bluuebunny/crossref_metadata_2025_split huggingface dataset:
OR66. The effect of combination bisoprolol therapy with quality of life in heart failure preserved ejection fraction (HFpEF)
Authors: Adityawati A D , Rohman M S , Rahimah A F , Sargowo D , Anjarwani S 
Published: April 2022

Abstract

Background and Aims
This study aimed to observe and evaluate the effect of bisoprolol in the improvement of HFpEF patient’s QoL. As we know, Global Public Health Burden of Heart Failure reported the growing prevalence of heart failure in 2020 and half of the case classified as HFpEF. It is well known that someone who have been diagnosed with heart failure will have a poorer quality of life/QoL. β-blocker is a heart rate lowering agent with a potency to improve the patient’s clinical outcome, such as QoL.

Methods and Results
This study is a retrospective cohort following HFpEF patients who received bisoprolol and who did not received bisoprolol. The study participant selected by purposive sampling method, who meet inclusion and exclusion criteria. This research was analysed by SPSS 25 version. It used comparasion test and regresion test to determine differences in the effects of using bisoprolol and which combination was good for lowering the MLHFQ score. The result of comparison between bisoprolol grup and non-bisoprolol grup showed a significance value of 0.000 (p &lt; 0.05). Meanwhile, if bisoprolol are combined with other drugs, only the combination of 2.5 mg bisoprolol with ACE-Inhibitor has a significant effect on QoL (p total score 0.007)

Conclusion
We conclude that the use of bisoprolol as combination therapy is usefull for management HFpEF, because it showed improvement in the HFpEF patient’s QoL.
OR72. The relationship between diabetes mellitus and homocysteine level in peripheral arterial disease population in mataram city
Authors: Anthony L M , Yanna I , Deasy I , Catarina B , Herpan S H 
Published: April 2022

Abstract

Background
Peripheral Arterial Disease (PAD) is partial or total blockage of blood vessel caused by occlusive atherosclerosis especially in lower extremity. Hyperhomocysteinemia had been used as a biomarker of cardiovascular disease such atherosclerosis formation process. Previous study have reported higher incidence of homocysteine level in patient with Diabetes Mellitus (DM) type 2. However, data on homocysteine level in PAD patient with DM type 2 is limited. Therefore, this study aim to investigate the comparation between DM and homocysteine level in PAD patient in Mataram City.

Methods and Results
This study is a cross sectional study conducted at Siti Hajar Islamic Hospital in Mataram City. The sample was patients with PAD with an ankle brachial index score &lt;0.90 and DM type 2. The outcome of this study was homocysteine level on DM PAD patient and non-DM PAD patient. Data analysis using the unpaired T test. fifty-two PAD patients in this study, with 75% female (39) and average age of 57.4 years old in this research. The average homocysteine level in PAD patient with DM (5.7±0.9 µmol/L) was significantly higher than those in non-DM PAD patient (4.8±1.0 µmol/L) (p = 0.001). We found that history of hypertension was significantly higher in non-DM PAD patient and ankle brachial index score was significantly lower in DM PAD patient (p = 0.049).

Conclusion
There is a significant differences of homocysteine level within DM patient compared to non-DM patient.
OR77. The Struggle of Improving Ejection Fraction in Heart Failure, Does Patient Adherence Has a Significant Role? A Single-Centre Pilot Study from CORE-HF Registry
Authors: Kusumastuti Irnizarifka F , Arifianto H , Ristiasah I H , Hafika A N , Myrtha R 
Published: April 2022

Abstract

Aim
Despite the development of its treatment, adherence is an important factor in reducing the mortality and morbidity of heart failure. This study aims to see the correlation between patient adherence and improvement of ejection fraction (EF) in a Heart Failure patients.

Method and Result
This is a retrospective cohort study held in HF Clinic UNS Hospital from CORE-HF (COmprehensive Registry and rEsearch on Heart Failure). The adherence was measured using MMAS-8. The total score was grouped into three categories; high = 8, moderate = 6 to &lt; 8, and poor &lt; 6. For HFrEF patient, the EF improvement within 12 months is grouped into; Recovery (EF evaluation &gt; 50%), improved (EF evaluation &gt; 40%), and none (EF evaluation &lt; 40%). For HFmrEF and HFpEF, the change of EF is categorized into increased more than 10%, &lt; 10%, and decreased. Among 130 patients, 47.7% have poor adherence, 58% moderate adherence, and 10% high adherence. The characteristics of the samples were 60.8% male, with a mean age of 57 years old, 10% with Atrial Fibrillation, 34.6% with CAD, 36% with HFrEF, 15% with HFmrEF, and 48% patients have HFpEF. Among HFrEF, the Kruskal-Wallis test showed a statistically significant difference in EF improvement between the adherence groups (χ2 (2) = 7.860; p = 0.02). This study also found a significant difference in EF improvement among adherence groups between HFmrEF and HFpEF (χ2 (2) = 9.159; p = 0.010)

