Indonesian Journal of Cardiology
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Does Chronic Inflammation Play a Role in Rheumatic Mitral Valve Restenosis after Percutaneous Transvenous Mitral Commissurotomy?
Get PDF In “Does Chronic Inflammation Play a Role in Rheumatic Mitral Valve Restenosis after Percutaneous
Transvenous Mitral Commissurotomy?” (Indonesian Journal of Cardiology, 43(3), 101-107. https://doi.
org/10.30701/ijc.1398), 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.1398. 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.139
C-Reactive Protein to Albumin Ratio Predict In-Hospital and Long-term Outcome of ST-Segment-Elevation Myocardial Infarction Patients with SARS-CoV2 Infection Underwent Fibrinolytic Therapy.
Get PDFIn “C-Reactive Protein to Albumin Ratio Predict In-Hospital and Long-term Outcome of ST-Segment-Elevation Myocardial Infarction Patients with SARS-CoV2 Infection Underwent Fibrinolytic Therapy” (Indonesian Journal of Cardiology, 43(2), 64-76. https://doi.org/10.30701/ijc.1305), 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.1305. 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.130
Cardiogenic Shock
Get PDFIn “Cardiogenic Shock” (Indonesian Journal of Cardiology, 43(2), 90-9. https://doi.org/10.30701/ijc.1505), there are an errors 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.1505. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.
An error also appears in the affiliations section. In the original article, the affiliations were incorrectly listed as:[1] Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada - Sardjito General Hospital, Yogyakarta[2] Faculty of Medicine, Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta[3] Faculty of Medicine, Universitas Sumatera Utara - Adam Malik General Hospital, Medan[4] Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta
The affiliations have been corrected to:[1] Department of Cardiology and Vacular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada - Sardjito General Hospital, Yogyakarta, Indonesia[2] Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia[3] Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sumatera Utara - Adam Malik General Hospital, Medan, Indonesia[4] Cardiology Research Office, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
The publisher apologizes for any inconvenience caused by this error.
DOI of original article: https://doi.org/10.30701/ijc.150
Mexiletine in the treatment of LQT2, LQT3, and acquired LQTS: a meta-analysis
Get PDFBackground: High mortality in patients with Long QT Syndrome (LQTS) can be reduced with proper treatment. Gene-specific therapy is crucial, as many treatments are not equally effective across different LQTS types. While mexiletine has been established in the treatment of LQT3, its use in other types of LQT need further evaluation.
Methods: A meta-analysis was conducted using systematic electronic searches of PubMed, Embase, and Cochrane Library. We assessed QTc reduction and cardiac events after Mexiletine treatment. Inclusion criteria: any study with no language restriction that diagnoses any type of LQTS, uses mexiletine treatment, and provides QTc comparison before and after treatment. Animal studies were excluded. The NIH Study Quality Assessment Tools and Newcastle-Ottawa Scale were used to evaluate bias. Data were analyzed using Review Manager 5.4 and MedCalc software
Results: Nine studies (n=281) were included. Mexiletine reduced QTc by -64ms (mean difference [MD], -64.22; 95% confidence interval [CI] -76.13 to -52.30; p<.001; I2 60%). Sensitivity and subanalyses showed consistent efficacy. In five studies (n=76), the number of patient with high-risk QTc (>500ms) significantly decreased (Risk Ratio [RR], 0.38; 95% CI 0.26-0.55; p<.001). Five studies (n=141) showed a significant reduction in cardiac events (RR, 0.25; 95% CI 0.14-0.44; p<.001). Two studies reported gastrointestinal (GI) problems and vertigo as side effects of mexiletine treatment.
