bluuebunny/crossref_metadata_2025 huggingface dataset:
OR15. Cell Surface Markers on Adipose-Derived Mesenchymal Stem Cells: Isolation, Culture, and Identification for Translational Success
Authors: Sativa Oryza , Nugraha Ricardo Adrian , Arjani Kandita , Hasan Muhammad Rifqi Djamal , Pikir Budi Susetyo , Dharmadjati Budi Baktijasa , Oktaviono Yudi Her
Published: April 2022

Aims

The purpose of this study is determining that each part of adipose tissue will generate stem cells with similar adipose-derived mesenchymal stem cells (AMSCs) characteristic and specific cell-surface markers, thus there is no waster product of part adipose tissue in regenerative medicine.

Methods

An invitro experimental study, used approximately 20 grams of human subcutaneous adipose tissue were isolated and processed, until stromal vascular factor (SVF) and creamy supernatant separated. Both substances then divided into single filtration group and double filtration group consecutively. Each group and control group were sextuplicate before further analysis using immunocytochemistry. Single and double filter of AMSCs were applied to the subsequent experiments. AMSCs were observed under a microscope, the growth curves of the cells were assessed using a cell counting kit‑8 assay and the membrane expression of cell surface antigens, including cluster of differentiation (CD) 34, CD45, CD90, and CD105 were detected by immunocytochemistry.

Results

Flow cytometry demonstrated that the cells were highly positive for fourth cell surface markers. CD34 and CD45 expressions were detected in control group, and gradually decreased among another groups whereas lack of CD45 expression were consistent on other remaining groups. The expression of CD90 and CD105 were visibly increased significantly from control group to fourth group.

Conclusion

This study demonstrated that either SVF and/or supernatant generates fibroblastic-like cells and surface markers expression that matched the MSCs criteria. Therefore, all parts of adipose tissue are an appealing alternative of stem cell source regardless of culture method chosen.
OR18. Combination of ramiprilat and human umbilical cord blood-mesenchymal stem cells derived secretome increase endothelial progenitor cells migration
Authors: Isaridha I A , Oktaviono Y H , Lefi A , Sandra F , Subagjo A
Published: April 2022

Background and Aims

Stem cells therapy has been studied in the cardiovascular field, but the limitations in terms of survival and risk of rejection make cell-free therapy with secretome worth considering. This study aims to identify the effect of human umbilical cord blood mesenchymal stem cells (hUCB-MSCs) derived secretome, ramiprilat, and combination of both on endothelial progenitor cells (EPCs) migration.

Methods and Results

EPCs were collected from mononuclear cells (MNCs) of the peripheral blood of chronic coronary syndrome patient using density gradient centrifugation method, then cultured in Stemline II medium (Sigma Aldrich, USA). Secretom was made by taking the supernatant from the hUCB-MSCs cell line culture media that had been centrifuged. Cultured EPCs was divided into control group, treatment with 10 µmol Ramiprilat, various concentrations of hUCB-MSCs-derived secretome (2%, 10%, and 20%) and combination of 10 µmol Ramiprilat and each concentration of secretome. EPCs migration was assessed using Boyden chamber assay. Results showed that ramiprilat and all doses of secretome increased EPCs migration compared to the control group (p < 0.001). Secretome 20% had higher EPCs migration than ramiprilat (51.00±5.15 vs 33.80±2.49, p < 0.001), and the combination of ramiprilat and secretome 20% showed the highest number of migrated EPCs among all groups.

Conclusion

hUCB-MSCs-derived secretome and ramiprilat increase EPCs migration. The combination of those two substances furtherly increased the migrated cells. hUCB-MSCs-derived secretome has the potential as a cell-free cardiovascular treatment for coronary artery disease patients.
OR19. Correlation between Circadian Variation of Idiopathic Ventricular Arrhytmia and Left Ventricular Intrinsic Systolic Function assessed by Speckle Tracking Echocardiography
Authors: Nugroho Bhayu Hanggadhi , Raharjo Sunu Budhi , Andriantoro Hananto , Lelya Olfi , Dwiputra Bambang , Sukmawan Renan
Published: April 2022

Aims

To investigate the correlation between circadian variation of idiopathic ventricular arrhytmia (IVA) and left ventricular (LV) intrinsic systolic function.

Methods

This cross sectional study included 67 patients with IVA originated from ventricular outflow tract. All patients underwent 24-hour Holter monitoring and speckle tracking echocardiography examinations. The circadian variation of IVA burden and global longitudinal strain (GLS) were determined and statistical analysis was conducted to evaluate their correlation.

Results

A total 31 patients (46.3%) had impaired LV systolic function by GLS (-15.1% + 1.8% vs -21.3% + 2.0%; p = <0.001) with less variation in circadian PVC distribution (coefficient of variation 6 hourly 26.8% + 15.6 vs 52.0 % + 28.2%; p = <0.00). Impaired LV systolic function was found in 31 patients (46.3%) with less variation in circadian IVA distribution (coefficient of variation/CoV 6 hourly 26.8%+15.6) compared to patients with normal LV systolic function (CoV: 52.0%+28.2%; p = <0.001). Multivariate analysis showed that less variation in circadian PVC distribution [CoV<35%) is correlated with LV dysfunction (OR = 3.89, 95%CI 1.09-13.80, p = 0.036). Other independent factors were episode of non-sustained VT (OR = 14.4, 95%CI=2.36-88.55, p = 0.008), IVA burden >9% (OR = 6.81, 95%CI 1.35-34.41, p = 0.020), and male gender (OR = 14.4, CI 95%=2.02-101.1, p = 0.004).

