Indonesian Journal of Cardiology

Risk Factor for Postoperative Pneumonia after Coronary Artery Bypass Grafting

Vita Karima Fadhilah, Chaerul Achmad, Rien Afrianti, Prayudi Santoso — Fri, 10 Jan 2025 22:53:56 +0700

Background: Postoperative pneumonia (POP) is a common infectious complication of coronary artery bypass grafting (CABG), leading to significant morbidity, mortality, and increased healthcare costs. This study found that the prevalence of POP was nearly double that reported in previous studies, underscoring the urgent need to identify specific risk factors. These findings emphasize the importance of local data in refining preventive strategies and improving clinical outcomes in CABG patients.

Material and Methods: This is a retrospective cohort study. The subjects comprised patients who underwent CABG procedures at a single institution between June 2020 and June 2024. A logistic regression analysis model for evaluating the risk of POP was established.

Results: This study observed a POP rate of 41.7%, significantly exceeding the 2–24% range reported in previous studies. Key risk factors included elevated creatinine levels, eGFR <60 ml/min/1.73 m², and low early postoperative albumin. POP strongly correlated with prolonged hospitalization, with an odds ratio of 13.043 (95% CI: 6.130–27.751, p < 0.0001), underscoring its substantial impact on patient outcomes.

Conclusions: The present study delineates renal impairment and hypoalbuminemia postoperative as pivotal risk factors for POP following CABG. It emphasizes the importance of tailored interventions, structured institutional practices, and continuous research to enhance preventive strategies and patient outcomes.

Novel Echocardiographic Parameter Assessing Pulmonary Vascular Resistance in Patient with Acyanotic Congenital Heart Disease

Fri, 10 Jan 2025 22:54:05 +0700

Background

Pulmonary vascular resistance (PVR) is an important variable in management of acyanotic congenital heart disease. Right heart catheterization (RHC) using impedance catheter remains gold standard for pulmonary vascular resistance (PVR) measurement. The ratio of peak tricuspid regurgitant velocity to the right ventricular outflow tract time-velocity integral (TRVmax/RVOTVTI) was presented as a reliable non-invasive method of estimating PVR. Recently, right ventricular 2-dimensional speckle tracking strain (RVGLS) was proven as a new promising parameter to evaluate PVR. This study performed to examine whether this new non-invasive variable ratio (TRVmax/RVGLS) provides clinically reliable method to determine pulmonary vascular resistance (PVR) obtained by echocardiography.

Methods

Right-heart catheterization and echocardiographic examination were performed in 56 patients with congenital heart disease. The ratio of TRVmax/RVOTVTI and TRVmax/RVGLS analysis performed using receiver-operating characteristic curve analysis, a cutoff value for the ratio was generated to determine PVR more than 5 WU.

Results

A TRVmax/RVOTVTI cutoff value of 0.21 provided a sensitivity of 77.1% and a specificity of 81% (CI 81% to 97.5%) and TRVmax/RVGLS cutoff value of -23.16 provided sensitivity of 74.3% and a specificity of 90.5% to determine PVR > 5 WU (CI 79.6% to 98.2%).

Conclusions

The echocardiography parameter (TRVmax/RVGLS) could serve as a dependable noninvasive method to predict PVR greater than 5 WU in acyanotic congenital heart disease patients.

Tailored BEST Exercise Protocol in Heart Failure Rehabilitation

Fri, 10 Jan 2025 00:00:00 +0700

Introduction

Heart failure with a reduced ejection fraction (HFrEF) significantly contributes to global morbidity and mortality, necessitating effective rehabilitation programs. Exercise-based rehabilitation improves functional capacity and quality of life in HFrEF patients, though responses vary. The tailored BEST (Breathing, Endurance, and Strengthening) exercise protocol addresses both cardiac and extracardiac rehabilitation, benefiting all patients regardless of response status. This study evaluated the protocol's effects on HFrEF patients and classified responses based on VO₂max changes.

Methods

In this etiologic study with prospective cohort design, all participants underwent a three-month cardiac rehabilitation program using the BEST Exercise Protocol. Assessments included the 6-minute walk test (6MWT), short physical performance battery (SPPB), handgrip strength, chest expansion, ultrasonographic measurements, and NT-proBNP levels before and after the intervention, with statistical comparisons made within and between groups. Groupings of responder level will be reliant on 6MWT distance achievement at the end of the program, with ≥6% improvement classified as good responders.

Results

Out of 107 HFrEF patients (median age 55 years, ejection fraction 29.50±7.34%), 63.56% were good responders and 36.44% were poor responders (<6% improvement). Good responders showed significant improvements in most extracardiac parameters, including a 20% increase in 6MWT distance (470.96±69.21 meters post-rehabilitation), chest expansion, handgrip strength, and SPPB scores (p<0.001 for all). Poor responders also improved in chest expansion, sit-to-stand time, and postural balance, with minor 6MWT gains (407.33±72.50 meters). NT-proBNP levels decreased in both groups but were not statistically significant (p=0.288 and 0.368 for good and poor responders, respectively).

