Indonesian Journal of Cardiology
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Phrenic nerve stimulation as a novel therapeutic approach for heart failure with central sleep apnea: a systematic review
Get PDFIntroduction: Heart failure (HF) is a chronic condition associated with significant morbidity and mortality. Phrenic nerve stimulation (PNS) has emerged as a novel therapeutic approach aimed at improving outcomes in patients with heart failure, particularly those suffering from central sleep apnea (CSA).
Objectives: This study aims to evaluate the efficacy and safety of PNS in HF patients with CSA, especially its impact on reducing CSA severity and improving the apnea-hypopnea index (AHI) and left ventricular ejection fraction (LVEF).
Methods: A comprehensive search was conducted across multiple databases including Pubmed, Web of Science, Science Direct, and ProQuest, following PRISMA guidelines. The search strategy used the MeSH keywords (phrenic nerve stimulation) AND (heart failure). Inclusion criteria encompassed studies published in 2014 - 2023 that evaluated the effects of PNS on patients with HF and reported on relevant clinical outcomes. After a thorough screening process, five studies were identified as relevant and included in the review. Data extraction and quality assessment were independently conducted by three reviewers, with results synthesized using a systematic approach. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The research protocol was registered at PROSPERO (ID: CRD42024604614).
Results: The studies reviewed demonstrated that PNS significantly reduces the central apnea index (CAI), AHI and improves sleep quality in heart failure patients. Moreover, improvements in LVEF and reductions in heart failure-related hospitalizations were observed. Patient satisfaction was generally high, and adverse events were minimal, suggesting that PNS is a safe and effective treatment option for HF patients especially those suffering from CSA.
Conclusion: Phrenic nerve stimulation presents a promising therapeutic option for improving cardiac and sleep outcomes in heart failure patients. Further large-scale, randomized controlled trials are warranted to establish the long-term efficacy and safety of PNS in this population. 
The Sub-Analysis of HFmrEF and HFrEF Group in CORE-HF Registry : When being Good is Not Enough
Get PDFIn “The Sub-Analysis of HFmrEF and HFrEF Group in CORE-HF Registry: When being Good is Not Enough” (Indonesian Journal of Cardiology, 44(1), 10-6. https://doi.org/10.30701/ijc.1545), 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.1545. 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.DOI of original article: https://doi.org/10.30701/ijc.154
When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT
Get PDFIn “When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT” (Indonesian Journal of Cardiology, 43(1), 30-6. https://doi.org/10.30701/ijc.1197), 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.1197. 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.DOI of original article: https://doi.org/10.30701/ijc.119
Comparison of right ventricular global longitudinal strain between pacemaker lead position in patients with permanent pacemaker
Get PDFBackground: The implantation of a permanent pacemaker (PPM) can reduce right ventricular function. Echocardiography using speckle tracking can detect a decreasing in right ventricular function earlier. The value of right ventricular global longitudinal strain (RVGLS) based on the location of the pacemaker lead between the apex and non-apex was currently unknown, although the placement of the correct pacemaker lead location was very important for evaluating right ventricular dysfunction to prevent right heart failure. This study aims to determined the comparison of RVGLS between pacemaker lead position in patients with permanent pacemaker.
Methods: This study was a nested case-control study to assess the comparison of RVGLS between pacemaker lead position in patients with permanent pacemaker, who were divided into the right ventricular apex group (RVA) and the non-right ventricular apex group (NRVA). This study used data from the pacemaker registry and medical records of patients who had undergone pacemaker implantation since June 2021. The shapiro-wilk normality test was performed before analyzing all numerical data, followed by an independent t-test or Mann-Whitney test to determine the differences between groups.
Results: In this study, there were 38 patients with permanent pacemakers, consisting of 18 samples with RVA group and 20 samples with NRVA group. In this study, no significant differences were found in age, sex, diagnosis, comorbidities, therapy, pacemaker mode, baseline QRS duration, pacing burden, puncture site, and initial echocardiography between of two groups. There was a significant difference in paced QRS duration between the RVA and RVNA groups (160 + 20 ms vs 140 + 28 ms, p=0.024). Based on statistical analysis, there was a significant difference in the value of RVGLS in the RVA group compared to the RVNA group (-14.87+4.48% vs -18.40+3.21%, p=0.015).