Conclusion

This study is the first to show that lack of circadian variation of IVA is associated with impaired LV systolic function by GLS. The finding of this study suggested that chronotherapy of antiarrhytmia medication may prevent the development of LV dysfunction.
OR22. Correlation Between the New York Heart Association Functional Class with depression in Heart Failure patients: A Cross sectional study
Authors: Arifin Y , Saifur Rohman M , Tjahjono C T , Sargowo D , Rahimah A F
Published: April 2022

Background

The prevalence of heart failure (HF) continues to increase and presents as one of the most financially burdensome diseases. The prevalence of depression in HF patients was higher than in general populations. Depression was known to increase the rehospitalization, cost, and mortality of HF patients. This study aimed to find the correlation between the New York Heart Association (NYHA) Functional Class in HF patients with the incidence of depression.

Method and Result

This cross-sectional study recruited 342 patients diagnosed with HF previously for more than 3 months at Dr. Saiful Anwar General Hospital from December 2016 to March 2021. Each patient was interviewed for their demographic and clinical data and assessed for depression with Montgomery-Asberg Depression Rating Scale Indonesian version. We used Spearman coefficients to evaluate the correlations between variables. Patients were predominantly male with ACE-i/ARB and beta-blockers treatment. Age ranged from 22 to 87 years old. The median baseline of the left ventricular ejection fraction (LVEF) was 52 (42-60) %. Baseline characteristics among the depression and non-depression groups demonstrated no significant difference (p > 0.05). There were significant correlations between NYHA Class and marital status (p < 0.05) with depression. We performed log regression for the confounding. The result was NYHA Class significantly with depression and NYHA Class also have effects on the depression.

Conclusion

In HF patients, NYHA Class was significantly correlated with depression.
OR23. Correlation of Right Ventricular Systolic Function by Right Ventricular Global Longitudinal Strain in Rheumatic Mitral Stenosis compared to Mitral Regurgitation before and after Intervention
Authors: Kesumawardani E S , Ketaren A P , Ardini T W , Akbar N Z , Hasan H
Published: April 2022

Background and Aims

Right ventricle systolic dysfunction develop prior to the onset of clinical systemic congestion; thus, early detection is beneficial for both diagnostic and therapeutic value. We aim to asses changes of Right Ventricular Global Longitudinal Strain (RVGLS) in rheumatic mitral valve disease, and assess correlation between Right Ventricular Systolic Pressure (RVSP) and RVGLS before and after intervention.

Methods and Results

Our study consisted of 21 patients with an established diagnosis of significant MS or MR and normal RV function, who were admitted for either Balloon Mitral Valvulotomy (BMV) or Mitral Valve Replacement (MVR). 2D echocardiography and measurement of RVGLS was obtained from RV-focused A4CH view. Patients were divided into 2 groups: (1) significant MS consists of 11 patients, (2) significant MR consists of 10 patients. Prior to intervention, MS group had significantly lower RVGLS compared to MR group (-11.64 vs. -18.29; p = 0.001). After MVR, the RVGLS of MS group was significantly increased compared to MR group (MS -11.64 to -15.59, p = 0.001 vs. MR -18.29 to -19.39, p = 0.069). Both MS and MR groups showed significant negative correlation between RVSP and RVGLS before and after intervention (r=-0.642; p = 0.002; r=-0.670; p = 0.001).

Conclusion

Pre-intervention with a background normal RV function, RVGLS was impaired significantly in MS group compared to MR group. Post intervention RVGLS improved significantly in MS group compared to MR group. Both groups showed significant negative correlation between RVSP and RVGLS before and after intervention.
OR26. Dedifferentiated Fat Cells versus Adipose Derived Mesenchymal Stem Cells Experimental Study about Adipose-derived Stem Cells for Cardiomyocyte Precursor using Traditional and Insert Culture
Authors: Sativa O , Nugraha R A , Pikir B S , Dharmadjati B B , Oktaviono Y O
Published: April 2022

Background and Aims

The discovery of dedifferentiated fat cell (DFAT) raises the question, are AMSC and DFAT the same type of mesenchymal stem cell (MSC)? We aim to analyze the immunocytochemistry (ICC) profile of both cells and the correlation between different methods with different passage to GATA-4 and cTnT expression in vitro.

Methods and Results

Human subcutaneous-fat tissue was isolated and divided into, first group, using single filtration by 100 µm cell strainer and second group using double filtration with addition of 70 µm strainer after the 100 µm. Cell obtained from both groups were labeled AMSC and DFAT respectively. Prior to passaging, CD34, CD45, CD90, and CD105 were analyze by ICC. After passaging, passage 1 and 4 was exposed to Gibco PSC Cardiomyocyte Differentiation Kit for 21 days. Colonies from days 7, -14, and -21 were analyze by ICC for GATA-4 and cTnT expression. Post hoc analysis shown that there is no significance difference in MSC markers expression between groups. There were significance differences in GATA-4 expression on all observation days, which decreased significantly from the 14th to the 21st day. Statistic significancy also found on cTnT expression, with a significant increase from day 14 to day 21. The filter variable consistently has a significant effect on the quantity of GATA-4 and cTnT expressions.

