TY - JOUR
AB - Hypertension in rural area: The determinants of left ventricular geometric alteration among hypertensive patients at Kubu Village, Karangasem, Bali A. Yasmin A. Yasmin 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia R. Widiana R. Widiana 2 Nephrology and Hypertension Division, Internal Medicine Department, Udayana University, Bali, Indonesia Hypertension Left Ventricular Geometry rural area Abstract Background Hypertension is one of the commonest cardiovascular risk factors, whose prevalence in Indonesia is 25.8%. Uncontrolled hypertension leads to altered geometric pattern of left ventricle, which is associated with a greater cardiovascular risk. Methods This study was conducted in conjunction with the annual social work clinic arranged by Department of Cardiology and Vascular Medicine, Udayana University on 21 November 2015. This cross-sectional study was performed in all patients who attended the social work clinic at Kubu Village and was diagnosed with hypertension. The subjects underwent electrocardiography examination and echocardiography examination to asses LV geometry, systolic function, and diastolic function. Results There were 28 subjects with hypertension enrolled in this study with median age 62 (range 40-83) year old with slight female predominance (53.6%). Among them, 60.7% have history of hypertension, but only 2 patients who had been receiving treatment. From electrocardiography examination, we found high LV voltage and LV strain pattern in 10 (35.7%) patients. Echocardiography results show that the prevalence of left ventricular geometric alteration was 57.1%, diastolic dysfunction grade I was 78.6%, and 1 patient was found to have systolic dysfunction. Bivariate analysis revealed that known history of hypertension [PR 8.67 (CI 95% 1.53-49.22, p < 0.05)] and duration of hypertension ≥ 5 years [PR 2.71 (CI 95% 1.57-4.89, p < 0.05)] were related with left ventricular geometric alteration among hypertensive patient in Kubu Village. Conclusion The prevalence of left ventricular geometric alteration and diastolic dysfunction is high among hypertensive patients at Kubu Village. Our study also found that majority of patient with known history of long-standing hypertension also have evidence of left ventricular geometry alteration. This result warrants the need for improved achievement of blood pressure goals alongside with aggressive screening for end organ damage in hypertensive patients, especially at rural area. Effectiveness comparison between lisinopril and amlodipine in Melanesian patients with hypertension A. Aryadi A. Aryadi 1 Faculty of Medicine Universitas Indonesia 2 National Cardiovascular Center Harapan Kita Y. A. Porotuo Y. A. Porotuo 1 Faculty of Medicine Universitas Indonesia 2 National Cardiovascular Center Harapan Kita N. Hersunarti N. Hersunarti 1 Faculty of Medicine Universitas Indonesia 2 National Cardiovascular Center Harapan Kita S. Dharma S. Dharma 1 Faculty of Medicine Universitas Indonesia 2 National Cardiovascular Center Harapan Kita A. M. Soesanto A. M. Soesanto 1 Faculty of Medicine Universitas Indonesia 2 National Cardiovascular Center Harapan Kita hypertension plasma rennin activity melanesian lisinopril amlodipine Abstract Background The success of antihypertensive treatment are influenced by many factors, one of which are genetic factors, including differences in race and plasma renin activity (PRA). Racial differences, regarding PRA, may give different response to antihypertensive drugs. Plasma renin activity and comparison of the effectiveness of antihypertensive medications (lisinopril and amlodipine) in the Melanesian race in the province of Papua have not been investigated. Objectives To measure plasma renin activity and compare the effectiveness of lisinopril and amlodipine in melanesian hypertensive patients to reduce blood pressure. Methods Sixty eight subjects were randomly assigned into 2 groups, those receiving lisinopril 5 mg (34 subjects) and amlodipine 2.5 mg (34 subjects). Blood pressure, PRA and other baseline characteristics were measured before the intervention, and then evaluated every week. Dose of lisinopril and amlodipine will be increased in subjects who have not achieved blood pressure target, 10 mg to 20 mg and 5 mg to 10 mg, respectively. At the end of the fourth week, blood pressure is measured as the main clinical outcome. Seven subjects were drop out, four from lisinopril group and three from amlodipin group. Results Plasma renin activity in this study population was 1.6 ng/ml/h (normal). Baseline characteristics did not differ between two groups, including blood pressure and PRA before intervention. Significant decrease in blood pressure occurred in both group after the intervention, including systolic blood pressure (SBP), diastolic (DBP) and mean arterial pressure (MAP). However, there are no differences in blood pressure reduction between lisinopril and amlodipine groups. (SBP 24.6 ± 9.3 vs 25.9 ± 8.9 mmHg, p = 0.56; DBP 13.3 ± 5.5 vs 11.4 ± 4.8 mmHg, p = 0.15; MAP 17.1 ± 5.6 vs 16.3 ± 5.0 mmHg, p = 0.55). Conclusion Plasma renin activity in melanesian hypertensive patients was normal and administration of lisinopril showed no difference in blood pressure reduction compared with amlodipine. An experimental study of β-D-Glucans exctract of Ganoderma lucidum polysaccharide peptides as anti-inflammation and anti-oxidant in patients at high-risk of atherosclerosis A. Widya A. Widya 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia N. Ubaidillah N. Ubaidillah 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia Vittryaturida Vittryaturida 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia K. Siwi K. Siwi 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia M. Failasufi M. Failasufi 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia F. Ramadhan F. Ramadhan 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia H. Wulandari H. Wulandari 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia Y. Waranugraha Y. Waranugraha 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia D.H. Putri D.H. Putri 1 Faculty of Medicine, University of Brawijaya, Malang, Indonesia D. Sargowo D. Sargowo 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Brawijaya, Dr Saiful Anwar General Hospital, Malang, Indonesia Ganoderma lucidum polysaccharide peptides anti-inflammation anti-oxidant Abstract Background Polysaccharide peptide (PsP) of Ganoderma lucidum mycelium extract has anti-inflammatory and anti-oxidant activities. The inflammatory process and oxidative stress must play causal role in the initiation and progression of atherosclerosis. This study was aimed to evaluate the anti-inflammation and anti-oxidant effects of Ganoderma lucidum PsP in patients at high-risk of atherosclerosis. Methods This is a true clinical trial experimental study on 37 high-risk patients based on Framingham Risk Score, with pre-test and post-test design without control. The patients were given PsP 3x250 mg for 3 months, while continuing the previous medications. Parameters measured were the level of High-sensitivity C-Reactive Protein (HS-CRP), Interleukin-6 (IL-6), Tumor Necrosis Factor-α (TNF-α), malondialdehyde (MDA) and Superoxide dismutase (SOD). The data was analyzed by paired t-test for parametric data and Wilcoxon test for non-parametric data. Results After PsP administration for three months, HS-CRP statistically significant reduced from 25329 ± 8682.10 mg/dl to 2659 ± 89 mg/dl (p = 0.000). IL-6 significantly reduced from 279.75 ± 120.76 mg/dl to 29.32 ± 26.44 mg/dl (p = 0,000). The level of TNF-α also significantly reduced from 13447.84 ± 2199.46 mg/dl to 544.85 ± 292.06 mg/dl (p = 0.000). MDA significantly reduced from 114.13 ± 24.56 mg/dl to 36.84 ± 28.39 mg/dl (p = 0.000). The level of SOD slightly increased from 3.12 ± 0.70 mg/dl to 3.62 ± 4.26 mg/dl. However, there was no statistically significant difference between the pre and post-test means of SOD level (p = 0.219). Conclusions PsP of Ganoderma lucidum when given to high-risk patients with on-going medications has anti-inflammation activities that significantly reduce HS-CRP, IL-6 and TNF-α during atherosclerosis process, moreover, can be used as antioxidant by reducing MDA, although statistically SOD not increased. Thus, PsP could be used as complementary therapy for patients suffering from those who are at high risk of atherosclerosis. Echocardiographic findings among hypertensive patients in rural area: The descriptive study at Kubu Village, Karangasem, Bali A. P. Suwirya A. P. Suwirya 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University A. Yasmin A. Yasmin 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University K.B Nadha K.B Nadha 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University R. Widiana R. Widiana 2 Nephrology and Hypertension Division, Internal Medicine Department, Faculty of Medicine, Udayana University Hypertension LV study rural area Abstract Background Based on data from Global Burden of Disease (GBD), 50% of heart disease were caused by hypertension and mortality rate from heart disease increased by 46% in hypertensive patients. Prevalence of hypertension according to RISKESDAS 2013 in Indonesia is 26.5%, but only 9,5% hypertensive patients were detected by healthcare provider and received hypertension treatment. In Bali, prevalence of hypertension reached 18.3% by 2013. From rural area in Bali, such as Kubu Village, Karangasem, hypertension was still included in ten most common disease in community. Methods This study was held together with social work clinic which were performed by Department of Cardiology and Vascular Medicine Udayana University at Kubu Village, Karangasem on November 21st, 2015. In this cross-sectional study, we included all hypertensive patients who attended the social work clinic. All subjects underwent transthoracic echocardiography with GE Vivid E Portable Ultrasound Machine. The demographic characteristics were obtained using structured questionnaire Result In this study, the prevalence of hypertension in Kubu Village was 24.3% (28 out of 115 patients). Among them, 60.7% had known history of hypertension, with duration <5 years in 67.9% patients. Only 2 (7,1%) patients with known hypertension that already had treatment. From echocardiography results, we found the prevalence of altered LV geometric was 57.1%, which were predominated by concentric remodeling type. Furthermore, from this study we also found that 1 (3.5%) patient had systolic dysfunction and 22 (78.6%) had diastolic dysfunction grade I. Conclusion The prevalence of LV geometry alteration and diastolic dysfunction in hypertension patients at Kubu Village Karangasem is quite high. Hence, the primary healthcare provider should put more attention to the primary and secondary prevention for hypertension especially in rural area. Addition of left ventricular ejection fraction to the GRACE score in prediction of short term prognosis in patients with non ST-elevation myocardial infarction N. Z. Akbar N. Z. Akbar 2 Departement of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia Z. Mukhtar Z. Mukhtar 2 Departement of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia A. A. Siregar A. A. Siregar 2 Departement of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia A. Handayani A. Handayani 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia K. Kaban K. Kaban 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia LVEF NSTEMI in-hospital MACE Abstract Background Identification of patients with NSTEMI at higher risk of in-hospital MACE is very important. It will gives crucial information for determining treatment strategy. GRACE was the most powerful risk score of recently used. LVEF demonstrated highly significant in several previous studies. The aim of this study is to see the value of LVEF as a predictor of in-hospital MACE in NSTEMI and see the incremental value if added to the GRACE score. Methods We collected the data of NSTEMI patients admitted to Haji Adam Malik General Hospital in 2014 that had been done echocardiography during hospitalization. Patients with other severe comorbidity such as sepsis and COPD were excluded. There was 83 patients eligible to this study. Result In bivariate analysis, GRACE Score >140, LVEF ≤35%, hemoglobin levels <12 mg/dl, and glomerular filtration rate (GFR) <60 mL/min were significantly associated with in-hospital MACE. There is a moderate correlation between GRACE with LVEF (r: -0496, p <0.0001). In the multivariate study shows that the LVEF ≤35% (OR 3.36, 95% CI 1.04 to 10.83, p 0.042) and GRACE score> 140 (5.39, 95% CI 1.54 to 18.45, p 0.008) had a significant association with in-hospital MACE. In all risk groups based of GRACE score, adding LVEF did not give incremental value. But in comparative analysis between group of LVEF ≤35% with GRACE score >140 versus other patients shows significant difference with p value 0.001 and OR 9.833 (95%CI 2.54-37.97). Conclusion These data show that LVEF is a strong predictor for the occurrence of in-hospital MACE. In the subgroup analysis, adding LVEF did not give incremental value. However, in patients with both LVEF ≤35% and GRACE Score >140 had a higher risk of occurrence of MACE during hospitalization. Effect of colchicine on HsCRP and mean platelet volume in acute myocardial infarction A. Yasa' A. Yasa' R. Myrtha R. Myrtha W. Trisulo W. Trisulo Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Sebelas Maret, Dr. Moewardi Hospital, Surakarta colchicine HsCRP MPV acute myocardial infarction Abstract Background Coronary artery disease (CAD) was still highly prevalent. Its mortality was high. Despite optimal standard therapy, coronary artery disease patients still face the risk for further cardiovascular events due to inability of standard therapy in blocking certain inflammatory pathways and thrombocyte aggregation. This study aimed to determine the effects of Colchicine on HsCRP and MPV level in acute myocardial infarction. Methods This was a randomized experimental study with pre and post design. A total of 32 patients were included and divided into two groups. Patients were randomized to receive colchicine 0,5 mg for five days (n = 16) or not (control, n = 16). Dependent t-test or Mann-Whitney test were used to compare means between two groups. Independent t-test or Wilcoxon test were used to compare paired means between two groups. All statistical analysis was carried out using SPSS version 22 for windows. Results HsCRP level and MPV were significantly lower in colchicine group compare to placebo (2,30 ± 2,01 vs 4,21 ± 3,93; p = 0,019); (7,14 ± 1,014 vs 7,98 ± 1,08; p = 0,031). HsCRP level and MPV after treatment were significantly lower compare to baseline in colchicine group [Delta HsCRP (-3,82 ± 2,20 vs -0,57 ± 3,12; p = <0,001), delta MPV ( -2,01 ± 1,16 vs -0,64 ± 0,83; p = 0,001)]. Conclusion This study showed that colchicine decreased HsCRP level and MPV in acute myocardial infarction patients. Correlation between GRACE score with spatial QRS-T angle in non-ST elevation myocardial infarction patients A. Hidayatullah A. Hidayatullah 1 Faculty of Medicine, University of Padjajdaran, Bandung, Indonesia A. Purnomowati A. Purnomowati 1 Faculty of Medicine, University of Padjajdaran, Bandung, Indonesia S. Hidayat S. Hidayat 1 Faculty of Medicine, University of Padjajdaran, Bandung, Indonesia T.M. Aprami T.M. Aprami 1 Faculty of Medicine, University of Padjajdaran, Bandung, Indonesia 2 Dr. Hasan Sadikin Hospital, Bandung, Indonesia GRACE score non-ST elevation myocardial infarction spatial QRS-T angle Abstract Background Non-ST elevation myocardial infarction (NSTEMI) is one of the spectrum of acute coronary syndromes. Myocardial infarction may cause distorsions of normal excitation of the heart. Alteration of depolarization and repolarization would widened spatial QRS-T angle which increased risk of mortality, particularly sudden cardiac death (SCD).GRACE score is the most accurate risk statification tool in NSTEMI patient.No study has been conducted to evaluate the correlations between GRACE score and spatial QRS-T angle. Methods This cross-sectional study was conducted in hospitals around Bandung, Sumedang, and Tasikmalaya with NSTEMI patients as the subject. GRACE score was calculated by GRACE ACS Risk Score software. Spatial QRS-T angle was based on ECG recording on patient admission and measured by independent investigator. Pearson's correlation was used to analyze the correlation between GRACE score and spatial QRS-T angle. Results There was 29 NSTEMI patients that has been included into this study (male 69%, mean age 60 ± 11 years old). Mean GRACE score was 138 ± 37 and mean spatial QRS-T angle was 102 ± 42o. There was a significant correlation between GRACE score and widened spatial QRS-T angle (r = 0.44; p = 0.008). Heart rate (r = 0.54; p = 0.001) and ST segment depression (r = 0.62; p < 0.001) were two GRACE score component which strongly associated with spatial QRS-T angle. Conclusion GRACE score was significantly correlate with spatial QRS-T angle in NSTEMI patients. Prevalence of Impaired Kidney Function in Hospitalized Hypertensive Patients in Agoesdjam General Hospital, Ketapang, West Borneo, Indonesia A. Sudharsono A. Sudharsono 1 General Practitioner, Agoesdjam General Hospital, Ketapang, West Borneo B. Effendi B. Effendi 2 Department of Epidemiology, Faculty of Public Health,Universitas Indonesia D.A. Hanafy D.A. Hanafy 3 Department of Cardiology and Vascular Medicinie, Faculty of Medicine, Universitas Indonesia Abstract Background Hypertension related kidney disease accounts for a large percentage of the population requiring renal replacement therapy worldwide. According to National Basic Health Research 2013, 25.8% of people ≥18 years in Indonesia are diagnosed with hypertension, which could lead into kidney disease. Objective Our aim in this study was to determine the burden of impaired kidney function among the hypertensive population in West Borneo especially Agoesdjam general hospital. Method In the period from January to December in 2015 we studied the hospital records and documented the demographic data of patients with hypertension which was defined as blood pressure equal or greater than 130/90 mmHg. We exclude a patients with a previous history of kidney disease. The hypertensive patients were classified into the normal or elevated serum creatinine (>1.5 mg/dl) groups. Results There were 252 patients were included in this study, 55% were male. Based on age distribution 54.8% were 41-60 years, 32.5% were 61-80 years, 9.9% were 20-40 years, and others were >= 51 years. The mean serum creatinine was 2.435 +/- 3.158 mg/dl with 43.5 % of the patients having elevated serum creatinine. The difference in age between the normal elevated creatinine groups was significant. (P = 0.007, 95% CI 1.621-9.655). Conclusion Impaired kidney function occurs frequently among the hospitalized hypertensive population in Agoesdjam General Hospital as a rural area. Proactive community based preventive measures; screening and treatment of all patients with hypertension and kidney damage are urgently needed. Inappropriate initial treatment in acute coronary syndrome patients: A gap in cardiovascular care A.A. Nursidiq A.A. Nursidiq T. Wasyanto T. Wasyanto Departement of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sebelas Maret/Dr Moewardi Hospital, Surakarta, Indonesia acute coronary syndrome inappropriate initial treatment Abstract Background Acute coronary syndrome (ACS) still become main problem in cardiovascular field because the high of morbidity and mortality. Treatment for patient with ACS has many progressions. Initial treatment for ACS patient should be given as soon as posible in first medical contact. We studied the frequency and factors associated with inappropriate initial treatment in acute coronary syndrome patients. Methods Retrospective study was conducted between June-November 2015 in patient who referred to Dr Moewardi General Hospital due to ACS. Data were collected from referral letter and medical record. They were divided into two groups according to appropriateness of initial treatment from previous health care facilities. Results 110 patients were included in this study. There were 64 patients received appropriate initial treatment and 46 patients received inappropriate initial treatment. Among 46 patient, 26 (56%) did not receive aspirin or adenosine diphosphate receptor inhibitor, 12 (26%) received NSAID other than aspirin, 4 (9%) received inadequate drug dose and 4 (9%) have more than one kind of inappropriate treatment. Multivariate analysis shown that patient with ACS more likely to receive inappropriate initial treatment if referred from primary health facilities, odds ratio (OR) 2.97, 95% confidence interval 1.26-7.02; p = 0.01 or have atypical symptom OR 3.09, 95% CI 1.20-7.99; p = 0.02. Conclusion The frequencies of ACS patients who get inappropriate initial treatment is remain high. Inappropriate initial treatments are associated with the type of health care facilities and clinical features of ACS. Efforts to reduce this problem should be endorsed. Correlation between plasma histamine level and atherosclerosis severity based on carotid intima media thickness (CIMT) measurement in patients with stable coronary artery disease A.I. Sadiati A.I. Sadiati D. Soemantri D. Soemantri J.N.E. Putranto J.N.E. Putranto Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia Plasma Histamine level Atherosclerosis Carotid Intima Media Thickness Abstract Background Atherosclerosis is a systemic disease and carotid and coronary arteries are the two most common sites on involvement of atherosclerosis. Histamine, a low-molecular-weight amine, has been suggested it is produced in the atherosclerotic lesion although the activity of histamine has not been clarified completely. The source of histamine in atherosclerotic lesion should be clarified in details; however, it could be macrophage, endothelial cells, and mast cells. Intima media thickness of the common carotid artery is a surrogate marker of atherosclerosis and associated with cardiovascular events. Objective To prove a symmetrical relationship between plasma histamine level and atherosclerotic severity based on CIMT measurement in patients with stable coronary artery disease (CAD). Methods Twenty-one patients collected by purposive sampling determined by standard diagnostic criteria in Cardiology outpatient clinic of Dr Soetomo Hospital Surabaya. Vein whole blood were drawn and centrifuged immediately after collection. The level of plasma histamine were measured using Histamine ELISA-Kit and then carotid intima media thickness were measured by vascular ultrasonography GE General Vivid 7. Results The mean values of plasma histamine level in this study were 18.30 ± 5.31 ng/ml. The mean value of CIMT were 1.14 ± 0.32 mm. Inferential analysis using Pearson correlation test showed a positive, moderate and significant correlation between plasma histamine level and atherosclerosis severity based on CIMT measurement, r = +0.504 and p = 0.02 (p <0.05). Conclusion There were significant, positive and moderate correlations between plasma histamin level and atherosclerosis severity based on CIMT in patients with stable CAD. Clinical characteristics, management and outcome of patients with ST elevation myocardial infarction in Pekanbaru city: Preliminary result of single center experience A.A. Alkatiri A.A. Alkatiri 1 Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia 2 National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia Y. Kurnia Y. Kurnia 1 Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia B. Y. Siregar B. Y. Siregar 1 Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia D. Siswanti D. Siswanti 1 Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia D. A. Sinaga D. A. Sinaga 1 Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia STEMI Reperfusion Outcome Abstract Backgound ST-elevation myocardial infarction (STEMI) is a time-critical emergency requiring prompt reperfusion. Acute myocardial infarction system of care at Indonesia capital city of Jakarta has been developed and under constant improvement for better outcome of STEMI patients. However in the other parts of the country, such system has not been made similarly. This report is our early preliminary result and the first study in our province to evaluate the effectiveness and outcome of STEMI management. Method We prospectively collected all STEMI patients managed in our hospital from January 2014 until December 2015. One month major adverse cardiac events (MACE) were collected from the medical record or by telephone calls. Result During the study period, 165 STEMI patients were admitted,mean of age 55 ± 10 years old, predominantly male (87%) with active smoking as the highest risk factor (64%). Onset of infarction to hospital admission was less than 12 hours in 57% cases. There were 74% of the patients received reperfusion therapy, most of them were more likely to undergo Primary percutaneous coronary intervention (PCI) (73%) or received fibrinolysis (27%). Median door-to-balloon and door-to-needle time were 150 and 67 minutes, respectively. The remainder (26%) did not receive any reperfusion therapy. In-hospital mortality was almost 3 times higher in patient who did not receive any reperfusion therapy (20%) compared with patients receiving acute reperfusion therapy (7.1%). One month follow up revealed heart failure as the highest (14.5%) adverse event. Conclusion Despite a high utilization rate of reperfusion therapy (74%), the time to reperfusion therapy exceeds the length of time recommended by current guidelines. Almost half of patients were admitted as late presenters, indicating needs of more optimal referral system and accurate diagnosis, as well as more awareness of cardiac symptoms in the community. Patient distribution from Pekanbaru STEMI Registry Phase II cardiac rehabilitation program increases functional capacity in post atrial septal defect surgical closure in adult patients A. Meidian A. Meidian 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi A. Santoso A. Santoso 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi D. Kusmana D. Kusmana 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi B. Setianto B. Setianto 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi A. Mahavira A. Mahavira 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi D. Yaniarti D. Yaniarti 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi R. Myrtha R. Myrtha 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sebelas Maret, Surakarta, Indonesia B. Radi B. Radi 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi atrial septal defect cardiac rehabilitation 6 minute walk distance Abstract Background Cardiac rehabilitation refers to a structured program of exercise and education purposed to help patients to return to their optimal fitness and function following cardiac surgery, including adult patient of atrial septal defect (ASD). We therefore aim to restrospectively assess the functional capacity after surgical ASD closure in adult patients. Methods This was an observational retrospective study to evaluate the benefit of phase II cardiac rehabilitation program after ASD surgical closure in adult patients from January 2013 until December 2013 in National Cardiovascular Center Harapan Kita, Jakarta. All patients attended 12 sessions exercise training consisted of warming-up, core exercise, and cooling down. The 6 minute walk distance (6MWD) was compared before and after cardiac rehabilitation program. Results Thirty two of 39 post ASD surgical closure patients were eligible for analysis. Mean age was 34.9 ± 11.3 year old. Most of them were female (68.7%). After completing the cardiac rehabilitation program, the 6MWD significantly improved from 358.5 ± 59.1 to 431.5 ± 53.3 meters (p < 0.001). The mean improvement 6MWD was 72.9 ± 54.2 meters. Age, gender, ejection fraction had no significant correlation to 6MWD. Conclusion There was significant 6MWD improvement after phase II cardiac rehabilitation program for post ASD surgical closure in adults. The phase II cardiac rehabilitation program had important role to improve functional capacity for these patients. The identification of human telomerase catalytic subunit in cervical cancer patients and its potential usage as strategy to reawaken hibernating myocardium post myocardial infarction T. Nurseta T. Nurseta 3 Department of Gynaecologic and Oncologic of Saiful Anwar General Hospital, Faculty of Medicine, Brawijaya University, Malang, Indonesia M. R. Indra M. R. Indra 2 Department of Physiologic, Faculty of Medicine, Brawijaya University, Malang, Indonesia F. Hidayatullah F. Hidayatullah 1 Faculty of Medicine, Brawijaya University, Malang, Indonesia A. B. Wijaya A. B. Wijaya 1 Faculty of Medicine, Brawijaya University, Malang, Indonesia Telomerase TERT Zebrafish Myocardial Infarction Cervical Cancer Abstract Background Post myocardial infarction, fibrotic tissue will replenish loss cardiomyocytes irreversibly. In the other hand, dedifferentiated preexisting cardiomyocytes of zebrafish will replenish dead cardiomyocytes after infarction, not by stem cells. Zebrafish cardiomyocytes can regenerate efficiently because of its telomerase hyperactivation. Telomerase is well known for its role in carcinogenesis and lymphocyte replicative life span control. Its activity is influenced by telomerase catalytic subunit (TERT) transcriptional regulation and post-transcriptional alternative splicing. In fact, 95% telomerase activity is associated with cervical cancer's malignancy. Therefore, it is important to identify human TERT (hTERT) in cervical cancer tissue, and compare it to zebrafish TERT (zTERT), refer to its potential usage as strategy to reawaken hibernating myocardium post myocardial infarction. Methods Biopsy tissue of cervical cancer patients, normal cervical smears, and normal lymphocyte, were characterized using SDS-PAGE and Western Blot. Fifteen biopsy tissue of cervical cancer patients and 15 normal cervical smears were measured for its hTERT level using ELISA. Results There was an inline band at 108 kDa between biopsy tissue of cervical cancer patient and lymphocyte cell extract. Western Blot showed that telomerase antibody only recognized 108 kDa protein in biopsy tissue of cervical cancer patient, identified as hTERT. No such identical band in normal cervical smear and lymphocyte extract. There was significant difference (p = 0.01) of hTERT level between biopsy tissue of cervical cancer patients and normal cervical smears. Discussion and Conclusion Human TERT was identified at 108 kDa in biopsy tissue of cervical cancer patient, and its level was significantly higher than normal cervical smear. It is assumed that hTERT splice variant; αβγ-Deleted hTERT, might be dominant in normal cell, rather than Full-Length hTERT. Zebrafish TERT (AA 367-1094) has 39% similarity, in comparison with human TERT (AA 356-1127). In the other hand, αβγ-Deleted hTERT from gastrointestinal cell lines have still showed few similar structure with zTERT. Figure 1 (A) Protein Profilling of Cervical Cancer Biopsy Tissue Extract and Normal Lymphocyte Extract Showed Inline Band at 108 kDa (A. Standard marker, B. Cervical cancer biopsy extract, C. Normal lymphocyte extract, D. Normal ectocervical smear extract, E. Normal endocervical smear extract). (B) Western Blooting Showed 108 kDa Protein in Cervical Cancer Tissue Extract, Suggested as Telomerase Catalytic Subunits (hTERT). Figure 2 (A) Protein Structure Between Full Length hTERT (green colour) and Its Splice Variant, αβγ-deleted hTERT (blue colour). (B) Conserved region between zebrafish hTERT(blue colour) and Human TERT (green colour). zTERT (AA 367-1094) has 39% similarity, in comparison with hTERT (AA 356-1127). Could EURO heart risk score predict the severity of coronary lesion? H. Hasbulah H. Hasbulah 1 Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi University, Manado Y. Arthur Y. Arthur 1 Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi University, Manado Johan Johan 1 Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi University, Manado A.L. Panda A.L. Panda 1 Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi University, Manado J. Pangemanan J. Pangemanan 1 Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi University, Manado B. Budiono B. Budiono 2 Cardiovascular Department of Awal Bros Private Hospital, Makassar B. Setiadi B. Setiadi 1 Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi University, Manado A. Sumargo A. Sumargo 1 Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi University, Manado EURO Heart Score Modified Gensini Score Total Cholesterol HDL Abstract Background Among four EURO Heart risk score's algorithms, chart based on total cholesterol in population at high risk cardiovascular disease is most frequently used in Asia; however study comparing the performance of four charts in Asian population is still limited. In addition, several studies indicate that ratio of lipid parameters have better correlation to severity of coronary artery lesion compared to any single lipid parameter. Methods Patients with diagnosis of stable angina pectoris who underwent coronary angiography were included in this study. The exclusion criteria include known malignancy, current statin treatment, diagnosis of acute coronary syndrome and incomplete data. EURO Heart Risk Score based on the four available charts were calculated for each patient. The severity of coronary artery lesion was evaluated by modified Gensini Score. The correlation between EURO Heart Risk Scores and modified Gensini Score was analyzed. Results A total 102 patients were included in this study. Majority were male (77 patients [75.5%]) with mean age 56,76 ± 8,85. Although total cholesterol/HDL ratio correlate better with the modified Gensini Score compared to total cholesterol alone, however EURO Heart Score calculated using chart based on total cholesterol have better correlation to the modified Gensini Score; with the strongest correlation was found between EURO Heart Risk Score calculated using chart based on total cholesterol in population at high risk cardiovascular disease (Table 1). Conclusion EURO Score calculated using chart based on total cholesterol in high risk population have strongest correlation to the severity coronary artery lesion compared to other algorithms and thus should be the chart of choice in Asian population. Table 1 Correlation between EURO Heart Risk Score Algorithms to the Modified Gensini Score Variables r p value Total Cholesterol 0.219 0.013 Total Cholesterol/HDL Ratio 0.360 <0.001 EURO Score-Total Cholesterol in High Risk Population 0.575 <0.001 EURO Score-Total Cholesterol in Low Risk Population 0.553 <0.001 EURO Score-Total Cholesterol/HDL in High Risk Population 0.506 <0.001 EURO Score-Total Cholesterol/HDL in Low Risk Population 0.514 <0.001 Variables r p value Total Cholesterol 0.219 0.013 Total Cholesterol/HDL Ratio 0.360 <0.001 EURO Score-Total Cholesterol in High Risk Population 0.575 <0.001 EURO Score-Total Cholesterol in Low Risk Population 0.553 <0.001 EURO Score-Total Cholesterol/HDL in High Risk Population 0.506 <0.001 EURO Score-Total Cholesterol/HDL in Low Risk Population 0.514 <0.001 Open in new tab Pericardial effusion in systemic lupus erythematosus N. P. H. Lugito N. P. H. Lugito Internal Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia A. Kurniawan A. Kurniawan pericardial effusion systemic lupus erythematosus Abstract Background Pericardial effusion is considered as one of criteria to diagnose systemic lupus erythematosus (SLE) based on American Rheumatism Association (ARA) criteria. There is limited data about the incidence and characteristic pericardial effusion in SLE patients in our country. The aim of this study is to report and assess the incidence of and characteristic pericardial effusion in SLE as a cardiac manifestation of the disease. Methods This is cross-sectional study conducted in secondary referral hospital in Tangerang county, west part of Jakarta, capital city of Indonesia. We evaluated from medical record and echocardiogram data from 2013-2015 patients diagnosed with SLE according to ARA criteria. Clinical characteristic of SLE and cardiac symptoms related to pericardial effusion were recorded. Results From 33 SLE medical records reviewed, we found 13 patients (40%) with pericardial effusions. All patients were in active stage. Clinical assessment and transthoracic echocardiogram were used to diagnose pericardial effusions. Eighty percent pericardial effusion positive patients had minimal effusion. The others had moderate effusion. No tamponade patients were recorded. Ninety six percent patients were female with median age 24(13-51) years old. Three patients were reported having pulmonary arterial hypertension. One patient had thrombus in left ventricle. All patients had clinical symptoms of cardiac such as heart failure and chest pain. Conclusion The incidence of pericardial effusion in SLE patient was 40 percent. Eighty percent patients had minimal effusion. All patients had cardiac symptoms related. Intracardiac metastasis of hepatocellular carcinoma N. P. H. Lugito N. P. H. Lugito Internal Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia A. Kurniawan A. Kurniawan Hepatocellular carcinoma Intracardiac metastasis Abstract Background Cardiac metastases are not as low as expected and range from 2.3% to 18.3%. There were several cases reported hepatocellular carcinoma as the secondary cancer in cardiac, especially in Asian country. There is limited data about the type and characteristic of intracardiac metastasis in our country. The aim of this study is to know the type and characteristic of intracardiac metastasis. Methods This is cross-sectional study conducted in secondary referral hospital in Tangerang county, west part of Jakarta, capital city of Indonesia. We evaluated from medical record and echocardiogram data from 2013-2015. The type of cancer, characteristic and survival of cancer patients were recorded. Clinical symptoms related to cardiac also recorded. Results There were 5 patients recorded having intracardiac metastasis. All patients had hepatocellular carcinoma as primary tumor. All patients were male with median age 56(53-61) years old. Three patients had tumor in right atrial and the other 2 patients had tumor in right ventricle. Four patients were diagnosed using transthoracic echocardiograph and the rest using multi sliced CT scan. All patients were having continuous thrombus from inferior cava vein until right atrial. All patients were recorded died just several weeks after diagnosed. All patients had clinical heart failure especially right heart failure. No arrhythmias symptoms and sign were reported. Conclusion Hepatocellular carcinoma patients were reported as the cause of intracardiac metastasis in our county. All patients were in late stage. Myocardial bridging assessed by computed tomography scan: A cause of chest pain in patients without obstructed coronary arteries N. Elen N. Elen C. A. Atmadikoesoemah C. A. Atmadikoesoemah M. Kasim M. Kasim Department of Cardiology and Vascular Medicine, Faculty of Medicine,University of Indonesia – National Cardiovascular Heart Center Harapan Kita, Jakarta, Indonesia N. Salim N. Salim W. Saragih W. Saragih K. B. Aji K. B. Aji T. M. Haykal T. M. Haykal A. Parlautan A. Parlautan myocardial bridging computed tomography (CT) chest pain Abstract Background Myocardial bridging is an anomaly in which a segment of one of the major coronary arteries takes intramyocardial route. Several studies showed that this anomaly can cause hemodynamic changes that may be associated with angina. Myocardial bridging classified as superficial or deep with respect to the depth (≤ 1 or > 1 mm). Recently, computed tomography scan appears to have a higher sensitivity than coronary arteriography for detecting this anomaly. Methods A total of 1066 Harapan Kita Hospital patients in 2015 with chest pain and suspected coronary disease but without previous coronary artery disease underwent MSCT using a 128-slice instrument. The results were retrospectively reviewed by Cardiovascular Imaging Team in National Cardiovascular Center, Harapan Kita hospital. Results Of the 1066 patients (mean age 55 years, 54.7 % male), normal coronary arteries and non obstructed coronary arteries were found in 609 of 1066 (57.1%) patients. Myocardial bridging was observed in 31 of 690 patients (4.4%). Superficial type was found in 17 of 31 (54.9%) cases and deep type was found in 14 of 31 (45.1%) cases. Most of the myocardial bridging found in the mid left anterior descending (LAD) (77.4%), followed by distal LAD (16.1%), and proximal LAD (6.5%). No myocardial bridging was seen in the left circumflex or right coronary arteries. The mean length of a tunneled segment for superficial type was 14.3 ± 6.7 mm. The mean length and depth of a tunneled segment for deep type were 20.4 ± 7.8 mm and 2.0 ± 0.6 mm, respectively. Atherosclerotic plaques were found in 32.2% patients proximal to tunneled segment. There were significant differences in pain characteristic between superficial and deep type of myocardial bridging. Typical angina was more often found in deep type than superficial type (P = 0.045). Conclusion MSCT can be used to detect myocardial bridging in patients presented with chest pain. Further evaluation are needed to optimize therapy and prevent coronary event. Correlation between resting heart rate and 6-Minute Walk Test distance in systolic heart failure patients A. Tobing A. Tobing H. William H. William A.A. Siregar A.A. Siregar Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Sumatera Utara, Haji Adam Malik General Hospital Medan, Indonesia A.H. Raynaldo A.H. Raynaldo D. Yulianda D. Yulianda resting heart rate 6-MWT systolic heart failure Abstract Background Earlier studies showed that resting heart rate (HR) to be an independent predictor of cardiovascular events and mortality. 