Indonesian Journal of Cardiology
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Non-traditional Lipid Profile and Obstructive Coronary Artery Disease Based On CAD-RADS Score
Full text linkBackground: The association between dyslipidemia and coronary artery disease (CAD) is undisputable. Current evidence suggests that, in comparison to conventional lipid parameters, a comprehensive non-traditional lipid profile serves as a more robust predictor of CAD. The evidence regarding the correlation between nontraditional lipid profile and severity of coronary lesions, as measured by the coronary artery disease-reporting and data system (CAD-RADS) score by Coronary Computed Tomography Angiography (CCTA), is still scarce. This study aimed to elaborate on the association between those parameters. Understanding these associations may improve risk stratification and management in CAD patients.
Methods: A cross-sectional single-center study was conducted in a large population of patients with suspected CAD. Data were obtained from medical records between January 2020 and February 2024. The CAD-RADS score was stratified into three groups: CAD-RADS 0 (no CAD), CAD-RADS 1-2 (stenosis <50%, classified as non-obstructive CAD), and CAD-RADS ≥3 (stenosis ≥50% in ≥1 coronary segment, classified as obstructive CAD). Logistic regression analysis analyzes the association between patients' lipid profiles and CAD-RADS scores. P-value <0.05 was considered statistically significant.
Results: A total of 543 (274 female) patients were included in this study. In the univariate analysis, the LDL/HDL ratio was significantly associated with the severity of CAD based on CAD-RADS scores. The multivariate analysis revealed that the LDL/HDL ratio was the most significant lipid parameter across all models (Adj OR: 9.728, 95% CI: 2.078-45.649, P = 0.004), with the highest adjusted odds ratio observed after adjustments for age, gender, family history, history of hypertension, diabetes mellitus, and chronic kidney disease, and also smoking status. The LDL/HDL ratio cut-off value was 2.82 with a sensitivity of 83.95% and a specificity of 21.05%. Other non-traditional lipid profiles lost their significance in the multivariate models.
Conclusions: The LDL/HDL ratio was significantly associated with obstructive CAD, as assessed by the CAD-RADS score, even after adjustment for other cardiovascular risk factor
Perubahan Elektrokardiografi Post-Intervensi pada Pasien dengan Atrial Septal Defect Secundum: sebuah Studi Observasional
No full textBackground:. Secundum Atrial Septal Defect (ASD) is one of the most common forms of left-to-right shunt congenital heart defect that leads to right-sided overflow inducing geometrical and electrical changes in the right chambers. Electrocardiograms (ECGs) are reliable non-invasive tools to detect various electrical patterns produced by Secundum ASD that can give important clues in diagnostic procedures. After shunt closure, either percutaneously or surgically, normalization of flow ratio will induce reverse remodelling, which is one of the most important prognostic factors after defect closure. Our study aims to detect reverse remodelling in electrical aspects using ECGs in short (< 24 hour) and long term (> 6 months) follow-up after defect closure.
Methods: We screened Secundum ASD patients that were admitted to undergo interventional closure percutaneously and surgically at RSUP Dr. Wahidin Sudirohusodo. After the screening process, 54 eligible subjects were enrolled in this study. Baseline characteristic data were obtained from medical record. ECGs measurements were taken at the time of admission for pre-closure baseline data, within 24 hours of closure and beyond 6 months after closure for follow-up data. Each ECGs parameter statistically was compared for pre-closure versus < 24 hour measurement after closure, and < 24 hour versus 6 months measurement after closure using paired T test or Wilcoxon signed-rank test.
Results: In analysis of pre-closure vs. < 24 hour after closure data. There was significant reduction in all of the ECGs parameters (P wave amplitude 0.19 ± 0.04 vs. 0.11 ± 0.03 mv (p<0.001), P wave duration 97.78 ± 11.94 vs. 75.35 ± 13.36 ms (p<0.001), PR interval 182.89 ± 26.47 vs. 156.83 ± 21.81 ms (p<0.001), QRS duration 112.97 ± 14.84 vs. 88.31 ± 14.43 ms (p<0.001), QRS axis 107.94 ± 23.00 vs. 95.25 ± 24.62 ˚ (p<0.001), QTc interval 403.84 ± 30.85 vs. 396.80 ± 33.76 ms (p 0.017), R wave V1 amplitude 0.74 ± 0.35 vs. 0.53 ± 0.24 mv (p<0.001). In analysis of < 24 hour vs. > 6 months after closure data. There was also significant reduction in most of the ECGs parameters (P wave duration 75.05 ± 13.82 vs. 69.46 ± 11.84 ms (p<0.001), PR interval 155.53 ± 22.82 vs. 148.30 ± 19.34 ms (p<0.001), QRS duration 89.74 ± 14.02 vs. 85.38 ± 14.22 ms (p<0.001), QRS axis 94.80 ± 23.57 vs. 81.26 ± 22.96 ˚ (p<0.001), QTc interval 396.22 ± 33.70 vs. 384.40 ± 37.87 ms (p 0.020), R wave V1 amplitude 0.51 ± 0.24 vs. 0.32 ± 0.21 mv (p<0.001), except P wave amplitude (0.121 ± 0.03 vs. 0.119 ± 0.03 ms (p 0.321)).
