Sabrina Erriyanti, A. Soesanto, I. Sakidjan, A. Atmosudigdo, Oktavia Lilyasari, R. Ariani, S. Siagian
{"title":"The Impact of Tricuspid Annular Plane Systolic Excursion (TAPSE) After Mitral Valve Surgery on Long Term Mortality","authors":"Sabrina Erriyanti, A. Soesanto, I. Sakidjan, A. Atmosudigdo, Oktavia Lilyasari, R. Ariani, S. Siagian","doi":"10.30701/ijc.1196","DOIUrl":"https://doi.org/10.30701/ijc.1196","url":null,"abstract":"<jats:p />","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41291941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Almazini, A. Soesanto, A. Kuncoro, R. Ariani, E. Rudiktyo, R. Sukmawan
{"title":"Incidence of Persistent Symptom and Echocardiographic Findings in Survivors of COVID-19 Infection with Mild Symptoms","authors":"P. Almazini, A. Soesanto, A. Kuncoro, R. Ariani, E. Rudiktyo, R. Sukmawan","doi":"10.30701/ijc.1160","DOIUrl":"https://doi.org/10.30701/ijc.1160","url":null,"abstract":"<jats:p />","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48513334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Rifanda, M. A. L. Parama, Teuku Muhammad Haykal Putra, W. A. Widodo
When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT Background: Particular ischemic process that portrayed in Electrocardiogram (ECG) changes bear similar depiction to different conditions, one of them is hypokalemia. On the other hand, Treadmill Test (TMT) has been used for decades for risk stratifying and diagnosing coronary artery disease as a non-invasive, safe and affordable screening test. However, using ECG changes as interpretation, TMT could have incidence of false positive results reported in various conditions, one of which is hypokalemia. The aim is to report a case of positive ischemic response resemblance in TMT of patient with severe hypokalemia. Case Illustration: A-43-years-old female with history of unstable angina pectoris with risk factors of diabetes mellitus and hypertension underwent several examinations. Computed Tomography Coronary Angiography (CTCA) showed a 60% stenosis lesion in Left Anterior Descending (LAD) coronary artery. Within 3 minutes of TMT the ECG showed ST-segment depression in lead II, III, aVF, V1-V6 and prominent elevation in lead aVR. Fear of left main coronary artery occlusion, the test was terminated and the patient was immediately planned for urgent Percutaneous Coronary Intervention (PCI). The result indicated non-significant coronary lesion. Potassium concentration of 1.87 mmol per liter and troponin levels were normal. Unbeknownst before, the patient had multiple episodes of vomiting for a whole day and felt dehydrated prior to the TMT. Patient then treated for potassium implementation and discharged uneventfully. Conclusion: Hypokalemia could induce widespread ST-Segment depression or ST-Segment elevation in right limb lead. Peculiarly in context of stress testing or accompanied with chest pain, it is difficult to differentiate ECG changes in hypokalemia with true myocardial ischemia. Hypokalemia should be considered when TMT result is not concordance with true myocardial ischemia.
{"title":"When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT","authors":"D. Rifanda, M. A. L. Parama, Teuku Muhammad Haykal Putra, W. A. Widodo","doi":"10.30701/ijc.1197","DOIUrl":"https://doi.org/10.30701/ijc.1197","url":null,"abstract":"When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT \u0000 \u0000Background: \u0000Particular ischemic process that portrayed in Electrocardiogram (ECG) changes bear similar depiction to different conditions, one of them is hypokalemia. On the other hand, Treadmill Test (TMT) has been used for decades for risk stratifying and diagnosing coronary artery disease