Indonesian Journal of Cardiology
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Original Articles
Get PDFAbstracts of the 5th InaPrevent in Conjunction with the 1st InTension Summit, 25-27 June 202
Correlation Of Left Ventricular Ejection Fraction And Spatial QRS-T Angle In Old Myocardial Infarct Patient
No full textObjective: Spatial QRS-T angle (the angle between the QRS and T vectors) is a strong independent predictor of cardiovascular death. Spatial QRS-T angle calculations can be obtained from the ECG 12 lead with Kors visual transform applications closest to Frank lead system. Half of patients with coronary artery disease (CAD) died from sudden cardiac death (SCD) with Left Ventricular Ejection Fraction (LVEF) as a predictor. The aim of this study was to correlate spatial QRS-T with LVEF in patients with old myocardial infarction (OMI).
Methods: This is a cross-sectional study in patients with OMI that have not undergone revascularization and have achieved medical therapy. 12-lead electrocardiography (ECG) and echocardiography were done simultaneously. Spatial QRS-T angle was measured by Kors visual transform applications. Statistical analysis was performed using Pearson correlation and multivariate analysis with linear regression.
Results: 46 patients meet the inclusion criteria. Baseline characteristics: mean age 58 ± 8 years, 89% male, mean spatial QRS-T was 108.72 ± 43° with mean LVEF 39.39 ± 10%. The spatial QRS-T angle and LVEF was strong negative correlation (r=-0.66, p<0.01) after adjusted with left ventricular mass index (LVMI) correlation between spatial QRS-T angle and LVEF decreasing (r=-0.57, p<0.01). The Spatial QRS-T angle and LVEF of patients with OMI is negative correlation.
Conclusion: The spatial QRS-T angle and LVEF of patients with OMI had negative correlation. Spatial QRS-T angle may be an easier index for assessing cardiac dysfunction in patients with OMI.
 
Echocardiography Detection of High-Risk Patent Foramen Ovale Morphology
No full textPatent Foramen Ovale occurs in 25% of the general population1. Several studies suggested that paradoxical embolism through a patent foramen ovale (PFO) correlate with cryptogenic strokes (CS). Many epidemiological and clinical observational studies, showed the association between CS and the presence of PFO. There is still a controversy whether PFO should be closed. The information about PFO morphology might be useful for the management of PFO. This article is discussing a technical information about how echocardiography detects PFO and identifies high risk morphologies for the occurrence of PFO related -stroke
Very Large Atrial Septal Defect Device Closure: Feasibility and Safety
No full textObjectives: There is limited data regarding feasibility and safety of very large ASD devices deployment. Percutaneous closure of very large atrial septal defect (ASD) is a valid alternative to surgical approach. But complications like erosion, cardiac perforation, atrioventricular block, pericardial effusion, infective endocarditis, or cardiac arrhythmias may occur following ASD device closure.
Methods: Forty four patients with very large ostium secundum ASD were studied in a tertiary medical centre. Adult patients with defect size of 38 mm or more and device size of 40 mm or more were selected for device closure. Patients having suitable anatomy, significant left to right shunt(>1.5:1) ,right ventricular volume overload and without significant pulmonary arterial hypertension were chosen for device closure.
Results : There were thirty six female patients and eight male patients in our study. Majority of our patients (twenty four) were in forty to fifty years age group. Device could be deployed successfully in forty two (95.5%). Twelve patients had device size of 46 mm (27%). Eight patients had 44 mm devices(18%). Forty two millimeter devices were used in sixteen patients (36%). Eight patients had device size of 40 mm(18%).Device embolization occurred in two patients. There were two cases of pericardial effusion and pericardiocentesis was needed in one patients. Transient complete heart block was seen in one patient. Four patients had suffered from transient and self terminating atrial arrhythmias. There was no mortality or erosion in our study.
Conclusion: Percutaneous closure of very large ASD is feasible and associated with low complication rat
Case Reports
Get PDFAbstracts of the 5th InaPrevent in Conjunction with the 1st InTension Summit, 25-27 June 202
The de Winter Pattern as Pre-Anterior ST-Elevation-Myocardial-Infarction: An Evolution Sequence
No full textIntroduction: The de Winter pattern (dWP) was first described by de Winter and colleagues in 2008 as static pattern associated with anterior myocardial infarction. A recent study showed the evolution sequence of this pattern into typical ST-elevation myocardial infarction (STEMI). This case discussed dWP who present as pre-anterior STEMI.