Conclusion
Besides optimal medical therapy, patient adherence has an important role in improving EF.
M2. Cardiorenal anaemia syndrome vs left ventricular ejection fraction: which is a better mortality prognostic factor for heart failure? A systematic review and meta-analysis
Authors: Laurentius Andrea , Wiyono Lowilius , Subali Anita Dominique , Rossimarina Vienna 
Published: April 2022

Abstract

Aim
Cardiorenal anaemia syndrome (CRAS) involves a vicious interaction between heart failure (HF), chronic kidney disease, and anaemia. CRAS is associated with higher morbidity, mortality, and health care cost. This study investigated CRAS as a predicting factor of all-cause mortality compared to left ventricular ejection fraction (LVEF) in HF patients as one of the established classifications being linked to prognosis in HF.

Methods and Results
A systematic review based on PRISMA guidelines was performed on 6 scientific databases (PubMed, ProQuest, Scopus, ScienceDirect, Springer) with search terms related to left ventricular ejection fraction, heart failure, and cardiorenal anaemia syndrome. Original English case-control and cohort studies in heart failure participants which analyzed hazard ratio (HR) of all-cause mortality were considered eligible. The quality assessment was evaluated with New Castle Ottawa Scale (NOS). A total of 17 studies comprising 90,092 participants from more than 14 countries were included in the qualitative analysis with eleven subjected to meta-analysis. The presence of CRAS aligns with a significantly higher mortality rate (HR 1.64 [95% CI 1.44 – 1.87]) as compared to current classification based on ejection fraction obtained insignificant clinical outcomes of reduced ejection fraction HF (HFrEF) (HR 1.06 [95% CI 0.98 – 1.15]) in the pooled analysis.

Conclusion
CRAS is a significant death prognosticator and indicates a worse prognosis in HF patients as compared to HF patients with reduced ejection fraction. CRAS is a potential alternative prognostic factor for heart failure patients to predict mortality outcomes.
M18. Three-year 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-diabetic drug. SGLT-2 Inhibitor has favourably effect in cardiovascular outcomes. However, the three-year cardiovascular outcomes of SGLT-2 Inhibitor in Type-2 Diabetes Mellitus remains unclear. We performed meta-analysis to evaluate cardiovascular outcomes in three-years of SGLT-2 Inhibitor therapy.

Methods
We performed a systematic literature search from various electronic databases. We used keywords “SGLT-2 Inhibitor”, “Type-2 Diabetes Mellitus”, and “Cardiovascular outcome”. Inclusion criteria for research is Randomized Control Trial and 3-year follow-up. Primary endpoint is Major Adverse Cardiovascular Event (MACE). Secondary endpoints are all-cause mortality, cardiovascular mortality and hospitalization of heart failure. Risk ratio (RR) with 95% confidence interval were used to report all outcomes.

Results
Total of two Randomized Control Trial was selected (EMPA-REG [Jardiance®] and VERTIS-CV [Steglatro®] trial) with 15.266 patients pooled in our analysis. Results of three-year primary outcome compared SGLT-2 Inhibitor with Placebo had no significant reduction in MACE (RR = 0.93 [95% CI, 0.81–1.07], p = 0.32; I2=56%). Result of secondary outcome showed no significant reduction in all-cause mortality (RR = 0.80 [95% CI, 0.60-1.08], p = 0.15; I2=85%) and cardiovascular mortality (RR = 0.77 [95% CI, 0.52–1.12], p = 0.17; I2=87%). However, there are significant reduction in hospitalization of heart failure (RR = 0.68 [95% CI, 0.57–0.82], p &lt; 0.00001; I2=0%).

