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) Sat, 17 Sep 2022 09:01:50 +0700 OJS 60 The The Impact of Tricuspid Annular Plane Systolic Excursion (TAPSE) After Mitral Valve Surgery on Long Term Mortality <p><strong>Abstract</strong></p> <p><strong>Background: </strong>Heart valve disease is still a significant health burden in the world, including Indonesia. The postoperative outcome of mitral valve surgery is influenced by many things, including decreased right ventricular (RV) function, which is the most common complication. Several studies have shown that decreased RV function after mitral valve surgery is associated with long-term outcomes. TAPSE is a routine and easy measurement of RV systolic function. A decrease in TAPSE after cardiac surgery is common because of the effects of pericardiotomy, and does not necessarily reflect a decrease in RV ejection fraction (RVEF). Regardless of whether postoperative TAPSE values ​​indicate right ventricular systolic function or only due to the effects of pericardiotomy, it is still not clear whether postoperative TAPSE values ​​have a prognostic value to long-term mortality after mitral valve surgery. Therefore, the objective of this study is to obtain information regarding the relationship of TAPSE echocardiographic parameters after mitral valve surgery with long-term mortality.</p> <p><strong>&nbsp;</strong></p> <p><strong>Methods: </strong>This is a retrospective cohort study, looking at the effect of TAPSE on outcome after mitral valve surgery. The analysis starts from the starting point of the study when the patient was discharged alive from the hospital after mitral valve surgery (operation period January 2016 – February 2017) to the end point of the study, which was June 30<sup>th</sup>, 2021 and the observed outcome was mortality from any cause.<strong>&nbsp;</strong><strong>Results: </strong>Of the 266 study subjects, 11 subjects died within 4-5 years after mitral valve surgery, the mortality is 4%. Bivariate analysis was performed on several factors and no relationship was found between the analyzed variables and mortality.</p> <p><strong>Conclusion: </strong>There is no relationship between mortality and TAPSE after mitral valve surgery.</p> <p><strong>Keywords</strong><strong>:</strong>&nbsp;&nbsp; TAPSE, Mitral Valve Surgery, Mortality</p> Sabrina Erriyanti, Amiliana M Soesanto, Indriwanto Sakidjan, A. Atmosudigdo, Oktavia Lilyasari, Rina Ariani, Sisca Natalia Siagian ##submission.copyrightStatement## Sat, 17 Sep 2022 00:00:00 +0700 The Incidence of Persistent Symptom and Echocardiographic Findings in Survivors of COVID-19 Infection with Mild Symptoms <p><strong>Background:</strong></p> <p>Survived from COVID-19 infection, some patients yet have residual symptoms. Multi-organ and mechanisms of disease can be involved. The data regarding echocardiographic dimension and function of the cardiac in the COVID-19 survivors remains scarce.</p> <p><strong>Method:</strong></p> <p>This was a descriptive cross-sectional study that involves a total of 63 subjects. Subjects were employees and medical residents at National Cardiovascular Center Harapan Kita, who previously get infected by COVID-19. Each subject was examined transthoracic echocardiography once at the time of recruitment. Echocardiographic parameters obtained in this study included dimension and systolic function of the left ventricle and right ventricle, global longitudinal strain by 2D speckle tracking echocardiography, and myocardial work index.</p> <p><strong>Result:</strong></p> <p>More than a half of the subjects experienced persistent symptoms after recovery from COVID-19 infection and mainly was fatigue (33.3%). The timing of data acquisition on the median was 32 days after the negative of the COVID-19 test result. 2D echocardiography measurement of left ventricle indicated mean of end-diastolic diameter and end-systolic diameter was 45 mm and 27 mm, respectively. The mean ejection fraction (EF) of the left ventricle by Simpson’s biplane method was 61%. The median of tricuspid annular plane systolic excursion (TAPSE) parameter was 23 mm and the fractional area change (FAC) parameter was 39%. The mean of global longitudinal strain (GLS) was -19.6%.