Abha Khandelwal

All Publications

• Improving Maternal Health Is a Team Sport. JACC. Advances Khandelwal, A., Lewey, J., Mehta, L. 2023; 2 (8): 100620

  View details for DOI 10.1016/j.jacadv.2023.100620

  View details for PubMedID 38938364

  View details for PubMedCentralID PMC11198584

• Reproductive Experiences and Cardiovascular Disease Care in Pregnancy-Capable and Postmenopausal Individuals: Insights from the American Heart Association Research Goes Red Registry. Current problems in cardiology Rao, S. J., Kwapong, Y. A., Boakye, E., Mallya, P., Zhao, J., Akel, W., Hong, H., Li, S., Oyeka, C. P., Metlock, F. E., Ouyang, P., Blumenthal, R. S., Nasir, K., Khandelwal, A., Kinzy, C., Mehta, L. S., Roger, V. L., Hall, J. L., Sharma, G. 2023: 101853

  Abstract

  To evaluate preconception health and adverse pregnancy outcome (APO) awareness in a large population-based registry.We examined data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry to questions regarding prenatal health care experiences, postpartum health, and awareness of the association of APOs with cardiovascular disease (CVD) risk.Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk, significantly varying by race-ethnicity. Fifty-nine percent of participants were not educated regarding this association by their providers, and 37% reported providers not assessing pregnancy history during current visits, significantly varying by race-ethnicity, income, and access to care. Only 37.1% of respondents were aware that CVD was the leading cause of maternal mortality.There is an urgent, ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.

  View details for DOI 10.1016/j.cpcardiol.2023.101853

  View details for PubMedID 37302649

• Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes A Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Pagidipati, N. J., Nelson, A. J., Kaltenbach, L. A., Leyva, M., McGuire, D. K., Pop-Busui, R., Cavender, M. A., Aroda, V. R., Magwire, M. L., Richardson, C. R., Lingvay, I., Kirk, J. K., Al-Khalidi, H. R., Webb, L., Gaynor, T., Pak, J., Senyucel, C., Lopes, R. D., Green, J. B., Granger, C. B., COORDINATE Diabet Site Investigators 2023; 329 (15): 1261-1270

  Abstract

  Evidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice.To assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]).Cluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies.Assessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n = 459) vs usual care per practice guidelines (n = 590).The primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences).Of 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P < .001) and were more likely to be prescribed each of the 3 therapies (change from baseline in high-intensity statins from 66.5% to 70.7% for intervention vs from 58.2% to 56.8% for usual care [adjusted OR, 1.73; 95% CI, 1.06-2.83]; ACEIs or ARBs: from 75.1% to 81.4% for intervention vs from 69.6% to 68.4% for usual care [adjusted OR, 1.82; 95% CI, 1.14-2.91]; SGLT2 inhibitors and/or GLP-1RAs: from 12.3% to 60.4% for intervention vs from 14.5% to 35.5% for usual care [adjusted OR, 3.11; 95% CI, 2.08-4.64]). The intervention was not associated with changes in atherosclerotic cardiovascular disease risk factors. The composite secondary outcome occurred in 23 of 457 participants (5%) in the intervention group vs 40 of 588 participants (6.8%) in the usual care group (adjusted hazard ratio, 0.79 [95% CI, 0.46 to 1.33]).A coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease.ClinicalTrials.gov Identifier: NCT03936660.

  View details for DOI 10.1001/jama.2023.2854

  View details for Web of Science ID 000947152200001

  View details for PubMedID 36877177

  View details for PubMedCentralID PMC9989955

• Preterm Birth Doubles in a Cardiac Affected Population: The Added Factor of Maternal Depression Beshar, I. E., Panelli, D., Lee, C. J., Dominguez, L., Padron, E., Ramirez, N., Ansari, J., Khandelwal, A., Bianco, K. SPRINGER HEIDELBERG. 2023: 213A-214A

  View details for Web of Science ID 001043029500427

• Effects of Adverse Childhood Experiences on Perinatal Outcomes in Patients with Cardiac Disease: A Pilot Study Ramirez, N., Panelli, D. M., Padron, E., Dominguez, L., Lee, C. J., Mayo, J., Khandelwal, A., Bianco, K. SPRINGER HEIDELBERG. 2023: 217A