6-Minute Walk Test (6-MWT) distance reflects the functional capacity and has prognostic value to predict the mortality of systolic heart failure (HF) patients. Methods A retrospective study involving 40 patients who were admitted to the cardiac care unit at RSUP H Adam Malik Medan with systolic HF during February until May 2015. A 6-minute walk test was done before the patients were discharged from the hospital. Resting HR was measured by palpation and cardiac auscultation at resting state before the test, then we count the distance that the patient can reach in 6-MWT. Results A total of 40 patients, 33 males (82,5%) and 7 females (17,5%) with systolic heart failure (EF ≤ 35%) were included in this study. Mean age 55,4 ± 9,01 years, Mean resting HR 83,22 ± 12,15 bpm, mean 6-MWT distance 29,44 ± 82,80 meters. Resting HR has significant moderate negative correlation (r = 0,461) with the 6-minute walk distance (p = 0,003). Conclusions There is significant negative correlation between the resting HR and 6-minute walk distance of the systolic heart failure patients. Severe pulmonary hypertension is a predictor of mortality in pregnant unoperated atrial septal defect A.B. Hartopo A.B. Hartopo 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia D.W. Anggrahini D.W. Anggrahini 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia K. Nakayama K. Nakayama 2 Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University School of Medicine, Kobe, Japan N. Emoto N. Emoto 2 Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University School of Medicine, Kobe, Japan 3 Department of Clinical Pharmacy Kobe Pharmaceutical University, Kobe, Japan Y. Suzuki Y. Suzuki 3 Department of Clinical Pharmacy Kobe Pharmaceutical University, Kobe, Japan L. Krisdinarti L. Krisdinarti 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia Pulmonary hypertension atrial septal defect pregnancy mortality Abstract Background Atrial septal defect (ASD) mostly affects woman and pregnancy in this illness associates with increased maternal risk especially in those with pulmonary hypertension (PH). Undiagnosed, therefore unoperated, ASD not uncommonly comes with severe symptom excacerbate by pregnancy. Aims To investigate the predictor of mortality among pregnant unoperated ASD patients. Methods Registry of ASD-PH was initiated in 2012 in Dr. Sardjito Hospital Yogyakarta Indonesia. The data of pregnant ASD is retrieved. Demographic, clinical, obstetrics and echocardiography data is collected and compared between two groups, i.e. survive and non-survive. Student's T test and chi square test are constructed to analyse the data between two groups. Statistical significance is determined when p value < 0.05. Results Forty-two pregnant ASD patients are analysed. Most of them (55 %) have severe PH. Six patients are died in hospital (non-survive). The non-survive group has a significantly higher tricuspid valvular gradient (112 mmHg versus 63 mmHg, p = 0.002), higher RV systolic pressure (120 mmHg versus 70 mmHg, p = 0.002) and higher WHO functional class as compared with survive group. Among non survive, four patients (67%) are primigravida with mean gestational age 31,2 weeks at time of first encounter and all patient chief complaints are dispnea . The mode of delivery is sectio caesarea (5 patients), while 1 patient undergo pervaginam delivery. All non survive have severe PH and 5 of them (83 %) are Eisenmenger syndrome. Mode of death are associated with desaturation and respiratory failure. Conclusion Severe PH and high WHO functional class are predictors of mortality in pregnant ASD patients. High plasma level of soluble ST2 associated with adverse outcomes during acute phase of ST-elevation myocardial infarction A.B. Hartopo A.B. Hartopo 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia I. Sukmasari I. Sukmasari 2 Department of Clinical Pathology Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia I. Puspitawati I. Puspitawati 2 Department of Clinical Pathology Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia B.Y. Setianto B.Y. Setianto 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia soluble ST2 ST-elevation myocardial infarction adverse outcomes Abstract Background Soluble ST2, a myocardial stretched biomarker, was released during acute myocardial infarction by cardiomyocites. Its role on adverse outcomes during acute phase needs to be corroborated. Aims To investigate the role of soluble ST2 on predicting in-hospital adverse outcomes during acute phase of ST-elevation myocardial infarction. Methods Cohort study enrolling 95 consecutive patients with ST-elevation acute myocardial infarction was performed. The inclusion criteria were ages 30-75 years and onset < 24 hour. The exclusion criteria were chronic kidney disease, chronic heart failure, acute infection, acute stroke and preadmisi reperfusion. Soluble ST2 level was measured from peripheral blood taken on admission, before reperfusion procedure commenced, with Aspect-PLUS ST2 rapid test. Follow-up during intensive hospitalisation were performed to detect in-hospital adverse outcomes, i.e. death, acute heart failure, cardiogenic shock and rescucitated ventricular arrhytmia. For analytical purpose, two groups were constructed based on soluble ST2 level, i.e supramedian group and inframedian group. The incidence of adverse outcome between groups was compared. Logistic regression analysis was performed for multivariable analysis. A p value < 0.05 was deemed statistically significant. Results Using Aspect-PLUS ST2 with detection limit 12.5 ng/ml – 250 ng/ml, the median soluble ST2 level was 152.1 ng/ml. Supramedian group (n = 47) had higher incidence of adverse outcome as compared with inframedian (n= 48), i.e 38.3 % versus 12.5 %, p =0.004. Fatal outcome did not significantly differ between groups. No significant difference of baseline characteristics, such as Killip class, gender, diabetes mellitus, hipertension, previous ischemic heart disease, anterior STEMI, coronary artery disease extent and reperfusion strategy, between groups. Multivariable analysis showed that supramedian ST2 level independently associated with high incidence of of adverse outcome (adjusted OR 8.3, 95% CI 1.8-36.9, p 0.005). Conclusion High level of soluble ST2 independently associated with adverse outcomes during acute phase of ST-elevation acute myocardial infarction. Effect of extracorporeal shockwave myocardial revascularization on spatial QRS – T angle resolution in stable coronary artery disease patients A. Saboe A. Saboe 1 Department of Cardiology and Vascular Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia K. P. Surjadi K. P. Surjadi 2 Santosa International Hospital, Bandung, Indonesia B.B. Tiksnadi B.B. Tiksnadi 1 Department of Cardiology and Vascular Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia E. Martanto E. Martanto 1 Department of Cardiology and Vascular Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia A. Purnomowati A. Purnomowati 1 Department of Cardiology and Vascular Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia T. M. Aprami T. M. Aprami 1 Department of Cardiology and Vascular Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia Extracorporeal Shockwave Myocardial Revascularization Spatial QRS – T angle Abstract Background Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms of ischemia in patients with refractory angina. Spatial QRS – T angle (spQRSTa) predict potently arrhythmic events and mortality in various patients groups. The objective of this study was to determine the effect of ESMR on spQRSTa in stable coronary artery disease (CAD) patient. Methods A retrospective cohort study of serial cases was conducted in ESMR division Hasan Sadikin Hospital, Bandung on March 2015 – August 2015. The inclusion criterias were patients who sent to ESMR division with Canadian Cardiovascular Society (CCS) class III–IV angina despite medical therapy scan who can't performed or refused to perform revascularization procedures and complete all cycles of ESMR therapy. Baseline echocardiography and nuclear scan were performed in all patients. Baseline ECG and spQRSTa was measured before and 4 months after completion of therapy. The exclusion criterias were patients who didn't complete full cycle of ESMR therapy and patients with incomplete data. We treated the patients with our cardiac shock wave therapy (100 shots/spot, 3 to 6 spots, 3 times a week) with 4 weeks interval on week 1, 5, and 9. Results Five patients (4 men, 1 woman; median age 68.8 years, range 44-80) were included in this study. All patients had documented ischemia on nuclear scan and abnormal regional wall motions on echocardiography. There was reduction on spQRSTa angle in all patients, and the most significant reduction was found in patient with the largest spQRSTa baseline. Conclusion All patients showed improvement of spQRSTa on serial ECG. This demonstrates the potential efficacy of ESMR on reducing ischemic burden in symptomatic stable CAD patients. A larger study is supposed to be done to conclude analyze whether spQRSTa changes is in tune with improvement in ischemic after ESMR. Fragmented QRS study, does it have any structural abnormality relation? A. Damarkusuma A. Damarkusuma H.P. Bagaswoto H.P. Bagaswoto H. Mumpuni H. Mumpuni E. Maharani E. Maharani Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta Fragmented QRS heart failure structural abnormality Abstract Background As one of the ECG markers, fragmented QRS (fQRS) is proposed to have diagnostic value to show myocardial fibrosis or scar on the patient and numerous cardiac diseases. This study was done to know whether the ECG markers show any structural abnormalities in heart failure patients. Methods Cohort retrospective study of the association between fQRS in heart failure patients who went to Sardjito General Hospital in 2015 was performed. FQRS is defined as additional R wave (R') or a notch in nadir S wave, or manifestation of >1 R', various RSR patterns such as more than R waves (R'') or more than two notches in a R wave, or more than 2 notches in S wave in 2 adjacent leads. Afterwards, two independent investigators analysed these ECGs blindly before assess the echocardiogram. Results Total 104 patients were included in this study with mean of age are 58.38 ± 9.43 years old in which 75 (72.1%) of them are male and 29 (29.1%) are female. Sixty one (58.7%) patients had fQRS feature on the EC. Then, fQRS feature in anterior-segment was found in 4 (3.8%), 1 (1%) in lateral-segment, 35 (33.7%) in inferior-segment, and 21 (20.2%) in infero-lateral. Structural abnormalities were analysed with result LA Dilatation (RR: 1.078, 95% CI 0.67-1.73; p: 0.84), Septal hypertrophy (RR: 0.71, 95% CI 0.46-1.08; p: 0.16), Reduced EF (RR: 0.81, 95% CI 0.52-1.25; p: 0.42), RV Disfunction (RR: 1.007, 95% CI 0.58-1.77; p: 1.00), and PH (RR: 1.67, 95% CI: 0.68- 1.06). These results show no evidence of association between fQRS and abnormalities heart structure. Conclusion FQRS has no evidence to show any abnormalities heart structure in the heart failure patients. Risk of coronary artery lesions severity to erectile dysfunction incidence in stable coronary heart disease patients A.B. Kurniawan A.B. Kurniawan I. Andiarso I. Andiarso N. Taufiq N. Taufiq Department of Cardiology and Vascular Medicine, Faculty of Medicine Gadjah Mada University/dr Sardjito General Hospital, Yogyakarta Severity of coronary artery lesions erectile dysfunction stable coronary heart disease Abstract Background Atherosclerosis is the underlying process of coronary heart disease. Atherosclerosis is preceded by endothelial dysfunction caused by systemic mechanical and chemical stressors that may occur throughout the blood vessels. Erectile dysfunction (ED) is a clinical manifestation might be caused by atherosclerosis in iliaca or pudendal artery. It can be also due to other factors such as neurogenic, psychogenic, endokrinogenic, and fibroelasticity. The most responsible factor cause of ED has not been known in patients with coronary heart disease. Previous studies have established the relationship between coronary artery involvement and the incidence of ED, but the odds of risk has not been well established. Methods This was an age matched-paired case-control study. Erectile dysfunction in CHD patients who had undergone coronary angiography was checked by IIEF - 5 questionnaire. The severity of coronary artery lesion was assessed with a Syntax score that were assessed by a single experienced observer, blind method and were shown consistency test. Then, the risk of coronary artery lesion severity of the ED was analyzed by chi square test using SPSS version 20 . Result There are 86 subjects consist of 57 subjects in the case group and 29 subjects in the control one. Stable CHD patients with high Syntax scores had 2.746 times risk for development of ED compare with low Syntax scores patients ( OR : 2.746, 95 % CI : 1.08 to 6.95, p = 0.031 ). The severity of coronary artery lesions were not statistically significant as an independent factor as the incidence of ED. Conclusion Stable CHD patients with higher severity of lesions in coronary artery have a higher risk of ED than patients with lower severity of the lesion but was not statistically significant as an independent factor on the incidence of ED. Clinical profiles and outcomes of patients with ST-Elevation Acute Coronary Syndrome (STE-ACS) in non-primary PCI capable hospital A. Rezeki A. Rezeki 1 Division of Cardiology, Sentra Medika Cibinong Hospital, Bogor, Indonesia B. Widyantoro B. Widyantoro 1 Division of Cardiology, Sentra Medika Cibinong Hospital, Bogor, Indonesia 2 National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia ST Elevation - Acute Coronary Syndrome arrhythmia acute heart failure cardiogenic shock predictors Abstract Background Despite an aggressive treatment, patients with ST Elevation - Acute Coronary Syndrome (STE-ACS) still have high mortality, especially for those who were not get revascularization. The aim of this study was to analyze clinical profiles, complication and outcomes in patients with STE-ACS admitted to Cardiac Intensive Care Unit in Sentra Medika Cibinong Hospital, a rural non-primary PCI capable hospital. Methods This study was a retrospective cohort study with a total of 34 patients with STE-ACS who registered in Cardiovascular Intensive Care Unit in our hospital in 2015. We obtained data from medical record and analyze using bivariate and multivariate analysis. Results A total of 149 patients admitted to emergency room with ACS, and 51 (34.2%) presented with STE-ACS. Thirty four of STE-ACS patient admitted to ICCU. Demographic data showed that most of patients were men (82.4%), less than sixty-five years old (70,6%) and 97.1% patients are survived. Diabetes Mellitus (DM) (26,5%), hypertension (52.9%), smoking (76.5%), history of chronic heart disease (38.2%) are analyzed as risk factors. Twenty two patients (64.7%) present with onset of symptom less than 12 hours, and among those, 14 patients (63.6%) received fibrinolytic therapy, three patients (13.6%) treated with fibrinolytic and followed by early PCI (pharmaco-invasive strategy), and another 5 patients refused revascularization. The others received optimal medical therapy without revascularization due to late onset of presentation. Complications are arrhythmia (11.8%), Acute Heart Failure (AHF) during hospitalization (20.6%), and cardiogenic shock (11.8%) in this hospital. Hypertension is associated with cardiogenic shock (p <0.05) but we could not get the value of OR. One patient with cardiogenic shock was not survive during hospitalization. Conclusion Hypertension is associated with incident of cardiogenic shock as one of complication in STE-ACS. Among all risk factors analyzed, we are not able to find independent predictor for all complication, which may due to limited number of patients. Correlation between QTc and QTcD with all caused in-hospital mortality after thrombolytic theraphy in Dr.Moewardi Hospital, Surakarta A. K. Martiana A. K. Martiana 1 Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia P. Septiani P. Septiani 1 Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia A. Jalaludinsyah A. Jalaludinsyah 1 Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia H. Arifianto H. Arifianto 1 Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia T. Wasyanto T. Wasyanto 2 Department of Cardiology and Vascular Medicine, Dr.Moewardi Hospital, Surakarta, Indonesia QTc QTcD STEMI Thrombolytic in-hospital mortality Abstract Background Both a prolonged QT interval (QTc) and increased QT interval dispersion (QTcD) have been proposed as surface ECG markers of vulnerability to ventricular arrhythmias and potential predictors of mortality. QTcD is equal to longer QTc minus shorter QTc measured by 12-lead electrocardiogram (ECG). QTcD reflects inhomogeneity in repolarization of ventricular myocardium.The aim of this study is to evaluate the correlation between QTc and QTcD with all caused in-hospital mortality after thrombolytic theraphy. Methods We retrospectively measured the QTc and QTcD on the 12 standard surface ECG leads in 28 patients with ST Elevation Myocardial Infarction (STEMI) underwent thrombolytic theraphy, who admitted to Department of Cardiology and Vascular Medicine, Dr. Moewardi General Hospital, Solo from December 2015 – January 2016. Streptokinase was the thrombolytic agent uses in all patients.The 12-lead ECG was recorded an hour after receiving streptokinase. We calculated the QTc according to the Bazett's formula, then we counted the QTcD, and the data were observed with all caused in_hospital mortality as primary end point. Spearman Correlation analyses was used with p <0.05 significant. Results Among died patient prolonged QTc were found (484 ± 63 ms), and shorter QTcD were found in discharged patient (56 ± 16 ms), while longer QTcD were found in died patients (118 ± 44 ms). This study demonstrated that they were moderately positive correlation between QTc and in-hospital mortality (p = 0.004, r = 0.531), and moderately positive correlation between QTcD and in-hospital mortality (p = 0.000, r = 0.686). Conclusion Prolonged QTc and increased QTcD were correlated with all caused in-hospital mortality after thrombolytic theraphy. Functional capacity improvement after newly-modified cardiac rehabilitation programe in post-revascularized coronary artery disease patients B. B. Tiksnadi B. B. Tiksnadi 1 Department of Cardiology and Vascular Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia M. Aziz M. Aziz 1 Department of Cardiology and Vascular Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia M.S. Chesario M.S. Chesario 1 Department of Cardiology and Vascular Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia M. Renaldi M. Renaldi 1 Department of Cardiology and Vascular Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia S. B. Sastradimaja S. B. Sastradimaja 2 Department of Physical and Rehabilitation Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia A. Purnomowati A. Purnomowati 1 Department of Cardiology and Vascular Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia T. M. Aprami T. M. Aprami 1 Department of Cardiology and Vascular Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia Abstract Background Improved functional capacity might has a better prognostic for post-revascularized-cardiac patients. We studied the effects of newly-modified Cardiac Rehabilitation Programe in improvement of functional capacity and its correlation with some factors that might influence it. Methods The study was observational, consecutive, without control group, in post-revascularization CAD patients, who attended Phase II Cardiac Rehabilitation Programe in Cardiac Rehabilitation Gymnastium, Hasan Sadikin Hospital Bandung, from October 2014-May 2015. The program lasts for 4-8 weeks (twice weekly), consisted of 6-12 education session and supervised aerobic exercises (using ergocycle and/or treadmill). Aerobic exercise was held for 30 minutes of moderate intensity [50-80% Heart Rate Reserve (from entrance maximal treadmill test) and/or Borg scale 11-15] with continuous training method. All patients were also prescribed home exercise program. Functional capacity and high-sensitive-C Reactive Protein (hs-CRP) was measured before and after the program. Functional capacity was assessed by maximal treadmill test, and VO2 max was determined from reference table. Results Fourty four patients were enrolled to this study with 7 of them were excluded (4 drop-out, 1 loss to follow-up and 2 incomplete procedure). A total 37 patients were analyzed, consisted mainly of men (81%); mean age 56.05 years; and 78.4% of them were post PCI. Our study showed that after this newly-modified cardiac rehabilitation program, the functional capacity increased significantly from mean 6.75 to 8.67 METs; increasing 28,4 % with p = 0.000. The median of METs differences was 1.68 METs. After a linear regression analysis, the improvement of fitness was associated with baseline METs (p = 0.000) and baseline hs-CRP (p = 0.006), and not influenced by age, gender, ejection fraction and type of procedure. Conclusions Newly-modified exercise-based cardiac rehabilitation program significantly increases functional capacity in post-revascularized CAD patient, and more prominent in patient with low functional capacity and high hs-CRP at baseline. Acute heart failure and diabetes are predictors for mortality in 6 months follow up after acute coronary syndrome B. Widyantoro B. Widyantoro D.A. Juzar D.A. Juzar I. Firdaus I. Firdaus S.S. Danny S.S. Danny D. Zamroni D. Zamroni S. Dharma S. Dharma Irmalita Irmalita D.P.L. Tobing D.P.L. Tobing Department of Cardiology and Vascular Medicine, Universitas Indonesia – National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia Abstract Background Despite aggressive intervention, morbidity and mortality of patients with acute coronary syndrome (ACS) remain high. Various clinical condition may contribute to the outcomes during hospitalization and after discharge. The aim of this study was to analyze predictor of mortality after follow up of 6 months in patient with ACS. Methods We examined 1315 consecutive patients admitted to CVCU with ACS in National Cardiovascular Center Harapan Kita Hospital during September 2014 to September 2015. After discharge, patients were followed up to 6 months for the clinical condition and cardiac event. Various clinical parameters were analyzed with multivariable logistic regression as predictors for mortality after 6 months follow up. Results Among 1315 patients, 786 (59.8%) were diagnosed as STEMI and 529 patients were UA or NSTEMI. In hospital mortality were 76 out of 1315 patients (5.7%), including 47/786 (5.9%) of STEMI patients and 29/529 (5.4%) of UA/NSTEMI patient. We followed 1268 patients and after 6 months, we observed 20 patients died from all cause (1.57%). STEMI patients who failed to survive during 6 months follow up most likely suffered from acute heart failure (AHF) and diabetes. However, after multivariable risk adjustment, only AHF remain independent predictors (odds ratio 6.32; 95% CI 1.66-24.05). Almost similar findings were observed in UA/NSTEMI population, with diabetes and AHF become strong predictor for mortality after 6 months (odds ratio 0.12; 95% CI 0.01-1.01 and odds ratio 10.59; 95% CI 1.3-85.8). We also observed interesting findings that 9 patients with UA/NSTEMI complicated with cardiogenic shock who survived during hospitalization remain alive after 6 months. Conclusion We observed AHF and diabetes as independent predictors for mortality among ACS patients in our center after 6 months of follow up. Respiratory training as adjuvant of phase 2 exercise program decreased systolic pulmonary artery pressure in post mitral valve surgery patients with residual pulmonary hypertension B. Radi B. Radi A. S. Kuncoro A. S. Kuncoro A. H. Joesoef A. H. Joesoef A. M. Soesanto A. M. Soesanto Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia B. Suryaatmaja B. Suryaatmaja Pulmonary Hypertension Post Mitral Valve Surgery Respiratory Training Systolic Pulmonary Artery Pressure Abstract Background Pulmonary hypertension (PH) is an independent factor for mortality, cardiovascular mortality, and heart failure in four years observation of patients underwent mitral valve operation. In patient with open chest surgery, lung physiology and mechanic function deteriorates. This leads to ventilation perfusion mismatch and hypoxia induced pulmonary vasoconstriction, causing problems in recovery post operatively. Respiratory training give beneficial effect on PH. Aims To study the effect of respiratory training as an adjuvant to structured physical exercise in the decrease of pulmonary artery systolic pressure in patient with pulmonary hypertension post mitral valve surgery. Methods A double blind randomized trial was done. Patients who underwent mitral valve operation with residual pulmonary hypertension were taken consecutively and were randomized to be given respiratory training of 50% of maximum inspiratory volume (MIV) as an adjuvant intervention to the current phase 2 rehabilitation program in intervention group vs control group. Systolic pulmonary artery pressure (sPAP) was measured by echocardiography before and after intervention was performed. Result A total of 43 subjects were divided in 2 groups. 21 patients were given respiratory training and 22 patients were in the control group. At the end of study, sPAP in the intervention group was significantly lower compare to the control group (35 [29-39] mmHg vs 43 [40-51] mmHg; p < 0.001) and ΔsPAP in the intervention group was significantly higher compare to the control group (16 [12-30] mmHg vs 3.5[2-4] mmHg; p < 0.001). Conclusion The decrease of sPAP was significantly higher in the intervention group than in the control group. Correlation between Tricuspid Regurgitation Duration with Pulmonary Pressure in Heart Failure Patients C. Kurniawan C. Kurniawan H.P. Bagaswoto H.P. Bagaswoto H. Mumpuni H H. Mumpuni H L. Krisdinarti L. Krisdinarti Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta Heart failure tricuspid regurgitation duration pulmonary hypertension Abstract Background Patient with left heart failure could be accompanied by right ventricular dysfunction due to pulmonary hypertension. In previous study, tricuspid regurgitation duration (TRDc) could be a useful echocardiographic surrogate marker for predicting RV dysfunction in patients with pulmonary artery hypertension, but correlation between TRDc and severity of pulmonary hypertension in heart failure was unclear. This study was aimed to investigate that TRDc is related to severity of pulmonary hypertension is heart failure. Methods We conducted a cross sectional study between November 2014-December 2015. We enrolled 50 patients with chronic heart failure. Tricuspid regurgitation duration was defined as the time between the onset and the cessation of TR flow. RR interval was measured in seconds using electrocardiographic tracing. TR duration was corrected for heart rate using a previously described correction formula: TRDc= TR duration/√(RR interval). We used cut off point TRDc at 400 ms as described in previous study. Pulmonary pressure was measured by tricuspid valvular gradient sum with estimated right atrial pressure by IVC using echocardiography machine. Results The study was done in 32 males (64%) and 18 females (36%), with average age of 56 + 9.07 years old. By Pearson correlation, tricuspid regurgitation duration corrected for heart rate showed positive correlation with pulmonary artery systolic pressure in heart failure patients, but not statistically significant (r = 0.116, p = 0.421). Additionally we found group with TRDc ≥ 400 ms has mean pulmonary pressure higher than group with TRDc < 400 ms, but not statistically significant (44.72 + 15.69 mmHg vs 26.33 + 9.12; p = 0.05). Conclusion There is no correlation between tricuspid regurgitation duration with pulmonary pressure in heart failure patients. Compatibility of myocardial damage observed by echocardiography to MSCT coronary assessment of arterial stenosis in acute coronary syndrome C. Perthy C. Perthy S. Surin S. Surin Harum Sisma Medika Hospital, Jakarta, Indonesia MSCT Coronary speckle tracking echocardiography acute coronary syndrome coronary artery disease Abstract Background Myocardial damage is occured after diminishing oxygen supply to the heart muscle, which is called acute coronary syndrome (ACS). Coronary arterial stenosis is the underlying pathophysiology of ACS. Speckle Tracking Echocardiography (STE) is an assessment tool to see the extent of myocardial damage, while Multislice Computed Tomography (MSCT) Coronary is used to assess the existence of coronary arterial stenosis. Method A cross sectional study was conducted in a year, between January to December 2015, in patients who admitted to Harum Sisma Medika Hospital due to ACS. Both examinations, STE and MSCT Coronary, were conducted in each patients after their condition were stable, usually after three days of hospitalization. The area of myocardial damage observed by STE then was compared to the area of arterial stenosis assessed by MSCT Coronary. Results A total 58 patients were included. The sensitivity and specificity of STE compared to MSCT coronary were 93% and 43%, respectively. This means that STE 93% detected the area of myocardial damage which concordant to the location of coronary arterial stenosis, however its low specificity means it could show false positive for a number of patients with good coronary artery. The positive predictive value (PPV) and negative predictive value (NPV) were 64% and 86%, respectively. Conclusion Since STE had high sensitivity and poor specificity, a person with negative result was very unlikely to have CAD. From the predictive value, subject who was shown not having myocardial damage by STE only had a 14% chance of having arterial stenosis assessed by MSCT coronary. STE was very helpful when showed negative result. Hypolipidemic effect and antioxidant activity of Tamarindus indica (Tamarind) leaves in hypercholesterolemic-fed rats C.A. Aprilia C.A. Aprilia G. Ninditasari G. Ninditasari D. Waluyo B.R D. Waluyo B.R Faculty of Medicine, University of Pembangunan Nasional “Veteran”, Jakarta, Indonesia Extract of Tamarind Leaves (ETL) hypercholesterol hypolipidemic effect antioxidant activity Abstract Background/Aims Higher cost and side effects that made by some anticholesterol drugs which used in long time is the reason why some people change to herb therapy. One of the herb is Tamarindus indica (Tamarind) leaves. This research aims to determine hypolipidemic effect and antioxidant activity of Extract of Tamarind Leaves (ETL). Methods Samples used 25 rats, divided into 5 groups: negative control (CMC 0.5 %), positive control (Ezetrol® (Ezetimibe 1.26 g/KgBW)), ETL 1st, 2nd, and 3rd dose in a row 0,93 g/KgBW, 1,86 g/KgBW, and 3,73 g/KgBW. Results Paired-samples T-test showed ETL significantly lower total cholesterol (TC) and triglyceride level when compared with both control groups (p<0.05), but Low-density Lipoprotein Cholesterol (LDL-C) and High-density Lipoprotein Cholesterol (HDL-C) level had no significant difference (p>0.05). TC level also were analyzed with Kruskal-Wallis test, and triglyceride and LDL-C level were analyzed with one-way ANOVA test. ETL exhibited the significant reduction between groups (p<0.05), but in triglyceride and HDL-C level had no significant difference (p>0.05). Furthermore, the data of TC level were analyzed with Post Hoc test and there was a significant difference between negative control with positive control group and all variance ETL doses (p < 0,05); In LDL-C level there was a significant difference between negative control group with positive control, ETL 1st and 2nd Dose. For antioxidant activity, ETL exhibited the significant reduction in the levels of Malondialdehyde (MDA) (p<0.05). The data of antioxidant activity were also analyzed with one-way ANOVA test, ETL exhibited no significant difference in MDA and Superoxide Dismutase (SOD) level (p>0.05). Conclusion All variance ETL doses h ave hypolipidemic effect and antioxidant activity. ETL also has similar effect with ezetimibe. Saponin, flavonoid, and tanin that is contained likely contribute to these pharmacologic effects. Correlation between pulmonary hypertension and functional tricuspid regurgitation in Cimacan General Hospital R.S.D. Gill R.S.D. Gill 1 Cimacan General Hospital, Cianjur, Indonesia D.R. Syawaluddin D.R. Syawaluddin 2 East Belitung General Hospital, Manggar, Indonesia Pulmonary hypertension Functional Tricuspid Regurgitation Abstract Background Functional Tricuspid Regurgitation(FTR) is a common result of Pulmonary Hypertension(PH). But other factors play a role in determining FTR. The objectives of our study were to determine the distribution of FTR severity in relation to PH and its severity in Cimacan General Hospital. Methods It was a crossectional study conducted from March to August 2015, echocardiography were performed to 22 patients with PH (classified into mild,moderate,severe). An echocardiographic parameter of functional Tricuspid Regurgitation were assessed and patients with FTR devided into 3 groups (mild, moderate, severe TR) . Results From all 22 patients with PH (mild 22.7%, moderate 9.1 %, severe 68.2%),21 patients (95.4%) have FTR ( moderate 36.4%, severe 59.1%,)and 1 patient (4.5%) was normal. A strong positive correlation (r = 0.450, P value 0.018 < 0.05) was shown between PH severity and FTR severity. Conclusion Pulmonary hypertension has a strong positive correlation with Tricuspid Regurgitation. Correlation knowledge and attitude regarding behaviour of controlling blood pressure in elderly hypertension patient in Manggar District D.R. Syawaluddin D.R. Syawaluddin E.C. Azlina E.C. Azlina N. Ruth N. Ruth East Belitung General Hospital, Manggar, Indonesia Knowledge attitude, behaviour hypertension Abstract Background The world prevalence of hypertension is 15-37% of the adult population. Half of the population itself are people above 60 years old suffering hypertension. Hypertension in Indonesia is as high as 25.8%, the highest in Bangka Belitung (30%). Hypertension is a stern matter, as people do not take them seriuosly. Aim of this study was to analyze the correlation between knowledge and attitude regarding behaviour in elderly hypertension patients in Manggar District. Methods A cross sectional design was used in this corelational study, and conducted from April through September 2015. The subject were elderly above 60 years old suffering hypertension and attended the community health center within the area of manggar community health center. Questioner was used as the instrument Result From 170 participants, 148 respondents (87.1%) represent good knowledge, 142 respondents (83.5%) represent positive attitude, 93 respondents (54.7%) represent good behaviour. Respondent that acquired good knowledge and good behaviour were as much as 93 people (54,7%), respondents that acquired low level of knowledge and bad behaviour were 22 people (12,9%), respondent that represent positive attitude and good behaviour shows 93 respondent (54.5%), respodent that represent negative attitude and bad behaviour were 28 people (16,5%). The correlation result of Spearman rank showed p = 0.000, r = 0.424 for the correlation between knowledge and behaviour, p = 0.000, r = 0,488 for the correlation between attitude and behaviour. From the logistic regretion result showed p = 0.000, r= 0,879 for the correlation between knowledge and attitude regarding the behaviour of controlling blood pressure. Conclusion There was a significant correlation between knowledge and attitude regarding behaviour of controlling blood pressure of elderly hypertension patients in Manggar District. Correlation of lipid profile and high sensitivity C-reactive protein among young people D. Budiono D. Budiono 1 Faculty of Medicine, University of Sam Ratulangi, Manado, Indonesia J. H. Surentu J. H. Surentu 1 Faculty of Medicine, University of Sam Ratulangi, Manado, Indonesia M. Melatunan M. Melatunan 1 Faculty of Medicine, University of Sam Ratulangi, Manado, Indonesia M. Mailangkay M. Mailangkay 1 Faculty of Medicine, University of Sam Ratulangi, Manado, Indonesia J. A. Pangemanan J. A. Pangemanan 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Sam Ratulangi, Prof Dr. R.D.Kandou General Hospital, Manado, Indonesia Atherosclerosis lipid profile high sensitivity c-reactive protein young people Abstract Background Cardiovascular disease (CVD) is the leading cause of death worldwide. The most frequent forms of CVD, coronary heart disease is almost always due to presence of atherosclerotic plaque. Necropsy studies have demonstrated that the development of atherosclerosis plaque begins early in life. Induced by dyslipidemia, inflammation plays a crucial role in the pathogenesis of the different stages of atherosclerosis. High sensitivity C-reactive protein (hs-CRP) is a biomarker of low grade inflammatory state, which characterizes an atherosclerotic process. This study aimed to know the correlation of lipid profile and Hs-CRP levels among young people. Methods A cross sectional study involved 34 young people aged 16 to 20 years. They didn't have infectious, malignancy, or another chronic disease. They didn't smoke, take lipid-lowering drug, and drink alcohol regularly. The correlation of lipid profile and hs-CRP were analyzed using Spearman's correlation Test. Results In this study, the mean of lipid profile were following: LDL 117.65 ± 26.558 mg/dL; HDL 46.32 ± 8.02 mg/dL; triglyceride 90.53 ± 35.22 mg/dL; total cholesterol 173 ± 27.25 mg/dL. The mean of Hs-CRP level 1.291 ± 1.33 mg/L. The correlation of Hs-CRP level and lipid profile were following, Total cholesterol: r = 0.18 and p = 0.307; HDL cholesterol: r = -0.366 and p = 0.033; LDL cholesterol: r = 0.364 and p = 0.034; Triglyceride : r= 0.214 and p = 0.223. Conclusion High density lipoprotein cholesterol level and low density lipoprotein cholesterol level have weak correlation with Hs-CRP level, meanwhile triglyceride level and total cholesterol level have no correlation with Hs-CRP level. Low-grade chronic inflammation which characterizes an atherogenesis is happening at young age. Increased in-hospital mortality associated with hyponatremia in acute heart failure patients D.K. Firmasyah D.K. Firmasyah D.R. Desandri D.R. Desandri R.S. Pratikto R.S. Pratikto N. Hersunarti N. Hersunarti B.B. Siswanto B.B. Siswanto A.M. Soesanto A.M. Soesanto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia – National Cardiovascular Centre Harapan Kita (NCCHK), Jakarta, Indonesia Hyponatremia acute heart failure in-hospital mortality length of stay Abstract Backround Hyponatremia presents in 10-20% of hospitalized patients with heart failure (HF) and has been identified as predictor of mortality and re-hospitalization. Despite its important prognostic value, there has not been any data showing correlation between hyponatremia with in-hospital mortality and length of hospital stay (LOS) in our center. Methods Analytical cross sectional study involving 969 data of patients with HF as primary diagnosis (ICD I50.0-9) admitted from Emergency Room National Cardiovascular Centre Harapan Kita has conducted from January to August 2015. Hospitalization was defined as hospital admission more than 24 hours. We evaluated baseline demographic characteristic, serum sodium level, osmolality, in-hospital mortality, and LOS. Results Median age was 60 years old. Hypertension was the most encountered comorbid (30.1%), followed by diabetes (23%), Coronary Artery Disease (12.9%), atrial fibrillation (11,8%), and Chronic Kidney Disease (11.6%). Hyponatremia was present in 32% patient, but only 5.4% is true hyponatremia (hypoosmolal-hyponatremia). From multivariate analysis, we found a significant association between hyponatremia and in-hospital mortality (Adjusted Odds Ratio [OR] 4.08; 1.38-11.99). Moderate and severe hyponatremia was associated with increased in-hospital mortality (p < 0.01 for both) but not mild hyponatremia (p = 0.16). In patient with true hyponatremia, we found mortality rate 5.8%, all attributed to the severe case. Median value for LOS was six days (2-40 days). However, we cannot prove there was a significant correlation between hyponatremia and LOS (p = 0.15). Conclusion Heart failure patient with hyponatremia has four times increased risk of in-hospital mortality compared to patients with normal sodium level. The risk is increased with increase in hyponatremia severity. No association between hyponatremia and LOS was proven in this study. The association between different criteria of obesity to the severity of coronary artery lesion D. Tiolung D. Tiolung 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi University, Manado A. Purabaya A. Purabaya 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi University, Manado B. Budiono B. Budiono 2 Cardiovascular Department of Awal Bros Private Hospital, Makassar J. Pangemanan J. Pangemanan 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi University, Manado A.L. Panda A.L. Panda 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi University, Manado B. Setiadi B. Setiadi 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi University, Manado Obesity coronary artery disease type C lesion classification Abstract Background Obesity was one of the important traditional risk factors of Coronary Artery Disease (CAD). Waist circumference (WC) and Body Mass Index (BMI) were the most common criteria used to define obesity; however study regarding the association between these criteria to the severity of coronary artery lesion is still limited. The aim of this study is to analyze the association between obesity defined by WC and BMI to the coronary artery lesion severity. Methods Patients with diagnosis of stable angina pectoris who underwent coronary angiography were included in this study. The exclusion criteria include known malignancy, current statin treatment, diagnosis of acute coronary syndrome and incomplete data. Obesity was determined by measuring WC and BMI. Central obesity was defined as waist circumference ≥ 90 cm in men and ≥ 80 cm in women. In 2000 the Western Pacific Regional Office of WHO (WPRO) proposed an alternative definition obesity (BMI ≥ 25.0) for Asian populations. Severity of coronary artery lesion was determined by using ACC/AHA lesion classification. Statistical analysis was done to analyze the risk of obesity based on WC criteria and BMI criteria in developing type C lesion classification. Results A total 117 patients with diagnosis of stable angina pectoris were included in this study. Obesity based on WC criteria was found in 44 patients; while obesity based on BMI criteria was found in 83 patients. From the statistical analysis, obesity based on WC criteria and BMI criteria were both associated with an increased risk of developing type C lesion classification (Odd Ratio [OR] = 5.316, p= 0.021 and OR= 6.05, p= 0.014). Conclusion Obesity based on WC criteria and BMI criteria are both associated with increased risk of type C lesion classification. Predictor postoperative arrhythmias after pediatric cardiac surgery using aortic cross clamp and cardiopulmonary bypass D.A. Paramita D.A. Paramita 1 Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia T. Wasyanto T. Wasyanto 2 Dr. Moewardi General Hospital, Surakarta, Indonesia G. M. Harimurti G. M. Harimurti 3 National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia arrhythmias pediatric cardiac surgery aortic cross clamp CPB Abstract Background Early postoperative arrhythmias are a known complication of cardiac surgery; however, little data exists specific to pediatrics. The purpose of this study was to determine the incidence and risk factors associated with the emergent of arrhythmias immediately after surgery using aortic cross clamp (AOX) and cardiopulmonary bypass (CPB) in a pediatric population. Methods Data were collected in a retrospective observational format from pediatric patients undergoing cardiac surgeries that were using aortic cross clamp between January and December 2015. This format included age, weight, oxygen saturation, surgical repair, pulmonary hypertension (PH), CPB and AOX times. Patients that had arrhythmias that need intervention to become normal sinus rhythm were reviewed from medical record. Results Arrhythmias occurred in 84 (13.8%) of 610 patients enrolled including 14 (0.02%) with TAVB, 36 (0.06%) with VT/VF, 3 (0.005%) with new atrial fibrillation, 4 (0.006%) with supraventricular tachycardia, and 27 patients (0.04%) with other arrhythmias. Significant differences were found using bivariate analysis between the arrhythmia and non-arrhythmia groups with regard to age (p:0.04); weight (p:0.001); oxygen saturation (p:0.035); PH (p:0,002); CPB time (p:0.001) and AOX time (p:0.001). Operations that carried an increased risk were complete closure of acyanotic congenital heart disease, valve replacement, TOF correction, and atrioventricular septal defect repair. Multivariate analysis showed that three variables — aortic cross clamp time, weight, and PH, were independent predictors of postoperative arrhythmias. Conclusions Postoperative arrhythmias are a frequent complication of pediatric cardiac surgery. Age, weight, oxygen saturation, PH, and CPB and AOX times are risk factors for arrhythmia. Aortic cross clamp time, weight, and PH were independent predictors of postoperative arrhythmias after pediatric cardiac surgery. Table 1 Mean of Variable Affecting the Emergent of Postoperative Arrhythmias Variable Arrhythmias Non-arrhythmia Age 69,12 ± 67,35 50,13 ± 53,39 PH 35 163 Weight 16,25 ± 13,76 12,0 ± 9,77 Oxygen saturation 90,18 ± 11,87 85,86 ± 18,13 CPB time 121,09 ± 75,68 96,46 ± 55,36 AOX time 70,3 ± 47,03 50,68 ± 37,76 Variable Arrhythmias Non-arrhythmia Age 69,12 ± 67,35 50,13 ± 53,39 PH 35 163 Weight 16,25 ± 13,76 12,0 ± 9,77 Oxygen saturation 90,18 ± 11,87 85,86 ± 18,13 CPB time 121,09 ± 75,68 96,46 ± 55,36 AOX time 70,3 ± 47,03 50,68 ± 37,76 Open in new tab Profile of hyperthyroid heart disease patients in National Cardiac Center Harapan Kita : A descriptive study D.Y. Hasanah D.Y. Hasanah R. Soerarso R. Soerarso N. Hersunarti N. Hersunarti B.B. Siswanto B.B. Siswanto Division of Clinical Cardiology, Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Hyperthyroid cardiovascular system symptoms rehospitalization Abstract Background It is well established that common signs and symptoms of thyroid disease are those that result from the effects of thyroid hormone on the heart and cardiovascular system.1 The wide range of hemodynamic changes and cardiovascular complications that accompany hyperthyroidism serve to emphasize the role of thyroid hormone in the physiology of the cardiovascular system.2,3 This study aims to describe patients profile with hyperthyroid heart disease admitted to National Cardiovascular Center Harapan Kita. Methods This is a descriptive study analyzing medical report