Conclusion

The study shows that different culture methods, presumably the use of filters, will have a significant effect on the differentiation of AMSC and DFAT into cardiomyocytes.
OR27. Depression, Anxiety, and Stress in Chronic Heart Failure patient
Authors: Rafidhinar R , Pramudyo M
Published: April 2022

Background

Heart failure is a progressive health problem with high mortality and morbidity rates, associated with a significant reduction in the quality of life (QoL)1,2,3. Heart failure greatly affects the physiological condition of the patient, such as depression, anxiety, and stress4,5. This study aimed to determine the prevalence of depression, anxiety, and stress symptoms in chronic heart failure patients.

Method & Results

A descriptive study was conducted from outpatients at the Heart Failure Clinic at Hasan Sadikin Hospital Bandung in June 2021, which screened for Depression, Anxiety, and/or Stress using the Depression, Anxiety, Stress Scale-21 (DASS-21) questionnaire. The descriptive analysis of this study showed several patients had depression and anxiety following chronic heart failure. This study comprised 20 patients consisting of female (45%), and male (55%). 7 patients (35%) had psychological problems (Depression, Anxiety, and/or stress). 4 patients (20%) had depression symptoms, which consists of 3 patients (80%) had mild depression and 1 patient (20%) had moderate depression. 6 patients (30%) had anxiety symptoms, 4 patients (80%) diagnosed with mild anxiety and 2 patients (20%) diagnosed with moderate anxiety. And there were no patients classified with stress.

Discussion

Based on these findings, patients with chronic heart failure were prone to have psychological problems such as depression and anxiety. We recommend the screening should be routinely performed, with appropriate referral pathways to psychiatrists. Further research is needed to improve detection and develop effective treatments for these disorders in HF patients.
OR33. Elevated d-dimer in predicting all-cause in-hospital mortality of coronavirus disease 2019 in kediri general hospital
Authors: Niazta N A , Nisa N K , Nuraini P E , Sulistyono W , Prasetyo S U , Haq M D K
Published: April 2022

Aims

COVID-19 has infected the world on a wide spectrum, from mild to severe and causing death. As of January 1st 2021, global case fatality rate (CFR) was 2.2 % due to COVID-19. CFR in Kediri district is 7.7 %, higher than Nasional CFR which is only 3 %. A huge number of COVID-19 patients who had increased D-dimer level. This study aimed to determine the association of D-dimer with all-cause in-hospital mortality in COVID-19 patients.

Method and Result

This was a retrospective single center cross sectional study. A total of 185 COVID-19 patients aged >18 years old and confirmed positive by RT-PCR were hospitalized at Kediri General Hospital since March to December 2020 met the inclusion criteria. Pregnant women and patients with incomplete records were excluded. In our research, optimal cut off point D-dimer was 2.5 µg/ml. The association of predictive factors for all-cause in-hospital mortality. Data were analysed by Chi-square and followed by logistic regression backward LR method. During hospitalization, 45 patients (24.3%) were died. Elevated D-dimer ≥ 2.5 µg/ml was statistically significant associated with all-cause in-hospital mortality (adjusted OR 95%CI = 3.46 [1.41 – 8.49], p = 0.007), with a sensitivity of 82.1% and a specificity of 42.2% (AUC, 0.628; 95% CI, 0.527 – 0.728).

Conclusion

Elevated D-dimer level were associated statistically significant with all-cause in-hospital mortality. In our study, optimal cut of point D-dimer value was 2.5 µg/ml.
OR41. Hypertension and Abnormal Renal Function Increased the Risk of Ischemic Stroke in Anticoagulated EHRA type-1 Valvular Atrial Fibrillation
Authors: Winanti R , Raharjo S B , Ariani R , Hanafy D A , Atmadikoesoemah C A , Almazini P
Published: April 2022

Aims

Atrial fibrillation increases the risk of stroke substantially, many scores have been developed to risk stratify these patients. Most of the studies have focused on non-valvular AF. The most widely used risk stratification score is the CHA2DS2-VASC score. Unfortunately, the validation of this score in valvular AF is poor. This study aimed to evaluate the clinical factors and echocardiographic parameters related to the incidence of ischemic stroke in anticoagulated EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type-1 valvular AF patients.

Methods and Results

We conducted a retrospective cohort study based on data from the Indonesian Registry on Atrial Fibrillation (OneAF). Patients with EHRA type-1 valvular AF between January 2015 and December 2019 were analysed. The clinical outcome was an ischemic stroke that occurred during the monitoring period of January 2015 - December 2019. Among 329 AF patients with mitral stenosis or prosthetic heart valves, the incidence of ischemic stroke was 17 (5.2%). Multivariate logistic regression analysis showed that two clinical factors, i.e., history of hypertension (OR 5.59; 95% CI: 1.93-16.15; p= 0.001) and estimated Glomerular Filtration Rate (eGFR) ≤59 mL/min/m2 (OR 3.62; 95% CI: 1.30-10.02; p= 0.013) were independently associated with the incidence of ischemic stroke. No echocardiographic parameters were associated with the incidence of ischemic stroke in this population.

Conclusion

We observed that two clinical factors i.e., history of hypertension and abnormal renal function, were markedly associated with stroke incidence in anticoagulated EHRA type-1 valvular AF patients.
OR42. Hypertensive Response to Exercise as Predictor for 1-Year Rehospitalization due to Major Adverse Cardiac Event: A Putative Role of Cardiac Remodeling?
Authors: Jagannatha G N P , Pradnyana I W A S , Kamardi S , Yasmin A A A D A
Published: April 2022

Background and Aims

Recent studies found that hypertensive response to exercise (HRE) was associated with development of target organ damage. The study was to determine the echocardiographic parameters associated with HRE and role of HRE in rehospitalization within 1 year due to major adverse cardiac event (MACE).