Conclusion: Our study showed electrical reverse remodelling in the most of the ECGs parameters after Secundum ASD closure except P wave amplitude in long term follow up.Latar belakang : Defek Septum Atrium (DSA) Sekundum merupakan salah satu bentuk defek jantung kongenital pintasan kiri ke kanan paling sering ditemukan yang menyebabkan aliran darah berlebih pada jantung kanan dan menginduksi perubahan geometri dan kelistrikan ruang jantung kanan. Elektrokradiogram (EKG) merupakan alat pemeriksaan non-invasif yang dapat diandalkan dalam mendeteksi berbagai pola kelistrikan yang dihasilkan DSA Sekundum yang dapat memberikan petunjuk penting dalam prosedur diagnostik. Setelah dilakukan penutupan pintasan, baik secara perkutan atau pembedahan, normalisasi rasio aliran akan menginduksi reverse remodelling yang merupakan salah satu faktor prognostik penting pasca penutupan defek. Studi ini bertujuan untuk melihat adanya reverse remodelling dalam aspek kelistrikan menggunakan EKG dalam jangka singkat (< 24 jam) dan panjang ( > 6 bulan) setelah penutupan defek.Metode : Kami melakukan skrining pada penderita DSA Sekundum yang datang ke RSUP Dr. Wahidin Sudirohusodo untuk dilakukan intervensi penutupan secara perkutan dan pembedahan. Setelah proses skrining, 54 subjek yang memenuhi syarat dimasukkan dalam studi ini. Data karakteristik dasar diambil dari rekam medis. Pengukuran EKG dilakukan saat penderita masuk rawat inap untuk data dasar pra-penutupan, dalam 24 jam dan 6 bulan pasca penutupan untuk data tindak lanjut. Setiap parameter EKG secara statisktik dilakukan perbandingan antara pengukuran pra-penutupan vs. < 24 jam pasca penutupan, dan pengukuran < 24 jam vs. > 6 bulan pasca penutupan menggunakan uji T berpasangan atau uji peringkat bertanda Wilcoxon.Hasil : Dalam analisis data pra-penutupan vs. < 24 jam pasca penutupan. Terdapat penurunan signifikan pada semua parameter EKG (amplitudo gelombang P 0.19 ± 0.04 vs. 0.11 ± 0.03 mv (p<0.001), durasi gelombang P 97.78 ± 11.94 vs. 75.35 ± 13.36 ms (p<0.001), interval PR 182.89 ± 26.47 vs. 156.83 ± 21.81 ms (p<0.001), durasi QRS 112.97 ± 14.84 vs. 88.31 ± 14.43 ms (p<0.001), aksis QRS 107.94 ± 23.00 vs. 95.25 ± 24.62 ˚ (p<0.001), interval QTc 403.84 ± 30.85 vs. 396.80 ± 33.76 ms (p 0.017), amplitudo gelombang R V1 0.74 ± 0.35 vs. 0.53 ± 0.24 mv (p<0.001). Dalam analisis data < 24 jam vs. > 6 bulan pasca penutupan. Terdapat juga penurunan signifikan pada semua parameter EKG (durasi gelombang P 75.05 ± 13.82 vs. 69.46 ± 11.84 ms (p<0.001), interval PR 155.53 ± 22.82 vs. 148.30 ± 19.34 ms (p<0.001), durasi QRS 89.74 ± 14.02 vs. 85.38 ± 14.22 ms (p<0.001), aksis QRS 94.80 ± 23.57 vs. 81.26 ± 22.96 ˚ (p<0.001), interval QTc 396.22 ± 33.70 vs. 384.40 ± 37.87 ms (p 0.020), amplitudo gelombang R V1 0.51 ± 0.24 vs. 0.32 ± 0.21 mv (p<0.001), kecuali amplitudo gelombang P (0.121 ± 0.03 vs. 0.119 ± 0.03 ms (p 0.321)).
Kesimpulan : Studi kami menunjukkan adanya reverse remodelling pada sebagian besar parameter EKG pasca penutupan DSA Sekundum amplitudo gelombang P pada periode jangka panjang
An Acute Anterior Reinfarction Complicating with Transient Symptomatic Total Atrioventricular Block
Full text linkIn “An Acute Anterior Reinfarction Complicating with Transient Symptomatic Total Atrioventricular Block” (Indonesian Journal of Cardiology, 43(3), 130-6. https://doi.org/10.30701/ijc.1216), there is an error noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1216. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.