Case Illustration: A-56-year old Male arrived in the emergency room complained chest pain about 3 hours. The patient also complained of diaphoresis, nausea, and fatigue. The patient has a previous history of hypertension. The vital signs were stable with an unremarkable physical examination. The initial electrocardiogram (ECG) revealed sinus rhythm with j-point depression followed by prominent T wave in precordial leads, slight ST-segment elevation in aVR, and loss of precordial R-wave progression. The initial-troponin-T was 31 pg/mL. Follow-up 1-hour after initial ECG showed typical ST-segment-elevation in V1-V4. The patient undergoing thrombolytic, followed by angiography that showed subtotal occlusion in the proximal left anterior descending (LAD) artery, occlusion in the proximal circumflex artery and stenosis in proximal right coronary artery, echocardiography revealed regional wall motion abnormality in the septal and anterior segments and preserved ejection fraction 58%, the patient was discharged after 8-days treated in intensive cardiac care unit.
Conclusion: dWP has been shown as static and dynamic pattern in some conditions and associated with acute LAD occlusion. In this case, we showed dWP as early anterior STEMI, recognition of this pattern lead to early reperfusion and better myocardial salvage as anterior STEMI has a poor outcome
The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients
Get PDFBackground
Management of acute limb ischemia (ALI) is still a huge challenge. Current advances of endovascular therapeutic approach in management of ALI have decreased the overall amputation rate, nevertheless, mortality rate remains high which may be caused by metabolic consequences of reperfusion injury.
Aim
To understand the role of vitamin E to intra-hospital and 30-day mortality among acute limb ischemia patients.
Methods
This retrospective cohort study included all patients with ALI between 2015 to 2018. Vitamin E 2x400 mg orally for seven days was given based on physician preference after ALI diagnosis was confirmed. Data were collected from Vascular Registries of National Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Univariate analysis and logistic regression models were used to explore factors that contribute to intra-hospital and 30-day mortality.
Results
A total of 160 patients with ALI involving 192 limbs were admitted to our hospital. Mostly were male (63.1%) and mean age were 56±13 years old. Majority of the patients had unilateral lesion (80%), and were diagnosed with Rutherford stage IIA (36.3%), followed by stage IIB (33.8%), stage I (20%), and stage III (10%) respectively. Intra-hospital and 30-day mortality were 28.1% and 36.9%, respectively. Low treatment of vitamin E increased intra-hospital mortality (HR 5,6 95%CI 1.7-18.3), however, it did not affect 30-day mortality. Other factors including IABP insertion, arrhythmia, bleeding requiring transfusion and acute renal failure were associated with higher intra-hospital and 30-day mortality. In addition, menopause (HR 3.2; CI 1.16-8.85) was also a predictor of 30-day mortality.
Conclusion
Vitamin E administration reduced intra-hospital mortality but not on 30-day mortality in acute limb ischemia patients.
Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injur
Pulmonary Doppler Notch Pattern in Relation with Pulmonary Vascular Resistance Index in Patients with Atrial Septal Defect
Get PDFBackground: Atrial septal defect (ASD) potentially causes pulmonary hypertension (PH) and increased pulmonary vascular resistance (PVR). In previous studies, pulmonary Doppler notch was evident in patients with high PVR. There was a distinct notch pattern in different types of PH. This study aims to examine whether echocardiographic notch pattern could estimate PVR in secundum ASD patients.
Methods: Cross sectional study was conducted in secundum ASD patients ≥18 years old who underwent clinically indicated right heart catheterization. Association of notch presence and PVR index (PVRi) and correlation of notch ratio (NR), a parameter of notch location, and PVRi were analyzed. The best cut off of NR value was obtained using the receiver operating characteristics curve.
Results: Among 60 patients, the notch was present in 50 patients (83%) and significantly associated with PVRi ≥6 WU.m2 (p<0.0001). Notch ratio and PVRi had a moderate negative correlation (r=-0.410, p=0.003). Receiver operating characteristics curve with area under curve 0.709 showed that cutoff NR value of 1.635 was a good discriminator for PVRi ≥6 WU.m2, with 70% sensitivity, 70% specificity, 56.8% positive predictive value, and 14.9% negative predictive value. Patients were then classified into three groups of notch pattern based on its presence and location, which was significantly associated with PVRi (p<0.0001).
