bluuebunny/crossref_metadata_2025_split huggingface dataset:
M10. Investigating prognostic value of cardiac biomarkers for predicting mortality in novel coronavirus disease-2019 patients: A meta-analysis of diagnostic test accuracy
Authors: Govardi Ericko , Kamarullah William , Sabrina Adelia Putri , Rocky Marthin Alexander 
Published: April 2022

Abstract

Aims
Cardiac injury is common in novel coronavirus disease-2019 (COVID-19) patients and is associated with an increased risk of mortality. However, the prognostic accuracy of cardiac biomarkers in predicting mortality in COVID-19 patients remains unclear. A meta-analysis of diagnostic test accuracy was conducted to find cost-effective biomarkers, particularly those frequently evaluated to enable risk stratification and sensible resource allocation.

Methods
We systematically searched PubMed, Europe PMC, and SCOPUS for studies published up to June 2021. Studies were enrolled, if they included assessment of the accuracy of predetermined cardiac biomarkers (troponin, lactate dehydrogenase (LDH), creatine kinase, and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in predicting mortality of COVID-19 patients and provided sufficient data to construct a 2 x 2 contingency table.

Results
This meta-analysis showed cardiac troponin was the most reliable biomarker in prognosticating mortality in COVID-19 patients (area under curve (AUC) = 0.79 (0.76–0.83), sensitivity = 0.63 (0.52–0.73), specificity = 0.80 (0.74–0.84)), followed by LDH (AUC = 0.75 (0.71–0.78), sensitivity = 0.72 (0.63–0.80), specificity = 0.65 (0.54–0.75)), NT-proBNP (AUC = 0.73 (0.69–0.77), sensitivity = 0.55 (0.41–0.68), specificity = 0.79 (0.68–0.87)), and creatine kinase (AUC = 0.35 (0.31–0.39), sensitivity = 0.27 (0.19–0.36), specificity = 0.76 (0.49–0.92)).

Conclusion
Increased cardiac injury biomarkers may aid in the identification of individuals who are most at risk, especially cardiac troponin with AUC 0.79, 63% sensitivity and 80% specificity.
M11. Magnesium Sulfate as Atrial Fibrillation Prophylaxis post Coronary Artery Bypass Graft Surgery: A Meta-analysis
Authors: Rismawanti R I , Rachmanadi M B 
Published: April 2022

Abstract

Background and Aims
Arrhythmia, especially atrial fibrillation (AF), is a common complication post coronary artery bypass graft (CABG) surgery and a major source of morbidity and mortality. This meta-analysis aims to evaluate the use of magnesium sulfate (MgSO4) as AF prophylaxis post CABG surgery.

Method and Results
A total of 10 studies enrolled 1,371 patients (1,114 males and 257 females) were retrieved from Pubmed, Cochrane, and Medline until July 2021 to identify studies about the association between MgSO4 and AF occurrence post CABG surgery. All suitable full text must accomplish Jadad score ≥2 for assessing study quality. Data were analyzed using Review Manager 5.3. Mantel-Haenszel formula was used for dichotomous variables to calculate the odds ratio (OR). Our results showed MgSO4 group (n = 711) compared to the placebo group (n = 660) were at decreased odds of having AF post CABG surgery (OR 0.59; 95%CI 0.39 to 0.91; p = 0.03) with AF occurrence in 134 patients and 188 patients, respectively. Data were derived from the random-effects model due to the heterogenous result between studies (Tau2=0.22, Chi2=18.99, df = 9 [p = 0.03], I2 = 53%).

Conclusion
This meta-analysis showed that administration of MgSO4 decreased the occurrence of AF occurrence post CABG surgery. Further research is needed to determine the optimal MgSO4 dose and time of administration.
C6. Acute Limb Ischemia Patient with Covid 19 Progressing to Chronic Limb-Threatening Ischemia: a Case Report
Authors: Wicaksono  , Kurnianingsih N 
Published: April 2022

Abstract

Background
Acute Limb Ischemia (ALI) and Chronic Limb-Threatening Ischemia (CLTI) are manifestations of Peripheral Artery Disease (PAD). The management of ALI and CLTI, apart from optimal medical treatment and lifestyle control, also includes surgery and endovascular revascularization. ALI and CLTI conditions can be a thromboembolic complication of Covid 19.

