Indonesian Journal of Cardiology
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Effect of Remote Ischemic Postconditioning on miRNA-145 and Troponin I levels in STEMI patients undergoing primary percutaneous coronary intervention
Get PDFBackground: Primary Percutaneous Coronary Intervention Procedure (PPCI) results in reperfusion injury which will result in more extensive infarction. Remote Ischemic Postconditioning (RIPC) is a protective strategy to reduce the increase in the area of infarction. miRNA-145 also plays a role in the protective effect of IPC and RIPC.
Research Methods: This study uses a pre and post test approach only with control group design with experimental research designs. Data is taken at the Integrated Heart Services Installation RSUP Dr. M. Djamil Padang from July to November 2019, 40 patients with ST-segment elevation myocardial infarction (STEMI) performed RIPC. Bivariate analysis was performed to determine differences in levels of miRNA-145 and troponin I in STEMI patients underwent PPCI with and without RIPC using the Wilcoxon test and the Mann Whitney test.
Results:A total of 40 patients who underwent the PPCI procedure were divided into two groups PPCI + RIPC (n = 20) and PPCI without RIPC (n = 20). There were no significant differences in the basic characteristics between the two groups. There were no significant difference in escalation of median expression of miRNA-145 in PPCI+ RIPC [pre test 36.33 (27.44-52.39), post test 34.83 (27.65-65.26), p = 0.765] compared to PPCI without RIPC [pre test 31.66 (26.31-43.28), post test 33.43 (26.83-64.97), p = 0.765]. There were an increase in median troponin I levels in both groups, PPCI+ RIPC [pretest 4,104.70 (67.30-40,000.00), post test 30,448.50 (120.00-16.3192.20), p = 0.001] and PPCI without RIPC [pretest 826.50 (17.00-48.259.00), post test 42.784.50 (2,119.00-162.897.00), p = <0.001].
Conclusion:There were no significant difference in median expression of miRNA-145 in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC. There were a significant difference in median levels of troponin I in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC.
Keywords: Remote Ischemic Postconditioning, miRNA-145, troponin
Detection and Management of Myocarditis and Fulminant Myocarditis
Get PDFMyocarditis is commonly caused due to systemic viral infection with cardiotropic nature. In the acute phase, this disorder could cause lethal hemodynamic or arrhythmic disorders. Newest studies showed that the use of guideline-directed medical care in the care of myocarditis will lead to better outcomes. This condition varies in presentation ranging from mild to life-threatening such as cardiogenic shock. With the current advances in early detection and circulatory support using extracorporeal membrane oxygenation (ECMO), myocarditis could be managed very well. Cases of myocarditis related to COVID 19 has been reported, however as per this time there has no confirmed pathological evidence regarding direct causation between COVID19 and myocarditis, however, in these severely ill patients, elevations in cardiac biomarkers (cTn, BNP and NTproBNP) occurs, and the administration of immunosuppressant could increase the chance of remission.
Keyword: Myocarditis, fulminant, COVID 19.Miokarditis umumnya terjadi akibat infeksi sistemik dari virus yang bersifat kardiotropik. Pada kondisi miokarditis akut ini dapat menyebabkan gangguan hemodinamik atau aritmia letal. Studi terbaru menunjukkan tatalaksana miokarditis terkait penyebab ditambah dengan “guideline directed medical care” akan memberi keluaran yang baik. Presentasi klinis miokarditis beragam dari yang tidak terlalu berat sampai dengan syok kardiogenik. Dengan perkembangan terapi saat ini, bantuan sirkulasi extracorporeal membrane oxygenation (ECMO) dan deteksi dini miokarditis fulminan, maka miokarditis dapat tertangani dengan baik. Dugaan miokarditis fulminan pada COVID-19 telah dilaporkan pada beberapa laporan kasus namun belum ada bukti patologi yang telah terkonfirmasi dari spesimen miokard adanya keterlibatan virus pada miokarditis COVID-19. Pada kasus dengan gambaran critical ill didapatkan tanda dan bukti peningkatan biomarker kerusakan miokard (cTn) dan peningkatan biomarker akibat stress dinding ventrikel kiri (BNP atau NTproBNP). Pada beberapa kasus, pemberian imunosupresan dan monitoring yang baik dapat meningkatkan peluang remisi.
