Indonesian Journal of Cardiology <p><strong>Indonesian Journal of Cardiology (IJC)&nbsp;</strong>is a peer-reviewed and open-access journal established by Indonesian Heart Association (IHA)/<em>Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI)</em>&nbsp;[] on the year 1979. This journal is published to meet the needs of physicians and other health professionals for scientific articles in the cardiovascular field. All articles (research, case report, review article, and others) should be original and has never been published in any magazine/journal. Prior to publication, every manuscript will be subjected to double-blind review by peer-reviewers. We consider articles on all aspects of the cardiovascular system including clinical, translational, epidemiological, and basic studies.</p> <p>Subjects suitable for publication include but are not limited to the following fields:</p> <ul> <li class="show">Acute Cardiovascular Care</li> <li class="show">Arrhythmia / Cardiac Electrophysiology</li> <li class="show">Cardiovascular Imaging</li> <li class="show">Cardiovascular Pharmacotherapy</li> <li class="show">Cardiovascular Public Health Policy</li> <li class="show">Cardiovascular Rehabilitation</li> <li class="show">Cardiovascular Research</li> <li class="show">General Cardiology</li> <li class="show">Heart Failure</li> <li class="show">Hypertension</li> <li class="show">Interventional Cardiology</li> <li class="show">Pediatric Cardiology</li> <li class="show">Preventive Cardiology</li> <li class="show">Vascular Medicine</li> </ul> <p>All articles published in the Indonesian journal of Cardiology are indexed in:</p> <ul> <li class="show">BASE</li> <li class="show">CiteFactor</li> <li class="show">CNKI</li> <li class="show">Crossref</li> <li class="show">DOAJ</li> <li class="show">GARUDA</li> <li class="show">Hinari</li> <li class="show">Embase</li> <li class="show">Google Scholar</li> <li class="show">WorldCat</li> </ul> en-US <p>Authors who publish with this journal agree to the following terms:<br><br></p> <ol type="a"> <ul> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> </ul> </ol> <ol type="a"> <ul> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> </ul> </ol> <ol type="a"> <ul> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>).</li> </ul> </ol> ([] dr. Sunu Budhi Raharjo, Sp.JP(K), Ph.D, FIHA) (Admin) Tue, 14 Jun 2022 00:10:13 +0700 OJS 60 A Clinical Profile of Acute Coronary Syndrome Patients in Kupang <p><strong>Background:</strong> Cardiovascular diseases (CVDs) have been the leading cause of global deaths over the years. In Indonesia, coronary heart disease (CHD) is the most common CVDs, responsible for 29% of all deaths in 2017. East Nusa Tenggara is one of the provinces in Indonesia with the highest prevalence of CHD, which corresponded with growing cases of acute coronary syndromes (ACS). Therefore, we develop a registry to obtain patients' profiles as a basis for strategy development in ACS management.</p> <p><strong>Methods:</strong> A retrospectively observational study was conducted on all patients who presented with ACS between January 2019 and September 2020 at a general hospital in Kupang, East Nusa Tenggara.&nbsp; Data collected include demography, patient awareness and transfer history, risk factors, physical findings, diagnosis, workup, treatment, and mortality.</p> <p><strong>Results: </strong>A total of 282 patients with ACS (STEMI, 41,2%; NSTEACS, 58,8%) were included in this study. Most patients were male with a mean age of 58,2 ± 12,2 years and normal BMI (32.6%). Nearly 50% of all ACS patients have one or more comorbidities, followed by relatively low adherence to therapy. Half of the patients were referred, but only 16,9% of patients arrived at the first medical facility less than 1 hour after onset. Patients with NTSEACS had more risk factors than patients with STEMI. The median LOS was five days (range, 1-17 days) with 2,8% in-hospital death. The presence of patient and system delay might contribute to the low number of STEMI patients who received reperfusion therapy.</p> <p><strong>Conclusions:</strong> This research serves as the primary data for the improvement of acute coronary syndrome management in Kupang and East Nusa Tenggara.</p> Aditya Angela Adam, MD, Leonora Johana Tiluata, MD, FIHA, Lowry Yunita, MD, FIHA, Magma Purnawan Putra, MD, FIHA, Niva Wilujeng, MD, FIHA, Leonita Vivian Homalessy, MD, Daniel Christian Fernandez Hutabarat, MD ##submission.copyrightStatement## Mon, 13 Jun 2022 23:52:52 +0700 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 <p><strong>Background</strong>: 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.<em> &nbsp;</em></p> <p><strong>Methods </strong>: 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.</p> <p><strong>Results</strong>: 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%.</p> <p><strong>Conclusion</strong>: The Tpe interval reduction can be a valuable additional marker of successful reperfusion in patients with STEMI treated with fibrinolytic.</p> <p>&nbsp;</p> <p><strong>&nbsp;</strong></p> <p>&nbsp;</p> MUHAMMAD DESFRIANDA ##submission.copyrightStatement## Mon, 13 Jun 2022 23:55:12 +0700 A Simple Scoring System for Predicting In-Hospital Mortality after Heart Valve Surgery in A Developing Country <p><strong>Background:</strong> Various scoring systems predict mortality after cardiac surgery, but not many were designed for specific valvular surgery. Developing countries have different characteristics of patients and conditions in cardiac centers compare to developed countries. We aimed to develop a simple scoring system for predicting in-hospital mortality after valve surgery and further validate the scoring system.