as a non-invasive, safe and affordable screening test. However, using ECG changes as interpretation, TMT could have incidence of false positive results reported in various conditions, one of which is hypokalemia. The aim is to report a case of positive ischemic response resemblance in TMT of patient with severe hypokalemia. \u0000 \u0000Case Illustration: \u0000A-43-years-old female with history of unstable angina pectoris with risk factors of diabetes mellitus and hypertension underwent several examinations. Computed Tomography Coronary Angiography (CTCA) showed a 60% stenosis lesion in Left Anterior Descending (LAD) coronary artery. Within 3 minutes of TMT the ECG showed ST-segment depression in lead II, III, aVF, V1-V6 and prominent elevation in lead aVR. Fear of left main coronary artery occlusion, the test was terminated and the patient was immediately planned for urgent Percutaneous Coronary Intervention (PCI). The result indicated non-significant coronary lesion. Potassium concentration of 1.87 mmol per liter and troponin levels were normal. Unbeknownst before, the patient had multiple episodes of vomiting for a whole day and felt dehydrated prior to the TMT. Patient then treated for potassium implementation and discharged uneventfully. \u0000 \u0000Conclusion: \u0000Hypokalemia could induce widespread ST-Segment depression or ST-Segment elevation in right limb lead. Peculiarly in context of stress testing or accompanied with chest pain, it is difficult to differentiate ECG changes in hypokalemia with true myocardial ischemia. Hypokalemia should be considered when TMT result is not concordance with true myocardial ischemia. \u0000 ","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43920989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Jagannatha, Rina Artha, Wayan Agus Surya Pradnyana, S. Kamardi, Anastasya Maria Kosasih
Background: The choice of reperfusion therapy in STEMI patients with COVID-19 is unclear. CRP to Albumin ratio (CAR) found to be a predictor of thrombus burden. This study was to determine the relationship and predictive value of CAR to in-hospital and long-term outcome of STEMI patients with COVID-19 treated with fibrinolytic. Methods: 297 COVID-19 patients with STEMI underwent fibrinolytic were enrolled. In-hospital outcomes were in-hospital mortality due to cardiovascular death which was divided into mortality <48 hours and >48 hours, fibrinolytic failure, and cardiogenic shock. The presence of reinfarction post fibrinolytic and mortality after the patient discharged was assessed as the long-term outcome. Results: During follow-up, 19.8% experienced in-hospital mortality and 16.1% had reinfarction. In the in-hospital outcome, patients with in-hospital death, failed fibrinolytic and cardiogenic shock had higher CAR (6.7+2.4 vs 4.7+1.9; 6.3+1.9 vs 2.1+1.6; 5.5+2.1vs1.8+1.5) with all p-value <0.05. CAR with an optimal cut-off >4.46 can be a predictor of fibrinolytic failure with sensitivity of 86.7% and specificity of 93.6% (PR19.82; 95%CI 10.32-38.06) and predictor of in-hospital death <48 hours with sensitivity of 84.6% and specificity of 82.7% (PR5.02; 95%CI 3.20-7.90). In the long-term outcome, patients who experienced reinfarction and out-hospital death had higher CAR (5.1+1.2vs2.5+2.4; 5.2+1.3vs2.6+2.4) than those who did not experience the event respectively with all p-value <0.05. CAR with an optimal cut-off >3.67 can be predictor of reinfarction with sensitivity of 87.5% and specificity of 73.5% (PR12.250; 95%CI 5.38-27.87). The Cox regression model showing CAR >3.67 was also associated with higher reinfarction event (p=0.001). Conclusion: CAR has the potential to be a predictor of in-hospital and long-term outcomes for STEMI patients with COVID-19 which can help determine which patients need more invasive strategy to prevent mortality and morbidity.