Case Description
A 58-year-old woman with risk factor Diabetes Mellitus presents with a black leg on the digiti I and digiti II of the right inferior extremity. She also complains of walking pain for 2 months. Previously, She had been treated with complaints of ischemic leg pain 2 months earlier and had performed a Doppler Ultrasound. At that time, she was diagnosed as ALI Grade II-A and was positive for Covid 19, from the laboratory examinations it was found an increase in fibrinogen, 419 mg/dl (Reference value 154.3-397.9) and D-Dimer increased to 0.9 mg/L (Reference value ≤ 0.5), She had undergone a surgical embolectomy procedure. At the time of the last control and based on CT-angiography, she was assessed as CLTI with Fontaine IV, Rutherford V, WIfI 1-1-0 and decided to do endovascular revascularization.

Discussion
The choice of either a surgical procedure or endovascular revascularization depends on grading and the initial assessment. Correct timing of ALI and CLTI treatment will increase limb salvage rate. Covid 19 can also manifest as a condition associated with a hypercoagulable state that can, in turn, lead to both arterial and venous thrombosis.
C15. Biventricular Heart Failure and Pulmonary Hypertension in Systemic Sclerosis: a rare and unusual case report
Authors: Farissa I P , Trisnawan M H , Ahnaf M F , Hellmi R Y 
Published: April 2022

Abstract

Backgrounds
Systemic sclerosis (SSc), chronic multisystem autoimmune disease, characterized by excessive fibrosis and vascular endothelial dysfunction. Cardiovascular involvement may be induced by various pathways, either primary or secondary to pulmonary hypertension or renal involvement.

Case Summary
A 46 years old woman presented to emergency department with cold, dark purplish ulcers in fingertips with progressive worsening pain in upper extremities, claudication intermitten, and dyspneu since 4 months ago. She had a mask-like facial, shiny skin, microstomia, restricted mouth opening, calcinosis cutis, Raynauds phenomenon, and sclerodactyly. There were pansystolic murmur grade III/6 in tricuspid area, and rales in basal lungs. ECG showed sinus rhythm with fragmented QRS, poor R-wave progression. Chest X-Ray revealed pancardiomegaly with pleural effusion and HRCT thorax revealed interstitial lungs disease. The laboratory revealed leucocytosis, increase D-dimer (870 ug/L), negative ANA and ds-DNA test, positive anti SCl test. Echocardiography showed biventricular dysfunction with decreased LVEF 37% (Teichz) and TAPSE 10 mm, RA RV dilatation, severe TR with high probability for PH. Extremities Doppler showed normal arteries and veins system. These findings indicates that primary and secondary cardiac involvement in SSc. Heart failure, pulmonary hypertension, and cyclophosphamide medication were administered

Discussion
Primary cardiac involvement, a direct consequence of SSc, may manifest as fibrosis of the myocardial, conduction system, pericardial and, valvular disease. Furthermore, a secondary phenomenon due to pulmonary arterial hypertension (PAH), and kidney pathology. Though the burden remains low, it may worsen the outcome, consequently, all patients with SSc should undergo screening.
C24. Cardioembolic Stroke due to LV Thrombus : Very High Risk NSTEMI Complication
Authors: Valdy Gerry , Syafri Masrul , Syukri M 
Published: April 2022

Abstract

Background
Ischemic heart disease is the major cause to the high mortality rate. Ischemic heart disease was responsible for 7 million of the 53 million deaths reported in 2010. Left ventricle thrombus that complicates acute myocardial infarction (AMI) is a major cause of cardioembolic stroke.

Case Summary
A 69-year-old man presented with typical of infarction chest pain and shortness of breath since 2 days before admission to the hospital. The patient was diagnosed with NSTEMI TIMI 4/7 GS 177, PVC Frequent and history of VT and was planned for immediate PCI. After cannulation in the left coronary artery, the patient developed VT/VF and therefore CPR was performed. The patient was in ROSC then admitted to the CVCU and had improved. After two days of treatment, the patient experienced weakness in right limbs and difficulty of speaking, followed by decreased consciousness and suspected with ischemic stroke. The patient was then immediately treated for cardioembolic stroke. After 1 day of treatment the patient got worsened and was declared dead.