Conclusions: Pulmonary Doppler notch pattern is associated with PVRi in secundum ASD patients. This may be used clinically to estimate PVR to aid patient selection for further invasive investigation.
Keywords: atrial septal defect, Doppler echocardiography, notch, notch ratio, pulmonary vascular resistanc
English
No full textBackground: Residual pulmonary hypertension after mitral valve surgery predicts a worse prognosis. This study aimed to explore the effect of inspiratory muscle training on functional capacity and pulmonary artery pressure in patients with residual pulmonary hypertension after mitral valve surgery.
Methods: Forty-three patients with residual pulmonary hypertension soon after mitral valve repair or replacement surgery were consecutively enrolled in this randomised controlled trial. They were randomly allocated to either an intervention group (n=22) or a control group (n=21). Both groups participated in usual 10-12 sessions of supervised aerobic exercise training, with low to moderate intensity. The subjects in the intervention group participated in additional inspiratory muscle training using an incentive spirometer with a series of 10-12 inspiration repetitions of 50% of maximum inspiratory volume in each aerobic session. Echocardiography and the 6-minute walking test were performed before and after the programme.
Results: The patients were 70% female, mean age 43.5+/-13 years. Both groups had similar baseline characteristics. The systolic pulmonary artery pressure declined from 51(43-68) mmHg to 35 (29-39) mmHg, p<0.001 in intervention group, and from 46(43-55) mmHg to 43(40-51)mmHg, p<0.01 in control group. The reduction was higher in the intervention group than in the control group, 16 (12-30) vs 3.5 (2-4) mmHg respectively, p<0.001, and in patients with higher baseline systolic pulmonary artery pressure. The 6-minute walk test distance increased from 308(242-353) meters to 407(377-433) meter, p<0.01 in intervention group, and from 353(334-381) meter to 391(376-429) meter, p<0.01 in control group. The improvement was higher in the intervention group than in control group, 101 (93-131) vs 48 (35-53) meter respectively, p<0.001.
Conclusion: Adding inspiratory muscle training to a usual exercise programme resulted in faster recovery from residual pulmonary hypertension and higher increase in functional capacity
Patent Foramen Ovale and Cryptogenic Stroke: Challenges in Diagnosis and Management
No full textA patent foramen ovale (PFO) is a common disorder that affects between 20-34% of the adult population. This condition is a benign finding for most people. However, In some the PFO can open widely and enabling paradoxical embolism to transit from venous to arterial circulation, which is associated with stroke and systemic embolization. There are still unclear to date regarding the effectiveness of pharmacological anticoagulant therapy, defined as antithrombin or antiplatelet therapy, which has proven to be more beneficial for patients with PFO and cryptogenic stroke. In addition, surgical and transcutaneous PFO closure has been proposed for secondary prevention of stroke in patients with cryptogenic stroke with PFO. Both catheter-based and surgical modes of closure have been shown to reduce the incidence of subsequent embolism substantially. This review will discuss the evidence regarding the relationship between PFO and cryptogenic stroke and decision making for management strategies.Patent foramen ovale (PFO) adalah kelainan umum yang mempengaruhi antara 20-34% populasi orang dewasa. Kondisi ini tidak berbahaya bagi kebanyakan orang. Namun, beberapa PFO dapat terbuka lebar dan memungkinkan emboli paradoks untuk transit dari sirkulasi vena ke sirkulasi arteri, dan berhubungan dengan stroke dan embolisasi sistemik. Sampai saat ini efektivitas terapi farmakologis antikoagulan, didefinisikan sebagai terapi antitrombin atau antiplatelet, masih belum jelas terbukti mana yang lebih bermanfaat untuk pasien PFO dan stroke kriptogenik. Selain itu, penutupan PFO secara bedah dan transkutan telah diusulkan sebagai pencegahan sekunder pada pasien dengan stroke kriptogenik dengan PFO. Baik mode penutupan menggunakan kateter dan bedah telah terbukti mengurangi insiden emboli. Review artikel ini akan membahas mengenai hubungan antara PFO dan stroke kriptogenik dan pengambilan keputusan untuk strategi manajemen