Indonesian Journal of Cardiology
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Systematic Review and Meta-analysis
Get PDFAbstracts of the 32nd Annual Scientific Meeting of the Indonesian Heart Association (ASMIHA) 202
Case Reports
Get PDFAbstracts of the 10th Annual Scientific Meeting of the Indonesian Heart Rhythm Society (InaHRS) 2023: Case Report
Uji validasi Mayo Cardiac Intensive Care Unit Admission Risk Score (M-CARS) untuk menilai mortalitas selama rawatan pada pasien Cardiovascular Care Unit (CVCU) di RSUP Haji Adam Malik
No full textBackground: Approximately 85% of all in-hospital deaths occur in Cardiovascular Care Unit (CVCU) where M-CARS will be an important starting point for development of CVCU-specific mortality risk prediction models.
Aim: This research aims to assess M-CARS validation to assess mortality during treatment in CVCU patients at Haji Adam Malik (HAM) General Hospital.
Methods: This research is a prospective research that examines M-CARS score validity as a predictor of intra-hospital mortality in patients treated at CVCU HAM General Hospital Medan from September 2021 - January 2022. If correlation test results show a significant relationship, cut-off value M-CARS score will be taken using ROC (Receiver Operating Characteristic) curve analysis, then analysis of M-CARS score diagnostic value will be carried out according to cut-off value obtained to predict mortality during hospitalization. Then Hosmer-Lemeshow test was carried out to assess suitability of logistic regression on risk prediction assessment within population that being assessed.
Results: M-CARS had a very good discriminatory ability (AUC 0.93) to predict intrahospital mortality. The calibration value using Hosmer Lemeshow test (R2 = 0.982; p = 1.516; p>0.05) shows that there is no significant difference between observed and expected mortality rate by two scoring systems therefore considered as accurate.
Conclusion: M-CARS is valid to be used in assessing risk of mortality events during CVCU treatment at H. Adam Malik Hospital Medan.
This article has a related Erratum.Abstrak
Latar Belakang: Sekitar 85% dari semua kematian di rumah sakit terjadi di Cardiovascular Care Unit (CVCU) dimana M-CARS akan menjadi titik awal yang penting untuk pengembangan model prediksi risiko kematian spesifik CVCU
Tujuan: Penelitian ini bertujuan untuk menguji validasi M-CARS untuk menilai mortalitas selama rawatan pada pasien CVCU di RSUP Haji Adam Malik.
Metode: Penelitian ini merupakan studi prospektif yang menguji validitas M-CARS score sebagai prediktor mortalitas intra hospital pada pasien yang dirawat di CVCU RSUP HAM Medan mulai dari September 2021 – Januari 2022. Jika hasil Uji korelasi menunjukan hubungan yang bermakna maka kemudian akan dilakukan pengambilan nilai cut-off dari nilai M-CARS score menggunakan analisa kurva ROC (Receiver Operating Characteristic), selanjutnya akan dilakukan analisa nilai diagnostik dari nilai M-CARS score menurut nilai cut-off yang didapat untuk memprediksi angka mortalitas selama rawatan. Kemudian dilakukan uji Hosmer-Lemeshow untuk menilai kecocokan regresi logistik pada penilain prediksi resiko dengan populasi yang dinilai.
Hasil: M-CARS memiliki kemampuan diskriminasi yang sangat baik (AUC 0.93) untuk memprediksi mortalitas intrahospital. Nilai kalibrasi dengan uji Hosmer Lemeshow (R2 = 0,982; p = 1,516; p>0.05) menunjukkan bahwa tidak terdapat perbedaan yang bermakna antara angka mortalitas yang teramati (observed) dengan angka kejadian mortalitas yang diprediksi (expected) oleh kedua sistem skor tersebut, sehingga dinilai akurat
Kesimpulan: M-CARS valid untuk digunakan dalam menilai risiko kejadian mortalitas selama rawatan CVCU di RSUP H. Adam Malik Medan.