In the original published version of this article, there is an error in the author’s name. The author’s name has been changed to “Mochamad Rizky Hendiperdana” from the previous “Rizky Hendiperdana.”The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.121
A Broken Heart Coexisting with Obstructive Coronary Artery Disease: Double Trouble
Full text linkIn “A Broken Heart Coexisting with Obstructive Coronary Artery Disease: Double Trouble” (Indonesian Journal of Cardiology, 43(4), 168-73. https://doi.org/10.30701/ijc.1368), there is an error noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1368. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.The publisher apologizes for any inconvenience caused by this error
Triglyceride Glucose Index as a Predictor of 30-Day Readmission and 6 Months Mortality After Hospitalization in Acute Decompensated Heart Failure
Full text linkIn “Triglyceride Glucose Index as a Predictor of 30-Day Readmission and 6 Months Mortality After Hospitalization in Acute Decompensated Heart Failure” (Indonesian Journal of Cardiology, 44(2), 53-60. https://doi.org/10.30701/ijc.1380), there are an errors noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1380. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.
An error also occurred in the author’s name. We have corrected the author’s name from “Vienna Rossiamarina” to “Vienna Rossimarina.”
There is also an error in the page numbering on the first page of the article. At the top, it says “57-64,” but we have changed it to the correct page numbers (53-60).
The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.138
Pulmonary Hypertension in Indonesia: An Urgent Call to Close the Gaps in Diagnosis and Care
Full text linkPredictors of Diffuse In-Stent Restenosis, a Retrospective Analysis in a Subset of Egyptian Population
Full text linkBackground: Despite the fact that DES implantation has decreased theincidence of ISR dramatically, it is not negligible. Diffuse ISR is associated withpoor outcomes. Most of the data regarding ISR are obtained from studiesincluding BMS stents.
Methods: A total of 263 ISR patients were treated at two tertiary carehospitals from September 2017 through December 2022. 40 patients wereexcluded because the previous angiography and procedure details were notavailable, IVUS data were available for only 30 patients and the patients werenot included in the analysis, so only 193 ISR patients were included in theanalysis. We compared different clinical and procedural risk factors betweendiffuse and focal patterns of ISR following DES implantations.
Results: A total of 193 ISR lesions were included in the analysis, distributedas 53.4% diffuse pattern and 46.6% focal pattern. In the multivariate analysis,only increased stent length [OR 1.270 (1.157 – 1.394) 95%CI, P<0.001],lower LVEF [OR 0.903, (0.860 – 0.949) 95%CI, P<0.001], occurrence ofprocedural complications [OR 15.584 (2.075 – 117.044) 95%CI, P=0.008],smoking [OR 3.182, (1.071 – 9.451) 95%CI, P=0.037] and older age [OR1.086, (1.014 – 1.163) 95%CI, P=0.019] were independent risk factors ofdiffuse ISR. DM was not associated with diffuse ISR in the multivariate analysis.
Conclusions: Increased age, smoking, reduced left ventricular ejectionfraction, occurrence of procedural complications and increased stent lengthare independent predictors of diffuse ISR. Diabetes mellitus was not found tobe independently associated with a diffuse pattern of ISR
Transient ST Elevation following Anaphylactic Shock: A Case Report of The Potential Kounis Syndrome
Full text linkBackground: Anaphylactic shock rarely can induce allergic-induced acute coronary syndrome known as Kounis Syndrome. It involves the release of inflammatory cytokines through mast cell activation, which leads to coronary artery vasospasm and ST elevations presentation on electrocardiography (ECG).Case Illustration: A 45-years-old woman with unknown past medical history presented with weakness all over the body, dizziness, pain on left hand and history of fainted, immediately after being stung by small wasps. She was in hypotension with wheezing and weak peripheral pulses. Her laboratory examination displayed leukocytosis, thrombocytosis, high level of blood sugar and triglyceride. Initial twelve-lead ECG demonstrated ST-segment elevation on the inferior leads (II, III, and aVF) and reciprocal ST-depression on the lateral lead. Diagnosis of anaphylactic shock caused by insect bite was made, with a potential of becoming Kounis Syndrome. Treatment for anaphylactic shock was initiated with fluid resuscitation, intramuscular epinephrine, intravenous methylprednisolone and ranitidine. Patient’s complaint vanished and the patient discharged in stable condition two days later.Discussion: Kounis Syndrome consists of three main types, including Type I Kounis Syndrome―manifested as coronary artery vasospasm with/without cardiac biomarker elevation among patient without predisposing factor of coronary artery disease. This type differs with the second and third type, which present plaque erosion or thrombosis, leading to myocardial infarction. The treatment for Type 1 Kounis Syndrome mostly in the form of aborting the anaphylactic reaction only, through medication administration until symptoms resolved. Based on this case, the patient was a non-smoker young Asian woman with a low risk (<1% of 10-years-risk) of fatal cardiovascular disease (CVD) in populations with high CVD risk. Clinically, the patient did not show any vascular thrombotic symptoms. In addition, administration of adrenaline, corticosteroid and antihistamine relieved patient's complaint, thus this case can be hypothesized as a potential Type I Kounis Syndrome. Emergency coronary angiography or echocardiography has to be done to clarify the diagnosis of this allergic-induced acute coronary syndrome.Conclusion: Transient ST elevation could happen in some rare cases following an anaphylactic shock. The swift recognition, accurate diagnosis, and prompt treatment are important for optimal outcomes in the probability of Kounis Syndrome.Keywords: anaphylactic shock, Kounis syndrome, ST elevatio
Tatalaksana Farmakologi takiaritmia supraventrikel pada pasien dengan pembesaran jantung kanan: Serial kasus
No full textBackground
Right atrial (RA) enlargement is a common finding in patients with pulmonary hypertension (PH). Supraventricular arrhythmia (SVA) is common in PH patients with RA enlargement. Treatment of SVA should be aggressive since it can cause hemodynamic worsening consequences because RA function plays an important role in right heart function.
