ACI (Acta Cardiologia Indonesiana)
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Significance of Mitral M-Mode Vp (Velocity Propagation) for Estimating Mitral Valve Area and Severity in Mitral Stenosis
No full textBackground: Confirming mitral valve area (MVA) by planimetry is one of the standard procedures for assessing mitral stenosis but MVA were frequently need to be confirmed by other echocardiography parameters that only available in sophisticated centers. Our aim was to evaluate the significance of a simple mitral inflow color M-mode velocity propagation (Vp) for estimating MVA and MS severity.Methods: The best color view of MS jet were taken from apical 4 chamber, the nyquist limit were adjusted for aliasing the central highest velocity, then M-mode were applied to MV to calculate Vp by measuring the slope of the blue jet with the first aliasing velocity. MVA,PHT and mean transmitral gradient were analyzed with Pearson correlation and linear regression. Predictive discrimination value of Vp were analyzed by ROC.Results: Thirty one MS patients had mean MVA planimetry 0.99 ± 0.35 cm2 and mean Vp 64.49 ± 21.63 cm/s. Vp that were found to have a strong negative correlation with MVA (Spearman rho -0.865, p < 0.01). Vp had a good predictive discrimination value as from AUC 0.931. Vp were found to have a moderate correlation with MVA by PHT ( Spearman rho -0.621, p <0.01). Vp more than 55 cm/s had 93.8% sensitivity and 86.7% specificity to distinguish severe MS.Conclusions: By making use of the high temporal resolution of M-mode, a simple color Mitral M-Mode Vp were found statistically significant for estimating MVA severity in MS. Interventional decision for MS could also consider Vp for its strong correlation with MVA on MS, especially for helping on targeting moderate to severe MS in rural and limited centers
Distinct Mechanism between Arterial and Venous Thrombosis: Impact for Clinical Manifestations
No full textHemostasis is a complex physiological process aiming to keep the integrity of a closed circulatory system after an occurrence of vessel wall injury. Hemostasis involving the role of circulating platelets and coagulation cascade.1 There are two major pathways that act independently to activate the platelet. The first pathway is mediated by collagen and the other by tissue factor. After intimal layer injury, platelets are recruited through the interaction between platelet’s surface glycoprotein (GPVI and GPIb/V/IX) with collagen and von Willebrand factor. This process results in adhesion of platelets in the site of injury. Further recruitment of platelets is achieved by secretion of aggregatory mediators such as thromboxane A2 and adenosine diphosphate
Correlation between Leptin with Diastolic Function in Young Adult Obesity
No full textBackground: Obesity is one of the global health problems with increasing prevalence, and the complication is related to the alteration of the left ventricle. An obese person without symptoms has impaired diastolic function compares to a normal population, but the mechanism is still unclear. One of the evolving theories is caused by chronic inflammation, characterized by the increase of proinflammatory adipocytokines in an obese person. Leptin is a chronic inflammatory marker which is synthesized by all adipose tissues and has a positive correlation with the body mass index. Leptin level are influenced by age except young adult group. The aim of this study is to investigate the correlation between leptin level and diastolic function of the left ventricle in youngadult obese.Method: This study was conducted in a single centre with cross-sectional design. The subject of this study consists of all young adult obese, worked in Dr. Hasan Sadikin General Hospital, between June-August 2018. The diastolic function of the left ventricle was measured by examining the ventricle relaxation (E/mean e’) by tissue doppler imaging method. The examination of leptin level was done by sandwich-ELISA testmethod. Pearson correlation test was done to assess the correlation between those two.Result: This study consisted of 38 patients with the mean of age 30.75±7.25 years old, 68% were males. The mean score of E/mean e’ was 6.49±3.02 ng/mL and the median of leptin was 13.95 (9.1–25.4) mg/L. After data log transformation of leptin was done, there was a significant positive correlation (r= 0.5892, p<0.001) between leptin level and E/mean e’.Conclusion: There was a significant correlation between the level of leptin and diastolic function of the left ventricle in young adult obese
Hemoglobin Variability as Risk Factor of Left Ventricle Dilation in Chronic Kidney Disease Patient on Routine Hemodialysis
