bluuebunny/crossref_metadata_2025 huggingface dataset:
OR48. Major risk factors for in-hospital mortality events of acute coronary syndrome patients in the rural hospital setting
Authors: Sukmadja D , Hartoko B
Published: April 2022

Aims

This study was performed to find major risk factors for all-cause in-hospital mortality events of acute coronary syndrome (ACS) patients in the rural hospital setting, where diagnostic and therapeutic resources were limited.

Methods and Results

We enrolled 57 ACS patient data that were admitted from January to December 2020 from medical records. Patient baseline data, clinical characteristics, risk factors and their association with in-hospital all-cause mortality events were analyzed. The median age of all patients was 58.0 ± 10.63 years, with predominantly male patients (68.4%). There were 35.1% ST-elevation acute coronary syndrome (STEACS) and 64.9% non-ST-elevation acute coronary syndrome (NSTEACS) cases, with 17.5% all-cause in-hospital death cases. All of the dead patients were male and had active smoking behaviour. The other most prevalent risk factors were history of chronic heart failure (60.0%), ST-segment deviation (50%) and atrioventricular block findings on electrocardiogram (50%). Bivariate Fischer’s exact test showed significant correlation in male patients (OR: 0.74; 95% CI: 0.62 to 0.89; p: 0.022), history of chronic heart failure (OR: 0.16; 95% CI: 0.04 to 0.68; p: 0.015), and active smoking behaviour (OR: 0.72; 95% CI: 0.59 to 0.84; p: 0.009) with all-cause in-hospital mortality events.

Conclusion

Active smoking behaviour, history of chronic heart failure and male patients were found to be major risk factors for all-cause in-hospital mortality events in acute coronary syndrome patients in the rural hospital setting.
OR51. Prognostic Value and Influencing Factors of High D-dimer Levels for Critical Care Needs in Coronavirus Disease 2019 (COVID-19) Patients
Authors: Suyani N A , Laitupa F S , Ruspiono E , Wibisono A , Astiawati T , Nugraha A W , Kusuma M A , Kumara K C , Kawiartha M M , Budiarti P , Mustafida R Y , Muhardian R A , Sungkono R D
Published: April 2022

Aims

Coronavirus disease 2019 (COVID-19) stimulates pro-thrombotic changes that lead to poor prognosis-associated conditions. Early and effective predictors of clinical outcomes are urgently needed to improve management. This study aims to explore the value and influencing factors of high D-dimer levels on the prognosis of critical care needs in COVID-19 patients.

Methods and Results

Patients admitted with confirmed COVID-19 in Dr. Iskak General Hospital from June to December 2020 were retrospectively enrolled. We examined the relationship between peripheral blood levels of D-dimer on admission, clinical characteristic, prognosis, and its related influencing factors. One hundred forty-eight patients were included in analysis. D-dimer levels of patients who need critical care needs were significantly higher (p < 0.001). The Receiver Operating Characteristic (ROC) curve was used to evaluate the sensitivity and specificity of D-dimer in predicting critical care needs. The optimal cut-off value of D-dimer to predict critical care needs was 1,707 ng/ml with a sensitivity of 84.6% and specificity of 84.4% (AUC=92.6%; 95% CI = 0.87-0.98). In addition, we found that patients with advanced age (OR 10.5, 95% CI 1.94-57.35, p = 0.005), history of stroke (OR 4.1, 95% CI 1.11-15.22, p = 0.039) and renal failure (OR 8.1, 95% CI 1.41-46.71, p = 0.020) had higher D-dimer levels.

Conclusion

D-dimer can be used to evaluate the prognosis of critical care needs of COVID-19 patients. The D-dimer value of 1,707 ng/ml was the optimal probability cut-off for judging critical care needs. Advanced age, history of stroke and renal failure are influencing factors for D-dimer levels, which impact the prognosis of patients.
OR56. Risk Factors of Diabetes Mellitus Type 2 and Chronic Kidney Disease In Patients With All Types of Cardiovascular Disease at Sanglah Hospital Denpasar, Bali, Indonesia In 2021 : A Cross-Sectional Hospital-Based Study
Authors: Upadhana P S , Sastrawan I G G , Cahyarini I G A A C , Umam A K , Wibhuti I B R
Published: April 2022

Background and Aims

This study aims to determine the risk factors of diabetes mellitus type 2 (DMT2) and chronic kidney disease (CKD) in a patient with all types of cardiovascular disease (CVD).

Methods and Results

This study was carried out using the analytical observational and cross-sectional design methods. Data were collected from 219 patients diagnosed with all types of CVD at Sanglah Hospital from January 2021 – April 2021. The result showed that the majority of the patients were male (n = 116, 53%), with a median of age 53 (14-80). Coronary artery disease (CAD) was the most common CVD found in patients (n = 111, 50.7%), while the most common comorbidity in patients were CKD (n = 162, 74%). Obesity (p = 0.030; PR: 1.879; 95%CI: 1.097-3.219) and CAD (p = 0.029; PR: 1.774; 95%CI: 1.046-3.011) were significantly associated with DMT2, while age (p = 0.000; PR: 1.435; 95%CI: 1.180-1.745), and hypertension heart disease (HHD) (p = 0.008; PR: 1.243; 95%CI: 1.072-1.440) were significantly associated with CKD. Meanwhile, age > 50 years old (p = 0.004; PR: 5.740; 95%CI: 1.384-23.803), HHD (p = 0.035; PR: 2.385; 95%CI: 1.050-5.419), and CAD (p = 0.009, PR: 4.091; 95 %CI: 1.253-13.354) were significantly associated with DMT2 comorbid with CKD. In logistic regression analysis, age (p = 0.015; PR: 2.909; 95%CI: 1.235-6.852), and obesity (p = 0.023, PR: 2.765; 95%CI: 1.149-6.307) were significantly associated with DMT2.