Method and Results

This study was a cohort retrospective study using medical records of patients who underwent treadmill stress test and echocardiography examination at Sanglah General Hospital from May 2018- May 2020 which enrolled 114 patients. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on 1-year rehospitalization after cardiac TST due to MACE that included heart failure, coronary artery disease, stroke, arrhythmia, and cardiovascular death. Mann-Whitney U test was used to compare echocardiographic parameters such as EF, EDV, ES, FS, LVIDd, LVIDs, LV mass index, LAVI, TAPSE, and E/E' ratio. Subjects with HRE had higher LV mass index (82.34±15.05 vs 70.62±9.76), higher E/E’ ratio (16.31±2.95 vs 16.01±13.23), higher LAVI (39.75±15.21 vs 34.27±11.15) with all p-value were <0.05. In this study, HRE also significantly associated with 1-year rehospitalization due to MACE (OR 2.27, 95% CI 1.62–3.16, p = 0.0001).

Conclusions

HRE may be used to predict 1-year rehospitalization due to MACE. In this study it was also found that HRE was associated with several echocardiographic parameters, such as LV mass index, LAVI, and E/E’ ratio. Further study is needed to determine the putative role of cardiac remodeling in patients with HRE.
OR43. Immature Platelet Fraction Levels and mayor adverse cardiac events in Acute Coronary Syndrome accompanied by Pneumonia Corona Virus Disease 19
Authors: Nurminsyah Peter Kabo , Mappangara Idar , Amir Muzakkir , Muzakkir Akhtar Fajar , jaya Irawaty Ilham
Published: April 2022

Introduction

Acute Coronary Syndrome is a major cardiovascular problem and currently is one of the complications of COVID-19. Immature platelet fraction (IPF) is newly released platelets and have strong thrombotic potential. Recent research has shown that IPF levels are higher in ACS and COVID-19 patients. In this study, we tried to see the IPF levels and ACS outcomes occurred in COVID-19 patients during the hospitalization period.

Metods and Results

This study is an analytical observational study with a cohort design that was conducted in August 2020 - December 2020 with 28 sample and follow up during hospitalization. IPF levels In the group following MACE, the IPF median was 5 and in the group that did not following MACE the IPF median was 2.40 . Based on statistical calculations, there were significant differences between the two groups (p = 0.004). Meanwhile, the group that following MACE and survivors got a median value 4.90 and grup following MACE and non-survivors a median value of 5.00. Based on statistical calculations, there was no significant difference between the two groups (p = 0.670).

Conclussion

The IPF level in ACS patients accompanied by covid who occurance MACE was significantly higher than those without MACE. And it was found that the IPF level was higher in non-surviving patients than in non-surviving patients, but it was not statistically significant.
OR49. Predictor of prolonged length of stay in patients hospitalized with acute coronary syndrome
Authors: Ardining H , Amshar M , Akbar F , Ulfiarakhma D , Nathania M , Napu R , Karimullah M D H , Widyantoro B
Published: April 2022

Aims

Acute coronary syndrome (ACS) is responsible for high rates of hospital admission with high cost burden. Knowing patients with projected prolonged length of stay (LOS) could enable clinicians to do early interventions and better preparations. This study aims to identify factors associated with prolonged LOS in ACS patients at the time of admission.

Method and Result

We included 237 ACS patients admitted to Kediri General Hospital and Bogor General Hospital between January and June 2020. Patients who died during hospitalization or discharged by their own will were excluded. Data were collected retrospectively and analyzed using SPSS v25. Prolonged LOS was defined as LOS more than 6 days. The mean age was 57.5±0.7 years, majority was male (65.8%) and had diagnosis of NSTE-ACS (56.5%). The median LOS was 5 days (2-23), and the prevalence of prolonged LOS was 18.1%. On bivariate analysis, factors associated with prolonged LOS were high risk age (men > 40 years and women > 50 years) (p = 0.01), hypotension (p < 0.01), decreased consciousness (p = 0.004), sign of shock (p = 0.002), tachycardia (p = 0.001), and higher Killip class (p = 0.002). After multivariable adjustment and stepwise elimination, hypotension was found to be significant independent predictor for prolonged LOS (OR 38.512 [95% CI 4.5-328], p = 0.001). The area under the receiver operating characteristic curve (AUC) was 0,704 (95% CI 0.614-0.794) which showed acceptable discrimination, and calibration was good (Hosmer-Lemeshow test: p = 0.96).

Conclusion

Hypotension was found to be strong independent predictor for prolonged LOS in ACS patients.
OR59. Speckle Tracking Echocardiography as A Feasible and Accurate Modality in Programming The Treatment Area of Extracorporeal Shockwave Myocardial Revascularization
Authors: Tantawi P
Published: April 2022

Aims

Extracorporeal Shockwave Myocardial Revascularization (ESMR) remain clinical chalange to be held as a routine treatment of patient with refractory angina. ESMR need a feasible and accurate planning program of treatment area to induce coronary angiogenesis optimally since Single Photon Emission Computed Tomography (SPECT) and Dobutamine Stress Echocardiography (DSE) was still limited in several hospital. This study evaluate the accuracy of Speckle Tracking Echocardiography (STE) as feasible and time-cost effective modality compare with Dobutamine Stress Echocardiography (DSE).

Methods and Results

This study uses quantitative approach, with a descriptive methodology. Data was obtained in June 2021. A nine patients with refractory angina was evaluate with DSE and STE. STE give 60,26% accuracy in obtaining the same target area compare with DSE and accuracy was increase to 79% when STE performed in peak stress motion.