</p> <p><strong>Methods:</strong> For developing the scoring system, the data was taken from the medical record of patient underwent valve surgery in 2012 - 2014, and for the validation study, it was from 2015 to 2016. The scoring system was developed using logistic regression models, then validated using calibration and discrimination analysis.</p> <p><strong>Result:</strong> For developing a scoring system, we recruited 1040 patients in the study. The in-hospital mortality rate was 68 (6.5%). Eight variables were incorporated, including; functional class, hypertension, previous open-heart surgery, impaired renal function, right ventricular dysfunction, emergent operation, &nbsp;coronary artery bypass surgery, and tricuspid valve surgery. The mortality risk score has Hosmer Lemeshow (H-L) test p-value = 0.212; AUC = 0.813 (CI 95% = 0.758–0.867); and cut-off point of 5, predicting 14% risk of death (sensitivity 72.1%, specificity 75.3%). In the validation study, 789 subjects were recruited. The observed and predicted mortality were 8.6% and 11.9% respectively, with H-L test p-value = 0.169 and AUC 0.761 (95% CI; 0.702-0.821)</p> <p><strong>Conclusion:</strong> We have developed a simple scoring system for predicting in-hospital mortality after valve surgery. The mortality risk score was well-calibrated with a moderate discrimination value in the validation study.</p> Amiliana M Soesanto, Aron Husink, Novi Ariyanti, Melyana Asmuni, - Oktavia Lilyasari, Arinto Bono Adji Hardjosworo ##submission.copyrightStatement## Mon, 13 Jun 2022 23:56:08 +0700 Lewis Lead: Reveal the Hidden P Wave <p><strong>Background</strong>. The Lewis lead configuration can help to detect atrial activity and its relationship to ventricular activity, so diagnosis can be achieved more accurately. With Lewis lead ECG, it will make easier to make a diagnosis, especially in identifying electrical activity in the atrium.</p> <p><strong>Case Illustration</strong>. <strong>Case 1.</strong> A 61-year-old male with decreased consciousness et causa metabolic. From a standard 12-lead ECG, the P waves are difficult to identify, and at first glance it looks like atrial fibrillation. From the Lewis ECG in lead I, it appears that the QRS wave is always preceded by a P wave, with different morphologies (more than 3 forms), that showed as multifocal atrial tachycardia (MAT) with a heart rate of 120 beats / minute. <strong>Case 2.</strong> The 58-year-old male patient complained of typical ischemic chest pain and palpitations. A standard 12 lead ECG examination revealed a rhythmic tachycardia with a wide QRS wave at a rate of 210 beats / minute. From the Lewis ECG in lead I, we can see that the P waves that appear are not always followed by QRS. Thus, it can be seen that the AV dissociation is a VT so that VT management can be done immediately. <strong>Case 3</strong>. A 65-year-old male patient diagnosed with grade 5 CKD on dialysis. From a standard 12 lead ECG examination, a wide QRS wave with a P wave is obtained which is sometimes seen behind the QRS wave, making the diagnosis difficult to establish. From the Lewis ECG in lead I, it appears that the P wave always appears at the end of the QRS wave, so it can be seen that the rhythm from the ECG is derived from accelerated idioventricular rhythm with ventriculoatrial conduction.</p> <p><strong>Conclusion</strong>. The accuracy of ECG interpretation is needed to determine the next treatment for the patient. Through the ECG examination with the Lewis lead method, the cardiac electrical activity will be more visible, so it will be very helpful in the interpretation of the ECG in cases that are not clear on the standard 12 lead ECG examination.</p> Afandi Dwi Harmoko, Heru Sulastomo ##submission.copyrightStatement## Mon, 13 Jun 2022 23:57:22 +0700 Rare Case of Vasospastic Acute Limb Ischemia <p><strong>Background</strong>: Acute limb ischemia (ALI) requires immediate treatment to maintain limb viability and prevent morbidity and mortality. Nevertheless, vasospastic acute limb ischemia on limb arteries is rarely reported.</p> <p><strong>Case Illustration</strong>: This article reported a 37-year-old woman with sudden pain in her left leg and foot. The absence of peripheral pulsation of the left dorsalis pedis artery and popliteal artery were noted. Her foot was cold and clammy with decreased oxygen saturation in the left toes. The symptoms were partially improved following heparinization therapy. Angiography was conducted, and it revealed the spasms of the left popliteal and dorsalis pedis arteries with no sign of acute embolism or thrombosis. Arterial vasospasm is a rare cause of acute limb ischemia. A theoretical etiology of this vasospasm might be a secondary Raynaud's phenomenon. The associated factors were female, pre-menopausal age, the use of combined injectable contraception containing estrogen, and exposure to cold temperatures.</p> <p><strong>Conclusion</strong>: This case report emphasizes the necessity to consider all possible causes in ALI-presenting cases to provide adequate therapy and prevent limb death.</p> Naesilla Naesilla, Suryono Suryono ##submission.copyrightStatement## Mon, 13 Jun 2022 23:58:20 +0700