Conclusion

Clinical characteristics and medical history of the patient are significantly associated with DMT2 and CKD. Early intervention against these factors tends to improve the outcome of the patient.
OR60. The acef (age, creatinine, ejection fraction) score predicts major adverse cardiac events in patients hospitalized for acute coronary syndrome
Authors: Ardining H , Niazta N A , Karimullah D H
Published: April 2022

Background and Aims

Age, Creatine, and Ejection Fraction (ACEF) score is a simple model for predicting mortality in patients undergoing elective cardiac surgery. However, the ability of ACEF score to predict other outcomes, such as major adverse cardiac events (MACE) in patients hospitalized with ACS, is less established.

Method and Result

In this study, 71 patients who were admitted with ACS to Kediri General Hospital between January and June 2020 with echocardiography data were included. The follow-up period to observe MACE was 6 months. The ACEF score was calculated using the following formula: age (years)/left ventricular ejection fraction (%) + 1 (if baseline serum creatinine was > 2 mg/dl). The median ACEF score was 1.15 (0.6-5.08). A higher ACEF score was linked with higher SGOT, the presence of diabetes mellitus, anaemia, and left bundle branch block (LBBB) on admission. ACEF score's predictive performance was then evaluated. Receiver-operating characteristic (ROC) curve analysis was used to assess the ability of ACEF score to predict MACE. The observed AUC was 0.8 (95% CI 0.6-0.98). Using ACEF score cut-off of 1.79, the sensitivity was 85.7% and the specificity was 82.8% to predict future MACE. The AUC in this study was higher than that in previous studies. Kristic et al (2021) found AUC of 0.63 (0.55-0.7) for ACEF score in predicting MACE in NSTE-ACS.

Conclusion

ACEF score may serve a simple way to predict risk of future MACE in patients hospitalized for ACS.
OR61. The Association Between Blood Glucose on Admission and Myocardial Infarct Size Measured by QRS Selvester Score
Authors: Dewi M R , Priyambodo S , Pintaningrum Y
Published: April 2022

Aim

Acute myocardial infarction (AMI) is one the highest cause of death out of all cardiovascular disease. Risk factors of AMI includes diabetes which causes hyperglycemia. Acute hyperglycemia post-AMI is called stress hyperglycemia. Hyperglycemia will increase oxidative stress which causes further inflammation that affects myocardial infarct size. This researchs aims to know the association between blood glucose on admission and myocardial infarct size measured by QRS Selvester Score.

Method and Result

This research is a cross-sectional study done in RSU Kota Mataram. The datas are collected from patient’s medical records from November 2019 – August 2020. Subjects that are included in this study are STEMI patients with ECG recording within 1 hour of arrival before given any definitive treatment, glucose on admission level before given any blood glucose lowering treatment, and patient’s identity consisting of name, age, and gender. The samples are taken with a consecutive sampling method. The amount of samples taken are 52 samples in which consists of 45 male and 7 female. The datas are distributed normally with a sig. value of 0.53 and 0.200 for myocardial infarct size and glucose on admission level respectively. The result from the correlation test using pearson method shows that there is no significant correlation with a p value of = 0.787 and r = 0.038.

Conclusion

There is no significant correlation between blood glucose on admission level and myocardial infarct size measured by QRS Selvester Score.
OR62. The Association Between Cardiovascular Diseases and Underlying Comorbidities in Patients with All Types of Cardiovascular Disease at Sanglah General Hospital Denpasar, Bali, Indonesia In 2021: a Hospital-Based Cross-Sectional Study
Authors: Upadhana P S , Sastrawan I G G , Cahyarini I G A A C , Umam A K , Wibhuti I B R
Published: April 2022

Background and Aims

Cardiovascular disease accompanied by underlying comorbidities increases morbidity, worsens the outcome of therapy and decreases a patient's quality of life. Therefore, this study aims to determine the distribution and association between various comorbidities and cardiovascular diseases.

Methods and Results

This study was carried out using the analytical observational and cross-sectional design methods. Data were collected from 219 patients diagnosed with all types of cardiovascular diseases (CVD) at Sanglah General Hospital from January 2021 to April 2021. The result showed that the majority of the patients were male (n = 116; 53%) with a median age of 53 (14-80) years. Furthermore, approximately 140 patients (63.9%) had more than one CVD, and comorbid (n = 123, 56.2%). The most common CVD and comorbid found in patients were coronary artery (n = 111; 50.7%) and chronic kidney (n = 162; 74%) diseases, respectively. The strongest associations within CVDs were between valvular and rheumatic heart diseases (PR: 12,121; 95%CI: 3,813-38,535). Meanwhile, diabetes mellitus (PR: 1.38; 95%CI: 1.061-1.797), chronic kidney disease (PR: 1.818; 95%CI: 1.213-2.724), dyslipidemia (PR: 1.715; 95%CI: 1.319-2.230), and obesity (PR: 1.473; 95% CI: 1.123–1.932) were strongly associated with the incidence of coronary artery disease. Patients with diabetes mellitus had a higher risk of having more than one cardiovascular disease (PR: 1.463; 95%CI: 1.016-2.107).