Conclusion

Clinical challange was made in ESMR with limited facility for SPECT. STE seems to be a potential modality to help cardiologist in programming the treatment area as for ESMR.
M3. Cardiovascular outcome of SGLT-2 Inhibitor in patient with Type 2 Diabetes Mellitus: a Meta-Analysis of Randomized Control Trial
Authors: Mukhammad W W , Kembangsari C , Santoso Y A A J , Mukti I R , Putra H B P , Adiwinoto R P , Adiwinoto R D
Published: April 2022

Aims

SGLT-2 Inhibitor is an anti-hyperglycaemic drug. SGLT-2 Inhibitor has favourably affect in Cardiovascular outcome. Nevertheless, the cardiovascular outcome of recent clinical trial of SGLT-2 Inhibitor in Type-2 Diabetes Mellitus remains unclear. We performed meta-analysis to evaluate SGLT-2 Inhibitor in type-2 Diabetes Mellitus.

Methods

We performed a systematic literature search from various electronic databases. We used keywords “SGLT-2 inhibitor”, “Cardiovascular outcome”, and “Type-2 Diabetes Mellitus”. Inclusion criteria is Randomized Control Trial and 2 to 4-year follow-up. Primary endpoint is Major Adverse Cardiovascular Event (MACE). Secondary endpoints are all-cause mortality, cardiovascular mortality and hospitalization of heart failure. Outcomes is reported using Risk Ratio (RR) with 95% Confidence Interval.

Results

Total of four Randomized Control Trial was selected (EMPA-REG [Jardiance®], CANVAS [Invokana®], DECLARE-TIMI 58 [Forxiga®] and VERTIS-CV [Steglatro®] trial) with 42.568 patients pooled within our analysis. The results of primary outcome compared SGLT-2 Inhibitor with Placebo had significant reduction in MACE (RR = 0.93 [95% CI, 0.87–0.99], p = 0.03; I2=0%). Result of secondary outcomes showed significant reduction in all-cause mortality (RR = 0.86 [95% CI, 0.75–0.99], p = 0.03; I2=65%) and hospitalization of heart failure (RR = 0.71 [95% CI, 0.63–0.80], p < 0.00001; I2=0%), however, no significant reduction in cardiovascular mortality (RR = 0.85 [95% CI, 0.69–1.05], p = 0.13; I2=73%).

Conclusion

SGLT-2 Inhibitor in Type-2 Diabetes Mellitus has significant reduction in MACE, all-cause mortality, and hospitalization of heart failure. However, no significant reduction was found in cardiovascular mortality within 2 to 4-year follow-up.
M12. Network Meta-Analysis about Cytokine Gene Functional Polymorphisms Towards the Susceptibility and Severity of Acute Rheumatic Fever and Rheumatic Heart Disease among Asian and Non-Asian People
Authors: Nugraha Ricardo Adrian , Khrisna Bagus Putra Dharma , Putra Tony Santoso , Rinjani Lalu Galih Pratama , Sativa Oryza , Lefi Achmad , Dharmadjati Budi Baktijasa , Subagjo Agus , Oktaviono Yudi Her
Published: April 2022

Background

Great diversity among public hereditary variants may play a role in the susceptibility and severity of acute rheumatic fever (ARF)/rheumatic heart disease (RHD). Cytokine gene polymorphisms may contribute to the disease-associated cytokine imbalance. However, to the best of our knowledge, there is no existing meta-analysis concerning an association of the cytokine gene functional polymorphisms with the susceptibility / severity of ARF/RHD.

Aims

To investigate the potential association between cytokine gene functional polymorphisms of TNF-α, TGF-β, IL-10, IL-6 and IL-1β and the susceptibility and severity of ARF/RHD.

Methods

Comprehensive and structured search on Pubmed/Medline, Embase, EBSCO, and Cochrane Central Register of Controlled Trials was performed. Statistical analyses were performed using STATA. First, we performed direct pairwise meta-analysis. Then, a network meta-analysis was performed with the consistency model to compare the genetic models of different cytokine gene polymorphisms.

Results

Evidence derived from the meta-analysis of 24 retrospective cohort and case-control studies identified that elevated serum levels of TNF-α have been observed in ARF cases, occurring as a result of a SNP (-308G>A) in the promoter site of the TNF-α gene. Our results also suggest that IL-1β (-511) C/T polymorphism, TGF-β1 [rs1800469], and IL-1β [rs2853550] single nucleotide polymorphisms (SNPs) contributed to the susceptibility of ARF/RHD. Egger’s test did not demonstrate significant asymmetry in the dominant.

Conclusion

In summary, the polymorphism model increased the risk of RHD in the dominant genetic model, recessive genetic model, homozygote model and allelic genetic model among non-Asians while, recessive genetic model and homozygote model among Asians.
C8. An Extremely Rare Case: Cardiac Contusion Presenting with an Atrioventricular Block, An Unfortunate Fall
Authors: Akbar R R , Nugraha M T
Published: April 2022

Background

Blunt cardiac injury (BCI), also referred to cardiac contusion, is a known cause of myocardial injury. It is often challenging to diagnose in the absence of clear diagnostic criteria. The clinical manifestation ranges from none to fatal arrhythmias to cardiac wall rupture seen on post-mortem examination. Cardiac biomarkers and electrocardiograms are usually helpful in identifying cardiac trauma but are not necessarily abnormal in all cases.

