Indonesian Journal of Cardiology

Heart Failure in Indonesia: A Growing Burden Beyond Conventional Care

2026-06-12T02:54:59+07:00

Remembering Eugene Braunwald: Personal Tributes from the Indonesian Cardiovascular Community

2026-06-12T02:54:58+07:00

The Association Between LDL Levels and Heart Failure Incidence in Patients with Acute Myocardial Infarction: Observational Study

2026-06-12T02:54:58+07:00

Background: Acute Myocardial Infarction (AMI) is one of the leading causes of cardiovascular morbidity and mortality worldwide. A serious complication that can arise from AMI is heart failure, which can significantly worsen the patient’s prognosis. LowDensity Lipoprotein (LDL) is recognized as a major risk factor for atherosclerosis and plays a critical role in the pathophysiology of AMI. This study aims to determine whether there is an association between LDL levels and the incidence of heart failure in patients with acute myocardial infarction.

Methods: This observational study used medical records from Purwokerto Islamic Hospital (January 2022-December 2024) relating to patients diagnosed with acute myocardial infarction, regardless of the presence of heart failure. LDL levels were categorized as optimal or non-optimal using a cut-off level of 100 mg/dL. Bivariate analysis was performed using RStudio, while baseline characteristics that were classified by the presence or absence of heart failure status were examined with SPSS software platform.

Results: Statistical analysis using the Chi-square test revealed a significant association between LDL levels and the incidence of heart failure in patients with acute myocardial infarction at Islamic Hospital Purwokerto, with a p-value of 3.52e-10/ < 0.05.

Conclusion: Higher LDL levels are significantly associated with an increased risk of heart failure in AMI patients, highlighting the importance of LDL control. Further studies should consider additional factors like infarct size, myocardial injury, hypertension, diabetes, ejection fraction, and the role of inflammation for a more comprehensive risk assessment.

Excessive Polypharmacy Among Indonesian Heart Failure Patients: Clinical Correlates and Care Implications

2026-06-12T02:54:58+07:00

Background: Heart Failure (HF) is a major global health problem that often coexists with multiple chronic comorbidities, requiring complex pharmacotherapy. The use of numerous concurrent medications increases the risk of polypharmacy and excessive polypharmacy, which may lead to adverse drug reactions, drug–drug interactions, poor adherence, and higher healthcare utilization. Despite growing awareness of this issue, evidence on the prevalence and determinants of excessive polypharmacy among Indonesian HF patients remains scarce.

Methods: This single-center cross-sectional sub-analysis was derived from a cross-sectional study involving 494 adult HF patients treated at Hasna Medika Cardiovascular Hospital, Cirebon, between January and December 2023. HF diagnosis was confirmed by cardiologists using the European Society of Cardiology (ESC) criteria. Polypharmacy was defined as the use of ≥7 medications, while excessive polypharmacy was defined as ≥10 medications. Clinical and demographic variables were extracted from electronic medical records (EMR). Bivariate analysis was performed using Chi-square or Fisher’s exact tests, followed by multivariate logistic regression to identify independent determinants of excessive polypharmacy.

Results: The mean age of participants was 58.1 ± 10.5 years, and 53.4% were male. Overall, 42.5% of patients met the criteria for polypharmacy, and 15.6% (n=77) met the criteria for excessive polypharmacy. The most frequent comorbidities were Coronary Artery Disease (CAD) (80.2%), hypertension (23.1%), and Type 2 Diabetes Mellitus (T2DM, 20.0%). In multivariate analysis, T2DM (Adjusted Odds Ratio [AOR] 17.21, 95% CI 8.39–35.34), Chronic Kidney Disease (CKD) (AOR 5.97, 95% CI 2.37–15.03), Chronic Obstructive Pulmonary Disease (COPD) (AOR 6.64, 95% CI 2.64–16.69), and asthma (AOR 26.32, 95% CI 5.79–119.67) were identified as independent determinants of excessive polypharmacy. The model demonstrated good fit (McFadden pseudo-R² = 0.351; Hosmer–Lemeshow p = 0.62).

