Abha Khandelwal

All Publications

• External validation of a novel transthoracic echocardiographic tool in predicting left atrial appendage thrombus formation in patients with nonvalvular atrial fibrillation EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING Doukky, R., Khandelwal, A., Garcia-Sayan, E., Gage, H. 2013; 14 (9): 876-881

  Abstract

  A recent study demonstrated that in patients with nonvalvular atrial fibrillation (AF), a ratio of left ventricular ejection fraction (LVEF) to the left atrial volume index (LAVI) of <1.5 has 100% sensitivity for detecting left atrial appendage (LAA) thrombus. We sought to validate this prediction tool in an external cohort.We conducted a cohort study of consecutive AF patients who underwent transoesophageal echocardiogram (TEE) to 'rule-out' LAA thrombus and had a prior transthoracic echocardiogram (TTE). The LAVI and LVEF were measured to calculate LVEF/LAVI ratio. The sensitivity and specificity of LVEF/LAVI <1.5 were calculated.Among 215 subjects, 19 (8.8%) had LAA thrombus and also had a higher mean CHADS2 score (2.5 vs. 1.9, P = 0.04), lower mean LVEF (24 vs. 44%, P < 0.001), higher mean LAVI (44 mL/m2 vs. 30 mL/m2, P < 0.001), and higher prevalence of cardiac failure (79 vs. 52%, P = 0.02). The LVEF and LAVI were found to be independent predictors of LAA thrombus (P < 0.05). The LVEF/LAVI ratio diagnosed LAA thrombus with an area under the curve = 0.83 by the receiver operator characteristics curve analysis (P < 0.001). All 19 (100%) subjects with LAA thrombus had LVEF/LAVI <1.5 vs. 87 (44%) among those without LAA thrombus (P < 0.001). The sensitivity and specificity of LVEF/LAVI <1.5 were 100 and 55.6%, respectively.This investigation validates a simple TTE prediction rule to exclude the diagnosis of LAA thrombus, which may obviate the need for pre-cardioversion TEE in selected patients with nonvalvular AF.

  View details for DOI 10.1093/ehjci/jes313

  View details for Web of Science ID 000322953100008

  View details for PubMedID 23291395

• Local Fibrinolysis for Massive Pulmonary Embolism: Teaching an Old Catheter New Tricks SOUTHERN MEDICAL JOURNAL Khandelwal, A., Spies, C. 2010; 103 (5): 396-397

  View details for DOI 10.1097/SMJ.0b013e3181d7e0c2

  View details for Web of Science ID 000278289700004

  View details for PubMedID 20375946

• Recurrent Events Following Patent Foramen Ovale Closure in Patients Above 55 Years of Age With Presumed Paradoxical Embolism CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Spies, C., Khandelwal, A., Timmemanns, I., Kavinsky, C. J., Schraeder, R., Hijazi, Z. M. 2008; 72 (7): 966-970

  Abstract

  The aim of this article is to summarize our experience of patent foramen ovale (PFO) closure in patients above the age of 55 years.PFO is associated with cryptogenic thromboembolic events (TEs) in patients younger than 55 years. Little is known about the recurrence rate of TE in patients above the age of 55 years undergoing PFO closure for presumed paradoxical embolism.PFO closure was performed in 1,055 patients, 423 of whom were above 55 years of age. Implantation of the device was guided by fluoroscopy and transesophageal or intracardiac echocardiography.A PFO occluding device was implanted successfully in all patients. Residual shunt was documented in 10% of patients above 55 years of age and in 8.4% of patients aged 55 years or younger (P = 0.325). During a median follow-up period of 18 months (range, 0-162 months) the annual incidence of recurrent TE in patients above 55 years was 1.8% while patients aged 55 or below had an annual incidence of recurrent TE of 1.3%. TE-free survival was similar in patients above 55 years of age compared with those aged 55 years and below.PFO closure in older patients is as efficient and seems comparable to those under the age of 55. Although traditional cardiovascular risk factors may be more frequent in the older age group compared with those younger than 55 years, PFO closure should not be withheld as a possible therapeutic option in this age group.

  View details for DOI 10.1002/ccd.21737

  View details for Web of Science ID 000261602000014

  View details for PubMedID 18942060

• Percutaneous Mechanical Thrombectomy for Massive Pulmonary Embolism Using a Conservative Treatment Strategy JOURNAL OF INTERVENTIONAL CARDIOLOGY Spies, C., Khandelwal, A., Smith, T. H., Jolly, N., Kavinsky, C. J. 2008; 21 (6): 566-571