Conclusion

Cardiovascular disease accompanied by underlying comorbidity has a significant effect on the course of the disease. Early identification and intervention against these comorbidities and CVDs prevents morbidity and improves the patient’s outcome.
OR63. The benefit of virtual anti-hypertensive diets campaign towards the changes of knowledge, attitude, practice, and reduction of blood pressure in the society during covid-19 pandemic
Authors: Andrianto Meity Ardiana , Yutha Alqi , Khrisna Bagus Putra Dharma , Nugraha Ricardo Adrian , Putra Tony Santoso , Shahab Achmad Rizal , Andrianto Henny , Kikuko Irawati Hajar , Puspitasari A’rofah Nurlina , Hajjrin Maltadilla Ratu
Published: April 2022

Background

Department of Cardiology and Vascular Medicine created a virtual education series about dietary guideline that refers to DASH by adapting the local wisdom of the Surabaya community.

Aims

We aimed to evaluate the impact of Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series towards knowledge, attitude, practice, and reduction of blood pressure in the primary care setting during COVID-19 pandemic.

Methods

This type of online action research is quantitative with a quasi-experimental design that designs using one group pretest-posttest, when this study was conducted in October-December 2020. The population in this study were all patients with hypertension who were treated in Mojo primary health care setting. A purposive sampling technique were done to receive 110 participants using online questionnaire.

Results

A total of 110 participants were included in the analysis, 55 in the intervention group and 55 in the control group. Following the Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series implementation, the only parameter that showed significant improvement were knowledge and attitude (p<0 .001). There is no significant change in the skill parameters (p=0.131) and blood pressure parameters (p=0.433) .

Conclusion

Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series implementation in our study population seems to be effective to improve knowledge and attitude of participants, however, this program seems to be ineffective to improve skill and blood pressure reduction in participants. Future study with longer durations and more comprehensive programme needs to be done to scrutinize the clinical impact of this program nationwide.
OR64. The differences of sum ST-deviation resolution of STEMI patients who underwent pharmaco-invasive strategy compared to primary percutaneous coronary intervention strategy in DR. Sardjito Hospital
Authors: Amin M I , Taufiq N , Maharani E
Published: April 2022

Aims

This study aims to determine the difference between sum ST-segment deviation (∑-STD) resolution in ST-segment elevation myocardial infarction (STEMI) patients who underwent Pharmaco-invasive strategy as compared to the Primary PCI strategy.

Methods and Results

This study design was a retrospective cohort. It measured the ∑-STD resolution in two groups. Forty-five patients who underwent both Pharmaco-invasive and Primary PCI strategy were compared. The cut-off > 50% was considered significant resolution and <50% was considered insignificant resolution. The difference was analyzed using comparative analysis and logistic regression test. The ∑-STD resolution between STEMI patients who underwent Pharmaco-invasive strategy compared with Primary PCI strategy was 26.63% (84.40% in the Pharmaco-invasive vs. 57.77 %% in Primary PCI group, RR = 1.46 (95% CI, 1.10-1.93), p = 0,005).

Conclusion

The ∑-STD resolution was significantly higher in STEMI patients who underwent Pharmaco-invasive strategy as compared to Primary PCI strategy.
OR68. The impact of coronavirus disease 2019 pandemic on acute coronary syndrome hospitalizations, treatments, and outcomes: a dual-center observational study
Authors: Amshar M , Ardining H , Nathania M , Akbar F , Ulfiarakhma D , Napu R , Karimullah M D H , Widyantoro B
Published: April 2022

Background and Aims

Since March 2020, transmission of coronavirus disease 2019 (COVID-19) in Indonesia have led to substantial decline in non-COVID-19 hospitalizations and healthcare services. We ought to determine the impact of COVID-19 pandemic on acute coronary syndrome (ACS) hospitalizations, treatments, and outcomes.

Methods and Results

We conducted a dual-center observational study in Bogor City General Hospital and Kediri General Hospital, Indonesia. We included all ACS patients between January-June 2020. Subjects were divided into two groups: pandemic period (admitted in March-June 2020) and pre-pandemic period (admitted in January-February 2020). 279 subjects were involved (107 pandemic vs 172 pre-pandemic). Monthly average ACS admissions reduced by 68.6% during pandemic period compared to pre-pandemic period. Proportion of STEMI subjects was significantly higher during pandemic compared to pre-pandemic (56.1% vs 38.4%; p = 0.004). Proportion of Killip 3-4 subjects was also significantly higher during pandemic compared to pre-pandemic (26.2% vs 14.5%; p = 0.016). However, reperfusion therapy (PCI or fibrinolytic) proportion for STEMI subjects was significantly lower during pandemic compared to pre-pandemic (16.7% vs 31.8%; p = 0.049), although there was no significant difference in onset time of ACS symptoms before hospitalization (p = 0.793). In-hospital mortality rate was significantly higher during pandemic compared to pre-pandemic (15.9% vs 8.1%; p = 0.045).

Conclusion

There was a significant decline in ACS hospitalizations, increased proportion of STEMI and KILLIP 3-4 patients, and higher in-hospital mortality rate in the pandemic period compared to pre-pandemic period. Paradoxically, reperfusion therapy proportion in STEMI patients has reduced significantly during pandemic period.
OR70. The Impact of Mitral Valve Replacement on Right Ventricle Longitudinal Strain Case Study in Dr Kariadi General Hospital Semarang
Authors: Elfa S A , Rifqi Sodiqur , Arif Nugroho Hardian M
Published: April 2022

Background

Right ventricular (RV) function often overlooked in routine echocardiography examination even some research found its association with outcome in various cardiovascular and cardiac surgery setting. Deterioration of RV function occurred immediately after cardiac surgery. Compared with conventional echocardiography examination, free wall RV longitudinal strain (RVLS) is less load dependent and have a better association with cardiac magnetic resonance imaging, the gold standard for the examination of RV function

Objective

To investigate the changes in free wall RVLS pre- and post-surgical mitral valve replacement (MVR) and the factors that contribute to postoperative free wall RVLS change.