背景:STEMI合并COVID-19患者再灌注治疗的选择尚不清楚。发现CRP与白蛋白比(CAR)是血栓负荷的预测因子。本研究旨在确定CAR与接受纤溶治疗的STEMI COVID-19患者住院和长期预后的关系和预测价值。方法:纳入297例经纤溶治疗的STEMI患者。住院结果为心血管死亡导致的住院死亡率，分为48小时死亡率、纤溶性衰竭和心源性休克。纤维蛋白溶解后再梗死的存在和出院后患者的死亡率被评估为长期结果。结果:随访期间，住院死亡率为19.8%，再梗死发生率为16.1%。在院内转归中，院内死亡、纤溶失败和心源性休克患者的CAR更高(6.7+2.4 vs 4.7+1.9;6.3+1.9 vs 2.1+1.6;5.5+2.1vs1.8+1.5)， p值均为4.46，可作为纤溶衰竭的预测指标，敏感性为86.7%，特异性为93.6% (PR19.82;95%CI 10.32-38.06)和院内死亡预测因子3.67可作为再梗死的预测因子，其敏感性为87.5%，特异性为73.5% (PR12.250;95%可信区间5.38 - -27.87)。Cox回归模型显示CAR - >3.67也与较高的再梗死事件相关(p=0.001)。结论:CAR有可能成为STEMI患者COVID-19住院和长期预后的预测指标，可以帮助确定哪些患者需要更有创性的策略来预防死亡率和发病率。
{"title":"C-Reactive Protein to Albumin Ratio Predict In-Hospital and Long-term Outcome of ST-Segment-Elevation Myocardial Infarction Patients with SARS-CoV2 Infection Underwent Fibrinolytic Therapy.","authors":"G. Jagannatha, Rina Artha, Wayan Agus Surya Pradnyana, S. Kamardi, Anastasya Maria Kosasih","doi":"10.30701/ijc.1305","DOIUrl":"https://doi.org/10.30701/ijc.1305","url":null,"abstract":"Background: The choice of reperfusion therapy in STEMI patients with COVID-19 is unclear. CRP to Albumin ratio (CAR) found to be a predictor of thrombus burden. This study was to determine the relationship and predictive value of CAR to in-hospital and long-term outcome of STEMI patients with COVID-19 treated with fibrinolytic. \u0000Methods: 297 COVID-19 patients with STEMI underwent fibrinolytic were enrolled. In-hospital outcomes were in-hospital mortality due to cardiovascular death which was divided into mortality <48 hours and >48 hours, fibrinolytic failure, and cardiogenic shock. The presence of reinfarction post fibrinolytic and mortality after the patient discharged was assessed as the long-term outcome. \u0000Results: During follow-up, 19.8% experienced in-hospital mortality and 16.1% had reinfarction. In the in-hospital outcome, patients with in-hospital death, failed fibrinolytic and cardiogenic shock had higher CAR (6.7+2.4 vs 4.7+1.9; 6.3+1.9 vs 2.1+1.6; 5.5+2.1vs1.8+1.5) with all p-value <0.05. CAR with an optimal cut-off >4.46 can be a predictor of fibrinolytic failure with sensitivity of 86.7% and specificity of 93.6% (PR19.82; 95%CI 10.32-38.06) and predictor of in-hospital death <48 hours with sensitivity of 84.6% and specificity of 82.7% (PR5.02; 95%CI 3.20-7.90). In the long-term outcome, patients who experienced reinfarction and out-hospital death had higher CAR (5.1+1.2vs2.5+2.4; 5.2+1.3vs2.6+2.4) than those who did not experience the event respectively with all p-value <0.05. CAR with an optimal cut-off >3.67 can be predictor of reinfarction with sensitivity of 87.5% and specificity of 73.5% (PR12.250; 95%CI 5.38-27.87). The Cox regression model showing CAR >3.67 was also associated with higher reinfarction event (p=0.001). \u0000Conclusion: CAR has the potential to be a predictor of in-hospital and long-term outcomes for STEMI patients with COVID-19 which can help determine which patients need more invasive strategy to prevent mortality and morbidity.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43787467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Juzar, A. Muzakkir, Y. Ilhami, N. Taufiq, T. Astiawati, I. M. J. R A, M. Pramudyo, Andria Priyana, Afdhalun Hakim, S. Anjarwani, Jusup Endang, B. Widyantoro
Background Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia. Methods IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes. Results Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients. Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%). Conclusion Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy.