  Abstract

  Percutaneous mechanical thrombectomy (PMT) for treatment of massive pulmonary embolism (PE) has been shown to be technically feasible, although the complication rate of the procedure appears relatively high. Whether a conservative treatment approach defined by an early termination of the PMT procedure once hemodynamic and clinical parameters of the patient have improved is associated with lower complication rates is unknown. We report our experience of PMT in patients with massive PE using the Angiojet system following a conservative treatment strategy.From April 2003 until November 2007, 13 patients underwent PMT with the Angiojet system. Indications for PMT were massive PE and either failed thrombolysis or contraindications to thrombolytic therapy. All patients were deemed high risk for surgical thrombectomy.Technical success was achieved in 12 patients (92%). Mean systemic arterial pressure increased from 87 to 106 mmHg following PMT (P = 0.011), while the heart rate decreased from 119 to 97 beats per minute (P = 0.041). In-hospital mortality was 15% (2 of 13 patients). No complications occurred which were attributable to the PMT procedure. Right ventricular size and function improved in the majority of patients following the PMT procedure.Using a conservative treatment approach of PMT for the treatment of massive PE carries a low periprocedural complication rate. The low morbidity was achieved without compromising clinical outcome, documented by an in-hospital mortality of 15%. PMT using a conservative treatment approach may result in comparable mortality, but lower morbidity than PMT using more aggressive, angiographically guided treatment strategies.

  View details for DOI 10.1111/j.1540-8183.2008.00405.x

  View details for Web of Science ID 000261065100014

  View details for PubMedID 18973510

• Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults AMERICAN JOURNAL OF CARDIOLOGY Spies, C., Khandelwal, A., Timmermanns, I., Schraeder, R. 2008; 102 (7): 902-906

  Abstract

  Transcatheter closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO) has become a routine procedure. Little is known about the effect of atrial septal device implantation on the occurrence of atrial fibrillation (AF). We evaluated the frequency of AF occurring after transcatheter PFO and ASD closure in a large population. From 1994 until 2007 a total of 1,062 patients underwent transcatheter closure of an interatrial communication. New-onset AF was defined by 12-lead electrocardiogram or Holter monitoring in patients without a history of AF at baseline. Of the 1,062 patients, 822 had a PFO and 240 had an ASD. During a median follow up of 20 months, new-onset AF was documented in 8% of patients. New-onset AF occurred in 7% of patients after PFO closure and in 12% of patients with underlying ASD. The annual incidence of new-onset AF was 2.5% and 4.1% in patients with PFO and ASD, respectively. Generally, patients with new-onset AF were older than those without AF. Device type or size did not influence the occurrence of AF. In the group of patients with PFO, residual shunt was more common in patients with AF compared with the non-AF group. In conclusion, AF is more common after PFO and ASD closure compared with the general population; although device type or size did not impact the occurrence of AF, residual shunt may influence the occurrence of AF after intervention in patients with underlying PFO.

  View details for DOI 10.1016/j.amjcard.2008.05.045

  View details for Web of Science ID 000259616100020

  View details for PubMedID 18805119

• Idiopathic hemophagocytic syndrome with a fulminant clinical course. Clinical advances in hematology & oncology : H&O Khandelwal, A., Shah, N. B., Eichenseer, P., Welker, M., Miller, I., Nangia, J., Farhat, M., Gimelfarb, A., Kassar, M., Batus, M., Gezer, S., Shammo, J., Gregory, S., Fung, H., Venugopal, P. 2008; 6 (8): 587-590

  View details for PubMedID 18820601

• Patent Foramen Ovale and the Risk of First Ischemic Stroke Expert Review of Cardiovascular Therapy Khandelwal, A., Spies, C. 2007; 5 (5): 821-824

  View details for DOI 10.1586/14779072.5.5.821

• The Clinical Picture - A young woman with an eroded plaque on the hand CLEVELAND CLINIC JOURNAL OF MEDICINE Laungani, A. G., Khandelwal, A., Tomecki, K. J. 2006; 73 (4): 369-371

  View details for Web of Science ID 000236650600013

• Subclinical chronic lymphocytic leukaemia associated with a 13q deletion presenting initially in the skin: apropos of a case JOURNAL OF CUTANEOUS PATHOLOGY Khandelwal, A., Seilstad, K. H., Magro, C. M. 2006; 33 (3): 256-259

  Abstract

  B-cell chronic lymphocytic leukaemia (B-CLL) represents a low-grade B-cell lymphoproliferative disease that is the most common leukaemia in adults. The neoplastic cell is an autoreactive CD5 CD23 B lymphocyte. B-CLL may involve the skin, typically in the context of known disease. We present a case of subclinical B-CLL presenting initially in the skin.A 73-year-old male developed a lesion on his right cheek in April 2003 compatible with basal cell carcinoma. The re-excision specimen contained a well-differentiated atypical lymphocytic infiltrate consistent with B-CLL along with residual carcinoma. Subsequent laboratory studies revealed peripheral blood lymphocytosis with smudge cells. A diagnosis was made of Rai stage 0 CLL. Chromosomal studies on peripheral blood showed a deletion at 13q14.3. Excision of a second primary skin carcinoma revealed a squamous cell carcinoma in association with B-CLL that was identical to his previously diagnosed skin involvement.This case identifies a cutaneous presentation of subclinical B-CLL. There are two prior reports describing B-CLL presenting initially in the skin. In one case, the infiltrates were incidental on a re-excision specimen. The second report suggests 16% of B-CLL patients have cutaneous manifestations as the first sign of disease.

  View details for Web of Science ID 000235210500011

  View details for PubMedID 16466516