Indonesian Journal of Cardiology

A Model of Cardiac Preparticipation Screening for Sports Competition in Indonesia: Challenges and Future Perspectives

2026-04-01T02:30:27+07:00

Sudden cardiac death (SCD) among athletes remains a preventable tragedy, yet Indonesia lacks a national registry, standardized protocols, and systematic data amid rising coronary artery disease prevalence and regional cardiovascular risks unique to the Asia-Pacific. While countries like Italy have reduced SCD by 89% through mandatory electrocardiogram-based screening, Indonesia's Law No. 11 of 2022 mandates athlete health services without specifying cardiac preparticipation screening (CPS) details, resulting in inconsistent implementations across events like the quadrennial Pekan Olahraga Nasional (PON).

This editorial proposes a feasible, cost-effective CPS model—history, physical exam, and 12-lead ECG using 2017 International Criteria—for PON athletes, delivered via Indonesian Heart Association, national sports committee, and ministry partnerships. Piloted with trained general practitioners and cardiologists at training centres, it aligns with WHO screening criteria, costs per athlete, and reserves echocardiography for high-risk cases.

By generating Indonesia's first athlete SCD data, enhancing provider training, and enabling scalable nationwide rollout, this framework promises to quantify risks, avert fatalities, and position Indonesia as a leader in equitable sports cardiology for resource-constrained settings, transforming competitive sport from potential peril to unalloyed benefit.

Utilization of Red Blood Cell Distribution Width in Predicting Length of Stay in Patients Treated in Cardiovascular Intensive Care Unit: A Cohort Study

2026-04-01T02:30:29+07:00

Background: The risk stratification of mortality in critically ill patients with heart disease has long been available and validated. Red blood cell distribution width (RDW) has traditionally been used in the differential diagnosis of anemias. High RDW is associated with worse outcomes in diverse scenarios, including in critical illness. This study aimed to investigate the correlation of RDW value with the length of Cardiovascular Intensive Care Unit (CICU) stay.

Methods: This cohort study was conducted at Prof. Dr. R. D. Kandou Hospital in Manado from February to May 2021. The study subjects were patients treated in the CICU. Statistical analysis was performed using Spearman’s correlation and linear regression.

Results: Among 97 patients studied, the median RDW-CV was 13.6% (IQR 12.7-15.3), and the median CICU length of stay was 2.0 days (IQR 2.0-4.5). RDW demonstrated a significant positive correlation with CICU length of stay (Spearman's ρ = 0.317, p = 0.002). Linear regression analysis revealed that each 1% increase in RDW was associated with a 0.213-day rise in length of stay (B = 0.213, β = 0.244, R² = 0.059, p = 0.016).

Conclusion: Higher RDW values are significantly associated with longer CICU stay. As an easily accessible parameter, RDW shows promise as a useful prognostic marker for risk stratification in cardiac critical care.

Association Between Cardiovascular Risk Factors and IVUS-Derived Coronary Calcium Score in the Indonesian Population

2026-04-01T00:47:23+07:00

Background: Coronary artery calcification reflects the chronic burden of atherosclerosis and contributes to procedural complexity during Percutaneous Coronary Intervention (PCI). While coronary calcium has been extensively studied using Computed Tomography (CT), data on Intravascular Ultrasound (IVUS)-derived calcium characteristics in Southeast Asian populations remain limited. The Southeast Asian population, particularly Indonesians, may exhibit distinct patterns of atherosclerosis influenced by genetic, lifestyle, and metabolic factors. Therefore, we sought to investigate the association between cardiovascular risk factors and IVUS-derived total coronary calcium score in an Indonesian population.

Methods: This single-center, retrospective observational study included consecutive patients who underwent IVUS-guided PCI between January 2020 and December 2021. Data on patient demographics and cardiovascular risk factors were obtained from medical records. The IVUS calcium scores recorded in the database were independently reanalyzed and validated by an experienced interventional cardiologist to ensure consistency and accuracy. Associations between cardiovascular risk factors and total IVUS calcium score were assessed using Spearman's rank correlation and the Kruskal–Wallis test.

Results: A total of 111 patients were included in this study with a mean age of 61.3 ± 10.2 years; 72.1% were male. Hypertension was present in 60.4%, DM in 45.0%, dyslipidemia in 38.7%, and active smoking in 40.5%. The mean IVUS total calcium score was 1.93 ± 1.41. Among individual risk factors, dyslipidemia (ρ = 0.22, p = 0.021) and smoking (ρ = −0.24, p = 0.009) were significantly associated with calcium score. Patients with ≥2 risk factors had higher mean calcium scores (2.15 ± 1.35) compared with those with ≤1 risk factor (1.15 ± 1.33; p = 0.028).