Methods

Patients undergoing MVR were enrolled consecutively. Free wall RVLS was assessed before the operation and 1-2 weeks after the operation.

Results

There were 29 samples in this study, consisted of 16 samples with mitral stenosis and 13 samples with mitral regurgitation. Paired T-test showed significant change between free wall RVLS pre- and post-operative (-18.8±3.41 and -13.5±3.21, respectively) with a difference of 5.07 (1.40-15.34), p<0.001. Analysis on preoperative and operative factors, such as preoperative left ventricular ejection fraction (LVEF), probability of pulmonary hypertension (PH), cardiopulmonary bypass (CPB) time, aortic cross clamp (Aox) time, and basal, mid, and longitudinal RV diameters, showed no significant association with postoperative free wall RVLS change.

Conclusion

There is significant decrease of free wall RVLS early after MVR. The decrease in postoperative free wall RVLS isn’t associated with factors such as preoperative LVEF, probability of PH, RV diameters CPB time and Aox time
OR75. The role of tricuspid annular plane systolic excursion for STEMI patients in the national PCI center
Authors: Shabrina N N , Tobing D
Published: April 2022

Aims

Tricuspid annular plane systolic excursion (TAPSE) is one of the most established echocardiographic parameters to assess global function of the right ventricle (RV). This study sought to evaluate TAPSE to predict early outcomes and ascertain whether its value adds beneficial prognostic information to patients with myocardial infarction.

Methods and Results

Of all 899 patients who were diagnosed with ST-segment elevated myocardial infarction (STEMI) between July 2018 to June 2019, 576 patients underwent echocardiography examination within 24-hour of onset. The subjects were categorized into two groups: TAPSE ≤18 mm (n = 265) and TAPSE >18 mm (n = 311). Primary outcomes were the incidence of cardiogenic shock, cardiac arrest, and in-hospital mortality.

A total of 576 patients (513 males, mean age 55±10) with STEMI diagnosis who underwent percutaneous coronary intervention were enrolled to this study. In the overall cohort, TAPSE ≤18 mm was statistically associated with greater incidence of cardiogenic shock (p = 0.001), cardiac arrest (p = 0.002), and in-hospital mortality (p = 0.001). Multivariate analysis showed that TAPSE ≤18 mm was an independent predictor of cardiogenic shock (OR, 2.951; 95% CI, 1.507 to 5.781), cardiac arrest (OR, 2.500; 95% CI, 1.381 to 4.527), and in-hospital mortality (OR, 2.868; 95% CI, 1.460 to 5.632).

Conclusion

The assessment of TAPSE that represents RV function among STEMI patients can be considered as a prognostic factor regarding early outcomes. Long-term follow-up is necessary to obtain more comprehensive prognostic information.
OR76. The Roles of Growth Differentiation Factor-15 for Prediction of Major Adverse Cardiac Event among Patients with Acute Myocardial Infarction
Authors: Tridamayanti A , Wasyanto T , Yasa T A
Published: April 2022

Background and Aims

Growth Differentiation Factor-15 (GDF-15) is a systemic inflammation marker that has emerged as a biomarker that capable to predicting cardiovascular events. Recent studies suggest that GDF-15 is elevated in patients with acute myocardial infarction, but the prognostic remains incompletely defined. This study aimed to investigate the difference between high and low GDF-15 levels with major cardiac adverse events (MACE) in patients with acute myocardial infarction.

Methods and Results

This cohort study was conducted with total of 64 acute myocardial infarction patients. GDF-15 was measured at admission and clinical data and 3 months follow up events was registered. MACE at hospitalization occurred in 43.75% of patients, whereas MACE at three months of observation occurred in 18.6% of patients. After adjustment multivariate analysis, higher levels of GDF-15 was independently associated with risk of MACE at 3 months follow up (OR 1.501; p = 0.003). The cut-off point value of GDF-15 was obtained 2256 pg/mL (AUC 0.848; 95% p = 0.001). Risk model with Kapplan Meier showed significant association between high GDF-15 levels (≥ 2256 pg/mL) and the incidence of MACE during hospitalization (HR 2.492; 95% CI 1.126-5.518; p = 0.0024) and MACE at 3 months follow up (HR 14.693; 95% CI 1.877-115.047; p < 0.001)

Conclusion

GDF-15 was significantly associated with the risk of MACE at hospitalization and at 3 months of observation after acute myocardial infarction
M1. Association between Subclinical Hypothyroidism and Heart Failure: A Systematic Review and Meta-Analysis
Authors: Faizah N N , Effendi G B
Published: April 2022

Background and Aims

The correlation between subclinical hypothyroidism and heart failure has been increasingly investigated, but still controversial. We performed a systematic review and meta-analysis to evaluate the association between subclinical hypothyroidism and the incidence of heart failure.

Methods and Results

Two reviewers systematically searched literature evaluating the association between subclinical hypothyroidism and heart failure on PubMed from inception to June 2021. Subclinical hypothyroidism was defined as thyroid-stimulating hormone (TSH) of 4.5 to 19.9 mIU/L with normal T4 level in the absence of symptoms. The quality of the studies was reported using the Newcastle-Ottawa scale (NOS). A meta-analysis was conducted using RevMan 5.4 software by analyzing the hazard ratio (HR) with 95% confidence intervals (95%CIs) using a random and fixed-effects model. 