Conclusion
SGLT-2 Inhibitor in Type-2 Diabetes Mellitus has significant reduction in hospitalization of heart failure. However, no significant results were found in MACE, all-cause mortality, and cardiovascular mortality after 3-year follow-up.
C4. Acute Limb Ischemia in Covid-19 Patient : A Rare Case Report from Rural to Tertiary Hospital
Authors: Sekaringtyas E , Handari S D , Sembiring Y E 
Published: April 2022

Abstract

Background
Acute limb ischemia is defined as a decrease in blood perfusion to the limbs caused by blockages in peripheral arteries. Coronavirus disease 19 (COVID 19), declared as a pandemic by WHO, affects not only respiratory system but also other organs including cardiovascular system. Patients mainly manifests as venous thromboembolism, while peripheral arteries blockages is less common.

Case Summary
A 53 years old man came to emergency room complaining of pain in his left leg. It was felt since the third day of treatment at the previous hospital, in Tuban, as a covid patient one month ago. The first and third of his left toes were also blackish. There was no history of hypertension, diabetes or smoking. On laboratory result, D-dimer level was elevated by 745 ng/ml (normal range &lt;500 ng/ml), while the others within normal limit. CT Angiography examination showed bilateral legs arterial thrombus which the left side was worse. A thrombectomy was performed, then heparin therapy intravenously was given. During observation at the 4th day after surgery, the sign of necrotic border in the 1st dan 3rd toes were seen clearer and we decided to do mutilation.

Discussion
The pathophysiology of acute limb ischemia in Covid-19 patients is known multifactorial, including endothelial damage, immobilization and hypercoagulable states that have a role in the occurrence of blockages. They may also have an acute thrombosis of non atherosclerotic native arteries. An immediate anticoagulants and vascular interventions are needed to reduce its morbidities.
C11. Aorto-Pulmonary Window in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome : A Rare Case Report
Authors: Suryawan Willy , Sakidjan Indriwanto 
Published: April 2022

Abstract

Background
Aorto-pulmonary window and Tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) are very rare entities. The combination of the two defects in adolescence patient made the diagnosis based on standard imaging modalities challenging.

Case Illustration
14-year-old boy was referred from Borneo Hospital with failure to thrive and shortness of breath symptoms. He was underwent multiple modalities procedure and it shows the presences of features of tetralogy of Fallot : right ventricular hypertrophy, sub-aortic ventricular septal defect and pulmonary infundibular stenosis. Pulmonary valve leaflets are not seen with mild dilatation of the main and left pulmonary artery (Absent PV syndrome) and a connection from Pulmonary Artery and Ascending Aorta (Aorta-Pulmonary Window)

Discussion
TOF-APVS is a relatively rare variant of TOF. Its co-existence with Aorto-Pulmonary Window make this case was very exceptional. There are only a few reported cases diagnosed with TOF-APVS in adult age in the literature as most of them are diagnosed at younger ages. The unique physiology due to the large connection of Ascending aorta and the main pulmonary artery resulting in L-R Shunt. The large connection from Ascending Aorta to Main Pulmonary artery (L-R Shunt) prompt this patient to pulmonary hypertension (before and after surgery) and heart failure, hence initial treatment of ACE-I and sildenafil was very necessary.
C12. Atrial Fibrillation post Sinovac-Coronavac Vaccine : A Case Report
Authors: Rismawanti R I , Lalitya W , Rachmanadi M B , Gumilang R A 
Published: April 2022

Abstract

Background
COVID-19 has become a global pandemic. Vaccines are currently used to reduce the morbidity and mortality of the disease. However, research regarding the use of the vaccine is still ongoing. Atrial fibrillation (AF) is one of the rare findings after receiving the COVID-19 vaccine.

Case Summary
A man, 64 years old, presented to the ER with palpitation an hour before admission. He refused to have any angina symptoms. Previously, he got a Sinovac-Coronavac injection one day before. On examination, BP 100/60, HR 114, RR 24, SpO2 99% room air, sub-febrile, other findings within normal limits. ECG showed AF with rapid ventricular response. A routine blood test showed no abnormality, rapid antigen SARS-COV2 negative, and hs Troponin I (hsTn-I) 2.5 ng/L. The patient was diagnosed with atrial fibrillation and given oxygen, amiodarone, aspirin, atorvastatin, and serial ECG post-therapy. ECG post therapy converted into sinus rhythm after 26 hours.