data of thyroid patients admitted to National Cardiovascular Center Harapan Kita, Jakarta, Indonesia from 2014 to 2015. We described patients profile with hyperthyroid heart disease admitted in NCCHK and we also analyzed association between compliance in thyroid medication and readmission related to thyroid disturbance on the heart and cardiovascular system . Results We analysed 44 patients with hyperthyroid heart disease. The majority of those patients are women (61.36%) with the average age of 51.93 year old. There are other comorbidities concerned in this study such as Hypertension (HT), Diabetes Mellitus (DM), and Dyslipidemia (DL). HT is the most frequent comorbidity in our group of patients, reaching up to 22 patients (50%). Then, among all patients, there are 2 patients (4.55%) suffered from stroke. From echocardiographic findings the average EF value for all patients is 53.86 ± 17.41 and 11 patients (25.00%) with concentric left ventricular hypertrophy. Binomial test is applied to compare proportions among categories. For gender in hyperthyroid patients, proportion of women, which is 61%, is significantly higher than men (p-value 0.002). As for the rhythm, there is no significant difference between those with Atrial Fibrillation (46.51%) and with Sinus rhythm (53.49%) (p-value 0.242). Proportion of Potassium level, known to be reduced in thyroid patients, seemed to be equal between those with normal and lower potassium level (p-value 0.338). The most interesting thing is that most of our patients were diagnosed during hospitalization (64%), despite all the sign and symptoms they've had. Heart failure is the most frequent cardiovascular manifestations related to hyperthyroidism (38.6%) and palpitation (29.5%). Propityourasil (PTU) is the most prescribed medicine mostly used for hyperthyroid (63.6%). Finally, among 29 patients without rehospitalisation, 27 patients (93.1%) have good compliance, meanwhile 15 patients who have hospitalization were mainly because of arrhythmia (AF Rapid Ventricular Response 3%) and non adherence to the thyroid medicine (3%). Conclusion In this study we found that there was a significant different proportion in hyperthyroid heart disease patients in term of gender, potassium level, and timing the diagnosed is performed. Effect of cardiac rehabilitation programs on functional capacity of post coronary revascularization patient with decrease ejection fraction using Six Minute Walk-Test A. Mahavira A. Mahavira 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center, Jakarta, Indonesia D. Yaniarti D. Yaniarti 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center, Jakarta, Indonesia F. Handayani F. Handayani 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Diponegoro/Karyadi Hospital, Semarang, Indonesia B. Radi B. Radi 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center, Jakarta, Indonesia A. Meidian A. Meidian 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center, Jakarta, Indonesia A. Santoso A. Santoso 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center, Jakarta, Indonesia D. Kusmana D. Kusmana 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center, Jakarta, Indonesia B. Setianto B. Setianto 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center, Jakarta, Indonesia Cardiac rehabilitation six minute walk test Abstract Background Coronary artery bypass graft surgery (CABG) is a well-established procedure worldwide due to its safety and effectiveness in treating patients with coronary artery disease.1 Despite the undeniable efficiency, recovery of functional capacity of patients in the postoperative period of cardiac surgery is one of the important aspects.1,2 This study was aimed to compare the improvement of functional capacity using six-minutes walking test (6MWT) after cardiac rehabilitation program in patients with low ejection fraction (EF) having CABG surgery. Methods This is a retrospective study analizing a database of patients who participating in cardiac rehabilitation program after coronary artery bypass surgery with EF < 40%, in National Cardiovascular Center Harapan Kita, Jakarta, Indonesia from 2013 to 2014. We compared pre and post cardiac rehabilitation functional capacity evaluation using 6MWT. We also compared its' relations with patients characteristics such as gender, age, diabetes mellitus (DM), and body mass index (BMI). Results There are 90 selected data of patients after CABG, with EF lower than 40%. Among those patients, 87 patients are men and 3 patients are women. Average age of men is 56.67 + 7.87 years old, while average age of women is 60 + 6.56 years old. The average distance of 6MWT1 is 238.32 ± 139.08 and average distance of 6MWT2 is 290.89 ± 143.29 (p-value = 0.000). Among all men patients, 60 patients (68.97%) are smoker, 37 patients (42.53%) have Diabetes Mellitus (DM), 45 patients (51.72%) have Hypertension (HT), 48 patients (55.17%) have dislipidemia. Average weight of patients is 64.03 ± 23.41 kg. Average BMI of patients is 25.05 ± 5.04. According to result of regression, factors significantly affecting the increase of 6MWT distance are age and DM, whereas the value of BMI does not significantly affect the increase of 6MWT. A one year addition of age reduces the increase of distance by 2.54 (p-value = 0.000) and DM risk factor significantly reduces the increase of distance by 43.60 meters (p-value = 0.000),meaning that patients with DM have increase of 6MWT shorter than patients without DM by 43.60 meters. Conclusion In this study we found that there was a significant difference in terms of functional capacity using six minute walk test before and after 6MWT in CAD patients after CABG surgery with decrease ejection fraction. Eldery and Diabetes Mellitus groups found to have lower improvement in six minutes walk test after cardiac rehabilitation. Association of postoperative hyperglycemia with in-hospital mortality in patients undergoing on pump coronary artery bypass grafting D. Yulianda D. Yulianda T.W. Siagian T.W. Siagian M. Nasri M. Nasri J. Sugandi J. Sugandi Marshal Marshal D. Pohan D. Pohan Z. Mukhtar Z. Mukhtar A.A. Siregar A.A. Siregar Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Sumatera Utara/Adam Malik Hospital, Medan, Indonesia postoperative hyperglycemia hospital mortality diabetes on pump CABG Abstract Background The roles of postoperative hyperglycemia and diabetes in the risk stratification of patients undergoing on pump coronary artery bypass graft surgery are unclear. The aim of this study is to explore the association of postoperative hyperglycemia with in-hospital mortality. Methods This was a retrospective study of 64 patients who undergoing on pump CABG between January 2012 – June 2015 at Haji Adam Malik General Hospital. The studied patients were divided into two groups according to the level of serum blood glucose. Postoperative hyperglycemia defined as increase of serum blood glucose > 180 mg/dl after CABG procedure. All patients were investigated for in-hospital mortality after on pump CABG. Data were analyzed with SPSS version 17.0 software and presented in percentage. Univariate analysis was performed and p value < 0.05 was considered to indicate statistical significance. Result There were 42 patient with postoperative serum blood glucose > 180 mg/dl. A total of 19 patients died during hospitalization (29.7%). Mortality was significantly higher in the hyperglycemic population (odd ratio 6.800; 95% CI 1.402 – 32.972; p = 0.009). Conclusion Postoperative hyperglycemia is associated with increased in-hospital mortality after on pump coronary bypass graft surgery. A comparison successful reperfusion with and without fibrinolytic therapy in acute ST-segment elevation myocardial infarct patients D. Ashrinda D. Ashrinda 1 Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia M. F. Sarahazti M. F. Sarahazti 1 Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia M. Komaria M. Komaria 1 Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia Z. Syahputra Z. Syahputra 1 Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia E. Hasibuan E. Hasibuan 1 Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia Z. Mukhtar Z. Mukhtar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia I. N. Kaoy I. N. Kaoy 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia A.A. Siregar A.A. Siregar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia STEMI fibrinolytic angiography TIMI Flow Abstract Background Patients with acute ST-Elevation Myocard Infarct (STEMI) who present onset 12 hours of symptom, should receive coronary reperfusion therapy, either primary percutaneous coronary intervention (PCI) or fibrinolysis. Intravenous fibrinolytic agents are the most widely used for reperfusion of vessel thrombus occlusion. It remains an important therapeutic modality, due in part to limited availability of primary PCI, and an experienced operator. Successful reperfusion after fibrinolytic therapy proved by coronary angiography, as TIMI Flow 2/3. TIMI flow 2/3 was also associated with decreased incidence of recurrent chest pain, heart failure and mortality than without reperfusion therapy. Methods This was a cohort retrospective study, from January 2014 to December 2015, we found 69 patients with STEMI onset less than 12 hours who came to Adam Malik General Hospital, 31 patients got fibrinolytic agent (case) and 38 patients did not get fibrinolytic agent (control). All of the patients got five days of anticoagulant. Then the TIMI Flow was assesed. Results From fibrinolytic group, we found 5 (9.9%) patients with TIMI flow 0/1 and 26 (55.3%) patients with TIMI flow 2/3. In the non fibrinolytic group 17 (77.3%) patients had TIMI flow 0/1 and 21 (44.7%) patients had TIMI flow 2/3 (spontaneus reperfusion). Statistical analysis (Pearson Chi-square), successful reperfusion result from two groups was significant difference, p = 0.01, Fisher's exact test found 95% Confidence Interval (1,33 - 13,30). For long term follow up, there were no difference from two groups in recurrent chest pain, heart failure, and mortality. Conclusion Fibrinolytic therapy had better successful reperfusion (TIMI flow 2/3). However, successful reperfusion did not influence in events of episode in recurrent chest pain, heart failure and mortality. Factors influencing ventricular function in repaired Tetralogy of Fallot (mid-term evaluation) S. Rifqi S. Rifqi Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro University - dr. Kariadi Central General Hospital Semarang D. Paramita D. Paramita I. Uddin I. Uddin A. Priyatno A. Priyatno tetralogy of fallot total corrective surgery impaired left ventricular function impaired right venticular function Abstract Background Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect. Total corrective surgery on has been shown to increase survival rate among patients, nevertheless the morbidity and mortality rate is still high in repaired TOF, due to impaired left and right ventricular function. The aim of this study was to evaluate factors influencing mid-term ventricular function in repaired TOF. Methods A retrospective cohort study was performed in DR. Kariadi General Hospital Semarang in TOF patients underwent total corrective surgery in National Cardiovascular Center Harapan Kita in 2008-2013. Data from medical records, cardiac catheterization and surgery report were obtained, and patients underwent echocardiography examination to evaluate left and right ventricular function. Statistical analysis was done using Fisher-exact test. Result There were 10 subjects fit the inclusion criteria, with 5 patients (50%) had impaired left ventricular function, and 6 patients (60%) had impaired right ventricular function. Factors influencing left ventricular function were age at operation more than 10 years old and previous BT shunt. While no factors influencing right ventricular function were found significant. Other factors such as left ventricular end diastolic volume index, the use of transannular patch, CPB duration more than 120 minutes dan AoX more than 90 minutes could not be excluded yet as risk factors for impaired both ventricular function. Conclusion Factors influencing left ventricular function in mid-term evaluation were age at operation more than 10 years old and previous BT shunt in patients with smaller pulmonary arteries size compared to half size. While no factors influencing right ventricular function were found significant. Correlation between tricuspid regurgitation duration with right ventricular dysfunction in atrial septal defect patients D. Krisnawati D. Krisnawati D.W. Anggrahini D.W. Anggrahini L. Krisdinarti L. Krisdinarti Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta Atrial septal defect tricuspid regurgitation duration right ventricular function Abstract Background Patient with uncorrected atrial septal defect often complicated with right ventricular dysfunction and pulmonary arterial hypertension. A decrease in the duration of tricuspid regurgitation corrected for heart rate (TRDc) has recently been shown to be associated with advanced right ventricular failure in patients with pulmonary arterial hypertension. The aim of the present study was to investigate whether TRDc correlates with right ventricular dysfunction parameter assessed using echocardiography in patients with atrial septal defect (ASD). Methods We conducted a cross sectional study between September 2012- November 2015. We enrolled 54 patients with ASD. We used tricuspid annular plane systolic excursion (TAPSE) as parameter of right ventricular function. Tricuspid regurgitation duration corrected for heart rate and TAPSE were measured on echocardiography. Tricuspid regurgitation duration was defined as the time between the onset and the cessation of tricuspid regurgitation flow. Tricuspid regurgitation duration was corrected for heart rate using correction formula: TRDc = TR duration /√RR interval. RR interval was measured in seconds using electrocardiographic tracing. Results Fifthy- four consecutive patients with ASD (41 females (75,9%) and 13 males (24,1%), mean age 37 ± 14 years) underwent echocardiography. The mean TRDc and TAPSE were 491.07 ± 55.79 ms and 22.98 ±5.84 mm, respectively. The correlation between TRDc and TAPSE was assessed using linear regression analysis using SPSS 20. Tricuspid regurgitation duration corrected for heart rate was not correlated with TAPSE (r = -0.136, p= 0.328) in atrial septal defect patients. Conclusion Tricuspid regurgitation duration corrected for heart rate was not correlated with right ventricular dysfunction in patients with atrial septal defect. The effect of therapy Spiritual Emotional Freedom Technique (SEFT) changes on blood pressure in elderly hypertension experience in Rejosari Karangan Trenggalek 2015 D.S. Wijaya D.S. Wijaya Brawijaya University, Malang, Indonesia Hypertension SEFT Elderly Abstract Background Period elderly is the last period of human development. Where a person has decreased physical function and social in nature. One method to treat hypertension that is the method of Spiritual Emotional Freedom Technique (SEFT) is by tapping on the 18 key points along the body's 12 energy pathways. This study aims to determine the effect on blood pressure SEFT method especially in the elderly with hypertension in the Rejosari Karangan Trenggalek Year 2015. Methods The method used is pre experiment with one group pretest posttest design. The level of blood pressure before and after the therapy is given in the measure for 6 sessions in 2 weeks. That each session takes 20 minutes and blood pressure measured again. Sampling is done by simple random sampling with a sample of 16 people. Analysis of data using Shapiro Wilk test Paired T Test and analyzed using computer software obtained results ρ value (0,000) < (α = 0.05). Result These results indicate that SEFT therapy effective in lowering blood pressure. The analysis results showed that the therapy SEFT effectively to changes in blood pressure with values (ρ value = 0.000). Conclusion Therefore SEFT therapy can be used as alternative therapy to lower blood pressure in elderly hypertensive patients. By doing non-pharmacological therapy is expected to reduce the patient's physical complaints and can enrich the knowledge and skills. Hyponatremia as a predictor of rehospitalization in patients with acute decompensated heart failure D.R. Desandri D.R. Desandri D.K. Firmansyah D.K. Firmansyah R.S. Pratikto R.S. Pratikto B.B. Siswanto B.B. Siswanto N. Hersunarti N. Hersunarti A.M. Soesanto A.M. Soesanto Department of Cardiology and Vascular Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita hyponatremia rehospitalization acute decompensated heart failure Abstract Background Hyponatremia is known as one of the predictor of mortality in patients admitted with acute decompensated heart failure (ADHF). Whether this factor is a predictor of ADHF rehospitalization is not well established. Methods Cross sectional study were conducted from January until August 2015 in National Cardiovascular Center Harapan Kita, Indonesia. We collected 1153 ADHF cases of all causes from 969 adult patients who were admitted from emergency room. We evaluated baseline demographic characteristics, serum sodium level, osmolality, comorbid factors (such as coronary artery disease (CAD), diabetes mellitus (DM), hypertension, chronic kidney disease (CKD), atrial fibrillation (AF)), and the risk of rehospitalization within eight months. Rehospitalization is defined as more than one admission during follow up period. We calculated the risk of rehospitalization associated with serum sodium on admission and other comorbid factors using bivariate analysis. Result The median length of stay is six days, median age is 60 years old. Hyponatremia was found in 312 patients (32%), 61 of them (5.3%) was true hyponatremia (hypoosmolar hyponatremia). During eight months follow up, there were 124 patients (13%) rehospitalized at least once. Hyponatremia increases the risk of rehospitalizatio with odds ratio 2.38 (95% confidence interval 1.63 – 3.49, p < 0.001). Other comorbid factors, such as CAD (p 0.773), DM (p 0.574), hypertension (p 0.894), CKD (0.422), AF (p 0.673) have no relationship with the risk of rehospitalization based on bivariate analysis. Conclusion Acute decompensated heart failure with hyponatremia has two times increased risk of rehospitalization compared to patients with normal sodium level. Effect of sildenafil therapy to functional capacity in congenital heart disease patient with severe pulmonary hypertension in Sardjito Hospital D. A. Kusumastuti D. A. Kusumastuti 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia D. W. Anggrahini D. W. Anggrahini 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia L. Krisdinarti L. Krisdinarti 2 Echocardiography Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia I. A. Arso I. A. Arso 3 Prevention and Rehabilitation Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia Congenital Heart Disease Pulmonary Hypertension Sildenafil Six-minute walk test Abstract Background Sildenafil therapy was given as therapy to congenital heart disease patient with severe pulmonary hypertension. In some study, sildenafil is associated with improving exercise capacity in Eisenmenger syndrome patient. This study was designed to evaluate functional capacity by six minute walk test in patient with severe pulmonary hypertension due to congenital heart disease who get sildenafil therapy. Methods A retrospective cohort study was established between November 2014 – December 2015 in Sardjito Hospital. We enrolled patients with severe pulmonary hypertension due to congenital heart disease, as diagnosed with echocardiography, who get sildenafil therapy. Functional capacity then measured by six minute walk test before given sildenafil and evaluated 3 months after therapy. Echocardiography was also done before therapy and 3 months after therapy. Results 24 patients (mean age 36.79 ± 11, 100% female, 23 ASD secundum, 1 PDA) were recruited. After 3 months evaluation, there was improvement in six-minute walk test distance (334.83 ± 49.59 meters to 358.47 ± 79.20 meters, p= >0.05), decreased of tricuspid valvular gradient (TVG) (87.17 ± 31.98 mmHg to 85.13 ± 28.69 mmHg, p= >0.05), decreased right ventricular systolic pressure (RVSP) (92.17 ± 32.3 to 89.33 ± 28.69 mmHg, p= >0.05) but decreased of oxygen saturation (94.38 ± 4.61% to 92.46 ± 5.97%, p= >0.05) but all not statistically significant. Conclusion In congenital heart disease patient with severe pulmonary hypertension, there is a trend of increased walking distance from six-minute walk test and decreased of TVG and RVSP after 3 months treatment. Longer time of follow up maybe needed to determine the effect of sildenafil therapy to exercise capacity in congenital heart disease patient with severe pulmonary hypertension. Eisenmenger syndrome is more prevalence in young female patients with uncorrected atrial septal defect: Result of a single-center registry D.W. Anggrahini D.W. Anggrahini A.B. Hartopo A.B. Hartopo L. Krisdinarti L. Krisdinarti Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada/RSUP dr. Sardjito, Yogyakarta, Indonesia Abstract Introduction Eisenmenger syndrome (ES) is the most advanced form of PAH related to congenital heart disease. The natural history of ASD rarely causes PH, thus ES in ASD often questionable as natural history or the PAH with ASD coincidence. Our hospital based registry, however, showed that among adult patients with uncorrected ASD, 69% were suffer from PH with various degrees. Therefore, in this study we aim to report the prevalence and characteristics of ES among ASD patients. Methods We performed a single-center registry of adult patients with uncorrected ASD in RSUP dr. Sardjito since 2012. The diagnosis of Eisenmenger Syndrome was performed using criteria of having bidirectional/right-to-left shunt with resting sianosis. Results One hundred eighty four adult patients with uncorrected ASD from the hospital-based registry in Sardjito Hospital were analyzed. The mean age of the patients was 36.3 ± 12.9 year-old. The prevalence of ES was 31 (16.1%) patients. 30 of them are having secundum type ASD and only 1 patient has multiple ASDs. The mPAP of ES patients was 65 ± 16.8mmHg; mean PVRI was 10.8 ± 1.2 WU; and Qp/Qs was 0.84 ± 1.1. Furthermore, ES was significantly associated with younger age, female, lower SpO2, lower 6MWD, higher mPAP, and TVG as compared to other non PH and PH patients. Interestingly, the ES was more prevalence in young female age 20-40 y.o as compared to the older ones or to male patients (73.4%vs26.9%, p < 0.05). Moreover, they had similar defect size (2.4 ± 0.6vs2.5 ± 0.7mm) showing that the occurrence of ES was not associated with ASD size. Conclusion We reported that the prevalence of ES among uncorrected adult ASD patients was high and independent of defect size. Given that the incidence of ES was in younger female, the nature of ES among ASD were needed further study of genetic background or other factors for excluding other type of PAH. Leuko-glycemic index as an in-hospital prognostic marker in patients with ST-segment elevation myocardial infarction in Haji Adam Malik General Hospital E. Hasibuan E. Hasibuan 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Z. Syahputra Z. Syahputra 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia M. F. Sarahazti M. F. Sarahazti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia D. Ashrinda D. Ashrinda 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia D. Komaria D. Komaria 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia A. Sitepu A. Sitepu 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia H. Hassan H. Hassan 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia A. A. Siregar A. A. Siregar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia Myocardial Infarction leuko-glycemic index Abstract Background Blood glucose and white blood cell count on admission have demonstrated prognostic significance in patients with myocardial infarction; leuko-glycemic index (LGI), a recently proposed marker, still lacks enough knowledge about its value. The aim of this study was to analyze the prognostic value of LGI in patients with ST-elevation myocardial infarction (STEMI). Methods A retrospective study was carried out in 88 patients with ST-segment elevation myocardial infarction, who were admitted on January to October 2015 in Haji Adam Malik General Hospital. Clinical and laboratory data were collected, including glucose and white blood cell count on admission, we calculated the LGI, then divided LGI into two groups according to the median value of LGI and evaluated the prognostic value. Results LGI was correlated with several variables such as KillipIII-IV (r= 0.623, p < 0.001), heart rate on admission (r= 0.235, p = 0.027) and sistolic blood pressure on admission (r= -0.429, p < 0.001). Patients who had a poor outcome such as death and Killip III-IV showed higher values of LGI (p < 0.001). In multivariate analysis, LGI was an independent predictor for death (OR 0.023, 95% CI 0.003-0.215, p = 0.001). Conclusions The LGI was an independent predictor for adverse outcome in STEMI patients (death or Killip III-IV), adding prognostic value to the TIMI risk score. Serum uric acid levels as predictors of incident complications in acute coronary syndrome E. Marfianti E. Marfianti 1 Department of Internal Medicine, Faculty of Medicine, Islamic University of Indonesia Yogyakarta Indonesia U. Setiasih U. Setiasih 2 Faculty of Medicine, Islamic University of Indonesia Yogyakarta Indonesia Levels of uric acid Incidence of Complications Acute coronary syndrome Abstract Background Cardiovascular disease is the highest cause of morbidity and mortality. One of the important cardiovascular disease is a disease of acute coronary syndrome. The role of serum uric acid as a risk factor for cardiovascular disease remains controversial, and not much is known that serum uric acid as a prognostic factor of disease mortality in congestive heart failure and stroke. Several studies have reported an increase in serum uric acid levels associated with the progression of the disease acute coronary syndrome. Objective To determine whether uric acid levels are predictors of complications in the acute coronary syndrome. Methods The study design was cross-sectional. Data was collected with consecutive sampling method of medical record patients with acute coronary syndrome in PKU Muhammadiyah Yogyakarta Hospital and Gramedika Hospital . Acute coronary syndrome patients are patients with a diagnosis of angina pectoris unstable, acute myocardial infarction (myocardial infarction with ST-elevation and myocardial infarction without ST-elevation. Uric acid levels used are uric acid levels were first measured when entering the hospital. Complications of acute coronary syndrome note of complications that occur during hospitalization. Statistical analysis used is descriptive analysis of univariate and bivariate with Chi Square test, considered significant if p <0.05. Results Obtained 80 subjects with acute coronary syndrome patients, Mean of Level uric acid was 8.6 mg / dl. In this study, subjects with high uric acid levels get complications of pulmonary edema 25% subjects, 18.18% heart failure, cardiogenic shock 4.55%, 9.09% and arrhythmias. Medium In the group of high uric acid did not experience complications of pulmonary edema 19.44%, 11.11% heart failure, cardiogenic shock, arrhythmias 0% and 5.56%. Statistical analysis show that no significant association between uric acid levels with the incidence complications of acute coronary syndrome (p> 0.05). Conclusion In this study, subjects with high uric acid levels, had higher incidence of complications, but statitistik meaningless. Anticoagulant therapy in heart failure patients with sinus rhythm F.P. Apriansyah F.P. Apriansyah B.B. Siswanto B.B. Siswanto B.B. Rizki B.B. Rizki Y. Iskandar Y. Iskandar F. Tedjasukmana F. Tedjasukmana R.S. Pratikto R.S. Pratikto N. Hersunarti N. Hersunarti A.M. Soesanto A.M. Soesanto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia National Cardiovascular Center Harapan Kita, Jakarta Heart failure sinus rhythm oral anticoagulant Abstract Background Anticoagulant treatments in heart failure (HF) patients in the absence of atrial fibrillation (AF), intra-cardiac thrombus and venous thromboembolism (VTE) remain controversial. However, the prevalence of patients who received this treatment is quite high. The objective of this study is to figure out the prevalence of oral anticoagulant (OAC) treatments and which factors that might influence the decision to give OAC therapy in such patients. Methods We performed a cross sectional study based on 2012 HF registry conducted in National Cardiovascular Center Harapan Kita, Indonesia. Only sinus rhythm patients were selected, with no other indications for OAC, such as intra-cardiac thrombus, prosthetic valves, or VTE. We compare patients who received OAC to the remaining patients. Results Five hundred forty four patients were included, of which 71% were male and mean age was 61 years. Ischemic etiology was reported in 63% patients. Twenty four percent patients were admitted for de novo HF and 76% for chronic HF. Mean ejection fraction (EF) was 37%. The most frequent comorbidity was hypertension found in 63% patients, followed by diabetes (47%) and chronic kidney disease (30%). Mean length of stay was 5.9 days. More than 25% of patients were treated with OAC. Multivariate analysis revealed that elderly (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.404-0.895), EF ≤ 35% (OR 2.11; 95% CI 1.358-3.289), and functional class III-IV (OR 2.5; 95% CI 1.327-4.723) were factors that influence the decision to give OAC. Conclusions There are more than 25% of HF patients received OAC therapy despite lack of indication. Lower EF and more advanced disease were the main factors in deciding whether to give anticoagulant therapy. Paradoxically, those who received OAC had lower prevalence of hypertension and diabetes, well-known factors associated with high risk of thromboembolism. Epicardial fat thickness is related to the blood pressure response abnormalities in exercise stress testing F. Anditasari F. Anditasari P. Kabo P. Kabo I. Mappangara I. Mappangara Department of Cardiology and Vascular Medicine, Hasanuddin University, Makassar Hypertension epicardial fat exercise test echocardiography Abstract Background Blood Pressure response abnormalities on exercise stress testing known as risk factors for future onset of hypertension, where epicardial fat, a new cardiometabolic risk factor, associated to hypertension in various recent studies. In this study, we tested the primary hypothesis suggesting that the epicardial fat thickness (EFT) is related to altered BP responses to treadmill exercise testing. We also evaluated the sensitivity and specificity of the EFT as a predictor of hypertensive response to peak exercise. Methods Normotensive subjects underwent to treadmill stress testing and transthoracic echocardiography. BP abnormality defined as either, hypertensive response defined as BP ≥ 210/105 mmHg and ≥ 190/105 mmHg at peak exercise in males and females, respectively or BP recovery index (BPRI) >0,91. Twenty-eight subjects with hypertensive response constituted Group 1 and 20 subjects into Group 2. Results The mean EFT of subjects with abnormality of BP was significantly higher ( 7,09 ± 1,51 mm vs 5,05 ± 1,43 mm; p = 0,0001). In correlation analysis, EFT found significantly correlated with BPRI and Peak SBP (p < 0,05). An EFT of ≥ 5,15 mm predicted the BP abnormality to peak exercise with 92,9% sensitivity and 65% specificity (95% CI: 0,714- 0,949, p < 0,001). Based on the futher linear analysis BPRI and Peak SBP were the only independent variables related to EFT. Conclusions EFT was found to be related to altered BP responses to exercise stress testing. The echocardiographic measurement of EFT may serve as a useful non-invasive indicator of heightened risk of future hypertension. Remote ischemic conditioning prior to primary percutaneous coronary intervention: The effect on Six Minutes Walk Test distance and serum NT-ProBNP level F. A. Muslim F. A. Muslim L. N. Waliy L. N. Waliy A. M. Soesanto A. M. Soesanto Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia Nasional Cardiovascular Center Harapan Kita S. Soerianata S. Soerianata B. Radi B. Radi reperfusion myocardial reperfusion injury remote ischemic conditioning six minutes walk test NT-proBNP Abstract Background Reperfusion injury has been recognized to cause cell damage and death. As consequence, it contributes about 50% of infarct size. Remote ischemic condiotioning (RIC) has been identified as a noninvasive, low-cost, and easy to performed method to prevent it, so cardioprotective effect such as reducing infarct size and ventricular contraction improvement could be achieved. Meanwhile, myocardial function can be clinically assessed bymeasuring 6 minutes walk test (6MWT) and serum NT-proBNP level. Many studies showed association and correlation between 6MWT, NT-proBNP level and infarct size and myocardial function. Aims To assess the effect of remote ischemic conditioning in ST-Elevation Myocardial Infarction (STEMI) patients prior to primary percutaneous coronary intervention (PPCI) to their 6 MWT distance and serum NT-proBNP level. Methods Eighty seven subjects were randomly assigned into 2 groups, those receiving RIC intervention (4 to 5 minutes cycles of cuff inflation/deflation on lower extremity) or control (uninflated cuff for 40 minutes) protocols prior to primary PCI. All subjects underwent 6MWT and NT-proBNP level evaluation, before discharge from hospital. Results 6MWT distance was not significantly different between RIC group compared to control group (316 ±46 m vs. 289 ± 66 m, p = 0.06 [CI: -0.6 – 55.1]). However, serum NT-ProBNP level was significantly lower in RIC group compared to control group (1073 (328-3974) pg/mL vs. 1514 (205-10696) pg/mL, p= 0.05 ). Conclusion RIC intervention did not improve 6MWT compared to control group. However, serum NT-ProBNP level was significantly lower in RIC group compared to control group. Correlation between urinary protein and vascular dysfunction before and after Delivery in preeclamptic women F. Habib F. Habib 1 Department of Cardiology & Vascular medicine, Faculty of Medicine Universitas Indonesia /National Cardiovascular Center Harapan Kita, Jakarta, Indonesia F. Shahab F. Shahab 1 Department of Cardiology & Vascular medicine, Faculty of Medicine Universitas Indonesia /National Cardiovascular Center Harapan Kita, Jakarta, Indonesia I. Sunu I. Sunu 1 Department of Cardiology & Vascular medicine, Faculty of Medicine Universitas Indonesia /National Cardiovascular Center Harapan Kita, Jakarta, Indonesia J. Sedyawan J. Sedyawan 1 Department of Cardiology & Vascular medicine, Faculty of Medicine Universitas Indonesia /National Cardiovascular Center Harapan Kita, Jakarta, Indonesia H. Sjarbaini H. Sjarbaini 2 Department of Obstetry and Gynecology, Woman and Children Hospital of Harapan Kita, Jakarta, Indonesia A. M. Soesanto A. M. Soesanto 1 Department of Cardiology & Vascular medicine, Faculty of Medicine Universitas Indonesia /National Cardiovascular Center Harapan Kita, Jakarta, Indonesia preeclampsia endothelial dysfunction FMD urine protein-creatinine ratio Abstract Background Endothelial dysfunction was associated with both of the predisposition of preeclampsia and the later development of vascular disease. Flow mediated vasodilation (FMD) was reduced in preeclamptic women and persist after delivery in several cases. Proteinuria in preeclampsia was also a manifestation of endothelial dysfunction in kidney, but there was no data untill now showing the correlation of FMD and the level of proteinuria in preeclamptic woman. Aim To asses the correlation between urine protein-creatinine ratio and flow mediated dilation (FMD) before and after delivery in preeclamptic women. Methods Women with a diagnosis of preeclampsia and planned for termination were enrolled for the study. History of hypertension before 20 weeks of gestation, diabetes mellitus, chronic kidney disease became exclusion criterias. The FMD was studied through the use of high resolution vascular ultrasound examination of brachial artery for 3 times; before delivery, 48-72 hours after delivery and 40-60 days after delivery. Urine protein-creatinine ratio (UPCR) was measured twice; prior to delivery and 40-60 days after delivery. Correlation between them was then evaluated. Results Thirty patients were enrolled in this study. The mean ages was 29.5 ± 6,4 years old. FMD was improved after delivery, 5.46 ± 0.27 % (before delivery) & 8.14 ± 2.48 % ( p <0.001) 40-60 days after delivery. Bivariates analysis showed that after delivery, there was an inverse correlation between UPCR with FMD (r = -0,735 p< 0,0001). UPCR prior to delivery also has inverse correlation with FMD after delivery (r= -0.55.p = 0.002) and with the change of FMD before and after delivery (r= -0.45 with p =0.01). Multivariate analysis showed that correlation between UPCR after delivery with FMD after delivery was independent. Conclusion This study demonstrated there was moderate-strong correlation between urinary protein prior and after delivery with flow mediated vasodilatation of brachial artery after delivery. Figure 1 Boxplots of mean differences of FMD prior to delivery, 48 hours after delivery and 40–60 days after delivery (There were statistically significant differences of mean of FMD among all of time measurements from reapated ANNOVA and post hoc analysis, but different of means of FMD between prior delivery and 48 hours after delivery was clinically not significant) Figure 2 Scaterred plots of corelation between urine-protein creatinin ration 40–60 days after delivery with fMD (%) 40–60 days after delivery. (Spearman test for bivariate corrlation showed strong inverse correlation between them with r = 0.735 and p < 0.001 and multivatiate analysis with linear regression showed at 40–60 days UPCR has independent correlation with FMD adjusted R square was 0.60) Impact of high hsCRP level on adverse cardiovascular events and mortality in ST-elevation acute myocardial infarction undergoing fibrinolysis Faizin Faizin 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia A.B. Hartopo A.B. Hartopo 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia I. Puspitawati I. Puspitawati 2 Department of Clinical Pathology Faculty of Medicine Universitas Gadjah Mada - Dr. Sardjito Hospital Yogyakarta, Indonesia N. Taufiq N. Taufiq 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia B.Y. Setianto B.Y. Setianto 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia hsCRP STEMI fibrinolysis adverse cardiovascular events Abstract Background Plaque rupture is an active process and inflammatory component appears to be associated with the development of acute coronary syndrome (ACS). C-reactive protein is an acute phase protein that appears in the circulation in response to inflammation. Aims To investigate the association between high sensitivity C-Reactive potein (hsCRP) on predicting in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) undergoing fibrinolysis. Methods This is a cohort study including 54 patients with STEMI and threated with fibrinolysis. The exclusion criteria are chronic kidney disease, chronic heart failure, acute infection, acute stroke and preadmisi reperfusion. The hsCRP is measured from peripheral blood taken on admission, before fibrinolysis is performed and patients are allocated into two groups, i.e. high hsCRP and low hsCRP based on median value. Assessment after fibrinolysis and observation during intensive hospitalisation is conducted. The incidence of failed fibrinolysis, major adverse cardiovascular events and mortality between groups is compared. Chi-square is performed for statistical analysis. A p value < 0.05 is determined as statistical significance. Results The median hsCRP level is 0.265 mg/l. Of 54 patients who undergoing fibrinolysis, 13 patients are failed. High hsCRP group has similar incidence of failed fibrinolysis as compared with low hsCRP group. The incidence of major adverse cardiovascular events is also comparable between group. The mortality is significantly higher in high hsCRP group as compared to low hsCRP,i.e 37 % versus 11,1 %, p =0.027. Conclusion High sensitivity C-Reactive potein (hsCRP) does not influence the fibrinolysis outcome and major adverse cardiovascular events but increases mortality rate following STEMI undergoing fibrinolysis. Correlation between baseline soluble ST2 and global longitudinal strain 2D Speckle tracking echocardiography with left ventricle remodeling post acute myocardial infarction F. S. Hasibuan F. S. Hasibuan M. Aminuddin M. Aminuddin Departement of Cardiology and Vascular Medicine, Soetomo General Hospital-Faculty of Medicine, University of Airlangga, Surabaya, Indonesia Left Ventricle Remodelling soluble ST2 GLS post AMI Abstract Background Left Ventricle remodelling is the most prognostically consequence of acute myocardial infraction (AMI). Soluble ST2 is a novel biomarker for myocardial fibrosis and also LV remodelling. Global longitudinal Strain (GLS) reflects subendocardial longitudinal layer of heart muscle is impaired at the early phase of ischemia, and confirmed a predictive role of LV remodelling following AMI. Methods This is an analytic observasional pra experimental study with one group pretest and posttest design. Fourty five (45) patients of AMI during August until December 2015 from ICCU and cardiology ward were analyzed and followed up after therapy for 12 weeks. Soluble ST2 and Global Longitudinal Strain (GLS) were measured after AMI (2-5 days after AMI) and 12 weeks after therapy. Mann Whitney U Test is used to examine the difference between subject with LV remodelling and no LV remodelling. Spearman correlation is used to examine correlation between soluble ST2 and GLS, with LV remodeling. Results There were 45 subjects, 82.2% males and 17.8% females. Proportion of AMI was 84.4% STEMI and 15.6% NSTEMI. There were 27 subject (60%) with LV Remodelling founded after AMI. There were significant difference of LVEDV baseline 76 ± 29.69 ml/m2 become 98.11 ± 36.84 ml/m2 after 12 week follow up (p = 0.003) and LVESV baseline 40.89 ± 23.89 ml/m2 become 51.96 ± 26.43 ml/m2 after 12 weeks follow up (p = 0.006) . There were strong correlation between high baseline soluble ST2 and Δ ST2 with LV remodelling (p = 0.0001 r = +0.723) and (p = 0.0001 r = +0.639) using Spearman correlation test. There were correlation between low baseline GLS with LV remodelling (p = 0.015 r = +0.362). Conclussion LV remodelling is found relatively significant number after AMI, high baseline soluble ST2 and low GLS may provide important predictive value in LV remodelling Difference of peripheral P Selectin level between univalvular and multivalvular of rheumatic heart disease F. Filianovika F. Filianovika A. Lefi A. Lefi R. Romdoni R. Romdoni Departement of Cardiology and Vascular Medicine, Soetomo General Hospital, Airlangga University, Surabaya, Indonesia Peripheral P selectin rheumatic heart disease univalve (mitral stenosis) multivalve Abstract Background Rheumatic Heart Disease (RHD) was sequelae of acute rheumatic fever, bacterial infection Group A beta Hemolitiycus streptococci (GAS) in the pharynx, lesions of heart valves progressive and permanent, cause of morphological changes and hemodynamic causing damage Endothelial and increased platelet activation, illustrated with elevated levels of P selectin Objective To prove the existence of a comparison between the levels of P selectin of peripheral blood in multivalve and univalve (mitral stenosis) in rheumatic heart disease Methods The study was observational analytic cross sectional shape There are 37 patient samples were analyzed RHD, where the group univalve (mitral stenosis) and multivalve respectively 18 and 19 people with 22 healthy controls. Samples obtained from the poly P selectin heart, space echocardiography, and cardiac inpatient room, while the patient is diagnosed RHD, through echocardiography. a comparison between two variables using comparison test independent sample t-test to determine differences in average levels of P selectin of peripheral blood between two variables with an estimated risk and a value of p < 0.05 was considered statistically significant. Results Peripheral P selectin in multivalve group was higher than univalve group (2,384 ng/mL vs 2,028 