Balram Bhargava

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (142)547.55 Total impact

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    ABSTRACT: 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. Copyright © 2014 Mosby, Inc. All rights reserved.
    American Heart Journal 01/2015; 169(1):170-4. · 4.56 Impact Factor
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    ABSTRACT: In Eisenmenger syndrome (ES), oral phosphodiesterase type-5 inhibitors, which are preferential pulmonary vasodilators, reduce the elevated pulmonary artery pressure and pulmonary vascular resistance index by increasing cyclic guanosine monophosphate (cGMP). However, no information is available as to how pulmonary vasodilatation alleviates the accompanying dyspnoea and improves patient's exercising ability. As the natural stimulus of juxtapulmonary capillary (J) receptors is an increase in interstitial pressure, the aim was to estimate their threshold level stimulation chemically by intravenous lobeline, before and after 6weeks of sildenafil therapy in treatment-naive ES patients. Nine Eisenmenger syndrome patients [mean age=26 (SD=1.6) years] underwent 6MWT and an exercise test before and 6weeks after oral sildenafil (20mg 3× D). Their respiratory responses to threshold doses of intravenous lobeline were determined at both these stages. After 6weeks of sildenafil therapy, the 6MWD [from 453.3 (SD=50.9) m to 516.6 (SD=48.9) m; P=0.001] and the duration of exercise with the modified Bruce protocol from 7min 53s (SD=0.04) to 10min 44s (SD=0.88) (P=0.001) improved significantly. However, the improvement in oxygen saturation was not noteworthy. The lobeline dose required to produce threshold level of respiratory effects was higher in ES patients [37.5 (SD=3.4) μg/kg] and with sildenafil therapy it fell significantly [20.6 (SD=1.8) μg/kg; P=0.001]. J receptor threshold doses were elevated in ES patients and fell significantly with sildenafil therapy that was associated with improved exercise tolerance, implying thereby a role of J receptors in producing dyspnea in ES patients.
    International journal of cardiology 04/2014; · 6.18 Impact Factor
  • JACC. Cardiovascular Interventions 03/2014; · 1.07 Impact Factor
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    Molecular Cytogenetics 01/2014; 7(1):35. · 2.66 Impact Factor
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    Molecular Cytogenetics 01/2014; 7(1):34. · 2.66 Impact Factor
  • Circulation 12/2013; 128(23):2542-5. · 14.95 Impact Factor
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    ABSTRACT: Inflammation may be an important contributing factor to the progression of Eisenmenger syndrome (ES). Markers of systemic inflammation in ES have not been systematically studied. Inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), interleukin-2 (IL-2), IL-6, and interferon-γ (IFN-γ) were measured in 42 consecutive ES patients (mean age, 24.3 ± 10.6 years) compared with their levels in 22 healthy control subjects. The patients were followed up for a mean duration of 16.3 ± 13.7 months. The levels of inflammatory markers were correlated with clinical and hemodynamic variables at baseline and the outcomes of death, hospitalization, and worsening World Health Organization (WHO) functional class at follow-up evaluation. Compared with the control subjects, ES patients showed a significant elevation in hs-CRP (2.99 ± 3.5 vs 1.1 ± 0.9 mg/dl; p = 0.002) and IFN-γ (41.3 ± 43.6 vs 10.4 ± 6.9 pg/ml; p < 0.001) levels. The levels of IL-2 and IL-6 also were elevated but did not differ significantly from those in the control subjects. The patients with hs-CRP levels higher than 3 mg/dl were significantly older (28.9 ± 10.6 vs 21.5 ± 9.8 years) and had a significantly shorter 6-min walk distance (421.5 ± 133.2 vs 493.3 ± 74.8 m). The levels of inflammatory markers did not correlate with baseline parameters or clinical outcomes. To conclude, the levels of hs-CRP and IFN-γ are significantly elevated in ES. Elevated hs-CRP in ES was associated with older age and shorter 6-min walk distance, but the levels of inflammatory markers were not predictive of clinical events.
    Pediatric Cardiology 05/2013; · 1.55 Impact Factor
