Indonesian Journal of Cardiology

Predictors of prolonged use of mechanical ventilation in patients with acute respiratory failure and acute heart failure in the CVCU RSUD Dr. Saiful Anwar Malang

Puspa Lestari — 2025-10-22

Background

Acute respiratory failure (ARF) is a critical condition that often complicates hospitalization and commonly arises from cardiopulmonary dysfunctions such as acute heart failure. Prolonged mechanical ventilation (PMV) in these patients is associated with increased morbidity, mortality of about 30%, and greater healthcare resource utilization. Identifying predictors of PMV is essential to improve outcomes and optimize management strategies.

Methods

A retrospective cohort study was conducted on all patients who underwent endotracheal intubation in the Cardiovascular Care Unit (CVCU) of RSUD Dr. Saiful Anwar Malang from 2015 to 2021. Patients with incomplete medical records or who died within 14 days of mechanical ventilation were excluded. Univariate and multivariate logistic regression analyses identified independent predictors of PMV. Receiver operating characteristic (ROC) curves were generated to assess model discrimination using the area under the curve (AUC), with corresponding sensitivity and specificity. Data were analyzed using SPSS 22.0.

Results

Five independent predictors of PMV were identified: tachycardia (p = 0.013), metabolic acidosis (p = 0.002), impaired renal function (p = 0.009), shock (p = 0.006), and major bleeding (p = 0.002). Multivariate analysis showed the following odds ratios
(OR, 95% CI): tachycardia 2.06 (1.09–5.99), metabolic acidosis 2.03 (1.09–6.33), impaired renal function 2.87 (1.28–6.46), shock 2.83 (1.13–7.06), and major bleeding 1.36 (1.18–2.15). The model demonstrated good discrimination with an AUC of 0.83 (95% CI 0.77–0.88), sensitivity 0.87, and specificity 0.73.

Conclusion

In patients with respiratory failure due to acute heart failure, tachycardia, metabolic acidosis, impaired renal function, shock, and major bleeding were independent predictors of prolonged mechanical ventilation. The predictive model showed high sensitivity and acceptable specificity, supporting its clinical usefulness for early identification of high-risk patients and targeted intervention.

The effect of a physical exercise program on functional capacity in patients with pulmonary arterial hypertension at Dr. M. Djamil Padang Hospital

Feiky Herfandi Soegistiono — 2025-10-22

Background: Pulmonary arterial hypertension (PAH) has been known to cause a decreases functional capacity. The underlying mechanisms include right ventricular dysfunction, chronotropic incompetence, ventilation abnormalities, and skeletal muscle dysfunction. Although exercise training programs are recommended, there is currently no standardized exercise training program that is easy to implement in patients with PAH. We aimed to investigate the effect of exercise training program on functional capacity in patients with PAH.

Methods: This study was a non-randomized clinical trial in adult patients with PAH who were divided into intervention and control groups. Cardiopulmonary exercise test (CPET) results were assessed before and after a four-week supervised program (5 sessions/week).
The program followed the FITT principle: frequency 5 times/week, intensity 60–85% of six minute walk test (6MWT) distance, time 25–30 minutes/session including warm-up and cool-down, type supervised indoor walking. Shapiro-Wilk normality test was performed before analyzing the numerical data, followed by the independent t-test or Mann-Whitney U test to determine differences between groups.

Results: This study included 26 patients with PAH, 14 in the intervention group, and 12 in the control group, consisting of 17 women (65%) and 9 men (35%) aged 18-54 years. Statistical analysis showed no significant differences in the baseline characteristics between the two groups (p >0.05). Characteristics of the CPET examination results before and after the exercise program. At baseline, there was no difference in VO2 peak in the intervention group and the control group (888.29 ± 435.99 (95% CI: 314-1823) vs 641.92 ± 231.98 (95% CI: 408 – 1111), p-value >0.05). After the physical exercise program, the
intervention group showed a significant increase in VO2 peak (1047.71 ± 456.05 (95% CI: 413-2175) vs 656.5 ± 223.85 (95%CI: 401–1105), p-value < 0.05). Therefore, ΔVO2 peak in the intervention group was significantly higher (159.42 ± 209.32 (95%CI: -92 – 707) vs 14.5 ± 60.4 (95%CI: -77 – 148), p-value < 0.05)

Conclusion: A four-week structured walking exercise program significantly improved functional capacity in PAH patients.

Phrenic nerve stimulation as a novel therapeutic approach for heart failure with central sleep apnea: a systematic review

Clara Alverina — 2025-10-22

Introduction: Heart failure (HF) is a chronic condition associated with significant morbidity and mortality. Phrenic nerve stimulation (PNS) has emerged as a novel therapeutic approach aimed at improving outcomes in patients with heart failure, particularly those suffering from central sleep apnea (CSA).