ng/mL; ρ < 0,05). Conclusion High levels of peripheral P selectin in rheumatic mitral stenosis heart disease due to ongoing chronic inflammation in these patients. This study proves that there is a difference of peripheral blood levels of P selectin between multivalve with univalve (mitral stenosis). P selectin plays an important role in relation multivalve and univalve (mitral stenosis) rheumatic heart disease. Correlation between the severity of hyperthyroidism with increased of systolic blood pressure in hyperthyroidism patients Firdawati Firdawati 1 Department of Cardiovascular Medicine dr.Zainoel Abidin General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia Purnawarman Purnawarman 1 Department of Cardiovascular Medicine dr.Zainoel Abidin General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia Krishna W. Sucipto Krishna W. Sucipto 2 Divison of Endocrinology Metabolism & Diabetic, Department of Internal Medicine, Faculty of Medicine dr.Zainoel Abidin General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia Hyperthyroidism Systolic Blood Pressure FT4 Abstract Background Hyperthyroidism (an overactive thyroid gland) is a condition in which excess thyroid hormone is produce and change hemodynamic system. Hyperthyroidism increases systolic blood pressure by decreasing systemic vascular resistance, increasing heart rate, and raising cardiac output. In diagnosis of hyperthyroidism FT4 laboratory measurement is to assess severity. The purpose of this study is to determine the correlation between the severity of hyperthyroidism with increased systolic blood pressure in patients with hyperthyroidism. Methods A cross sectional study was done on 33 accidental hyperthyroidism patients visiting endocrine outpatient clinic of dr. Zainoel Abidin General Hospital, Banda Aceh in November 2015. The severity was available by free thyroxine (FT4) laboratory measurement using enzyme link fluorescence assay (ELFA) method then classified them into normal, mild, moderate, and severe levels. The blood pressure measurement was available in patient's medical record. Appropriate statical analysis were use to determine the correlation of the hyperthyroid severity and increased of systolic blood pressure. Result Study subject were 78.8 % females and 21.2% males. A total of 33 hyperthyroidism samples mean of systolic blood pressure 129.7 ± 9.18 mmHg and mean of diastolic blood pressure 81.82 ± 4.64 mmHg. FT4 by laboratory measurement was 35.46 ± 25.02 pmol/L. Using Spearman's test, there was a correlation between increased the hyperthyroidism severity with increased of systolic blood pressure. (r = +0.529; p < 0.05). Conclusion The current study revealed a significant correlation between increased the severity of hyperthyroidism with increased of systolic blood pressure in hyperthyroidism patients. Correlation of red cell distribution width with the severity of coronary artery disease in patients with stable coronary artery disease R. Setiadji R. Setiadji Department of Cardiology and Vascular Medicine, Hasanuddin University, Makassar F. Leksmono F. Leksmono P. Kabo P. Kabo I. Mappangara I. Mappangara red blood cell distribution width coronary artery disease Gensini score Abstract Background It has been reported that increased red blood cell distribution width (RDW) is a marker associated with the presence and adverse outcomes of various cardiovascular diseases. The aim of the present study was prospectively evaluate the severity of coronary artery disease (CAD) and RDW in a stable coronary artery disease patients. Methods A total of 121 consecutive individuals who underwent coronary angiography due to the presence of angina and diagnosed with stable coronary artery disease were enrolled in this study. The clinical information including classical CAD risk factors and RDW were analyzed to identify their relationship to CAD. The severity of CAD was evaluated by Gensini score and its relationship with RDW was also analyzed. Results There was a significant positive correlation between RDW and the Gensini score (P <0.001). In logistic regression analysis, RDW was demonstrated to be an independent predictor for a higher Gensini score (>13, OR = 1.6, P <0.001) In a receiver operating characteristic (ROC) curve analysis, an RDW value of 13.5% was identified as an effective cut-point in predicting the presence of severe coronary artery stenosis with a sensitivity of 0.69 and a specificity of 0.52. Conclusion RDW is associated with severity of coronary artery stenosis, suggesting that it might be a readily available low cost marker for the prediction of CAD severity. Chest pain presentation on acute coronary syndrome patients in Dustira Hospital F.N. Habibi F.N. Habibi 1 Faculty of Medicine,Jendral Achmad Yani University, Bandung, Indonesia P. Pujowaskito P. Pujowaskito 2 Cardiovascular Departement Dustira Hospital, Bandung, Indonesia E. Mansoor E. Mansoor 3 Radiology Departement, Jendral Achmad Yani University, Bandung, Indonesia Acute coronary syndromes chest pain Abstract Background chest pain on Acute Coronary Syndrome (ACS) patients have many variety symptomps in type and location. This condition cause delay for prompt recognition and treatment. Delay could impact on the high mortality rate in the world. This study aims to describe the chest pain symptoms on ACS patients at Dustira Hospital during September to Desember 2011. Methods this study was conducted by descriptive method. Data were collected from medical record and interview hospitalized patients at cardiology departement of Dustira Hospital. The result was analyzed using SPSS version 20.0 which presented in the form of graphs and tables. Results the result showed patients (43,5%) felt pressure pain, stabbing (38,7%), and burning sensation (17,7%). Duration of chest pain reported by most of patients (69,4%) more than 3 hours, lesser than 20 minutes (19,4%), and during 1 until 3 hours (11,3%). Most of patients (45,2%) have referred pain more than two location, in two location (14,5%), and only in epigastric region (14,5%). Conclusion most of patients felt pressure pain (43,5%). The duration of chest pain most happened in patients more than 3 hours (69,4%). Most of patients have referred pain more than two location (45,2%). Result of exercise stress testing after cardiac rehabilitation program after coronary artery bypass grafting surgery F. Handayani F. Handayani 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Diponegoro, Semarang, Indonesia I.F. Yuwono I.F. Yuwono 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Diponegoro, Semarang, Indonesia D.Y. Hasanah D.Y. Hasanah 2 Department of Cardiology and Vascular medicine, Faculty of Medicine Universitas Indonesia- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia B. Radi B. Radi 2 Department of Cardiology and Vascular medicine, Faculty of Medicine Universitas Indonesia- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia A. Meidian A. Meidian 2 Department of Cardiology and Vascular medicine, Faculty of Medicine Universitas Indonesia- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia A. Santoso A. Santoso 2 Department of Cardiology and Vascular medicine, Faculty of Medicine Universitas Indonesia- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia D. Kusmana D. Kusmana 2 Department of Cardiology and Vascular medicine, Faculty of Medicine Universitas Indonesia- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia B.S. Purwowiyoto B.S. Purwowiyoto 2 Department of Cardiology and Vascular medicine, Faculty of Medicine Universitas Indonesia- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia ischemic response exercise test Abstract Background Coronary artery bypass grafting (CABG) surgery is an effective treatment of patients with coronary artery disease. Eventhought 80% of patients are still free from angina at 5 years and 63% after 10 years, graft occlusion can occurs in 8-12% in first month. The main aim of the this study is to assess the result of exercise stress testing after cardiac rehabilitation program for patients after coronary artery bypass graft surgery. Methods We performed a cross sectional study among patients undergoing cardiac rehabilitation after CABG in National Cardiovascular Center Harapan Kita (NCCHK) between July until Desember 2014. All patients were undergoing exercise test with treadmill or ergocycle test after 12 visits of cardiac rehabilitation program with exercise. Results A total 125 patients were included in this study. Of 125 patients, 34 patients (27.2%) had ischemic response in exercise test. There were 26,4% (n = 33) of patients that used both saphenous vein and left internal mammary artery, and 0,8% (n = 1) patients used only saphenous vein as grafts had positive ischemic response (p = 0.809). Baseline RPP value in ischemic group was similar with non ischemic group (9.32 ± 0.32 vs 9.61 ± 0.21 mmHg beats/min x 10 3 (p = 0.420). Peak RPP value in both groups was also similar (20.25 ± 0.75 vs 20.37 ± 0.47 mmHg beats / min × 10 (p = 0.067). There were unsignificant correlation between ischemic response to total risk factors, ejection fractions, functional class, Mets, exercise duration, grafts type, number of coronary lesion. There were significant correlation between body mass index 18.0-22.9 (n = 32, p = 0.029). Conclusions There were 27.2% patients with ischemic response on exercise stress testing after cardiac rehabilitation program, with similar baseline and peak rate pressure product. Patients with normoweight BMI had significant correlation with ischemic response. Relationship between plasma level of Endothelin-1 with major adverse cardiac event in ST-elevation myocardial infarction undergoing percutaneous coronary intervention G.B. Putra G.B. Putra 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia A.B. Hartopo A.B. Hartopo 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia I. Puspitawati I. Puspitawati 2 Department of Clinical Pathology Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia N. Taufiq N. Taufiq 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia B.Y. Setianto B.Y. Setianto 1 Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia Endotelin-1 ST-elevation myocardial infarction primary percutaneous coronary intervention major adverse cardiac event Abstract Background Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and elevated systemic ET-1 levels predict a poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Aims To investigate the relationship between systemic ET-1 plasma levels with major adverse cardiac events (MACE) in STEMI patients treated with a primary percutaneous coronary intervention (PCI), . Methods This was a cohort study enrolling 69 consecutive patients with STEMI that undergoing primary PCI. The inclusion criteria were ages 30-75 years and onset < 24 hour. The exclusion criteria were chronic kidney disease, chronic heart failure, acute infection, and acute stroke. Endothelin-1 was measured from peripheral blood taken on admission, before primary PCI, with ELISA method. With median ET-1 value as cut-off to divide patients into two groups, i.e ET-1 supramedian and ET-1 inframedian. Observation during intensive hospital care were done with outcome of interest was in-hospital MACE (death, acute heart failure, cardiogenic shock and rescucitated ventricular arrhytmia). The incidence of MACE between these two groups was compared. Chi-square was performed for analysis. A p value of < 0.05 was set as statistical significance. Results Supramedian ET-1 groups (n = 34) had higher MACE as compared with inframedian ET-1 group (n = 35), which is 47.1% versus 22.9% with p = 0,031. The mortality rate did not significantly differ between these two groups (14,3% versus 14,7% with p = 0,614). Furthermore, the extent of diseased coronary vessels did not associate with plasma ET-1 level. Conclusion High level of plasma ET-1 associated with higher incidence of MACE in STEMI patients treated with primary PCI. Controlled clinic blood pressure lowers the risk of left ventricular hypertrophy: An internship study among hypertensive Indonesians in rural areas A. Kristanto A. Kristanto 2 Robert Wolter Mongisidi General Hospital, Manado, Indonesia F.C. Fredy F.C. Fredy 3 Sangatta General Hospital, Sangatta, Indonesia D. Pravian D. Pravian 1 Tanjung General Hospital, Tanjung, Indonesia G. Lilihata G. Lilihata 1 Tanjung General Hospital, Tanjung, Indonesia R. Andriyati R. Andriyati 1 Tanjung General Hospital, Tanjung, Indonesia C.K. Simanjuntak C.K. Simanjuntak 1 Tanjung General Hospital, Tanjung, Indonesia C.T. Handjaya C.T. Handjaya 1 Tanjung General Hospital, Tanjung, Indonesia Left ventricular hypertrophy hypertension clinic blood pressure ambulatory blood pressure monitoring Abstract Background Left ventricular hypertrophy (LVH) is a well-known predictor for morbidity and mortality of hypertension. Studies have showed that LVH is greatly affected by blood pressure control, and best reflected by ambulatory blood pressure monitoring (ABPM). However, ABPM and echocardiography are difficult to be performed in rural areas in Indonesia due to lack of health facilities. Although clinic blood pressure (CBP) and electrocardiography (ECG) are inferior to ABPM and echocardiography, but they can be used as alternatives. We sought to evaluate whether CBP correlates with risk of LVH. Methods Cross-sectional study was conducted in three primary hospitals in rural areas in Indonesia, from April to September 2013. Hypertensive patients admitted to ER or outpatient were classified into controlled CBP and uncontrolled CBP. Diagnosis of LVH was based on ECG using combination of five voltage-based and point score criteria (Sokolow-Lyon, Cornell voltage, Lewis, Minnesota code, and Romhilt-Estes point-score) to increase sensitivity. Bivariate and multivariate analysis were performed to evaluate significance between CBP and electrocardiographic LVH before and after adjusted with other factors. Result Of 145 hypertensive patients included (46,2% male; mean age 56 years), 35 patients (24.1%) had controlled CBP. Prevalence of electrocardiographic LVH was 40 %. LVH was significantly higher in patients with uncontrolled CBP (48,2% vs 14.3% p= 0.001) than controlled CBP (Odds Ratio 5.5; 95% CI 2.016-15.440). Multivariate analysis showed that CBP remained significant as predictor for electrocardiographic LVH (OR 3.9, 95% CI 1.228-12.163) after adjusted to duration of known hypertension, smoking, diabetes, dyslipidemia, and body-mass index. Conclusion CBP correlates with risk of LVH. Controlled CBP predicts lower risk of electrocardiographic LVH. CBP can be used as an alternative when ABPM is difficult to be performed in rural areas. Correlation of CHA2DS2-Vasc-HS scores with coronary artery lesions complexity based on SYNTAX score G.A.R. Prawisanthi G.A.R. Prawisanthi Y.H. Oktaviono Y.H. Oktaviono Faculty of Medicine, Airlangga University, Surabaya, Indonesia CHA2DS2-Vasc-HS score SYNTAX score the complexity of coronary artery lesions Abstract Background CHADS2 (Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus and stroke), and CHA2DS2-VASc (Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) score are the clinical predictor of the risk of stroke in non-valvular atrial fibrillation, which consists of the same risk factors for the development of CAD. Therefore, this score can provide important information about the severity of coronary artery lesions. To increase the likelihood of determining the CHD severity, CHA2DS2-Vasc-HS is formed by adding hyperlipidemia (HL) and smoking (S) as well as using the male gender in sex variable category (Sc). The purpose of this study is to describe the mean of SYNTAX score in CHA2DS2-Vasc-HS score and analyze the correlation between CHA2DS2-Vasc-HS score with the complexity of coronary artery lesions based on SYNTAX Score Methods This is a cross sectional study. Forty-five patients who underwent elective coronary angiography were collected by purposive sampling. CHA2DS2-Vasc-HS scores from patient risk factors and SYNTAX score from the coronary angiogram were calculated. Results The mean CHA2DS2-Vasc-HS score in this study was 4 ± 1.34 and the mean SYNTAX score was 27.47 ± 12.47. There is a positive, moderate and significant correlation between CHA2DS2-Vasc-HS score with SYNTAX score, r = 0.682 and p = 0.000 (p <0.05). Patients with CHA2DS2-Vasc-HS score ≥4 had a mean SYNTAX score> 33. While patients with CHA2DS2-Vasc-HS score <4 had a mean SYNTAX score <22 Conclusion Patients with CHA2DS2-Vasc-HS score ≥4 had a mean SYNTAX score> 33. While patients with CHA2DS2-Vasc-HS score <4 had a mean SYNTAX score <22. There were significant, positive and moderate correlations between CHA2DS2-Vasc-HS Score and SYNTAX score. The correlation between body mass index and diastolic indices in non-diabetic hypertensive male subjects H. A. Kuncoro H. A. Kuncoro J. Winata J. Winata I. Suhartono I. Suhartono M. Rotty M. Rotty K. Elka K. Elka S. Widjaja S. Widjaja J. A. Pangemanan J. A. Pangemanan A. L. Panda A. L. Panda Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi University, Prof. Dr. R.D. Kandou Manado General Hospital body mass index diastolic indices hypertension Abstract Background Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. On the other hand left ventricular diastolic dysfunction which is usually asymptomatic and associated with future heart failure is still underdiagnosed. We evaluated the correlation between body mass index (BMI) and diastolic indices in non-diabetic hypertensive male subjects. Methods The study population consisted of 40 consecutive asymptomatic non-diabetic hypertensive male, aged 40-60 years old, BMI was calculated by dividing weight in kilograms by height in meters square (BMI = kg/m2). We performed echocardiography to evaluate diastolic indices. The correlations between BMI and diastolic indices were analyzed. Results BMI was associated with higher left ventricular end-diastolic pressure (E/E') (r = 0.320, p = 0.044), higher E'/A'(r = -0.433, p = 0.005), higher left ventricular end diastolic diameter (LVEDD) (r = 0.414, p = 0.008), thicker interventricular septum diastolic diameter (IVSDd) (r = 0.219, p = 0.251). Conclusion BMI is significantly associated with E'/A', E/E', LVEDD and IVSDd in non-diabetic hypertensive male subjects. Risk of traditional cardiovascular risk factor for the development of erectile dysfunction in stable coronary artery disease patients I.A. Arso I.A. Arso E. Maharani E. Maharani Departement of Cardiology and Vascular Medicine/dr Sardjito General Hospital, Gadjah Mada University, Yogyakarta H. Hernawan H. Hernawan erectile dysfunction stable coronary artery disease traditional cardiovasculars risk factor Abstract Background Erectile Dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient to permit satisfactory sexual intercourse. Erectile dysfunction affects more than 150 million men worldwide and impairs psychological well-being and personal relationships and hence quality of life. Epidemiological study showed clearly role of traditional cardiovascular risk factors such as diabetes, hypertension, dyslipidemia and smoking in CAD. Erectile dysfunction and vascular diseases share a similar risk factors and pathogenic involvement of nitric oxide (NO)-pathway leading to impairment of endothelium-dependent vasodilatation (early phase) and structural vascular abnormalities (late phase). This study was conducted to determine whether the stable CAD patients who have traditional cardiovascular risk factors has a higher risk for ED compared with stable CAD patients without traditional cardiovascular risk factors. Method We performed an age matched-paired case control study. Men with CAD documented by angiography were evaluated for ED. Erectile function was assessed by a 5-item version of the International Index of Erectile Function (IIEF-5). Traditional cardiovascular risk factors such as diabetes, hypertension, dyslipidemia and cigarette smoking were assesed. Depression and anxiety were screened using Indonesian version of Hospital Anxiety and Depression Scale (HADS). Basic demographic and other variables were also collected. Result This study evaluated 127 men, 96.8% of them had traditional cardiovascular risk factors, 25.2% had diabetes melitus, 77.2% had dyslipidemia, 55.9% had hypertension and 64,6% were smoker. Traditional cardiovascular risk factors was strongly associated with ED (odds ratio [OR] = 10.67 [1.25-232.83]). ED was independently associated with diabetes melitus (OR = 4.17[1.14-15.24]), hypertension (OR = 2.64 [1.07-6.49]) and cigarret smoking (OR = 2.26 [1.01-5.75]). Conclussion CAD patients with traditional cardiovascular risk factor had more risk for developing ED than those with no traditional cardiovascular risk factor. Relationship between left ventricle ejection fraction and submaximal exercise capacity in cardiovascular patients H.W. Parlindungan H.W. Parlindungan Y. Saragih Y Y. Saragih Y A.H. Raynaldo A.H. Raynaldo S. Kasiman S. Kasiman A.A. Siregar A.A. Siregar Z. Mukhtar Z. Mukhtar Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Sumatera Utara, Adam Malik Hospital, Medan, Indonesia cardiac rehabilitation 6MWT LVEF METs submaximal exercise capacity Abstract Background The measurement of left ventricular ejection fraction (LVEF) plays a key role in many strategies for managing cardiovascular patients. We tested the hypothesis that exercise capacity provides additional information in patients with a low LVEF. The purpose of this study was to examine the relationship between left ventricular ejection fraction with distance and metabolic equivalent (METs) in cardiovascular patients. Methods One hundred and thirty all cardiovascular patients were assessed with commonly 6-minute walk distance as submaximal exercise capacity measurement in Haji Adam Malik Hospital Medan. Pretest clinical variables, including age, Body Mass Index (BMI), and ejection fraction (EF), comorbid disease, family history were also considered. Result All variables obtained in 6MWT proved to be significant with high correlation; METs and distance (r = 0.992, p < 0,0001), METs and heart rate at beginning (r= -2,26, p < 0,0001). In turn, LVEF showed significant and weak correlation with METs and distance; (r = 0,184, p = 0,037 and r = 0,189, p = 0,32). Conclusion We found that ejection fraction is not the only factor affect variables in distance and METs in our sample. Probably because there are too many group of sample, and many factor include in measurement of ejection fraction. Relationship between type 2 diabetes mellitus with poor heart rate autonomic response in post acute myocardial infraction patients I.G.B.G.P. Putra I.G.B.G.P. Putra W. Wita W. Wita K.B. Nadha K.B. Nadha Department of Cardiology And Vascular Medicine, Faculty Of Medicine, Udayana University Type 2 diabetes mellitus acute myocardial infarction heart rate at rest heart rate recovery treadmill Abstract Background DM with cardiovascular disease are very closely related. Heart rate recovery (HRR) and resting heart rate (resting HR) is an investigative tool that is both reliable and easy to measure in evaluating the cardiac autonomic regulation and as a strong predictor factor for all cause mortality in healthy adults as well as in someone with cardiovascular disease. This study aims to determine that type 2 diabetes mellitus as factors that worsen heart rate at rest and recovery heart rate after treadmill exercise test in patients with post myocardial infarction is an important variable factors as predictors of incidence of morbidity and mortality in patients with post acute myocardial infarction. Methods The research is observational analytic study. Study subjects consisted of 70 people who will be divided into two groups: exposed (with diabetes mellitus) and the unexposed group. Samples taken consecutively in the inpatient unit Integrated Cardiac Services Sanglah then at the time before discharge from hospital, the patient undergone treadmill using the modified Bruce protocol with target submaximal or symptom limited. To determine the relationship between heart rate autonomic response and diabetes mellitus, bivariate analysis were done with Chi Square and to see the relationship between the dependent variable to another variable with logistic regression with significance level (α) at p <0.05. Results In the bivariate analysis, patients with type 2 diabetes mellitus and without diabetes mellitus type 2 differ significantly worsen the autonomic response of the heart rate (heart rate at rest and recovery heart rate) in patients post-AMI with a value of p <0.01. And from multivariate analysis didn't found the relationship of the other variables : age, gender, family history, dyslipidemia, hypertension, smoking, physical activity, and beta blockers on poor heart rate autonomic response in diabetic patients post-AMI (p> 0.05). Conclusion Observational studies have been conducted to prove the type 2 diabetes mellitus in worsening heart rate autonomic response consist of high resting heart rate (RR 7.00; 95% CI 2.74-17.87; p <0,001) and abnormal heart rate recovery (RR 5,17; 95% CI 2.47-10.81; p <0,001). The ECG features among hypertensive patients in rural area: A descriptive study at Kubu Village, Karangasem, Bali I.B.K. Wisasmita I.B.K. Wisasmita 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia A. Yasmin A. Yasmin 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia R. Widiana R. Widiana 2 Nephrology and Hypertension Division, Internal Medicine Department, Udayana University, Bali, Indonesia W. Wita W. Wita 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia electrocardiography hypertension rural area Abstract Background Hypertension is the most common condition seen in primary care and leads to morbidity and mortality if not detected early and treated appropriately. In hypertension, the presence of left ventricular hypertrophy (LVH) is associated with increased risk of both cardiovascular morbidity and mortality. Since hypertension is an insidious disease, early ECG signs for cardiac electrical remodeling provide a wealth of information for disease stratification. Methods This is a cross-sectional study which was performed as a part of social work clinic by Department of Cardiology and Vascular Medicine, Udayana University on 21 November 2015 at Kubu village, Karangasem, Bali. All patients who attended the social work and diagnosed with hypertension were included in this study. All subjects underwent electrocardiography examination and the results were analyzed by Cardiologist. Demographic data were obtained using structured questionnaire. Result The overall prevalence of hypertension in the study was 24,3% (28 out of 115 patients), The subjects were between 40-83 year old, about 54 % of them was female. Among the subjects, about 39% still not aware of having hypertension, and the other hand, about 32% had hypertension for more than 5 years. The ECG abnormalities was found in 50% patient, among them high LV voltage was found in 32.1 %, LV strain pattern in 3.6%, complete RBBB in 7.1%, LAFB in 3.6%, and AV block grade I in 3.6% subjects. Conclusion The prevalence of ECG abnormalities in our study relatively high. The majority of the ECG abnormalities was high LV voltage that indicates the presence of LV hypertrophy. Although, the use of the ECG in the diagnosis of LVH is somewhat limited by its poor sensitivity but it is still useful in detecting LV remodeling related to hypertension especially for primary health care in rural area. Chronotropic incompetence in coronary artery bypass graft and heart valve surgery patients: The role of β-blocker I.F. Yuwono I.F. Yuwono 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Diponegoro University, Semarang, Indonesia R. Myrtha R. Myrtha 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas Maret University, Solo, Indonesia F. Handayani F. Handayani 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Diponegoro University, Semarang, Indonesia B. Radi B. Radi 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine,University of Indonesia, Jakarta, Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia A. Meidian A. Meidian 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine,University of Indonesia, Jakarta, Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia A. Santoso A. Santoso 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine,University of Indonesia, Jakarta, Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia D. Kusmana D. Kusmana 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine,University of Indonesia, Jakarta, Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia B. S. Purwowiyoto B. S. Purwowiyoto 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine,University of Indonesia, Jakarta, Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Chronotropic incompetence coronary artery bypass graft surgery heart valve surgery β-blocker Abstract Background Chronotropic Incompetence (CI) is an independent predictor of major adverse cardiovascular events and overall mortality. Although β-blocker may improve patients' clinical status and reduce risk of death, it may cause pharmacologically induced CI. There is uncertainty about the use of β-blocker regarding its effect to CI. This study aimed to describe the relationship of β-blocker use and CI in Coronary Artery Bypass Graft (CABG) and Heart Valve (HV) surgery patients. Methods Four hundred and twelve consecutive patients who had exercise stress test for evaluation after Cardiac Rehabilitation Program for CABG (n = 277) or HV Surgery (n = 135) at National Cardiovascular Center Harapan Kita, Jakarta, Indonesia between July 2014 and December 2014 were evaluated. Failure to achieve ≥ 80% of the Age Predicted Heart Rate Reserve (APHRR) or > 62% of APHRR for patients taking β-blockers constituted CI. Results No difference of prevalence of CI was found in CABG and HV surgery patients (57% vs 52,2%, p = 0.451). There was similar proportion of patients with Digitalis (p = 0.071), non-dihydropyridine Calcium Channel Blocker (p = 0.695) and Amiodarone (p = 0.364) between group with and without CI. Patients with Diabetes Mellitus (DM) had greater percentage to develop CI (32% vs 19%, p = 0.016). Meanwhile, patients treated with β-blocker (76.7% vs 87.6%, p = 0.021) and patients with NYHA functional class I (32.7% vs 46.3%, p = 0,022) had smaller percentage of CI. At multivariate analysis, Diabetes Mellitus (DM) was independently positively associated with CI and β-blocker use was negatively associated with CI. Conclusion There was no difference found in CI between CABG and HV surgery patients. Diabetes mellitus related to CI. The use of β-blocker may improve chronotropic response in these patients. Correlation between fibrinogen and low density lipoprotein (LDL) cholesterol levels with acute myocardial infarction I.S. Warno I.S. Warno J.N.E. Putranto J.N.E. Putranto Department of Cardiology and Vascular Medicine, Soetomo General Hospital, Airlangga University, Surabaya, Indonesia Fibrinogen levels LDL cholesterol levels Acute myocardial infarction Abstract Background Fibrinogen has been identified as a risk factor for cardiovascular disease especially acute myocardial infarction (AMI). Role of elevated fibrinogen in thrombosis suggests that it may be on the causal pathway for their effect. Elevated Low density lipoprotein (LDL) cholesterol plasma also can induce development of atherosclerosis and associated with AMI events. Objectives To determine correlation between fibrinogen and low density lipoprotein cholesterol levels with acute myocardial infarction. Methods Cross sectional study in Dr. Soetomo Hospital Surabaya on August-November 2015. In 67 subjects were divided into 49 subjects with acute myocardial infarction and 18 subjects as control. Evaluating at age, sex, diagnose, and management as a baseline characteristics. In each of groups were measured fibrinogen and LDL cholesterol levels. The statistical analysis was done with the software packages SPSS. Result 47 males and 20 females were studied. In AMI subjects, 28 patients underwent revascularization procedure with PCI and thrombolytic strategy. The statistic analysis revealed significant differences ( p < 0.05) between plasma fibrinogen and LDL cholesterol levels at AMI patient than control. Significant correlation also showed between fibrinogen levels with LDL cholesterol levels on subjects. Conclusions Fibrinogen was associated with AMI risk factors as well as LDL cholesterol. Elevation of fibrinogen were revealed almost of all AMI events. Also, fibrinogen and LDL cholesterol levels were higher among subjects with AMI compared with those without disease. The statistic test showed an association between fibrinogen and LDL cholesterol levels with AMI. Cardiac rehabilitation use among patients with coronary artery disease on July–December 2015 in Dr. Hasan Sadikin General Hospital Bandung I. Marita I. Marita 1 Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia B. B. Tiksnadi B. B. Tiksnadi 2 Department of Cardiology and Vascular Medicine, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia S. B. Sastradimaja S. B. Sastradimaja 3 Department of Physical Medicine and Rehabilitation, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia Cardiac rehabilitation coronary artery disease enrollment Abstract Background Cardiac rehabilitation (CR) programs is underutilized despite the well documented benefits in reducing mortality and morbidity rate for patients with coronary artery disease (CAD). The purpose of this study is to assess the rates of CR enrollment in patients with CAD in Dr. Hasan Sadikin General Hospital Bandung. Methods A retrospective medical record review was performed for all CAD patients on July–December 2015 who were hospitalized in Cardiac Unit Services and were referred to CR programs in Cardiac Rehabilitation Gymnasium, Dr. Hasan Sadikin General Hospital, Bandung. CR enrollment was ascertained by documentation in the CR program clinical database and was defined as attendance at 1 or more CR sessions. Results There were 379 CAD patients referred to the CR program, consisting of 161 (42.48%) patients with CAD post Acute Coronary Syndrome and 218 (57.52%) patients with CAD non post Acute Coronary Syndrome. Among these patients, 43 (11.35%) patients enrolled in the CR programs. There were 298 (78.63%) males and 81 (21.37%) females. Fourteen patients aged ≤40 years old, 77 patients aged 41–50 years old, 136 patients aged 51–60 years old, 119 patients aged 61–70 years old, and 33 patients aged ≥71 years old. In general, these results was not much different from the study in other countries. Conclusion Participation of coronary artery disease patients in cardiac rehabilitation programs continue to be disappointingly low. Differences of plasma histamine level between acute coronary syndrome and stable coronary artery disease patients I.S. Prihatiningsih I.S. Prihatiningsih 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Airlangga University, Surabaya, Indonesia 2 Dr. Soetomo General Hospital, Surabaya, Indonesia J. N. E. Putranto J. N. E. Putranto 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Airlangga University, Surabaya, Indonesia 2 Dr. Soetomo General Hospital, Surabaya, Indonesia D. Soemantri D. Soemantri 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Airlangga University, Surabaya, Indonesia 2 Dr. Soetomo General Hospital, Surabaya, Indonesia histamine acute coronary syndrome stable coronary artery disease Abstract Background Atherosclerosis may cause angina in Coronary Artery Disease (CAD) patients either in Acute Coronary Syndrome (ACS) or Stable Coronary Artery Disease (SCAD). Histamine is a mast cell-preformed mediator which was suspected to play a role in atherosclerosis but the mechanism is still not clearly understood and data in CAD population is lacking. We hypothesized that plasma histamine level is different between Acute Coronary Syndrome and Stable Coronary Artery Disease patients. Methods This was an observational analytic study with transversal study design in 49 CAD patients by purposive sampling. We identified 25 ACS patients (72% men, mean age 55.6 ± 9.66 years) and 24 SCAD patients (83.3% men, mean age 52.71 ± 8.03 years) as determined by standard diagnostic criterias. Vein whole blood were drawn and centrifuged immediately after collection. The level of plasma histamine were measured using Histamine Enzyme-linked Immunosorbent Assay (ELISA) Kit. Results Plasma histamine level median values in ACS group and in SCAD group were 30.79 ng/ml (range 5.85-36.09 ng/ml) and 26.42 ng/ml (range 0.30-41.39 ng/ml), respectively. Statistically significance differences in plasma histamine level median values were observed between the two groups using Mann-Whitney U Test (p = 0.011). Based on the severity of angina as described by Canadian Cardiovascular Society (CCS), plasma histamine level median values in patients with CCS I, CCS II, CCS III and CCS IV were 26.26 ng/ml, 26.44 ng/ml, 30.62 ng/ml and 32.08 ng/ml, respectively. Subanalysis using Spearman Rank Correlation Test showed moderate-positive correlation between plasma histamine level with the severity of angina (r(49) = +0.379, p = 0.007, two-tailed). Conclusion There were significant differences of plasma histamine level between Acute Coronary Syndrome and Stable Coronary Artery Disease patients. High Endothelin-1 plasma level gives a tendency toward increasing rate of in-hospital major adverse cardiovascular outcomes in ST-elevation myocardial infarction undergoing fibrinolysis I.W. Nugraha I.W. Nugraha 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia A.B. Hartopo A.B. Hartopo 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia I. Puspitawati I. Puspitawati 2 Department of Clinical Pathology Faculty of Medicine Universitas Gadjah Mada - Dr. Sardjito Hospital Yogyakarta, Indonesia N. Taufiq N. Taufiq 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia B.Y. Setianto B.Y. Setianto 1 Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia Endothelin-1 ST-Elevation Myocardial Infarction Fibrinolysis Major Adverse Cardiovascular Event Abstract Background Endothelin1 (ET-1) is a potent vasocontrictor that are increased in the acute phase of myocardial infarction. An elevated plasma ET-1 level previously known to be associated with poor outcome in patient with ST-Elevation Myocardial Infarction (STEMI). Aims To investigate the association between ET-1 plasma level with the outcome of fibrinolysis and subsequent in-hospital major adverse cardiovascular event (MACE) and mortality in patient with STEMI. Methods This was a cohort study enrolling 56 consecutive patients with STEMI undergoing fibrinolysis. The inclusion criteria were ages 30-75 years and onset < 24 hour. The exclusion criteria were chronic kidney disease, chronic heart failure, acute infection, and acute stroke. Endothelin-1 was measured from peripheral plasma taken on admission, before fibrinolysis. Observation was done during and after fibrinolysis therapy to determine whether the fibrinolysys succeeded or failed. Follow-up during intensive treatment were also performed to record in-hospital MACE, i.e. death, acute heart failure, cardiogenic shock and rescucitated ventricular arrhytmia. Patients were divided into 2 groups based on ET-1 plasma level, i.e High ET-1 and Low ET-1 group. The incidence of failed fibrinolysis and MACE between groups was compared with Chi square test. Significancy was tested as p value < 0.05. Results The median ET-1 plasma level was 3.445 pg/mL. The rate of failed fibrinolysis did not significantly differ between groups. High ET-1 group (n = 28) had a higher incidence of MACE as compared with Low ET-1 group (n = 28), i.e 32.1% versus 17.9%, but that difference was not statistically significant (p = 0.217). Mortality rate did not significantly differ between groups either. Conclusion High ET-1 plasma level had a tendency toward increased incidence of in-hospital major adverse cardiovascular outcome following STEMI treated with fibrinolysis. Correlation between serum p53 levels and vascular age determined by carotid intima media thickness (CIMT) in patients with intermediate cardiovascular risk factor J.R.S. Tengor J.R.S. Tengor J. Nugroho J. Nugroho D. Soemantri D. Soemantri Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia serum p53 carotid intima media thickness vascular age chronological age intermediate cardiovascular risk factor Abstract Background Cardiovascular risk factors accelerate normal biological aging of vessels, resulting in premature vascular aging. Vascular age in patients with cardiovascular risk factors is greater than chronological age. Carotid intima media thickness (CIMT) is one of the non - invasive method that has been used to determine the vascular age. Protein p53 is one of the biological aging marker, but the research for p53 is limited. Whether p53 is associated with vascular age determined by CIMT remains to be further evaluated. Methods This study was a cross sectional study which conducted at cardiovascular outpatient clinic Dr. Soetomo General Hospital Surabaya from August 2015 until November 2015. This study enrolled 38 patients with intermediate cardiovascular risk factor symptomatically free from atherosclerotic cardiovascular disease. Serum p53 levels were measured with human p53 ELISA kit (Bender MedSystems, Austria). CIMT was measured by B - Mode ultrasound. The composite CIMT was used to determine vascular age based on nomograms from the Atherosclerosis Risk in Communities Study (ARIC study). Spearman rank test was used to analyze the correlation between serum p53 levels and vascular age. Results There were 19 males and 19 females included in this study. The mean chronological age was 51.11 ± 6.47 years. The mean vascular age using CIMT was 54.34 ± 8.5 years. Significant correlation between serum p53 levels and vascular age determined by CIMT was found by using Spearman Rank Test. Serum p53 levels were positively correlated with vascular age in this group of participants (p < 0.001; r = 0.58). Conclusion Serum p53 levels were significant correlated with vascular age determined by CIMT in patients with intermediate cardiovascular risk factor. Clinical significance of precordial ST segment depression on admission electrocardiogram in patients with acute inferior myocardial infarction E. J. H. Sinaga E. J. H. Sinaga 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Agustina Agustina 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Hasinah Hasinah 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia A. A. Siregar A. A. Siregar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia H. Hasan H. Hasan 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia Z. Mukhtar Z. Mukhtar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia N. Z. Akbar N. Z. Akbar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia J. Suganti J. Suganti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia K. Kaban K. Kaban 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia A. Handayani A. Handayani 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Precordial ST Segment depression inferior myocardial infarction Abstract Background The clinical significance of precordial ST segment depression (PSTD) during acute inferior myocardial infarction (AIMI) has been an area of debate, and still under investigation with conflicting results. Previous studies have suggested that PSTD in patients with AIMI is a marker of a more extensive myocardial damage. Despite of these results, others still considered this ECG findings as benign electrical phenomena. The aim of this study is to investigate the clinical significance of PSTD during AIMI. Methods A total of 60 AIMI patients admitted from December 2013-2015 at Haji Adam Malik General Hospital were divided into two groups and retrospectively analyzed. Group I consisted of 30 patients with PSTD, Group II consisted of 30 patients without PSTD. Patients with history of myocardial infarction and heart failure were excluded. All patients were investigated with admission ECG, cardiac biomarkers, echocardiography, coronary angiography. Statistic analysis was performed, p value <0.05 was considered statistically significance. Results There were no significant differences in mean age, the proportion of sex and coronary artery disease risk factors in both groups. Group I has an early onset of chest pain (19 ± 18 vs 43 ± 46 hours, p = 0.025), higher troponin T (1.46 ± 0.5 vs 0.97 ± 0.6 ug/L, p = 0.002) and CKMB level (204 ± 129 vs 99 ± 100 U/L, p < 0.001), more severe regional