Kata Kunci: Mortalitas, Cardiovascular Care Unit, Mayo Cardiac Intensive Care Unit Admission Risk Score, Braden Score
Usefulness of The CHADS2 and CHA2DS2-VASc Scores in Predicting In-Hospital Mortality in Acute Coronary Syndrome Patients: A Single-Center Retrospective Cohort Study
Get PDFBackgroundAlthough the GRACE risk score is widely accepted as an established scoring system to predict in-hospital mortality in acute coronary syndrome (ACS) patients, this scoring system still depends on electrocardiography and laboratory findings to determine the results. Therefore, we aim to retrospectively evaluate the association between the CHADS2 and CHA2DS2-VASc score as an anamnesis-only mediated scoring system and in-hospital mortality in hospitalized ACS patients.
MethodsThis retrospective cohort study analyzed data of ACS patients from the ACS registry in Dr. Hasan Sadikin Central General Hospital from 2018 to 2021. The outcome of this study was in-hospital mortality. The association between these scoring system and in-hospital mortality were evaluated using binary logistic regression analysis. Receiver operating characteristics (ROC) analysis was also performed to assess the success rate of this scoring system in predicting in-hospital mortality.
ResultsA total of 1339 patients were included in this study, and 162 (12.1%) of them died in the hospital. High CHA2DS2-VASc score group (cut-off >2) was significantly associated with higher risk of in-hospital mortality before (OR=2.56 [1.75,3.75]; p<0.001) and after adjustment of several confounding factors (OR=3.39 [1.73,6.64]; p<0.001). Meanwhile, the high CHADS2 score (cutoff >2) was only significantly increased the risk of in-hospital mortality in univariate analysis (OR=2.05[1.47,2.87];p<0.001), but was not significantly associated with in-hospital mortality after multivariate analysis (OR=1.31 [0.92,1.86];p=0.129). ROC analysis revealed that predictive accuracy of CHA2DS2-VASc score was significantly greater compared to CHADS2 score (AUC: 0.653 vs 0.609, p<0.001). However, the predictive value of CHA2DS2-VASc score was significantly lower than the GRACE risk score (AUC: 0.789 vs 0.653, p<0.001).
ConclusionOur study showed that the CHA2DS2-VASc score >2 was significantly and independently associated with higher in-hospital mortality in ACS patients compared to the CHA2DS2-VASc score of 1 or lower. Despite its lower predictive accuracy compared to the GRACE risk score, CHA2DS2-VASc score can still be used in practical situations as an alternative scoring system in predicting in-hospital mortality in ACS patients, especially in primary health care settings located in rural areas that lack the diagnostic facilities.This article has a related Erratum
Simplified Selvester QRS Score as an Infarct Size Parameter in STEMI Patients Undergoing Pharmacoinvasive or Primary Percutaneous Coronary Intervention
Get PDFBackground:Cardiovascular disease especially acute myocardial infarct (AMI) is one of the highest cause of mortality worldwide. Majority of AMI comes in the form of ST elevation myocardial infarct (STEMI) that requires timely diagnosis and revascularization management to restore myocardial circulation. The simple method to estimate infarct size is by using simplified Selvester QRS Score to electrocardiogram records, which is a tested method that have good correlation with gold standard, namely cardiac magnetic resonance imaging.
Objectives : To investigate difference of infarct size with simplified Selvester QRS score parameter between STEMI patients undergoing pharmacoinvasive compared to primary PCI.
Methods: Eighty-two STEMI patients, 41 of pharmacoinvasive and 41 of primary PCI was scored with simplified Selvester QRS score from electrocardiogram recording. Patient data are retroactively taken form Sardjito Cardiovascular Intensive Care (SCIENCE) registry. Scoring of simplified Selvester QRS Score was done by two experienced cardiologist blinded to patient procedure, and results then measured for interobserver agreement with Bland-Altman test. Comparison of QRS Score in pharmacoinvasive and primary PCI group was done with independent sample T test followed with multivariable linear regression test.