Conclusion: The position of the apex right ventricular lead resulted in a lower value of RVGLS compared to the position of the non-apex right ventricular lead
Dyslipidemia management among patients with high and very high cardiovascular risk in Indonesia: a multi-center registry
Get PDFBackground
Indonesia, the world's largest archipelago, faces significant challenges in equitable healthcare delivery due to its geographical and infrastructural disparities. Atherosclerotic Cardiovascular Disease (ASCVD) remains the leading cause of mortality, with over 659,000 deaths recorded in 2019. Effective dyslipidemia management is crucial for preventing adverse ASCVD events. Unfortunately, the lack of implementation of an updated national lipid management registry might hinder optimal strategy for the adverse events. This study evaluated dyslipidemia cholesterol management practices among high- and very high-risk patients across the country.
Methods
The study recruited 322 patients from eight centers across six provinces in Indonesia between May 2022 and March 2023. Patients were stratified based on the ASCVD risk and followed over three visits. Baseline clinical characteristics, lipid profiles, and treatment regimens were analyzed. Descriptive statistics summarized continuous and categorical variables, and low-density lipoprotein cholesterol (LDL-C) achievement was assessed.
Results
Of the 322 patients, 98.8% were very high-risk, with only 4.9% achieving <55 mg/dL and 21.2% achieving <70 mg/dL. Moderate-intensity statins were the most prescribed (51.2%), followed by high-intensity (36.6%). LDL-C reduction was most pronounced in private insurance patients, achieving a mean LDL-C of 69.8 mg/dL at the third visit compared to 98.9 mg/dL in National Health Insurance (Jaminan Kesehatan Nasional/JKN) participants. Missed visit rates increased over time, with 57.5% of patients missing the third visit, predominantly among JKN participants and low-income groups.
Conclusion
Majority of the population failed to achieve the recommended target of LDL-C levels. Dyslipidemia management in Indonesia remains suboptimal, with disparities driven by socioeconomic factors. Improved policies addressing medication availability, national lipid registry establishment, and equitable healthcare access are essential to enhance lipid management and reduce the burden of ASCVD in Indonesia.Latar Belakang Indonesia, negara kepulauan terbesar di dunia, menghadapi tantangan signifikan dalam penyediaan layanan kesehatan yang adil karena disparitas geografis dan infrastruktur. Penyakit Kardiovaskular Aterosklerotik (ASCVD) tetap menjadi penyebab kematian utama, dengan lebih dari 659.000 kematian tercatat pada tahun 2019. Pengelolaan dislipidemia yang efektif sangat penting untuk mencegah kejadian buruk ASCVD. Sayangnya, kurangnya implementasi registri pengelolaan lipid nasional yang diperbarui mungkin menghambat strategi optimal untuk kejadian buruk tersebut. Penelitian ini mengevaluasi praktik pengelolaan kolesterol dislipidemia di antara pasien berisiko tinggi dan sangat tinggi di seluruh negeri.
Metode Penelitian ini merekrut 322 pasien dari delapan pusat di enam provinsi di Indonesia antara Mei 2022 dan Maret 2023. Pasien dikelompokkan berdasarkan risiko ASCVD dan diikuti selama tiga kunjungan. Karakteristik klinis dasar, profil lipid, dan regimen pengobatan dianalisis. Statistik deskriptif merangkum variabel kontinu dan kategorikal, serta pencapaian kolesterol lipoprotein densitas rendah (LDL-C) dinilai.
