Indonesian Journal of Cardiology
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Simple Scoring System for Predicting In-Hospital Mortality after Heart Valve Surgery in A Developing Country
Get PDFBackground: Various scoring systems predict mortality after cardiac surgery, but not many were designed for specific valvular surgery. Developing countries have different characteristics of patients and conditions in cardiac centers compare to developed countries. We aimed to develop a simple scoring system for predicting in-hospital mortality after valve surgery and further validate the scoring system.
Methods: For developing the scoring system, the data was taken from the medical record of patient underwent valve surgery in 2012 - 2014, and for the validation study, it was from 2015 to 2016. The scoring system was developed using logistic regression models, then validated using calibration and discrimination analysis.
Result: For developing a scoring system, we recruited 1040 patients in the study. The in-hospital mortality rate was 68 (6.5%). Eight variables were incorporated, including; functional class, hypertension, previous open-heart surgery, impaired renal function, right ventricular dysfunction, emergent operation, coronary artery bypass surgery, and tricuspid valve surgery. The mortality risk score has Hosmer Lemeshow (H-L) test p-value = 0.212; AUC = 0.813 (CI 95% = 0.758–0.867); and cut-off point of 5, predicting 14% risk of death (sensitivity 72.1%, specificity 75.3%). In the validation study, 789 subjects were recruited. The observed and predicted mortality were 8.6% and 11.9% respectively, with H-L test p-value = 0.169 and AUC 0.761 (95% CI; 0.702-0.821)
Conclusion: We have developed a simple scoring system for predicting in-hospital mortality after valve surgery. The mortality risk score was well-calibrated with a moderate discrimination value in the validation study
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No full textBackground: Immediate reperfusion is the key of ST Elevation Myocardial Infarction (STEMI) Management. Despite the superiority of primary percutaneous coronary intervention (PCI), fibrinolytic therapy is still the preferred choice in many settings because of their availability and easy resources. Assessment of successful fibrinolytic determines the next strategy, ST-segment resolution (STR) correlates well with TIMI flow, reflects myocardial perfusion, and has a better prognostic value. T Peak – T End (Tpe) interval is proposed to be a valuable tool for reperfusion marker as it measures the transmural dispersion of repolarization (TDR) which can be an additional myocardial perfusion assessment. This study aims to see whether the Tpe interval reduction can be a marker of the successful reperfusion in patients with STEMI treated with fibrinolytic.
Methods : This cross-sectional study involved STEMI patients underwent fibrinolytic therapy. Tpe interval was measured at admission and 90 minutes after fibrinolytic, then the changes in the form of difference (ms) and resolution (%) were assessed and compared between successful and failed reperfusion groups according to STR.
Results: Among total of 86 patients, there were 53 patients (61.2%) with successful reperfusion. Tpe interval reduction was greater in the successful reperfusion group. The value of Tpe difference in predicting STR ³ 50% had a sensitivity of 66% and specificity of 75.8% with an area under curve (AUC) of 0.726 and a cut-off point of 20 ms. While the AUC of Tpe resolution 0.726 with a cut-off point of 16.2%, had a sensitivity of 66% and a specificity of 72.7%.
Conclusion: The Tpe interval reduction can be a valuable additional marker of successful reperfusion in patients with STEMI treated with fibrinolytic.
 
Case Reports
Get PDF8th Annual Scientific Meeting of the Indonesian Heart Rhythm Society 2021
Abstracts: Case Report
Insiden gejala menetap dan gambaran ekokardiografi pasca infensi COVID-19 ringan
No full textBackground:Survived from COVID-19 infection, some patients yet have residual symptoms. Multi-organ and mechanisms of disease can be involved. The data regarding echocardiographic dimension and function of the cardiac in the COVID-19 survivors remains scarce.
Method:This was a descriptive cross-sectional study that involves a total of 63 subjects. Subjects were employees and medical residents at National Cardiovascular Center Harapan Kita, who previously get infected by COVID-19. Each subject was examined transthoracic echocardiography once at the time of recruitment. Echocardiographic parameters obtained in this study included dimension and systolic function of the left ventricle and right ventricle, global longitudinal strain by 2D speckle tracking echocardiography, and myocardial work index.
Result:More than a half of the subjects experienced persistent symptoms after recovery from COVID-19 infection and mainly was fatigue (33.3%). The timing of data acquisition on the median was 32 days after the negative of the COVID-19 test result. 2D echocardiography measurement of left ventricle indicated mean of end-diastolic diameter and end-systolic diameter was 45 mm and 27 mm, respectively. The mean ejection fraction (EF) of the left ventricle by Simpson’s biplane method was 61%. The median of tricuspid annular plane systolic excursion (TAPSE) parameter was 23 mm and the fractional area change (FAC) parameter was 39%. The mean of global longitudinal strain (GLS) was -19.6%.
