommodity ow problem in which the object is to maximize the sum of the ows routed and prove the following approximate max-ow min-multicut theorem min-multicut O(log k) max-ow min-multicut where k is the number of commodities. Our proof is based on a rounding technique from 34]. Further, we show that this theorem is tight.
Asian cardiovascular & thoracic annals, Jan 28, 2015
Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosi... more Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosis. Data on intermediate outcomes of this procedure are limited. Thus we investigated the intermediate outcome after balloon mitral valvotomy performed at a large tertiary center in India. Case records and follow-up data of 2330 patients who underwent valvotomy from June 1999 to December 2005 were retrieved from the hospital information system and analyzed. The median age of the patients was 32 ± 11 years, 1363 were female including 36 who were pregnant, and 379 were in atrial fibrillation. Follow-up ranged from 1 to 14 years (mean 4.5 years, median 4.0 years). The procedural success rate was 93%. Atrial fibrillation, higher functional class, and worse valve morphology were independent predictors of a poor procedural outcome. Patients with sinus rhythm had better event-free survival (10.43 years, 95% confidence interval: 10.1-10.7) compared to those with atrial fibrillation (8.17 years, 9...
Left ventricular dysfunction (LVD) with subsequent congestive heart failure (CHF) constitutes the... more Left ventricular dysfunction (LVD) with subsequent congestive heart failure (CHF) constitutes the final common pathway for a host of cardiac disorders. The impaired LV function develops in response to an ischemic insult followed by a fall in cardiac output that leads to activation of renin-angiotensin-system (RAS). Angiotensin II type I receptor (AT1), which mediate the vasoconstrictive and salt-conserving actions of the RAS, represent interesting candidate genes for cardiovascular diseases. Therefore, we conducted an association study between single nucleotide polymorphism (SNP) in AT1 gene and LVD in CAD patients. The present study recruited a total of 950 subjects including 720 angiography confirmed CAD patients and 230 healthy controls. Among 720 CAD patients, 229 with reduced left ventricle ejection fraction (LVEF≤45%) were categorized as LVD. The AT1 (A1166C, rs5186) polymorphism was determined by ARMS-PCR. Our results showed that the frequency of AT1 1166AC and CC genotypes were significantly higher in LVD patients in comparison to non-LVD (LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;45%) patients (p value = 0.003; OR = 1.81 and p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; OR = 4.33). Further analysis showed that AT1 A1166C polymorphism was significantly associated with LV end diastole (p-value = 0.031), end systole (p-value = 0.038) dimensions, and mean LVEF (p-value = 0.035). Moreover, on comparing the AT1 A1166C polymorphism in CAD patients with healthy controls, we did not find any association both at genotypic and allelic level (p value = 0.927; OR = 1.04 and p value = 0.219; OR = 0.83) respectively. Our study suggests that AT1 A1166C polymorphism may play significant role in conferring genetic susceptibility of LVD.
This study was aimed to assess the association of Protein tyrosine phosphatase non-receptor22 (PT... more This study was aimed to assess the association of Protein tyrosine phosphatase non-receptor22 (PTPN22) gene single nucleotide polymorphisms (SNPs) with rheumatic heart disease (RHD) susceptibility in 400 RHD patients and 300 controls. The PTPN22 polymorphisms (rs2476601, rs1217406 and rs3789609) were genotyped using Taqman probes (Applied Biosystems, Foster City, CA). Statistical analysis was performed by spss and haplotype analysis by snpstat. The frequencies of variant alleles were not different between controls and cases (rs2476601: 2.00% & 1.05%; rs1217406: 36.33% & 34.75%; and rs3789609: 38.17% & 40.00%, respectively]. However, G rs2476601 A rs1217406 T rs3789609 haplotype turned out to be a low risk factor for RHD (P = 0.0042) predisposition in females and adult patients. This study suggests PTPN22 haplotype may modulate the risk to RHD in North Indians.
