ACI (Acta Cardiologia Indonesiana)
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Functional Capacity Improvement Related to Inflammatory Marker Reduction After Phase II Cardiac Rehabilitation Program in Postrevascularization Coronary Artery Disease Patients
No full textBackground: Improved functional capacity (FC) and inflammatory marker reduction is a good prognostic factor in post-revascularization cardiac patients. However, there is still limited study investigated association of functional capacity and inflammatory marker after cardiac rehabilitation program. We studied the effects of cardiac rehabilitation (CR) program in the improvement of FC and high-sensitive-C Reactive Protein (hs-CRP) reduction and association between those variables.Methods: This was quasi experimental study in post-revascularization CAD patients who attended phase II CR program at CR gymnasium, Dr. Hasan Sadikin General Hospital, Bandung, from October 2014 to May 2015. The CR program included additional education sessions and consistently strict program intensity on 50-80% heart rate reserve based on formula and Borg scale 11 to 15. Functional capacity and hsCRP were measured before and after the program. Functional capacity was assessed by maximal treadmill test through indirect VO2 max measurement.Results: A total of 37 patients aged 56.05±7.3 years old were analyzed in this study. They consisted mainly of men (81.1%) which 78.4% of them underwent percutaneous coronary intervention (PCI). Our study revealed significant FC improvement after completion of this newly-modified CR program from an average of 6.76 to 8.68 METs (28.4%) ( p<0.001). Hs-CRP reduction was also occurred from mean of 0.49 mg/L to 0.20 mg/L (59.2%) of log hs-CRP level (p= 0.005). Linear regression analysis showed the improvement of fitness was associated with baseline FC (p<0.001) and reduction of hs-CRP was associated with baseline hs-CRP (p<0.001), and not influenced by age, gender, ejection fraction and type of procedure. There is moderate correlation (rs= 0.636, p<0.001) between functional capacity improvement and hs-CRP reduction. Each 1 METs improvement can reduce 9.317 mg/L of transformed hs-CRP level (p=0.006, 95%CI 2.942,15.693).Conclusions: CR program significantly increased functional capacity and reduce hsCRP level in post-revascularization CAD patient, and more prominent in a patient with low baseline functional capacity and high hs-CRP level. Functional capacity improvement and hs-CRP reduction were moderately correlated
Increasing Age, Diabetes Mellitus and Beta Blocker Influence Heart Rate Recovery Values in Patients Undergoing Exercise Treadmill Test
No full textBackground: Heart disease is the number one cause of death globally. This disease is initiation affected by autonomic dysfunction which will cause disruption of the sympathetic-parasympathetic system. Heart Rate Recovery (HRR) is used to determineautonomic dysfunction.Objective: To determine the relationship of risk factors and cardiovascular treatment to HRR values of 1 minute and 2 minutes.Methods: Cross sectional study to measure HRR 1 and 2 minute undergoing exercise treadmill test for the screening of coronary heart disease in Saiful Anwar hospital in May 2016 until September 2017. Univariate analysis was performed to determine the frequency and proportion of HRR values classified into normal groups (HRR 1 minute > 12x / minute or HRR 2 minutes > 22x / minute) and abnormal groups (HRR 2 minutes ≤ 12x / minute or HRR 2 minutes ≤ 22x / minute).We also performed bivariate analysis using comparative test (Generalized Linear Model) and correlation test (Pearson, Spearman and Eta) and multivariate linear regression analysis.Results: This study found that age, hypertension and beta blocker were significantly associated with HRR abnormalities (p<0.05). HRR 1 and HRR 2 were significantly associated with diabetes mellitus (DM) (p=0.004 and p=0.039) and beta blocker (p=0.042 and p=0.039). Then looking at the relationship of multivariate correlations found a significant correlation between age (β=-0.133, p=0.000) and DM (β=-2.617, p=0.032) at 1 minute HRR and significant correlation with age (β=-0.165, p=0.004) and beta blockers (β=-2,947, p=0.017).Conclusion: increasing of age, diabetes mellitus and beta blockers correlate with decreasing of HRR. The most influential risk factors for HRR values of 1 minute were increasing age and DM, while for HRR values of 2 minutes were increasing age and beta blockers
Significance of Electrocardiographic QTc Interval on Assessment of Left Ventricular Diastolic Dysfunction in Hypertensive Patient: A Simple Screening Tool
