ACI (Acta Cardiologia Indonesiana)
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Correlation between High-Sensitive C-Reactive Protein and HighSensitive Troponin I with 6-Minute Walk Distance in Acute Myocardial Infarction
No full textBackground: Biomarker has a role in diagnosis and risk stratification of ischemic heart disease patients. Troponin has become the reference biomarker for acute myocardial infarction (AMI). However, some other biomarkers have benefit on prognostic value, such as C-Reactive Protein (CRP). Six-minute walk test (6MWT) could be performed to assess functional capacity in patients with heart disease.Aim: To assess the correlation between hsCRP and hsTroponin I with 6-minute walk distance (6MWD) in AMI patients.Method: This is an observational analytic study with prospective cohort design, conducted in August-September 2018. The subjects were AMI patients at Dr. Moewardi district general hospital, Surakarta. The hsCRP and hsTroponin I sampling was carried out on admission. 6MWT was performed before discharge. Statistical analysis was performed to assess the correlation. Then the ROC curve was used to determine the cut-off point, sensitivity and specificity.Result: 6MWD of 40 subjects was divided into 2 groups based on the mean distance (<378 m and ≥378 m). There was a significant negative correlation between hsCRP and 6MWD (r =-0.475, p =0.002), but no significant correlation between hsTroponin I and 6MWD (r =-0.048, p = 0.244). However, hsCRP together with hsTroponin I have a significant correlation with 6MWD (r =0.491, p =0.006). Using the ROC curve, obtained AUC of 0.725 and a cut-off point of 0.555 mg/l, as well as a sensitivity of 69.6% and specificity of 88.2%Conclusion: There was a significant negative relationship between hsCRP and 6MWD, but no significant relationship between hsTroponin I with 6MWD.HsCRP together with hsTroponin I have a significant correlation with 6MWD in AM
Acute Changes on Pulmonary Pressure Following Percutaneous Closure of Secundum Atrial Septal Defect
No full textPulmonary hypertension is a common complication of congenital heart disease due to systemic – pulmonary circulation shunt which if left uncorrected leads to increased pulmonary artery pressure, vascular remodeling and further increase of pulmonary vascular resistance. Percutaneous closure of the defect interrupts this shunt thus reducing right heart and pulmonary circulation load and pulmonary artery pressure. In this paper we present two cases of percutaneous secundum atrial septal defect closure complicated by pulmonary hypertension along with echocardiographic evaluation of cardiopulmonary hemodynamic changes before and shortly after device closure. Forty years old and thirty three years old females presented to our clinics with classical symptoms of atrial septal defects, assessment revealed TVG of 37 mmHg and 30 mmHg,shortly after the procedure patient was re-evaluated and revealed TVG of 39 mmHg and 23 mmHg respectively. From these cases we conclude that changes in pulmonary artery pressure is not constantly found after device closure. However both patients display improvements in functional capabilities
Correlation between Left Ventricular Eccentricity Index and Mean Pulmonary Arterial Pressure in Secundum Type Atrial Septal Defect Adult Patients
No full textBackground: Secundum type atrial septal defect (ASD) is the most common adult congenital heart disease. Hemodynamically, ASD result in a left-to-right shunt that causes right heart volume overload. This condition affects interventricular septal position and shape. Left ventricular (LV) eccentricity index (EI) suggests right ventricle (RV) overload when this ratio is >1.0. The aim of this study was to assess correlation between LV EI and mean pulmonary arterial pressure (mPAP) in secundum type ASD patients. Methods: We conducted a cross sectional study from ASD patients registry data. We enrolled subjects with secundum type ASD from the complete registry data. The LV EI was calculated from transthoracal echocardiography. The mPAP was measured by right heart catheterization as a gold standart. The correlation was performed by Spearman correlation test. Results: There were 40 adult secundum type ASD patients participated. The mean LV EI in enddiastolic was 1.55±0.39 and LV EI in end-systolic was 1.75±0.58. The median value of mPAP was 29 (12-99) mmHg. There was a moderate strength, positive and significant correlation between LV EI in end-diastolic and mPAP (r=0.37, p=0.018). The correlation was more significant and stronger between LV EI in end-systolic and mPAP (r=0.52, p=0.001). Conclusion: There was sufficiently strong and significant correlation between LV EI in both end-diastolic and end-systolic phase with mPAP in adult secundum type ASD
Addition of Risk Factors of Coronary Heart Disease in Diagnostic Value of Treadmill Score for Detecting Complexity of Coronary Arterial Lesions