Accidental introduction of air into veins can occur during a variety of surgical operations or di... more Accidental introduction of air into veins can occur during a variety of surgical operations or diagnostic procedures. High mortality rate results without early diagnosis and appropriate treatment. This is due to "air lock" at the right ventricular outflow tract, compromising the left ventricular filling. We describe a 2-year-old male with Tetralogy of Fallot who developed air embolism due to unexpected rupture of Swan-Gang catheter during a cardiac catheterization study, which was managed successfully by intracardiac aspiration.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2011
Malignant metastases to the heart and pericardium, which occur far more often than do primary car... more Malignant metastases to the heart and pericardium, which occur far more often than do primary cardiac neoplasms, typically lead to fatal outcomes. The phyllodes tumor is a rare, predominantly benign fibroepithelial breast neoplasm with variable malignancy potential. Herein, we describe the case of a 35-year-old woman who, 3 years after undergoing a simple mastectomy for a rapidly enlarging breast neoplasm, presented with cardiogenic shock and was found to have a large right ventricular tumor that obstructed the right ventricular outflow tract. Despite successful resection of the ventricular mass and a right atrial mass of organized thrombus, the patient died 8 days postoperatively of multiorgan failure due to severe right ventricular dysfunction. Histopathologic analysis determined that the right ventricular mass was a malignant, metastatic phyllodes tumor. To our knowledge, this is only the 2nd reported case of a phyllodes tumor that metastasized to the heart and presented as an in...
Rheumatic heart disease (RHD) is the most serious complication of heart that comprises inflammato... more Rheumatic heart disease (RHD) is the most serious complication of heart that comprises inflammatory reactions in heart valves. Cytokines play a critical role in triggering inflammatory reactions and they activate the Janus Kinase/Signal Transducers and Activators of Transcription (JAK/STAT) signaling pathway. Altered signals of STATs play important roles in the balance between proinflammatory and anti-inflammatory cytokines in inflammatory diseases. The aim of the present study was to investigate for the association of polymorphisms related with STAT genes, i.e. STAT3 (rs4796793 C/G) and STAT5b (rs6503691 C/T) with the pathogenesis of RHD. This case-control association study involved 300 healthy controls and 400 RHD patients from North Indian Population. We categorized RHD patients into two subgroups based on involvement of heart valves, mitral valve lesion alone (MVL), and combined valve lesions including mitral valve (CVL). Genotyping was done by RFLP/Taqman probes. We observed th...
To investigate soluble (s) E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and intercellu... more To investigate soluble (s) E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and intercellular cell adhesion molecule-1 (ICAM-1), and their relationship to disease activity in Takayasu's arteritis (TA). Levels of adhesion molecules were measured by enzyme immunoassay in the sera of 35 patients with TA, 17 healthy controls, and 15 patients with 12 months followup. Compared to controls, patients had elevated levels of sE-selectin (54.5 +/- 35.0 vs 36.4 +/- 13.0 ng/ml, p < 0.05), sVCAM-1 (280.9 +/- 267.6 vs 141.2 +/- 76.1 ng/ml, p < 0.05), and sICAM-1 (261.3 +/- 168.1 vs 198.3 +/- 74.3 ng/ml, p < 0.05). Compared to controls, patients with inactive TA also had elevated levels of sE-selectin (67.4 +/- 45.9 vs 36.4 +/- 13.0 ng/ml, p < 0.02), sVCAM-1 (327.6 +/- 327.8 vs 141.2 +/- 76.1 ng/ml, p < 0.02), and sICAM-1 (321.9 +/- 179.5 vs 198.3 +/- 74.3 ng/ml, p < 0.02). There was no difference between active TA and controls. sE-selectin had a trend towards increased...