No full textBackground: Diastolic dysfunction as part of heart failure with preserved ejection fraction (HFpEF) has gain interests, due to the increasing prevalence rate and poor prognosis. Besides the mechanism is not fully understood, there are some difficulties in detecting the presence of diastolic dysfunction. Previous studies have shown correlation between some electrocardiographic parameters and diastolic function. Furthermore, the aim of this study is to assess the diagnostic value of the QTc interval in detecting left ventricular diastolic dysfunction.Methods: A cross sectional study was conducted on patients with clinical suspicion of heart failure. Electrocardiographic examination was performed to obtain QTc interval (msec) using the Bazett formula. Left ventricular diastolic function was assessed using Tissue Doppler Imaging by echocardiography. Using correlation test and ROC method, the relationships between QTc interval and LV diastolic function were investigated.Results: Of 82 patients analyzed, there were 62 patients (75.9%) known to have diastolic dysfunction. The QTc interval was found to be longer in the group with diastolic dysfunction compared to the normal group (442.9±27 vs. 402.1±18.2, p <0.001). There was a strong negative correlation between the QTc interval and diastolic function (r = -0.619; p <0.001). Using ROC analysis, the cut off point for QTc interval was 410 ms with 91% sensitivity, 70% specificity, and 90% positive predictive value.Conclusion: The QTc interval is an accurate, simple and highly feasible electrocardiographic parameter as a screening tool to determine the presence of left ventricular diastolic dysfunction
Functional Capacity Improvement on Patent Ductus Arteriosus with Pulmonary Arterial Hypertension: A Case Report and Literature Review
No full textPulmonary artery hypertension (PAH) is a pathophysiological disorder involving a wide range of clinical conditions. This can be a condition of complications from heart disease and respiratory system. Pulmonary arterial hypertension is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg at rest assessed by right heart catheterization. The cardiovascular rehabilitation program is a set of efforts to improve the underlying cause of cardiovascular disease such that it can maintain or restore the best conditions and secondary prevention. Cardiac rehabilitation and physical exercise programs have the benefit of improving pulmonary vascular endothelial function, physical activity capacity and quality of life parameters for PAH patients. A 6-minute walk test can be used to assess the functional capacity of PAH patients
Relationship of P Terminal Force V1 on Electrocardiogram with Left Atrial Function in Chronic Kidney Failure Patients on Hemodialysis
No full textBackground: Chronic kidney failure is a worldwide public health problem.Cardiovascular disease is a common complication and the main cause of mortality in this population.Impaired left atrial function is an early marker of cardiovascular involvement and a prognostic factor that correlated with mortality in chronic kidney disease patients. We aimto investigate the relationship between P terminal force V1 (PTFV1), an ECG parameter, with left atrial function in chronic kidney failure patients on hemodialysis.Method: This cross sectional study was done in chronic kidney failure patients on hemodialysis in Dr. Sardjito General Hospital Jogjakarta. Electrocardiogram and echocardiography were done after hemodialysis procedure. P terminal force V1 was measured by multiplying amplitude and duration of negative deflection of terminal P wave in V1. Abnormal PTFV1 was defined as PTFV1 value ≥ 40 mm.msec. Left atrial function was measured using left atrial peak global longitudinal strain (LA PGLS).Results: This study was done in 71 patients with mean age 50 years old. Forty three subjects (61%) were men. Sixty four subjects (90%) had hypertension. Forty four subjects (62%) had abnormal PTFV1 on ECG. Mean LA PGLS was 24.89 ± 8.23%. No significant correlation was found between PTFV1 value with LA PGLS (r= -0.178; p=0.138). By multivariate analysis, left ventricular ejection fraction, left atrial diameter and hemodialysis duration (in months) were variables that independently correlated with LA PGLS. In subanalysis, amplitude of negative deflection of terminal P wave in V1 was significantly correlated with LA PGLS(r= -0.257, p= 0.031).Conclusions: This study reveals no correlation between P terminal force V1 and left atrial function in chronic kidney failure patients on routine hemodialysis. There is significant correlation between amplitude of negative deflection of terminal P wave in V1 with LA PGLS
Relationship between Carotid Intima-Media Thickness and Left Ventricular Hypertrophy