Case Illustration
Three cases of SVA in underlying right heart enlargement with preserved ventricular function that successfully managed by pharmacological cardioversion according to the guidelines. The first case describes atrial flutter with right bundle branch block (RBBB) morphology which successfully converted to sinus rhythm by amiodarone (class III antiarrhythmic drug) administration, meanwhile the second and third cases demonstrate paroxysmal SVA that converted to sinus rhythm by diltiazem (class IV antiarrhythmic drug) administration.
Conclusion
Supraventricular arrhythmia is a frequent arrhythmia that occurs in pulmonary hypertensive and right heart dilation patients. The tachyarrhythmia in this patient population tolerated poorly and led to hemodynamic perturbation. Pharmacological cardioversion is one of the effective approaches to alleviate patient symptoms with significant clinical improvement.
Pemantauan Kesehatan Jantung secara Klinis, Ekokardiografik dan Laboratoris pada Pasien Kanker Payudara yang Menjalani Kemoterapi Agen Antrasiklin: Penelitian Perintis Algoritme Kardioproteksi di RSUP Mohammad Hoesin Palembang
No full textObjectives We analyzed echocardiography and laboratory results of breast cancer patients undergoing chemotherapy with anthracycline agents, to find cardiotoxicity risk and prevalence among South Sumatra population.
Background Improved cancer therapy and early disease detection, increase the survival rate, also increase risk of CTRCD, range between 2 and 48% for patient with breast cancer treated by anthracyclines. There was limited data about prevalence of CTRCD in South Sumatra. Study of demographic factors and potential laboratory cardiac marker in specific population will give others additional important information.
Methods In 2024, from March until November, 30 breast cancer patients were included in this analysis. Age 51,50 (41-69) years. All patients were in anthracycline chemotherapy treatment in Mohammad Hoesin General Hospital. Data of demography, laboratory and echocardiography was collected at baseline and after 3 cycles of treatment.
Results Data collection and analysis was processed in outpatient department of Brain and Heart Installation Mohammad Hoesin General Hospital. From 30 patient, cardiovascular risk factors was detected: hypertension 30%, diabetes 10%, dyslipidemia 13,3%, body mass index 23,32 (13,30- 31,18), and almost all patients were not smoker (96,7%). Baseline to serial echocardiography showed that anthracycline did not affect the decrease of left ventricular ejection fraction (LVEF) (p=0,212), but correlated with the decrease of left ventricle global longitudinal strain (GLS) (p<0,05). There were 16 patients with >15% global longitudinal strain (GLS) reduction, without significant clinical heart failure signs and symptoms, known as mild asymptomatic cancer-therapy related cardiac dysfunction (CTRCD). Laboratory examination showed anthracycline agent was not correlated with Troponin T (p=0,093), NT-pro BNP (p=0,150), Serum Iron (p= 0,775), Total Iron Binding Capacity (TIBC) (p=0,692) and Transferrin Saturation (p=0,748). Ferritin level was affected by anthracycline agents (p= 0,026).
Conclusion Higher prevalence of CTRCD in South Sumatra population was found. There was low incidence of cardiovascular risk factors in this population, indicated stronger isolated effect of chemotherapy agent for cardiac dysfunction progression. GLS by echocardiography measurement remain to be a good marker for cardiotoxicity related anthracycline agents. Ferritin level is potential parameter in guiding the stages and strategies in cancer treatment.
Keywords: anthracycline, cardiac dysfunction, global longitudinal strain, ferriti