To evaluate the incidence and predictors of radial artery occlusion (RAO) after transradial coron... more To evaluate the incidence and predictors of radial artery occlusion (RAO) after transradial coronary angioplasty (TRA). RAO can occur after TRA but has not been well studied by serial vascular Doppler examination. A total of 198 patients undergoing TRA were included. Radial pulse and Doppler examination of the radial artery were performed 1 day before, 1 day after, and 3 months after the procedure. RAO was defined as an absence of antegrade flow on Doppler studies. Logistic regression analysis was done to evaluate the predictors of RAO. The mean radial arterial diameter was 2.8 ± 0.4 mm. On the day after TRA, radial artery Doppler examination revealed RAO in 30 patients (15.2%). Radial pulse was still palpable in 30.0% of these patients. All of them were asymptomatic. At 3-month follow-up, no new RAO was noted. Interestingly, the radial artery had spontaneously recanalized in 8 patients (26.7%) with RAO. Patients with persistent RAO remained asymptomatic. On univariate analysis, fem...
Coronary artery disease (CAD) is associated with a higher incidence of allograft failure and mort... more Coronary artery disease (CAD) is associated with a higher incidence of allograft failure and mortality in patients with end-stage renal disease (ESRD) following renal transplant. To evaluate the efficacy of using carotid intimal medial thickness (CIMT) to predict the presence of CAD in patients with ESRD, using coronary angiography (CAG) as the gold standard. This prospective study enrolled consecutive patients with ESRD who underwent CAG as a part of pretransplant evaluation to rule out the presence of atherosclerotic CAD. An operator who was blinded with respect to the results of the CAG, measured carotid IMT in all patients prior to CAG and recorded it on videotape. Two independent observers blinded to the results of CAG measured carotid IMT offline to validate its predictive accuracy as a noninvasive test in predicting the presence or absence of CAD. Measurement of carotid IMT was done on USG B mode 7.5 MHZ probe [HP 5500 andover, Massachusetts]. Student's t-test was used fo...
Anomalies of the coronary artery are often asymptomatic and are uncommon in the general populatio... more Anomalies of the coronary artery are often asymptomatic and are uncommon in the general population. We present a case of a double right coronary artery along with anomalous origin of the left main coronary artery and first septal perforator, all originating from the right coronary sinus.
Consider the polyhedron represented by the dual of the LP formulation of the maximum s-t flow pro... more Consider the polyhedron represented by the dual of the LP formulation of the maximum s-t flow problem. It is well known that the vertices of this polyhedron are integral, and can be viewed as s-t cuts in the given graph. In this paper we show that not all s-t cuts appear as vertices, and we give a characterization. We also characterize pairs of cuts that form edges of this polyhedron. Finally, we show a set of inequalities such that the corresponding polyhedron has as its vertices all s-t cuts.
Texas Heart Institute Journal from the Texas Heart Institute of St Luke S Episcopal Hospital Texas Children S Hospital, 2011
Malignant metastases to the heart and pericardium, which occur far more often than do primary car... more Malignant metastases to the heart and pericardium, which occur far more often than do primary cardiac neoplasms, typically lead to fatal outcomes. The phyllodes tumor is a rare, predominantly benign fibroepithelial breast neoplasm with variable malignancy potential. Herein, we describe the case of a 35-year-old woman who, 3 years after undergoing a simple mastectomy for a rapidly enlarging breast neoplasm, presented with cardiogenic shock and was found to have a large right ventricular tumor that obstructed the right ventricular outflow tract. Despite successful resection of the ventricular mass and a right atrial mass of organized thrombus, the patient died 8 days postoperatively of multiorgan failure due to severe right ventricular dysfunction. Histopathologic analysis determined that the right ventricular mass was a malignant, metastatic phyllodes tumor. To our knowledge, this is only the 2nd reported case of a phyllodes tumor that metastasized to the heart and presented as an intracavitary mass with cardiogenic shock. In addition to discussing our patient's case, we review the pertinent medical literature.