Case Illustration

A 55-year-old male with no history of cardiac disease was brought to the emergency department after a motor vehicle collision resulted in chest wall injury. The patient was found to have left clavicle fracture, left costae II-VII fractures, and hematothorax followed by chest tube insertion. The patient had multiple episodes of complete heart block with junctional escape rhythm alternate with high degree 2:1 AV conduction, and sometimes became a normal sinus rhythm. A temporary pacemaker was inserted. After the patient underwent the ORIF procedure, cardiac rhythm revealed normal sinus rhythm and temporary pacemaker is removed.

Discussion

High-degree AV block has been reported in human studies following BCI, secondary to necrosis, inflammation, or fibrotic changes in the subendocardial tissue. 50% of patients reviewed in the literature had a recurrence or permanent complete heart block requiring pacemaker implantation and complete heart block secondary to BCI which was associated with a 20% mortality in the post-traumatic period. Our patient developed a fatal heart block in the early period which could have easily been missed.
C18. Cardiac AA amyloidosis presenting with refractory heart failure complicated by polymorphic ventricular tachycardia: a case report
Authors: Susanti M , Subagjo A
Published: April 2022

Background

Systemic AA amyloidosis is a rare infiltrative disease representing a complication of chronic inflammatory disorders. Cardiac involvement is rare and is associated with a poor prognosis. Early recognition is imperative as appropriate measures, and treatment of the underlying disease may prevent death from refractory heart failure and fatal arrhythmias.

Case Summary

A 53-years-old male patient with psoriatic arthritis presented with heart failure and nephrotic syndrome. Electrocardiogram revealed first-degree AV block, low voltage QRS complexes, and prolonged QT interval. On echocardiography, a normal systolic function of hypertrophic left ventricle with signs of diastolic dysfunction was present. An abdominal fat pad punch biopsy was able to confirm amyloid deposition. Self-terminated polymorphic ventricular arrhythmia was recorded by 24-hour Holter. Immunosuppressive, anti-inflammatory, anti-arrhythmic, and heart failure agent were promptly instituted, which are ineffective.

Discussion

Restrictive cardiomyopathy is the hallmark finding in cardiac amyloidosis that caused by the interstitial deposits of amyloid fibrils. Clinically, this manifests in progressive diastolic dysfunction, elevated left ventricular filling pressures, and heart failure with preserved ejection. The presence of rapidly progressed heart and renal failure with characteristic features of ECG should prompt further evaluation to confirm an infiltrative cardiomyopathy. This is highly suggestive that the natural course of cardiac amyloidosis often unpredictable and can be aggressive if left undiagnosed and untreated.
C22. Cardiac Morphology in Congenital Heart Disease with 3D Modeling, 3D Printing and Augmented Reality Smartphone Application: a Case Series of Cardiac Computed Tomography Assessment of Right Ventricular Outflow Tract Obstruction with Shunt
Authors: Laode M , Nurawita R , Andi A U , Julius P , Nikmatiah L
Published: April 2022

BACKGROUND

Obstruction of the right ventricular outlet may include stenosis of the Right Ventricular Outflow Tract (RVOT) or the presence of atresia in the valve or pulmonary artery. The Cardiac Computed Tomography (CCT) examination for RVOT obstruction with a shunt has several indications, including pulmonary and coronary artery assessment, and lesions accompanying RVOT obstruction with a shunt.

CASE DESCRIPTION

In this report, we present five cases with RVOT obstruction with shunts in the form of Tetralogy of Fallot (ToF), pulmonary atresia with Ventricle Septal Defect (VSD), and pulmonary stenosis with Double Outlet Right Ventricle (DORV). The first patient with ToF and infective endocarditis. The second patient with atypical ToF, cardiac dextroposition, and suspect Scimitar Syndrome. The third patient with pulmonary atresia, VSD, and post-R-BT shunt. The fourth patient with pulmonary stenosis, DORV, remote VSD, post-BT shunt, and suspect Criss Cross Heart. The fifth patient with pulmonary stenosis, DORV, RA isomerism, malposition of the great artery, bilateral SVC, and dextrocardia.

DISCUSSION

The CCT assessment can be carried out in a segmental sequential to systematically and comprehensively approach. For complex lesions, CCT provides 3D printing of the heart and may help to understand the cardiac morphology easily. CCT is a recommended examination for RVOT obstruction with shunt, shows a good sensitivity for assessing BT-shunt, and provides good spatial resolution for assessing the pulmonary and coronary arteries. 3D printing and augmented reality can improve practitioners' understanding of RVOT obstruction with shunt, including the accompanying lesions.
C25. Cardiogenic shock in a 25-year-old male with tombstone ST-segment elevation pattern in emergency department, early hemodynamic assessment to guide the management: a case report of mixed cardiogenic shock phenotype
Authors: Tiyantara M S , Furqon M
Published: April 2022

Background

Cardiogenic shock (CS) is a lethal condition. There are several phenotypes, and classification based hemodynamic and/or clinical parameters for CS. We present CS with tombstone ST-segment elevation in emergency department (ED) with assessment of hemodynamic using bedside ultrasound to classify and guide the management.