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    ABSTRACT: To study the temporal relationship of smoking with electrophysiological changes. Prospective observational study. Tertiary cardiac center. Male smokers with atypical chest pain were screened with a treadmill exercise test (TMT). A total of 31 such patients aged 49.8±10.5 years, in whom TMT was either negative or mildly positive were included. Heart rate variability (HRV) parameters of smokers were compared to those of 15 healthy non-smoking participants. All patients underwent a 24 h Holter monitoring to assess ECG changes during smoking periods. Heart rate increased acutely during smoking. Mean heart rate increased from 83.8±13.7 bpm 10 min before smoking, to 90.5±16.4 bpm during smoking, (p<0.0001) and returned to baseline after 30 min. Smoking was also associated with increased ectopic beats (mean of 5.3/h prior to smoking to 9.8/h during smoking to 11.3/h during the hour after smoking; p<0.001). Three patients (9.7%) had significant ST-T changes after smoking. HRV index significantly decreased in smokers (15.2±5.3) as compared to non-smoking controls participants (19.4±3.6; p=0.02), but the other spectral HRV parameters were comparable. Heart rate and ectopic beats increase acutely following smoking. Ischaemic ST-T changes were also detected during smoking. Spectral parameters of HRV analysis of smokers remained in normal limits, but more importantly geometrical parameter-HRV index-showed significant abnormality.
    BMJ Open 04/2013; 3(4). · 2.06 Impact Factor
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    ABSTRACT: Dual antiplatelet therapy is the cornerstone in the management of acute coronary syndromes (ACS) and prevention of stent thrombosis (ST). Genetic polymorphisms in CYP2C19 gene involved in hepatic activation of clopidogrel leads to clopidogrel non-responsiveness and may influence clinical outcomes. These polymorphisms in CYP2C19 gene and their impact on clinical outcome in coronary artery disease (CAD) have not been studied in Indian population. We studied 110 consecutive patients (mean age 55.7 ± 10.7 years; 90% male) taking clopidogrel with angiographically proven CAD for various genetic polymorphisms in CYP2C19 gene. Relationship between loss of function mutation and clinical presentation with recurrent ACS including ST was analyzed. Out of 110 patients, 26 (23.64%) had normal genotype, 52 (47.23%) had loss of function mutation *2 and 39 (35.45%) had a gain of function mutation *17, 7 (6.36%) patients were undefined metabolizers (*2/*17) which were excluded from analyses. Final analyses included 103 patients, with 45 (40.90%) having loss of function. Overall 51 patients had ACS, with 27 developing recurrence while on clopidogrel. The prevalence of loss of function mutation was no different between the group with recurrences and those without recurrences (55.6% vs. 50%, p = 0.7). Two patients developed ST while on clopidogrel; both had loss of function mutation. CYP2C19 gene polymorphisms are common in Indian population. Loss of function mutation status did not affect the clinical outcomes. A larger study also considering P2Y12 receptor polymorphisms together with platelet activity testing, may be required to establish the role of CYP2C19 gene polymorphisms in clinical practice.
    Indian Heart Journal 01/2013; 66(1):16-24. · 0.17 Impact Factor
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    ABSTRACT: 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.
    International Journal of Trichology 01/2013; 5(2):97-100.
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    ABSTRACT: Hypertrophic Cardiomyopathy (HCM) is an autosomal dominant disorder due to mutations in sacromeric genes with variable penetrance. Hypertrophic Obstructive Cardiomyopathy (HOCM) is a major complication of Hypertrophic Cardiomyopathy. Unexplained hypertrophy in the Left Ventricle (LV) or Intraventricular Septum (IVS) had been the diagnostic criterion for HCM which is more often confirmed by the echocardiography [1]. The frequency of HCM in general population is 1:500 and about 60-70% genetic predisposition is known [2]. It has been observed that mutations in the Cardiac myosin binding protein C (MYBPC3) gene causes late onset of disease with mild symptoms while mutations in the Beta Myosin Heavy chain (MYH7) gene leads to early onset with severe symptoms. Apart from Epigenetic and Environmental factors, modifier genes further complicate the situation leading to altered clinical outcome even among the same family members having identical mutation [3].
    Journal clinical and Experimental cardiology. 11/2012; 3(225):1.