A total of six cohort studies involving 602,176 subjects were included. Among the participants, 14,995 (2.5%) had subclinical hypothyroidism. Our pooled analysis showed that individuals with subclinical hypothyroid had an increased risk of heart failure compared to those with euthyroid (HR = 1.03; 95%CI = 0.95-1.11, p = 0.50); however, it was not statistically significant. Furthermore, subgroup analysis was done based on TSH level divided into 4.5-6.9 mIU/L, 7.0-9.9 mIU/L, and ≥10.0 mIU/L. Increased risk of heart failure was significantly associated with TSH level of ≥ 10.0 mIU/L (HR = 1.93; 95%CI = 1.24-3.01, p = 0.004).

Conclusion

Higher TSH level in subclinical hypothyroidism is associated with an increased risk of heart failure, particularly for TSH ≥10 mIU/L.
M4. Catheter ablation versus medical therapy for atrial fibrillation treatment in older adults: a systematic review and meta-analysis
Authors: Tandaju J R , Mangkuliguna G
Published: April 2022

Background

Prompt treatment of atrial fibrillation is essential to reduce mortality and morbidity and increase quality of life. Catheter ablation remains one of effective treatments, yet its efficacy on elderly was unknown. In addition, elderly have different drug tolerance, thus results on the general population were not reliable. 

Aim

Compare the outcomes of catheter ablation (CA) versus antiarrhythmic drug (ARD) for older patients (55 and above) with AF.

Methods

The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021262067).

Results

Nine studies involving 2,307 patients were included. The majority of studies had low risk-of-bias. CA was associated with lower mortality (OR = 0.40; 95% CI [0.27,0.61]; p < 0.0001), recurrence rate (OR = 0.31; 95% CI [0.15,0.65]; p = 0.002) and higher quality of life measured with SF-36 (MD = 4.78; 95% CI [2.28,7.28]; p = 0.0002) compared to those who received ARD only. Improvement in left ventricular ejection fraction (MD = 4.53; 95% CI [2.18,6.87]; p = 0.0002) and brain natriuretic peptide level (MD=-108.85; 95% CI [-195.59,-22.11]; p = 0.01) were also observed. There were some risks of cerebrovascular accidents post-ablation (OR = 0.46; 95% CI [0.25,0.85]; p = 0.01). 

Conclusion

CA seems to offer more clinical benefits than ARD among older patients, however its execution must be warranted by patient-tailored therapy choice.
M7. Effects of the angiotensin receptor–neprilysin inhibitor/sacubitril-valsartan administration on quality of life and outcome in heart failure with reduced ejection fraction: a meta analysis
Authors: Dewi Kadek Intan Murti , Pintaningrum Yusra
Published: April 2022

Background and Aims

Improved quality of life is a mayor treatment goal in heart failure. Based on the PARADIGM-HF trial, ARNI was found improved quality of life in heart failure with reduced ejection fraction (HFrEF). The aims of this study are to evaluate the quality of life and outcome patient HFrEF after ARNI administration.

Methods and Result

Published scientific articles is searched through PubMed database with inclusion criteria were Randomized Control Trial (RCT) or observational study in the last 10 years (2014 - 2021), the QoL is measured by Kansas City Cardiomyopathy Score (KCCQ). A total of 4 RCTs and 3 observational studies were selected. There was significantly increase in KCCQ Overall Summary score (MD = 2.01 [95% CI, 1.07, 2.96], p < 0.00001). There was also significantly increase in KCCQ physical limitation domain (MD = 1.21[95% CI, 0.12, 2.30], p = 0.03), QoL domain (MD = 2.66[95% CI, 0.64, 4.69], p = 0.010) and social limitation domain (MD = 1.97[95% CI, 0.98, 2.95], p < 0.0001). The relative risk in HFrEF patients for first hospital admission was 0.82 (95% CI, 0.77, 0.87, p < 0.00001) and relative risk for cardiovascular death was 0.81(95% CI, 0.76, 0.87, p < 0.00001). Hypotension was found as significant adverse event after treatment with ARNI (RR = 1.57 [95% CI, 1.41, 1.75], p < 0.00001).

Conclusion

ARNI was found significantly improved quality of life, reduced morbidity and mortality in patient HFrEF compared with control but might causes a serious adverse event such as hypotension. Due to limitation data of adverse event, a further investigation might be needed.
M8. Electrocardiogram findings as predictor of atrial fibrillation recurrence after intervention: systematic review and meta-analysis
Authors: Tandaju J R , Wardhana I L , Inayati F , Moegandi R P , Suhada D S , Rahmat F A
Published: April 2022

Background

Atrial fibrillation (AF) recurrence rate still stands between 40% and 50%, causing complications. Therefore, early diagnosis of AF recurrence is needed for prompt treatment, thus morbidity and mortality could be reduced and quality of life could be improved.

Aim

Determine predictive value of electrocardiogram and its findings towards AF recurrence in population who have underwent intervention.

Methods

Systematic review and meta-analysis was conducted according to PRISMA statement. Six reviewers searched studies from PubMed, ProQuest, ScienceDirect, and EBSCO from inception to June 2021 with primary outcome of AF recurrence. Data was appraised and processed using random effects or fixed effects model with the outcome of mean difference (MD) or odds ratio (OR) with 95%-confidence interval (95% CI).

Results

Thirty included studies involving 5,490 subjects were found good in terms of quality assessment. AF recurrence on patients underwent cardioversion was more likely found in patients with larger P-wave duration (OR = 2.90; 95% CI [1.47, 5.74]; p = 0.01) and P-wave dispersion (MD = 12.67 ms; 95% CI [10.73, 14.62]; p < 0.00001). AF recurrence on patients underwent pulmonary vein isolation (PVI) was highly associated with larger P-wave duration (MD = 13.92 ms; 95% CI [11.54, 16.30]; p < 0.00001) and P-wave dispersion (MD = 11.53 ms; 95% CI [8.41, 14.65]; p < 0.00001). However, the relation between P-wave duration and AF recurrence on cathether ablation yet to be determined (MD = 6.34 ms; 95% CI [-0.77, 13.44]; p < 0.00001).