Conclusion: Mexiletine significantly reduces QTc and cardiac events in LQT2, LQT3, and aLQT patients. Mexiletine also significantly reduces the number of Long QT patients with high-risk QTc
Funding: No external funding was received for this study
Registration: CRD42025065257
2023 Indonesian Guidelines for Heart Failure Treatment: Working Group on Heart Failure and Cardiometabolic Diseases, Indonesian Heart Association
Get PDFHeart failure is a health problem with high mortality and morbidity rates in developed and developing countries such as Indonesia. The prevalence of heart failure itself is increasing because patients who experience acute heart failure can progress to chronic heart failure. Guidelines-Directed Medical Therapy (GDMT) with recommended doses is still underutilized in heart failure patients with reduced ejection fraction (HFrEF). In Indonesia itself, even though it has a fairly high rate of use of ACE-inhibitors (ACE-I) or angiotensin receptor blockers (ARB), Indonesia has the lowest rate of use of β-blockers and aldosterone inhibitors (also called Mineralocorticoid Receptor Antagonists, MRA) of the entire ASIAN-HF registry.84
Therefore, the writing of this guideline was carried out as an effort to provide practical guidance regarding the diagnosis, assessment and management of acute and chronic heart failure. Thus, it is hoped that efforts can be made to prevent the increase in prevalence and reduce the number of rehospitalization with complete management.
This book was written as an update to the 2020 Guideline for the Management of Heart Failure: Indonesian Heart Association. The sources of our updates came from many references and literatures carried out by each contributor and reviewed by EBM team
Longitudinal Strain Assessment Of Myocardial Dysfunction In Covid-19 Patients: Correlating Clinical Symptoms And Laboratory Results At Admission And Four Months Post-Treatment
Get PDFBackground: Myocardial dysfunction is increasingly recognized as a complication of COVID-19 infection, with implications for patient prognosis and long-term cardiovascular health. Longitudinal strain, measured via echocardiography, is a sensitive marker of myocardial function that may provide valuable insights into cardiac involvement in COVID-19 patients. This study aimed to assess myocardial dysfunction using longitudinal strain analysis in COVID-19 patients, correlating clinical symptoms and laboratory results at admission and four months post-treatment.
Methods : This study compared clinical and laboratory parameters in COVID-19 patients post-recovery with and without myocardial dysfunction. Adult COVID-19 survivors were included if they were hospitalized and met certain criteria. Independent variables included clinical factors and laboratory factors at admission, while the dependent variable was myocardial dysfunction assessed through longitudinal strain of the left and right ventricles on speckle tracking echocardiography. The study was conducted at the Harapan Kita Heart and Blood Vessel Center (RSJPDHK - FKUI)/Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta.
Results: This study examined the cardiovascular health of 162 participants three months after getting infected with COVID-19. Those with comorbidities had the lowest LV GLS levels. Admission factors like obesity, SpO2, and PaO2 levels were linked to decreased LV GLS levels. These findings suggest that these admission factors may predict the progression of COVID-19 syndrome and its implications on cardiovascular health.
Conclusion: COVID-19 patients with cardiovascular comorbidities have lower LV-GLS values. CAD status during admission affects LV GLS values 3-6 months after COVID-19 infection, indicating myocardial dysfunction. Basal lateral LV-GLS correlates with obesity status, SpO2, and PaO2 during admission. Closely monitor COVID-19 patients with cardiovascular comorbidities and recognize the implications of CAD status on myocardial function post-infection.
 
Protokol Latihan BEST yang Disesuaikan dalam Rehabilitasi Gagal Jantung
No full textIntroduction
Heart failure with a reduced ejection fraction (HFrEF) significantly contributes to global morbidity and mortality, necessitating effective rehabilitation programs. Exercise-based rehabilitation improves functional capacity and quality of life in HFrEF patients, though responses vary. The tailored BEST (Breathing, Endurance, and Strengthening) exercise protocol addresses both cardiac and extracardiac rehabilitation, benefiting all patients regardless of response status. This study evaluated the protocol's effects on HFrEF patients and classified responses based on VO2max changes.
Methods
In this etiologic study with prospective cohort design, all participants underwent a three-month cardiac rehabilitation program using the BEST Exercise Protocol. Assessments included the 6-minute walk test (6MWT), short physical performance battery (SPPB), handgrip strength, chest expansion, ultrasonographic measurements, and NT-proBNP levels before and after the intervention, with statistical comparisons made within and between groups. Groupings of responder level will be reliant on 6MWT distance achievement at the end of the program, with ≥6% improvement classified as good responders.