</p> <p>&nbsp;</p> <p><strong>Conclusion:</strong></p> <p>After recovery from COVID-19 infection, some survivors may have post-acute infectious consequences of COVID-19 such as fatigue, dyspnea, and malaise. However, echocardiographic findings in those patients with mild symptoms, including 2D echocardiography, myocardial strain analysis, and myocardial work index, indicate normal dimension and systolic function in both left ventricle and right ventricle.</p> Prima Almazini, Amiliana M Soesanto, Ario S Kuncoro, Rina Ariani, Estu Rudiktyo, Renan Sukmawan ##submission.copyrightStatement## Sat, 17 Sep 2022 08:25:59 +0700 Evaluation of Cardiometabolic Factors Affecting Chronotropic Incompetence: A Cross-Sectional Retrospective Study in Sanglah General Hospital, Bali <p><strong>Background: </strong>Recent studies have identified that chronotropic incompetence is correlated with poor cardiometabolic health and systemic inflammation that results in exercise intolerance, impaired quality of life and death due to cardiovascular disease (CVD). Unfortunately, there’s still paucity of data regarding cardiometabolic factors associated with chronotropic incompetence. The purpose of this study was to identify the cardiometabolic factors associated with chronotropic incompetence.</p> <p><strong>Methods: </strong>This study was a cross-sectional retrospective study using cardiac treadmill stress test data at Sanglah General Hospital from May 2018 - May 2020 and 136 patients were enrolled. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on cardiometabolic risk factors in chronotropic incompetence.</p> <p><strong>Results: </strong>Patients were divided based on the characteristics of age, gender, smoking status, body mass index, coronary artery disease, heart failure, hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), the levels of HbA1C, total cholesterol, LDL, HDL, and triglyceride. In this study, it was found that T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), high total cholesterol (PR 2.396; 95%CI 1.650-3;481), and high LDL level (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value &lt;0.05), while other factors were not significantly related.</p> <p><strong>Conclusion: </strong>Chronotropic incompetence can impair quality of life and contribute to cardiovascular mortality. However, T2DM, high HbA1C, dyslipidemia, high total cholesterol and LDL levels were found to be associated with chronotropic incompetence. This may contribute to higher cardiovascular risk attributed to those factors.</p> Gusti Ngurah Prana Jagannatha, AA Ayu Dwi Adelia Yasmin, I Wayan Agus Surya Pradnyana, Stanly Kamardi, I Nyoman Wiryawan, I Wayan Wita ##submission.copyrightStatement## Sat, 17 Sep 2022 08:33:42 +0700 Traumatic Coronary Artery Dissection as A Potential Cause of Acute Myocardial Infraction in Motorcycle Accident <p><strong>Background: </strong>Chest pain in blunt chest trauma can be caused by various intrathoracic&nbsp;injuries. Pneumothorax, hemothorax, and rib fractures are commonly seen in the emergency department. Although cardiac involvement is very rare, the probability should not be excluded.</p> <p><strong>Case Illustration: </strong>A-31-years-old male who complained of chest pain and diaphoresis was brought to the emergency department after a high-speed motorcycle collision. Chest X-ray revealed no abnormality but a 12-lead Electrocardiogram (ECG) demonstrated ST-segment elevation in lead I, AvL, V2-6, and atrial fibrillation. Because of the unusual presentation, the decision was to proceed with percutaneous coronary intervention (PCI). Coronary Angiography detected a thrombus at proximal LAD and spiral dissection at mid LAD (TIMI 2 Flow). After the procedure, he was transferred to the High Care Unit.</p> <p><strong>Conclusion: </strong>Following blunt chest trauma, chest pain in the setting of a vehicle collision can be caused by dissection of the coronary artery. Prompt cardiac workup (ECG, cardiac enzyme, and echocardiography) must be done in a highly suspected patient.</p> Alexander Edo Tondas, Fredy Tandri, Edrian Zulkarnain ##submission.copyrightStatement## Sat, 17 Sep 2022 08:37:15 +0700 When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT <p><strong>When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT</strong></p> <p>&nbsp;</p> <p>Background:</p> <p>Particular ischemic process that portrayed in Electrocardiogram (ECG) changes bear similar depiction to different conditions, one of them is hypokalemia. On the other hand, Treadmill Test (TMT) has been used for decades for risk stratifying and diagnosing coronary artery disease as a non-invasive, safe and affordable screening test. However, using ECG changes as interpretation, TMT could have incidence of false positive results reported in various conditions, one of which is hypokalemia. The aim is to report a case of positive ischemic response resemblance in TMT of patient with severe hypokalemia.