Conclusion: The total IVUS calcium score correlated significantly with the presence of dyslipidemia in this Indonesian population. A cumulative increase in cardiovascular risk factors was associated with greater coronary calcium burden, suggesting that multifactorial risk exposure plays an important role in coronary calcification in this population.

Evaluation of Serum Uric Acid as a Potential Predictive Biomarker in Pulmonary Arterial Hypertension

2026-04-01T02:30:30+07:00

Background: Pulmonary arterial hypertension (PAH) is a relatively rare fatal disease, confounding many cardiopulmonary diseases. Systolic pulmonary artery pressure (sPAP), measured by transthoracic echocardiography, can be taken as a surrogate marker for diagnosing this disease. Uric acid, a marker of oxidative stress, has been investigated as a potential predictive biomarker for risk stratification. Our study was conducted to ascertain the incidence and severity of sPAP, to evaluate the level of uric acid levels, and to establish a correlation.

Methods: This is an observational case-control study that included 51 cases of PAH diagnosed by sPAP ≥36 mm Hg, along with 51 controls. Serum uric acid was assayed using a spectrophotometric method. Statistical analysis was performed using Microsoft Excel and SPSS version 20.0.

Results: Cases were observed in the range of 24 to 87 years (average 48 years) with female predominance. Uric acid levels were significantly higher in cases than in controls. Females showed slightly lower levels of uric acid as compared to males. Correlation analysis indicated a significant positive correlation between sPAP and uric acid levels. Receiver operating characteristic (ROC) analysis demonstrated that serum uric acid had 68% predictive accuracy for sPAP severity at a cutoff of 5.45 mg/dL.

Conclusion: The level of uric acid, a routine biomarker analysed in laboratories, is found to be increased in PAH patients and closely correlates with the severity of sPAP. This suggests a potential role of uric acid as a predictive biomarker in PAH management.

Gulf of Tomini Cardiac Arrhythmia Research and Exploration (G-CARE): A Multicenter Hospital-Based Outpatient ECG Study

2026-04-01T02:30:29+07:00

Introduction: Cardiac arrhythmias pose a significant burden on global health, especially in underserved regions with limited access to diagnostics. In Indonesia, particularly in the Gulf of Tomini, epidemiologic data on arrhythmia prevalence are scarce.

Methods: The G-CARE (Gulf of Tomini Cardiac Arrhythmia Research and Exploration) study was a hospital-based, multicenter, cross-sectional study conducted from 2023–2025 across four referral centers in Gorontalo Province. Adults aged ≥18 years who underwent 12-lead ECG examination were included through purposive sampling. ECGs were interpreted by board-certified cardiologists and classified by arrhythmia type.

Results: A total of 3,177 patients were included (mean age: 53.9±14.9 years; 54.6% female). Normal ECGs were found in 43.4%. The most common abnormalities were ischemic ST-T changes (18.9%, 95% CI: 17.5–20.3), QTc prolongation (15.5%, 95% CI: 14.2–16.8), and left ventricular hypertrophy (10.1%, 95% CI: 9.1–11.2). Atrial fibrillation/flutter occurred in 3.5% (95% CI: 2.8–4.3), AV block in 3.7% (95% CI: 3.0–4.5), and Brugada Pattern in 0.4% (95% CI: 0.2–0.8). Age-related increases were observed for AF, AV block, and QT prolongation. PVC morphology showed high-risk features (QRS >160 ms, coupling interval <300 ms) in young adults.

Conclusion: The G-CARE study identifies a high prevalence of electrocardiographic abnormalities among adults undergoing ECG in outpatient settings within the Gulf of Tomini region. Because the study used hospital-based, purposive sampling of patients who had an ECG ordered as part of routine clinical care, these estimates may be amplified by selection bias and do not directly represent the general population. Rather than serving as definitive evidence to support mass, population-level ECG screening, our findings should be considered hypothesis-generating and supportive of conducting a properly designed population-based study (with probability sampling) to determine the true community burden and to inform screening policy.

Non - Fluoroscopic Transesophageal Echocardiography Guided Transcatheter Closure of Atrial Septal Defects: Single Centre Experience in The North of Sumatra Island, Indonesia

2026-04-01T02:30:27+07:00

Background: Non-fluoroscopic, transesophageal-guided percutaneous closure of Atrial Septal Defect (ASD) can be a first-line strategy to reduce radiation exposure and its cumulative effects. We report our experience as the first center located far from the capital city of Indonesia that routinely performs transcatheter closure of ASD under the guidance of Transesophageal Echocardiography (TEE) without fluoroscopy.

Methods: We collected data of patients whose ASD was successfully closed percutaneously from May 2020 to August 2024. For a total of 116 patients of secundum ASD that are suitable for device closure, we routinely intend to do non-fluoroscopy transcatheter ASD closure guided by TEE.