Results
Out of 107 HFrEF patients (median age 55 years, ejection fraction 29.50±7.34%), 63.56% were good responders and 36.44% were poor responders (<6% improvement). Good responders showed significant improvements in most extracardiac parameters, including a 20% increase in 6MWT distance (470.96±69.21 meters post-rehabilitation), chest expansion, handgrip strength, and SPPB scores (p<0.001 for all). Poor responders also improved in chest expansion, sit-to-stand time, and postural balance, with minor 6MWT gains (407.33±72.50 meters). NT-proBNP levels decreased in both groups but were not statistically significant (p=0.288 and 0.368 for good and poor responders, respectively).
Conclusion
The tailored BEST Exercise Protocol offers substantial cardiac and extracardiac benefits for HFrEF patients by enhancing functional capacity and muscle strength. Both good and poor responders exhibited significant improvements, indicating the protocol's broad applicability. However, the lack of statistically significant NT-proBNP reduction suggests further studies on cardiac biomarkers are needed. The 6MWT provides accessible rehabilitation insights, though more precise evaluations like Cardiopulmonary Exercise Testing (CPET) can offer clearer insights into cardiopulmonary adaptations.Pendahuluan
Gagal jantung dengan fraksi ejeksi yang berkurang (HFrEF) secara signifikan berkontribusi pada morbiditas dan mortalitas global, sehingga memerlukan program rehabilitasi yang efektif. Rehabilitasi berbasis latihan meningkatkan kapasitas fungsional dan kualitas hidup pada pasien HFrEF, meskipun responsnya bervariasi. Protokol latihan BEST (Breathing, Endurance, and Strengthening) yang disesuaikan menangani rehabilitasi kardiak dan ekstrakardiak, memberikan manfaat bagi semua pasien terlepas dari status responnya. Studi ini mengevaluasi efek protokol tersebut pada pasien HFrEF dan mengklasifikasikan respons berdasarkan perubahan VO2max.
Metode
Dalam studi etiologis dengan desain kohort prospektif ini, semua peserta menjalani program rehabilitasi jantung selama tiga bulan menggunakan Protokol Latihan BEST. Penilaian meliputi 6 minute walking test (6MWT), short physical performance battery (SPPB), kekuatan genggaman tangan, ekspansi dada, pengukuran ultrasonografi, dan kadar NT-proBNP sebelum dan sesudah intervensi, dengan perbandingan statistik dilakukan dalam dan antar kelompok. Pengelompokan tingkat responden didasarkan pada pencapaian jarak 6MWT di akhir program, dengan peningkatan ≥6% diklasifikasikan sebagai responden baik.
Hasil
Dari 107 pasien HFrEF (usia median 55 tahun, fraksi ejeksi 29,50±7,34%), 63,56% merupakan responden baik dan 36,44% responden kurang baik (<6% peningkatan). Responden baik menunjukkan peningkatan signifikan pada sebagian besar parameter ekstrakardiak, termasuk peningkatan jarak 6MWT sebesar 20% (470,96±69,21 meter pasca-rehabilitasi), ekspansi dada, kekuatan genggaman tangan, dan skor SPPB (p<0,001 untuk semua). Responden kurang baik juga mengalami peningkatan pada ekspansi dada, waktu duduk-berdiri, dan keseimbangan postural, meskipun peningkatan 6MWT lebih kecil (407,33±72,50 meter). Kadar NT-proBNP menurun pada kedua kelompok namun tidak signifikan secara statistik (p=0,288 dan 0,368 untuk responden baik dan kurang baik, secara berturut-turut).