Conclusion:After recovery from COVID-19 infection, some survivors may have post-acute infectious consequences of COVID-19 such as fatigue, dyspnea, and malaise. However, echocardiographic findings in those patients with mild symptoms, including 2D echocardiography, myocardial strain analysis, and myocardial work index, indicate normal dimension and systolic function in both left ventricle and right ventricle.This article has a related Erratum
Reviews
No full text8th Annual Scientific Meeting of the Indonesian Heart Rhythm Society 2021
Abstracts: Review
Ratio C-Reactive Protein Terhadap Albumin Dalam Memprediksi Lauren Rumah Sakit Dan Jangka Panjang Pasien STEMI Dengan Infeksi SARS-CoV2 Yang Menjalani Terapi Fibrinolitik
No full textBackground: The choice of reperfusion therapy in STEMI patients with COVID-19 is unclear. CRP to Albumin ratio (CAR) found to be a predictor of thrombus burden. This study was to determine the relationship and predictive value of CAR to in-hospital and long-term outcome of STEMI patients with COVID-19 treated with fibrinolytic.
Methods: 297 COVID-19 patients with STEMI underwent fibrinolytic were enrolled. In-hospital outcomes were in-hospital mortality due to cardiovascular death which was divided into mortality <48 hours and >48 hours, fibrinolytic failure, and cardiogenic shock. The presence of reinfarction post fibrinolytic and mortality after the patient discharged was assessed as the long-term outcome.
Results: During follow-up, 19.8% experienced in-hospital mortality and 16.1% had reinfarction. In the in-hospital outcome, patients with in-hospital death, failed fibrinolytic and cardiogenic shock had higher CAR (6.7+2.4 vs 4.7+1.9; 6.3+1.9 vs 2.1+1.6; 5.5+2.1vs1.8+1.5) with all p-value <0.05. CAR with an optimal cut-off >4.46 can be a predictor of fibrinolytic failure with sensitivity of 86.7% and specificity of 93.6% (PR19.82; 95%CI 10.32-38.06) and predictor of in-hospital death <48 hours with sensitivity of 84.6% and specificity of 82.7% (PR5.02; 95%CI 3.20-7.90). In the long-term outcome, patients who experienced reinfarction and out-hospital death had higher CAR (5.1+1.2vs2.5+2.4; 5.2+1.3vs2.6+2.4) than those who did not experience the event respectively with all p-value <0.05. CAR with an optimal cut-off >3.67 can be predictor of reinfarction with sensitivity of 87.5% and specificity of 73.5% (PR12.250; 95%CI 5.38-27.87). The Cox regression model showing CAR >3.67 was also associated with higher reinfarction event (p=0.001).
Conclusion: CAR has the potential to be a predictor of in-hospital and long-term outcomes for STEMI patients with COVID-19 which can help determine which patients need more invasive strategy to prevent mortality and morbidity.
This article has a related Erratum.Latar Belakang: Pemilihan terapi reperfusi pada pasien STEMI dengan COVID-19 masih belum jelas. Rasio CRP terhadap Albumin (CAR) ditemukan sebagai prediktor beban trombus. Penelitian ini bertujuan untuk mengetahui hubungan dan nilai prediktif CAR terhadap outcome rawat inap dan jangka panjang pasien STEMI COVID-19 yang diobati dengan fibrinolitik.
Metode: 297 pasien COVID-19 dengan STEMI yang menjalani fibrinolitik terinklusi pada studi. Outcome di rumah sakit adalah mortalitas di rumah sakit akibat kematian kardiovaskular yang dibagi menjadi mortalitas <48 jam dan >48 jam, kegagalan fibrinolitik, dan syok kardiogenik. Kehadiran reinfarction pasca fibrinolitik dan kematian setelah pasien dipulangkan dinilai sebagai hasil jangka panjang.