Conclusion

P-wave and P-wave dispersion were considered as predictive factor for AF recurrence in patients underwent cardioversion and PVI.
M9. Five–year Outcome of Bioresorbable Vascular Scaffold versus Drug-Eluting Stent for Coronary Artery Disease: A Meta-Analysis of Randomized Control Trial
Authors: Putra H B P , Mukhammad W W , Kembangsari C , Jovie B , Juslim R R
Published: April 2022

Introduction

Late stent thrombosis and restenosis remain major drawbacks of Drug-Eluting Stent (DES). Therefore, Bioresorbable Vascular Scaffolds (BVS) were created to combat these disadvantages. However, the long-term outcome of BVS versus DES for treating coronary artery disease remains inconclusive. 

Method

We performed an orderly literature search from several electronic databases. We used the keyword “bioresorbable vascular scaffold” and “drug-eluting stent”. The inclusion criteria were comparing BVS and DES, Randomized Control Trial (RCT), and reported 5-year follow-up. The primary endpoints were cardiac death and stent thrombosis. Secondary endpoints were ischemic-driven target lesion revascularization (ID–TLR) and target lesion failure (TLF) as a composite of cardiac death, target vessel myocardial infarction (TVMI), or ID–TLR. Risk ratio (RR) with 95% confidence intervals (CIs) were used to report all outcomes.

Results

A total of 3 RCT were selected (ABSORB II, ABSORB III, and ABSORB JAPAN) with 2.890 patients were pooled in our analysis. At five years, compared to DES, BVS had no significant difference in cardiac death (RR = 0.81 [95% CI, 0.50-1.32], p = 0.40). However, BVS had higher risk of stent thrombosis (RR = 2.74 [95% CI, 1.38-5.46], p = 0.004), ID–TLR (RR = 1.38 [95% CI, 1.04-1.84], p = 0.03) and TLF (RR = 1.26 [95% CI, 1.03-1.54], p = 0.02).  

Conclusions

Comparing to DES, BVS has a significantly greater risk of stent thrombosis, ID–TLR, and TLF after five years of follow-up.
M14. The Effectiveness of Telemedicine Approach for Treating Patients with Hypertension: a meta-analysis
Authors: Haydar H , Firmanda D R
Published: April 2022

Background

Hypertension has become one of the major global burdens with high morbidity even in developed countries. Telemedicine intervention may be able to monitor and provide better blood pressure management in patients with hypertension.

Aims

This study evaluated the effects of telemedicine intervention on blood pressure management in patients with hypertension. 

Methods

We conducted a literature search in PubMed and Cochrane Library, published up to 22 July 2021. All RCT that evaluated telemedicine intervention were included. The Cochrane risk of bias tool was used to assess the quality of the studies. The primary outcomes were systolic blood pressure (SBP), and diastolic blood pressure (DBP) changes. 

Results

Sixteen RCTs were included in this analysis. Our pooled analysis showed that telemedicine was associated with reduction in SBP and DBP compared to usual care ([MD -4.21; 95% CI -5.56 to -2.85; p < 0.001] and [MD -2.13; 95% CI -2.69 to -1.56; p < 0,001], respectively). A subgroup analysis showed that telemedicine intervention with a period of more than six months was associated with a better reduction in SBP (MD -5.29; 95% CI -7.34 to -3.25; p < 0.001). 

Conclusion

Telemedicine intervention may improve the effectiveness of blood pressure in patients with hypertension.
M15. The potential benefits of renin-angiotensin-aldosterone and beta-adrenergic inhibitions for lowering trastuzumab-associated cardiotoxicity risks among breast cancer patients: meta-analysis of randomized controlled trials
Authors: Putra P , Putra F N
Published: April 2022

Background and Aims

Trastuzumab is one of the principal treatments for HER2-positive breast cancer patients and related to high cardiotoxicity risk. This study aims to compare the efficacies among Renin-Angiotensin-Aldosterone inhibitors (RAASi) and beta-blockers (BB) to lower trastuzumab-associated cardiotoxicity risks.

Method and Results

Comprehensive literature searching was conducted through online databases then followed the PRISMA guideline. Studies included were all randomized controlled trials (RCTs) that compared the changes of left ventricular ejection fraction (LVEF) and brain natriuretic peptides (BNP) among RAASi, BB, and placebo (PCB) in HER2-positive breast cancer patients who received trastuzumab. Bias risk was accessed by using the Cochrane Risk-of-bias (RoB 2) instrument. Analysis was performed to provide pooled risk ratio (RR) and standard mean difference (SMD) with 95% confidence interval (CI) using fixed-effect heterogeneity test. The RAASi group shows significant LVEF improvement compared with PCB (SMD=0.63, 95%CI 0.27 to 0.99, p = 0.0006, I2=0%), while the BB group also shows LVEF improvement compared with PCB although not statistically significant (SMD=0.04, 95%CI -0.32 to 0.39, p = 0.84, I2=0%). Both RAASi (SMD=0.18, 95%CI 0.00 to 0.37, p = 0.05, I2=0%) and BB (SMD=0.23, 95%CI 0.05 to 0.42, p = 0.01, I2=0%) groups have significant BNP improvement. Patients received RAASi have significant reduction of 2-year cardiac risk development (RR = 0.42, 95%CI 0.27-0.67, p = 0.0002, I2=42%) and non-significance LVEF <50% reduction risk (RR = 0.49, 95%CI 0.23-1.08, p = 0.08, I2=50%).

