bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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 &lt;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

Abstract

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

Abstract

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 &gt; 40 years and women &gt; 50 years) (p = 0.01), hypotension (p &lt; 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

Abstract

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

Abstract

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 &lt; 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

Abstract

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&gt;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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &lt;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 &gt; 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

Abstract

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.