Results: The zero-fluoroscopy technique was successfully performed in 111 patients. The ASD diameter is 10-40 mm, and the mean size of the occluding device is 9-42 mm. The mean procedural times are 55.81 ± 22.7 minutes. The success rate is 95% with only one case of pericardial effusion. Five cases were excluded as they were finally assisted by fluoroscopy due to the limitation of the echocardiographic view.

Conclusion: A thorough transcatheter ASD closure technique guided by TEE can routinely be performed without fluoroscopy.

Relationship Between Pre Operation Risk Factor Profiles With Clinical Outcomes In Post Isolated CABG Patients Treated In ICU

2026-04-01T02:30:27+07:00

Background: Atherosclerotic Cardiovascular Disease (ASCVD) causes around 31% death all over the world. This disease can be managed with Coronary Artery Bypass Graft (CABG). Although its success ratio continues to increase, patients tend to have more complex conditions, which complicate the results.

Methods: This retrospective cohort study was conducted with samples consisting of ≥18 years old patients who underwent isolated CABG between January 2017 and June 2022 and were admitted to the Intensive Care Unit (ICU) afterward. Clinical outcomes measured were prolonged ICU and intrahospital mortality. A 77-hour post-procedural ICU treatment period is considered the standard of care.

Result: A total of 2611 patients were included. The mean age was 59 years. Geriatric, overweight, obesity, kidney failure, Heart Failure with reduced Ejection Fraction (HFrEF), Cardiogenic Shock, Left Main Disease (LMD), and Pre Incision Intra-Aortic Balloon Pump (IABP) are associated with prolonged ICU care; while female gender, Family history of ASCVD, Diabetes, Hypertension, Acute Coronary Syndrome (ACS), Stroke, and history of cardiac surgery are associated with higher mortality. The lengthening of ICU care is also associated with higher mortality (OR 4.02; p<0.00). According to multivariate analysis, the factors associated with prolonged ICU are geriatric, obesity, kidney failure, stroke, HFrEF, Cardiogenic shock, very poor Ejection Fraction (EF), urgent procedure and pre incision IABP, meanwhile factors associated with mortality are female, diabetes, stroke, history of ACS<24H, poor and very poor EF, History of Cardiac Surgery, and prolonged ICU itself.

Conclusion: In Indonesian isolated CABG patients, prolonged ICU stay and increased mortality are independently driven by specific demographic, comorbid, and clinical factors, necessitating targeted preoperative risk assessment to optimize outcomes.

The Role of Inspiratory Muscle Training for Enhancing Functional Capacity in Post Heart Valve Surgery Patients: A Scoping Review

2026-04-01T02:30:30+07:00

Background: Valvular Heart Disease (VHD), particularly Rheumatic Heart Disease (RHD), is a major health burden in Indonesia, often requiring heart valve surgery. Post-operative respiratory muscle dysfunction and reduced functional capacity hinder recovery. Inspiratory Muscle Training (IMT) is a non-invasive intervention that improves respiratory muscle strength and functional outcomes. This scoping review evaluates the role of IMT in enhancing functional capacity among patients after heart valve surgery.

Methods: A systematic search of PubMed and Scopus identified Randomized Controlled Trials (RCTs) and cohort studies involving adult patients who underwent IMT interventions after heart valve surgery. The search strategy combined controlled vocabulary (Medical Subject Headings [MeSH]) Key terms included: (“heart valve surgery” OR “valve replacement” OR “valvular heart disease”) AND (“inspiratory muscle training” OR “respiratory muscle training”) AND (“functional capacity” OR “exercise capacity” OR “respiratory muscle strength” OR “pulmonary function”). Outcomes included functional capacity, respiratory muscle strength, pulmonary function, Post-operative Pulmonary Complications (PPCs), and hospital Length of Stay (LOS). Data were synthesized narratively.

Results: Four RCTs (273 patients) showed IMT significantly improved Maximal Inspiratory Pressure (MIP), Six-Minute Walk Distance (6MWD), and pulmonary function [Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV₁)]. Interventions of 4–12 weeks reduced PPCs and LOS. Optimal benefits were observed with 8–12-week protocols.

Conclusion: IMT enhances functional capacity, respiratory muscle strength, and pulmonary function post-heart valve surgery, with the potential to reduce complications and costs. Its integration into rehabilitation programs is recommended, particularly in regions with high RHD prevalence, such as Indonesia. Further studies should standardize protocols and assess long-term outcomes.