  View details for Web of Science ID 001043029500435

• Addressing postpartum contraception practices utilizing a multidisciplinary Pregnancy Heart Team approach. AJOG global reports Miller, H. E., Do, S. C., Cruz, G., Panelli, D. M., Leonard, S. A., Girsen, A., Lee, C. J., Khandelwal, A., Shaw, K. A., Bianco, K. 2022; 2 (4): 100100

  Abstract

  BACKGROUND: Cardiovascular disease has emerged as the leading cause of maternal morbidity and mortality, making planned pregnancy, and thereby reliable contraception among people with cardiovascular disease, vital.OBJECTIVE: This study aimed to compare postpartum contraceptive practices among people with cardiovascular disease (cardiac cohort) cared for by a Pregnancy Heart Team to people with other chronic comorbidities (high-risk cohort), and people without comorbidities (low-risk cohort). We hypothesized that the Pregnancy Heart Team influenced baseline contraception counseling and practices among those with cardiovascular disease.STUDY DESIGN: This was a retrospective cohort study comparing postpartum contraceptive practices between a cardiac cohort who received care by a multidisciplinary team between 2012 and 2020 and high-risk and low-risk cohorts delivering at a single academic center between 2016 and 2019. We investigated presence of a contraceptive plan (at birthing admission, discharge, and postpartum visit) and uptake of reliable contraception by 8 weeks postpartum.RESULTS: We included 1464 people: 189 with cardiovascular disease, 197 with other chronic comorbidities, and 1078 low-risk people. At birth hospitalization admission, reliable contraception was planned among 42% of the cardiac cohort, 40% of the high-risk cohort, and 31% of the low-risk cohort, with similar distributions at the time of discharge and at 8 weeks postpartum.Compared with the cardiac cohort, by 8 weeks postpartum,the high-risk cohort had similar odds of using highly reliable forms of contraception (39% vs 36%; adjusted odds ratio, 0.78; 95% confidence interval, 0.50-1.21) and similar odds of having a plan to use the most reliable forms of contraception (intrauterine device, implant, bilateral tubal ligation) at the time of birthing admission (42% vs 40%; adjusted odds ratio, 0.78; 95% confidence interval, 0.50-1.22), discharge (47% vs 45%; adjusted odds ratio, 0.95; 95% confidence interval, 0.61-1.48), and postpartum visit (35% vs 29%; adjusted odds ratio, 0.76; 95% confidence interval, 0.49-1.17).The low-risk cohort had lower odds of using a reliable form of contraception (39% vs 27%; adjusted odds ratio, 0.53; 95% confidence interval, 0.37-0.75) and was less likely to have a plan for reliable contraception at the time of birthing admission (42% vs 31%; adjusted odds ratio, 0.54; 95% confidence interval, 0.38-0.76), discharge (47% vs 33%; adjusted odds ratio, 0.58; 95% confidence interval, 0.4-0.82), and postpartum visit (35% vs 21%; adjusted odds ratio, 0.50; 95% confidence interval, 0.35-0.71).CONCLUSION: People with cardiovascular disease cared for by a Pregnancy Heart Team had higher odds of reliable postpartum contraception planning and uptake compared with a low-risk cohort and similar odds compared with a high-risk cohort. Pregnancy could serve as a critical period for contraception counseling and family planning among people with cardiovascular disease. A multidisciplinary team should be used to address postpartum contraception as a modifiable risk factor to reduce maternal morbidity and mortality among those with cardiovascular disease.

  View details for DOI 10.1016/j.xagr.2022.100100

  View details for PubMedID 36536840

• Lipoprotein(a) and Incident Atrial Fibrillation: Leveraging Nature's Randomization to Identify Novel Causal Associations. Journal of the American College of Cardiology Kim, D. S., Khandelwal, A. 2022; 79 (16): 1591-1593

  View details for DOI 10.1016/j.jacc.2022.02.026

  View details for PubMedID 35450576

• ETHNICITY, INCOME, OR INSURER: OUTCOMES IN PERIPARTUM CARDIOMYOPATHY Balla, S., Tremblay-Gravel, M., Malhame, I., Pacheco, C., Wheeler, M., Khandelwal, A. ELSEVIER SCIENCE INC. 2022: 1964

  View details for Web of Science ID 000781026602165

• Research Goes Red: Early Experience With a Participant-Centric Registry. Circulation research Gilchrist, S. C., Hall, J. L., Khandelwal, A., Hidalgo, B., Aggarwal, B., Kinzy, C., Mallya, P., Conners, K., Stevens, L. M., Alger, H. M., Mehta, L., Wexler, L., Mega, J. L., Hernandez, A., Hayes, S. N., Mieres, J. H., Jessup, M., Roger, V. L. 1800; 130 (3): 343-351