No full textBackground: Several patients with chronic kidney disease (CKD) undergoing routine hemodialysis (HD) have abnormalities of left ventricle (LV) morphology with feature LV dilation due to volume overload and chronic ischemia, which has high risk of mayor adverse cardiovascular event. Anemia causes LV dilation through high output state mechanism. Anemia management in CKD patients causes hemoglobin (Hb) fluctuations or hemoglobin variability (Hb-Var) which is thought to cause LV dilation through relative repetitive ischemia mechanisms. Research linking Hb-Var as risk factor for LV dilation has never been done.Method: Matched case-control study was carried out by taking echocardiographic data of CKD patients undergoing routine HD in HD Unit Dr. Sardjito hospital. The LV diameter is divided into samples with LV (+) dilated profile as a case group, and LV (-) dilated as a control group. Matching was done on variables of age, gender and HD frequency. The HbVar parameter was calculated by the residual SD method based on the Hb value in the last 6 months. Fisher-Exact hypothesis test was used to assess the relationship between Hb-Var and LV dilation, while the logistic regression test was used for multivariate testing.Result: Total of 79 subjects entered in this study, there were 23 subjects of case groups and 28 subjects of control group after matching and adjusting the control formula. The proportion of high Hb-Var in the group with dilated LV (+) and dilated LV (-) were 21.7% and 17.9%, respectively. The Fisher-Exact test shows that there is no relationship between HbVar and LV dilation, with OR 1.28 (95% CI 0.32-5.10). Logistic regression test shows that there are no variables that affect independently of LV dilation.Summary: CKD patients undergoing routine HD with high Hb-Var profiles do not have a higher risk of LV dilation than patients with low Hb-Var profiles
Correlation between HbA1c Levels with Carotid Intima Media Thickness in Newly Diagnosed Type 2 Diabetes Mellitus Patients
No full textBackground: Type 2 diabetes mellitus (T2DM) is the most common chronic disease in the world. Macrovascular complications such as cardiovascular and cerebrovascular diseases can be detected early, one of them by using an ultrasound examination to assess carotid intima-media thickness (CIMT). HbA1c examination had a strong predictive value for the occurrence of T2DM complications. HbA1c levels are associated with CIMT in the non-DM group. In the T2DM group there was an increase in CIMT compared to the non DM group. HbA1c levels can be used as a predictor of the progression of CIMT improvement in the T2DM group, but there is no study on populations with newly diagnosed T2DM.Aims: This study was conducted to find out the correlation between HbA1c in newly diagnosed T2DM and CIMT.Methods: This was a cross-sectional study with correlation analysis carried out on newly diagnosed T2DM in four Primary Health Centers in the city of Bandung who were randomly selected from July to August 2018. HbA1c measurement was carried out at Dr. Hasan Sadikin hospital. The CIMT examination was done according to the Manheim Consensus by a cardiologist. Pearson correlation analysis was performed to assess the relationship between those two variables.Results: This study involved 32 subjects with a median age of 52 (40 - 60) years. The mean value of CIMT was 0.77±0.22 mm, while the median value of HbA1c was 6.7 (5.2- 12.3). Bivariate analysis showed a moderate positive correlation between HbA1c and CIMT in newly diagnosed patients with T2DM. (r= 0.567, p<0.001).Conclusion: There was a significant positive correlation between HbA1c in newly diagnosed T2DM and CIMT
Two Cases of Acute Myocardial Infarction in Patients with Severe Aortic Stenosis and Normal Coronary Arteries
No full textIn patients with aortic stenosis (AS), the development of left ventricular systolic dysfunction and heart failure predicts poor prognosis. Myocardial ischemia, particularly of the circumferential sub endocardial region, commonly occurs in patients with severe AS duringhemodynamic stress, even in the setting of angiographically documented normal coronary arteries. We report two case patients who experienced of ischemic chest pain with ST-changes and undergoing a coronary angiography but we found normo coronary arteries and echocardiography with nomokinetic. These cases highlight the importance of the correlating between history taking, physical examination and other supporting examination, especially focused on bedside investigation like echocardiography in the management of patients presenting with chest pain
Predicting and Preventing Sudden Cardiac Death in the Young
No full textSudden cardiac death (SCD) is an unexpected death condition and occurs with unknown causes or cardiac condition. The SCD incidence at young age is a rare condition but when this condition happens it become traumatic event for both family and community. Incidence rate of death on 1-35 years old is around 0.8-2.8/100.000 each year. This number also varies according to age and sex. Death incidence on 1-4 years old is more common than on 5-10 years old group. This number is increasing after 15 years old, where age of 31-35 years has 10 fold risk of SCD compared to 1-10 years old group. Ratio of SCD in men and woman are 2: 1. Early detection of underlying heart disease is the most important action of preventio. If young people are known to have a risk of SCD, the lifestyle changing and appropriate medical therapy, including implantation of implantable cardioverter defibrillator, according to risk stratification must be done