Kesimpulan
Protokol Latihan BEST yang disesuaikan memberikan manfaat substansial pada aspek kardiak dan ekstrakardiak bagi pasien HFrEF dengan meningkatkan kapasitas fungsional dan kekuatan otot. Baik responden baik maupun kurang baik menunjukkan peningkatan yang signifikan, menunjukkan penerapan protokol yang luas. Namun, tidak adanya penurunan signifikan pada kadar NT-proBNP menunjukkan perlunya studi lebih lanjut mengenai biomarker kardiak. Tes 6MWT memberikan wawasan rehabilitasi yang dapat diakses, meskipun evaluasi yang lebih presisi seperti Cardiopulmonary Exercise Testing (CPET) dapat memberikan pemahaman yang lebih jelas tentang adaptasi kardiopulmoner
Faktor Risiko Pneumonia Paska Operasi Bedah Pintas Arteri Koroner
No full textBackground: Postoperative pneumonia (POP) is a common infectious complication of coronary artery bypass grafting (CABG), leading to significant morbidity, mortality, and increased healthcare costs. This study found that the prevalence of POP was nearly double that reported in previous studies, underscoring the urgent need to identify specific risk factors. These findings emphasize the importance of local data in refining preventive strategies and improving clinical outcomes in CABG patients.
Material and Methods: This is a retrospective cohort study. The subjects comprised patients who underwent CABG procedures at a single institution between June 2020 and June 2024. A logistic regression analysis model for evaluating the risk of POP was established.
Results: This study observed a POP rate of 41.7%, significantly exceeding the 2–24% range reported in previous studies. Key risk factors included elevated creatinine levels, eGFR <60 ml/min/1.73 m², and low early postoperative albumin. POP strongly correlated with prolonged hospitalization, with an odds ratio of 13.043 (95% CI: 6.130–27.751, p < 0.0001), underscoring its substantial impact on patient outcomes.
Conclusions: The present study delineates renal impairment and hypoalbuminemia postoperative as pivotal risk factors for POP following CABG. It emphasizes the importance of tailored interventions, structured institutional practices, and continuous research to enhance preventive strategies and patient outcomes.Latar Belakang: Pneumonia pascaoperasi (POP) merupakan komplikasi infeksi umum dari Bedah Pintas Arteri Koroner (BPAK), yang menyebabkan morbiditas, mortalitas, dan peningkatan biaya perawatan kesehatan yang signifikan. Studi ini menemukan bahwa prevalensi POP hampir dua kali lipat dari yang dilaporkan dalam studi sebelumnya, yang menggarisbawahi kebutuhan mendesak untuk mengidentifikasi faktor risiko spesifik. Temuan ini menekankan pentingnya data lokal dalam menyempurnakan strategi pencegahan dan meningkatkan hasil klinis pada pasien BPAK.
Materi dan Metode: Ini adalah studi kohort retrospektif. Subjek terdiri dari pasien yang menjalani prosedur BPAK di satu institusi antara Juni 2020 dan Juni 2024. Model analisis regresi logistik untuk mengevaluasi risiko POP telah ditetapkan.
Hasil: Studi ini mendapatkan tingkat kejadian pneumonia paska operasi (Posoperative Pneumonia/ POP) sebesar 41,7%, lebih tinggi dibandingkan kejadian yang dilaporkan dalam studi sebelumnya (2–24%). Faktor risiko utama meliputi peningkatan kadar kreatinin, eGFR <60 ml/menit/1,73 m², dan albumin paskaoperasi yang rendah. POP berkorelasi kuat dengan lama rawat inap, dengan OR 13,043 (95% CI: 6,130–27,751, p < 0,0001), menggambarkan dampak substansialnya pada pasien.