BACKGROUND AND METHODS: Vitamin D deficiency has been linked to an increased risk of coronary art... more BACKGROUND AND METHODS: Vitamin D deficiency has been linked to an increased risk of coronary artery disease (CAD) and cardiovascular (CV) death. Endothelial dysfunction plays an important role in pathogenesis of CAD and vitamin D deficiency is postulated to promote endothelial dysfunction. Despite rising trends of CAD in Asians, only limited data are available on the relationship between vitamin D, CAD, and endothelial dysfunction.RESULTS: In a study of 100 patients undergoing coronary angiography, mean 25(OH)D level was 14.8 ± 9.1 ng/mL; vitamin D deficiency was present in 80% and only 7% had optimal 25(OH)D levels. Nearly one-third (36%) were severely deficient, with 25(OH)D levels <10 ng/mL. Those with vitamin D deficiency had significantly higher prevalence of double- or triple-vessel CAD (53% vs 38%), diffuse CAD (56% vs 34%), and higher number of coronary vessels involved as compared to those with higher 25(OH)D levels. Those with lower 25(OH)D levels had significantly lower brachial artery flow-mediated dilation (FMD; 4.57% vs 10.68%: P<.001) and significantly higher prevalence of impaired FMD (values <4.5%; 50.6% vs 7%; P<.002). A graded relationship between 25(OH)D levels and FMD was observed; impaired FMD was noted in 62.2%, 38.6%, and 13.3% in those with 25(OH)D levels <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively.CONCLUSION: Indian patients with angiographically documented CAD frequently have vitamin D deficiency. Patients with lower 25(OH)D levels had higher prevalence of double- or triple-vessel CAD and diffuse CAD. Endothelial dysfunction as assessed by brachial artery FMD was also more frequently observed in those with low 25(OH)D levels.
This thesis is about multicommodity ows and their use in designing approximation algorithms for p... more This thesis is about multicommodity ows and their use in designing approximation algorithms for problems involving cuts in graphs. In a ground-breaking work Leighton and Rao 34] showed an approximate max-ow min-cut theorem for uniform multicommodity ow and used this to obtain an approximation algorithm for the ux of a graph. We consider the multicommodity ow problem in which the object is to maximize the sum of the ows routed and prove the following approximate max-ow min-multicut theorem min-multicut O(log k) max-ow min-multicut where k is the number of commodities. Our proof is based on a rounding technique from 34]. Further, we show that this theorem is tight.
Asian cardiovascular & thoracic annals, Jan 28, 2015
Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosi... more Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosis. Data on intermediate outcomes of this procedure are limited. Thus we investigated the intermediate outcome after balloon mitral valvotomy performed at a large tertiary center in India. Case records and follow-up data of 2330 patients who underwent valvotomy from June 1999 to December 2005 were retrieved from the hospital information system and analyzed. The median age of the patients was 32 ± 11 years, 1363 were female including 36 who were pregnant, and 379 were in atrial fibrillation. Follow-up ranged from 1 to 14 years (mean 4.5 years, median 4.0 years). The procedural success rate was 93%. Atrial fibrillation, higher functional class, and worse valve morphology were independent predictors of a poor procedural outcome. Patients with sinus rhythm had better event-free survival (10.43 years, 95% confidence interval: 10.1-10.7) compared to those with atrial fibrillation (8.17 years, 9...
Left ventricular dysfunction (LVD) with subsequent congestive heart failure (CHF) constitutes the... more Left ventricular dysfunction (LVD) with subsequent congestive heart failure (CHF) constitutes the final common pathway for a host of cardiac disorders. The impaired LV function develops in response to an ischemic insult followed by a fall in cardiac output that leads to activation of renin-angiotensin-system (RAS). Angiotensin II type I receptor (AT1), which mediate the vasoconstrictive and salt-conserving actions of the RAS, represent interesting candidate genes for cardiovascular diseases. Therefore, we conducted an association study between single nucleotide polymorphism (SNP) in AT1 gene and LVD in CAD patients. The present study recruited a total of 950 subjects including 720 angiography confirmed CAD patients and 230 healthy controls. Among 720 CAD patients, 229 with reduced left ventricle ejection fraction (LVEF≤45%) were categorized as LVD. The AT1 (A1166C, rs5186) polymorphism was determined by ARMS-PCR. Our results showed that the frequency of AT1 1166AC and CC genotypes were significantly higher in LVD patients in comparison to non-LVD (LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;45%) patients (p value = 0.003; OR = 1.81 and p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; OR = 4.33). Further analysis showed that AT1 A1166C polymorphism was significantly associated with LV end diastole (p-value = 0.031), end systole (p-value = 0.038) dimensions, and mean LVEF (p-value = 0.035). Moreover, on comparing the AT1 A1166C polymorphism in CAD patients with healthy controls, we did not find any association both at genotypic and allelic level (p value = 0.927; OR = 1.04 and p value = 0.219; OR = 0.83) respectively. Our study suggests that AT1 A1166C polymorphism may play significant role in conferring genetic susceptibility of LVD.