  Abstract

  RATIONALE: Cardiovascular disease remains the leading cause of death in women. To address its determinants including persisting cardiovascular risk factors amplified by sex and race inequities, novel personalized approaches are needed grounded in the engagement of participants in research and prevention.OBJECTIVE: To report on a participant-centric and personalized dynamic registry designed to address persistent gaps in understanding and managing cardiovascular disease in women.METHODS AND RESULTS: The American Heart Association and Verily launched the Research Goes Red registry (RGR) in 2019, as an online research platform available to consenting individuals over the age of 18 years in the United States. RGR aims to bring participants and researchers together to expand knowledge by collecting data and providing an open-source longitudinal dynamic registry for conducting research studies. As of July 2021, 15350 individuals have engaged with RGR. Mean age of participants was 48.0 48.0±0.2 years with a majority identifying as female and either non-Hispanic White (75.7%) or Black (10.5%). In addition to 6 targeted health surveys, RGR has deployed 2 American Heart Association-sponsored prospective clinical studies based on participants' areas of interest. The first study focuses on perimenopausal weight gain, developed in response to a health concerns survey. The second study is designed to test the use of social media campaigns to increase awareness and participation in cardiovascular disease research among underrepresented millennial women.CONCLUSIONS: RGR is a novel online participant-centric platform that has successfully engaged women and provided critical data on women's heart health to guide research. Priorities for the growth of RGR are centered on increasing reach and diversity of participants, and engaging researchers to work within their communities to leverage the platform to address knowledge gaps and improve women's health.

  View details for DOI 10.1161/CIRCRESAHA.121.320403

  View details for PubMedID 35113661

• Association of Neighborhood Income with Clinical Outcomes Among Pregnant Patients with Cardiac Disease Reproductive Sciences Carland, C., Panelli, D. M., Leonard, S. A., Bryant, E., Sherwin , E. B., Lee, C. J., Levin, E., Jimenez , S., Tremmel, J. A., Tsai , S., Heidenreich , P. A., Bianco , K., Khandelwal , A. 2022

  View details for DOI 10.1007/s43032-022-00978-z

• Clinical factors associated with a positive postpartum depression screen in people with cardiac disease during pregnancy. Current research in psychiatry Panelli, D. M., Sherwin, E. B., Lee, C. J., Leonard, S. A., Miller, S. E., Miller, H. E., Tolani, A. T., Hoover, V., Ansari, J. R., Khandelwal, A., Bianco, K. 2022; 2 (2): 25-29

  Abstract

  Background: While people with cardiac disease are known to be at increased lifetime risk of depression, little is known about postpartum depression rates in this population. Describing rates of positive postpartum depression screens and identifying risk factors that are unique to cardiac patients may help inform risk reduction strategies.Methods: This retrospective cohort study included pregnant patients with congenital and/or acquired cardiac disease who delivered at a single institution between 2014 and 2020. The primary outcome was a positive postpartum depression screen, defined as Edinburgh Postpartum Depression Score (EPDS) ≥10. Potential exposures were selected a priori and compared between patients with and without a positive postpartum depression screen using Wilcoxon rank-sum and Fisher's exact tests. Secondary outcomes were responses to a longitudinal follow-up survey sent to English-speaking patients evaluating cardiac status, mental health, and infant development.Results: Of 126 eligible cardiac patients, 23 (18.3%) had a positive postpartum depression screen. Patients with a positive postpartum depression screen were more likely to have had antepartum anticoagulation with heparin or enoxaparin (56.5% versus 26.2%, p=0.007), blood transfusion during delivery (8.7% versus 0%, p=0.032), and maternal-infant separation postpartum (52.2% versus 28.2%, p=0.047) compared to patients with a negative screen. Among 29 patients with a positive screen who responded to the follow up survey, 50% reported being formally diagnosed with anxiety or depression and 33.3% reported child development problems.Conclusions: Our results highlight the importance of screening for postpartum depression in patients with cardiac disease, especially those requiring antepartum anticoagulation or maternal-infant separation postpartum.