Conclusion: Excessive medication burden is common among HF patients, particularly among those with metabolic and pulmonary comorbidities. These findings highlight the need for systematic medication review and rational prescribing strategies while recognizing that higher medication counts do not necessarily indicate inappropriate prescribing.

A Comparative Study of sFt-1 and Prolactin Levels in Peripartum Cardiomyopathy Patients With and Without Preeclampsia

2026-06-12T02:54:57+07:00

Introduction: Peripartum Cardiomyopathy (PPCM) is a type of heart failure that occurs from late pregnancy to the early postpartum period. While the exact etiology of PPCM remains unclear, several risk factors, including preeclampsia, have been identified. It is hypothesized that PPCM with and without preeclampsia may involve distinct pathophysiological mechanisms, which could be reflected in differences in biomarker levels. This study aims to explore this hypothesis by comparing prolactin levels between PPCM patients with and without preeclampsia.

Methods: This observational analytical study employed a cross-sectional design. The study population consisted of PPCM patients registered at Dr. Hasan Sadikin Hospital, Bandung, from September 2018 to June 2024. Subjects were classified into two groups: PPCM with preeclampsia and PPCM without preeclampsia. Soluble Fms-Like Tyrosine Kinase-1 (sFlt-1) and prolactin levels were measured at the time of PPCM diagnosis.

Results: A total of 66 patients were included in the final analysis (43 with PPCM and preeclampsia and 23 without preeclampsia). Patients with PPCM and preeclampsia had higher sFlt-1 levels than patients with PPCM without preeclampsia (128.1 [Interquartile Range (IQR) 90.8–279.5] vs. 94.9 [IQR 82.7–110.6] pg/ml; p = 0.046), while prolactin levels did not differ significantly between two groups (36.52 [15.59–88.58] vs. 22.11 [12.69–44.25] ng/ml; p = 0.176). In the PPCM group with preeclampsia, 44.2% (p = 0.002) of patients had elevated levels of both sFlt-1 and prolactin, while none of the subjects without preeclampsia exhibited this combination.

Conclusion: sFlt-1 levels are higher in PPCM with preeclampsia, whereas prolactin levels do not differ significantly between the two groups.

Factors Associated with Early Acute Kidney Injury in Patients with Acute Decompensated Heart Failure: A Retrospective Observational Study in Bandung, Indonesia

2026-06-12T02:54:57+07:00

Background: Acute Kidney Injury (AKI) frequently complicates Acute Decompensated Heart Failure (ADHF) and is associated with adverse clinical outcomes. Early recognition of patients at higher risk is clinically important, particularly during the first 48 hours of hospitalization when decongestive treatment and renal monitoring are actively adjusted.

Methods: This retrospective observational registry-based study analyzed adult patients hospitalized with ADHF at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from January 2024 to October 2025. Of 279 screened registry records, 148 were included in the final analysis. AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours after admission. Baseline demographic, clinical, echocardiographic, treatment, and laboratory variables were evaluated using bivariate analysis and multivariable logistic regression.

Results: Among 148 included patients, AKI occurred in 67 patients (45.3%). The cohort was predominantly composed of patients with reduced Left Ventricular Ejection Fraction (LVEF), with 145 patients (98.0%) having LVEF <=40%. Admission N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) >5,000 pg/mL was associated with higher odds of early AKI in the adjusted model (Adjusted Odds Ratio [AOR] 2.04; 95% Confidence Interval [CI] 1.02-4.11; p=0.045). Hypertension and high initial furosemide dose showed nonsignificant trends, whereas other demographic and comorbidity variables did not show statistically significant associations in this cohort.

Conclusions: Elevated admission NT-proBNP was associated with early AKI among patients hospitalized with ADHF. However, these findings should be interpreted as exploratory and hypothesis-generating rather than causal or predictive. Validation in larger and more diverse cohorts is required.