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    ABSTRACT: A 55 year old male patient with a diagnosis of hypertrophic cardiomyopathy was admitted with features of sepsis related to cholangitis. Initial management with intravenous (i.v.) fluids and antibiotics did not cause any change in his general condition mandating an emergency endoscopic retrograde cholangio-pancreatography (ERCP). After successful retrieval of CBD stone on ERCP, patient had massive upper gastrointestinal bleed leading to hypotension and shock. Addition of inotropes had led to further deterioration in his clinical status with a mean arterial BP falling to 44 mm of Hg. His echocardiography showed a resting left ventricular outflow tract (LVOT) gradient of 90 mm of Hg and thus was taken up for emergency alcohol septal ablation (ASA). Immediately after ASA, patient had significant decrease in LVOT obstruction and rise of systemic arterial pressures. After 10 days of antibiotic therapy patient was discharged with a residual LVOT obstruction of 28 mm of Hg.
    Indian Heart Journal 11/2012; 64(6):588-90. · 0.17 Impact Factor
  • Journal of the American College of Cardiology 09/2012; 60(11):e19. · 15.34 Impact Factor
  • EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 05/2012; 8(1):155-63. · 3.17 Impact Factor
  • International Journal of Cardiology 03/2012; 155:S4. · 6.18 Impact Factor
  • Salman Salahuddin, Balram Bhargava
    Indian Heart Journal 03/2012; 64(2):159-61. · 0.17 Impact Factor
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    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(5):758-760. · 0.67 Impact Factor
  • Salman Salahuddin, Balram Bhargava
    Heart (British Cardiac Society) 11/2011; 98(2):172. · 6.02 Impact Factor
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    ABSTRACT: To study the prevalence and medium term outcome of subclinical rheumatic heart disease (RHD) in India. Cross sectional echocardiographic screening study. School children aged 5-15 years living in rural areas of north India. A cross sectional echocardiographic screening study was carried out among 6270 randomly selected school children aged 5-15 years (10.8 ± 2.6 years; 52.7% male). Of all the abnormal cases, 100 children (78%) were restudied at a mean follow-up of 15.4 ± 6.6 months. Echocardiographic screening. Echocardiography-Doppler criteria based prevalence of RHD. Clinical examination detected mitral regurgitation in five patients and the estimated prevalence of clinical RHD was 0.8/1000 school children. Echocardiography-Doppler diagnosed RHD in 128 cases, giving a prevalence of 20.4/1000 school children (95% CI 16.9 to 23.9/1000 children). On multivariate analysis, older age (OR 1.93, 95% CI 1.29 to 2.88; p = 0.001), female sex (OR 1.84, 95% CI 1.25 to 2.72; p = 0.002) and government funded school student, which is a surrogate measure of lower socioeconomic status (OR 1.55, 95% CI 1.02 to 2.34; p = 0.039) were found to be independent predictors of RHD. On follow up, the severity of subclinical RHD was non-progressive in 68 children (68%) while it worsened in four (4%) and regressed in 28 children (28%). The prevalence of RHD is several fold higher using echocardiographic screening compared with clinical examination. The prevalence is higher among girls and children of lower socioeconomic status. In the majority of cases, subclinical RHD appears to be non-progressive on medium term follow up. Routine echocardiographic screening may be indicated in populations at high risk of RHD.
    Heart (British Cardiac Society) 11/2011; 97(24):2018-22. · 6.02 Impact Factor
  • Bharat B Kukreti, S Ramakrishnan, Balram Bhargava
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    ABSTRACT: Congenitally corrected transposition of great arteries is a rare congenital anomaly. This case report describes a 30-year-old patient of congenitally corrected transposition of the great arteries with rheumatic involvement of systemic (tricuspid) atrio-ventricular valve.
    Heart Views 10/2011; 12(4):178-80.

Publication Stats

1k Citations
547.55 Total Impact Points


  • 1995–2014
    • All India Institute of Medical Sciences
      • Department of Cardiology
      New Dilli, NCT, India
  • 2013
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India
  • 2011
    • Govind Ballabh Pant Hospital
      New Dilli, NCT, India
  • 1998–2007
    • Washington Hospital Center
      Washington, Washington, D.C., United States
  • 2001–2002
    • The Washington Institute
      Washington, Washington, D.C., United States
    • MedStar Health Research Institute
      Maryland, United States
  • 2000
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States