No full textBackground: Hypertension is a 50% cause of cardiovascular disease and stroke, 40% of cause of death in Diabetics, and is a major risk of kidney failure, pregnancy and dementia. Left ventricular hypertrophy (LVH) is a preclinical manifestation of cardiovascular disease and a strong predictor of cardiovascular morbidity and mortality. Examination of carotid intima-media thickness (CIMT) is one method that can be used to Evaluate the occurrence of coronary heart disease and in Several studies reported that CIMT is also associated with left ventricular function and hypertrophyMethods: This cross-sectional study conducted on hypertensive patients in the outpatient unit in Cardiac Center Haji Adam Malik General Hospital since March 2018-August 2018. Examination of Carotid B-Mode ultrasound was conducted to obtain CIMT values. LVH is assessed by left ventricle mass index (LVMI) as measured by M-mode method using the Cube formulas from echocardiography. Then the analysis is done using the Spearman correlation test to see the relationship between CIMT and LVHResults: The CIMT >0.5 mm have a positive correlation with LVM (r = 0.594, p 0.5 mm has a sensitivity of 83.6%, specificity 90.4%, PPV NPV 76% and 93.8%. The CIMT value of 0:55 mm is considered to be the optimal value in diagnosing LVH in hypertensive patients in our subjects based on the ROC curve with a sensitivity of 83.6% and specificity of 90.5%, and area under the curve of 0.9.Conclusion: There is a positive correlation between carotid intima-media thickness and left ventricular hypertrophy in hypertensive patient
Risk Stratification for Sudden Cardiac Death in Heart Failure
No full textHeart failure (HF) is a complex clinical syndrome in which structural / functional myocardial abnormalities result in symptoms and signs of hypoperfusion and/or pulmonary or systemic congestion at rest or during exercise. More than 80% of deaths in patients with HF recognize a cardiovascular cause, with most being either sudden cardiac death (SCD) or death caused by progressive pump failure. Risk stratification of SCD in patients with HF represents a clinical challenge. This review will give an update of current strategies for SCD risk stratification in HF
The Era of Endovascular Treatment in Venous Disease: What Can We Do and Who Gets Benefit?
No full textVenous system is very different and more complex than arterial system. To deliver blood against the forces of gravity, venous system rely on valve function and peripheral muscle pump. In acute venous disease, blood becomes stasis and leads to deep vein thrombosis. In chronic condition, clinical manifestation may vary from either venous obstruction or vascular incompetence. In general venous diseases are devided into venous thromboembolism and chronic venous insufficiency
Comparison of TIMI Flow in STEMI Patients With and Without Resolution on Reciprocal ST Segment Depression Obtaining Fibrinolytic Alteplase Therapy
No full textBackground: STEMI patients need revascularization to improve blood flow and myocardial reperfusion. Further information can be obtained from the ECG including infarct size and prognosis of STEMI patients. ST segment depression (STSD) in reciprocal leads isassociated with poorer prognosis. STEMI patients with STSD resolution have a better TIMI flow compared with no STSD resolution. The aim of this study was to look for TIMI flow for STEMI subjects who received fibrinolytic therapy with and without resolution of STSD shortly after fibrinolytic.Methods: This study is a prospective cohort study, in which 60 STEMI subjects, patients performed coronary angiography diagnostics to assess TIMI flow. The resolution on reciprocal STSD is defined as a decrease of 50% in the amount of reciprocal STSD in 90- minute after fibrinolytic therapy started.Results: Bivariate analysis showed that ejection fraction <40% with p = <0.001; QRS duration, p = <0.001; anterior STEMI with p = <0.001; are significant factors for STSD resolution. QRS Fragmentation with p = <0.001; STSD resolution with p = <0.001; ST elevation resolution with p = <0.001; are significant factors for TIMI Flow. In the TIMI Flow comparison with reciprocal STSD resolution; the resolution of reciprocal STSD has a better TIMI flow with OR 28 [(5.5-141.9), p = <0.001].Conclusion: There were differences in TIMI Flow in STEMI patients with reciprocal STSD resolution and without reciprocal STSD resolution who received fibrinolytic alteplase therapy, where STEMI patients with reciprocal STSD resolution had a better TIMI Flow compared with STEMI patients without reciprocal STSD resolution
Non-ST-Elevation Acute Myocardial Infarction and Sustained Slow Ventricular Tachycardia due to Coronary Slow Flow Phenomenon: a Case Report
No full textCoronary slow flow is a phenomenon that is found in coronary angiography.It is a rare case and identified by the corrected TIMI frame count. The presence of a slow flow in the coronary arteries is associated with life-threatening arrhythmias, sudden death, andacute coronary syndrome. We aim to report a coronary slow flow phenomenon present with non-ST-elevation acute myocardial infarction and sustained slow ventricular tachycardia in 66-year-old male patient. Brief heparinisation and continued by oral acetosal, ticagrelor, bisoprolol and atorvastatin therapy successfully diminish the symptom