Hasil Dari 322 pasien, 98,8% termasuk dalam kategori berisiko sangat tinggi, dengan hanya 4,9% mencapai <55 mg/dL dan 21,2% mencapai <70 mg/dL. Statin intensitas sedang paling banyak diresepkan (51,2%), diikuti oleh intensitas tinggi (36,6%). Penurunan LDL-C paling signifikan pada pasien dengan asuransi swasta, mencapai rata-rata LDL-C 69,8 mg/dL pada kunjungan ketiga dibandingkan 98,9 mg/dL pada peserta Asuransi Kesehatan Nasional (Jaminan Kesehatan Nasional/JKN). Tingkat kunjungan yang terlewat meningkat seiring waktu, dengan 57,5% pasien melewatkan kunjungan ketiga, terutama di kalangan peserta JKN dan kelompok berpenghasilan rendah.
Kesimpulan Mayoritas populasi gagal mencapai target tingkat LDL-C yang direkomendasikan. Pengelolaan dislipidemia di Indonesia tetap suboptimal, dengan disparitas yang didorong oleh faktor sosial-ekonomi. Kebijakan yang lebih baik untuk mengatasi ketersediaan obat, pendirian registri lipid nasional, dan akses layanan kesehatan yang adil sangat penting untuk meningkatkan pengelolaan lipid dan mengurangi beban ASCVD di Indonesia
Percutaneus Transluminal Angioplasty Using Carbon Dioxide Contrast in Chronic Limb Threatening Ischemia patient with Renal Failure
Get PDFBackground:
At the present times, it is estimated that more than 202 million patients suffer from peripheral arterial disease (PAD) worldwide. Chronic limb-threatening ischemia (CLTI) represents the end stage of PAD often need lower extremity amputation, and the aftermath can be worse. For the patient with CLTI and chronic renal disease (CKD) who need endovascular therapy, iodinated contrast may enhance the risk of contrast-induced nephropathy (CIN). CIN is an acute renal injury and may lead to irreversible loss of renal function. In high-risk patients who were allergic to iodinated contrast material and for those with renal insufficiency Hawkins in the 1970s pioneered the intra-arterial application of carbon dioxide (CO2) gas angiography to reduce the volume use of iodinated contrast.
Case Illustration:
Single case was presented in this report. An 80-years old man referred to National Cardiovascular Center Harapan Kita with the chief complaint of independent rest pain and non healing wound in his left forefinger, in accordance with the criteria CLTI. The duplex ultrasound examination shows total occlusion at left anterior tibialis artery. The patient then undergone percutaneous transluminal angioplasty (PTA) procedure using Carbon Dioxide (CO2) contrast agent and using Plain Old Balloon Angioplasty (POBA) technique for revascularization. The flow to the distal of left anterior tibialis artery returned using only 30 ml of Iodinated contrast. The follow up of this patient shows there is no increase of serum creatinine level and eGFR
Summary:
Endovascular therapy in patient with CLTI with high risk of operation could be performed in patient with CKD using the carbon dioxide contrast agent in order to minimize the usage of iodinated contrast avoiding further loss of renal function. In this case report, the procedure has performed successfully without increase in serum creatinine and decrease of GFR.
Keywords: CLTI, Carbondioxide Contrast, Endovascular Therap
Beneath the Rhythm: Deciphering the Subtle Perforation of the Right Ventricle by a Pacemaker Lead
Get PDFCardiac perforation by the lead of permanent pacemaker implantation (PPM) devices is a critical complication that often occurs within 24 hours after the implantation but can occur later. Here we report a case of 82-year-old female patient with perforation of the right ventricular wall due to RV lead after 3 months of pacemaker implantation, which was managed conservatively
Non-surgical intervention for palliative treatment in Late-presentation Tetralogy of Fallot (TOF): Is there any hope?
Get PDFBackground: Late congenital heart disease (CHD) in patients with tetralogy of Fallot (TOF). Due to the variable severity of defects in patients with TOF, late presentation of CHD may only be discovered beyond the neonatal period. Chronic polycythemia from TOF may increase the risk of hemorrhaging during surgery and patients with untreated TOF risk developing CHD-related pulmonary hypertension. Non-surgical transcatheter palliation in patients with TOF may be applied; however, the efficacy and safety of the method remained very scarce. Therefore, we report two cases of late-presenting TOF treated with non-surgical transcatheter palliation due to high perioperative risks for surgical repair of the defects.