Right Heart Catheterization Hemodynamic Parameters and Cardiovascular Adverse Events in Advanced Heart Failure: A Retrospective Cohort Study

2026-06-12T02:54:59+07:00

Background: Right Heart Catheterization (RHC) is an important tool in advanced heart failure because it provides invasive assessment of hemodynamics, congestion, pulmonary hypertension, and right ventricular function, and helps determine candidacy for advanced therapies. However, the prognostic value of RHC-derived hemodynamic parameters in real-world advanced heart failure remains unclear. This study aimed to describe the clinical, echocardiographic, and invasive hemodynamic characteristics of patients with advanced heart failure undergoing RHC and to explore their association with Cardiovascular Adverse Events (CVAE).

Methods: This retrospective cohort study was conducted at two tertiary referral centers in Indonesia. Consecutive adult patients with advanced heart failure who underwent RHC were included. The primary outcome was CVAE, defined as a composite of cardiovascular death or rehospitalization due to acute heart failure, arrhythmia, or cardiogenic shock during a median follow-up of 6 (IQR 3-12) months after the index RHC. Baseline clinical, echocardiographic, and invasive hemodynamic data were collected from medical records and catheterization reports. No formal sample size calculation was performed. Patients with and without CVAE were compared, and bivariate logistic regression was used to explore associations between hemodynamic parameters and CVAE.

Results: A total of 33 patients were included, and 22 (68.6%) developed CVAE. Mean age was 48.0 ± 11.3 years, and 29 patients (87.9%) were male. Most patients were INTERMACS profile 4, and 27 (81.8%) had combined post- and pre-capillary pulmonary hypertension. Compared with 11 patients without CVAE, the 22 patients with CVAE had lower cardiac output (3.23 ± 0.8 vs 3.99 ± 1.1 L/min; p=0.027), lower cardiac index (1.85 ± 0.4 vs 2.34 ± 0.7 L/min/m²; p=0.019), and lower pulmonary artery pulsatility index (0.56 [0.14-1.31] vs 1.35 [0.53-4.38]; p=0.044). Other hemodynamic parameters were not significantly different. In bivariate logistic regression, higher cardiac output, cardiac index, and pulmonary artery pulsatility index were associated with lower odds of CVAE.

Conclusion: In this two-center retrospective cohort of patients with advanced heart failure undergoing RHC, lower cardiac output, lower cardiac index, and lower pulmonary artery pulsatility index were associated with CVAE, whereas conventional pressure-based and pulmonary vascular parameters were not. These findings suggest that impaired forward flow and reduced right ventricular-pulmonary arterial pulsatile reserve may be important for risk stratification in advanced heart failure.

Impact of Cardiac Contractility Modulation on Left Ventricular Ejection Fraction and Clinical Outcomes in Heart Failure: A Systematic Review and Meta-Analysis

2026-06-12T02:54:56+07:00

Patients with heart failure and narrow QRS often remain symptomatic despite Optimal Medical Therapy (OMT), while CRT is usually not indicated. Cardiac Contractility Modulation (CCM) may improve symptoms and quality of life in this population. This systematic review and meta-analysis included studies comparing CCM to either OMT alone or OMT with CRT. Assessed outcomes included improvements in clinical, structural, and physiological domains. Random-effects models were applied for all analyses, and results were reported as Odds Ratios (OR) or Mean Differences (MD) with 95% Confidence Intervals (CI). All statistical analyses were conducted using Review Manager V.5.4 A total of eight studies involving 1,486 patients with heart failure were included in this analysis. In terms of structural outcomes, CCM demonstrated improvements in LVEF comparable to those of CRT, with no statistically significant difference between the two therapies (p>0.05). Compared to the OMT-only group, CCM showed significantly greater improvements in VO₂ max (MD 0.91; 95%CI 0.44-1.37; p<0.001; I²=33%), 6MWD (MD 17.95; 95% CI 5.45-30.45; p=0.005; I²=0%), and MLHFQ (MD -7.56; 95% CI -11.65 to -3.47; p<0.001; I²=39%). Although no significant differences were observed between CCM and control in terms of all-cause mortality, MACE, or rehospitalization (p>0.05), CCM group showed significant improvements in quality of life, as measured by NYHA functional class (MD 2.74; 95%CI 1.47-5.12; p<0.001; I²=76%). CCM is a promising therapy for heart failure, offering structural benefits comparable to CRT in narrow QRS patients and improving function and quality of life beyond OMT, despite no significant reduction in hard clinical outcomes.