Discussion
Based on NSTEMI startification, patients was included in very high risk with a major cardiovascular event rate of 40.9%. During the treatment, patients experiencing cardioembolic stroke which causes increased mortality. Management of cardioembolic stroke as soon as possible increases the chances of success in therapy
C43. Eisenmenger Syndrome The Challenge of Untreated Large Ventricular Septal Defect in Pregnant Women: A Case report
Authors: Kalista Yuliet , Djoen Herdianto , Rheza Giovanni 
Published: April 2022

Abstract

Background
Eisenmenger syndrome is a constellation of symptoms that arise from an uncorrected large congenital heart disease that have a reversed shunt to right to left. Eisenmenger syndrome in pregnancy is rare because pregnancy in this patient is not recommendeed due to high mortality for mother and baby. The objective of this case report is to highlight the argument of Eisenmenger syndrome in pregnancy.

Case Summary
A 38-years pregnant woman presented to the emergency room with dyspnea since the third trimester. Reported history of the untreated ventricular septal defect. Central cyanosis, systolic murmur and lower extremity oedema were found. ECG showed a right axis deviation with right ventricular hypertrophy. Cardiomegaly was found from a chest x-ray. Left ventricular diastolic dysfunction, large ventricular septal defect with Right-Left shunt, and pulmonary hypertension were found from echocardiography. Based on characteristic appearance, a diagnosis of Eisenmenger syndrome was made. Caesarean delivery was performed and the baby delivered safely, but the mother passed away.

Discussion
Eisenmenger syndrome in pregnancy comes with high mortality to mother and baby. A ventricular septal defect is a common cause of Eisenmenger syndrome. The choice for medical treatment from Eisenmenger syndrome in pregnancy is still controversial. Both caesarean section and vaginal delivery could be harmful to the patient due to vulnerability to hemodynamic change.
C45. Exercise-Induced Ventricular Tachycardia in Normal Coronary Artery Patient with Incidental Finding of COVID-19 : a case report
Authors: Taim A I , Saleh K , Muzakkir  
Published: April 2022

Abstract

Background
Exercised-induced ventricular tachycardia is associated with pre-existing ischemia or structural heart disease. However, exercise-induced ventricular tachycardia in asymptomatic patient without evident of coronary artery disease or structural heart disease needs further investigation.

Case Description
A 53-year-old woman with suspected coronary artery disease underwent an Exercise Stress Test. During recovery phase, the patient developed monomorphic ventricular tachycardia accompanied by drowsiness, which lasted eight minutes before resolving. The patient was tested positive on COVID-19 screening, a mandatory testing before hospital admission. Subsequent evaluation with transthoracic echocardiography and coronary angiography revealed absence of coronary artery stenosis and significant structural heart disease. Twenty-four hours Holter monitoring results were low-grade premature ventricular contractions.

Discussion
Exercise-induced ventricular tachycardia in normal coronary artery patient may be associated with an increased risk of sudden cardiac death, thus required careful examinations and establishment of underlying pathology. COVID-19 was reported to be associated with and might trigger episodes of ventricular tachycardia through sympathetic hyperactivity or re-entry in myocarditis. This case is noteworthy due to the absence of typical cause of exercise-induced ventricular tachycardia and the possible relation with COVID-19 infection. However electrocardiogram monitoring should be taken periodically to observe recurrences and to determine prognosis.
C48. How to handle VT storm in ICD patient : serial case report
Authors: Prismadani M , Julario R 
Published: April 2022

Abstract

Background
Ventricular tachycardia (VT) storm can cause sudden death in patients with trans-venous implantable cardioverter-defibrillator (ICD) and adversely affects prognosis in survivors. Patients with recurrent shocks have a poor quality of life and increased mortality rates. The purpose of this case series was to discuss the available treatment option for VT storm in ICD patients.

Case Summary
We reported two patients with VT storm on ICD. Both patients had palpitation, clinical heart failure, and recurrent shocks from ICD with appropriate rhythms. The first case had hypokalemia with ICD recording showed 45 episodes of VT, 45 antitachycardia pacing (ATP), and 5 shocks therapy. The second case had hypomagnesemia with ICD recording showed 195 episodes of VT, 42 ATP, and 3 shocks therapy. Management approaches to these patients include ICD reprogramming, correcting electrolyte abnormalities, treating heart failure and administering anti-arrhythmic drugs (AADs).