背景急性冠脉综合征(ACS)是一种危及生命的疾病，在世界范围内具有很高的发病率和死亡率。ACS的注册为改进和研究提供了很好的指导。我们整理了一个多中心注册表，以获得有关印度尼西亚ACS的人口统计、管理和结果的信息。方法印度尼西亚急性冠脉综合征登记处(One ACS Registry)是一个前瞻性的全国性多中心登记处，有14家医院通过标准化电子病例报告表(eCRF)提交ACS数据。2018年7月至2019年6月期间，登记了7634例ACS患者。该注册表记录了基线特征;发病、意识和转移时间;体格检查和附加检查;诊断;院内用药和干预;并发症;还有住院的结果。结果近一半(48.8%)的患者诊断为STE-ACS。最常见的危险因素是男性、吸烟、高血压。NSTE-ACS患者往往有更多的合并疾病，包括糖尿病、血脂异常、既往AMI、HF、PCI和CABG。在我们的登记中，大多数ACS患者(89.4%)是由国家健康保险资助的。抗血小板、抗凝、降压、他汀类药物作为24小时治疗和出院治疗;而强效P2Y12抑制剂的处方量较少。接受再灌注治疗的STE-ACS患者多于不接受再灌注治疗的患者(65.2% vs. 34.8%)，其中首次PCI是最常见的方法(45.7%)。只有21.8%的STE-ACS患者在发病0-3小时内采用再灌注策略。17.6%的NSTE-ACS患者采用了有创策略，只有6.7%的患者在早期(<24小时)采用了有创策略。早期有创患者的中位LoS短于晚期有创患者(P<0.001)。中、低危患者的中位LoS也较短。ACS患者的死亡率为8.9%;STE-ACS患者的死亡率高于NSTE-ACS (11.7% vs. 6.2%)。结论:我们的注册表显示STE- acs和NSTE-ACS患者的比例相当，以中年男性为主。STE-和NSTE-ACS具有相同的危险因素。我们需要改善转诊时间，特别是STE-ACS患者。我们登记处的证据表明，为了改善ACS的结果，有两个问题需要解决:最佳和充分的药物治疗和侵入性策略。
{"title":"Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry","authors":"D. Juzar, A. Muzakkir, Y. Ilhami, N. Taufiq, T. Astiawati, I. M. J. R A, M. Pramudyo, Andria Priyana, Afdhalun Hakim, S. Anjarwani, Jusup Endang, B. Widyantoro","doi":"10.30701/ijc.1406","DOIUrl":"https://doi.org/10.30701/ijc.1406","url":null,"abstract":"Background \u0000Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia. \u0000Methods \u0000IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes. \u0000Results \u0000Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients. Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%). \u0000Conclusion \u0000Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47829897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Atrioventricular (AV) block in children may pose a challenge for phycisians. However, it can be detected with careful physical examination. Case illustration: A 4 month old infant presented with bradycardia that did not improve during observation period. Her electrocardiography (ECG) showed complete atrioventricular block and her echocardiography showed secundum atrial septal defect (ASD) and patent ductus arteriosus (PDA). Her father’s ECG showed first degree AV block. She was recovered well after pacemaker implantation and PDA ligation. Conclusion: An infant who suffered from complete AV block was successfully treated with pacemaker.
{"title":"High Degree AV Block in Infants","authors":"A. Cahyono","doi":"10.30701/ijc.1244","DOIUrl":"https://doi.org/10.30701/ijc.1244","url":null,"abstract":"Background: Atrioventricular (AV) block in children may pose a challenge for phycisians. However, it can be detected with careful physical examination. \u0000Case illustration: A 4 month old infant presented with bradycardia that did not improve during observation period. Her electrocardiography (ECG) showed complete atrioventricular block and her echocardiography showed secundum atrial septal defect (ASD) and patent ductus arteriosus (PDA). Her father’s ECG showed first degree AV block. She was recovered well after pacemaker implantation and PDA ligation. \u0000Conclusion: An infant who suffered from complete AV block was successfully treated with pacemaker.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48524169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As the primary cause of hospitalization in acute heart failure (AHF) patients, congestion was responsible for a higher risk of mortality, rehospitalization, and renal dysfunction in AHF patients. Although loop diuretic was routinely used as the mainstay of AHF therapy, it is still ineffective to obtain the euvolemic state in most hospitalized AHF patients. Therefore, a higher loop diuretic dose was often required to increase the decongestion effect. However, consequently, it can cause several detrimental complications, including renal dysfunction, neurohormonal activation, hyponatremia, hypokalaemia, and reduced blood pressure, which eventually result in poor prognosis. Hence, the new approach may be proposed to optimize decongestion in acute phase, including the use of arginine vasopressin V2 receptor antagonist – Tolvaptan. As an additive therapy to loop diuretic in AHF patients, it can be considered due to its several beneficial effects, including greater decongestion effect, lowered worsening renal function incidence, counteract neurohormonal activation, neutralized hyponatraemic state, no alteration of potassium metabolism, stabilize the blood pressure, and reduced requirement of a higher dose of loop diuretic to achieve an equal or even greater decongestion effect compared to a high dose of loop diuretic alone. Tolvaptan provided favourable outcomes in several specific populations and was considered safe with several mild adverse effects. Several guidelines across countries have approved the use of Tolvaptan in AHF patients with or without hyponatremia. The initial dose of Tolvaptan was 7.5 to 15 mg and can be titrated up to 30 mg. However, further studies were still required to determine the timing dose and optimal dose of Tolvaptan in general and elderly populations with AHF, respectively.