Bridging HFpEF Across the Care Continuum: From Screening to Phenotyping and Targeted Management

2026-06-12T02:54:56+07:00

Heart Failure with preserved Ejection Fraction (HFpEF) has become an important form of Heart Failure (HF), characterized by marked heterogeneity in pathophysiology, clinical presentation, and treatment response. It is an increasingly prevalent form of HF driven by aging populations and comorbidities such as hypertension, diabetes, obesity, and Chronic Kidney Disease (CKD). HFpEF is also associated with high morbidity, frequent hospitalizations, and diagnostic challenges, particularly in resource-limited settings. This manuscript provides a clinically focused overview of HFpEF, integrating current concepts in pathophysiology, diagnosis, phenotyping, and management. Its pathophysiology is multifactorial, involving systemic inflammation, endothelial dysfunction, myocardial stiffness, and contributions from comorbid conditions. Emerging evidence highlights the roles of adiposity and inflammatory pathways, reinforcing the view of HFpEF as a multisystem disorder rather than purely a cardiac condition. The condition is also markedly heterogeneous, with several phenotypes identified, including cardiometabolic, obesity-related, cardiorenal, chronotropic incompetence, and Atrial Fibrillation (AF)–associated HFpEF. These phenotypes influence disease progression and therapeutic response. Additionally, numerous clinical mimics, such as pulmonary disease, valvular heart disease, and infiltrative cardiomyopathies, complicate diagnosis. Diagnosis requires a structured, probability-based approach combining clinical assessment, biomarkers, echocardiography, and, when necessary, stress testing or invasive hemodynamics. However, limited access to advanced diagnostics necessitates pragmatic, tiered approaches, especially in low-resource settings. Management focuses on three pillars: optimization of comorbidities, guideline-directed medical therapy, and phenotype-specific treatment strategies. While no therapy conclusively reduces mortality, recent advances have improved symptom control and hospitalizations. Overall, HFpEF demands a holistic, individualized approach integrating pathophysiology, clinical phenotyping, and healthcare system constraints to improve patient outcomes.

Cardiac Resynchronization Therapy (CRT) Optimization: A Way Out for Non-Responders - A Case Report

2026-06-11T09:55:59+07:00

Background

Non-responders account for 30% of patients receiving Cardiac Resynchronization Therapy (CRT). Optimization of CRT using Electrocardiographic (ECG) and Transthoracic Echocardiographic (TTE) guidance has been proposed as a strategy to enhance therapeutic efficacy in this subset. This case report presents a young female patient with advanced heart failure secondary to ischemic cardiomyopathy, highlighting the role of ECG- and TTE-guided CRT optimization in improving clinical and hemodynamic outcomes.

Case Illustration

A 37-year-old female presented with advanced heart failure. Her medical history was notable for recurrent episodes of acute coronary syndrome, multiple Percutaneous Coronary Interventions (PCIs), and Cardiac Resynchronization Therapy with Pacemaker (CRT-P) implantation, despite adherence to Guideline-Directed Medical Therapy (GDMT).
On admission, the ECG demonstrated atrial sensing with consistent biventricular pacing. Laboratory evaluation revealed an elevated N-terminal pro–B-type natriuretic peptide (NT-proBNP) level of 5.462 pg/mL. TTE showed a severely reduced Left Ventricular Ejection Fraction (LVEF) of 20% and an absent A wave on mitral inflow Doppler, indicating impaired diastolic filling. Additionally, the Left Ventricular Outflow Tract (LVOT) Velocity Time Integral (VTI) was reduced to 7.4 cm, consistent with low forward stroke volume.
Six months after the implantation, CRT optimization was performed using ECG and TTE guidance. Optimization resulted in a reduction of QRS duration to 129 ms, distinct separation of the mitral inflow E and A waves, an increase in LVOT VTI to 10.9 cm, and an improvement in functional capacity to New York Heart Association (NYHA) class III.

Conclusion

CRT optimization, guided by ECG or TTE, is critical in managing non-responders. In this case, it led to improved QRS duration, hemodynamics, and NYHA functional class. Routine reassessment should be considered in patients with persistent symptoms despite optimal GDMT to enhance clinical response.