Kesimpulan: Penelitian saat ini menggambarkan gangguan ginjal dan hipoalbuminemia paskaoperasi sebagai faktor risiko penting untuk kejadian POP setelah BPAK. Penelitian ini menekankan pentingnya intervensi per individual, praktik kelembagaan yang terstruktur, dan penelitian berkelanjutan untuk meningkatkan strategi pencegahan dan luaran pasien
Collagen-Based Hydrogel Encapsulated Cardiosphere-Derived Cell (CDC): Potential of Stem Cells as Tissue Repair Therapy Post-Acute Myocardial Infarction
Get PDFAcute myocardial infarction (AMI) is a global health issue that is the leading cause of morbidity and mortality. Post-AMI management currently has therapeutic and side effect limitations, and has not been able to repair damage to myocardial tissue caused by AMI. The development and discovery of therapeutic modalities with the potential for a more optimal therapeutic effect remains a challenge in this post-AMI treatment. The purpose of this literature review is to collect and analyze various sources related to collagen-based hydrogel encapsulated cardiosphere-derived cell (CDC). This literature review is written systematically by gathering library sources from various search engines, such as Google Scholar, PubMed, and Research Gate. According to the findings of the study, CDC has the potential to be used as a post-AMI therapy because it can promote regeneration of the heart, which has lost function as a result of the AMI. To achieve the greatest effect, this modality is administered intracoronary. This modality will be encapsulated with collagen hydrogel, which has a cardioprotective effect, in order to increase the survival and effectiveness of CDC. The use of collagen-based hydrogel encapsulated CDC can provide post-AMI cell regeneration effects comparable to existing modalities while having minimal side effects. Further investigation in larger and more definitive trials is needed to elucidate the potential use of CDC therapy in AMI.Infark miokard akut (IMA) merupakan masalah kesehatan global yang menjadi penyebab utama morbiditas dan mortalitas. Penatalaksanaan pasca IMA saat ini memiliki keterbatasan terapi dan efek samping, serta belum mampu memperbaiki kerusakan jaringan miokard akibat IMA. Pengembangan dan penemuan modalitas terapeutik dengan potensi efek terapeutik yang lebih optimal tetap menjadi tantangan dalam pengobatan pasca-IMA ini. Tujuan dari tinjauan pustaka ini adalah untuk mengumpulkan dan menganalisis berbagai sumber yang terkait dengan cardiosphere-derived cell (CDC) yang terenkapsulasi hidrogel berbasis kolagen. Tinjauan pustaka ini ditulis secara sistematis dengan mengumpulkan sumber pustaka dari berbagai mesin pencari, seperti Google Scholar, PubMed, dan Research Gate. Menurut temuan penelitian, CDC berpotensi untuk digunakan sebagai terapi pasca-IMA karena dapat mendorong regenerasi jantung, yang telah kehilangan fungsi akibat AMI. Untuk mencapai efek maksimal, modalitas ini diberikan secara intrakoroner. Modalitas ini akan dienkapsulasi dengan kolagen hidrogel, yang memiliki efek kardioprotektif, untuk meningkatkan kelangsungan hidup dan efektivitas CDC. Penggunaan CDC yang dienkapsulasi hidrogel berbasis kolagen dapat memberikan efek regenerasi sel pasca-IMA yang sebanding dengan modalitas yang ada dengan efek samping yang minimal
Outcome Analysis and Determinants of Major Adverse Cardiac Events in Young Adults After Coronary Artery Bypass Graft Surgery Who Participated in Early Phase II Cardiac Rehabilitation Program: A single-centre study
Get PDFBackground: Cardiac rehabilitation (CR) program is proven to reduce mortality risk after coronary artery bypass surgery (CABG). Our study aimed to investigate the determinants of survival in young adult patients after CABG.
Method: This was a single-centre, longitudinal study with a survival analysis method from MACE of consecutive patients under 55 years old who underwent CABG and participated in the early phase II CR program between January 2017 and December 2018. The major adverse cardiac events (MACE) rates were determined over a 2-year follow-up time. Cox regression and Kaplan-Meier analysis were used to determine the predictors of the events based on the data registry.
Result: 279 patients who fulfilled the inclusion criteria were recruited in this study. MACE happened to 23 (8.45%) of them (3 patients died, 20 patients were hospitalised). Patients who dropped out (12%) from the CR program had a higher risk of developing events (HR 3.86, 95% CI 1.36-10.99). Of those who completed the CR program (245 patients), beta-blocker usage, chronotropic index, resting heart rate, and functional capacity after the CR program independently correlated with MACE. Six-minute walk distance (6-MWD) 376 meters was a significant predictor (p=0.001), with a shorter mean survival time of 6 months.
Conclusion: The early phase II CR program after CABG in young adult patients reduced the risk for cardiovascular mortality, major adverse events, and related readmission. It also increased the survival rate and mean survival time for participants who completed the CR program compared to dropouts. Optimum beta blocker medication, chronotropic index, resting heart rate, and functional capacity after the CR program are essential predictors of survival after CABG in young adults