Heart Science Journal
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Are mechanical and electromechanical methods accurately interchangeable for measuring plasma prothrombin time and activated partial thromboplastin time? A comparative analysis study and potential implication to cardiovascular disease
Full text linkINTRODUCTION: The DT100 offers both optical and mechanical modes, with its mechanical mode showing better homogenization than the STAGO, but comparative study is limited.
OBJECTIVES: The study aimed to evaluate the diagnostic accuracy of plasma Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) measurements using the DT100 and STAGO instruments.
METHODS: Designated as a cross-sectional study, this study was conducted at RSUD Dr. Soetomo from October 2022 to January 2023. Venous blood samples with plasma citrate anticoagulant 0.109 M 3.2% were consecutively collected from hospitalized patients, and all samples underwent testing using both the DT100 in mechanical mode (DT100, TCoag Ireland Limited, Ireland) and the STAGO employing an electromechanical method (Compact Max3, STAGO, France). Statistical analysis included comparison using Paired t-test, Pearson correlation, and Bland-Altman analysis to assess agreement between the results obtained from the two instruments.
RESULTS: The study included 51 patients. PT levels were significantly lower with the DT100 compared to STAGO (MD: -2.0; 95%CI: (-2.30) – (-1.3); p<0.0001), and showed a strong positive correlation between methods (r:0.9535; p<0.0001). However, Bland-Altman analysis for PT showed a bias of 1.84, with limits of agreement (3.30-0.37), indicating systematic differences and variability. APTT levels were significantly higher with DT100 compared to STAGO (MD:3.60; 95%CI: 2.13–5.07; p<0.0001), with a moderate positive correlation (r:0.6690; p<0.0001). For APTT, bias of Bland-Altman analysis was -3.60, with limits ((-9.84) – (2.64)), suggesting significant discrepancies and variability between methods.
CONCLUSION: The study found significant variability in PT and APTT measurements between the DT100 and STAGO methods
Unveiling strategies in acute cardiac care for ventricular septal rupture following acute myocardial infarction: Lessons from cases
Full text linkBackground: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is drastically decreasing in the reperfusion era but mortality remains high. VSR correction is the definitive treatment and using mechanical support to delay closure is an attractive option despite data on success being limited.
Case Illustration: A 60-year-old man presented with late presentation of anterior STEMI complicating hemodynamic deterioration. Echocardiography showed apical VSR 11-14 mm L-R shunt. Patient was given adequate fluids, multiple inotropic agents, and IABP insertion, then a successful PPCI procedure was performed immediately. IABP was maintained for hemodynamic stabilization and patient was scheduled for interventional closure. Unfortunately, the patient worsened due to cardiogenic shock and passed away on the 5th day of admission.
In another case, a 61-year-old man came to our hospital also with a late presentation of anterior STEMI but stable in hemodynamics. Echocardiography showed apical VSR 9-11 mm L-R shunt. Coronary angiography showed CAD three vessel disease with critical stenosis at LAD. In hospital’s heart team discussion, patient was planned to be performed VSR closure percutaneously and continue with PCI procedure. Both procedures were performed successfully. Patient was improved and discharged on 20th day of admission.
Conclusion: Rapid diagnosis and prompt treatment are the keys to optimal management of VSR complicating late presentation STEMI. Mechanical circulatory support and correction of VSR are required to optimize patient outcomes despite VSR is still a challenging case
The influence of renal insufficiency on in-hospital major adverse cardiovascular events in STEMI patients receiving primary percutaneous coronary intervention
Full text linkIntroduction: Renal insufficiency (RI) is related to poor clinical results in STEMI patients receiving primary percutaneous coronary interventions (PCI).
Objectives: This study evaluates the effect of RI on in-hospital major adverse cardiovascular events (MACE) in STEMI patients receiving primary PCI.
Methods: The study was predicated on the registry of 1447 STEMI patients from January 2020–December 2023. Study samples were categorized into two groups: RI (eGFR<60mL/min/1.73m²) and no RI (eGFR≥60mL/min/1.73m²). Patients’ characteristics and in-hospital MACE in the two groups underwent analysis.
Results: Among 848 consecutive subjects, 238 (28%) had RI, and 610 (72%) had no RI. Age (p = 0.000), diabetes mellitus (p = 0.007), and onset STEMI>12 hours (0.043) were correlated with RI. Dyslipidemia (p = 0.025), Onset STEMI>12 hours (p = 0.006), and RI (p = 0.000) were correlated with MACE. RI was correlated with MACE (OR 2.04, 95% CI: 1.46–2.85, p = 0.000). RI was correlated with sub-group analysis of MACE; cardiogenic shock (OR 2.00, 95% CI: 1.34-2.99, p = 0.001), acute heart failure (OR 1.80, 95% CI: 1.22-2.65, p = 0.003), malignant arrhythmia (OR 2.40, 95% CI: 1.61-3.58, p = 0.000), and mortality (OR 2.74, 95% CI: 1.78-4.24, p = 0.000).