Discussion
Acute SARS-CoV-2 infection increases the susceptibility to new-onset atrial fibrillation (NOAF), but the pathophysiology is not well understood. After receiving the COVID-19 vaccine, the immune system will mimic primary infection. It was unclear why our patients developed NOAF. However, we found an observational zone hs-TnI value and a sub-febrile temperature. Troponin might be elevated in critically ill patients even without myocardial involvement, but this patient is in a good state. However, the correlation between atrial fibrillation and the COVID-19 vaccine is not well understood because of the lack of data.
C17. Can we improve the clinical manifestation of superior vena cava syndrome without treat the underlying disease?
Authors: Mappangara Idar , Syamsuddin Deni , Idul Hafiz 
Published: April 2022

Abstract

Background
Superior vena cava syndrome (SVCS) is a clinical manifestations from obstruction of superior vena cava that has thin wall. The main goals of SVCS management are to relieve the symptom and give therapy for the underlying disease. For now, there some additional therapies that connected to this disease such as steroid, diuretic, and anticoagulant. Flavonoid which a derivate from gamma benzopyrone has pharmacodynamics mechanism that appropriate with SVCS.

Case Summary
We reported a male 35 years old came with SVCS typical manifestations. Then, we done some additional examinations, and we establish the diagnose with SVCS et cause anterior mediastinum mass suspected thymoma. The patient was planned to done histology biopsy, but the patient was refused to done any examination or interventions. We already gave diuretic, Vit-K antagonist anticoagulant, and high dose in short period steroid, but there was no any clinical improvement. Then, we add flavonoid hesperidin-diosmin, and there was clinical improvement after 1 months.

Discussion
Based on the management algorithm of SVCS, we should done histology biopsy to this patient to establish the main cause of SVCS, so we can treat the patient by the cause. In literatures about SVCS, there was no any pharmacotherapies that believed can give clinical improvement, including steroid, diuretics, and anticoagulant. Flavonoid that has pharmacodynamics such as anti-inflammation, improve venous tone, increase lymphatic drainage appropriate with the clinical pathomechanism of SVCS. So it may has rational therapeutic effect to this patient.
C19. Cardiac Amyloidosis: A Great Pretender of Left Ventricular Hypertrophy with Systemic Manifestation
Authors: Tampi G G , Farissa I P , Nugroho M A , Dewi R A C K , Pangarsa E A , Hellmi R Y , Rahardjo S B , Puspasari D 
Published: April 2022

Abstract

Background
Systemic amyloidosis encompasses an underdiagnosed disorder characterized by the extracellular deposition of amyloid in one or more organs, including the heart. The therapeutic strategy depends on the characterization of amyloid protein type and the extent of the disease. When founding a pathological left ventricular hypertrophy, initial clues provided by electrocardiography and echocardiography combined with other clinical manifestations could support a suspicion of cardiac amyloidosis.

Case Summary
A 54-year-old male patient was repeatedly admitted to a local hospital for recurrent heart failure and refractory bilateral pleural effusions of unknown cause. There was intolerance of any heart failure medications and repeated thoracocentesis failed to control the pleural effusion. The echocardiogram revealed severely impaired left ventricular function with phenotypic overlap between hypertrophic and restrictive cardiomyopathy. In contrast, we found a low voltage electrocardiogram. After an extensive diagnostic workup, including speckle tracking echocardiography, cardiac magnetic resonance, serum immunofixation and free light chain, bone marrow biopsy, and also Congo Red staining for amyloid, the final diagnosis was light chain (AL) amyloidosis.

Discussion
Cardiac involvement in systemic amyloidosis is the leading cause of morbidity and mortality. Frequently, myocardial wall thickening is incorrectly referred to as hypertrophy which may potentially lead to the wrong diagnosis and therapy. However, a need remains for improved awareness and expertise, while a multidisciplinary approach is important in making the correct diagnosis and management of this debilitating disease.
C20. Cardiac Arrest in COVID-19 Patient Presenting with Takotsubo Cardiomyopathy
Authors: Wardhani Louisa Fadjri Kusuma , Suwanto Denny , Sativa Oryza , Lefi Achmad 
Published: April 2022

Abstract

Background
Takotsubo cardiomyopathy (TC) presents as a result of catecholamine surge. There are increase of TC among COVID-19 patients, which is induced by cytokine storm. TC is previously known as a self-limiting and benign cardiac manifestation, but it has been uncovered that TC can be associated with fatal cardiac outcome due to cardiogenic shock and life-threatening arrhythmia.