wall motion abnormality (70% vs 30%, p < 0.001), lower EF (48 ± 8% vs 54 ± 7%, p = 0.001) than group II. In group I, LAD lesion was not statistically significant (63% vs 46%, p = 0.118), but multivessel disease was significantly more frequent (70% vs 30%, p = 0.037) with higher Gensini score (47 ± 34 vs 32 ± 25, p = 0.045) than group II. Conclusion Patient with AIMI who have PSTD have greater global and regional left ventricular dysfunction due to a more extensive myocardial damage, they also have a greater extent of coronary artery disease. Postprocedural high sensitivity C-reactive protein and the risk of recurrent ischemic events after percutaneous coronary intervention in patients with stable angina pectoris J. W. Purba J. W. Purba A. A. Nasution A. A. Nasution S. M. N. Silaban S. M. N. Silaban Syaifullah Syaifullah Z. Mukhtar Z. Mukhtar A. A. Siregar A. A. Siregar Department of Cardiology and Vascular Medicine, Medical Faculty, University of Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia hsCRP recurrent ischemic events PCI Abstract Background High sensitivity C-reactive protein (hsCRP) has been identified as a predictor of adverse cardiovascular outcomes. Whether hsCRP is a useful biomarker for risk stratification in patients with angina undergoing percutaneous coronary intervention (PCI) remains unknown. Methods We conducted a prospective study among 50 patients undergoing non-emergency percutaneous coronary intervention and examined the relationship between hsCRP after PCI and recurrent ischemic events during follow-up of 6 months. Patients were divided according to the postprocedural hsCRP levels (0.3 mg/dL). Recurrent ischemic events was defined as occurrence of cardiac death, recurrent angina requiring repeat PCI or coronary artery bypass graft (CABG), and acute coronary syndrome (ACS). Results Patients with high hsCRP had significantly more adverse outcomes. Postprocedural hsCRP was a predictor of recurrent ischemic events in 6 months (OR 7.5 [95% confidence interval, 0.945-59.504]; P = 0.032). In multivariate analysis, predictors of the occurence of events (obesity, previous MI, impaired renal function, and hsCRP) were not significant (p = 0.239; p = 0.509; p = 0.425; p = 0.081). Conclusion High postprocedural hsCRP levels were significantly associated with increased risk of cardiac death, recurrent angina requiring repeat PCI or CABG, and ACS, but was not an independent predictor of recurrent ischemic events post PCI. Larger studies with longer-term follow-up are needed to confirm the relationship. The messenger ribonucleic acid expression of B-type natriuretic peptide, natriuretic peptide receptor type-A and type-C in cardiomyocytes of obese population J. Ulaan J. Ulaan S. Adiarto S. Adiarto A. Santoso A. Santoso A.M. Soesanto A.M. Soesanto Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia/ National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia obesity mRNA expression of BNP mRNA expression of NPR-A mRNA expression of NPR-C human cardiomyocytes Abstract Background Obesity is presenting as a significant health problem across the world. Obesity is a risk factor for cardiovascular diseases. The plasma level of B-type natriuretic peptide (BNP) has been identified to be lower in obese people compare to normal. As we know, BNP is one of the cardiac hormones synthesized by atrial myocyte that plays a role in hemodynamic regulations. In addition, BNP exerts its anti fibrotic and anti hypertrophic effects in the heart. It has been hypothesized that one of the possible mechanism responsible for this inverse relationship is the impaired synthesize of BNP by cardiomyocytes. Therefore, the aim of our study is to evaluate the mRNA expression profile of BNP, Natriuretic peptide receptor type-A (NPR-A) and Natriuretic peptide receptor type-C (NPR-C) in cardiomyocytes of obese population. Method A cross-sectional study was conducted in Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK). Cardiomyocytes that have been performed the RNA extraction proses were divided into 2 groups, Obese group (BMI ≥27) and Normal group (BMI <27), according to BMI and inclusion and exclusion criteria. Synthesize cDNA, protein extraction and Real-Time PCR were performed in order to have the mean of ΔCt. Livak method was used to determine the relative expression mRNA value. SPSS 20 for Windows was used for the purpose of statistical analyses. Results 48 patients were included in this study that consist of 34 patients in normal group and 14 patients in obese group. The mRNA expression of BNP, NPR-A and NPR-C were lower in obese group compared to normal group. However, there was no significant difference between groups. Conclusion In conclusion, there is no significant difference of mRNA expression of BNP, NPR-A and NPR-C between obese and normal group. The correlation between serum galectin-3 level with wall motion score index in patietns with ST-segment elevation myocardial infarction K. Halid K. Halid 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Airlangga University, Surabaya, Indonesia 2 Dr.Soetomo General Hospital, Surabaya, Indonesia M. Aminuddin M. Aminuddin 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Airlangga University, Surabaya, Indonesia 2 Dr.Soetomo General Hospital, Surabaya, Indonesia Galectin-3 ST-Elevation Myocardial Infarction Inflammation Fibrosis Wall Motion Score Index Abstract Background Inflammation plays a key role in atherosclerosis and reparative response following myocardial infarction. Galectin-3 is a macrophage and endothelium derived mediator actively involved in the regulation of many aspects in inflamatory cell behaviour. Up-regulation of galectin-3 has a role in fibrosis and scar formation of the maladaptive cardiac response to injury. Correlation between level of galectin-3 with decrease myocardial contractility which assessed by Wall Motion Score Index (WMSI) in patient with ST-Segment Elevation Myocardial Infarction (STEMI) was unknown yet. Methods Cross-sectional study was enrolled 35 patients with ST-Segment Elevation Myocardial Infarction by purposive sampling. Anamnestic data was collected as baseline characteristics. Galectin-3 levels were measured by using R & D System ELISA Quantikine® Human galectin-3 Immunoassay with units ng/mL. WMSI measured by 2D-echocardiography. Results Patients with ST-Segments showed significantly high serum galectin-3 level (12.545 ± 6.504 ng/mL, p = 0.01) and moderate postive corellation with WMSI (r =+ 0.429). Conclusion There is positive significant correlation between serum galectin-3 level with WMSI in patient with STEMI. Risk factors of atrial fibrillation in patients with chronic heart failure K.N. Pratiwi K.N. Pratiwi 1 Mitra Plumbon Hospital E. Hoetama E. Hoetama 2 dr. H. Marsidi Judono Belitung General Hospital O. Lilyasari O. Lilyasari 3 National Cardiovascular Heart Centre Hospital Chronic heart failure atrial fibrillation CHF AF Abstract Introduction Atrial fibrillation (AF) and Chronic Heart Failure (CHF) are common and related conditions, each promoting the other and both associated with increased mortality. AF is a common atrial arrhythmia in patients with CHF caused by left ventricular dysfunction. The mechanism by which CHF promotes AF are still confusing. There seem to be trigger – and substrate – dominant mechanisms and this study was provide to assessing the risk factors leading to AF in patients with CHF. Methods All patients who admitted to hospital were recorded through a year period with history of chronic heart failure and atrial fibrillation event. This study was a retrospective study referred to consecutive patients' medical records meeting all the inclusion criteria. The analyses comprised 89 patients with history of chronic heart failure. Result During the study period there were 89 patients with chronic heart failure registered in our database. Factors that were independently associated with AF were Age (P = 0.001, OR 5.25 (1.95 – 14.1)), Hypertension (P = 0.02, OR 2.95 (1.17 – 7.43)), Diabetes (P = <0.001, OR 6.47 (2.42 – 17.32)), Obesity (P = <0.001, OR 8.62 (3.12 – 23.75)), Gender (P = 0.008, OR 3.43 (1.34 – 8.74)). In multivariate analyses, the results showed that Obesity (Adjusted OR 0.14, 95%CI 0.04 – 0.49), Diabetes (Adjusted OR 0.18, 95%CI 0.05 – 0.64), Age > 65 years old (Adjusted OR 0.20, 95%CI 0.05 – 0.78) were independent risk factors for chronic heart failure leading to atrial fibrillation. Conclusion Obesity, Diabetes, and Age > 65 years old are independent risks of patients with chronic heart failure leading to atrial fibrillation. QT interval prolongation after non-ST elevation myocardial infarction in type 2 diabetic compared with nondiabetic patients K. Kaban K. Kaban 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia A. Handayani A. Handayani 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia J. Suganti J. Suganti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia A. A. Siregar A. A. Siregar 2 Departement of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia Z. Mukhtar Z. Mukhtar 2 Departement of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia QT interval NSTEMI Diabetes type-2 Abstract Background The clinical profile of patients with Non-ST Elevation Myocardial Infarction (NSTEMI) is highly heterogenous and widely insidence of serious adverse events . NSTEMI patients with Diabetes type 2 known to have poorer outcome than nondiabetic population that is why we need early and simple predictor's tools. QT interval parameters have been suggested as simple bedside predictors of lethal arrhytmias and mortality in acute myocardial infarction. The aim of this study is to compare QT interval in between NTSEMI patients with type 2 DM and non-DM and the association with Mayor Adverse Cardiac Event (MACE). Methods This study evaluated QT interval parameters in 102 patients (40 diabetic and 62 nondiabetic) diagnosed with NSTEMI between January 2014 and December 2014. From that population 3 were exluded because of non sinus rhytm ecg. The following QT intervals indices were compared between diabetic and nondiabetic patients: maximum(max) and minimum(min) QT interval; max and min corrected QT interval(QTc); QT dispersion and QTc dispersion. QT interval parameter that has significant difference between the two groups was used in bivariat and multivariat analysis to see the significance in MACE during hospitalization. Result There were no significant differences in clinical characters between DM and Non-DM group. There was significant difference in QTc max between two groups (p = 0.024). When compare QT interval between NSTEMI patients with MACE and without MACE there was sinificant difference in QTc max (p < 0,001), but when compare in sub group MACE in Diabetic and Nondiabetic patient show no significant difference of QTc max (p = 0.459) Conclusions Type 2 diabetics with NSTEMI have prolonged QTc max. NSTEMI patients with MACE also show prolonged QTc max interval, but there're many comorbids in NSTEMI patients that make QTc max between DM and NonDM show poor differences. The novel effect of polysaccharide peptides of Ganoderma lucidum to endothelial disfunction and dislipidemia in high risk groups of atherosclerosis K.S. Proboretno K.S. Proboretno Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia High risk patients Ganoderma lucidum polysaccharide peptides anti-lipid dyslipidemia CEC and EPC Abstract Background Endothelial disfunction and dislipidemia have an important role in the development of atherosclerotic cardiovascular disease. Ganoderma lucidum is a mushroom that effects of antiinflamation, immunomodulator, antioxidant and anti-lipid. High level of circulating endothelial cells (CECs) and low level of endothelial progenitor cells (EPCs) predict poor outcome of endothelial damage. This study was aimed to explore the effects of polysaccharide peptides (PSP) of Ganoderma lucidum on CECs, EPCs, and lipid profile at high-risk of atherosclerosis patients. Methods This study used true experimental study in vivo on 34 High Risk patients of cardiovascular event based on Framingham Risk Score, with pre-test and post-test design. The patients consumed PSP 3x250 mg for 3 months, as an additional therapy of their regular medications. The data was analyzed by paired t-test for parametric data and Wilcoxon test for non-parametric data. Results Post test were performed after administration of PsP for 3 months. The results shows that, total cholesterol level reduced from 219,46 ± 49,49 mg/dl to 201,43 ± 81,63 mg/dl (P = 0,193). There were no significant reduction of total cholesterol. The level of CECs significantly reduced (2,07 ± 1,54 % to 0,6457 %, p = 0.000), and did the EPCs level (3,28 ± 3,66 % to 1,72 ± 2,24 %, p = 0.000). Conclusion The result shows Ganoderma lucidum polysaccharide peptides significantly reduced the level of CECs. But, the increasing of EPCs which are biomarkers of repair with therapeutic potential and the level of total cholesterol does not show significant differences between pre test and post test. Relation of Left Atrial Spontaneous Echocardiographic Contrast to Neutrophil/Lymphocyte Ratio in Patient With Mitral Stenosis Komaria Komaria 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Zunaidi Zunaidi 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia D. Ashrinda D. Ashrinda 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia M.F. Sarahazti M.F. Sarahazti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia E. Hasibuan E. Hasibuan 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia A.A. Siregar, A.A. Siregar, 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia H. Hasan H. Hasan 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia N. Z. Akbar N. Z. Akbar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia A.P. Ketaren A.P. Ketaren 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia Left atrial spontaneous echo contrast mitral stenosis neutrophil/lymphocyte ratio Abstract Background Left Atrial Spontaneous Echocardiographic Contrast (LASEC) is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism. The role of systemic and chronic inflammatory processes in the pathophysiology of rheumatic heart valve disease is well-known. Neutrophil/Lymphocyte ratio (N/L ratio) was shown to be an indicator of systemic inflammation. The purpose of our study was to determinate the association between N/L ratio and LASEC in patients with mitral stenosis (MS). Methods Retrospective study was conducted between January 2014 to December 2015 in patient who admitted to Haji Adam Malik Hospital due to symptomatic MS. Blood examination and transthoracic echocardiography were performed to all patients. They were divided into two groups according to presence of LASEC. Results From 104 patients, 41 (mean age 42 ± 11 years; 79% women) were in the LASEC-negative group and 38 patients (mean age 40 ± 12 years; 73% women) were in the LASEC-positive group. The neutrophil levels (60.5 ± 9.8 vs 72.6 ± 10.7, p < 0.001) were significantly greater in the LASEC-positive group, and the lymphocyte level (25.2 ± 6.9 vs 14.5 ± 6.9, p < 0.001) were significantly greater in the LASEC-negative group. The N/L ratio was significantly higher in patient with LASEC-positive group [2.6(1.0-6.1) vs 5.0(1.7-33), p < 0.001]. N/L ratio was divided into two subgroups for bivariate analysis, more than 3.1 and below according to previous study. Higher level N/L ratio was associated with presence of LASEC, odds ratio (OR): 9.025, 95% confidence interval (CI) 3.604-22.598; p < 0.001. In multivariate analysis, N/L ratio (OR: 8.917, 95% CI 3.064-25.947; p < 0.001), mitral valve area (OR: 16.796, 95% CI 3.095-91.142; p = 0.001), atrial fibrillation (OR: 4.321, 95% CI 1.024-18.225; p = 0.046) and RV basal (OR: 3.759, 95% CI 1.332-10.608; p = 0.012) were independent predictors of LASEC. Conclusion These study show that higher level of N/L ratio associated with presence of LASEC and an independent risk factor of LASEC formation in patient with MS. N/L ratio is an easily available and cheap method, it can easily be used in daily clinical practice. Analysis of characteristic of atrial fibrillation versus not atrial fibrillation in hospitalized heart failure patients L. D. Suryani L. D. Suryani 1 National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia A. Pramudita A. Pramudita 2 Medical Research Unit, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia A. Basuki A. Basuki 2 Medical Research Unit, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia A. W. Siemann A. W. Siemann 2 Medical Research Unit, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia D. P. Sari D. P. Sari 2 Medical Research Unit, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia B. B. Siswanto B. B. Siswanto 1 National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia R. S. Pratikto R. S. Pratikto 1 National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia N. Hersunarti N. Hersunarti 1 National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia Atrial fibrillation heart failure characteristics Abstract Background Atrial fibrillation (AF) is the most common arrhythmia in heart failure (HF); it increases the risk of thrombo-embolic complications and may lead to worsening of symptoms. Both conditions shared some common risk factors. However, the causative relationship between the two has not been fully determined and the number of study is limited. This study aims to find the associations between AF and several demographical and clinical parameters among hospitalized HF patients. Methods A total of 937 hospitalized patients with HF in National Cardiovascular Center Harapan Kita from January 2012 to September 2013 were included in this cross-sectional study. The patients were categorized based on whether had AF (group 1) or not (group 2) when the data was taken. The parameters examined were sex, age, heart rate, systolic blood pressure, diastolic blood pressure, smoking status, diabetes mellitus, history of angina, history of prior CHF hospitalization, history of hypertension treatment, NYHA functional class, length of stay, ejection fraction, BUN, and serum creatinine levels. Results Among 937 patients, 187 (19.96%) were in group 1 and 750 (80.04%) were in group 2. There was an association between AF in HF patients with sex (p = 0.008), smoking status (p = 0.036), history of angina (p = 0,000), and history of prior CHF hospitalization (p = 0.047). Heart rate (p = 0.000), age (p = 0.002), and EF (p = 0.002) were significantly higher in group 1. Meanwhile, serum creatinine level was significantly lower compared to group 2 (p = 0.010). Other parameters were comparable between the groups. Conclusion In addition to shared common risk factors (sex, age, and history of angina); other parameters such as smoking status, history of prior CHF hospitalization, heart rate, EF, and serum creatinine level also have a role in the presence of AF in HF patients. Further study is needed to get the exact causative relationship among them. Pulmonary hypertension features in adult atrial septal defect at RSUP Dr. Sardjito L. Krisdinarti L. Krisdinarti 1 Department of Cardiology and Vascular Medicine, School of Medicine, Universitas Gadjah Mada/Rumah Sakit Sardjito, Yogyakarta, Indonesia D.W. Anggrahaeni D.W. Anggrahaeni 1 Department of Cardiology and Vascular Medicine, School of Medicine, Universitas Gadjah Mada/Rumah Sakit Sardjito, Yogyakarta, Indonesia A.B. Hartopo A.B. Hartopo 1 Department of Cardiology and Vascular Medicine, School of Medicine, Universitas Gadjah Mada/Rumah Sakit Sardjito, Yogyakarta, Indonesia K. Nakayama K. Nakayama 2 Department of Cardiovascular Medicine, Kobe University Japan N. Emoto N. Emoto 2 Department of Cardiovascular Medicine, Kobe University Japan 3 Department of Clinical Pharmacy, Kobe Pharmaceutical University Japan B.Y. Setianto B.Y. Setianto 1 Department of Cardiology and Vascular Medicine, School of Medicine, Universitas Gadjah Mada/Rumah Sakit Sardjito, Yogyakarta, Indonesia pulmonary hypertension atrial septal defect adult mortality Abstract Baclground Unestablished childhood screening for congenital heart disease along with inadequate medical technologies for heart surgery have become critical issues in Indonesia. As a result, severe PH complicating ASD may lead to mortality in adult patients. This study aims to evaluate the incidence of severe PH complicating ASD in adults. Methods Previously, the hospital's data have showed increased incidence of ASD patients attending out-patient clinic from year to year. Thus, we conducted a single center-hospital based registry from July 2012. Newly diagnosed patients came to our cardiac center in Sardjito Hospital Yogyakarta, Indonesia were recorded. Results During the last 3 years we registered 360 new cases of uncorrected ASD in adult, the median age was 34 years old and 79% were female. The majority of the cases were secundum-ASD (94%), then SVD and ASD primum (2.5% and 1.75%; respectively); while 1.75% cases were having multiple ASDs. Among those who were performed RHC (n = 220), 43.6% surprisingly has moderate-severe PH with mPAP > 40 mmHg. This group has larger RV diameter, lower TAPSE, SpO2, and 6MWD. There was no correlation between age and defect size with mPAP and PVRI. However, interestingly, the incidence of moderate-severe PH was highest in the ≤20-40 years-old group (36.8%). Moreover, in the younger female group the risk for having moderate-severe PH higher than the older one; OR = 2.865 (p < 0.05). During this study, there were 37 mortalities (10.3%); in which 30 cases were having severe PH. Conclusion Our registry data showed that the incidence of PH was high in uncorrected adult ASD. In addition, younger age and female gender have increased risks of having PH. The early incidence of PH raised questions about the factors behind severe PH. The high mortality rate due to severe PH requires further attention for better management and childhood screening in Indonesia. The association between plasma tryptase with ventricular remodeling after 1 month in patients with acute coronary syndrome L.D. Yuni L.D. Yuni J.N.E. Putranto J.N.E. Putranto D. Soemantri D. Soemantri Faculty of medicine Airlangga University Surabaya Tryptase acute coronary syndrome ventricle remodeling Abstract Background Acute Coronary Syndrome was initiated by the rupture or erosion of atherosclerotic plaque triggered by the release of inflammatory mediators of mast cell degranulation one of which is tryptase. Ventricular remodeling occurs immediately after Acute Coronary Syndrome and can be evaluated by echocardiography. Tryptase plays a role in the ventricular remodeling, especially in infarct healing phase where tryptase can modulate the expression of endothelial chemokine and induce fibroblast proliferation and collagen through the activation of matrix metalloproteinase Objectives Analyze association between the levels of tryptase with ventricular remodeling after 1 month in patients with acute coronary syndrome Methods This study is observational analytic research with cohort approach. 37 patients with Acute Coronary Syndrome. At the end of observation periode 25 patients were collected. Tryptase levels and echocardiography examined when patient was admitted. Echocardiography re-examination were performed after1 month. Result There is a non-significant differences of total ventricular remodeling experinced patients after 1 month between tryptase group, p = 0.668. There is no significant interdependency between groups of tryptase with a ventricular remodeling, p > 0.05. Logistic regression test analysis showed levels of tryptase and tryptase group categories have no significant effect on ventricular remodeling but they tend to be a risk factor for ventricular remodeling. Multiple linear regression analysis showed multicollinearity between variables left ventricle end diastolic volume and left ventricle end systolic volume when admitted to hospital and after 1 month discharge to the the relationship between tryptase and ventricular remodeling,VIF ≥ 10, tolerance ≤0,10 . Conclusion There is no significant association between tryptase with ventricular remodelling after a month in Acute Coronary Syndrome patients. The correlation of plasma histamine and tryptase with ST-elevation acute myocardial infarction in acute coronary syndrome patients M. Sukmana M. Sukmana J.N.E. Putranto J.N.E. Putranto D. Soemantri D. Soemantri Faculty of medicine Airlangga University Surabaya Histamine tryptase acute coronary syndrome Abstract Background Mechanisms of Acute Coronary Syndrome included thrombosis and vasoconstriction in atherosclerosis lesions. Acute Coronary Syndrome can be triggered by the release of inflammatory mediators derived from Tryptase mast cell degranulation and histamine plays a role in the process of atherogenesis and plaque rupture process of atherosclerosis. Acute Coronary Syndrome clinically may include unstable angina, non- ST Elevation Myocardial Infarction and ST Elevation Myocardial Infarction. Heart failure is one of the most frequent complications of Acute Coronary Syndrome Objectives Analyze the relationship between histamine and tryptase levels with the incidence of ST Elevation acute myocardial infarction in patients with acute coronary syndrome Methode This study is observational analytic research with cross sectional approach. Samples of 40 patients with Acute Coronary Syndrome were collected by purposive sampling. Histamine and tryptase levels are examined. Myocardial infarction diagnosis based on universal definition of myocardial infarction Result The mean of histamine levels at ST Elevation Myocardial Infarction group was different than non- ST Elevation Acute Coronary Syndrome group but not significant (29.05 ± 9.14vs28.33 ± 8.19, p > 0.05) ng/ml. The mean of typtase levels at ST Elevation Myocardial Infarction group was different than non- ST Elevation Acute Coronary Syndrome group but not significant (14.30 ± 7.12 vs 12.69 ± 9.29, p > 0.05) ng/ml . Conclusion There are differences in the levels of histamine and tryptase in the group of ST Elevation Myocardial Infarction and non- ST Elevation Acute Coronary Syndrome group but not significant Acute kidney injury after coronary artery bypass graft surgery: Incidence and pre operative risk profile A. Willianto A. Willianto L. Yuliando L. Yuliando U. Abshor U. Abshor S. Sakasasmita S. Sakasasmita C.N. Wingardi C.N. Wingardi Siloam Heart Institute, Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia M. Hendrata M. Hendrata AKI CABG risk factors length of stay Abstract Background Acute Kidney Injury (AKI) is a common complication following Coronary Artery Bypass Graft (CABG) surgery and is related to increased mortality and prolonged length of stay in hospital. Objective of this study is to evaluate risk factors for acute kidney injury in post CABG patients. Methods Sixty three patients who underwent CABG surgery in Siloam Hospitals Kebon Jeruk from January to December 2015 were reviewed. Thirteen patients were excluded from the sample because of incomplete data. AKI incidence after CABG surgery were identified. AKI was defined as an increase of serum creatinine ≥ 50% or ≥0.3 mg/dL according to AKI network (AKIN) classification. In this study, we analyze association between AKI with diabetes mellitus, hypertension, pre existing Chronic Kidney Disease (CKD), and reduced Ejection Fraction (EF) as a single or multiple risk factors and also the correlation of AKI incidence to prolonged length of stay. Result Out of 50 patients, 45 patients (90%) were male and 5 patients (10%) were female. The mean age of our patients was 58.2 years old (38-80 years old). Acute kidney injury was observed in 36 patients (72%). Patients with multiple risk factors (>1 risk factor) had a significantly higher incidence of AKI (CI 95%; p = 0.02). However, no significant correlation between single risk factor and AKI incidence after CABG surgery were found. The overall length of stay was significantly longer in patients who developed AKI after CABG surgery (CI 95%; p = 0.012). Conclusion AKI is highly prevalent after CABG surgery. Patients with multiple risk factors are at a higher risk to develop AKI after CABG surgery which implicate in a prolonged length of stay. Further study with a larger sample are required to predict mortality in patients with AKI after CABG surgery. The effect of diabetes mellitus on in-hospital mortality and major complications after isolated coronary artery bypass grafting surgery M. Nasri M. Nasri 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia T.W. Siagian T.W. Siagian 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia S. Saragih S. Saragih 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia D. Yulianda D. Yulianda 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Z. Mukhtar Z. Mukhtar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia A.A. Siregar A.A. Siregar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia D.Pohan D.Pohan 3 Department of Thorax and Cardiovascular Surgery,Haji Adam Malik General Hospital, Medan, Indonesia CABG DM in-hospital mortality post operatif complications Abstract Background Coronary Artery Bypass Graft (CABG) is the choice of revascularization modality in multi-vessel diseases with Diabetes Mellitus (DM). This study was conducted to determine whether DM is a predictor of in-hospital mortality and major complications after CABG. Methods This study was a retrospective study of 64 patients who underwent CABG surgery between January 2012- June 2015. The pre-operative, intra-operative and post-operative risk factors as well as complications and in hospital mortality were compared in diabetics and non-diabetics. Among 64 patients; 30 patients (46.8%) were in diabetic group and 34 patients (53.1%) were in non-diabetic group. Result No significant difference was observed between diabetic group and non-diabetic groups on in-hospital mortality (36.7% vs 20.6%; P =0.15). Incidence of major complications; Atrium fibrillation (AF) (16.7% vs 8.8%; P =0.45), stroke (10% vs 8.8%; P =1), acute myocardial infarction (AMI) (10% vs 11.8%; P = 1), and infection (30% vs 13.7%; P = 0.224) after CABG did not differ significantly between the two groups Conclusion No significant difference on in-hospital mortality and major complications after CABG between diabetic and non-diabetic groups. Factor those influence return to woek after CABG revascularization on coronary artery disease patients M. Ardiana M. Ardiana 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Airlangga University, Surabaya, Indonesia D. Yaniarti D. Yaniarti 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine Indonesia University/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia I.F. Yuwono I.F. Yuwono 3 Departmen of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro University, Semarang, Indonesia B. Radi B. Radi 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine Indonesia University/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia A. Meidian A. Meidian 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine Indonesia University/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia A. Santoso A. Santoso 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine Indonesia University/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia D. Kusmana D. Kusmana 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine Indonesia University/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia B. Setianto. B. Setianto. 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine Indonesia University/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia CABG return to work factors cardiovascular rehabilitation programme Abstract Background Return to work is one kind of succesfull revascularization therapy with CABG parameter for patient with coronary artery disease. There are some factors those can infuence patients to return to work, like clinical symptom and signs, psychologic factors, socio-demographic, socio-proffesional, fitness level, the job before, physical activity related with work and ejection fraction of left ventricle. The rehabilitation programme was needed to increase the life quality of CAD patient who experienced CABG revascularization based on some factors above. Objectives Accordingly, we conducted a study to determine some factors whose influenced patients post CABG revascularization decision to return to work, which are taken at Harapan Kita Heart and Vascular Hospital Jakarta from July, 1st 2014 to June, 30th 2015, in order to give optimal cardiac rehabilitation programme to support it. Method A retrospective, population based, analytical descriptive study was done. Through a consecutive sampling which are taken from medical record and interview with patients post CABG, 78 individuals were selected to be enrolled to this study. The data contains of cardiac risk factors, ejection fraction, cardiac functional capacity, and job statue before CABG, whose described by frequency, percent and standard deviation. Chi square test was used to analize the significances of factors data. Result Socio proffesional job statue “white collar job” and regular salary were significantly affected patients decision to return to work (p value 0.000, 95% CI). Moreover, another factor that also affecting return to work at 10% significance level was level of stress. White-collar workers tend to return to work 27.8 times higher than another type of employment and patients who previously received a regular salary (permanent workers) has also a tendency to return to work by 15 times higher compared with the others who had not received regular salary. Furthermore, patients who did not experienced stress have a tendency to return to work by 3.7 times higher than the others who experienced it. Conclusion Factors those affected the decision to return to work for patients who experienced CABG revascularization found in this study based on the job type, its salary and stress level at work. Multiple intervention were needed in cardiovascular rehabilization programme to raise psychologic and physiologic statue CAD patients to return to work optimally in the right time. The correlation of pulmonary vein endothelin-1 level with pulmonary vascular resistance before and after mitral valve surgery with pulmonary hypertension M. Ginanjar M. Ginanjar O. Lilyasari O. Lilyasari D. Firman D. Firman A.M. Soesanto A.M. Soesanto Department Cardiology and Vascular Medicine Universitas Indonesia- National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia Pulmonary Vascular Resistance Mitral Stenosis Endotelin-1 Pulmonary Hypertension Abstract Background The increased of Pulmonary Vasculaar Resistance (PVR) in mitral stenosis (MS) patient occurs in reactive pulmonary hypertension, and it affects clinical outcome after mitral valve surgery. Endothelin-1 (ET-1) as vasoconstrictive agent have important role in reactive pulmonary hypertension so far there is no study that corelate pulmonary vein (PV) ET-1 with PVR in MS. Objectives To study the correlation of PV ET-1 level with PVR measured by echo before and after mitral valve surgery in patient MS with pulmonary hypertension. Methods Twenty eight MS patients with moderate and severe pulmonary hypertension who underwent mitral valve surgery at National Cardiovascular Centre Harapan Kita from April to November 2014. Statistical analysis was done to see the correlation of PV ET-1 level with PVR before and after mitral valve surgery. Blood sample was taken from VP in the operating room and analyzed with Quantikine® ELISA ET-1 Immunoassay. PVR was measured by PVR-AMS formula by echocardiography. Result There was a correlation between PV ET-1 and PVR pre surgery (r = 0,49, p = 0,008), whereas, there was no significant correlation with PVR post surgery (r = 0,204, p = 0,32). Linear regression analysis was performed, PV ET-1 and PVR pre surgery were adjusted to confounding variables hypertension, diabetes mellitus, atrial fibilation, use of beta blocker and diuretic; r = 0,5 β coefisien level 1,04 with confidance interval (CI) 95 % (0,401-1,691), p = 0,003. PVR post surgery was adjusted to confounding variables hypertension, dislipidemia, use of ACE-I/ARB, beta blocker, vasodilator, cross clamp time, r = -0,08 β coefisien level -0,2 with CI 95 % (-0,99-0,5), p = 0,5. Conclusion There was a moderate positive correlation between PV ET-1 with PVR pre surgery, the increased of PV ET-1 level 1 pg/ml, would increase PVR level 1,04 WU. There was no significant correlation between PV ET-1 with PVR post surgery. Mitral valve E-Point septal separation as an independent predictor for in-hospital mortality after acute ST-elevation myocardial infarction M. F. Sarahazti M. F. Sarahazti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Z. Syahputra Z. Syahputra 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia D. Ashrinda D. Ashrinda 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia E. Hasibuan E. Hasibuan 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Komaria Komaria 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia J. Suganti J. Suganti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia N. Z. Akbar N. Z. Akbar 2 Departement of Cardiovascular, Haji Adam Malik General Hospital, Medan, Indonesia A. P. Ketaren A. P. Ketaren 2 Departement of Cardiovascular, Haji Adam Malik General Hospital, Medan, Indonesia Z. Safri Z. Safri 2 Departement of Cardiovascular, Haji Adam Malik General Hospital, Medan, Indonesia A. A. Siregar A. A. Siregar 2 Departement of Cardiovascular, Haji Adam Malik General Hospital, Medan, Indonesia EPSS LVEF STEMI mortality Abstract Background It has long been known that Left Ventricluar Ejection Fraction (LVEF) is a predictor for mortality in ST-elevation Myocardial Infarction (STEMI). Recent studies show that wall motion abnormality in acute STEMI make it difficult to obtain true global systolic function. Mitral valve E-point Septal Separation (EPSS) is a simple M-Mode measurement and has been studied as a bedside tool to assess true LVEF in many cardiac disease, this study carried out to see if there was any association between EPSS and mortality in acute STEMI patient. Methods We performed echocardiography to measured EPSS and LVEF from 52 adult subject diagnosed with acute STEMI who were admitted to Haji Adam Malik General Hospital from May 2015 until November 2015. Patients with other comorbidity such as chronic kidney disease, cerebrovascular disease, chronic obstructive pulmonary disease and sign of infection or malignancy was excluded. Patients then were divided into normal EPSS(<10) and abnormal EPSS(>10), each group was followed during the hospitalization. Result Bivariate analysis showed among the LVEF biplane Simpson's methode (LVEFs) (OR = 13.42, 95% CI 1.60 to 112.64, p = 0.004), LVEF Teicholz's methode (LVEFt) (OR = 11, 95% CI 2.16 to 55.92, p = 0.001) and EPSS (OR = 18.75, 95% CI 2.23 to 157.51, p = 0.007) were associated with in-hospital mortality. In all patient with LVEFs and LVEFt value <40 there was 85,3% and 96,4% had EPSS value >10, respectively. In multivariate analysis, EPSS > 10 remained significantly associated and had 94,9% probability for in-hospital mortality (OR 18,7, 95% CI 2.23 to 157.51, p = 0.007). Conclusion Our data show that EPSS >10 appears to be an independent predictor for in-hospital mortality in patient with acute STEMI. This simple M-Mode bedside objective tool measurement can help the physician for futher appropriate management planing. Effects of allopurinol on complications of post coronary artery bypass graft (CABG) surgery in coronary artery disease's patient with left ventricular dysfunction N. M. Suryana N. M. Suryana S. F. Supari S. F. Supari N. Haryono N. Haryono A. M. Soesanto A. M. Soesanto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia allopurinol coronary artery bypass graft left ventricular dysfunction post surgery complication reperfusion injury Abstract Background Reperfusion of coronary blood flow is important to resuscitate the ischemic or hypoxic myocardium. However the return of blood flow to the ischemic area can result paradoxical cardiomyocyte dysfunction, this is referred to as “reperfusion injury”. Clinical manifestations of reperfusion injury post CABG surgery are arrhythmias, decrease cardiac output and perioperative myocardial infarct. Oxidative stress has been confirmed as one of the main initiator in myocardial injury at ischemic and reperfusion state. Allopurinol as an effective inhibitor of xanthine oxidase (XO) can reduce the oxidative stress by blocking the formation of reactive oxygen species (ROS). Pre-operative allopurinol on CAD's patient with LV dysfunction is expected reduce the complications of post CABG surgery. Objective To analyze effects of pre-operative administration of allopurinol on complications of post CABG surgery (low cardiac output syndrome which is measured by the use of post-surgery inotropic and IABP, hospital mortality, perioperative myocardial infarction and arrhythmias) in CAD's patient with LV dysfunction. Methods This study is a double randomized clinical trial, 34 CAD's patients with LV dysfunction were randomly selected by consecutive sampling methods from September-November 2015. They were divided into two groups. Sixteen patients were given 600 mg dose of allopurinol per oral one day before and 6 hours before surgery, and the rest received placebo. Complications of post CABG surgery were observed since the aortic cross clamp off until discharged. Results The use of post-surgery inotropic and IABP found significantly lower in allopurinol group (p 0.047). There was no significant difference in proportion of death in post-operative hospitalization period in both groups, 6.25% vs 5.6% (p 1.000). While for the incidence of arrhythmias was found significantly different in the two groups (31% vs 66%; p 0.039), with atrial fibrillation as the most common arrhythmia. No perioperative myocardial infarction was found in this study, therefore effects of allopurinol to the event is unknown. Conclusions Pre-operative administration of allopurinol may reduce the complications of post CABG, especially the use of inotropic and IABP, and occurrence of arrhythmias. Maternal and fetal outcomes of pregnancy with valvular heart disease N. Virginia N. Virginia 1 Faculty of Medicine, Diponegoro University, Semarang, Indonesia M. B. A. Pramono M. B. A. Pramono 2 Department of Obstetrics and Gynecology, Faculty of Medicine Diponegoro University – Dr. Kariadi Central General Hospital Semarang Y. Herry Y. Herry 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro University – Dr. Kariadi Central General Hospital Semarang pregnancy valvular heart disease maternal outcome fetal outcome Abstract Background Valvular heart disease (VHD) is the most common cardiovascular disease in pregnancy found in developing countries. Pregnancy with VHD remains a challenge for the clinicians due to high maternal and fetal morbidities and its complex management. Objective The aim of this study was to evaluate maternal and fetal outcomes of pregnancy with VHD. Methods An observational descriptive study done retrospectively in a cross-sectional manner involving pregnant patients with valvular heart disease who underwent labor and delivery in dr. Kariadi Central General Hospital Semarang in the period of January 2013 to September 2015. Result From a total of 13 study subjects, 6 subjects (46,2%) had mitral stenosis as the predominant valve disease, while the other 7 (53,8%) had predominant mitral regurgitation. 92,3% of patients had worsening NYHA functional class and all subjects had worsening stages of progression of VHD. Maternal complication in the form of pulmonary edema was seen in 30,8% subjects, while arrhythmia was seen in 15,4% subjects. Maternal mortality was not found in this study. Mode of delivery was vaginal in 7 subjects (53,8%), while the rest of the subjects had Caesarean section. 