Objectives: This study aims to evaluate the efficacy and safety of PNS in HF patients with CSA, especially its impact on reducing CSA severity and improving the apnea-hypopnea index (AHI) and left ventricular ejection fraction (LVEF).

Methods: A comprehensive search was conducted across multiple databases including Pubmed, Web of Science, Science Direct, and ProQuest, following PRISMA guidelines. The search strategy used the MeSH keywords (phrenic nerve stimulation) AND (heart failure). Inclusion criteria encompassed studies published in 2014 - 2023 that evaluated the effects of PNS on patients with HF and reported on relevant clinical outcomes. After a thorough screening process, five studies were identified as relevant and included in the review. Data extraction and quality assessment were independently conducted by three reviewers, with results synthesized using a systematic approach. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The research protocol was registered at PROSPERO (ID: CRD42024604614).

Results: The studies reviewed demonstrated that PNS significantly reduces the central apnea index (CAI), AHI and improves sleep quality in heart failure patients. Moreover, improvements in LVEF and reductions in heart failure-related hospitalizations were observed. Patient satisfaction was generally high, and adverse events were minimal, suggesting that PNS is a safe and effective treatment option for HF patients especially those suffering from CSA.

Conclusion: Phrenic nerve stimulation presents a promising therapeutic option for improving cardiac and sleep outcomes in heart failure patients. Further large-scale, randomized controlled trials are warranted to establish the long-term efficacy and safety of PNS in this population.

Inverted U wave & de Winter pattern: under-recognized sign of acute coronary occlusion

Zaky Faris Maulana — 2025-10-22

Background: Interpreting ECGs for evidence of ischemia in patients with noticeable changes, such as ST-segment elevation and ST-segment depression, can be easily identified. However, identifying & recognizing atypical ECG patterns of acute coronary syndrome is essential in preventing significant mortality and morbidity. In the
following case report, we describe inverted U wave & de Winter pattern.

Case Illustration: A 58-year-old male presented to the emergency department with pressure-like chest pain. His initial evaluation revealed normal blood pressure and elevated blood glucose levels, and an initial ECG was incorrectly interpreted as normal. Eight hours later, he returned with worsened chest pain. The new ECG revealed the de Winter ECG pattern, which indicates acute occlusion of the left anterior descending artery. Additionally, previously overlooked inverted U waves in the initial ECG suggested myocardial ischemia.
Eventually, the angiography revealed a complete occlusion of the proximal left anterior descending coronary artery. The patient underwent stent placement and have a good outcome

Conclusions: Inverted U wave and the de Winter pattern described in this case indicates an acute LAD occlusion. It’s a rare finding, but it is critical for emergency physicians to recognize it for urgent reperfusion therapy. Unfamiliarity with these high-risk ECG pattern may lead to delays in appropriate treatment, causing negative effects on morbidity and mortality.

Acute ST-Elevation Myocardial Infarction in a 25-Year-Old Female with Polycystic Ovary Syndrome: A Cardiometabolic Risk in Women of Reproductive Age

Elbert Aryo Kenlie — 2025-10-22

Background

Acute myocardial infarction is relatively rare in young patients. The age of onset gradually decreases due to multiple risk factors. The causes of Myocardial Infarction (MI) among patients aged less than 45 can be divided into four groups: atheromatous coronary artery disease, non-atheromatous coronary artery disease, hypercoagulable states, and MI related to substance misuse.

Case Illustration

A 25-year-old female came to the emergency department with chest discomfort for the past 40 minutes, has a history of diabetes for the past 3 years, and a Polycystic Ovary Syndrome (PCOS) history. Her vital signs show elevated Blood Pressure (BP) 150/100 mmHg. ECG showed sinus rhythm with ST elevation in the anterior leads. Random Blood Glucose (RBG) was 477 mg/dL, High Sensitivity (HS)-troponin 403 ng/L, and blood ketone
3.1 mmol/L. She was initially treated with: ticagrelor 180 mg, Acetosal 320 mg, insulin 4 u/hour. She was diagnosed with ST-Segment Elevation Myocardial Infarction (STEMI) and Diabetic Ketoacidosis (DKA). Coronary angiography revealed 95% stenosis in proximal
Left Anterior Descending (LAD) and was treated as the culprit lesion, while 85% stenosis in mid Right Coronary Artery (RCA) was considered as the residual stenosis. Primary Percutaneous Coronary Intervention (PCI) was initiated at the proximal LAD, and post-PCI
angiography showed a good result with TIMI 3 flow to the distal LAD.

Conclusion

PCOS increases cardiovascular risk primarily by promoting insulin resistance and metabolic dysfunction. Young individuals suspected of elevated cardiovascular risk should undergo a
comprehensive cardiometabolic evaluation. PCI remains the cornerstone treatment for STEMI across all ages due to its well-established mortality benefit.