Hasil: Selama masa tindak lanjut, 19,8% mengalami kematian di rumah sakit dan 16,1% mengalami reinfark. Dalam hasil di rumah sakit, pasien dengan kematian di rumah sakit, gagal fibrinolitik dan syok kardiogenik memiliki CAR yang lebih tinggi (6,7+2.4 vs 4.7+1.9; 6.3+1.9 vs 2.1+1.6; 5.5+2.1vs1.8+1.5) dengan semua nilai p < 0,05. CAR dengan cut-off optimal >4,46 dapat menjadi prediktor kegagalan fibrinolitik dengan sensitivitas 86,7% dan spesifisitas 93,6% (PR19,82; 95%CI 10,32-38,06) dan prediktor kematian di rumah sakit <48 jam dengan sensitivitas sebesar 84,6% dan spesifisitas 82,7% (PR5.02; 95%CI 3,20-7,90). Dalam hasil jangka panjang, pasien yang mengalami reinfark dan kematian di luar rumah sakit memiliki CAR lebih tinggi (5.1+1.2vs2.5+2.4; 5.2+1.3vs2.6+2.4) dibandingkan mereka yang tidak mengalami kejadian tersebut masing-masing dengan semua p -nilai <0,05. CAR dengan cut-off optimal >3,67 dapat menjadi prediktor reinfark dengan sensitivitas 87,5% dan spesifisitas 73,5% (PR12.250; 95%CI 5.38-27.87). Model regresi Cox yang menunjukkan CAR >3,67 juga dikaitkan dengan kejadian reinfark yang lebih tinggi (p=0,001).
Kesimpulan: CAR berpotensi menjadi prediktor hasil rawat inap dan jangka panjang pasien STEMI dengan COVID-19 yang dapat membantu menentukan pasien mana yang memerlukan strategi lebih invasif untuk mencegah mortalitas dan morbiditas
Review Articles
Get PDFIndonesian Society of Interventional Cardiology Annual Meeting 2021
Abstracts: Review Article
Research Articles
Get PDFAbstracts of the 31st Annual Scientific Meeting of the Indonesian Heart Association (ASMIHA) 202
Cardiogenic Shock
Get PDFCardiogenic shock (CS) is the most common cause of death in hospitalized patients with acute myocardial infarction (AMI). The incidence and mortality of CS in hospitals is also high, although advanced therapy is widely used in CS patients. CS is a condition characterized by inadequate cardiac output due to primary cardiovascular diseases, leading to clinical and biochemical manifestations of insufficient tissue perfusion. CS complicates 5–10% of AMI. STEMI increases the risk of CS approximately twice as much as NSTEMI. In the last 10 years, in-hospital mortality due to CS that occurs in AMI has not changed, that is at 40-50%. The pathophysiology of CS shows several overlaps and can occur simultaneously, that is starting with a cardiac insult that reduces cardiac output, central hemodynamic changes, microcirculatory dysfunction, systemic inflammatory response syndrome, and multi-organ dysfunction. CS classification based on SCAI, divided into 5, that’s A(at risk), B(beginning CS), C(classic CS), D(deteriorating), and E(extremis). The key to managing CS is treating the patient as soon as possible, as each higher SCAI shock stage was associated with increased hospital mortality. All patients with suspected ACS-associated CS should have an early invasive strategy with appropriate revascularization. Vasoactive medicines have the potential to improve hemodynamics but at the expense of increased myocardial oxygen consumption and arrhythmogenic risk. Mechanical circulatory support (MCS) has insufficient data as the first-line device solution for CS patients. However, the use of durable MCS devices in a bridge-to-bridge strategy is becoming more prevalent and is supported by clinical recommendations. APACHE-III and SAPS-II, had the best mortality discrimination values to assess the outcome in CS patients.Abstract: Cardiogenic shock (CS) is the most common cause of death in hospitalized patients with acute myocardial infarction (AMI). The incidence and mortality of CS in hospitals is also high, although advanced therapy is widely used in CS patients. CS is a condition characterized by inadequate cardiac output due to primary cardiovascular diseases, leading to clinical and biochemical manifestations of insufficient tissue perfusion. CS complicates 5–10% of AMI. STEMI increases the risk of CS approximately twice as much as NSTEMI. In the last 10 years, in-hospital mortality due to CS that occurs in AMI has not changed, that is at 40-50%. The pathophysiology of CS shows several overlaps and can occur simultaneously, that is starting with a cardiac insult that reduces cardiac output, central hemodynamic changes, microcirculatory dysfunction, systemic inflammatory response syndrome, and multi-organ dysfunction. CS classification based on SCAI, divided into 5, that’s A(at risk), B(beginning CS), C(classic CS), D(deteriorating), and E(extremis). The key to managing CS is treating the patient as soon as possible, as each higher SCAI shock stage was associated with increased hospital mortality. All patients with suspected ACS-associated CS should have an early invasive strategy with appropriate revascularization. Vasoactive medicines have the potential to improve hemodynamics but at the expense of increased myocardial oxygen consumption and arrhythmogenic risk. Mechanical circulatory support (MCS) has insufficient data as the first-line device solution for CS patients. However, the use of durable MCS devices in a bridge-to-bridge strategy is becoming more prevalent and is supported by clinical recommendations. APACHE-III and SAPS-II, had the best mortality discrimination values to assess the outcome in CS patients.
Keywords: cardiogenic shock, classification, heart failure, myocardial infarction, SCA