4 of 6 Caesarean sections were done for obstetric reasons. Fetal complications in the form of prematurity, small for gestational age, low APGAR score, and intrauterine fetal death (IUFD) occurred in 46.2%, 23.1%, 15.4%, and 7.7% cases, respectively. Conclusion This study showed that pregnancy with VHD is associated with high maternal and fetal morbidities, thus it should be managed by a capable multidisciplinary team. QRS duration in ST elevation myocardial infarction patients undergoing a primary percutaneous intervention Nani Nani M. Fadil M. Fadil M. Syukri M. Syukri Y. Karani Y. Karani M. Syafri M. Syafri Department of Cardiology and Vascular Medicine, Faculty of Medicine Andalas University of Andalas Djamil Hospital Padang STEMI QRS duration reperfusion therapy Abstract Background ST elevation myocardial infarction (STEMI) generally results from intraluminal thrombus formation and occlusion of a ruptured or an unstable plaque. The main goal of therapy in STEMI is to restore microvascular flow and sustain the myocardial perfusion. A variety of markers including ECG and coronary angiography have been utilized to assess myocardial reperfusion. In the present study, we identify of QRS duration in the patients with STEMI treated with primary percutaneous coronary intervention. Material and methods This study enrolled 30 patients with a diagnosis of STEMI within 12 hours of symptom who undergoing primary percutaneous intervention from July until Desember 2015. The diagnosis of STEMI was made on the basis of the presence of at least two of the following: chest pain lasting longer than 30min, increase in the creatinine kinase myocardial band, and new ST elevation of at least 0.1mV in two or more contiguous leads. All patients were administered 320 mg aspirin and 600 mg clopidogrel loading dose before the procedure. Blood samples were obtained on admission, and patients with normal creatinine levels were included in the present study. Result Total STEMI within 12 hours of symptom who undergoing primary percutaneous intervention from July until Desember 2015 in Dr.M. Djamil Hospital Padang from July until Desember were 30 patients. In this study, male was dominant (88%) patients with mean age of 51 ± 1 years. Smoking as a major risk factor in 22 (72%) patients. Average time of ischemic time in this study was 61 hours. Left ascending diagonal (LAD) was the main culprit of lesion (54%). Most of patients had 2 vessel disease (54%). QRS duration pre procedure (88 ± 18) and post procedure (86 ± 72) showed a reduction of time. Conclusions STEMI was more common in adult males with smoking being the major risk factor. Shortening of QRS duration was showed in patients who undergoing primary PCI and could be a marker of microvascular perfusion. Knowledge of resident medical officers on hypertensive emergency: A descriptive study N.P.H. Lugito N.P.H. Lugito A. Kurniawan A. Kurniawan T.A. Yanto T.A. Yanto I. Wijaya I. Wijaya M.M. Tjiang M.M. Tjiang R. Setiadinata R. Setiadinata S. Sumantri S. Sumantri E. Seto E. Seto Internal Medicine Department, Faculty of Medicine, Pelita Harapan University resident medical officers knowledge hypertensive emergency Abstract Background Nearly one billion of world population has hypertension but hypertensive emergency occurred in less than 1%. Hypertensive emergency is a life-threatening state because of acute damages of target organs. The primary aim of hypertensive emergency management is to safely reduce blood pressure within hours. The success of the management is dictated by the health personels first in contact with the patient. This study aimed to assess the knowledge of resident medical officers (RMOs), physicians attending patients in the emergency unit, wards, and intensive care in Siloam General Hospital, Karawaci, Banten, Indonesia. Methods This descriptive cross sectional study was performed in January 2016 using a questionnaire about the characteristics and knowledge of RMOs. The questionnaire about the knowledge consisted of open question about the definition, target organ, drug therapy, and target management of hypertensive emergency according to the 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension. Data is presented as mean + standard deviation and percentage. Results Twenty six RMOs participated in survey, with mean age of 27.42 + 0.32 year-old, 65.4% were female. Mean time since graduation was 4.38 + 1.74 years, mean working experience in hospital was 3.08 + 0.37 years. Definition about target organ damage was correct in 92.30%, with 53.84% and 42.31% correct about systolic and diastolic blood pressure threshold. Above 80% knows the brain, heart, kidney and eyes as target organ. Approximately 69.23% would use intravenous nicardipine for drug therapy, but only 7.69% and none would use beta blockers and diuretics. The target of decreasing mean arterial pressure was correct in 80.76%. All RMOs know that patient has to be admitted to intensive care unit. Conclusion The knowledge of the RMOs about the definition, clinical signs, and management of hypertensive emergency is quite sufficient, but still needs update in certain aspects. Hyperuricemia and its association with incident of congestive heart failure in Madurese population N. Rahmy N. Rahmy 1 Faculty of Medicine Padjadjaran University I. Maghfirah I. Maghfirah 2 Faculty of Medicine Airlangga University R. Maulana R. Maulana 3 Faculty of Medicine Muhammadiyah Jakarta University F. Alzahra' F. Alzahra' 4 Faculty of Medicine Gadjah Mada University A. Putrinarita A. Putrinarita 2 Faculty of Medicine Airlangga University A. Lestari A. Lestari 2 Faculty of Medicine Airlangga University V. Tandy V. Tandy 2 Faculty of Medicine Airlangga University I.D. Sanjaya I.D. Sanjaya 2 Faculty of Medicine Airlangga University Y. Nurina Y. Nurina 2 Faculty of Medicine Airlangga University L. Lidjaja L. Lidjaja 2 Faculty of Medicine Airlangga University L. Agustin L. Agustin 2 Faculty of Medicine Airlangga University D. Listiarini D. Listiarini 2 Faculty of Medicine Airlangga University E. Pradyta E. Pradyta 2 Faculty of Medicine Airlangga University A. Aulani A. Aulani 2 Faculty of Medicine Airlangga University A. Pramudya A. Pramudya 2 Faculty of Medicine Airlangga University hyperuricemia congestive heart failure madurese population Abstract Background Congestive heart failure as one of the leading cause of mortality and morbidity worldwide, has trigger researches about the etiology and pathophysiology of the disease. Current study about metabolic imbalances occurring in CHF has leads to show that hyperuricemia could be a prognostic indicator of the disease. However, the relationship between hyperuricemia and the risk for incidence of CHF remains uncertain. The objective of this study was to examine the strength of correlation between hyperuricemia and CHF in RSUD Sampang, Madura. Methods Data were taken from patients who admitted to RSUD Sampang Policlinic between July to December 2015 as a cross sectional study. Samples consist of 117 subjects who fulfilled inclusion and exclusion criteria. Data were analyzed by Chi-Square test and Fisher's as an alternative test with 95% confidence interval. Result Among the 117 patient, 38.5% (n = 45) were men and 61.5% (n = 72) were woman. The mean age was 53.71 ranging from 23-92 years which predominated by age group of 51-55 years old (23.1%). Congestive heart failure were diagnosed in 60 subjects (51.3%) and 57 (48.7%) were normal. There was no significant relationship between hyperuricemia (p = 0.2) towards congestive heart failure. The odd ratio was 1.78 (95% CI:0.64 to 4.91). Conclusion This present study show there was no significant relationship between hyperuricemia towards congestive heart failure in RSUD Sampang, Madura. Diagnostic value of Duke Treadmill Score in predicting coronary lesions severity in patients with suspecter stable coronary artery diseases N.M.E. Mayasari N.M.E. Mayasari I.A. Arso I.A. Arso E. Maharani E. Maharani Department of Cardiology and Vascular Medicine, Faculty of Medicine Gadjah Mada University Yogyakarta Stable coronary artery disease treadmill exercise testing Duke Treadmill Score Syntax score severity of coronary lesions Abstract Background Duke Treadmill Score (DTS) is a well known score to stratify prognosis with good diagnostic value in predicting number of diseased coronary arteries in ischemic heart disease patient. DTS has also been shown to have a strong correlation with the severity of coronary lesion based on the Syntax score. This study aim to know the diagnostic value of DTS in predicting the coronary lesions severity based on Syntax score. Methods Cross sectional study was performed in Dr. Sardjito General Hospital. Patients who had positive exercise test result, already had coronary angiography and met the inclusion and exclusion criteria, were included in the study. DTS was calculated based on the assessment of the exercise test result and Syntax score was measured from the coronary angiography result. Statistical analysis was performed to determine the diagnostic value of DTS in predicting coronary lesions severity based on Syntax Score. Result There were 76 patients with average age of 56.64 ± 7.41 year old. Subjects with high Syntax score and the low Syntax score were found in 30 subjects (39.5%) and 46 subjects (60.5%) respectively. In this study, the DTS diagnostic value in predicting high Syntax score was determined by the value of area under the curve based on the the Receiver Operating Characteristic (ROC) curve analysis was 92% (95% CI: 86%-97%, p: <0.0001). Moreover, DTS with value -8.5 had sensitivity 83%, specificity 82%, positive predictive value 75%, negative predictive value 88%, and accuracy 83% to predict high Syntax score. Conclusion DTS has a good diagnostic value in predicting coronary lesions severity, particularly in patients with suspected stable coronary artery diseases. DTS value of -8.5 has shown to have the best cut point in this study. Relationship of plasma glucose levels and troponin-I in patiens with acute myocardial infarction N.A. Putri N.A. Putri 1 Division of Cardiac Intervention, Department of Cardiovascular Medicine dr. Zainoel Abidin General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia A. Purnawarman A. Purnawarman 1 Division of Cardiac Intervention, Department of Cardiovascular Medicine dr. Zainoel Abidin General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia H. Zufry H. Zufry 2 Division of Endocrinology, Methabolism & Diabetic, Department of Interna Medicine, dr. Zainoel Abidin General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia Acute Myocardial Infarction (AMI) plasma glucose troponin-I Abstract Background Myocardial infarction takes the first place in the 10 leading causes of death in the world. Positive correlation between blood plasma glucose value of the incident and mortality from Acute Myocardial Infarction (AMI) has been researched. Troponin becomes one biomarker of unknown myocardial damage. Objective To evaluate the correlation of increased plasma glucose levels and troponin-I in patients with AMI. Methods This study was an observational analytic study with cross sectional survey, in 46 patients with AMI from July to September 2015 in the Intensive Cardiac Care Unit (ICCU) dr. Zainoel Abidin General Hospital Banda Aceh. We collect diagnostic, troponin-I value, plasma glucose value in medical records. Analysis statistical were performed using Fisher's exact test with p value of < 0.05 indicated statistical significance. Results Man (76.1%) with the age range of 40-60 years (69.6%) highest incidence of AMI. Patients with disorders plasma glucose when they got into the hospital, they all (100%) had abnormal levels of troponin-I with a mean ± SD value blood glucose of 214.47 ± 105.93 mg/dl. This showed that the disturbances of plasma glucose is associated with troponin-I in patients with AMI (p = 0.001, RP = 0.533). Conclusion The current study revealed a significant relationship of plasma glucose levels and troponin-I in patients with AMI. The novel effect of polysaccharide peptides ganoderma lucidum in endothelial dysfuction on stable angina patients N. Ubaidillah N. Ubaidillah 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia A. Widya A. Widya 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia Vittryaturida Vittryaturida 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia K. Siwi K. Siwi 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia M. Failasufi M. Failasufi 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia F. Ramadhan F. Ramadhan 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia H. Wulandari H. Wulandari 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia Y. Waranugraha Y. Waranugraha 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia D. Hayuning Putri D. Hayuning Putri 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia D. Sargowo D. Sargowo 2 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia Ganoderma lucidum polysaccharide peptides anti-lipid dyslipidemia CECs and EPCs Abstract Background Endothel dysfunction and dyslipidemia are cornerstone and independent contributing factor to development of atherosclerotic cardiovascular disease. Stable angina pectoris as common problem for atherosclerotic cardiovascular disease. Ganoderma lucidum is a mushroom that is known for its numerous pharmacological effects such as immunomodulator, anti-tumour, antioxidant, anti diabetic and anti-lipid. This study was aimed to evaluate the effects of polysaccharide peptides (PsP) of Ganoderma lucidum on inhibits CECs, EPCs as the hallmark of endothel vascular injury and effects as anti lipid in stable angina pectoris patients. Methods This is a true clinical trial experimental study on 34 Stable Angina patients in Saiful Anwar General Hospital was determined based on ESC Stable CAD guidelines, with pre-test and post-test design without control. Parameter measured were CECs, EPCs, total cholesterol and LDL. The patients were given PsP 750 mg/day in divided dose for 90 days, while continuing the previous medications as directed by guidelines. The data was analyzed by paired t-test for parametric data and Wilcoxon test for non-parametric data. Results After PSP administration for three months found significantly reduce the level of CECs from 2,52 ± 3,05% to 0,71 ± 1,41% (p = 0.000) and did the EPCs level from 5,16 ± 4,59% to 1,19 ± 1,76% (p = 0.000) and total cholesterol level reduced from 205,49 ± 48,49 mg/dl to 182,11 ± 73,81 mg/dl (p = 0.081). Conclusion Ganoderma lucidum polysaccharide peptides have potent protective vacular effect and anti lipid in stable angina pectoris and promising as additional drug in the treatment of coronary artery disease caused by atherosclerotic process. The correlation between serum galectin-3 level with the echocardiographic parameter of left ventricular diastolic function (E/e' ratio) in patients with heart Failure with preserved ejection fraction N. Widiawanto N. Widiawanto M. Aminuddin M. Aminuddin Department of Cardiology Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Dr. Soetomo General Hospital, Surabaya, Indonesia Galectin-3 E/e' ratio Heart Failure HFpEF Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome with many potential pathophysiological contributors. Myocardial fibrosis is a major pathophysiological component of HFpEF. Galectin-3 is a marker of myocardial fibrosis, but its correlation with pathological processes against HFpEF has not been widely studied. Left ventricular diastolic dysfunction is considered as the cause of abnormalities in the pathophysiology HFpEF. E/e' ratio is an echocardiographic parameter of left ventricular diastolic function in patients HFpEF. The aim of this research is to determine the correlation between galectin-3 serum level with the echocardiographic parameter of left ventricular diastolic function (E/e' ratio) in HFpEF patients. Methods Analytic observational with cross sectional study enrolling 35 patients with HFpEF obtained by purposive sampling. The serum levels of galectin-3 was measured with ELISA (R&D Systems ELISA Quantikine® Human Galectin-3 Immunoassay). E/e' is a ratio between the peak value of the E wave divided by the peak value of the septal e' as measured by examination of pulsed wave Doppler and tissue Doppler on transthoracal echocardiography. Statistical analysis using Pearson correlation test because the data have a ratio scale and normally distributed Result There is a strong and significant positive correlation between serum galectin-3 level and the E/e' ratio (r = +0.681 and p < 0.0001) in HFpEF patients. Conclusion The mean of galectin-3 serum level was 10,8471 ± 4,820 ng/ml. There is a strong and significant positive correlation between serum galectin-3 level with echocardiography parameter of left ventricular diastolic function (E/e' ratio) in HFpEF patients. There is a potential role of galectin-3 serum as a biomarker of diastolic dysfunction in HFpEF patients. Correlation between soluble Suppression of Tumorigenicity 2 (sST2) and creatine kinase-myocardial band level: Study on percutaneous coronary intervention N. Sitorus N. Sitorus A. Nugroho A. Nugroho Y. Herry Y. Herry Departement of Cardiology and Vascular Medicine, Medical Faculty of Diponegoro University Dr. Kariadi Hospital, Semarang – Indonesia soluble Supression of Tumorigenicity (sST2) Creatine Kinase-Myocardial Band (CK-MB) Percutaneous Coronary Intervention (PCI) Abstract Background Elevated level of creatine kinase-myocardial band (CK-MB) affects the long term outcome for patients underwent PCI (Per Cutaneous Intervention) and this elevation of CK-MB was reported as high as 25% from all PCI procedures and known as myocardium injury related to PCI. soluble Suppression of Tumorigenicity2 (sST2), a new cardiac marker is released as a respon to myocardial stress. Its correlation with CK-MB in patients undergoing PCI never been investigated. Objective To asses the correlation between sST2 and CK-MB level in patients undergoing PCI. Methods This is a cross-sectional study conducted, using the ASPECT-PLUS ST2 Assay Kit to measure the sST2 level and ELISA methode for CK-MB level measurement. All subjects had their CK-MB level measured before and 18-24 hours after PCI along with their sST2 level. Result A total of 30 subjects were enrolled. Mean level of CK-MB before, after PCI and changes (delta CK-MB level) were 20,1 ± 5,04 U/L, 26,0 ± 20,80U/L, 7,03 ± 20,39U/L. Mean level of sST2 was 27,5 ± 52,03 ng/ml, with minimum and maximum level were 10 ng/ml and 260 ng/ml. There were three subjects who had myocardial injury related to PCI, with levels of sST2 were 25.753 ng/ml, 30.570 ng/ml and 260 ng/ml. There was a positive moderate correlation between sST2 level with CK-MB level after PCI and with delta CK-MB. Platelet to lymphosite ratio is a predictor of in-hospital mortality patient with acute myocardial infarctionion N. Meriedlona N. Meriedlona 1 Resident. Cardiology and Vascular Medicine. University of Sebelas Maret. Surakarta. Indonesia R.K. Marsam R.K. Marsam 1 Resident. Cardiology and Vascular Medicine. University of Sebelas Maret. Surakarta. Indonesia A.N. Famila A.N. Famila 1 Resident. Cardiology and Vascular Medicine. University of Sebelas Maret. Surakarta. Indonesia I. Christina I. Christina 1 Resident. Cardiology and Vascular Medicine. University of Sebelas Maret. Surakarta. Indonesia T. Wasyanto T. Wasyanto 2 Cardiologist. Cardiology and Vascular Medicine. University of Sebelas Maret. Moewardi Hospital. Surakarta. Indonesia acute myocardial infarction platelet to lymphocyte ratio in hospital mortality Abstract Background There was limited data regarding relationship between Platelets to Lymphocyte Ratio (PLR) and mortality patient with acute myocardial infarction. High level of platelet triggered atherosclerosis and lymphocyte was a modulator of immune response. The aim of this study is to investigate relationship between platelet to lymphocyte ratio and in-hospital mortality of acute myocardial infarction. Methods We collected 79 patients between July 2015 to December 2015 in Moewardi Hospital. This study is retrospective observational analytic. Inclusion criteria was patiens with acute myocardial infarction and exclusion criterias were valvular heart disease, malignancy, advanced renal or liver disease, active infection, and autoimmune disease. Platelet and differentiated leucocyte count were measured by automated hematology analyzer. Result 79 patients with mean age 59.97 +11.78 years (64.4% male) were enrolled in this study. In-hospital mortality was significantly higher in PLR >224(n = 13, 16.45%) compared to PLR < 224(n = 4, 5.06%). According to bivariate analysis, PLR, age, creatinin, smoking, ejection fraction, type of myocardial infarction, and dyslipidemia with p < 0.25 were included to multivariate analysis. PLR (OR:0.029, 95% CI: 0.03-0.275) was independet predictor of in-hospital mortality together with creatinin (OR:0.07, CI 95%:0.057-0.967), determine by multiple logistic regression analysis. The PLR cut off point 224 from receiver operating characteristic analysis predicted in-hospital mortality with sensitivity 82.4% and spesitivity 74.2% (area under curve. 83.8%, p-value < 0.001, and CI 95%:0.709-0.966). Conclusion We found that the PLR was significant to predict in-hospital mortality patients with acute myocardial infarction. Platelet to lymphocyte ratio can be used for cardiac risk stratification acute myocardial infarction. Effect of depression on erectile dysfunction in stable coronary heart disease patients H. Hariawan H. Hariawan Department of Cardiology and Vascular Medicine, Faculty of Medicine Gadjah Mada University Yogyakarta N.A. Sulistyo N.A. Sulistyo I. Andiarso I. Andiarso Erectile dysfunction stable coronary heart disease depression Abstract Background Coronary heart disease (CHD) is ranked first as morbidity and cause of death in Indonesia. Atherosclerosis is a systemic disease and may involve atherosclerosis of the arteries in penis and produce erectile dysfunction (ED) in patients with CHD. Depression and ED are common in patients with CHD. Depression can affect normal erectile function. The aim of this study was to determine whether stable CHD patients with depression have a higher risk for the incidence of ED when compared with them without depression. Methods This paired case-control study was conducted in Dr. Sardjito Hospital, from April to July 2015. Stable CHD patients diagnosed with coronary angiography who make regular visit were investigated the risk factors for the occurrence of ED. The assessment of ED using the IIEF-5 questionnaire (Indonesian version) and depression with the HADS questionnaire (Indonesian version). Stable CHD patients with ED was a group of cases. The control group was stable CHD patients without ED with age matching of the case group. Results Eighty six patients were included in the study, with 57 patients as cases and 29 patients as controls. Depression was present in 5 stable CHD patients with ED (8.7%). The odds ratio for incidence of ED in stable CHD patients with depression was 2.692, but not statistically significant (CI 95% 0.300-24.192; p: 0.306). Conclusion Stable CHD patients with depression have a higher risk of ED when compared with them without depression, however it was not statistically significant. The correlation betwen the electroniccardiographic findings based on Seattle criteria and the left ventricular mass index of the football players Nurhikmawati Nurhikmawati 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Hasanuddin University, Makassar M. Amir M. Amir 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Hasanuddin University, Makassar I. Mappangara I. Mappangara 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Hasanuddin University, Makassar I.J. Ganda I.J. Ganda 2 Department of Pediatric, Faculty of Medicine Hasanuddin University, Makassar P. Tandean P. Tandean 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Hasanuddin University, Makassar K. Saleh K. Saleh 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Hasanuddin University, Makassar Abstract Background Exercise and regular physical exercise associated with process of remodeling in the form of Left Ventricular Hypertrophy which is we have known that the increase of ventricular mass index will increase the risk of sudden cardiac death. This research aimed to assess the correlation between between Seattle Criteria and the increase of left ventricular mass index of a football player.Thus, it was hoped that the Seattle Criteria could be used to predict the increase of the left ventricular mass index. The research was a cross-sectional observational study design. Methods The study was conducted in Hasanuddin University Teaching Hospital from November 2015 through December 2015. The respondents comprised 46 people, and the research population included the football players of Makassar football club. The assessment was performed using the questionnaire, then the examinations of ECG and echocardiography were carried out. The data were analyzed with correlation coefficients Kontingesia. Results The research results indicated that there 34 players (73.9%) had the normal variants, 5 players (10.9%) had the normal pictures, and 7 players (15.2%) had the abnormal pictures. The research also indicated that there was a significant correlation between the Seattle Criteria and the left ventricular mass index – the value of the correlation coefficient being 0.401, p <0.05. Conclusion From the research we found that the finding of the normal variant of Seattle Criteria showed the normal left ventricular mass index. The development model of Ganoderma lucidum polysaccharide peptides as antioxidant and anti-inflammation in patients with atherosclerosis O. Handayani O. Handayani N. Ubaidillah N. Ubaidillah A. Widya A. Widya Vittryaturida Vittryaturida K. Siwi K. Siwi M. Failasufi M. Failasufi F. Ramadhan F. Ramadhan H. Wulandari H. Wulandari Y. Waranugraha Y. Waranugraha D.H. Putri D.H. Putri D. Sargowo D. Sargowo Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia Ganoderma lucidum polysaccharide peptide atherosclerosis antioxidant stable angina Abstract Background Ganoderma lucidum is a type of mushroom that has been used for thousand years throughout Asia, and has been known for its numerous health benefiting properties including antioxidant, anti-inflammatory, and anticancer properties. This study was conducted to demonstrate the efficacy of Ganoderma lucidum polysaccharide peptides (PSP) as anti-inflammation and antioxidant in cardiovascular disease. Methods In a prospective, randomized trial, with pre- and post-test design, we assigned 72 patients with atherosclerosis, 37 high-risk patients based on the Framingham Risk Score and 35 patients with stable angina, to receive polysaccharide peptides (PSP) 3 x 250mg for three months as adjuvant to their previous medications. The primary end points were the changes in biomarkers of inflammation and oxidative stress, including interlukin-6 (IL-6), TNF-alpha, C-reactive protein (CRP), malondialdehyde (MDA) and superoxide dismutase (SOD). Results There were significant reductions in inflammatory biomarkers IL-6, TNF-alpha and CRP levels (p = 0.000) in both high-risk patients and patients with stable angina. The greatest reduction was shown in CRP level, from 20158.88 ± 8968.08 ng/ml to 25329 ± 8682.10 ng/ml (p = 0.000) in stable angina patients. Moreover, PSP could reduce MDA level (from 114.13 ± 24.56 uM to 36.48 ± 28.39 uM and 95.63 ± 21.27 uM to 44.84 ± 50.95 uM, p = 0.000, in high-risk and stable angina patients respectively), and increase SOD level, which is the primary internal antioxidant from 3.41 ± 0.46 U/ml to 5.97 ± 4.19 U/ml (p = 0.001) in patients with stable angina. The efficacy of PSP administration on the levels of SOD, MDA, TNF-alpha, CRP and IL-6 was most significantly shown on SOD levels (r = 0.392, p < 0.05). Conclusion Ganoderma lucidum PSP as adjuvant therapy has significantly demonstrated its benefits as anti-inflammation and antioxidant in high-risk patients and patients with stable angina. Hypertension knowledge, awareness, and attitudes in hypertensive patients in primary health center in Mataram, Lombok island, Indonesia P. A. Syah P. A. Syah 1 General Practicioner, Arjawinangun Public Hospital, West Java, Indonesia M.E. Sanif M.E. Sanif 2 Cardiologist, Permata Cirebon Hospital, West Java, Indonesia hypertension public health mataram primary health center Abstract Background Hypertension (HTN) is one of the most common world's most common health condition and a leading risk factor to mortality. A good understanding of the importance of the HTN is the key factor for the primary and secondary prevention of HTN among the patients. The aim of this study is to investigate HTN knowledge, awareness, and attitudes in hypertensive patients in primary health center in Mataram, West Nusa Tenggara, Indonesia. Methods We identified patients with HTN (n = 30) in primary health care in Mataram, West Nusa Tenggara, Indonesia from Mei-October 2015. Hypertension was defined as a mean systolic and/or diastolic blood pressure of 140 ≥ 90 mmHg and/or antihypertensive medication use during the last two weeks. Results Only 36.7% of all patients correctly identified the meaning of HTN as “high blood pressure”. All of the patients (100%) were not able to identified systolic blood pressure(SBP) as the “top number” of the reading and diastolic blood pressure (DBP) as the “bottom number” of the reading. Most of the patients (93.3%) knew that they have hypertension. Eighty sevent percent of the patients agreed that taking medicine was very important to keep the blood pressure under control. When asked whether a hypertension was a life long disease or not, more than a half of the patients (56.7%) agreed that hypertension was a life long disease. Conclusion These results suggest that, although perception and awareness of HTN are adequate, but patients do not have a complete understanding of the knowledge of the disease, for an example only 36.7% patients correctly identified the meaning of HTN as “high blood pressure”. This observation suggest that a public health approach is necessary to improve the patients's knowledge of HTN. Right ventricular dysfunction as an independent predictor of longer hospital stay in patients with acute decompensated heart failure P.P. Yamin P.P. Yamin S.B. Raharjo S.B. Raharjo V.K.P. Putri V.K.P. Putri R. Soerarso R. Soerarso B.B. Siswanto B.B. Siswanto N. Hersunarti N. Hersunarti Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia acute decompensated heart failure right ventricle tricuspid annular systolic excursion length of stay Abstract Background Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs. Longer LOS is associated with lower performance on quality of care measures and higher rates of subsequent readmission and mortality. Right ventricular (RV) dysfunction predicted poor outcomes in patients with stable chronic HF, however, its prognostic value in the setting of acute decompensated heart failure (ADHF) patients has not been sufficiently clarified. Purpose To investigate the prognostic value of RV dysfunction in predicting longer LOS in ADHF patients. Methods A prospective cohort study was conducted in our hospital to all patients admitted with ADHF and had data on baseline RV functions assessed by tricuspid annular plane systolic excursion (TAPSE). Detailed clinical, laboratory and echocardiographic data were collected on admission. Clinical comorbidities including malnutrition, concomitant pneumonia and worsening renal function (WRF) were monitored during hospitalization. The primary outcome was hospital LOS. Cox regression analysis were used to identify independent predictors for longer LOS. Results Two hundred and fifty-nine patients presenting to the emergency department with the diagnosis of ADHF were included in this cohort study. On time-to-event analysis, diastolic blood pressure (HR 1.011, 95% CI 1.004-1.018, p = 0.002), hemoglobin levels (HR 1.102, 95% CI 1.045-1.162, p < 0.001), RV dysfunction (measured by TAPSE) (HR 0.659, 95% CI 0.506-0.857 p = 0.002), WRF (HR 2.015, 95% CI 1.520-2.670, p < 0.001) and malnutrition (HR 5.965, 95% CI 4.402-8.082, p < 0.001) were associated with longer LOS. In a multivariate Cox regression model, RV dysfunction (HR 0.515, 95% CI 0.303-0.874, p < 0.02), WRF (HR 2.989, 95% CI 2.160-4.135, p < 0.001) and malnutrition (HR 8.211, 95% CI 5.883-11.459, p < 0.001) were the sole independent predictors of longer length of hospital stay. Conclusions Right ventricular dysfunction is an important predictor of longer length of hospital stay. Routine assessment of the right ventricle should be considered in the evaluation of patients with ADHF. Correlation of cardiac T2* magnetic resonance imaging, left ventricular ejection fraction, and serum ferritin level in patients with Beta-Thalasemia P. Almazini P. Almazini A. Kristyagita A. Kristyagita T.M. Haykal T.M. Haykal Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia Cardiac T2* MRI LVEF Ferritin Thalasemia Abstract Background Myocardial hemosiderosis still remains as one of the serious leading causes of death in patients with thalassemia. Early detection of iron overload may lead to more effective tratment but it still challenging. The aim of this study was to evaluate correlation of cardiac T2* Magnetic Resonance Imaging (MRI), left ventricular ejection fraction (LVEF) measured by echocardiography, and serum ferritin level in patients with beta-thalasemia. Methods This was a cross-sectional retrospective study identified 36 patients with beta-thalasemia who underwent cardiac T2* MRI, echocardiography, and serum ferritin level assessment in Cipto Mangunkusumo Hospital. Data were analyzed using SPSS version 17.0 software. Results Of 36 patients with beta-thalasemia, mean age of patient was 13.7 ± 12.9 ms. Mean value of LVEF was 67.1 ± 5.2%. Median value of serum ferritin was 3066.5 ng/mL, at the range 1031-5188 ng/mL. Statistical analysis showed there was no significant correlation between LVEF and cardiac T2* MRI (r = 0.273, p = 0.107). No significant correlation was observed between LVEF and serum ferritin level (r = -0.012, p = 0.946). However, a significant negative correlation was observed between cardiac T2* MRI and serum ferritin level (r = -0.346, p = 0.039). Conclusion Our study showed LVEF is not alternative parameter for detection iron deposition in patient with beta-thalasemia. However, serum ferritin level is still feasible method to estimate iron burden in patien with beta-thalasemia. Association between risk factors of acute myocardial infarction and QTc dispersion after streptokinase administration in Dr.Moewardi Hospital, Surakarta P. Septiani P. Septiani 1 Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia A. K. Martiana A. K. Martiana 1 Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia A. Jalaludinsyah A. Jalaludinsyah 1 Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia T. Wasyanto T. Wasyanto 2 Department of Cardiology and Vascular Medicine, Dr.Moewardi Hospital, Surakarta, Indonesia QTc dispersion acute myocardial infarction streptokinase hypertension diabetes smoking Abstract Background Cardiovascular risk factors and acute myocardial infarction (AMI) can impair mechanical and electrical activity of the heart. A better ventricular repolarization is expected after administration of fibrinolytic. QTc dispersion (QTcd) is a parameter that can be used to evaluate the ventricular repolarization heterogeneity. It is the difference between the longest and the shortest QTc interval in the electrocardiogram (ECG). The aim of the study is to evaluate the association between risk factors of AMI and QTc dispersion after streptokinase administration. Methods In this retrospective sudy, we collected data from the medical records of 73 AMI patients who were treated with streptokinase from January 2014 – December 2015. The 12-lead ECG was recorded before receiving streptokinase and an hour after receiving streptokinase. We measured the QT interval using a digital caliper and calculated the QTc according to the Bazett's formula, then we counted the QTc dispersion. Data analysis was performed using Chi square test. Results Among the male (82%) patients, shorter QTcd (30.515 ± 24.322 ms) after streptokinase administration was found in 55%; while among the female (18%) patients, shorter QTcd (29.400 ± 11.371 ms) was found in 38%. Among discharged patients (80%), shorter QTcd (32.781 ± 24.925 ms) was found in 54%; while among died (in hospital) patient (20%), longer QTcd (37.500 ± 22.633 ms) was found in 58%. There were no association between hypertension and QTcd (OR = 0.657, 95% CI = 0.258-1.674, p = 0.377), between diabetes and QTcd (OR = 0.700, 95% CI = 0.233-2.100, p = 0.524), and between smoking and QTcd (OR = 0.987, 95% CI = 0.381-2.555, p= 0.979). Conclusion After streptokinase administration, QTcd shortening was more likely in male patients and discharged patients. There was no association between hypertension, diabetes, and smoking with QTcd. Use of anticoagulants and antiplatelet agents in patients with stable coronary artery disease and atrial fibrillation in outpatient clinic RSUP Dr. M.Djamil Padang M. Syafri M. Syafri Division of Cardiology and Vascular Medicine, Faculty of Medicine, Andalas University, General Hospital of Dr. M. Djamil Padang P. Yeantesa P. Yeantesa M. Fadil M. Fadil T. Daindes T. Daindes D. Puspita D. Puspita R. Musritha R. Musritha C.K. Krevani C.K. Krevani Y. Karani Y. Karani atrial fibrillation stable coronary artery disease anticoagulant antithrombotic Abstract Background Patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) remain a therapeutic challenge because of the different antithrombotic therapies for these conditions and the increase in bleeding with concomitant antiplatelet and anticoagulant medications. Current guidelines extrapolated data from studies of antithrombotic regimens of each condition separately but there is limited evidence for the optimal regimen in patients with atrial fibrillation and stable coronary artery disease beyond the first year after an acute coronary syndrome or stent implantation. The aim of this study is to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease. Methods Data were collected between July 1st, 2015 – December 31st, 2015. We studied outpatients with stable coronary artery disease, defined as prior (≥12 months) myocardial infarction, revascularization procedure, or chest pain associated with evidence of myocardial ischemia. Result We recruited 289 patients to be screened, and 16 of them were excluded. Furthermore, we found 31 (11%) patients had a history of AF and mostly are male (70.9%) with mean age 59.9 ± 11.8. Among patients with CAD and AF, 93% of the patient required antithrombotic treatment according to the CHA2DS2-VASc score (≥2). Oral anticoagulation alone was used in 38.8%, antiplatelet therapy alone in 38.5% (single 22.3%, dual 16.2%), and both in 22.5%. OAC use was independently associated with permanent AF (p < 0.001), CHA2DS2-VASc score (p < 0.001), and longer history of coronary artery disease (p < 0.001). History of percutaneous coronary intervention (p = 0.004) was associated with reduced oral anticoagulant use. Conclusion Patients with stable coronary artery disease and AF, who are theoretical candidates for anticoagulation as the appropriate medication, apparently only used in 61.3% of all the samples. One-third of the patients received antiplatelet therapy alone and one-fifth received both antiplatelet and oral anticoagulants. Efforts are needed to improve the knowledge and adherence to guidelines in treat these patients. Prevalence of overweight and obesity among hypertensive patients in a rural area: A descriptive study at Kubu Village, Karangasem, Bali P. Nugiaswari P. Nugiaswari 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia A. Yasmin A. Yasmin 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia P. Antara P. Antara 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia R. Widiana R. Widiana 2 Nephrology and Hypertension Division, Internal Medicine Department, Udayana University, Bali, Indonesia W. Wita W. Wita 1 Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia Hypertension Obesity Central Obesity Rural Area Abstract Background Hypertension and obesity are major risk factors of cardiovascular morbidity and mortality in developing countries. According to the Regional Health Department Survey 2015 in Bali, the prevalence of hypertension was 28% and 12% of excess body weight. This study was carried out to establish the prevalence of overweight and obesity among hypertensive patient at Kubu Village, Karangasem District of Bali Province. Methods The study included 115 subjects from Kubu Village who attended the social work clinic held by the Department of Cardiology and Vascular Medicine, Udayana University. Hypertension was defined as systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90mmHg or being on any hypertensive therapy. All subjects underwent anthropometric measurement such as body weight, height, and waist circumference. Demographic data were obtained using structured questionnaire. Subjects considered overweight were those with a body mass index (BMI) of 25 kg/m2 or greater, and those considered obese as having a BMI of 30 kg/m2 or greater. Results The overall prevalence of hypertension in the study was 24.3% (28 out of 115 patients). The prevalence was higher in women (54%) than in men (46%). Among these subjects, the prevalence of overweight, obesity, and central obesity were found to be 25%, 3.6%, and 32% respectively. The majority of subjects had low educational profile (71%) and half of them had regular fish consumption. Conclusion The prevalence of hypertension was high as expected, meanwhile central obesity seems to be much higher compared to data from the regional survey. The findings confirm the growing concern about hypertension and central obesity as a public health problem, especially in rural areas such as Kubu Village. This warrants for good control of cardiovascular risk factors in those populations. Pulmonary hypertension : Echocardiographic characteristics in Cimacan General Hospital R.S.D. Gill R.S.D. Gill 1 Cimacan General Hospital, Cianjur, Indonesia D. R. Syawaluddin D. R. Syawaluddin 2 East Belitung General Hospital, Manggar, Indonesia Echocardiography characteristic pulmonary hypertension Abstract Background Pulmonary hypertension defined as an increase in mean pulmonary arterial pressure ≥ 25 mm at rest and is more often diagnosed in its advanced stage because of the nonspecific early symptoms and signs. Echocardiography is a key screening tool in the diagnostic algorythm. Objectives Objectives of this study is to know pulmonary hypertension echocardiographic characteristic in Cimacan general hospital as a rural hospital. Methods This study was a crossectional study, 22 consecutive patients with pulmonary hypertension referred for echocardiography were evaluated. Result Echocardiographic characteristics of the patients with pulmonary hypertension can be seen in table 1. 16 patients (72.7%) shows right atrium enlargement, 1 patient (4.5%) shows anterior wall hypertrophy, 14 patients (63.6%) shows posterior wall hypertrophy, 16 patients (72.7%) shows septal hypertrophy, 8 patients (36.4%) shows moderate tricuspid regurgitation,and 13 patients (59.1%) shows severe tricuspid regurgitation. 9 patients (40.9%) have pericardial effusion, and 1 patient (4.5%) shows thrombus in the right atrium. Conclusion Right atrium enlargement is usually found in patients with pulmonary hypertension as seen in the result. In this study we found right atrium enlargement and septal hypertrophy in 72.7% of the patients. Correlation study shall be done in order to investigate what causes both of the cardiac anatomy changes. Clinical profile and risk factor of congestive heart failure patients in Subang General Hospital, West Java R.S.D. Gill R.S.D. Gill 1 Subang General Hospital, West Java, Indonesia G. C. Massie G. C. Massie 2 Kembangan District General Hospital, Jakarta, Indonesia N. Y. Nasser N. Y. Nasser 3 Faculty of Medicine, Airlangga University, Surabaya, Indonesia A. A. Hartono A. A. Hartono 4 Koja General Hospital, Jakarta, Indonesia clinical profile risk factors congestive heart failure Abstract Background Congestive heart failure (CHF) has become an increasingly frequent reason for hospital admission and clearly represents a major health problem. In general population, CHF is the most common complication of hypertensive and coronary heart disease. It is a growing health problem in most countries and yet there is not enough data available in Indonesia. Objectives of this study are to investigate clinical profile and risk factors of CHF patients in Subang General Hospital. Methods This was a crossectional study, carried out in Subang General Hospital, conducted from July – December 2015. Results A total of 29 patients presented with CHF were included in the study. There were 21 males (72. 