Acute Bilateral Limb Ischemia in Peripartum Cardiomyopathy: An Often Overlooked Complication

2026-06-12T02:54:55+07:00

Background:

Peripartum Cardiomyopathy is a specific subset of systolic heart failure with potentially devastating complications. Thromboembolism, as one of the complications, requires a careful evaluation to assess risk and guide management. This case report of acute limb ischemia complicating peripartum cardiomyopathy is an example of how to deal with thromboembolism in PPCM.

Case Illustration:

A 42-year-old woman came to our center with a classic presentation of acute heart failure; dyspnea on effort, paroxysmal nocturnal dyspnea, and orthopnea. These complaints started 4 months ago, just three weeks after her second childbirth. She had not taken medications diligently. Rales were heard on both lungs, with elevated jugular pressure and pitting edema on the extremities. Echocardiography revealed a dilated heart and reduced LVEF of 23%. She was diagnosed with PPCM and treated accordingly. On the first night in hospital, she felt sudden pain and paresthesia in her right foot. Distal pulse was weakly palpated, and there was hypoesthesia in the toes. Duplex ultrasound found fresh thrombi in bilateral popliteal arteries. Diagnosis of acute limb ischemia was confirmed, warranting the use of anticoagulants aside from her existing heart failure medications. Symptoms continued to improve until discharge.

Conclusion:

A case of a 42-year-old pregnant woman diagnosed with PPCM suffering from an acute thromboembolic episode was reported. Risk assessment is essential to predict the occurrence of future thromboembolism and therefore take necessary prevention before they happen. Different anticoagulants are indicated for different PPCM patient profiles, and careful consideration regarding their safety profile for this particular population is needed.

The Forgotten Spongy Myocardium: Clinical Trajectory of Left Ventricular Noncompaction Cardiomyopathy in an Asymptomatic Adult

2026-06-12T02:54:55+07:00

Background: Left Ventricular Noncompaction (LVNC) is a rare cardiomyopathy characterized by a thin compacted epicardial layer and an extensive noncompacted endocardial layer with prominent trabeculations and deep intertrabecular recesses that communicate with the Left Ventricular (LV) cavity. The classic triad of complications includes chronic heart failure, ventricular arrhythmias, and systemic embolic events. At present, evidence-based management guidelines remain limited.

Case Illustration: We report a 42-year-old man with LVNC, initially detected as an incidental Left Bundle Branch Block (LBBB) on Electrocardiogram (ECG) during a routine medical checkup. Although he remained asymptomatic, LV Ejection Fraction (LVEF) progressively declined, accompanied by rising N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) levels. Coronary artery disease was excluded by coronary computed tomography angiography. Given worsening LV systolic function over 2 years, Cardiac Magnetic Resonance (CMR) demonstrated an LVNC phenotype consistent with cardiomyopathy. Guideline-Directed Medical Therapy (GDMT) for heart failure was initiated, along with oral anticoagulation for primary prevention of LV thrombus. After medication optimization, LVEF improved markedly, and NT-proBNP normalized.

Conclusions: This case illustrates the value of comprehensive evaluation and multimodality imaging in patients with unexplained LBBB, even when asymptomatic. Early diagnosis, phenotype-guided treatment, and longitudinal surveillance may help prevent clinical progression and future heart-failure, arrhythmic, or thromboembolic complications.

Closer Insight through Ventriculo-Arterial Coupling Perspective of Late-recognized Peripartum Cardiomyopathy in The Presence of a Predictor of Non-Recovery: Case Report

2026-06-12T02:55:00+07:00

Background: Peripartum Cardiomyopathy (PPCM) is ventricular systolic dysfunction that develops in the last months of pregnancy to several months postpartum. Emerging evidence suggests that PPCM may develop up to 1 year after delivery. This condition is associated with several predictors of non-recovery.