This study was aimed to assess the association of Protein tyrosine phosphatase non-receptor22 (PT... more This study was aimed to assess the association of Protein tyrosine phosphatase non-receptor22 (PTPN22) gene single nucleotide polymorphisms (SNPs) with rheumatic heart disease (RHD) susceptibility in 400 RHD patients and 300 controls. The PTPN22 polymorphisms (rs2476601, rs1217406 and rs3789609) were genotyped using Taqman probes (Applied Biosystems, Foster City, CA). Statistical analysis was performed by spss and haplotype analysis by snpstat. The frequencies of variant alleles were not different between controls and cases (rs2476601: 2.00% & 1.05%; rs1217406: 36.33% & 34.75%; and rs3789609: 38.17% & 40.00%, respectively]. However, G rs2476601 A rs1217406 T rs3789609 haplotype turned out to be a low risk factor for RHD (P = 0.0042) predisposition in females and adult patients. This study suggests PTPN22 haplotype may modulate the risk to RHD in North Indians.
Accidental introduction of air into veins can occur during a variety of surgical operations or di... more Accidental introduction of air into veins can occur during a variety of surgical operations or diagnostic procedures. High mortality rate results without early diagnosis and appropriate treatment. This is due to "air lock" at the right ventricular outflow tract, compromising the left ventricular filling. We describe a 2-year-old male with Tetralogy of Fallot who developed air embolism due to unexpected rupture of Swan-Gang catheter during a cardiac catheterization study, which was managed successfully by intracardiac aspiration.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2011
Malignant metastases to the heart and pericardium, which occur far more often than do primary car... more Malignant metastases to the heart and pericardium, which occur far more often than do primary cardiac neoplasms, typically lead to fatal outcomes. The phyllodes tumor is a rare, predominantly benign fibroepithelial breast neoplasm with variable malignancy potential. Herein, we describe the case of a 35-year-old woman who, 3 years after undergoing a simple mastectomy for a rapidly enlarging breast neoplasm, presented with cardiogenic shock and was found to have a large right ventricular tumor that obstructed the right ventricular outflow tract. Despite successful resection of the ventricular mass and a right atrial mass of organized thrombus, the patient died 8 days postoperatively of multiorgan failure due to severe right ventricular dysfunction. Histopathologic analysis determined that the right ventricular mass was a malignant, metastatic phyllodes tumor. To our knowledge, this is only the 2nd reported case of a phyllodes tumor that metastasized to the heart and presented as an in...
Rheumatic heart disease (RHD) is the most serious complication of heart that comprises inflammato... more Rheumatic heart disease (RHD) is the most serious complication of heart that comprises inflammatory reactions in heart valves. Cytokines play a critical role in triggering inflammatory reactions and they activate the Janus Kinase/Signal Transducers and Activators of Transcription (JAK/STAT) signaling pathway. Altered signals of STATs play important roles in the balance between proinflammatory and anti-inflammatory cytokines in inflammatory diseases. The aim of the present study was to investigate for the association of polymorphisms related with STAT genes, i.e. STAT3 (rs4796793 C/G) and STAT5b (rs6503691 C/T) with the pathogenesis of RHD. This case-control association study involved 300 healthy controls and 400 RHD patients from North Indian Population. We categorized RHD patients into two subgroups based on involvement of heart valves, mitral valve lesion alone (MVL), and combined valve lesions including mitral valve (CVL). Genotyping was done by RFLP/Taqman probes. We observed th...