</p> <p>&nbsp;</p> <p>Case Illustration:</p> <p>A-43-years-old female with history of unstable angina pectoris with risk factors of diabetes mellitus and hypertension underwent several examinations. Computed Tomography Coronary Angiography (CTCA) showed a 60% stenosis lesion in Left Anterior Descending (LAD) coronary artery. Within 3 minutes of TMT the ECG showed ST-segment depression in lead II, III, aVF, V<sub>1</sub>-V<sub>6 </sub>and prominent elevation in lead aVR. Fear of left main coronary artery occlusion, the test was terminated and the patient was immediately planned for urgent Percutaneous Coronary Intervention (PCI). The result indicated non-significant coronary lesion. Potassium concentration of 1.87 mmol per liter and troponin levels were normal. Unbeknownst before, the patient had multiple episodes of vomiting for a whole day and felt dehydrated prior to the TMT. Patient then treated for potassium implementation and discharged uneventfully.</p> <p>&nbsp;</p> <p>Conclusion:</p> <p>Hypokalemia could induce widespread ST-Segment depression or ST-Segment elevation in right limb lead. Peculiarly in context of stress testing or accompanied with chest pain, it is difficult to differentiate ECG changes in hypokalemia with true myocardial ischemia. Hypokalemia should be considered when TMT result is not concordance with true myocardial ischemia.</p> <p>&nbsp;</p> Dmitri Muhammad Rifanda, M. A. L. Parama, Teuku Muhammad Haykal Putra, Wishnu Aditya Widodo ##submission.copyrightStatement## Sat, 17 Sep 2022 08:38:52 +0700 Pacing Induced Cardiomyopathy: What is The Solution? <p><strong>ABSTRACT</strong></p> <p><strong>Background</strong></p> <p>Right ventricular pacing is associated with adverse outcome including increased risks of cardiovascular morbidity and mortality. RV pacing causes abnormal ventricular activation results in an inefficient contraction pattern with ventricular dyssynchrony and loss of myocardial work that may lead to LV dilation, systolic dysfunction, and clinical HF. Pacing induced cardiomyopathy (PICM) is caused by chronic and high burden RV pacing that may occur several months or years after pacemaker implantation.</p> <p><strong>&nbsp;</strong></p> <p><strong>Objective</strong></p> <p>To present a case of pacing induced cardiomyopathy (PICM) managed by CRT-P implantation.</p> <p><strong>&nbsp;</strong></p> <p><strong>Case Illustration</strong></p> <p>A male, 56 years old, was referred from dr. M. Djamil General Hospital with CHF Fc II-III, s/p PPM DDDR due to high degree AV block (2016) and history of failed CRT-P implantation (2018). He complained DOE (+), PND (+) and OP (+) since April 2017. Physical examination revealed pansystolic murmur grade 2/6 at apex, no rales and no oedema at both legs. ECG showed pacing rhythm and intrinsic rhythm was type 2 second degree AV block and RBBB with QRS duration 150 ms. Echocardiography showed global hypokinetic and dilated LV (LV EDD 71 mm, LV ESD 63 mm) with progressively reduced EF 38% à&nbsp; 33% (Simpson), functional moderate MR and mild TR. CAG showed non-significant coronary artery stenosis with 20% stenosis at distal LAD. Patient was diagnosed as pacing induced cardiomyopathy (PICM). At catheter laboratory, there was stenosis of left subclavian vein. His-Bundle pacing (HBP) was planned at first, however CRT-P with biventricular epicardial pacing was then performed in which LV lead was inserted through right axillary vein. During follow up at general ward, ECG showed biventricular pacing rhythm. There was no signs and symptoms of heart failure. Patient was hospitalized for 3 days and then discharged in a good condition.</p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> <p><strong>Summary</strong></p> <p>We reported a case of pacing induced cardiomyopathy in male patient 56 years old. Pacing induced cardiomyopathy is a complication of high burden RV pacing. Options to treat PICM once it has developed, or to prevent it from developing in the first place, may include conduction system pacing (e.g.: HBP) or CRT-P implantation.</p> <p>&nbsp;</p> Maruli Wisnu Wardhana Butarbutar, Sunu Budhi Raharjo ##submission.copyrightStatement## Sat, 17 Sep 2022 08:39:53 +0700