Case Illustration: A 41-year-old (Case 1) and 19-year-old man (Case 2) were admitted to the emergency room due to chief complaint of dyspnea and severe headache with previous history of hypoxic spell, respectively. Both patients had presented with signs of right ventricular hypertrophy and cardiomegaly from physical examination. Echocardiography had confirmed TOF in both cases. Non-surgical palliation for both cases were performed with right ventricular outflow tract (RVOT) stenting and balloon pulmonary valvuloplasty (BPV), respectively. Both patients had shown clinical and systolic function improvement after both interventions.
Conclusion: Late-presentation TOF may present with major comorbidities that contraindicates definitive repair of the defects due to high perioperative risk. Palliative interventions in late-presentation TOF may be considered as a bridging procedure prior to the definitive repair to minimize the risk of complications from untreated TOF beyond neonatal period.
 
PERBANDINGAN SKOR HARKIT DENGAN SKOR SOCIETY OF THORACIC SURGEONS (STS) DALAM MEMPREDIKSI TINGKAT MORTALITAS PASIEN PASKA OPERASI KATUP DI RUMAH SAKIT UMUM PUSAT HAJI ADAM MALIK MEDAN
No full textBackground: Valvular heart disease is a major contributor to increased mortality. The HARKIT score has been validated to predict mortality after specific valve surgery and the STS score to predict mortality rates in patients after cardiac surgery. Haji Adam Malik General Hospital Medan has never used the HARKIT score and the STS score to predict mortality in patients with post valve surgery.
Methods: A cross-sectional study from January 2022-April 2023 at Haji Adam Malik General Hospital Medan. The data used is obtained from patient medical record who had heart valve surgery. The data were analyzed with descriptive statistics and presented the form of frequency distribution. Comparison of the HARKIT score with the STS score to predict mortality rates were analyzed using chi-square test.
Results: Among 63 patients who underwent valve surgery, 8 patients died after surgery. The HARKIT score system has good analytical power and very strong discriminant (H-L test P=0.646; AUC=0.916; 95% CI=0.794-1.000), while the STS score has poor analytical power (H-L test P=0.002) but has moderate discriminant (AUC=0.798; 95% CI=0.632-0.964).
Conclusion: The HARKIT score is more accurate than the STS score in predicting the mortality rate of post-valve surgery patients at Haji Adam Malik General Hospital Medan
Antiphospholipid Syndrome Manifesting as Myocardial Infarction: A Case Report and Review of the Literature
Get PDFBackground: Antiphospholipid syndrome (APS) is characterized by the presence of antiphospholipid antibodies, including lupus anticoagulant, anticardiolipin antibodies, and β2-glycoprotein I. These antibodies target phospholipids and associated proteins, leading to diverse clinical manifestations such as stroke, myocardial infarction, and deep vein thrombosis. Acute myocardial infarction caused by arterial thromboembolism is a rare first manifestation of APS.
Case summary: We present a case study of a 37-year-old female with a suspicious history of Deep Vein Thrombosis (DVT) with no identifiable risk factors a decade ago and recently suffered a sudden Myocardial Infarction (MI) due to arterial Thrombosis. Angiographic appearance and Angioplasty were challenging at the presentation time since the clot was migratory and moved between coronary vessels. We conducted a Thrombophilia evaluation due to the unusual site of Thrombosis and the patient's age at the presentation, which led us to establish the diagnosis of antiphospholipid syndrome (APS)
Brief conclusion: Different anticoagulation regimes are suggested depending on whether an APS patient has an arterial or venous thrombosis. According to the clinical situations, there may be potential therapeutic challenges. Patients with APS are required to maintain lifelong oral anticoagulation with vitamin K antagonists. Meanwhile, Non-vitamin K Oral Anticoagulants (NOACs) are under investigation as potential future treatments for APS.