  View details for DOI 10.46439/Psychiatry.2.027

  View details for PubMedID 36570491

• Managing Ischemic Heart Disease in Women: Role of a Women's Heart Center. Current atherosclerosis reports Khandelwal, A., Bakir, M., Bezaire, M., Costello, B., Gomez, J. M., Hoover, V., Nazir, N. T., Nichols, K., Reisenberg, A., Rao, A., Sanghani, R., Tracy, M., Volgman, A. S. 2021; 23 (10): 56

  Abstract

  PURPOSE OF REVIEW: Heart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD).RECENT FINDINGS: HCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD. There has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.

  View details for DOI 10.1007/s11883-021-00956-x

  View details for PubMedID 34345945

• Development and validation of a risk prediction index for severe maternal morbidity based on preconception comorbidities among infertile patients. Fertility and sterility Murugappan, G., Alvero, R. J., Lyell, D. J., Khandelwal, A., Leonard, S. A. 2021

  Abstract

  OBJECTIVE: To develop and validate a preconception risk prediction index for severe maternal morbidity (SMM), defined by the Centers for Disease Control and Prevention as indicators of a life-threatening complication, among infertile patients.DESIGN: Retrospective analysis of live births and stillbirths from 2007 to 2017 among infertile women.SETTING: National commercial claims database.PATIENT(S): Infertile women identified on the basis of diagnosis, testing, or treatment codes.INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): The primary outcome was SMM, identified as any indicator from the Centers for Disease Control and Prevention Index except blood transfusion alone, which was found to overestimate cases. Twenty preconception comorbidities associated with a risk of SMM were selected from prior literature. Targeted ensemble learning methods were used to rank the importance of comorbidities as potential risk factors for SMM. The independent strength of the association between each comorbidity and SMM was then used to define each comorbidity's risk score.RESULT(S): Among 94,097 infertile women with a delivery, 2.3% (n = 2,181) experienced an SMM event. The highest risk of SMM was conferred by pulmonary hypertension, hematologic disorders, renal disease, and cardiac disease. Associated significant risks were lowest for substance abuse disorders, prior cesarean section, age ≥40 years, gastrointestinal disease, anemia, mental health disorders, and asthma. The receiver operating characteristic area under the curve for the developed comorbidity score was 0.66. Calibration plots showed good concordance between the predicted and actual risk of SMM.CONCLUSION(S): We developed and validated an index to predict the probability of SMM on the basis of preconception comorbidities in patients with infertility. This tool may inform preconception counseling of infertile women and support maternal health research initiatives.

  View details for DOI 10.1016/j.fertnstert.2021.06.024

  View details for PubMedID 34266662

• Myocardial Bridge in Pregnancy: Beyond a 'Normal Anatomic Variant'. Joudi, N., Datoc, I., Leonard, S., Lee, C., Schnittger, I., Khandelwal, A., Bianco, K. SPRINGER HEIDELBERG. 2021: 267A

  View details for Web of Science ID 000675441000561

• Long Term Patient Follow-Up of Cardiac Disease in Pregnancy: Multidisciplinary Teams Tether At-Risk Patients to the System. Miller, S. E., Panelli, D., Sherwin, E., Lee, C., Miller, H., Tolani, A., O'Mara, A., Khandelwal, A., Bianco, Y. SPRINGER HEIDELBERG. 2021: 268A-269A

  View details for Web of Science ID 000675441000564

• Nurse Practitioner-Directed Cardio-Diabetes Pilot Program JNP-JOURNAL FOR NURSE PRACTITIONERS Bryant, E., Janaszek, K., Nejedly, M., Li, E., Bouvier, M., Schroeder, K., Khandelwal, A., Lough, M. E., Lamendola, C., Reisenberg, A., Purewal, S., Maron, D. J. 2020; 16 (8): E123–E128

  View details for DOI 10.1016/j.nurpra.2020.05.009

  View details for Web of Science ID 000566686900008

• PRE-CONCEPTION RISK PREDICTION INDEX FOR SEVERE MATERNAL MORBIDITY AMONG INFERTILE WOMEN. Murugappan, G., Alvero, R. J., Lyell, D. J., Khandelwal, A., Leonard, S. A. ELSEVIER SCIENCE INC. 2020: E65

  View details for Web of Science ID 000579355300157

• Effect of ranolazine on symptom and quality of life in patients with angina in the absence of obstructive coronary artery disease: A case control study INTERNATIONAL JOURNAL OF CARDIOLOGY Pargaonkar, V. S., Tremmel, J. A., Schnittger, I., Khandelwal, A. 2020; 309: 8–13