Conclusion

Both RAASi and BB show potential benefits in lowering the trastuzumab-associated cardiotoxicity risks. However, further studies are needed to establish the efficacies.
M16. The potential role of pentraxin-3 as prognostic factor to predict outcome in heart failure patients with reduced left ventricular ejection fraction: a meta-analysis study
Authors: Soemarno H W , Nursabur B M
Published: April 2022

Aims

This study was aimed to investigate the prognostic value of pentraxin-3 in predicting cardiac events in heart failure with reduced left ventricular ejection fraction (HFrEF) patients.

Methods and Results

A comprehensive search was conducted on Pubmed, Science Direct, Taylor-Francis and LILACS database with the date of publication ranging from inception until 20 July 2021. The identified articles were screened based on pre-specified eligibility criteria which resulted in four prospective cohort studies included in quantitative analysis. Their risk of biases have a mean score of 8.2 ± 0.4 according to the Newcastle-Ottawa Scale, equivalent to good quality rating based on the Agency for Healthcare Research and Quality. In these studies, 3,427 HFrEF patients were enrolled to measure their pentraxin-3 levels on admission and to observe cardiac events, defined as cardiac death or rehospitalization for worsening HF. The association between pentraxin-3 and cardiac events was summarized using forest plot and the heterogeneity was evaluated by I2 index. Higher concentrations of pentraxin-3 on admission were consistently associated with increased cardiac events in HFrEF patients (HR: 1.21, 95% CI: 1.14 - 1.29, I2: 12%). Unfortunately, most of the studies were conducted in Asia and had small sample sizes, which affects the external validity of this meta-analysis.

Conclusion

Elevated concentrations of pentraxin-3 on admission are associated with cardiac events in HFrEF patients. Further investigations with an emphasis on multi-centre studies, as well as the establishment of the standard cut-off value, are needed.
C2. A Case of Arrhythmogenic Right Ventricular Cardiomyopathy Presenting with Recurrent Ventricular Tachycardia : The Role of Imaging to Confirm Diagnosis
Authors: Permitasari D A , Habibi F N , Ardhianto P
Published: April 2022

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited condition which predominantly affects young people, characterized by fibrofatty replacement of the right ventricle. It is also commonly being underdiagnosed, so that the role of imaging is imperative to confirm diagnosis of ARVC patient.

Case Summary

A 57-year-old man presented with palpitation, syncope and chest pain. The symptoms had begun since 3 month prior to hospital admission with no family history of premature sudden death. He had been hospitalized 3 times before due to palpitation. Electrocardiogram (ECG) revealed ventricular tachycardia with LBBB morphology and superior axis. Patient was undergoing 100 Joule cardioversion, and the ECG post-cardioversion showed sinus rhythm with inverted T-wave in inferior and anterior leads. Echocardiography revealed enlargement and reduced function of right ventricle (RV). Coroangiography revealed nonsignificant stenosis coronary artery disease. Cardiac MRI showed dyssynchrony RV contraction, reduced RV ejection fraction <40%, hyperintensity in RV endocardium and posteroinferior aspect of endocardium to myocardium left ventricle, representing the fatty infiltration. Our patient had 2 major criteria which established the diagnosis of definite ARVC according to revised Task Force Criteria. Patient was planned to have an implantable cardiac defibrillator.

Discussion

Late clinical presentation of ARVC is rare, thus it should be included in the differential diagnosis when treating older patient with ventricular tachyarrhythmia. This case highlights the importance of imaging, either with echocardiography and cardiac MRI to confirm the diagnosis of ARVC as the potential cause sudden cardiac death.
C3. A case of extreme discrepancy between office and ambulatory blood pressure: is it true uncontrolled hypertension?
Authors: Tartila T S , Pujowaskito P , Jannah F D K , Tafriend N A
Published: April 2022

Background

White coat uncontrolled hypertension (WCUH), defined as drug-treated hypertension but with increased blood pressure in the office and normal ambulatory blood pressure, should be assessed in patients with uncontrolled hypertension to prevent overtreatment. We report a case of an extreme WCUH found by ambulatory blood pressure monitoring (ABPM).

Case Summary

A 66-year-old woman was a regular patient in Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto with uncontrolled hypertension, CAD post-PCI, and insulin-dependent type 2 diabetes mellitus. The patient was overweight (BMI was 24.56 kg/m2) with dyslipidemia and uncontrolled blood glucose. Despite aggressive treatment with ARB, CCB, beta-blockers, diuretic, and clonidine, the patient had persistent hypertension with mean office systolic blood pressure >160/90 mmHg. Echocardiography showed concentric left ventricular hypertrophy. ABPM result found extreme variability of blood pressure with the average 24-hour blood pressure of 93.6/59 mmHg (mean daytime blood pressure was 90/55 mmHg and mean night-time blood pressure was 98.7/65.2 mmHg), intermittent hypotension, and reverse dipper pattern. The blood pressure once dropped to the lowest point of 69/44 mmHg, and the highest was 211/186 mmHg. Based on this result, we classified the patient’s condition as WCUH and adjusted the antihypertensive regiment.

Discussion

This case emphasizes the need to evaluate the presence of WCUH by ABPM in patients with uncontrolled hypertension so antihypertensive drugs could be adjusted accordingly and prevent hypotension.
C7. Air Traveling – Related Acute Decompensated Heart Failure, The Nightmare Begin in The Sky: A Case Report
Authors: Abdul G , Akhtar F M
Published: April 2022

Background

Patients with heart failure are prone to experience problem contributed air travel. The major cardiovascular problem with aviation is mainly as a result of dropping air pressure. During flight the cabin pressure will drop and be maintained at 8000 ft, bringing oxygen levels down to 15%.