{"title":"Management of Decongestion in Acute Heart Failure: Time for a New Approach?","authors":"M. Pramudyo","doi":"10.30701/ijc.1381","DOIUrl":"https://doi.org/10.30701/ijc.1381","url":null,"abstract":"As the primary cause of hospitalization in acute heart failure (AHF) patients, congestion was responsible for a higher risk of mortality, rehospitalization, and renal dysfunction in AHF patients. Although loop diuretic was routinely used as the mainstay of AHF therapy, it is still ineffective to obtain the euvolemic state in most hospitalized AHF patients. Therefore, a higher loop diuretic dose was often required to increase the decongestion effect. However, consequently, it can cause several detrimental complications, including renal dysfunction, neurohormonal activation, hyponatremia, hypokalaemia, and reduced blood pressure, which eventually result in poor prognosis. Hence, the new approach may be proposed to optimize decongestion in acute phase, including the use of arginine vasopressin V2 receptor antagonist – Tolvaptan. As an additive therapy to loop diuretic in AHF patients, it can be considered due to its several beneficial effects, including greater decongestion effect, lowered worsening renal function incidence, counteract neurohormonal activation, neutralized hyponatraemic state, no alteration of potassium metabolism, stabilize the blood pressure, and reduced requirement of a higher dose of loop diuretic to achieve an equal or even greater decongestion effect compared to a high dose of loop diuretic alone. Tolvaptan provided favourable outcomes in several specific populations and was considered safe with several mild adverse effects. Several guidelines across countries have approved the use of Tolvaptan in AHF patients with or without hyponatremia. The initial dose of Tolvaptan was 7.5 to 15 mg and can be titrated up to 30 mg. However, further studies were still required to determine the timing dose and optimal dose of Tolvaptan in general and elderly populations with AHF, respectively.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42140557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Zwolle, TIMI, and GRACE risk scores have been proven to predict mayor adverse cardiovascular events (MACE) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). However, they were developed over a long time ago which many advances have been made in the cardiovascular field today. The scores were also developed in the non-Asian majority population and their accuracy for Indonesian population remains unknown. We aimed to validate and compare these scores for Indonesian population. Methods An analytical observational study was conducted on 193 patients undergoing primary PCI. The Zwolle, GRACE, and TIMI risk scores were calculated for each patient. Then, the risk score validation was carried out with the calibration test using Hosmer Lemeshow test and discrimination test using the AUC ROC. Furthermore, the comparisons between the risk scores were carried out using the DeLong test. Results The three scores have good results in the Hosmer Lemeshow calibration test (p > 0.05). The discrimination test also indicated good results with AUC ROC Zwolle, TIMI and GRACE risk scores respectively 0.776; 0.782; 0.831 (p<0.05). There was no significant difference in the prediction accuracy of the three risk scores in the DeLong test. Conclusions The Zwolle, TIMI, and GRACE risk scores had good validity for predicting major adverse cardiovascular events in STEMI patients undergoing primary PCI. There was no significant difference in the prediction accuracy of the three risk scores. Keywords: Risk score, major adverse cardiovascular events, primary percutaneous coronary interventions
{"title":"The Validation and Comparison of Zwolle, TIMI, and GRACE Risk Scores for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention in The Indonesian Population.","authors":"An Aldia Asrial, Anggit Pudjiastuti","doi":"10.30701/ijc.1324","DOIUrl":"https://doi.org/10.30701/ijc.1324","url":null,"abstract":"Background \u0000Zwolle, TIMI, and GRACE risk scores have been proven to predict mayor adverse cardiovascular events (MACE) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). However, they were developed over a long time ago which many advances have been made in the cardiovascular field today. The scores were also developed in the non-Asian majority population and their accuracy for Indonesian population remains unknown. We aimed to validate and compare these scores for Indonesian population. \u0000Methods \u0000An analytical observational study was conducted on 193 patients undergoing primary PCI. The Zwolle, GRACE, and TIMI risk scores were calculated for each patient. Then, the risk score validation was carried out with the calibration test using Hosmer Lemeshow test and discrimination test using the AUC ROC. Furthermore, the comparisons between the risk scores were carried out using the DeLong