  View details for Web of Science ID 000531868300003

• Perinatal Outcomes in Women With Cardiac Arrhythmia. Lee, J., Sie, L., Sherwin, E. B., Girsen, A. I., Tolani, A. T., Miller, H. E., Panelli, D. M., Do, S. C., Khandelwal, A., Bianco, K. SPRINGER HEIDELBERG. 2020: 161A

  View details for Web of Science ID 000525432600268

• Effect of ranolazine on symptom and quality of life in patients with angina in the absence of obstructive coronary artery disease: A case control study. International journal of cardiology Pargaonkar, V. S., Tremmel, J. A., Schnittger, I., Khandelwal, A. 2020

  Abstract

  BACKGROUND: More than 20% of patients presenting to the catheterization lab have no significant obstructive coronary artery disease (CAD) despite having angina. Several occult coronary abnormalities, including endothelial dysfunction, microvascular dysfunction (MVD), and/or a myocardial bridge (MB), may explain their symptoms. We studied the effect of ranolazine on symptoms and quality of life (QOL) in these patients.METHODS: We retrospectively studied 53 patients prescribed with ranolazine, matched on sex and age, with 106 patients on standard of care who underwent comprehensive invasive testing. Endothelial dysfunction was defined as a decrease in luminal diameter of >20% after intracoronary acetylcholine, MVD as an index of microvascular resistance ≥25, and a MB as an echolucent half-moon sign and/or ≥10% systolic compression on intravascular ultrasound. A Seattle Angina Questionnaire (SAQ) and SF-12 questionnaire were completed at baseline and follow-up.RESULTS: Median follow-up was 1.9 (1.7-2.2) years. Endothelial dysfunction was present in 109 (69%), MVD in 36 (23%), and an MB in 86 (54%). Both groups had significant improvement in all dimensions of the SF-12 and SAQ with the exception of treatment satisfaction. We found no significant difference in change in SAQ and SF-12 scores between the groups, although the ranolazine group had significantly lower baseline SAQ scores.CONCLUSION: In patients with angina and no obstructive CAD, ranolazine is no different than standard of care in symptomatic and QOL improvement. Further randomized trials are warrented to confirm our findings and identify novel medical therapies in this patient population.

  View details for DOI 10.1016/j.ijcard.2020.02.014

  View details for PubMedID 32220488

• Takayasu's Arteritis and Pregnancy CARDIAC PROBLEMS IN PREGNANCY, 4TH EDITION Khandelwal, A., Elkayam, U. 2020: 319–25

  View details for Web of Science ID 000509558000022

• Bicuspid Aortic Valve and Ascending Aortic Aneurysm in a Twin Pregnancy. JACC. Case reports Bryant, E., Tsai, S., Levin, E., Fleischman, D., Ansari, J., Fischbein, M., Bianco, K., Khandelwal, A. 2020; 2 (1): 96-100

  Abstract

  Bicuspid aortic valve with ascending aortic aneurysm is a common condition encountered in pregnancy. There are limited data on how to manage these patients. To our knowledge, we report the only case of a bicuspid aortic valve and aortic aneurysm with twin gestations. (Level of Difficulty: Intermediate.).

  View details for DOI 10.1016/j.jaccas.2019.12.012

  View details for PubMedID 34316973

• Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic AMERICAN JOURNAL OF CARDIOLOGY Edwards, K. S., Hekler, A. C., Baum, J., Nejedly, M., Tsai, S., Khandelwal, A., Naderi, S., Hoover, V., Tremmel, J. A. 2019; 123 (12): 2026–30

  View details for DOI 10.1016/j.amjcard.2019.03.029

  View details for Web of Science ID 000472238900022

• Efficacy of a Telehealth Preventive Cardiology Lifestyle Intervention Program to Treat High-Risk South Asians Parameswaran, V., Josan, K., Khandelwal, A., Abbasi, F., Dash, R. AMER DIABETES ASSOC. 2019

  View details for DOI 10.2337/db19-885-P

  View details for Web of Science ID 000501366902250

• Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic. The American journal of cardiology Edwards, K. S., Hekler, A. C., Baum, J., Nejedly, M., Tsai, S., Khandelwal, A., Naderi, S., Hoover, V., Tremmel, J. A. 2019