Discussion
VT storm on ICD refers to three or more appropriate therapies for ventricular tachyarrhythmias, including ATP or shocks, within 24 hours. The known triggers must be treated, such as electrolyte disturbance and worsened heart failure. AADs therapy could suppress VT and increased the tachycardia cycle length (TCL) so that the response to ATP is better. ICD reprogramming include higher heart rate treshold, longer detection period, and improving ATP programming. Catheter ablation and cardiac sympathetic denervation (CSD) may be an option if VT storm persists.
C52. Infected Femoral Artery Pseudoaneurysm with Klebsiella pneumoniae Bacteremia in Injected Drug Abuser: A Case Report
Authors: Khairunnisa H , Mardhiyah I , Mahavira A , Pasaribu F Z 
Published: April 2022

Abstract

Background
Injected drug abuse is a significant problem in modern societies today, with increases various vascular complications due to repeated punctures under septic conditions. One of the severe vascular complications is infected pseudoaneurysm. However, no study reported the involvement of Klebsiella pneumonia in infected pseudoaneurysm.

Case Summary
A 40-year-old homeless man, an injected drug abuser, presented to the emergency department with a severe pain lump in the right groin area since three weeks ago. The hemodynamic was unstable and the laboratory examination revealed severe infection. While ultrasonography was suggesting high suspicion of lymphadenitis in the right groin area, the Doppler ultrasonography was showing a pseudoaneurysm in the right common femoral artery. The blood cultures grew Klebsiella pneumonia ESBL. Patient was planned to be referred to vascular surgery center. Unfortunately, before patient got a referral, his condition worsened with a fall of hemoglobin suggesting rupture of pseudoaneurysm that didn’t improve with resuscitation.

Discussion
A tender swollen groin in an injected drug abuser should prompt a high index of suspicion for the presence of pseudoaneurysm. When faced with uncertain diagnosis, further investigation with appropriate imaging is warranted. In this case, diagnosis of infected pseudoaneurysm was confirmed due to the co-incidence of septic condition. Surgical management with controlled infection and resuscitation was required, however, it remained a challenge due to the unstable condition and pseudoaneurysm itself that was prone to rupture. In addition, Klebsiella pneumonia ESBL made bacteria resistant to cephalosporins and monobactams.
C53. Infection of Coronavirus Disease 2019 Reveals Brugada Pattern
Authors: Patriya N A S , Yasa A 
Published: April 2022

Abstract

Background
Coronavirus Disease 2019 (COVID-19) resulted considerable morbidity and mortality worldwide since December 2019. In the other hand, Brugada syndrome had higher risk of sudden cardiac death. Although it was manifested with an electrocardiographic (EGC) abnormalities, the patients with Brugada syndrome were often healthy and unaware of their genetic predisposition.

Case Summary
A 59 years old man without significant medical history was reported a day of fever, productive cough, and shortness of breath. He did not complain any chest pain, palpitation, and episode of syncope. The patient had no family history of sudden cardiac death. On presentation, he was febrile (39,5°C), tachycardia (110 beats/ min), and tachypnea (28 breath/ min). Laboratory findings of the patient were elevated High-sensitivity C-reactive protein (hs-CRP), with normal electrolyte level, and troponin. The Polymerase chain reaction (PCR) test for COVID-19 performed with the positive result. The chest radiograph showed multifocal bilateral interstitial with a normal cardiac silhouette. The ECG revealed Brugada type 2 ECG pattern. A bedside echocardiogram demonstrated with the normal result. His condition continued to improve and the ECG demonstrated complete resolution of the initial Brugada ECG pattern.

Discussion
COVID-19 infection has been described as unmasking Brugada pattern. The most frequently reported symptoms of COVID-19 was fever. Brugada syndrome was a genetic disorder, that was most commonly involving SCN5A gene, which encoded the cardiac sodium channel. Fever caused blockade of sodium channel was being well described provocative trigger that might incite arrhythmia in patient with Brugada syndrome.
C54. Infective Endocarditis with Ventricular Septal Defect and Ruptured Sinus of Valsalva: A Case Report
Authors: Zebua J , Nasution A N , Siregar A A , Hasan H 
Published: April 2022

Abstract

Background
Ventricular Septal Defect (VSD) is the most common congenital heart defect with incidence rate about 50% of all case in children. VSD is often followed by weakness of the wall in the sinus of Valsalva causing aneurysms, where 30-50% of cases of aneurysms in the sinus of Valsalva is associated with VSD. Congenital heart defects also increased risk factors for infective endocarditis (IE) with the risk of infection 15-140 times greater than the general population.