Kata kunci : Miokarditis, fulminan, COVID 1
Improvement of exercise capacity after early phase II cardiac rehabilitation in patients who undergo rheumatic mitral valve surgery
Get PDFBackground: Rheumatic heart disease still become a major concern in developing countries. Recent studies showed the benefits of early phase II cardiac rehabilitation (CR) on improving the exercise capacity but the evidence in patients after rheumatic mitral valve surgery due to rheumatic heart disease is limited. This study aims to investigate the effects of early phase II CR program on increasing exercise capacity in the rheumatic mitral valve surgery patients.
Methods: This is a cohort retrospective study. A review of medical records identified 254 patients who underwent early phase II CR after rheumatic mitral valve surgery between July 2009 – June 2019. Effects of CR was assessed by 6 Minutes Walking Distance (6MWD) pre and post early phase II CR and peak oxygen uptake (VO2 peak) calculated by Cahallin formula. In this study, we observed and analyzed the increasing of 6MWD and VO2 peak.
Results: Our findings showed that 6MWD and VO2 peak increased significantly in these patients after early phase II CR program (p = 0.001). Mean of 6MWD increased from 316.3 ± 71.7 meters to 378.6 ± 60.3 meters and VO2 peak increased from 7.7 ±2.4 mL/kg/min to 8.9 ± 2.2 mL/kg/min. The mean difference of 6MWD was 62.3 meters and VO2 peak was 1.2 mL/kg/min. There was a strong correlation between VO2 peak and 6MWD (r = 71%; R2 = 51%; p = 0.001).
Conclusion: Early phase II CR in patients with Rheumatic Mitral Stenosis after mitral valve surgery improved the exercise capacity. Based on 6MWD, we can predict the value of VO2 peak patients with rheumatic mitral stenosis surgery patients.
Keywords: Cardiac rehabilitation, rheumatic mitral stenosis, 6MWD, VO2 pea
Case Reports
Get PDFAbstracts of the 29th Annual Scientific Meeting of the Indonesian Heart Association (ASMIHA)
1st ASMIHA Digital Conference, 23-25 October 202
Case Reports
Get PDFAbstracts of the 12th Indonesian Society of Interventional Cardiology Annual Meeting (ISICAM) 2020
27-29 November 202
Cardiovascular Complications In COVID 19 Infection
Get PDFSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) yang dikenal dengan COVID-19 adalah penyakit yang baru dan telah menyebar dengan cepat dari Wuhan (provinsi Hubei) ke provinsi lain di Cina dan seluruh dunia termasuk Indonesia. Secara umum, COVID-19 adalah penyakit akut yang bisa sembuh tetapi juga mematikan, dengan case fatality rate (CFR) sebesar 4%. Spektrum klinis pneumonia COVID-19 berkisar dari kondisi ringan sampai dengan berat. COVID 19 diduga memiliki risiko potensiasi proses patofisiologi terhadap timbulnya komplikasi kardiak, dan telah diketahui bahwa mekanisme penyakit kardiovaskular serupa dengan mekanisme jalur imunologi. Penyakit kardiovaskular adalah komorbid terbanyak pada pasien COVID 19, SARS, dan MERS. Prevalensi diabetes mellitus (DM) dan penyakit kardiovaskular pada SARS adalah 11% dan 8% dan membawa angka kematian meningkat 2 kali lipat. Pada kasus COVID 19, komorbid penyakit kardiovaskular lebih banyak menunjukkan kasus yang berat. Bagaimana mekanisme komorbid ini memperburuk keluaran pasien masih tidak jelas, namun beberapa hipotesisnya antara lain usia lanjut, gangguan sistem imun, peningkatan kadar ACE2 atau mungkin ada hubungan antara COVID 19 dengan penyakit kardiovaskular. Tinjauan pustaka ini akan menjelaskan berbagai gangguan kardiovaskular yang mungkin terjadi pada infeksi COVID 19 secara lebih mendalam.