  Abstract

  Female cardiac patients are at greater risk for mental health disorders than their male counterparts, and these mental health disorders have been associated with increased cardiac morbidity and mortality. However, few studies have closely examined the mental health disorders found among the female cardiac population. The primary aim of this study was to examine the prevalence of psychological distress in a sample of female cardiac outpatients at an academic medical center. A secondary aim was to determine whether different demographic variables, cardiac risk factors, or cardiac diagnoses were associated with different levels of emotional distress. A survey, including demographic information, medical status, and standardized symptom measures was completed by 117 female patients scheduled for medical visits at an outpatient women's heart health clinic over a 4-month period. Using standardized self-report questionnaires, 38% scored in the moderate-to-severe range for at least 1 mental disorder and 50% endorsed current insomnia. Symptoms of clinical depression (20%) and anxiety (42)% were endorsed at higher rates than predominantly male or mixed comparison samples. Although there was no apparent relation between the severity of cardiac problems and the degree of psychological distress, women with diagnoses of hyperlipidemia, prediabetes, and diabetes reported greater psychological distress than those without these problems. Women with lower income also reported more psychological distress. In conclusion, our findings suggest an unmet need for integrated mental health services for female cardiac patients.

  View details for PubMedID 31006484

• Maternal Outcomes in Planned and Unplanned Pregnancies in Women with Cardiac Disease. Do, S. C., Tolani, A. T., Sie, L., Girsen, A. I., Lee, C. J., Sherwin, E., Panelli, D. M., El-Sayed, Y. Y., Khandelwal, A., Blumenfeld, Y. J., Bianco, K. SAGE PUBLICATIONS INC. 2019: 323A

  View details for Web of Science ID 000459610400771

• A Multidisciplinary Approach to Care of Pregnant Patients with History of Open Heart Surgery. Do, S. C., Lee, C. J., Sie, L., Tolani, A. T., Sherwin, E., Girsen, A. I., El-Sayed, Y. Y., Khandelwal, A., Bianco, K., Blumenfeld, Y. J. SAGE PUBLICATIONS INC. 2019: 323A–324A

  View details for Web of Science ID 000459610400772

• Care of the pregnant cardiac patient e the importance of a multidisciplinary approach Tolani, A. T., Do, S. C., Blumenfeld, Y. J., Sie, L., Girsen, A. I., Lee, C. J., Sherwin, E. B., Tsur, A., El-Sayed, Y. Y., Khandelwal, A., Bianco, K. MOSBY-ELSEVIER. 2019: S536

  View details for DOI 10.1016/j.ajog.2018.11.842

  View details for Web of Science ID 000454249402297

• CardioClick an Innovative Telehealth Approach to Lifestyle Intervention in High Risk South Asians Parameswaran, V., Josan, K., Winterbottom, J., Shearer, J., Khandelwal, A., Nallamshetty, S., Dash, R., Rodriguez, F. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for DOI 10.1161/circ.139.suppl_1.P337

  View details for Web of Science ID 000478079000280

• EFFECT OF RANOLAZINE ON SYMPTOMS AND QUALITY OF LIFE IN PATIENTS WITH ANGINA IN THE ABSENCE OF OBSTRUCTIVE CORONARY ARTERY DISEASE: A RETROSPECTIVE COHORT STUDY Pargaonkar, V., Tremmel, J., Schnittger, I., Khandelwal, A. ELSEVIER SCIENCE INC. 2018: 161

  View details for DOI 10.1016/S0735-1097(18)30702-2

  View details for Web of Science ID 000429659701011

• Hypertensive Disorders of Pregnancy. Current atherosclerosis reports Naderi, S., Tsai, S. A., Khandelwal, A. 2017; 19 (3): 15-?

  Abstract

  Although pregnancy-related deaths are rare in the USA, they are on the rise and have more than doubled in the last 20 years. A substantial portion of these deaths are related to cardiovascular disease, specifically hypertensive disorders of pregnancy (HDP). In this review, we will discuss the definitions and proposed pathophysiology of HDP as well as its potential role in cardiovascular morbidity and mortality.Placental hypoperfusion may lead to an imbalance in proangiogenic and antiangiogenic factors, notably an increase in soluble fms-like tyrosine kinsase-1 (sFlt-1), thereby leading to endothelial dysfunction. Progress has been made in terms of determining the factors which lead to preeclampsia. Potential novel biomarkers for predicting preeclampsia risk have been identified through this research. Preeclampsia not only has important implications for the health during pregnancy but also for future cardiovascular risk. However, the exact mechanism by which it increases cardiovascular risk and the degree of risk it portends are yet to be elucidated.

  View details for DOI 10.1007/s11883-017-0648-z

  View details for PubMedID 28229431

• 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

• 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

• 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

• 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