Unveiling the Burden of Prevalence of Congenital Heart Defects in Down Syndrome Patients in Indonesia: A Systematic Review and Meta-analysis

2026-04-13T17:09:47+07:00

Down syndrome or trisomy 21 is frequently accompanied by Congenital Heart Disease (CHD), which is a major cause of mortality and morbidity within the first two years of life in children with Down Syndrome (DS). This systematic review and meta-analysis aimed to analyze the literature to assess the pooled prevalence of overall CHDs among children with DS in Indonesia. The search was conducted across major databases, including PubMed, Google Scholar, ScienceDirect, Cochrane, and Garuda (an Indonesian database), using Boolean operators and a range of keywords. Citation management was performed using the Rayyan Intelligent Systematic Reviews website (https://www.rayyan.ai/). Quantitative data synthesis was conducted using Comprehensive Meta-Analysis version 4.0 (Biostat, Englewood, NJ, USA). Initially, 1,915 citations were retrieved from the primary search; after screening titles and assessing full texts, a total of 11 articles were included in this study. A total of 1,122 subjects from 11 different studies were analyzed. The overall pooled prevalence of CHDs among children with DS was 44.6% (95% CI: 34.9% to 54.8%). We also found a high degree of heterogeneity between the studies (I² = 88.8%), and inspection of the forest plot revealed that the distribution of the plotted data was asymmetrical. Approximately one in two children with DS in Indonesia has at least one type of CHD. These findings highlight the need for early routine cardiac screening to reduce morbidity and mortality. We recommend further research to provide more data to assess the prevalence of CHD

Myocardial Remission in High Burden Outflow Tract Premature Ventricular Complex-Induced Cardiomyopathy after Radiofrequency Catheter Ablation: Case Report

2026-04-01T00:47:24+07:00

Background: Premature Ventricular Complex (PVC)-induced Cardiomyopathy (PVC-CMP) is a spectrum of dilated cardiomyopathy.

Case Illustration: A 51-year-old female patient who was diagnosed with high suspicion of PVC-CMP underwent successful 3D mapping radiofrequency catheter ablation with a good result. Post-ablation 24-hour ECG-Holter evaluation showed a significant reduction of PVC burden. Echocardiographic evaluation 5 months post-ablation showed improvement in left ventricular systolic function parameters. The presence of high-burden PVC with a typical outflow tract origin could raise suspicion of a specific PVC-CMP aetiology. PVC burden emerged as a major predictor of the development of CMP. Several criteria can be used to identify PVC-CMP. Our case met those descriptive criteria, increasing the likelihood of PVC-CMP.

Conclusion: PVC-CMP should be considered in patients with dilated cardiomyopathy who are accompanied by frequent outflow tract origin PVC (> 10 % burden). Early recognition of PVC-CMP is essential, as removal of the primary aetiology improves ventricular structure and function.

Double-Chambered Right Ventricle in Adults: Characteristic Echocardiographic Features from an Incidental Case

2026-04-01T02:30:28+07:00

Background: A Double Chambered Right Ventricle (DCRV) is an uncommon congenital heart defect in which an abnormal muscular bundle divides the Right Ventricle (RV) into two chambers with different pressure levels. Diagnosing DCRV in adults is challenging because it is often asymptomatic and may be misdiagnosed.

Case Illustration: We present a 37-year-old male with a history of an uncorrected Ventricular Septal Defect (VSD), who was incidentally found to have type 2 DCRV on echocardiography during evaluation for abdominal pain. No residual VSD was detected, possibly due to spontaneous closure. Electrocardiography (ECG) revealed first-degree Atrioventricular (AV) block. Chest radiography showed cardiomegaly with a Cardiothoracic Ratio (CTR) of 0.56. Transthoracic Echocardiography (TTE) demonstrated an anomalous muscular bundle that divided the RV into a high-pressure proximal chamber and a low-pressure distal chamber, accompanied by left atrial and ventricular enlargement.

Conclusion: DCRV in adults is often misdiagnosed as pulmonary stenosis, especially in patients with mild or no symptoms. TTE and Doppler imaging are key diagnostic modalities for accurate diagnosis; however, advanced imaging techniques such as Transesophageal Echocardiography (TEE) may be required in complex cases. Management includes symptom control, such as beta-blockers, and further evaluation to determine the need for surgical intervention.

The Role of Coronary Artery Calcium Score as a Systemic Marker of Atherosclerosis: A Cross-sectional Imaging Study

2026-04-01T00:47:23+07:00

Following publication of this article, the authors notified the Editorial Office of an error in the order of authorship. The order of the author is wrong and should have been:

Mohammad Sidqi Aulia, Raymond Pranata, Syarief Hidayat, Nuraini Yasmin Kusumawardhani

All authors have provided written consent to approve the revised authorship order. The authorship order has now been corrected in the published article. The authors apologize for any inconvenience caused by this error.