 
Incidence and outcome of no flow after primary percutaneous coronary intervention in acute myocardial infarction
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Background: Mechanical revascularization of the infarct-related artery (IRA)
is the most effective treatment modality in ST-segment elevation myocardial
infarction (STEMI).No flow occurs in ∼8.8-10% of cases of primary
percutaneous coronary intervention(PCI) in STEMI patients. Our aim was to study
actual incidence and outcome of no flow patients.
Methods: Five hundred and eighty primary PCI patients
were studied over a period of two years i.e. January 2016 to December 2017.
Drug eluting stents were used in all cases. Majority of our patients(>90%) came 6
hours after onset of chest pain. There were many patients where there was
no flow even after mechanical thrombus aspiration and pharmacological
vasodilator therapy. We have studied primary outcome(mortality) of no flow in
those patients.
Results: There were 44 cases of no flow in our
series(7.75%). Left anterior descending artery(LAD )was involved in eighteen
patients. Right coronary artery(RCA) was culprit in twenty four cases. Only
two cases were seen in LCX territory. One month mortality rate in no flow group
was 50% and 6.25% in successful recanalization group. One year mortality was
12.5% in successful recanalization group and 66% in no flow group.
Conclusion: Refractory no flow during primary PCI in STEMI is associated
with high mortality and morbidity. There is no established strategy to solve
this phenomenon.
 
A Significant Addition of Left Ventricular Fractional Shortening to Ejection Fraction correlated with Global Longitudinal Strain Value in Predicting Major Acute Cardiovascular Event in patients with Acute Coronary Syndrome
Get PDFBackground: Global longitudinal strain (GLS) was a proven predictor of systolic function improvement and myocardial remodeling after acute coronary syndrome (ACS) for a residual left ventricular function defined their prognosis. However, not all echocardiography devices are equipped by speckle tracking (STE) as compare to the availability of M-mode modality which capable on assessing fractional shortening (FS) instead.
Methods: This study evaluated clinical and echocardiography parameters on myocardial infarction (MI) and non-MI ACS patients. Clinical outcome was defined as composite major acute cardiovascular event (MACE) on 6 months of follow up.
Results: Over 145 patients, GLS>-9.4% was found to be an independent predictor of MACE despite of troponin, age, ejection fraction (EF), prior reperfusion and infarct location [(HR 5.89 (1.82-16.51)]. There is negative correlation between FS and GLS (Spearman r -0,717; p<0,01). By using logistic regression analyses, it was found that the addition of FS<25% to biplane Simpson EF<50% could be useful to rule in the presence of GLS>-9.4% (AUC 0.831).
Conclusion: GLS had a prognostic value in patients with ACS. Left ventricular conventional M-mode FS in addition to Simpson EF were well correlated with GLS as well they can be considered as an alternative in predicting the incident of MACE in patient with ACS.
Keywords: global longitudinal strain, prognostic, fractional shortening, acute coronary syndromeLatar belakang: Global longitudinal strain (GLS) secara signifikan terbukti dapat digunakan sebagai prediktor perbaikan fungsi sistolik dan remodeling miokard pada pasien dengan sindroma koroner akut (SKA), dimana fungsi sistolik residual dari ventrikel kiri akan sangat mempengaruhi prognosis pasien. Namun, tidak semua alat ekokardiografi memiliki modalitas speckle tracking (STE) dibandingkan dengan ketersediaan modalitas M-mode yang dapat menghitung Fractional Shortening (FS).
Metode: Penelitian ini mengevaluasi parameter klinis dan ekokardiografis ventrikel kiri pada pasien SKA dengan atau tanpa infark. Perjalanan klinis pasien akan dinilai ada tidaknya kejadian kardiovaskular mayor akut (KKVM) dalam waktu 6 bulan.
Hasil: Dari 145 pasien, nilai GLS>-9.4% didapatkan signifikan sebagai prediktor KKVM dan independen terhadap status troponin, umur, fraksi ejeksi, tindakan reperfusi, dan lokasi infark [(HR 5.89 (1.82-16.51)]. Terdapat korelasi negatif yang baik antara FS dan GLS (Spearman r -0,717; p<0,01). Dengan menggunakan analisa regresi logistik, didapati bahwa penambahan parameter FS <25% terhadap EF Simpson<50% dapat digunakan untuk menginklusikan pasien dengan nilai GLS>-9.4% (AUC 0.858).