Clinical Presentation
A 54-year-old woman presented to the emergency department with a fever since 9 days before admission accompanied by DOE, PND, and fatigue that worsened since 5 days before admission. Fifteen days before her complaints, she experience bereavement from his son death from motorcycle accident. She was referred from regional hospitals due to respiratory failure necessitating ventilator support. Physical examination revealed normal blood pressure and desaturation. ECG shows tachycardia with global ST-elevation. CXR shows cardiomegaly (CTR 62%) and pneumonia. The laboratory demonstrated increased Neutrophil to Lymphocyte Ratio (NLR), C-Reactive Protein, Troponin, and positive PCR COVID-19 swab. An echocardiography presented regional wall motion abnormality with apical ballooning appearance and reduced systolic function with LVEF of 51% resembling Takutsubo cardiomyopathy. Despite maximal ventilatory and pharmacology, she experienced malignant ventricular tachycardia not responding to defibrillation and expired in only 6 hours

Discussion
The presence of cardiac arrhythmia followed by cardiac arrest in COVID-19 patient complicated by TC can be a direct effect of catecholamine surge and myocardial injury or indirect effect from QT-prolongation and inflammatory process. Concurrent COVID-19 pneumonia and TC may progress with dismal prognosis, so that in need of prompt referral system.
C21. Cardiac Complications in Immunocompromised Patient : A Case Report
Authors: Hanafiah R , Candra V F K 
Published: April 2022

Abstract

Background
Cardiovascular diseases in human immunodeficiency virus (HIV)-positive patients are becoming increasingly detected in developing countries. Pericardial involvement may be manifested as acute pericarditis, constrictive pericarditis, symptomatic pericardial effusion and cardiac tamponade. The aim of this report is to present a patient with AIDS clinical stage IV who developed pericarditis and pericardial effusion.

Case Summary
A 27-year-old male came to our ER with 7-day fever and delirium syndrome. He has been diagnosed with AIDS clinical stage IV for the past 3 years with the latest CD4 count was 6/mm3. Serial Transthoracic Echocardiography (TTE) revealed small to moderate circumferential pericardial effusion, thickening of pericardium and reduced left ventricular ejection fraction without signs of cardiac tamponade from TTE. Upon hospitalization, he developed signs of hypotension without distended jugular veins nor muffled heart sounds. It was decided to initiate supportive treatment and NSAIDs without pericardiocentesis. The patient recovered uneventfully. As an outpatient, no other cardiovascular complications developed.

Discussion
Pericardial conditions are the most frequent cause of heart disease in patient with HIV infection. Most cases are mild and asymptomatic. Pericardial effusion may be marker of end-stage HIV infection because it is associated with low CD4 cell count and is often caused by opportunistic infections and malignant neoplasms. Treatment of pericarditis in HIV patients is no different from that in general population. Asymptomatic patients with small pericardial effusion without tamponade require no intervention.
C23. CARDIAC REHABILITATION AFTER CONGENITAL HEART DISEASE SURGERY
Authors: Suryawan Willy , Ambari Ade Meidian 
Published: April 2022

Abstract

Background
The survival rates of children with congenital heart disease (CHD) have dramatically increased due to the contribution of advance in medical and surgical care. Nonetheless, patients often have decreased exercise capacity and health-related issues that affect their quality of life. Cardiac rehabilitation programs in patients after CHD surgery have shown improvement in peak-VO2 and cardio respiratory fitness . Paradoxically, only a minority of CHD patients receives formal cardiac rehabilitation and are often encouraged towards a sedentary lifestyle as a result of overprotection and uncertainty as to which physical activities and with what intensity should be recommended. We therefore present case report about cardiac rehabilitation after CHD surgery based on current evidence to show the importance and benefit in CHD patient

Case Illustration
A 17 years old female patient came to Rehab clinic after Valve replacement and ASD surgical closure for severe mitral and tricuspid regurgitation, ASD secundum and Cor triatiatum. Her last stay in hospital was prolonged due to several complications. Her appearance was frail and she even was not able to walk. After a thorough examination and 6 minutes walk test, she went phase II rehabilitation. After Cardiac rehabilitation, she got better and her cardio respiratory fitness was improved. Based on her result in 6 minutes walk test and calculation, She was capable to do daily activity life on her own and ready to continue phase III rehabilitation.

Discussion
Patient who have underwent cardiac rehabilitation after congenital heart disease surgery have been presented. Systematic Examination should be performed prior cardiac rehabilitation in order to give an individualized exercise prescription.