Conclusions: RI was correlated with in-hospital MACE in STEMI patients receiving primary PCI. In a sub-group analysis of in-hospital MACE, RI constituted a strong independent predictor of cardiogenic shock, acute heart failure, malignant arrhythmia, and mortality, respectively
The effect of exercise training as adjuvant treatment on mean pulmonary arterial pressure by echocardiography and functional capacity in congenital heart disease with negative vaso reactivity test pulmonary hypertension patient at Saiful Anwar Hospital Malang
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Background : PH is defined by mPAP >20 mmHg at rest. Exercise training enhances hemodynamics and exercise capacity in PH patients. Echocardiography is essential for assessing and evaluating PAP in PH cases.
Objective : This study aims to determine the effect of 12-weel exercise training on mPAP by echocardiography and functional capacity
Methods : A prospective cohort study at Saiful Anwar General Hospital (Sept 2024-Jan 2025) investigated exercise effects on mPAP and functional capacity in pulmonary hypertension patients. Participants were randomized to control (medication only) or treatment (medication plus exercise training) groups. Both underwent SMWT and echocardiography at baseline and after 12 weeks. Standardized exercise was monitored by healthcare experts.
Result : This study compared 12 non-vasoreactive PH patients receiving standard therapy to 12 undergoing exercise training. The treatment group showed a significant mPAP decrease (66.8 to 63.4 mmHg, p=0.006), while the control group\u27s reduction was non-significant (53.1 to 51.7 mmHg, p=0.061). Both groups improved 6MWT distances significantly after 12 weeks from 306.5 ± 72.7 meters to 318.3 ± 74.0 meters in the control group (p=0.041) and from 363.8 ± 63.6 meters to 382.9 ± 64.7 meters in the treatment group (p=0.000). No significant correlation was found between mPAP decrease and 6MWT increase in either group
Conclusion : This study demonstrates improvements in mPAP and functional capacity following exercise training as an adjunctive therapy. However, no correlation was observed between the enhancement in functional capacity and the reduction in mPAP.
Use of SAPS 3, APACHE IV, and GRACE as prognostic scores for acute coronary syndrome patients in the cardiovascular care unit
Full text linkA grading system based on disease severity has been widely used in intensive care units (ICUs) since around 1980. These systems are used to predict mortality and assess severity in clinical trials. Simplified Acute Physiology Score 3 (SAPS3) and Acute Physiology and Chronic Health Evaluation Score (APACHE IV) are prognosis ratings that can predict in-hospital mortality within the first hour of ICU care. Although these technologies have been widely employed in the ICU, they have yet to be commonly deployed in the cardiovascular care unit (CVCU) due to different patient populations. Intensive care doctors typically employ the standard prognostic
scores, SAPS3 and APACHE IV, which were generated from diverse populations of critically ill patients. Although these scores are the most widely used early versions, APACHE IV and SAPS 3 do not include acute coronary syndrome patients. The Global Registry of Acute Coronary Events (GRACE) score has performed the best; this may be because of its straightforward design, which does not distinguish between individuals with SCA and those without ST-segment elevation. Our review article attempts to evaluate the performance of standard predictor scores, namely SAPS 3, APACHE IV, and GRACE, on patients with cardiovascular emergencies. Thus, these score systems can precisely assess the relationship between mortality prediction scores and outcomes of patients admitted to the CVCU rapidly and comprehensively.
Analysis of activated clotting time in patients receiving unfractionated heparin with and without continuous infusion during elective percutaneous coronary intervention
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Background: Percutaneous coronary intervention (PCI) involves a risk of thrombotic events. Unfractionated heparin (UFH) remains a preferred antithrombotic agent during PCI, though the optimal administration method is still under debate. Given its narrow therapeutic range, UFH requires careful monitoring through the measurement of activated clotting time (ACT)
Objective: The aim is to compare ACT value and the outcomes of administering a bolus of UFH at 70–100 IU/kgBW, with and without a continuous infusion of 2000 IU/hour
Methods: An observational retrospective study was conducted on 133 patients who underwent elective PCI by meeting the inclusion and exclusion criteria during the period of July 2022–July 2024. Clinical information, ACT value and the outcome were gathered from medical records. Statistical analyses were performed using SPSS 22, employing univariate, bivariate, and multivariate logistic regression analyses to determine correlations.
Result: The range of ACT results of administering an UFH bolus of 70-100 IU/kgBW with continuous infusion 2000 IU/hour was 191 to 426 seconds (mean 281.9 seconds). Among the 44 patients, 66.6% exhibited ACT levels below 300 seconds, 15 patients (22.7%) had ACT levels ranging from 300 to 350 seconds, while 6 patients (8.3%) had ACT levels exceeding this range. The percentage of patients who attained therapeutic success in the unfractionated heparin (UFH) infusion group (22.7%) was significantly higher than the UFH bolus group (5.9%) with statistically significant results (p = 0.000). Complications were observed in both groups, with 1 patient in each group experiencing acute thrombosis (p = 1.000) and no patients experienced bleeding complications.
Conclusion: Administering a UFH bolus of 70-100 IU/kgBW with continuous UFH infusion at 2000 IU/hour achieved better optimal ACT values. No significant results were found regarding the risk of acute thrombosis with no bleeding complications.