Kesimpulan: GLS memiliki nilai prognostik pada pasien SKA. Nilai FS ventrikel kiri konvensional yang didapatkan dari M-mode, jika ditambahkan pada EF Simpson, memiliki korelasi yang baik dengan GLS, sehingga dapat dipertimbangkan sebagai parameter alternatif yang dapat memprediksi KKVM pada pasien SKA
Kata kunci: global longitudinal strain, prognosis, fractional shortening, sindroma koroner aku
English
No full textBackground: Coronary collateral circulation (CCC) is linked to myocardial remodeling severity in patients with chronic ischaemic heart disease (IHD). However its effect on left ventricular reverse remodeling (LVRR) in patients with chronic IHD underwent coronary artery bypass surgery (CABG) has never been reported. Purpose of this study was to investigate the effect of CCC grade on the LVRR event in patients with chronic IHD underwent CABG.
Methods: This prospective cohort study was performed in patients with chronic IHD underwent CABG. The CCC was classified using Rentrop collateral score, i.e low CCC grade (Rentrop score 0 and 1) and high CCC grade (Rentrop score 2 and 3). LVRR event was defined as a reduction in left ventricular end systolic volume (LVESV) of 10% or more, measured by a 3D echocardiography at 1.5 months post CABG compared to the baseline before CABG.
Results: A total of 22 patients (81.8% male) with mean of age 58.6 years old were enrolled. LVRR occurred in 50% patients. LVRR event was significantly higher in the patients with high CCC grade than the low CCC grade patients (p=0.009). The high CCC grade increased LVRR event independently (odds ratio=26.67; relative risk=6.93).
Conclusions: High coronary collateral circulation may increase left ventricular reverse remodeling event in patients with chronic ischemic heart disease underwent coronary artery bypass surgery.
Keywords: coronary collateral circulation; left ventricular reverse remodeling; chronic ischaemic heart disease; coronary artery bypass surgery; 3D echocardiography
Effect of Exercise Duration Toward Heart Rate Recovery in Elderly
Get PDFBackground: Age-related change in autonomic nerves covers parasympathetic function decrease that hampers heart rate (HR) control. The effective attempt to improve autonomic nervous function for elderly is routine exercise, however exercise duration among elderly is not always standardized. This study is aimed to compare the effect of different exercise duration to post-exercise Heart Rate Recovery (HRR) between two elderly groups with the same frequency, intensity, type criteria of routine exercise.
Method: Method was cross-sectional study which compared exercise duration of standardized group (3x90 minutes/week) and unstandardized group (3x30 minutes/week). Group 1 was elders with standardized duration from Healthy Heart Club and Group 2 was elders who take unstandardized duration from Elderly Home in Bandung city. Each group consisted of 43 elders and data were collected in July-August 2019. After one hour of medium intensity exercise, all respondents were examined for resting HR (HRrest), maximum HR (HRmax), one minute post-exercise HR, and four minutes post-exercise HR. HRR was obtained by subtracting HRmax by one minute post-exercise HR and normal if > 12 bpm. Analysis data was done by SPSS with Mann-Whitney U Test, Fisher Chi Square and Logistic regression.
Result: Most of respondents were 60-69 years old and female. Respondents in unstandardized group were more low education, hypertension and smoking. The HRrest of both groups was categorized as normal but increased greater (30x/min) in standardized group. The result showed a significant difference in comparation of median HRR (p=0.001) and number of normal and abnormal HRR (p=0.001) between both groups. Gender, smoking and standardized duration of exercise associated with abnormality of HRR, elders who take unstandardized duration have 12.7 times risk to get abnormal HRR.
Conclusion: Routine exercise for elderly is recommended in standardized duration with minimal 150 minutes per week in order to increase post-exercise HRR.Almatsier S, Soetardjo S SS. Gizi Seimbang Dalam Dasar Kehidupan. Jakarta: PT. Gramedia Pustaka Utama; 2011.
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