No full textBackground: Coronary heart disease (CHD) is still the leading cause of death in the world. There are various risk factors for atherosclerosis leading to CHD. Duke Treadmill Score (DTS) is known to demonstrate prognostic stratification and has a diagnostic value in predicting the number of coronary arteries involved in patient populations with ischemic heart disease. However, DTS does not describe the role of risk factors for coronary heart disease to the complexity of coronary artery lesions. This study aims to add risk factors for coronary heart disease on DTS to detect the complexity of coronary artery lesions with stable angina pectoris.Methods: This study was a cross-sectional study in stable angina pectoris patient who comes to Haji Adam Malik Hospital Medan from January 2017 until February 2018. Patients who have done treadmill test and coronary angiography, and fulfill inclusion and exclusion criteria are included in the study. ECG examination and recording of risk factors for coronary heart disease were done. DTS assessment was performed based on a treadmill test and Syntax score based on coronary angiography results. Diagnostic tests were performed to assess the sensitivity and specificity of the addition of CHD risk factors to detect the complexity of coronary artery lesions.Results: Of the 76 people with stable angina pectoris, 55 people were found with low SYNTAX and 21 people with high Syntax. DTS is divided into 3 groups: mild (> -10), moderate (-10 to - 13.5), and severe (≤-13.6) based on the cut off of the ROC curve. Risk factors for CHD are divided into 3 groups, mild (≤3 CHD risk factors), moderate (4-6 CHD risk factors), and severe (7 CHD risk factors) based on the cut off of the ROC curve, then assessed the relationship with Syntax which has been divided into 2 groups, low Syntax, and high Syntax. Diagnostic test shows the addition of risk factors of CHD to DTS to detect the complexity of coronary artery lesions have greater sensitivity and specificity than DTS without the addition of risk factors of CHD, 95%, and 89%.Conclusion: The addition of risk factors for coronary heart disease on DTS can detect the complexity of coronary artery lesions
3 Dimensional Printing in Cardiology: Innovation for Modern Education and Clinical Implementation
No full textMedical uses of three-dimension (3D) printing have advantages for many importances, such as tissue and organ fabrication, creation of prosthetics, and model structural anatomy. Visualization of 3-dimensional structure of heart for the importance of examination, management or education is not fully comprehensive describe toward the complexity of anatomical structure and also toward the illustration of medical procedure. The aim of this study was to identify the potential application of heart’s 3D printing for the enhancement of case understanding for doctor, medical students or residents and also for patient and its family. A normal model of heart is used in this research to stimulate next 3D object in cardiology area.We retrieved data from patients’ CT scan performed in Gadjah Mada University Hospital, Yogyakarta from December 2017 to March 2018. Our focus is on normal heart anatomy. Data from CT scan results are exported into Digital Imaging and Communications format (DICOM), then dimension measurement and threshold segmentation are performed using Mimics Medical 20.0 (Materialise) application. Finally the file must be exported into STL format due to final process to cut the desirable parts using Mesh editing application. After the final model has been done, then it will be printed by fuse deposition method to make a 3D object.The making and implementing 3D printingof heart model has many advantages for medical education especially for the doctor, medical students or residents and also for the patient and its family to be more aware on the condition of the heart. This study may stimulate another trial of using this technique into several heart abnormalitie
Interval TpTe Diagnostic Value in Diastolic Dysfunction of Patients with Hypertension
No full textIntroduction: Diastolic dysfunction has been shown to be associated with an increase in mortality rates in both normal and decreased systolic function. In patients with hypertension, there is elongation of transmural repolarization dispersion in left ventricular, which will cause heart diastolic relaxation disorders. The elongation of the transmural repolarization dispersion is indicated by the increase of the TpTe interval. We conducted this study to fnd out whether the TpTe interval had a good diagnostic value in detecting diastolic dysfunction in patients with hypertension.Methods: This is an analytic observational research using cross sectional design on hypertensive patients in whom echocardiography was performed. The study conducted in February 2017 until March 2017 in Dr. Sarjito general hospital Yogyakarta. Electrocardiography examination was taken after the patient was performed echocardiography. The TpTe interval was calculated using the ‘tail’ method at lead V5. Diastolic dysfunction was established using echocardiographywith the ASE / EAE 2016 algorithm.Results: Of the 112 patients met the criteria of the study subjects. The cut-off value for TpTe was 103.97 m.s., based R.O.C curve analysis. TpTe interval ≥ 103.97 m.s. had a moderate diagnostic value for detecting diastolic dysfunction with 73% accuracy, 83% sensitivity, 64% specifcity, 22% positive predictive value, and 97% negative predictive value. There were 66 (58.9%) subjectswith TpTe interval <103.97 m.s. and 46 subjects (41.1%) with TpTe interval ≥103.97 m.s. There were 12 subjects (10.7%) with diastolic dysfunction. Bivariate and multivariate analyzes showed no demographic and clinical factors that independently affected the TpTe interval.Conclusion: The TpTe interval ≥ 103.97 m.s. had a moderate diagnostic value for detecting diastolic dysfunction in patients with hypertensio