Results: The means of simplified Selvester QRS score in pharmacoinvasive and primary PCI group is 7.240±3.015 and 8.900±4.188, p=0.043, respectively. Independent sample T test shows significant difference in the simplified Selvester QRS score in pharmacoinvasive and primary PCI group. The multivariable analysis shows that variables other than revascularization method independently influences QRS score are onset, anterior segment ST elevation and ST segment elevation in more > 3 leads in electrocardiogram.
Conclusion: There is significant difference in infarct size measured by simplified Selvester QRS score betweem STEMI patient undergoing pharmacoinvasive method compared to primary PCI procedure, which is lower in the pharmacoinvasive group
This article has a related Erratum
Predictors of Acute Kidney Injury in Critically Ill Patient at Intensive Cardiac Care Unit
Get PDFBackground: Acute kidney injury (AKI) occurs frequently in the intensive cardiac care unit (ICCU) and is recognized as a heterogeneous syndrome with variable etiology and clinical presentation that affects acute morbidity and mortality. AKI needs to be identified early and underlying causes must be treated
Method: We performed a retrospective analysis of patient registry from Sardjito Cardiovascular Intensive Care (SCIENCE) between January 2021 and December 2021. This registry provided demographic data, risk factors, comorbidities, laboratory findings and survival outcomes. The KDIGO criteria were used to define AKI characterized by an increase in serum creatinine more or equal to 0.3 mg/dL in 48 hours, or an increase in serum creatinine more or equal to 1.5 times than previous value, or urine volume less than 0.5 mL/kg BW/hour for 6 hours. Univariate and multivariate data analyses were carried out.
Results: This study included 428 patients with an incidence of AKI was 14,3 %. Univariate analysis showed that AKI was related to diabetes, acute heart failure, sepsis, APACHE score, SAPS, Sardjito score, MCARS, hemoglobin, leukocyte, and plasma albumin concentration. Furthermore, we did multivariate analysis and showed the independent predictor of AKI at ICCU admission is acute heart failure (OR 3.90; 95% CI 1.95–7.77; p <0.001), sepsis (OR 3.02; 95% CI 1.03-8.90; p 0.045) and high APACHE II score (OR 0.33; 95% CI 0.13-0.80; p 0.015).
Conclusions: Acute heart failure, sepsis and high APACHE score at admission is independent predictors of AKI among critically ill in ICCU Sardjito General Hospital. The results of this study may contribute to the implementation of targeted therapies.
This article has a related Erratum
A Broken Heart Coexisting with Obstructive Coronary Artery Disease: Double Trouble
Get PDFBackground. Takotsubo is a syndrome characterized by transient regional systolic dysfunction of the left ventricle (LV). The most common clinical presentation mimics acute myocardial infarction without angiographic evidence of obstructive coronary artery disease or acute plaque rupture.1-3 The diagnosis and management became a challenge when it presented as atypical symptoms and significant obstructive coronary artery. Thus, this case report highlights the diagnosis and management of Takotsubo Cardiomyopathy with obstructive coronary artery disease.
Case illustration. A 71 years old woman came to the emergency room with a chief complaint of dyspnea from one week ago and worsened in the last three days. The initial electrocardiogram showed slight ST-elevation, and thorax Rontgen showed the congestion and elongation of the aorta. Increased high-sensitive Cardiac Troponin T and The NT-Pro BNP levels were present, along with apical ballooning of the LV and reduced RV function. Physiological stress was found to be the death of her husband one week ago. Although the left ventriculography of this patient was classically depicted as the octopus trap, we did find obstructive coronary artery disease in the left anterior descending artery.This article has a related Erratum.Background. Takotsubo is a syndrome characterized by transient regional systolic dysfunction of the left ventricle (LV). The most common clinical presentation mimics acute myocardial infarction without angiographic evidence of obstructive coronary artery disease or acute plaque rupture.1-3 The diagnosis and management became a challenge when it presented as atypical symptoms and significant obstructive coronary artery. Thus, this case report highlights the diagnosis and management of Takotsubo Cardiomyopathy with obstructive coronary artery disease.Case illustration. A 71 years old woman came to the emergency room with a chief complaint of dyspnea from one week ago and worsened in the last three days. The initial electrocardiogram showed slight ST-elevation, and thorax Rontgen showed the congestion and elongation of the aorta. Increased high-sensitive Cardiac Troponin T and The NT-Pro BNP levels were present, along with apical ballooning of the LV and reduced RV function. Physiological stress was found to be the death of her husband one week ago. Although the left ventriculography of this patient was classically depicted as the octopus trap, we did find obstructive coronary artery disease in the left anterior descending artery.