Case Summary

A 50 yo woman presented with diaphoresis, acute worsening of dyspnea, and hypoperfused after air travel. In the first 10-15 minutes of 1-hour flying, she felt tachycardic and becoming increasingly short of breath that doesn’t relieve after debarking off. The previous history included chronic heart failure due to severe mitral regurgitation and hypertension. Echocardiography study revealed severe mitral regurgitation due to prolapse AML and dilated LA with preserved ejection fraction. Initial management with dobutamine and norepinephrine and then furosemide improved her clinical status. The patient was discharged with planning for surgical correction for mitral regurgitation.

Discussion

The presentation of signs and symptoms denote clinical conditions termed acute decompensated heart failure wet and cold type. The onset of symptoms revealed that this situation related to air traveling. Drop in air pressure and oxygen levels that occur at the cabin during flight make physiological and psychological stress, hypoxia, and raised sympathetic tone. In the patient with preexisting chronic heart failure, these responses will lead to clinical decompensation and deterioration.
C9. An Extremely Rare Dual Congenital Disorder of The Heart: Aberrant Tendinous Chords with Tethering of The Tricuspid Leaflet Associated with Wolff-Parkinson-White Syndrome
Authors: Hartoko A , Nugraha M T
Published: April 2022

Background

Aberrant tendinous chords with tethering of the tricuspid leaflets is a rare congenital etiology of tricuspid regurgitation (TR), defined as abnormal insertion of tendinous cords at the clear zone of the tricuspid leaflet and connect to the endocardium instead of the papillary muscles. Wolff-Parkinson-White (WPW) syndrome defined as a congenital condition involving additional conductive cardiac tissue between the atria and the ventricles that provides a pathway for a reentrant tachycardia circuit. Ebstein's anomaly (EA) is the most commonly occurring congenital abnormality that caused TR associated with the WPW. Until now, there is no case report of aberrant tendinous chords with tethering of the tricuspid leaflets that associated with WPW.

Case Illustration

A 26-year-old female with history of recurrent palpitation she was given was referred to our hospital. Resting ECG revealed sinus rhythm with delta wave suggesting diagnostic of WPW. On physical examination we found loud systolic murmur on left lower sternal border. Echocardiography examination revealed dilated right atrial and right ventricle, severe tricuspid regurgitation with restricted septal TV caused by aberrant tendinous chords. No apical displacement of tricuspid leaflet >8 mm/m2 excluding the diagnosis of EA.

Discussion

Both WPW and aberrant tendinous chords with tethering of the tricuspid leaflet are rare congenital disorder of the heart. EA is most common congenital TR associated with WPW, there are rarely reported other congenital TR associated with WPW. This case illustrates extremely rare case where we found both WPW and Aberrant Tendinous Chords.
C10. An ultra-rare case of Hutchinson–Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl
Authors: Rasaki R , Novita  , Heriansyah T
Published: April 2022

Background

Hutchinson-Gilford progeria syndrome (HGPS) is an ultra-rare autosomal dominant that result in progressive premature aging syndrome. Cardiovascular diseases become the main cause of mortality including myocardial infarction, interstitial myocardial fibrosis, hypertension and calcification of the mitral and aortic valves. However, the relationship between HGPS and bicuspid aortic valve (BAV) has not been documented yet.

Case Summary

A 9-year-old girl with HGPS presented to the outpatient clinic with a complaint of shortness of breath since 5 years ago, especially when she did moderate physical activity. Chest pain and palpitation were denied. Her physical examination revealed short stature, thin, wrinkled skin, craniofacial disproportion with alopecia, shrunken facies and prominent scalp veins. There was failure to thrive and diastolic murmur grade 2/4 is heard on the aortic area. Laboratory test showed leukocytosis. Transthoracic echocardiogram showed severe aortic regurgitation due to calcified bicuspid aortic valve and mild mitral regurgitation. She was managed by conservative therapy because her parents were still considering the aortic valve repair procedure.

Discussion

The HGPS patient with severe aortic regurgitation due to BAV should be managed to reduce cardiovascular complications. Aortic valve repair is an interesting alternative to replacement managing aortic regurgitation due to BAV in young adults. Recently, advanced science about BAV disease and refinement of surgical techniques improved standardization of BAV repair procedure.
C13. Atropine Challenge: Bedside Diagnosis of Block Level
Authors: Akbar R R , Wasyanto T
Published: April 2022

Background

The concept of 2:1 AV block remains poorly understood by many physicians even after so many years of advancement in the field of electrophysiology. It cannot be classified into type I or type II second-degree AV block because there is only one PR interval to examine before the blocked P wave.

Case Illustration

Case 1  . A 78-year-old male with asymptomatic bradycardia was referred to our hospital. Resting ECG revealed 2:1 conduction AV block. In order to define the site of block we performed the atropine challenge test, revealed improvement of AV block to Mobitz I and then 1st degree AV block, suggesting the suprahissian block. Case 2. A 74-year-old male with inferoposterior and right ventricular STEMI was referred to our hospital. His resting ECG revealed 2:1 conduction of P wave. The atropine challenge test revealed improvement of block to 1st degree AV block, suggesting the suprahissian block.

Discussion

It is often difficult to distinguish intranodal and infranodal blocks when 2:1 conduction is present. Therefore, a careful search of a long ECG tracing for two consecutive P waves should be made. In addition, atropine can improve AV node conduction due to sympathetic and/or parasympatholytic stimulation. Therefore, it may increase AV node conduction but worsen infranodal block without affecting the refractory period of the infranodal. This case illustrates the importance of a noninvasive test for confirming the location of a 2:1 conduction AV block, as guide to diagnostic and therapeutic determinations.