Case Description

A 25-year-old-male complained sense of fatigue, fever, and myalgia for 2 days. The initial blood pressure and SpO2 were unrecordable, heart rate 112x/m, respiration rate 28x/m, temperature 36.8 °C. The patient was pale, anxious, with difficult jugular venous pressure assessment due to overweight appearance, diminished S1, and cold extremity. Electrocardiogram revealed tombstone ST-elevation in V2-V6, I, and aVL. After oxygenation management, initial dobutamine and norepinephrine, we performed bedside cardiac ultrasound revealed anterior left ventricular wall hypokinesis, mild pericardial effusion, ejection fraction 52%, mitral E/A ratio 2.7, E deceleration time 90.82ms, positive lung B-lines, inferior vena cava diameter 2.14cm with collapsibility <50%. Tricuspid annular plane systolic excursion 19mm. Estimated cardiac index 1.88L/m/cm2, and systemic vascular resistance (SVR) 775dynes.sec/cm5. This pattern suggests mixed CS phenotype. Vasopressor was up titrated with improved blood pressure, SpO2, and urinary output. CXR revealed cardiomegaly, troponin T > 10.000pg/ml. The patient was successfully stabilized in ED and transferred to ICCU.

Discussion

We classify our case as mixed CS. With hemodynamic assessment, we can determine the character of the shock with more objective parameters, guide the treatment, and avoiding over (increase oxygen demand, afterload, arrhythmia) and underused of vasopressor to bridging the treatment of causative factor.
C26. Case report: COVID-19 associated Takotsubo cardiomyopathy
Authors: Mulia E P B , Dewi I P , Subagjo A , Pikir B S
Published: April 2022

Background

COVID-19 infection can lead to several cardiovascular sequelae, including Takotsubo cardiomyopathy (TCM), which may portend worse clinical outcomes.

Case Description

A 56-years-old woman with history of hypertension presented to the emergency room for dyspnea and gradual decrease of consciousness for seven days. She was positive for COVID-19 and transferred to intensive care unit to receive mechanical ventilation due to respiratory failure. Electrocardiogram showed pathological Q wave and ST elevation in inferior and anterior. Troponin I was mildly elevated (5.52 ng/ml). Inflammatory marker CRP and procalcitonin were increased (3.6 mg/dl and 0.235 ng/ml, respectively). Serum cortisol level was 525.8 ng/ml. Echocardiography showed reduced left ventricular ejection fraction (LVEF 41%), with severe hypokinetic of the apical segments and preserved basal myocardial function consistent with visual signs of apical ballooning in TCM. Her follow-up echocardiography showed normal contractility of the apical myocardial segments, with normalization of the left ventricular systolic function, further supporting the reversibility of acute stress cardiomyopathy.

Discussion

Mechanisms of TCM in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. A presumptive diagnosis of TCM was made based on the characteristic echocardiogram findings of apical ballooning, normalization of left ventricular systolic function, unremarkable past cardiac history and spontaneous improvement in serum troponin-I levels in the setting of a severe systemic illness.

Conclusion

Clinicians should be aware of the diversity of cardiovascular complications of COVID-19, including Takotsubo cardiomyopathy and should strategize appropriately for diagnosing and managing them.
C28. Chronic Limb Threatening Ischemia in Patient With Aortoiliac Occlusive Disease (Leriche Syndrome) and Pulmonary Hypertension
Authors: Permana E , Suwirya A P , Sutanegara B A
Published: April 2022

Background

Chronic limb-threatening ischemia (CLTI) is a manifestation of peripheral arterial disease (PAD) which is characterized by stenosis or occlusion of peripheral arteries causing impaired perfusion to the extremities, especially during rest and chronic progresses, which are associated with decreased quality of life and increased morbidity and mortality.

Case Description

A 51-year-old man complained of wound on both legs and pain during light activity. Risk factor is smoking for 30 years. History of primary pulmonary hypertension since 30 years. Physical examination revealed decreased pulsation from femoral artery to dorsalis pedis arteries in both leg. Echocardiography with RA and RV dilatation, D-shaped LV during systolic, mild TR and normal LV systolic function. Dupplex ultrasound and MSCT scan pulmonary-abdominal angiography shows thrombus in the abdominal aorta causing occlusion of blood flow distally. There is a comorbid pulmonary hypertension which causes right heart failure with symptoms of dyspnea. This patient is at high risk of undergoing revascularization surgery, so that in severe comorbid conditions an extraanatomical bypass with axillobifemoral bypass graft is considered.

Discussion

Atherosclerosis that occurs in the abdominal aorta, iliac artery, and femoropopliteal artery is called aortoiliac occlusive disease (AIOD). This condition when symptomatic is known as Leriche syndrome with a triad of symptoms of claudication, impotence, and reduced or no palpable pulsation of the femoral artery. Medical management include antiplatelet, statin, analgetic, and therapy according to risk factors. The main purpose is revascularization by surgery or endovascular which aims to improve blood flow to the distal artery.
C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series
Authors: Nursalim S , Setyawan D , Limbong M , Ahmad F
Published: April 2022

Background

Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention.

Case Summary

We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (<36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (>42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%.

Discussion

Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.
C34. Concomitant Finding of Hemorrhagic Cardiac Tamponade and Venous Thromboembolism as the First Manifestation of Occult Malignancy – A Case Report
Authors: Sitorus Sondang Jasmine , Alsagaff Mochamad Yusuf , Kusumastuti Etty
Published: April 2022

Background

Venous thromboembolism (VTE) encompasses pulmonary embolism (PE), and deep vein thrombosis (DVT) is a common complication of cancer. Cancer manifestation in cardiac often secondary from the metastatic process, mostly in the pericardium. These concomitant findings of PE, DVT, and hemorrhagic cardiac tamponade as the first signs of cancer in a young patient is rare.

Case Summary

A 39-years-old man was referred to the emergency department from secondary hospital with the main complaint of dyspnea that onset abruptly two days before admission and swollen of the entire right leg since one week before. We report concomitant finding of hemorrhagic cardiac tamponade, deep vein thrombosis, and acute pulmonary embolism as initial presentations of occult malignancy. Starting anticoagulant in the hemorrhagic state and finding the primary cancer were problematic and challenging.