Case Description
A 7-year-old boy was reported with fever and shortness of breath, echocardiography examination showed subaortic VSD, ruptured sinus of Valsalva, multiple vegetation on left ventricular outflow tract, right coronary cusp, and right ventricle, moderate aortic, pulmonal and tricuspid regurgitation with mild pulmonal hypertension. Although there was no growth of bacteria from blood culture but result from kidney ultrasound showed sign of glomerulonephritis, suggesting additional findings in Duke criteria. The patient was treated with broad spectrum antibiotic and heart failure drugs. Then, Heart Team decided to refer the patient to Cardiac Center Harapan Kita for evacuating vegetations and repairing congenital heart defect.

Discussion
Infective endocarditis is one of the most arduous complication that must be treated immediately in patients with VSD. Besides reducing the symptoms that arise from heart defects, the clinicians also have to stop the process of infection. Adequate antibiotics and immediate surgery are the best strategy to evacuate the focus of infection as well as to repair congenital defects.
C57. Left Main Coronary Artery Compression by A Dilatated Pulmonary Artery in Patients with Pulmonary Arterial Hypertension: What Should We Do?
Authors: Jauhari H , Anggrahini D W , Hartopo A B 
Published: April 2022

Abstract

Background
Pulmonary artery hypertension (PAH) is often associated with angina and extrinsic compression of left main coronary artery (LMCA) by a dilatated pulmonary artery is recognized as the cause. The optimal management for pulmonary arterial hypertension with extrinsic LMCA compression has not been clearly established.

Case Summary
We report on 31-year-old female with secundum atrial septal defect and 44 -year-old female with incomplete atrioventricular septal defect complain of progressive typical angina that aggravated with exertion. The electrocardiogram showed right heart strain and chest radiograph showed cardiomegaly involving the right cavities with enlargement of the pulmonary arch. Right heart catheterization showed pulmonary arterial hypertension with the mean pulmonary artery pressure of 61 mmHg and 65 mmHg respectively. Cardiac CT demonstrated compression of proximal LMCA by dilatated pulmonary artery. Although with optimal phosphodiesterase-5 (PDE5) inhibitor and prostacyclin analog therapy, patients still complain of angina.

Discussion
LMCA compression may be associated with additional complications of severe myocardial ischemia, including myocardial infarction, left ventricle dysfunction, arrhythmia, and eventually, sudden death. It may occur in patients with PAH with severely dilated PA and can be identified with either computed tomographic coronary angiography or selective coronary angiography. Furthermore, there are no guidelines recommending optimal management of this disease entity. Optimalization of pharmacologic treatment of PAH may reduce compression-related symptoms. A stent implantation is a promising alternative option for the treatment of LMCA compression and provides an optimal risk-to-benefit ratio, both for symptom relief and for long-term outcomes.
C62. May-Thurner syndrome, a diagnosis and endovascular treatment in adult women with no risk factor: a case report and literature review
Authors: Hidayatullah F N , Pasciolly R M R J 
Published: April 2022

Abstract
May-Thurner syndrome (MTS) is a venous compression syndrome in which the left common iliac vein (LCIV) is compressed between the lower lumbar spine and the right common iliac artery (RCIA). This syndrome is suspected when a patient presents with recurrent or chronic venous insufficiency (CVI) or deep vein thrombosis (DVT) on his/her left lower extremity; although MTS’ clinical presentation varies. A history of recurrent left lower extremity DVT and symptoms associated with chronic venous hypertension, including varicosities, venous ulcers, lower limb swelling, and pain in the inguinal, calf, or upper leg regions suggests MTS diagnosis. We present a case report and conduct a literature review on a patient presenting with painful, numb, and swollen left leg since three months before admission. Intermittent claudication was found. Doppler ultrasonography confirmed no thrombus, yet suggested that the RCIA compressed the LCIV. Doppler’s finding was confirmed using computed tomography (CT) scan, and RCIA compression seemed to cause an obstruction. MTS diagnosis is often missed in patients with lower limb pain because the block is not caused by a thrombus and a clinician often misses to conduct Doppler examination on the iliac artery/vein. This study highlights the importance of considering MTS in a patient with left lower limb pain, and chronic DVT which is unresponsive to pharmacological treatment, hence, endovascular treatment may be warranted.