Keywords: Takotsubo Cardiomyopathy, Uncommon presentation, Coronary artery disease, apical ballooning, acute heart failur
Added Value of CHA2DS2-VASc Score to Safe Contrast Volume for Contrast Induced Nephropathy Prediction after Percutaneous Coronary Intervention
Get PDFBackground: The CHA2DS2-VASc score is utilized to order the danger of embolization in atrial fibrillation (AF). Also, it has been assessed the worse clinical scenario in acute coronary syndrome patients, regardless of having AF. The study aim was to use CHA2DS2-VASc score added to the safe contrast volume (Volume /CrCl) for contrast-induced nephropathy (CIN) early prediction post PCI.
Patients and Methods: The study included two hundred fifty nine patients who underwent percutaneous coronary intervention . For each patient, The CHA2DS2-VASc score and Volume /CrCl were evaluated. The patients in our study were divided, according to CIN development into two groups. CIN was identified as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within48 to 72 hours after PCI. Statistical analysis: the receiver operating characteristic analysis was used to detect the best cut off values to predict CIN, and we concluded the predictors of CIN through multivariate logistic regression analysis. Results: There was a positive correlation between Mehran score and CHA2DS2-VASc score. Independent predictors of CIN were Mehran score, Volume/CrCl ratio>3.2 and CHA2DS2-VASc >3, CHF or EF < 40%, hypotension, anemia, primary PCI and weight. If the patient had (CHA2DS2-VASc score>3 or Volume/CrCl >3.2), as a single predictor, we could predict CIN with (sensitivity 96.97 %, 95% CI 0.71 to 0.82).
Conclusion: The CHA2DS2-VASc score and Volume/CrCl ratio are new predictor of CIN, and we can use the CHA2DS2-VASc score , safe contrast volume for early detection of CIN after PCI.This article has a related Erratum
The Sub-Analysis of HFmrEF and HFrEF Group in CORE-HF Registry : When being Good is Not Enough
Get PDFBackground : As the prevalence of heart failure (HF) kept rising each year, the burden caused by it also escalating, especially in terms of economic burden. This is urging the physician to quickly tackle the problem. Although HFrEF medications were developing vastly, the outcome of HF in real world still varies. This indicates another approach is still needed to manage HFrEF/HFmrEF comprehensively. This paper is aimed to give an overview of HFrEF and HFmrEF epidemiological data, based on CORE-HF real world data.
Methods : The CORE-HF is a single-center, prospective-cohort registry, which enrolls all patients with chronic HF, that were recruited consecutively from the outpatient Sebelas Maret HF Clinic. Both enrollment and follow-up have been performed since January 2018 until December 2022. Variables recorded consists of baseline characteristics, risk factors, subjective indicators, objective diagnostic assessments, therapies, and outcomes (readmission and mortality).
Results : The population of this registry was younger (58.7 ± 12.14) compared to other HF registries, with more multi comorbidities. The number of HFrEF patient was higher than HFmrEF (77.7% vs 22.3%), with clinically higher mortality rate (7.2% in the 1st year and 18.2% in the next year). Although triple therapy initiation and uptitration were excellent in number, the mortality rate during second year of follow-up was higher than other registries. We found non-compliant behavior to be responsible for those results.
Conclusion : Based on CORE-HF sub-analysis of the HFrEF and HFmrEF groups, adherence to HF guidelines is the main but not the only key leading to lower mortality and rehospitalization. Our data provide satisfying low hard outcomes, but solving the non-compliance behavior and optimizing the non-pharmacological approach should be done comprehensively by the HF team.This article has a related Erratum
Rare Case of Ventricular Standstill and High-Grade AV Block in Patient with Thyrotoxicosis
No full textBackground Stokes-Adams Syndrome can be caused by high-grade AV Block, ventricular tachycardia, and one of the uncommon cause, ventricular standstill. Although thyrotoxicosis is commonly presented as tachycardia, it’s unusual for AV blocks to occur, especially a high-grade one.