Discussion

The challenge in management, posed by hemorrhagic versus thrombosis state in cancer, prompted us to cautiously deliver the treatment with consideration of benefit over the risk. Primary cancer is not always easy to identify. Comprehensive (re-)evaluation is mandatory.
C39. Ductus Arteriosus Stenting: A Promising and Life Saving Procedure for Ductal-Dependent Pulmonary Blood Flow
Authors: Permitasari D A , Priyatno A , Ayukusuma A R , Andini A R , Christina M , Susilawati M
Published: April 2022

Background

Duct-dependant congenital heart disease in newborn presents as a life-threatening emergency and the survival depends on patency of the ductus arteriosus. Stent implantation into ductus arteriosus has been proposed as non-surgical management for critical congenital heart disease with duct-dependent.

Case Summary

We present full-term newborn babies who had critical congenital heart disease with ductal-dependent pulmonary blood blow and successfully managed with ductal stenting. Patient A, a 13-days-old male had Tetralogy of Fallot-Pulmonary Atresia and restrictive Ventricular Septal Defect (VSD). Patient B, a 3-days-old male had Pulmonary Atresia-Intact Ventricular Septum (PA-IVS) with Patent Foramen Ovale (PFO). Patient C, a 5-days-old female had Tricuspid Atresia with restrictive VSD and multiple congenital anomaly. Patient D, a 2-days-old female had PA-IVS with PFO stretch. Prostaglandin-E1 infusion was started at first and stop 6 hours prior to the procedure. Ductus arteriosus stenting using drug-eluting stent and femoral artery approach was successful in all 4 patients. All patient had improvement of oxygen saturation and good post-procedure outcome.

Discussion

Ductal stenting in patient with duct-dependent pulmonary circulation appears to be an alternative to surgery. It provides a bridging palliation in cyanotic congenital heart disease until the time of definitive surgery. Stenting of ductus arteriosus is feasible and safe with good result, thus early recognition and timely management are important to save the life.
C42. Eisenmenger Syndrome, Could Its Pathophysiological Changes Serve as Protective Factors Against Severe COVID-19 Infection?
Authors: Gunawan R Y , Medishita H
Published: April 2022

Background

Congenital heart disease (CHD) and pulmonary artery hypertension (PAH) are comorbidities to severe COVID-19 infection. We reported a case of adult congenital heart disease (ACHD) with Eisenmenger Syndrome (ES) who survived COVID-19 without progression to severe infection.

Case Description

A 39 years old male with history of uncorrected ACHD complained of low-grade fever and cough for 3 days. Initial oxygen saturation was 85%, no tachypnoea, no tachycardia, and blood pressure was normal. SARS-CoV2 RT-PCR results was positive. Thorax CT showed lung fibrosis, minimal GGO, and prominent pulmonary notch. Notable laboratory result was haemoglobin: 20.4g/dL. Echocardiography showed a large secundum ASD with bidirectional shunt, dilated RA and RV, normal ventricular systolic functions, mild TR with increased tricuspid gradient (TR V max 4.27m/s) which concluded the diagnosis of ES. The patient was treated according to moderate COVID-19 guidelines and ES management. His response to treatment was favourable and was discharged in 3 weeks uneventfully.

Discussion

Studies have documented CHD and PAH as comorbid to severe COVID-19 infection, but our patient had moderate COVID-19 infection and recovered without progression to severe disease. We proposed several pathophysiological characteristics of ES which could serve as protective factors against severe COVID-19, which are: 1) Pre-existing PAH, where pulmonary vasculopathy and remodelling lessened endothelial response to inflammation, and reduced expression of ACE2 receptors,  2) Chronic hypoxia, which prepared cells and tissues against hypoxic environment, and 3) Polycythaemia, might be beneficial in haemoglobinopathy directly caused by SARS-CoV2.
C44. Electrocardiogram might failed identify acute coronary occlusion: When every minute counts
Authors: Habibi F N , Mangkoesoebroto A P , Pradityawati A , Ardhianto P
Published: April 2022

Backgrounds

Prompt diagnosis of acute coronary occlusion based on electrocardiogram (ECG) are essential to decide proper treatment. However, particular ECG such as Wellens syndrome have been higlighted without obvious ST-segmen elevation which is signifies critical stenosis or occlusion of the proximal left anterior descending (LAD) artery but unfortunately is often unrecognized by physicians.

Case Illustration

A 51-year old male patient referred from district hospital diagnosed as five day onset STEMI with recurrent chest pain. The first ECG in there emergency room was a deep inverted T wave in anterior and lateral lead that immediate intervention approach not choosen. The typical infarct evolution in anteroseptal lead appear one day after the onset. Troponin level was significantly increased. Urgent angiography was performed in our hospital, unfortunately it resulted critical stenosis in proximal LAD with triple vessels and left main coronary artery disease. Then we consider send to surgery due to high coronary complexity (Syntax score:62) and optimize antianginal agent.

Discussion

In current practice, ST-segment elevation at the J-point, ≥ 1 mm in ≥ 2 adjacent leads (other than leads V2 and V3, where elevation of ≥ 2 mm in men or ≥ 1.5 mm in women is considered significant) for STEMI diagnosis. However, these general ECG criteria fail to identify the STEMI equivalents. Wellens syndrome is one of them that suggesting severe stenosis of the proximal LAD artery, which will develop into an acute anterior wall MI within a few days to weeks in 75% of untreated patients.