The current perspective of oxygen therapy and ventilatory support in acute heart failure
Full text linkOxygen (O2) therapy in acute heart failure (AHF) is purposed to address hypoxemia and thereby avert irreversible harm to essential organs caused by cellular hypoxemia. The O2 therapy is recommended for patients with AHF who have an oxygen saturation (SpO2) level below 90% or an oxygen partial pressure (PaO2) below 60 mmHg. The initial strategy of O2 therapy in AHF involves administering O2 using the nasal, face mask, or non-rebreathing mask (NRBM). In more severe clinical conditions or respiratory distress, non-invasive positive pressure ventilation (NIPPV) or intubation with mechanical ventilation may needed
An alternative retrograde access puncture for EVLA: a case report
Full text linkBackground: CVI manifests with a variety of clinical symptoms, spanning from varicose veins to venous ulcers, significantly impacting patients\u27 daily lives. While traditional treatments such as compression therapy and surgery remain options, on endovenous laser treatment (EVLT) has emerged as a viable alternative. This article delves into the management of CVI, with a particular focus EVLT as a minimally invasive intervention. Through two case illustrations, it sheds light on the difficulties encountered when accessing the great saphenous vein (GSV) using the conventional antegrade approach, particularly in cases involving obesity and vasospasm. Consequently, a retrograde EVLT technique utilizing proximal GSV access, resulting in successful vein ablation with minimal complications. Overall, this approach presents a promising addition to the management of CVI, offering enhanced patient care and improved outcomes.
Case Presentation: Two patients with CVI and challenging antegrade GSV access underwent retrograde EVLT using proximal GSV access. Despite initial difficulties, including obesity and vasospasm, successful vein ablation was achieved with minimal complications. Post-procedural evaluations demonstrated significant symptomatic improvement, highlighting the efficacy of the retrograde technique.
Conclusion: Retrograde EVLT utilizing proximal GSV access proves to be a safe and effective alternative in cases where antegrade access is challenging. The technique offers simplicity, minimal complications, and high patient satisfaction, with outcomes comparable to traditional approaches. Extended follow-up studies are needed to confirm the long-term effectiveness of retrograde EVLT compared to antegrade methods. Overall, retrograde EVLT presents a valuable option for managing CVI, particularly in patients with anatomical complexities or vasospasm, contributing to improved patient care and outcomes
Cardioprotective effects of colchicine: Targeting pyroptosis and inflammation in myocardial infarction
Full text linkMyocardial infarction (MI) is a significant contributor to global morbidity and mortality. The outcome of MI is associated with the inflammatory response triggered by ischemic or necrotic cells. Pyroptosis is a type of programmed cell death that can exacerbate cardiac injury following MI. This study reviewed the potential therapeutic effects of colchicine in regulating cardiac pyroptosis in response to MI. Primarily, colchicine inhibits tubulin polymerization and microtubule formation, disrupting inflammasome advancement and the subsequent secretion of various pro-inflammatory mediators. In particular, colchicine disrupts the NLRP3 inflammasome assembly process by blocking ASC recruitment into the complex, suggesting its potential to mitigate the inflammatory response related to cardiac pyroptosis. Additionally, colchicine binds to P2X7 receptors, reducing ATP-induced microtubule and pore formation, which attenuates reactive oxygen species and IL-1β production. A clinical trial involving colchicine showed positive outcomes in lowering the occurrence of major cardiovascular events in individuals with coronary artery disease (CAD). Nonetheless, additional studies are required to ascertain the ideal dosage, timing, and long-term effects of colchicine in the infarcted myocardium before it can be routinely recommended for post-MI treatment. In conclusion, colchicine\u27s modulation of the inflammatory response and inhibition of pyroptosis highlight its potential as a cardioprotective agent for MI management
The complex relationship between arterial carbon dioxide levels and acute heart failure: implications for prognosis and management
Full text linkAcute Heart Failure (AHF) can affect carbon dioxide levels in the body by altering the balance between ventilation and carbon dioxide production, leading to either hypocapnia or hypercapnia. Arterial carbon dioxide (CO2) levels are essential for maintaining respiratory function and acid-base balance. However, the relationship between arterial CO2 levels and AHF remains complex and not fully understood. Diverse factors affect arterial CO2 levels in patients with AHF, including neurohormonal activation, respiratory compensation for hypoxemia, and changes in pulmonary perfusion. Hypocapnia, characterized by low arterial CO2 levels (PaCO2 < 35 mmHg), is commonly observed in AHF due to hyperventilation-driven respiratory alkalosis secondary to pulmonary congestion. It showed a strong connection with the survival rates of patients following a cardiac arrest. Nevertheless, elevated levels of carbon dioxide in the blood, known as hypercapnia, with a partial pressure of arterial carbon dioxide (PaCO2) exceeding 45 mmHg, can also arise in the later phases of acute heart failure (AHF), indicating fatigue in respiratory muscles or deterioration in pulmonary edema. Abnormal arterial CO2 levels have been associated with increased morbidity and mortality in AHF patients, serving as a valuable prognostic marker.