Case Illustration: A 39-year-old woman was admitted with heart failure syndrome. The patient had late-recognized PPCM after an 18-month postpartum period. Echocardiography showed Left Ventricular (LV) dilation and severely reduced Ejection Fraction (EF). The predictor of non-recovery is also present in this case. However, after 5 months of administered Guideline-Directed Medical Treatment (GDMT), the patient developed structural and complete functional reverse remodeling. During the follow-up period, we observed significant improvement in Left Ventricular Ejection Fraction (LVEF) from 23 % to 57 %, Global Longitudinal Strain (GLS) from –5.2 % to –17.5 %, Left Atrial Strain (LAS)-reservoir from 8 % to 31 %, and global work index (GWI) from 516 mmHg % to 1702 mmHg % from myocardial work index analysis.

Conclusions: Several factors have been identified as predictors of non-recovery in PPCM in previous studies, including LVEF <30%, LV dilation, and severe valvular regurgitation. The current scoring system for PPCM recovery, developed by ESC EORP, also predicts 6-month recovery. There was significant improvement in surrogate markers for myocardial systolic function despite of the presence of late-recognized predictors of non-recovery in this case. Hemodynamic phenotype, rather than a single marker measurement, is emerging as a key factor in PPCM prognostication.

Benign Prostate Hyperplasia (BPH) – Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): A Rare Precipitant of Acute Decompensated Heart Failure

2026-06-12T02:55:00+07:00

In Acute decompensation of heart failure (ADHF), the precipitating factors need to be identified and treated promptly. Urinary retention is rarely recognized as a cause of ADHF. Here, we presented a case of Benign Prostate Hypertrophy (BPH) with urinary retention inducing SIADH, which precipitated an episode of decompensated heart failure. The correction of hyponatremia and placement of a DC catheter, along with diuretic and tolvaptan administration, dramatically improved the patient’s condition.

Dyslipidemia management among patients with high and very high cardiovascular risk in Indonesia: a multi-center registry

2026-06-11T09:55:59+07:00

In “Dyslipidemia management among patients with high and very high cardiovascular risk in Indonesia: a multi-center registry” (Indonesian Journal of Cardiology, 46(2), 51-63. https://doi.org/10.30701/ijc.1880), there is an error noted. An error has been found in the PDF version of this article.

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DOI of original article: https://doi.org/10.30701/ijc.1880

Comparison of right ventricular global longitudinal strain between pacemaker lead position in patients with permanent pacemaker

2026-06-11T09:55:59+07:00

In “Comparison of right ventricular global longitudinal strain between pacemaker lead position in patients with permanent pacemaker” (Indonesian Journal of Cardiology, 46(2), 64-70. https://doi.org/10.30701/ijc.1592), there is an error noted. An error has been found in the PDF version of this article.

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DOI of original article: https://doi.org/10.30701/ijc.1592

Mexiletine in the treatment of LQT2, LQT3, and acquired LQTS: ameta-analysis

2026-06-11T09:56:00+07:00

In “Mexiletine in the treatment of LQT2, LQT3, and acquired LQTS: a meta-analysis” (Indonesian Journal of Cardiology, 46(2), 71-79. https://doi.org/10.30701/ijc.1835), there is an error noted. An error has been found in the PDF version of this article.

The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1835. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.

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DOI of original article: https://doi.org/10.30701/ijc.1835

Hemodynamic impairment of double culprit ST elevation myocardial infarction, double the trouble: a case report

2026-06-11T09:56:00+07:00

In “Hemodynamic impairment of double culprit ST elevation myocardial infarction, double the trouble: a case report” (Indonesian Journal of Cardiology, 46(2), 80-88. https://doi.org/10.30701/ijc.1791), there is an error noted. An error has been found in the PDF version of this article.

The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1791. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.

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DOI of original article: https://doi.org/10.30701/ijc.1791

Hemodynamic Conundrum of Thyroid Storm-Induced Acute Heart Failure: Challenging Case in a Remote Area

2026-06-11T09:56:00+07:00

In “Hemodynamic Conundrum of Thyroid Storm-Induced Acute Heart Failure: Challenging Case in a Remote Area” (Indonesian Journal of Cardiology, 46(2), 89-95. https://doi.org/10.30701/ijc.1701), there is an error noted. An error has been found in the PDF version of this article.

The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1701. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.

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DOI of original article: https://doi.org/10.30701/ijc.1701