Case Illustration A 45-year-old female was admitted with fatigue, dizziness, and recurrent episodes of unconsciousness. She had a history of hyperthyroid, routinely managed with Propylthiouracil and Propranolol. Physical examination showed HR: 30 x/min, and other unremarkable systemic examinations. Initial ECG showed 3:1 AV Block. Patient was managed with Dopamin and moved to ICU for further observation. In the ICU, suddenly she had a Stokes-Adam episode presented as a seizure, her monitor showing P waves with an absence of ventricular activity lasting for few seconds. Due to the condition of ventricular standstill, a Temporary Pacemaker (TPM) was installed urgently, and so patient’s vital sign was stable with pacing rhythm. We found Free Thyroxine (T4) level of 46.85 pmol/l, TSH of 0.005 ulU/ml, and unremarkable echocardiographic findings. Considering these results, we suspect that the cause of the ventricular standstill was due to thyrotoxicosis. Propylthiouracil and dexamethasone were given to manage the disease. After 7 days of treatment, she was discharged with sinus rhythm on her ECG. Conclusion Ventricular standstill is frequently associated with conduction blockages, but it can sometimes occur without them. Ventricular standstill treatment often necessitates the use of temporary pacing wires or a pacemaker. In thyroid crises, high-degree AV-block is uncommon, but when the euthyroid condition is restored, clinical status and conduction problems can be reversible.This article has a related Erratum.Latar belakang Sindroma Stokes-Adams dapat disebabkan oleh AV Blok derajat tinggi, takikardia ventrikel, dan salah satu penyebab yang jarang ditemui, Ventricular Standstill. Meskipun tirotoksikosis biasanya muncul dalam bentuk takikardia, jarang ditemukan manifestasi berupa AV blok, terutama yang derajat tinggi. Ilustrasi Kasus Seorang wanita berusia 45 tahun dirawat dengan keluhan cepat lelah, pusing, dan episode pingsan berulang. Dia memiliki riwayat hipertiroid, secara rutin ditangani dengan Propylthiouracil dan Propranolol.Pemeriksaan fisik menunjukkan denyut jantung 30 x/menit, dan pemeriksaan sistemik lain dalam batas normal. EKG awal menunjukkan AV Block 3:1. Pasien dikelola dengan Dopamin dan dipindahkan ke ICU untuk observasi lebih lanjut. Di ICU, tiba-tiba pasien mengalami episode Stokes-Adam dalam bentuk kejang, monitor menunjukkan gelombang P dan tidak didapatkan aktivitas ventrikel yang berlangsung selama beberapa detik. Karena kondisi tersebut, Alat Pacu Jantung Sementara segera dipasang, sehingga tanda vital pasien stabil dengan ritme pacing. Kami menemukan kadar Free Thyroxine (T4) 46,85 pmol/l, TSH 0,005 ulU/ml, dan temuan ekokardiografi dalam batas normal. Mempertimbangkan hasil yang ada, kami menduga bahwa penyebab dari Ventricular Standstill adalah tirotoksikosis. Propiltiourasil dan deksametason diberikan untuk mengatasi penyakit ini. Setelah 7 hari perawatan, dia dipulangkan dengan irama sinus pada EKG-nya. Kesimpulan Ventricular Standstill sering dikaitkan dengan penyumbatan konduksi, tetapi terkadang dapat terjadi tanpa adanya penyumbatan. Perawatan henti jantung sering kali mengharuskan penggunaan pacu jantung sementara atau alat pacu jantung transkutan. Pada krisis tiroid, blok AV derajat tinggi jarang terjadi, tetapi ketika kondisi eutiroid dipulihkan, status klinis dan masalah konduksi dapat bersifat reversibel