Conclusion

The tailored BEST Exercise Protocol offers substantial cardiac and extracardiac benefits for HFrEF patients by enhancing functional capacity and muscle strength. Both good and poor responders exhibited significant improvements, indicating the protocol's broad applicability. However, the lack of statistically significant NT-proBNP reduction suggests further studies on cardiac biomarkers are needed. The 6MWT provides accessible rehabilitation insights, though more precise evaluations like Cardiopulmonary Exercise Testing (CPET) can offer clearer insights into cardiopulmonary adaptations.

Systolic Blood Pressure, Cardiac Index and Eisenmenger Syndrome are Predictors of Mortality in Pulmonary Arterial Hypertension-associated with Congenital Heart Disease: An Analysis from the COHARD-PH registry

Fri, 10 Jan 2025 00:00:00 +0700

Background: Pulmonary arterial hypertension (PAH) is a complication of left-to-right intracardiac shunt congenital heart disease (LtR-shunt CHD). There are several known predictors of mortality in PAH patients, however predictors of mortality in LtR-shunt CHD-associated PAH need to be validated.

Objectives: We aimed to investigate the predictors of mortality among adult LtR-shunt CHD-associated PAH patients.

Methods: This research was a retrospective cohort study that included adult patients with LtR-shunt CHD-associated PAH retrieved from the COHARD-PH registry. Several baseline variables were selected as potential predictors of mortality, namely (1) clinical data: WHO-functional class, SaO₂, 6-min walking distance, systolic blood pressure, and Eisenmenger syndrome; (2) laboratory data: hemoglobin and NT-pro BNP levels; (3) echocardiography data: pericardial effusion, defect size, and TAPSE; and (4) hemodynamic data: right atrial pressure, cardiac output and index, SvO₂, and flow ratio. The mortality outcome was assessed from the cohort registry.

Results: A total of 124 subjects with LtR-shunt CHD-associated PAH were included. Sixteen subjects (12.9%) died during the follow-up period. The baseline variables which showed significant association with mortality were lower systolic blood pressure, Eisenmenger syndrome, higher NT-pro BNP level, and lower cardiac output. The multivariable analysis showed that systolic blood pressure <100 mmHg (OR 10.99; 95% CI 2.54-47.51, p=0.001), cardiac index <2.5 L/min/m² (OR 8.13; 95% CI: 1.59-42.28, p=0.011) and Eisenmenger syndrome (OR 3.87; 95%CI: 1.06-14.07) were the independent predictors for mortality.

Conclusions: The systolic blood pressure <100 mmHg, cardiac index <2.5 L/min/m², and Eisenmenger syndrome were independent predictors of mortality among adults with LtR-shunt CHD-associated PAH.

Examining the Specificity of Smartphone ECG Devices in Decision-Making for ST-Elevation Myocardial Infarction and Non-ST-Elevation Myocardial Infarction

Fri, 10 Jan 2025 00:00:00 +0700

Background & Objectives: Electrocardiography (ECG) stands as a cornerstone diagnostic tool for assessing cardiac health, particularly in ruling out abnormalities. The integration of smartphone devices presents a promising avenue for expedited detection of cardiac irregularities. This study aims to evaluate the diagnostic efficacy of smartphone ECG devices in subjects admitted to Cardiac Care Units (CCUs) and Cardiac Intensive Care Units (CICUs).

Methods: A retrospective analysis was conducted on a cohort comprising 62 patients presenting with cardiac symptoms. Utilizing smartphone ECG devices as the index, 12-lead ECG tests were administered alongside the Gold Standard ECG machine for comparison among patients in CCUs and CICUs. Diagnostic decisions concerning the presence of ST-Elevation Myocardial Infarction (STEMI) or Non-ST-Elevation Myocardial Infarction (NSTEMI) were made by a team of cardiologists following a meticulous review of both sets of ECG reports.

Results: Data analysis was conducted on 56 patients. The smartphone-based ECG device exhibited 100% specificity, 93% sensitivity, 80% Negative Predictive Value, and 100% Positive Predictive Value, yielding an F-score of 0.96 and a Mathew Correlation Coefficient value of 0.86.

Discussions: This study unequivocally underscores the significant potential of the Spandan ECG device in accurately identifying a range of cardiac abnormalities, including critical conditions such as STEMI and ischemia. Despite its portable nature, smartphone ECG technology demonstrates utility within Critical Care Units for timely monitoring and diagnosis.

Beneath the Rhythm: Deciphering the Subtle Perforation of the Right Ventricle by a Pacemaker Lead

Kalyan Munde, Mohan Paliwal, Akshat Jain — Fri, 10 Jan 2025 00:00:00 +0700

Cardiac perforation by the lead of permanent pacemaker implantation (PPM) devices is a critical complication that often occurs within 24 hours after the implantation but can occur later. Here we report a case of 82-year-old female patient with perforation of the right ventricular wall due to RV lead after 3 months of pacemaker implantation, which was managed conservatively.