test. \u0000Results \u0000The three scores have good results in the Hosmer Lemeshow calibration test (p > 0.05). The discrimination test also indicated good results with AUC ROC Zwolle, TIMI and GRACE risk scores respectively 0.776; 0.782; 0.831 (p<0.05). There was no significant difference in the prediction accuracy of the three risk scores in the DeLong test. \u0000 \u0000 \u0000Conclusions \u0000The Zwolle, TIMI, and GRACE risk scores had good validity for predicting major adverse cardiovascular events in STEMI patients undergoing primary PCI. There was no significant difference in the prediction accuracy of the three risk scores. \u0000Keywords: Risk score, major adverse cardiovascular events, primary percutaneous coronary interventions","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42136977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Immediate reperfusion is the key of ST Elevation Myocardial Infarction (STEMI) Management. Despite the superiority of primary percutaneous coronary intervention (PCI), fibrinolytic therapy is still the preferred choice in many settings because of their availability and easy resources. Assessment of successful fibrinolytic determines the next strategy, ST-segment resolution (STR) correlates well with TIMI flow, reflects myocardial perfusion, and has a better prognostic value. T Peak – T End (Tpe) interval is proposed to be a valuable tool for reperfusion marker as it measures the transmural dispersion of repolarization (TDR) which can be an additional myocardial perfusion assessment. This study aims to see whether the Tpe interval reduction can be a marker of the successful reperfusion in patients with STEMI treated with fibrinolytic. Methods : This cross-sectional study involved STEMI patients underwent fibrinolytic therapy. Tpe interval was measured at admission and 90 minutes after fibrinolytic, then the changes in the form of difference (ms) and resolution (%) were assessed and compared between successful and failed reperfusion groups according to STR. Results: Among total of 86 patients, there were 53 patients (61.2%) with successful reperfusion. Tpe interval reduction was greater in the successful reperfusion group. The value of Tpe difference in predicting STR ³ 50% had a sensitivity of 66% and specificity of 75.8% with an area under curve (AUC) of 0.726 and a cut-off point of 20 ms. While the AUC of Tpe resolution 0.726 with a cut-off point of 16.2%, had a sensitivity of 66% and a specificity of 72.7%. Conclusion: The Tpe interval reduction can be a valuable additional marker of successful reperfusion in patients with STEMI treated with fibrinolytic.
{"title":"The Role of T Peak – T End Interval Reduction on Electrocardiogram as a Marker of Successful Reperfusion in Patients with ST Elevation Myocardial Infarction undergoing Fibrinolytic Therapy","authors":"Muhammad Desfrianda","doi":"10.30701/ijc.1195","DOIUrl":"https://doi.org/10.30701/ijc.1195","url":null,"abstract":"Background: Immediate reperfusion is the key of ST Elevation Myocardial Infarction (STEMI) Management. Despite the superiority of primary percutaneous coronary intervention (PCI), fibrinolytic therapy is still the preferred choice in many settings because of their availability and easy resources. Assessment of successful fibrinolytic determines the next strategy, ST-segment resolution (STR) correlates well with TIMI flow, reflects myocardial perfusion, and has a better prognostic value. T Peak – T End (Tpe) interval is proposed to be a valuable tool for reperfusion marker as it measures the transmural dispersion of repolarization (TDR) which can be an additional myocardial perfusion assessment. This study aims to see whether the Tpe interval reduction can be a marker of the successful reperfusion in patients with STEMI treated with fibrinolytic. \u0000Methods : This cross-sectional study involved STEMI patients underwent fibrinolytic therapy. Tpe interval was measured at admission and 90 minutes after fibrinolytic, then the changes in the form of difference (ms) and resolution (%) were assessed and compared between successful and failed reperfusion groups according to STR. \u0000Results: Among total of 86 patients, there were 53 patients (61.2%) with successful reperfusion. Tpe interval reduction was greater in the successful reperfusion group. The value of Tpe difference in predicting STR ³ 50% had a sensitivity of 66% and specificity of 75.8% with an area under curve (AUC) of 0.726 and a cut-off point of 20 ms. While the AUC of Tpe resolution 0.726 with a cut-off point of 16.2%, had a sensitivity of 66% and a specificity of 72.7%. \u0000Conclusion: The Tpe interval reduction can be a valuable additional marker of successful reperfusion in patients with STEMI treated with fibrinolytic. \u0000 \u0000 \u0000 ","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48595475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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