To investigate soluble (s) E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and intercellu... more To investigate soluble (s) E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and intercellular cell adhesion molecule-1 (ICAM-1), and their relationship to disease activity in Takayasu's arteritis (TA). Levels of adhesion molecules were measured by enzyme immunoassay in the sera of 35 patients with TA, 17 healthy controls, and 15 patients with 12 months followup. Compared to controls, patients had elevated levels of sE-selectin (54.5 +/- 35.0 vs 36.4 +/- 13.0 ng/ml, p < 0.05), sVCAM-1 (280.9 +/- 267.6 vs 141.2 +/- 76.1 ng/ml, p < 0.05), and sICAM-1 (261.3 +/- 168.1 vs 198.3 +/- 74.3 ng/ml, p < 0.05). Compared to controls, patients with inactive TA also had elevated levels of sE-selectin (67.4 +/- 45.9 vs 36.4 +/- 13.0 ng/ml, p < 0.02), sVCAM-1 (327.6 +/- 327.8 vs 141.2 +/- 76.1 ng/ml, p < 0.02), and sICAM-1 (321.9 +/- 179.5 vs 198.3 +/- 74.3 ng/ml, p < 0.02). There was no difference between active TA and controls. sE-selectin had a trend towards increased...
To evaluate the incidence and predictors of radial artery occlusion (RAO) after transradial coron... more To evaluate the incidence and predictors of radial artery occlusion (RAO) after transradial coronary angioplasty (TRA). RAO can occur after TRA but has not been well studied by serial vascular Doppler examination. A total of 198 patients undergoing TRA were included. Radial pulse and Doppler examination of the radial artery were performed 1 day before, 1 day after, and 3 months after the procedure. RAO was defined as an absence of antegrade flow on Doppler studies. Logistic regression analysis was done to evaluate the predictors of RAO. The mean radial arterial diameter was 2.8 ± 0.4 mm. On the day after TRA, radial artery Doppler examination revealed RAO in 30 patients (15.2%). Radial pulse was still palpable in 30.0% of these patients. All of them were asymptomatic. At 3-month follow-up, no new RAO was noted. Interestingly, the radial artery had spontaneously recanalized in 8 patients (26.7%) with RAO. Patients with persistent RAO remained asymptomatic. On univariate analysis, fem...
Coronary artery disease (CAD) is associated with a higher incidence of allograft failure and mort... more Coronary artery disease (CAD) is associated with a higher incidence of allograft failure and mortality in patients with end-stage renal disease (ESRD) following renal transplant. To evaluate the efficacy of using carotid intimal medial thickness (CIMT) to predict the presence of CAD in patients with ESRD, using coronary angiography (CAG) as the gold standard. This prospective study enrolled consecutive patients with ESRD who underwent CAG as a part of pretransplant evaluation to rule out the presence of atherosclerotic CAD. An operator who was blinded with respect to the results of the CAG, measured carotid IMT in all patients prior to CAG and recorded it on videotape. Two independent observers blinded to the results of CAG measured carotid IMT offline to validate its predictive accuracy as a noninvasive test in predicting the presence or absence of CAD. Measurement of carotid IMT was done on USG B mode 7.5 MHZ probe [HP 5500 andover, Massachusetts]. Student's t-test was used fo...
Anomalies of the coronary artery are often asymptomatic and are uncommon in the general populatio... more Anomalies of the coronary artery are often asymptomatic and are uncommon in the general population. We present a case of a double right coronary artery along with anomalous origin of the left main coronary artery and first septal perforator, all originating from the right coronary sinus.
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Papers by Naveen Garg