4 %) and 8 females (27.6%). Majority of patients (n = 20, 69.0%) were aged >50 years old. Dyspneu on effort was the most common symptom found in 24 patients (82.8%), followed by cough (n = 20, 69.0%), orthopneu (n = 17, 58.6%), fatique (n = 12, 41.4%), oedeme extremities and weight loss (n = 10, 34.5%), chest pain and tachycardia (n = 8, 27.6%), Paroxysmal nocturnal dyspnea (n = 7, 24.1%), palpitation (n = 5, 17.2%%). Patients risk factors can be seen in figure 1. Conclusion Hypertension is the leading cause and dyspneu on effort is the most common symptom found in CHF patients in Subang General Hospital. Patients also came in late stages, as can be seen in the severe symptoms shown. These results can be explained by considering the remote location of Subang itself, limited access to healthcare, and low level of knowledge of the patients. Correlation between troponin T and plasma magnesium level in acute myocardial infarction patient R. H. Wibowo R. H. Wibowo S. Hidayat S. Hidayat A. Purnomowati A. Purnomowati Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia plasma magnesium acute myocardial infarction troponin Abstract Background Ischemic heart disease still the main cause of death worldwide. Magnesium (Mg) status is often ignored in Acute Myocardial Infarction (AMI). The reduction of Mg level in AMI occurs due to migration of Mg from extracellular to intracellular space caused by increased catecholamine level in acute stress condition. There are limited studies regarding correlation between cardiac enzym biomarker and Mg level in AMI, however there were inconsistency in research results. The objective of this study is to analyze correlation between troponin T and plasma Mg level in AMI patients. Methods We conducted a cross-sectional study of AMI patients presenting within 3-24 hour of symptom onset in Hasan Sadikin Hospital. Electrocardiograms were collected during admission and and blood samples were collected within 16-24 hour of symptom onset. Correlation between troponin T and plasma Mg level were analyzed with Spearman correlation. Results A total of 46 patients (73.9% male, 59 ± 11 years old) were included in the analysis. Median for symptom onset was 8 (3-24) hours. The median troponin T level was 0.99 (0.10-2.00) ng/ml and the average Plasma Mg level was 2.02 ± 0.24 mg/dL. There was a moderate significant negative correlation between troponin T and Mg level (r = -0.510, p = <0.001). In the present study, plasma Mg level was found to have a significant relationship with the infarct size assessed by troponin T. Conclusion There was a moderate significant negative correlation between troponin T and plasma Mg level in AMI patients. Effect of atorvastatin loading prior to fibrinolysis on nitric oxide levels in patients with acute myocardial infarction R. K. Marsam R. K. Marsam N. Purwaningtyas N. Purwaningtyas T. Wasyanto T. Wasyanto Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia Atorvastatin fibrinolysis nitric oxide acute myocardial infarction Abstract Background Incidence of acute myocardial infarction as a form of coronary heart disease (CHD) is increasing. Reperfusion as definitive therapy aims to relaunch the bloodstream and improve endothelial dysfunction. Previous studies have demonstrated the beneficial effect of additional therapy prior to reperfusion to improve endothelial dysfunction. Statins as lipid-lowering therapy have pleiotropic effects that have been shown to improve endothelial dysfunction. Giving statins before primary percutaneous coronary intervention shown to increase levels of nitric oxide (NO). Data on statin before fibrinolysis action is still lacking. Aims To determine the effect of atorvastatin 80 mg immediately prior to fibrinolysis on nitric oxide levels in patients with acute myocardial infarction. Methods This study was a randomized controlled trial (RCT). 30 consecutive patients with acute myocardial infarction undergoing fibrinolysis at Intensive Cardiovascular Care Unit (ICVCU) Dr Moewardi Hospital Surakarta were included in the study. The eligible patients were randomized into two groups : Treatment group (atorvastatin 80 mg prior to fibrinolysis, n = 15) and Control group (without atorvastatin prior to fibrinolysis, n = 15). Venous blood samples were collected from all patients prior to and 24 hours after fibrinolysis. Serum concentrations of NO were measured using colorimetric assays. Normally distributed data were compared using independent t-test. p < 0.05 was considered to indicate a statistically significant difference. Results NO levels in treatment grup was higher than the control group (6.18 ± 2.48 vs 4.50 ± 2.52; p = 0.077). Elevation of NO levels in the treatment group was higher than the control group and statistically significant (3.18 ± 1.52 vs 1.88 ± 1.55; p = 0.028). Conclusions Administration of atorvastatin 80 mg immediately prior to fibrinolysis increases levels of nitric oxide in patients with acute myocardial infarction with ST segment elevation Cardiovascular manifestation after long-term glucocorticoid abusers from traditional herbal drinks: A population based-study R.A. Nugraha R.A. Nugraha 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia R.B. Wicaksono R.B. Wicaksono 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia D. Octavia D. Octavia 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia D.P. Zennita D.P. Zennita 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia W. Sudihardjo W. Sudihardjo 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia I. Yunita I. Yunita 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia G. Anggiridiaksha G. Anggiridiaksha 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia H. Hekmatyar H. Hekmatyar 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia N. Salsabilla N. Salsabilla 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia V. Wati V. Wati 1 Faculty of Medicine, Airlangga University, Surabaya – Indonesia I. Wahyuni I. Wahyuni 2 Ophtalmology Department, Dr. Soetomo Hospital – Airlangga University N. Widajanti N. Widajanti 3 Geriatric Division, Internal Medicine Department, Dr. Soetomo Hospital – Airlangga University L. Djuari L. Djuari 4 Public Health Department, Faculty of Medicine, Airlangga University, Surabaya – Indonesia S. Prayitno S. Prayitno 4 Public Health Department, Faculty of Medicine, Airlangga University, Surabaya – Indonesia Elderly Hypertension Glucocorticoid Steroid Abusers SBP DBP Abstract Background Glucocorticoid misuse is a common problem in Indonesia, especially in rural area. Many unofficial traditional herbal drinks containing glucocorticoid are commonly found in Indonesia, especially at Mojoagung District, Jombang. Many corticosteroid drugs and their derivatives drugs are easy to get in drugstores. Nevertheless, there is very few published literature regarding the magnitude of glucocorticoid misuse and their long-term effect in developing countries on South East Asia. Objective Analyze the relationship between long-term glucocorticoid abusers with cardiovascular manifestation in pre-elderly and elderly population at Mojoagung District, Jombang. Methods Cross-sectional study was conducted at Mojoagung District, Jombang with multi-stage cluster random sampling, collecting 63 samples. Data were collected by questionnaire to access history of consuming glucocorticoid from traditional herbal drinks and/or medication. Statistical analysis applied Pearson's correlation, Independent Sample t-test, Chi-square test with Coefficient Contigency. 63 subjects were composed of 19 pre-elderly (55-64 years old) and 44 elderly subjects (>65 years old), 28.6% men and 71.4% women, with a mean age of 69.65 (±10.07) years. Results 18 subjects(28.6%) were steroid abusers for more than 30 years. Of the 18 abusers subjects, hypertension were found in 15 subjects(83.33%), whereas in 45 non-abusers subjects, hypertension were only found in 16 subjects (35.56%). There is a moderate relationship between long-term glucocorticoid abusers with hypertension (p = 0.001, r = +0.396, PR 2.344 [1.503-3.655; 95%CI]). Results showed a significant increase in systolic and diastolic blood pressure (SBP and DBP) in glucocorticoid abusers which associates with duration of abuse (p = 0.02 and p = 0.03, respectively). No significant electrocardiography changes had been found. No major cardiovascular complication, ASCVD, Stroke, and Cardiomyopathy, and Hypoadrenal Crisis had been found during observation. Conclusion Increase in SBP or DBP is a common complication of long-term glucocorticoid abusers which can lead serious cardiovascular manifestation. Glucocorticoid misuse is an important problem which has been inadequately addressed in the rural and semi-urban communities of Mojoagung District, Jombang. Association between sex differences with congestive heart failure in Madurese population, Sampang, Madura R. Maulana R. Maulana 1 Faculty of Medicine Muhammadiyah Jakarta University I. Maghfirah I. Maghfirah 2 Faculty of Medicine Airlangga University F. Alzahra' F. Alzahra' 3 Faculty of Medicine Gadjah Mada University A. Putrinarita A. Putrinarita 2 Faculty of Medicine Airlangga University N. Rahmy N. Rahmy 4 Faculty of Medicine Padjajaran University A. Lestari A. Lestari 2 Faculty of Medicine Airlangga University V. Tandy V. Tandy 2 Faculty of Medicine Airlangga University I.D. Sanjaya I.D. Sanjaya 2 Faculty of Medicine Airlangga University Y. Nurina Y. Nurina 2 Faculty of Medicine Airlangga University L Lidjaja L Lidjaja 2 Faculty of Medicine Airlangga University L. Agustin L. Agustin 2 Faculty of Medicine Airlangga University D. Listiarini D. Listiarini 2 Faculty of Medicine Airlangga University E. Pradyta E. Pradyta 2 Faculty of Medicine Airlangga University A. Aulani A. Aulani 2 Faculty of Medicine Airlangga University A. Pramudya A. Pramudya 2 Faculty of Medicine Airlangga University sex congestive heart failure madurese population Abstract Background Congestive heart failure represents a major heart problem for the aging population, particularly among women. According to the Framingham Study, the risk of heart failure is increased by two fold in men and 3 fold in women. Objective The objective of this study was to examine the strength of evidence available for gender differences in the etiology of congestive heart failure in Madurese population, Sampang, Madura. Method A cross sectional study was conducted between July to Desember 2015 from medical records of outpatient department, RSUD Sampang. Samples were 137 subjects who fulfilled inclusion and exclusion criteria. Data were analyzed by Chi-Square test and Fischer's as an alternative test with 95% confidence interval. Result Among the 137 patients, 38% (n = 52) were men and 62% (n = 85) were woman. The mean age was 52.94 raging from 23-92 years, which predominated by age group of 50-54 years old (24.1%). Congestive heart failure was diagnosed in 61 subjects (44.5%) and 76 (55.5%) were normal. There was a significant relationship between sex differences (p = 0.03) towards congestive heart failure. The odds ratio was 2.08 (95% CI:1.03 to 4.21), female has greater risk than male. Conclusion This study shows that there is a relationship between sex of the participants and the incidence of congestive heart failure, as female are more at risk by 2.08 times compared to male. Reperfusion strategy for acute myocardial infarction : Comparing in-hospital outcome between primary PCI and fibrinolytic in M. Djamil Hospital Padang M. Fadil M. Fadil Acute Cardiac and Intensive Care Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine Andalas University of Andalas/ ICCU M. Djamil Hospital Padang R. Yandriani R. Yandriani M. Syafri M. Syafri STEMI reperfusion therapy primary PCI fibrinolytic in-hospital outcome Abstract Background Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care. Primary PCI is the preferred reperfusion strategy for patients with STEMI if it can be performed in a timely manner. Fibrinolytic therapy is the alternative to primary PCI. The objective of this study was to analyze in-hospital outcome in STEMI patients who underwent primary PCI or fibrinolytic in Cardiovascular Unit Care of M. Djamil Hospital. Material and Methods STEMI patients within 12 hours of onset who underwent primary PCI or fibrinolytic in CVCU of M. Djamil hospital from July 2015 to Desember 2015 were analyze. Patients underwent primary PCI received aspirin and clopidogrel. Heparin was administrated in conjuction with PCI. Patients who underwent fibrinolytic received aspirin and clopidogrel followed by streptokinase infusion for 60-90 minutes. Patients with failed fibrinolytic and then underwent PCI were excluded from Primary PCI group. The clinical profile, length of stay and in-hospital outcome in these two group were compared. Result Total STEMI patients within 12 hours of onset hospitalized in CVCU of Dr.M. Djamil Hospital Padang from July until Desember were 106 patients. This study was predominantly male dominated (86% in PPCI and 72% in fibrinolytic) patients with mean age of 56 ±4 years in PPCI and 58 ±5 years in fibrinolytic. Cigarette smoking was identified as a major risk factor in these two group (56% in PPCI and 58% in fibrinolityc).The mean time from hospital admission to start of streptokinase infusion was 56 ± 15 min and door to balloon time was 65 ± 25 min. There was no significant difference between the groups in the number in-hospital mortality. The major bleeding is higher in fibrinolytic group (8,8%). The most complication of STEMI were KILLIP II and there were no difference in these group. There was difference in the length of stay in hospital ( primary PCI group 4,2 days, fibrinolysis group 5,6 days). Conclusions The most common reperfusion strategy in STEMI patients was fibrinolityc. Patients who underwent primary PCI have shorter length of stay in hospital. Fibrinolytic was associated with significantly higher risk of major bleeding. Knowledge, attitude, and practice of primary health care providers in prevention and management towards hypertension in Morotai Island, North Maluku R. Istisakinah R. Istisakinah R.G. Aurora R.G. Aurora R.U. Setiany R.U. Setiany T.K. Perdamaian T.K. Perdamaian H.D. Tjipto H.D. Tjipto D.R. Amalia D.R. Amalia A. Makmur A. Makmur M.M. Lubis M.M. Lubis Morotai Island Government Health Office, North Maluku, Indonesia Hypertension KAP health provider primary care Morotai Island Abstract Background Morotai Island has high hypertension prevalence. Evaluation for prevention and management of hypertension is still scarce especially in remote area. Thus, we decide to study knowledge, attitude, and practice of health workers in primary care settings toward prevention and management of hypertension. Methods A cross sectional study was conducted in all public health centers of Morotai Island. The respondents were asked to fill questionnaire consisting of knowledge, attitude, and practice questions that had been tested for its reliability using Cronbach Alpha with value of 0.862. Level of knowledge, attitude, and practice was considered poor if the percentage of correct answers was less than 50%, moderate if between 50-75%, and good if more than 75%. We performed univariate and bivariate analysis using SPSS 17.0. Results From 113 respondents, 82 (72.6%) were female. The mean age was 28 ± 4.36 years old. Only eight of them were medics, the rest were paramedics. Most respondents had D3 degree (75.25%). Only five (4.4%) respondents had participated in seminar associated with hypertension. Most respondents (57.5%) had moderate knowledge about prevention and management of hypertension. Most of them had positive attitude (70.8%) and more than half of respondents had adequate practice towards prevention and management of hypertension. Knowledge of respondents was not associated significantly with profession, length of work, and history of attending hypertension seminar or workshop, but it was associated significantly with education degree (p= 0.013). Both attitude and practice were not associated significantly with all four factors. Conclusion Most of the primary health care providers in Morotai Island had moderate knowledge, positive attitude, and adequate practice towards hypertension prevention and management. Knowledge was associated significantly with education degree. Attitude and practice did not have association with profession, length of work, and history of attending hypertension seminar or workshop. Correlation between tricuspid regurgitation duration with severity of pulmonary arterial hypertension in atrial septal defect patients. R.P. Kaneko R.P. Kaneko 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta D.W. Anggrahini D.W. Anggrahini 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta A.B. Hartopo A.B. Hartopo 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta L. Krisdinarti L. Krisdinarti 2 Echocardiography Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta Atrial septal defect right heart catheterization pulmonary arterial hypertension tricuspid regurgitation duration Abstract Background Pulmonary arterial hypertension (PAH) is characterized by abnormally elevated pressure in the pulmonary circulation that are the result of progressive vascular remodeling, increased pulmonary vascular resistance and increased pulmonary arterial pressure (PAP). Gold standard for measuring PAP is using Right Heart Catheterization (RHC). It was recently reported that profound right ventricular dysfunction, that reflects deteriorate PAP, could be assessed using Tricuspid Regurgitation (TR) duration. Decrease in TR duration may predict poor deterioration of the PAP. Therefore we aimed to investigate whether TR duration correlates with severity of PAP in Atrial Septal Defect patients. Methods We conducted a cross sectional study using hospital based registry in Dr. Sardjito Hospital Yogyakarta between September 2012 – November 2015. All patients underwent echocardiography and RHC to measuring mean PAP (mPAP). PAH was defined as a mPAP ≥ 25 mmHg measured by RHC. TR duration was defined as the time between onset and cessation of TR flow. TR duration was corrected for heart rate using formula TR duration (TRDc) = TR duration/ √(R-R interval). R-R interval was measured in seconds using electrocardiography tracing. Results Thirty nine consecutive patients with ASD, 30 female (76.9%) and 9 male (23.1%). Mean age of this population is 39.9 ± 13.6 years old. These patients underwent echocardiography and right heart catheterization with result mean TRDc and mPAP are 498.23 ± 52.5 ms and 43.85 ± 20.64mmHg respectively. Afterwards, mPAP was divided into three categories in which mild, moderate, and severe PAH to show the PAH severity. Correlation between TRDc and PAH severity were assessed using ANOVA by SPSS 20. In this study, PAH severity was correlated with the TRDc (r: 0.555; P: <0.0001). The higher the TRDc, the more likely the patient has more severe PAH. Conclusion Our study confirms In Our study confirms the correlation between TRDc with PAH severity among ASD population. Thus, TRDc may surrogate the determination of PAH severity using noninvasive methods, and the degree may reflects more of PAP than the enlargement of right heart chambers in ASD. Comparison of functional capacity between atrial fibrillation and sinus rhythm patients after mitral valve surgery R. Myrtha R. Myrtha 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret I.F. Yuwono I.F. Yuwono 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Diponegoro A. Mahavira A. Mahavira 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia A.M. Ambari A.M. Ambari 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia B. Radi B. Radi 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia A. Santoso A. Santoso 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia B.S. Purwowiyoto B.S. Purwowiyoto 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia functional capacity 6MWD atrial fibrillation Abstract Background Atrial fibrillation (AF) is associated with a reduction in functional capacity in healthy subjects and in patients with different pathological conditions such as post valvular surgery. The aim of this study is to evaluate the impact of atrial fibrillation on functional capacity among patients after mitral valve surgery. Methods We performed a cross sectional study among patients undergoing cardiac rehabilitation after mitral valve surgery in National Cardiovascular Center Harapan Kita between January until December 2013. We compared functional capacity of AF patients to sinus rhythm. Six minute walking test distance (6MWD) was used to measure functional capacity. Results A total 151 patients were included in this study. There were 84 (55.3%) male. Of 151 patients, 67 patients (44.1%) were atrial fibrillation. Baseline 6MWD in AF was significantly lower compared to sinus rhythm group (292.1 +68.5 vs 322.7 +85.2, p = 0.02). After phase II cardiac rehabilitation, 6MWD in AF group was still significantly lower compared to sinus rhythm group (365.5 +70.8 vs 412.7 +83.3, p = 0.001). But both groups showed similar improvement after phase II cardiac rehabilitation (Delta 6MWD 72.5 +65.5 vs 90.9 +70.3, p = 0.122). At multivariate analysis, 6MWD was negatively associated with age (p < 0.001). Conclusion Post mitral valve surgery patients with AF had lower baseline functional capacity, however cardiac rehabilitation program improved their capacity and the improvement was comparable to their counterparts with sinus rhythm. Knowledge, attitude and perception (KAP) of patients with hypertension about hypertensive disease in Baso Primary Health Center, Agam District, West Sumatera on 2014 R. U. Setiani R. U. Setiani 1 Baso Primary Health Center, Agam District, West Sumatera G.A. Temi G.A. Temi 2 The Faculty of Medicine, University of Indonesia Hypertension KAP Level of Education West Sumatera Abstract Background Untreated hypertension can cause premature complications. About one-third of hypertensive patients late-diagnosed with hypertension, resulting in multiple organ complications such as stroke and myocardial infarction. West Sumatera Province has high prevalence of hypertension. Therefore; we tried to identify the level of knowledge, attitude and perception (KAP) of hypertensive patients in one of common treating facility, Baso Primary Health Center, so that we could optimize the prevention of hypertension complications. Methods This study use cross-sectional design, using modified and validated KAP questionnaire written in Indonesian. The inclusion criterion is all patients diagnosed with hypertension (SBP ≥ 140 mmHg and DBP ≥ 90 mmHg) at least three months previously. The data analyzed with regression-linear to find relationship between level of education and patient's KAP. Results There are 31 subjects involved, 64,5% of them are female. Average age of subjects is 61,29 years old. The level of education shows that 58,1% of subjects has low education level (not educated or not graduated from elementary school). We also found that 19,4% and 35,5% of subjects has obesity and abdominal obesity respectively. From the analysis, we found that 67,8% of subjects has good and average knowledge, 87,1% of subjects has good and average attitude, and all subjects has good and average perception. However, the regression test does not show any relationship between the level of education and the level of KAP (p > 0,05). Conclusion This study shows that almost all subjects have good KAP on hypertension and its complications although over half of them have low education level. This also shows that health education has been distributed equally in rural areas despite the low education level. We hope that this could be an example to increase our awareness of hypertension and its complications. Readmission rate of chronic heart failure patient and it's characteristic in Meilia Hospital Cibubur, Depok, West Java : A descriptive study R. Hendiperdana R. Hendiperdana 1 Meilia Hospital, Cibubur, West Java Sugiantoro Sugiantoro 2 Cardiologist at Al-Islam Hospital, Bandung, West Java Heart failure readmission Abstract Background Acute decompensated heart failure is one of the most often case which need for hospitalization. Re-hospitalization in heart failure patient indicate poor prognosis, bad Quality of Life and unsuccessful treatment. One of two chronic heart failure patient will have hospital re-admission in 6 months. Euro Heart Failure Survey Program have found 24 % patient with heart failure were admitted within 12 weeks post-discharge. The significant morbidity associated with heart failure is reflected in hospital readmission rates. This study aim to describe hospital readmission rate in chronic heart failure patient that present to emergency department (ED) at Meilia hospital based on patient medical record. Methods This was a cross-sectional descriptive study from medical record in June until December 2015. The study take place from hospitalized adult patient due to heart failure in Meilia Hospital Cibubur. The study describe time between last hospital admission with recent hospitalization in patient due to heart failure syndrome. Patient comorbid also describe in this study. Comorbid variables are hemoglobin, serum creatinine, left ventricular ejection fraction (LVEF) and myocardial injury marker (cardiac troponin). All documented data present by descriptive method. Result There 35 patients with CHF hospital admission were documented form June until December 2015. seven patients (20 %) have hospital readmission due to heart failure symptom less than 1 month post-discharge, 4 patient (11.5 %) have hospital readmission in less than 6 months post-discharge, and 24 patient (68.5 %) have hospital readmission more than 6 months periode post-discharge. From those data, 8 patients ( 22.85 %) have Hb level < 12 g/dL, 10 patients (28.5 %) have serum creatinine > 1.2 mg/ dL, 21 patients ( 60 %) have reduced LVEF < 50 %, and 6 patients ( 17.2 %) have high serum cardiac troponin T > 100 ng/L. Conclusion In Meilia hospital from June-December 2015, readmission from CHF was still high. Twenty percent patient readmitted in less than 1 months post-discharge. Patient comorbid of CHF admission like anemia, azotemia, low LVEF, and high cardiac troponin levels accompany patients profile in more than 15 % patients. Predictors of prolonged length of stay in acute heart failure patients based on 2012 Heart Failure Registry of National Cardiovascular Centre Harapan Kita Rizki Rizki B.B. Siswanto B.B. Siswanto F.P. Apriansyah F.P. Apriansyah F. Tedjasukmana F. Tedjasukmana R.S. Pratikto R.S. Pratikto N. Hersunarti N. Hersunarti A.M. Soesanto A.M. Soesanto Departement of Cardiology and Vascular Medicine, Universitas Indonesia / National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia Heart Failure predictors length of stay Abstract Background Hospitalizations due to acute heart failure caused a huge economic burden on our health care system. Little amount of data is known from Indonesia. Predicting the length of stay (LOS) and knowing factors that influenced it may help clinicians to manage their patient, and the government to arrange a well-defined insurance policy. Methods This study was based on heart failure registry of National Cardiovascular Centre Harapan Kita in 2012. We identified local demographic, previous medical history and medications, clinical profiles on admission, laboratory data, and use of intravenous (IV) therapy that were associated with hospital LOS. Prolonged hospitalizations was defined as more than seven days, based on previous studies. From 27 parameters analyzed using bivariate analysis, 16 of them (p <0.25) were included in the multivariate analysis using logistic regression. Results This study included 1207 patients in our registry. Median LOS was 5 (ranged from 1 to 29) days, 24.7% patients were hospitalized more than seven days. Variables associated with prolonged LOS from multivariate analysis (p <0.05) were history of diabetes mellitus (adjusted odds ratio [OR] 1.68; 95% confidence interval [CI] 1.26-2.24); use of IV inotropic (OR 5.72; 95% CI 3.08-10.63) and IV nitrates (OR 1.99; 95% CI 1.26-3.15) on admission; and hiponatremia (OR 1.57; 95% CI 1.14-2.16). Conclusion We identified four predictors of prolonged LOS in our acute heart failure patients. The use of IV inotropic drugs and nitrates on admission were the two strongest predictors. Patients with high-risk profiles who benefit from this kind of treatment should be treated more aggressively to minimize the LOS. Transcatheter closure of large patent ductus arteriosus with severe pulmonary hypertension: A three year experience form national refferal center in Indonesia R.M. Candrasatria R.M. Candrasatria R. Prakoso R. Prakoso P.S. Roebiono P.S. Roebiono I. Sakidjan I. Sakidjan Y. Kurniawati Y. Kurniawati O. Lilyasari O. Lilyasari A.U. Rahajoe A.U. Rahajoe G. M. Harimurti G. M. Harimurti Department of Cardiology and Vascular Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita-Indonesia Large PDA severe pulmonary hypertension transcatheter closure Abstract Background Transcatheter closure is an established procedure for patent ductus arteriosus (PDA). However, it carries higher risk in large PDA with severe pulmonary hypertension. This study aims to evaluate the early and follow-up results in such population. Methods Retrospective study has been conducted from January 2013 until December 2015 in National Cardiovascular Center Harapan Kita, Jakarta-Indonesia. Sixteen patients with PDA diameter ≥5mm and mean pulmonary arterial pressure (mPAP) >50 mmHg without other major structural heart disease underwent transcatheter closure with device. Results The mean age was 17.4 ± 10.7 years old. The mean smallest duct diameter was 11.5 ± 4.2mm. The median flow ratio (FR) was 1.7 (0.5-6.6) and mean pulmonary arterial resistance index (PARi) was 6.5 ± 4.4 WU. Fourteen patients underwent oxygen test with subsequent mean FR was 6.7 ± 5.2 and median PARi was 0.9 (0.4-6) WU. After PDA closure, the mean mPAP decreased from 58.9 ± 5.8 mmHg to 40.4 ± 14.9 mmHg (p < 0.001). Immediately after closure, 9 patients (56.3%) had minimal central residual PDA. Upon follow-up to 6 months (median of one week), no residual PDA was detected. One patient experienced major bleeding requiring transfusion. One patient experienced dislodged device and underwent uneventful emergency surgery accordingly. Conclusions Transcatheter closure is feasible, effective and safe in patients with PDA and associated reversible severe pulmonary arterial hypertension. Correlation between P wave dispersion and left atrial volume in obese young adults S. Sinambela S. Sinambela M.R. Akbar M.R. Akbar C. Achmad C. Achmad A. Purnomowati A. Purnomowati T.M. Aprami T.M. Aprami Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University/ dr. Hasan Sadikin General Hospital, Bandung, Indonesia atrial fibrillation left atrial volume obesity P wave dispersion young adults Abstract Background The prevalence of obesity tends to increase including in young adults. Obesity increases the risk of cardiovascular diseases, including atrial fibrillation (AF). Previous studies showed that remodeling in the left atria, i.e. electrical remodeling and structural remodeling, predate AF. Both remodeling can be quantified, using P wave dispersion (PWd) for electrical remodeling, and left atrial volume (LAV) for structural remodeling. No previous studies have analyzed the correlation of both parameters in obese young adults. The objective of this study is to analyze the correlation between PWd and LAV in obese young adults. Methods This was a cross-sectional study in obese young adults population, performed at Installation of Cardiovascular Services at dr.Hasan Sadikin General Hospital Bandung, May 1st, 2015–August 30th, 2015. The Body Mass Index (BMI) was measured, subjects also underwent electrocardiography (ECG) procedure for PWd assessment, and echocardiography to assess LAV. Pearson correlation analysis was used to determine the correlation between PWd and LAV. Results A total of 46 subjects [mean age 30.3 ± 4.6 years, 67.4% male, median BMI 30.8 (27.05-39.03) kg/m2], were enrolled in this study. Mean PWd was 62.9 ± 15.9 ms and mean LAV was 39.2 ± 7.7 mL. Analysis showed a positively weak correlation (r = 0.398; p < 0.05) between PWd and LAV. Conclusion There is a positively weak correlation between PWd and LAV in obese young adults. In this population, electrical remodeling predates structural remodeling. Correlatioon between waist circumference and blood pressure in patients of Cardiology Department Policlinic in General Province Hospital of West Nusa Tenggara S.S. Fitri S.S. Fitri Y. Pintaningrum Y. Pintaningrum R. Cholidah R. Cholidah Medical Faculty of Mataram University, Indonesia; 2 Department of Cardiology, Medical Faculty of Mataram University, Indonesia Waist circumference systolic blood pressure diastolic blood pressure obesity Abstract Background The prevalence of obesity continues to increase. Obesity is one of the risk factor of cardiometabolic diseases such as diabetes, hypertension, dislypidemia, and coronary heart disease. Waist circumference is one of the method that is used for anthropometric measurements of the body which can be used as a screening for obesity. Objective To find the corelation between waist circumference and blood pressure. Method This study was an observational research with cross sectional design. Samples were taken by consecutive sampling. Respondents of this study were patients aged 25 years or over in cardiology department policlinic at general province hospital of west nusa tenggara. Subjects that meets the inclusion and exclusion criteria had their blood pressure and waist circumference measured. The collected data were statistically tested using Spearman correlation test. Result The statistical analysis indicated a significant association between waist circumference and systolic and diastolic blood pressure (p < 0,05). A positive correlation was found between waist circumference and systolic and diastolic blood pressure. The strength of the correlation between waist circumference and systolic and diastolic blood pressure was moderate (R = 0,509; R = 0,459). Conclusion There is a correlation between waist circumference and systolic and diastolic blood pressure Relationship between total bilirubin concentration with Gensini Score as severity level of coronary atherosclerotic in stable coronary disease S. Mariani S. Mariani Erwinanto Erwinanto P. Tedjokusumo P. Tedjokusumo A. Purnomowati A. Purnomowati T. M. Aprami T. M. Aprami Department of Cardiology and Vascular Medicine, Padjadjaran University, Dr. Hasan Sadikin Hospital, Bandung, Indonesia Stable coronary disease total bilirubin Gensini score atherosclerotic Abstract Background Stable coronary artery disease happen because of supply and demand myocardial oxygen imbalance. Oxygen myocardial supply decrease because of stenotic coronary artery with atherosclerosis Oxidative stress is important role in atherosclerotic that can make endothelial dysfunction. Oxidative stress happen when oxidant is more radical than endogenous antioxidant, like total bilirubin. There is no previous studies that examine the relationship between total bilirubin concentration with severity of coronary atherosclerotic in stable coronary disease. Methods This study is a cross-sectional to adult patients with stable coronary disease. It was performed at invasive diagnostic of dr.Hasan Sadikin General Hospital Bandung, Juli 1, 2015 – August 15, 2015. Subject underwent coronary angiography examination to assess severity of coronary atherosclerotic and laboratory examination to assess total bilirubin serum. Severity of coronary atherosclerotic was calculated using Gensini score. Correlation between total bilirubin serum and Gensini score was analyzed using Kendall's tau correlation. Results Total of 30 subjects with mean age 57 ± 9 year and 86,7% males were enrolled in this study. Mean total bilirubin serum was 0,61 ± 0,26 mg/dl and Gensini score was 72,5 ± 44,82. Analysis showed a significant negative and moderate correlation (r= -0.555; p < 0.001) between bilirubin total and Gensini score. Conclusion Lower total bilirubin in stable coronary disease patients may indicate higher severity of coronary atherosclerotic which is marked by higher Gensini score. High plasma level of hsCRP associated with mortality and major adverse cardiovascular effect (MACE) after percutaneous coronary intervention in STEMI patients S. Widodo S. Widodo A.B. Hartopo A.B. Hartopo B.Y. Setianto B.Y. Setianto Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia hsCRP ST-elevation myocardial infarction MACE Abstract Background High sensitive C-reactive protein (hsCRP) is an acute phase protein that appears in the circulation in response to inflamatory. hsCRP, a marker for cardiovascular co-morbidities Aims To investigate the role of hsCRP to predicte MACE and mortality after percutaneous coronary intervention in STEMI patients. Methods Cohort study enrolling 61 patients with ST-elevation acute myocardial infarction that performed PCI. The inclusion criteria were ages 30-75 years and onset < 24 hour. The exclusion criteria were chronic kidney disease, chronic heart failure, acute infection, acute stroke and preadmisi reperfusion. hsCRP was measured from peripheral blood taken on admission STEMI patients, before Percutaneous Coronary Intervention . Follow-up after to investigate mortality and MACE after PCI. For analytical purpose, subject devide into two groups based on mean with High and low hsCRP. The incidence of mortality and MACE was compared between these group. Chi-square was performed for analysis. A p value < 0.05 was deemed statistically significant. Results Using Chi-square, the mean hsCRP level was 0.41, High hsCRP group (n = 30) and low hsCRP group(n= 31). Incidence mortality 16.7 % versus 9.7 %, p = 0.473; MACE 40% versus 25.8%, p = 0.238 Fatal and MACE outcomes did not significantly differ between groups. Conclusion High level of hsCRP not associated with mortality and cardiovascular adverse outcomes post percutaneous coronary intervention in STEMI patiens Association between hypoxemia in cyanotic congenital heart disease with post catheterization arterial thrombosis S.N. Siagian S.N. Siagian S. Adiarto S. Adiarto I. Sakidjan I. Sakidjan I. Sunu I. Sunu Department of Cardiology and Vascular Medicine, Universitas Indonesia – National Cardiac Centre Harapan Kita, Jakarta, Indonesia hypoxemia cyanotic congenital heart disease arterial thrombosis heart catheterization Abstract Background Arterial thrombosis is one of complication that can happen to congenital heart disease patient post catheterization which consequence can be life threathening. According to many studies, the incidence varies between 1% to 30% and the risk factors are related to catheterization procedure, age and weight. Hypoxemia in cyanotic stimulates various abnormalities which based on Trias Virchow will increase the risk for thrombosis which are change in blood flow, blood composition and endothelial integrity. Whether this predisposition factor is the main factor causing post catheterization thrombosis is still uncertain. Therefore, the purpose of this study is to find the association between hypoxemia in cyanotic and the occurrence of post catheterization arterial thrombosis. Methods This cross sectional study is conducted in National Cardiovascular Center Harapan Kita (NCCHK) to congenital heart disease patients undergoing catheterization. The subjects are divided into 2 groups: cyanotic and acyanotic based on the abnormality of the heart and the degree of saturation that measured directly from the blood and peripheral oxygen saturation with oximetry. Hypoxemia was defined as oxygen saturation less than 95%. Duplex sonography is conducted post chateterization to find the arterial thrombosis. Thrombosis is diagnosed with the appearance of thrombus and the change of Doppler waveform from proximal to distal extremity. Results There are 86 post catheterization congenital heart disease patients involved in this study. They are subsequently divided into 2 groups: 53 (61.6%) in cyanotic group, and 33 (38.4%) in acyanotic group. Post catheterization arterial thrombosis is found in 24.4% of cyanotic subjects, and 4.7% in that of acyanotic subjects. Significant association between hypoxemia in cyanotic congenital heart disease and post catheterization arterial thrombosis is found. The risk for cyanotic congenital heart disease with hypoxemia to have arterial thrombosis is high. (OR 4.758; 95% IK 1.460-15.505; p= 0.006). Conclusion This prospective study has demonstrated the significant association between hypoxemia in cyanotic congenital heart disease with post catheterization arterial thrombosis. The risk for having thrombosis is high in cyanotic congenital heart disease. Gender differences on cardiovascular risk perception and heatlh-care seeking behaviour among patients surviving myocardial infarction S.S. Danny S.S. Danny D.A. Juzar D.A. Juzar I. Firdaus I. Firdaus D. Zamroni D. Zamroni B. Widyantoro B. Widyantoro Irmalita Irmalita D. Tobing D. Tobing Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - National Cardiovascular Center Harapan Kita Jakarta, Indonesia myocardial infarction in women gender differences in STEMI Abstract Background Cardiovascular disease remains a major cause of death among men and women worldwide, but its significance in women has been traditionally underappreciated. Many studies showed that women fared worse than men when hospitalized for acute coronary syndrome, with higher morbidity and mortality rates. Lack of awareness among women might contribute to this worse outcome. We aim to investigate gender differences on cardiovascular health perception and health care seeking behavior among patients admitted with ST elevation myocardial infarction (STEMI). Methods The study was conducted in National Cardiovascular Center Harapan Kita Jakarta, Indonesia. We collected data from consecutive patients with STEMI during November 2014-June 2015. Data collected by questionnaire-guided interview before the patient was discharged. Results From 448 STEMI patients discharged alive during the study period, 377 (84.2%) were male and 71 (15.8%) were female. Women were older (mean age 60 and 57 years old, p < 0.001) and presented with more coronary risk factors (69.7% women and 48.1% men with > 3 risk factors, p < 0.001). Chest pain was the main chief complaints in both genders (86.3% in women and 83.7% in men, p = 0.783). Women presented to our hospital much later compared to men (240 min and 180 min, respectively, p = 0.005). There were significant differences in socio-economic status; only 64.9% women compared with 84.4% men (p < 0.001) graduated senior high school or higher, and women also reported lower income than men. Prior knowledge on signs and symptoms of heart attack were low in both genders; only 26.8% women and 41.4% of men reported that they had had received some information on this subject. Only 11.3% women compared to 31.8% men suspected their initial symptoms to be cardiac in origin (p = 0.001). Both genders thought that men are more likely to die out of heart attack than women (80.3% women and 76.4% men, p = 0.57) and that cancer is the main cause of death in women (53.5% women and 57.8% men, p = 0.46). More men stated their ability to make an independent decision for emergency medical procedures like primary percutaneous coronary intervention or coronary artery bypass grafting without waiting for approval from another family member, although this did not reach statistical significance (32.4% in men and 21.1% women, p = 0.08) Conclusion Female STEMI patients in our study had lower level of education, had lower income, and showed more pronounced lack of awareness and prior knowledge on signs, symptoms and risks of heart attack than men, and this might contribute to the delayed admission to healthcare facilities. Upper-limb artery anomalies found during transradial approach coronary angiography and intervention S. Widjaja S. Widjaja 1 Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Prof R.D.Kandou Hospital, Manado, Indonesia H.A. Kuncoro H.A. Kuncoro 1 Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Prof R.D.Kandou Hospital, Manado, Indonesia Ronaldi Ronaldi 1 Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Prof R.D.Kandou Hospital, Manado, Indonesia G. Yoga G. Yoga 1 Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Prof R.D.Kandou Hospital, Manado, Indonesia H. Wijaya H. Wijaya 1 Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Prof R.D.Kandou Hospital, Manado, Indonesia B. Budiono B. Budiono 2 Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Awal Bross Hospital, Makassar, Indonesia J.A. Pangemanan J.A. Pangemanan 1 Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Prof R.D.Kandou Hospital, Manado, Indonesia Transradial approach upper-limb artery anomalies Abstract Background Transradial Approach (TRA) for diagnostic catheterization and percutaneous coronary intervention (PCI) has become popular over the last few years. Increased use of TRA compared to Transfemoral Approach (TFA) is related to patient preference and comfort, low risk of vascular and bleeding complications and better clinical outcomes associated with TRA. However, upper-limb arterial anomalies are sometimes encountered during transradial coronary procedures. Challenging anatomy must be avoided to minimise the risk of complications and shorten the duration of both the procedure and radiation exposure. For this reason, a systematic preliminary angiogram of the arteries of the upper-limb has been suggested by some experts. We investigated the frequency of upper-limb arterial anomalies using retrograde arteriography in patients undergoing transradial approach coronary angiography or intervention. Methods We studied 187 consecutive patients who underwent right transradial coronary angiography or intervention from May 2014 to September 2014. Following the transradial procedure, we performed retrograde transradial arteriography of right upper-limb arteries in these patients and investigated the frequency and anatomy of arterial anomalies. Results A total of 40 upper-limb arterial anomalies were observed in 36 patients. These included 8 small caliber radial artery (4.2%), 7 radial artery stenosis (3.7%), 6 high take-off Ulnar (3.2%), 4 radial tortuosity (2.1%), 4 lusoria artery (2.1%), 2 small caliber ulnar artery (1%), 2 small radio-ulnar (1%), one case (0.5%) for each of the following anomalies : high take-off radial, no ulnar artery, radial loop, radial-ulnar tortuosity, brachial tortuosity, brachial artery occlusion, and ulnar artery disease. Some methods were used to overcome the anomalies such as the use of soft-tipped hydrophilic wire, Balloon-Assisted Tracking technique, specialized catheter for loop and tortuosity, small diameter, and lusoria artery respectively. Conclusion Upper-limb arterial anomalies cause of transradial procedure failure even for experienced transradial operators. Retrograde radial arteriography helps to delineate underlying anomalies and identify patients with unfavourable anatomy, thereby informing the operator to plan a strategy to overcome the anomaly or change access route with the potential to save time and avoid vascular complications. This can be performed with a minimum of contrast and should be considered part of a routine transradial procedure. The relationship between fragmented QRS complexes and severity of coronary artery disease in patients with acute coronary syndrome S. Hendyanto S. Hendyanto Sheila Sheila A.H. Alkatiri A.H. Alkatiri P. Kabo P. Kabo Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin,Wahidin Sudirohusodo General Hospital, Makassar, Indonesia Abstract Background Fragmented QRS (fQRS) complexes on 12-lead electrocardiography (ECG) have been reported to be predictors of cardiac events and all-cause mortality in coronary artery disease (CAD) and acute coronary syndrome. It also can be used to estimate cardiac injury and infarct size; therefore fQRS complexes would help physicians to make treatment strategies. Methods Sixty-three patients with ACS whom underwent coronary angiography were included. ECG performed on admission, then fQRS complexes were manually calculated. SYNTAX scores were calculated based on angiographic findings. Patients were divided into two complexity lesion groups according to their Syntax scores: low SYNTAX score (<22) and moderate to high SYNTAX score (≥22); two vessel groups: one or no vessel disease and multivessel disease (2/3 vessels); also two left main groups: no left main disease or equivalent and with left main disease or equivalent. Results There was significant correlations between two SYNTAX groups and the presence of fQRS (Spearman's rho, r = 0.503, p = 0.0001), also number of fQRS (2.57 ± 1.88 vs. 0.7 ± 1.54, p = 0.0001). Correlation analysis showed a significant and positive relationship between number of fQRS and SYNTAX score (Pearson, r = 0.550, p = 0.0001). There was significant correlations between two vessel groups and the presence of fQRS (Spearman's rho, r = 0.479, p = 0.0001), also number of fQRS (1.95 ± 1.97 vs. 0.32 ± 1.13, p = 0.001). There was significant correlations between left main groups and the presence of fQRS (Spearman's rho, r = 0.326, p = 0.009), also number of fQRS (2.75 ± 2.32 vs. 0.91 ± 1.47, p = 0.0001). Conclusion The present study indicates that the presence and fQRS number on 12-lead ECG on admission is associated with severity of CAD in patients with ACS. Moreover, the fQRS might be useful to identify high-risk patients. Correlation between tricuspid regurgitation duration corrected for heart rate and right ventricular dysfunction in heart failure patients Sudiyoko Sudiyoko H. P. Bagaswoto H. P. Bagaswoto H. Mumpuni H. Mumpuni L. Krisdinarti L. Krisdinarti Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta Heart failure tricuspid regurgitation duration RV dysfunction Abstract Background The physiology of right ventricular contraction is different and more difficult to be described than that of left ventricular. A decrease in the duration of tricuspid regurgitation corrected for heart rate (TRDc) has recently been shown as a useful surrogate marker for predicting RV dysfunction in PAH patients. The aim of this study was to investigate whether TRDc correlates with RV dysfunction in heart failure patients. Methods We conducted a cross sectional study between November 2014-December 2015. We enrolled 50 patients with chronic heart failure. Tricuspid regurgitation duration was defined as the time between the onset and the cessation of TR flow. RR interval was measured in seconds using electrocardiographic tracing. TR duration was corrected for heart rate using a formula: TRDc = TRduration/√(RR interval). Right ventricular dysfunction was defined by TAPSE <16 mm using echocardiography. Results The study was done in 32 males (64%) and 18 females (36%), with average age of 56 + 9.07 years old. The mean RVSP, TAPSE and TRDc was 46.62 + 15.93 mmHg, 17.34 + 4.64 mm and 518.20 + 65.67 ms, respectively. By Pearson correlation, tricuspid regurgitation duration corrected for heart rate has negative correlation with TAPSE in heart failure patients, but not statistically significant (r = -0.189, p = 0.188). Additionally we found group with TAPSE <16 mm has mean TRDc higher than group with TAPSE ≥16 mm, but not statistically significant (525.71 + 51.73 ms vs 512.30 + 75.24 ms; p = 0.479). Conclusion Tricuspid regurgitation duration corrected for heart rate was not correlated with RV dysfunction in heart failure patients. Correlation of small dense low density lipoprotein with conventional lipid levels: An interesting fact finding Sugiri Sugiri S.A. Wiyono S.A. Wiyono M A. Nugroho M A. Nugroho U. Bahrudin U. Bahrudin Department of Cardiology and Vascular Medicine, Diponegoro University Faculty of Medicine – Dr. KariadiGeneral Hospital, Semarang, Indonesia small dense low density lipoprotein conventional lipid coronary artery disease Abstract Background Dyslipidemia is known as a risk factor for coronary artery disease (CAD). Patients with high level of small dense low density lipoprotein (sdLDL) have an increasing cardiac event despite their normal level of LDL cholesterol.However, correlation between sdLDL and conventional lipid levels remains elusive. Purpose To know the correlation between sdLDL and conventional lipid levels in patients with CAD. Methods This is an observational analytic study with cross sectional approach in the Cardiovascular Center, Dr. Kariadi General Hospital Semarang. The patients with proven CAD by angiography and receiving 20 mg simvastatin orally for more than 2 weeks were involved. Measurement of levels of sdLDL, LDL, HDL, total cholesterol, and triglyceride was performed for all patients. SPSS computer program was used for statistical analysis. Results A total of 30 CAD patients with mean of age 55 years old were enrolled in this study. Risk factors for CAD were dyslipidemia (93.33%), overweight(76.67%), metabolic syndrome (66%), smoking (46.67%), and diabetes mellitus (26.67%). Mean of sdLDL level was 28.67 ± 15.34 mg/dL. sdLDL had a strong correlation with both triglyceride (r = 0.757, p < 0.001) and total cholesterol (r = 0.682, p < 0.001), moderate correlation with LDL (r = 0.548, p = 0.002), but had no correlation with HDL cholesterol level (r = 0.100, p = 0.601). Conclusion Level of sdLDL is strongly correlated with both triglyceride and total cholesterol, on the other hand correlation with LDL cholesterol level is moderate. It seems that the term “small dense lipoprotein” is better than “small dense low density lipoprotein”. Detailed precision of computed tomography angiography compared to invasive angiography in different coronary vessels: Overestimate, underestimate, or concordance? late experience in National Cardiovascular Center Harapan Kita T.M. Haykal T.M. Haykal P. Almazini P. Almazini A. Parlautan A. Parlautan W.M. Saragih W.M. Saragih Elen Elen C.A. Atmadikoesoemah C.A. Atmadikoesoemah M. Kasim M. Kasim Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita CT angiography,invasive coronary angiography (ICA) precision Abstract Background Quantitative analysis of stenosis lesion by Multi-Detector Computed Tomography (MDCT) coronary angiography show good correlation with stenosis detected by Invasive Coronary Angiography (ICA). However, detailed precision whether MDCT angiography overestimate or underestimate have not been explored thoroughly. Method There are 195 patients examined by both MDCT angiography and ICA from October 2014 until December 2015 in our hospital. ECG-gated MDCT angiography was performed by using a 128-sliced MDCT scanner with a standardized protocol. CT coronary angiography was analyzed by a team of cardiovascular imaging cardiologists. Quantitative grading of stenosis in each lesion was determined visually using 2014 SCCT guidelines classification. Quantitative measurement of stenosis during ICA was classified with the same criteria so that it can be comparable. The final comparison of both test was classified as concordance, overestimate and underestimate. Results The mean age of our sample population is 59.19 ± 9.79 (126 men and 66 women). Lesion of stenosis was found in 573 coronary vessels. Coronary vessels are significantly associated with detailed precision of quantitative analysis comparison in MDCT angiography and ICA. LM coronary stenosis quantification from MDCT angiography is predominantly overestimate (concordance in 6% vessels and overestimate in 75.9% vessels), while stenosis analysis by MDCT angiography in other major coronary vessels is spread without conspicuous domination (p < 0.001). Calcified plaque is prominently noticeable among vessels with overestimate analysis, however it is not statistically significant. Sensitivity, specificity, PPV, and NPV of MDCT coronary angiography to detect obstructive lesion (stenosis ≥ 50%) found by ICA is 81.4%, 80.4%, 73.9%, and 86.3%, respectively (780 vessels). Conclusion Degree of stenosis in LM is predominantly overestimate by MDCT angiography. This finding should give better understanding to clinician that the precision of stenosis grading in MDCT angiography in different coronary vessels is not the same. Preoperative serum creatinine level as a predictor of acute kidney injury in patient undergoing coronary artery bypass graft T.W. Siagian T.W. Siagian 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia J. Suganti J. Suganti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia M. Nasri M. Nasri 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia D. Yulianda D. Yulianda 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia Z. Mukhtar Z. Mukhtar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia A.A. Siregar A.A. Siregar 2 Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia Marshal Marshal 3 Department of Thorax and Cardiovascular Surgery,Haji Adam Malik General Hospital, Medan, Indonesia D. Pohan D. Pohan 3 Department of Thorax and Cardiovascular Surgery,Haji Adam Malik General Hospital, Medan, Indonesia Preoperative serum creatinine AKI CABG Abstract Background Elevation in postoperative creatinine or acute kidney injury (AKI) after coronary artery bypass grafting (CABG) surgery has been consistently shown to be a predictor of increase short term mortality and poor postoperative outcomes. However, only few data are available concerning the prognostic preoperative serum creatinine related to AKI post CABG. The aim of this study is to prove the association between preoperative creatinine with AKI after CABG. Methods This was a retrospective study of 56 patients undergoing CABG between January 2012- June 2015 with a preoperative serum creatinine < 1.8 mg/dl at Adam Malik General Hospital. Patients were divided into two groups according to preoperative serum creatinine level. AKI defined as increase serum creatinine ≥ 1.5 fold compare to baseline. The baseline serum creatinine was 1.2 mg/dl according to the laboratory Adam Malik Hospital. Preoperative serum creatinine was the last measurement before undergoing CABG. Bivariate and multivariate analysis was performed and p value < 0.05 was considered to indicate statistical significance. Result There were 42 patients with normal serum creatinine < 1.2 mg/dl and 14 patient with mildly increase serum creatinine 1.2-1.8 mg/dl. From all patients, 28 patients ( 50%) had AKI post CABG during hospitalization. From the analysis of the chi-square test found a significant correlation between serum creatinine levels and AKI post CABG (p = 0.014,(95% CI 1.307 – 22.25)). Multivariate analysis using logistic regression confirmed that preoperative serum creatinine 1.2 – 1.8 mg/dl (p = 0.02; OR 5.39; 95% CI 1.307 – 22.25) as independent predictor of AKI post CABG. Conclusion Preoperative serum creatinine level is an important predictor of AKI in patient undergoing CABG. Circulating uric acid links to metabolic syndrome: A population study in urban area of Indonesia U. Bahrudin U. Bahrudin 1 Department of Cardiology and Vascular Medicine, Diponegoro University Faculty of Medicine – Dr. Kariadi General Hospital B. Dayana B. Dayana 2 Department of Physiology, Diponegoro University Faculty of Medicine V. Amalia V. Amalia 2 Department of Physiology, Diponegoro University Faculty of Medicine I. Sholeh I. Sholeh 2 Department of Physiology, Diponegoro University Faculty of Medicine B. Surastri B. Surastri 3 Department of Pharmacology, Diponegoro University Faculty of Medicine, Semarang, Indonesia Y. Herry Y. Herry 1 Department of Cardiology and Vascular Medicine, Diponegoro University Faculty of Medicine – Dr. Kariadi General Hospital I. Hisatome I. Hisatome 4 Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Yonago, Japan hyperuricemia metabolic syndrome Indonesian population Abstract Background Hyperuricemia is strongly associated with cardiovascular disease, kidney disease, and hypertension, increasing the risk of mortality, but it is not commonly considered a true risk factor for metabolic syndrome (MetS). Purpose of this study was to know the correlation between the level of circulating uric acid and MetS in urban adult (≥40 years old) Indonesian population. Methods We determined the prevalence of MetS in the general population in Semarang, Central Java, Indonesia by a cross-sectional study. Prevalence of MetS was determined by the existence of a combination of 3 or more factors: central obesity (waist circumference ≥90 cm for male or ≥80 cm for female), hypertension, abnormal fasting glucose metabolism (fasting blood sugar ≥110 mg/dl), high triglyceride ≥150 mg/dl), and low HDL cholesterol level (<40 mg/dl for male or <50 mg/dl for female). Results This study involved 196 adults (126 females), who were 40 years of age or older (mean: 57.4 years old). The incidence of MetS was 33.67%; women had a higher incidence (34.92%) than men (31.43%). Hyperuricemia (serum uric acid level >7.0 mg/dl for men or >6.0 mg/dl for woman) was found in 32% subject with MetS. There was a significant association between hyperuricemia and MetS (p = 0.035). Abnormal fasting glucose metabolism had a significant correlation with hyperuricemia (p = 0.001), while other factors of MetS had no significant correlation statistically, i.e. hypertension p = 0.084, low HDL level p = 0.109, central obesity p = 0.220, high triglyceride p = 0.473, and waist circumference p = 0.220. In addition, in the subject with MetS, uric acid level was correlated with intensity of physical activity (p = 0.004). Conclusion Data of this study showed that hyperuricemia was associated with metabolic syndrome in Indonesian urban population, particularly with a factor of syndrome metabolic abnormal fasting glucose metabolism. The Neutrophil/Lymphocyte Ratio (NLR) as predictor of poor coronary collateral in patients with coronary chronic total occlusion U. Malik U. Malik M. Amir M. Amir Department of Cardiology and Vascular Medicine, Hasanuddin University, Makassar Neutrophil-lymphocyte Ratio Coronary collateral circulation Abstract Background Coronary collateral circulation (CCC) is the adaptation mechanisms of the heart to ischemia in order to maintain tissue perfusion and correlate with inflammation. Neutrophil-Lymphocyte ratio (NLR) value has been proposed as a inflammation marker for chronic total occlusion (CTO). This study aims was to evaluate The Neutrophil/lymphocyte Ratio (NLR ) as Predictor of Poor Coronary collateral in patients with chronic total occlusion (CTO). Methods A nested case control on 69 patients with CTO from August to November 2015. Patients then classified according to their Rentrop collateral grades as either poor collateral (Rentrop grades 0-1) or good collateral (Rentrop grades 2-3). The NLR was calculated based on the complete blood count. Results The NLR values of the patients with poor CCC (3.77 ± 0.43) were higher than of those with good CCC (2.69 ± 0.32) p < 0.001). In ROC curve analysis, the cut-off value of NLR to predict poor CCC was 3.05 with 82.9% sensitivity and 90% specificity (95% CI; 0.958-1.005, p <0.001). In the binary linear regression, it was found that a high NLR has a percentage of 120 times to predict poor coronary collateral. There is a strong correlation between NLR as a predictor and the degree of collateral circulation (spearman, r:-0.763; p : < 0.001). Conclusion NLR can be considered a significant predictor of poor Coronary collateral circulation in CTO. Association between waist circumference to body height ratio and blood pressure in cardiology clinic U. Hasanah U. Hasanah 1 Medical Faculty of Mataram University, Indonesia I.L. Harahap I.L. Harahap 2 Department of Anatomy, medical faculty of Mataram University, Indonesia Y. Pintaningrum Y. Pintaningrum 3 Lecturer, department of cardiology, medical faculty of Mataram University, Indonesia Waist to height ratio WHtR obesity blood pressure hypertension Abstract Background Overweight and obesity are established risk factors for hypertension, and hypertension is approximately twice as prevalent in the obese than in the nonobese. The prevalence of overweight and obesity has been increasing in the United States for at least the past 2 decades. This risk has been estimated by the Framingham Heart Study that suggests that approximately 78% of the hypertension cases in men and 65% in women can be directly attributed to obesity. The Framingham Heart Study revealed that a 5% weight gain increases hypertension risk by 30% in a 4-year time period. Waist to height ratio (WHtR) is one of the indicator of obesity which is effective to evaluate the distribution of body fat. Objective To find the association between waist to height ratio and blood pressure. Methods Cross-sectional population-based observational analytical study using consecutive sampling. The subjects were 51 patients aged > 25 years in cardiology clinic government hospital of west nusatenggara, Lombok, Indonesia, in August 2015. Hypertension was defined according to the disease history, the use of anti-hypertensive drugs or the mean of three consecutive measures, in mm/Hg, ≥ 140 for systolic and ≥ 90 for diastolic blood pressure. Waist- to- height ratio (WHtR) is defined as their waist circumference divided by their height, both measured in the same units. A WHtR of over 0.5 is an increased risk. The collected data were statistically tested using Spearman correlation test. Result The results showed a significant association between WHtR and systolic - diastolic blood pressure, p < 0.05 (systolic p = 0.004 and diastolic p =0.013). A positive correlation was found between WHtR and systolic - diastolic ratio, with the strength of correlation was low (systolic r = 0.393, diastolic r= 0.347). Conclusion Increase in waist to height ratio is associated with high blood pressure in Lombok, Indonesia. Validated-internally Kidney Protection Program (VKPP) scoring system as a predictor of worsening renal function among hospitalized acute decompensated heart failure patients V. K. P. Putri V. K. P. Putri P.P.D. Yamin P.P.D. Yamin N. Hersunarti N. Hersunarti D.P.L. Tobing D.P.L. Tobing R. Soerarso R. Soerarso B.B. Siswanto B.B. Siswanto Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita scoring system worsening renal function acute decompensated heart failure Abstract Background Worsening renal function (WRF) is associated with worse outcomes among patients who are hospitalized with acute decompensated heart failure (ADHF). Clinical characteristics at admission may help identify patients at increased risk of WRF. The aim of this study was to create in admission scoring system to simplify identification patients at risk of WRF in ADHF setting. Methods A retrospective data of 614 patients admitted with ADHF was analyzed. By the definition WRF occurred when serum Creatinin increased at anytime during hospitalization by ≥ 0.3 mg/dL or by ≥ 25% from admission. Results Worsening renal function developed in near 26% patients. The independent predictors of WRF analyzed with backward selection logistic regression were: age > 75 years old (p < 0.0001), female (p = 0.034); history of hypertension (p = 0.001); anemia (p = 0.005); and in admission serum Creatinin (p = 0.013). A scoring system was generated from this final model. An internal validation with bootstrap method showed good optimism (0.01088808). Conclusion A new scoring system could predict in-hospital worsening renal function among patients hospitalized with acute decompensated heart failure. Effect of low dose ace inhibitor towards Six Minute Walk Test and NT-ProBNP in mitral stenosis patients without hypotension V.G. Rejeki V.G. Rejeki B.B. Siswanto B.B. Siswanto R. Sukmawan R. Sukmawan N. Hersunarti N. Hersunarti Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita Mitral stenosis ACE inhibitor 6MWT NT-proBNP Abstract Background Mitral stenosis (MS) is an obstructive lesion in which the definitive therapy is mechanical intervention. The prevalence of MS in developed countries has been decreasing due to the development of mechanical intervention. In Indonesia the prevalence remains high especially in the era of national health coverage, there are too many patients queuing for mitral valve operation. By this situation, we want to know if the angiotensin converting enzyme (ACE) inhibitor could reduce the burden of symptoms and other neurohormonal activation such as NT-proBNP in MS patients. There are many controversies to the use of ace inhibitor in MS patients, questioning the benefit and safety of ace inhibitor to these patients. Objective To study the safety and efficacy of low dose ACE inhibitor towards six minute walk test (6MWT) and N-Terminal pro B type natriuretic peptide (NT-proBNP) in Mitral Stenosis Patients without Hypotension. Methods This study is a double blind randomized control trial. Sample was taken consecutively, and randomized to be given lisinopril 2.5mg or placebo. Every patient was assigned for echocardiography evaluation, 6MWT, and laboratory examination before and after intervention. Result 37 patients were included in the analysis; 19 was in the intervention group, 18 patient was in the placebo group. No significant difference were found between the two groups in terms of NT-proBNP and 6MWT, (Δ NT proBNP 59 (-6747) – 2145) vs (-166) (-1495 – 1664) pg/mL; p = 0.443) dan (Δ 6 MWT 11.66 + 73 vs 21.37 + 47; p = 0.638). In terms of blood pressure and stroke volume, there was also no significant difference between the two groups after intervention, median for stroke volume in intervention group and control group were 54 (34 – 74) vs45 (34 – 94), p = 0.126. Conclusion Low dose ACE inhibitor is safe to be given in MS patient without hypotension, however, it did not increase functional capacity measured by 6MWT, neither improve NT-proBNP. Correlation of the platelet to lymphocyte ratio with cardiac enzyme in male patients with acute coronary syndrome V.A. Damay V.A. Damay A. Albertus A. Albertus A. Budiman A. Budiman T. Veony T. Veony S. C. Aprianti S. C. Aprianti Yerssenia Yerssenia Silvia Silvia M. Tiofan M. Tiofan A.A. Lukito A.A. Lukito Faculty of Medicine, Universitas Pelita Harapan - Siloam Hospitals, Karawaci, Banten, Indonesia acute coronary syndrome platelet to lymphocyte ratio Abstract Background Acute inflammatory reaction is part of the chains during acute coronary syndrome's (ACS) mechanism. Platelets and inflammatory cells including lymphocytes are among acute inflammation's puzzles. Platelet and differential count in blood panel are relatively easy, quickly and widely found in almost every hospital. Cardiac enzymes -in the other hand- should be ordered whenever we have a appropriate suspicion of ACS. Cardiac enzymes relatively more expensive and need more time for the result. Perhaps we could use this simple blood examination to warn consideration of possible ACS . Methods Hospitalized male patients with acute coronary syndrome during January until December 2015 were evaluated for the PLR, CKMB, and Troponin T. Correlation between CKMB, and Troponin T with PLR were analyzed using Spearman Correlation Test. Data was analyzed with SPSS 22.0.0.0 software. Results There were 124 patients collected in this study period. The mean of age of the patients is 58.5 ± 10.9. Diagnosis of Unstable Angina Pectoris (UAP) was found in 23 (18.5%) patients, Non-ST-segment Elevation Myocardial Infarction (NSTEMI) in 28 (22.6 %) patients, and ST-segment Elevation Myocardial Infarction (STEMI) in 73 (58.9 %) patients. There are 83 (66.9%) patients who have history of smoking, 75 (60.5%) patients have hypertension, 32 (25.8%) patients have dyslipidemia, and 30 (24.2%) patients have diabetes mellitus. Median of PLR is 14.77 (1.46 – 72.25). CKMB, and Troponin T were significantly correlated with PLR (p < 0.05). Spearman's correlation coefficient (r) was 0.3 for CKMB, and 0.28 for Troponin T Conclusion There was a significant correlation between Troponin T, and CKMB with PLR in male patients with ACS. The novel effect of β-D-Glucans exctract of Ganoderma lucidum as antiinflammatory and antioxidative in stable angina patients Vittryaturida Vittryaturida 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia N. Ubaidillah N. Ubaidillah 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia A. Widya A. Widya 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia K. Siwi K. Siwi 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia M. Failasufi M. Failasufi 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia F. Ramadhan F. Ramadhan 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia H. Wulandari H. Wulandari 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia Y. Waranugraha Y. Waranugraha 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia D. H. Putri D. H. Putri 1 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia D. Sargowo D. Sargowo 2 Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar General Hospital, Malang, Indonesia Stable Angina β-D-Glucans Ganoderma lucidum Anti-inflammatory Antioxidative Atherogenesis Abstract Background Atherosclerotic is the most common cause of stable angina pectoris. Atherosclerosis is a systemic inflammatory process characterized by the accumulation of lipids and macrophages within the intima of vessel. New insight into the atherosclerotic pathology is endothelial damage and reactive oxygen species. This study was aimed to evaluate β-D-Glucans of the extract of Ganoderma Lucidum as an anti-inflammatory and antioxidative activities that inhibit atherogenesis in Stable Angina. Matherial and methods 37 stable angina pectoris patients was included in this clinical trial experimental study with pre test and post test design without control. Stable angina patients were given Ganoderma Lucidum caps dose 3x250 mg/day during 90 days on top of guideline directed optimal medical treatment. Parameters used are level of Interleukin-6 (IL-6), high sensitivity C-reactive protein (hsCRP), TNF-alpha, (Superoxyde dismutase (SOD) and Malondialdehyde (MDA). Results After 90 days of treatment, we found significant decreased level of IL-6 (p = 0.0000), TNF-alpha (p = 0.0000), hsCRP (p = 0.0000), MDA (p = 0.0000) and significant increased level of SOD (p = 0.0001) descriptively in stable Angina Pectoris patients Conclussion Based on study, β-D-Glucans of the extract of Ganoderma lucidum is promising novel antiinflammatory and antioxidant effect to inhibit atherogenesis in Stable Angina. Risk factors contributing to myocardial hypoperfusion detected by cardiac magnetic resonance W. M. Saragih W. M. Saragih T. M. Haykal T. M. Haykal A. Parlautan A. Parlautan K. B. Aji K. B. Aji I. S. Waty I. S. Waty Elen Elen C. A. Atmadikoesoemah C. A. Atmadikoesoemah M. Kasim M. Kasim Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia CMR hypoperfusion microvascular nonsignificant stenosis Abstract Background Microvascular dysfunction (MVD) or microvascular obstruction can be detected by cardiac magnetic resonance (CMR) seen as hypoenhanced area within the first 2 minute of contrast administration. Often, patients with nonsignificant coronary stenosis revealed hypoperfusion area by CMR indicating MVD. This study aimed at finding cardiovascular risk factors that contribute to MVD detected by CMR in patients with normal or nonsignificant coronary stenosis. Methods Subjects were chosen from all patients who underwent CMR at Harapan Kita Hospital in 2015. Patients must have either coronary multi-detector computed tomography (MDCT) data or coroangiography data in the same year. There were 107 patients who met the criteria. The variables were divided according to each coronary artery segments: left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA). Every coronary segment with significant stenosis (>50%) was excluded. CMR data was then screened by each coronary territory focused on the presence of hypoperfusion (hypoenhanced) area. Independent variables were sex, age, diabetes, hypertension, dyslipidemia, and smoking history. Results There were 138 coronary segments that fulfill the criteria normal or nonsignificant stenosis ( < 50 %). There were 69 (50%) segments revealing hypoperfusion by CMR and 69 (50%) with no hypoperfusion. Men found more frequent than women in no-hypoperfusion subgroup, with p value 0,54. Chi-square test shows no association between the four classical cardiovascular risk factors: diabetes (p = 0,33), hypertension (p = 0,86), dyslipidemia (p = 0,39), and smoker history (p = 0,48). More segments with hypoperfusion were in age 40-59 years old (75,4 %), age 20-39 (2,9 %), and age 60-80 (21,7 %) with significant p value (p = 0,03). An experimental study has proved that myocardial fibrosis in human begin after 40 years of age. Animal model experiments have also demonstrated increased collagen deposition in the aging heart. Conclusion Aging factor contributes to MVD detected by CMR in normal or nonsignificant stenosis coronary artery. There were no significant association with sex and any classical risk factors: diabetes, hypertension, dyslipidemia, and smoker. CMR with T-1 mapping method is suggested to evaluate myocardial tissue more accurately and precisely. Corelation between clinical factors and autonomic outcome after coronary artery bypass graft surgery Y.B. Hartanto Y.B. Hartanto 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Diponegoro University, Semarang, Indonesia R. Putra R. Putra 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Diponegoro University, Semarang, Indonesia U. Bahrudin U. Bahrudin 1 Department of Cardiology and Vascular Medicine Faculty of Medicine, Diponegoro University, Semarang, Indonesia M. Ardiana M. Ardiana 2 Dr. Soetomo Hospital, Surabaya, Indonesia A.M. Ambari A.M. Ambari 3 National Cardiovascular Center Harapan Kita, Jakarta, Indonesia B. Radi B. Radi 3 National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Autonomic balance heart rate recovery CABG surgery Abstract Background Heart rate recovery over 1 minute (HRR-1) after graded exercise is one techniques that reflects autonomic activity. Despite of overall improvement, there are groups of post coronary artery bypass graft (CABG) surgery patients with HRR-1 after cardiac rehabilitation. This study aimed to search clinical factors that related to abnormal HRR-1 after cardiac rehabilitation for CABG surgery. Methods A retrospective analysis of post CABG surgery patients who underwent exercise test from June 2014 until August 2015 after completion of phase II cardiac rehabilitation. Gender, age, ejection fraction, risk factors such as hypertension, diabetes mellitus, smoking, and HRR-1 were analyzed Result 276 post CABG patiens underwent treadmill test with Bruce protocol at the end of phase II cardiac rehabilitation. There were 105 (38%) patients with HRR-1 < 12. Of them, 59 subjects (56.2%) had diabetes mellitus compared with 65 subjects (38%) in the normal HRR-1 group, p = 0.003. There were 50 (47.6%) patiens >60 years old with abnormal HRR-1 compared with 54 (31.6%) patients in their counterparts, p = 0.008. Risk estimation demonstrated that diabetes mellitus (OR 2.092; 95% CI 1.276-3.428) and age > 60 years old (OR 1.970; 95% CI 1.194-3.250) were associated with decrease HRR-1 in post CABG surgery patients. Conclusion After cardiac rehabilitation for CABG surgery, there were association between diabetes mellitus and age > 60 years old with abnormal HRR-1. Further analysis is needed to find predictor of autonomic balance after CABG surgery. Correlation between NYHA functional class with TNF- α/IL-10 ratio in patients with heart failure Y.Y. Patra Y.Y. Patra J.N.E. Putranto J.N.E. Putranto D. Soemantri D. Soemantri Faculty of Medicine Airlangga University TNF-α IL-10 heart failure Abstract Background Pro-inflammatory mediator activation TNF-α, lead to endothelial dysfunction, ventricular remodelling and apotosis caused worsening heart failure. In patients with heart failure, as a counter balance, there is also an increase of anti-inflammatory mediator IL-10. TNF-α works as a stimulus for the production of the IL-10. IL-10 inhibits synthesis of TNF-α, ROS generation and apoptosis which in turn provide a protective effect. Methods This is a correlational study. 29 patients with heart failure were collected by purposive sampling. Results The results showed that the concentrations of TNF-α and IL-10 increase with increasing NYHA class. Mean TNF-α in NYHA class II is 3.52 pg/mL. Mean TNF-α in NYHA class III is 4.50 pg/mL. In NYHA class IV, mean concentration of TNF-α is 7.07 pg/mL. Mean IL-10 in NYHA class II is 2.33 pg/mL. Mean IL-10 in NYHA class III is 2.61 pg/mL. In NYHA class IV, mean concentration of IL-10 is 3.04 pg/mL. The minimum value of TNF-α / IL-10 ratio in NYHA class II is 1.00 and the maximum value is 2.18 with mean value 1.52. The minimum value of TNF-α / IL-10 ratio in NYHA class III is 1.10 and the maximum value is 2.03 with mean value 1.74. The minimum value of TNF-α / IL-10 ratio in NYHA class IV is 1.59 and the maximum value is 2.84 with mean value 2.36. There were a positive, strong and significant correlation between NYHA class with TNF-α/IL-10 ratio. (r = 0.72; p <0.001) Conclusion There were a positive, strong and significant correlation between NYHA class with TNF-α/IL-10 ratio in patients with heart failure. Effects of local intracoronary adjunctive therapy cocktail improved microvascular perfusion and left ventricle function in primary percutaneous intervention Z. Mukhtar Z. Mukhtar S. Kasiman S. Kasiman A. Lubis A. Lubis N. Akbar N. Akbar Cardiology Department Faculty of Medicine, University of Sumatera Utara / Adam Malik General Hospital/Murni Teguh Memorial Hospital, Medan, Indonesia. Abstract Background The purpose of this study is to investigate the effect of local intracoronary bolus administration of combination eptifibatide and streptokinase to dissolve occlusive thrombus (TIMI grade 0 / 1) in patients with acute and subacute STEMI. Methods and Results The study design is a cohort, control nonrandomised and approved by Health Research Ethical Committee, Medical Faculty of Universitas Sumatera Utara / Adam Malik Hospital. Patients with acute and subacute STEMI after having been recanalized by the use of a small diameter (1.25 – 2.0 mm) balloon dilation or thrombectomy with manual thrombus aspiration device-TAD, successive administration of local intracoronary slow bolus 3.75 mg eptifibatide diluted with 5 ml saline via TAD in IRA vessel for 3 minutes, subsequent flushing of TAD with 2 ml saline, after 3 minutes followed by 100 kU streptokinase diluted with 5 ml saline for 3 minutes. Three minutes later performed angiography then inserted long stent (2 – 4 mm more than length size stenosis), finally stent deployment on culprit lesion in IRA vessel and occasionally continued with local intracoronary bolus nitroglycerine-NTG. Assessment of postprocedural TIMI and myocardial blush grade-MBG is graded by two independent intervention cardiologists who were blind to all data apart from coronary angiogram. Angioplasty procedure for case of patients was performed by single operator. Samples were collected from March 2015 – 27 January 2016, 68 patients (case group) fulfilled the inclusion criteria. Patients aged between 31 to 78 years, 63 males and 5 females. All patients received local intracoronary slow bolus eptifibatide 3.75 mg and continuing with 100 kU streptokinase. Local bolus NTG doses 100, 200 and 300 µg was 7, 15 and 14 patients consecutively. Symptom to procedural time was 4.5 – 384 hours. The infarct location was 40 anterior and 28 inferior wall. Recanalized by balloon 62 and TAD 6 patients. Diagnostic coronary angiography showed TIMI and MBG 0 was 55 patients. TIMI and MBG 1 were 13 patients. After PCI, coronary angiography showed TIMI 3 was found in 60 patients (88.2 %), TIMI 2 in 8 patients (11.8 %), MBG 3 in 59 patients ( 86.8 %) and MBG 2 in 9 patients (13.2 %). In echocardiography finding, there was elevation of LVEF 7.88 – 17.69 %. A control group 44 colleagues' patients was treated with standard therapy, aged 42 to 75 years, 37 males and 7 females, infarct location was 29 anterior, 15 inferior and symptom to procedural time was 2 – 218 hours. Diagnostic coronary angiography showed TIMI and MBG 0 was 39 patients. TIMI and MBG 1 were 5 patients. After PCI, coronary angiography showed TIMI and MBG 3 was found in 25 patients (56.8 %), TIMI and MBG 2 in 17 patients (38.6 %), TIMI and MBG 1 in 2 patients (4.5 %). Statistical analysis ( Pearson Chi-Square) reperfusion result after PCI from two groups (case and control) was significant difference, p = 0.001, Fisher's exact test found 95% confidence interval (0.068 – 0.453). There were no effects of hypotensive intracoronary bolus NTG, allergic reaction, minor and major bleeding. Conclusions The use of intracoronary combination bolus 3.75 mg eptifibatide and 100 kU streptokinase showed a successful dissolve of occlusive thrombus in patients with acute and subacute STEMI and improvement of LV function. The role of Mitral Leaflets Length Index ( MLLI ) as a simple parameter in determining the severity of mitral stenosis Z. Syahputra Z. Syahputra 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia E. Hasibuan E. Hasibuan 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia E. Komariah E. Komariah 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia N. Akbar N. Akbar 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia A.P. Ketaren A.P. Ketaren 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia Z. Mukhtar Z. Mukhtar 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia A.A. Siregar A.A. Siregar 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia Mitral Stenosis Mitral Leaflets Length Index (MLLI) Planimetry Abstract Background Determining the severity of mitral stenosis is important for both prognostic and therapeutic reasons. TTE is the gold standard method for assessment of severity mitral stenosis by using planimetry and pressure half time (PHT). Planimetry is accurate but is highly operator dependent. PHT is affected by changes in preload or left ventricular compliance. In this study, we evaluate Mitral Leaflets Length Index (MLLI) as a new simple parameter that can be used in peripheral by using common ultrasound to assess the severity of MS. Methods Fifty two patients with rheumatic MS who evaluate echocardiography in Adam Malik Hospital from January to December 2015 were enrolled for this cross-sectional study. The severity MS were classified by planimetry and PHT. MLL index was obtained by dividing posterior mitral valve leaflet length to anterior mitral valve leaflets lenght in the PLAX views at the end diastole. Results Severe MS(59.3%), moderate (29.6%), mild ( 7.4 %). There was strong correlation with MLLI and Mitral valve area by planimetry in spearman correlation (r = 0.920, p 0.000). ROC analysis of the MLLI with cut-off point < 0.68cm can predict severe MS with sensitivity 93%, specificity 95%, positive predictive value 96%, LR (+) 18,6. Intra-observer and intre-observer variability of MLLI is good (Kappa value 0.709 – 0.877) and significant (p < 0.001). Conclusion The Mitral Leaflets Length Index (MLLI) < 0.68 cm can be used as a simple parameter in determining the severity of mitral stenosis. A new scoring system of hospital mortality for acute heart failure syndrome (SMAHS Score) Z. Syahputra Z. Syahputra 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia M.F. Sarahazti M.F. Sarahazti 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia D. Ashrinda D. Ashrinda 1 Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia H. Hassan H. Hassan 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia H.A.P. Lubis H.A.P. Lubis 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia A. Sitepu A. Sitepu 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia A.A. Siregar A.A. Siregar 2 Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia Scoring System Acute Heart Failure Hospital mortality Abstract Background The prognosis of patients hospitalized with acute heart failure (AHF) is poor and risk stratification may help clinicians guide care. Patients with a poor prognosis may benefit from more aggressive treatment and closer follow-up. Unfortunately, the use of risk scoring systems for patients with AHF is limited. The aim of this study was to design a simple, bedside clinical prognostic scoring model and validate its ability to predict hospital mortality for patients with AHF. Method 169 patients with AHF were enrolled, divided randomly into training (n = 127) and validation (n = 42) cohorts. The data were collected from January 2014 to December 2015. The inclusion criteria for the database were in conformance to the European guidelines for AHF set in 2005. Multivariable analysis was applied to determine independent risk factors and develop the scoring system. Results In the training cohort, multivariate logistic regression analysis, hospital mortality was employed as dependent variable, while age (p = 0.068 OR = 0.142 CI 95% 0.017-1.157), diastolic BP (p = 0.003 OR = 16 CI 95% 2.6-105.515), systolic BP (p = 0.004 OR = 11 CI 95% 2.216-62.060), heart rate (p = 0.005 OR= 0.092 CI 95% 0.017-0.489), haemoglobin (p = 0.040 OR = 5.76 CI 95% 1.083-30.731), arrhytmia (p = 0.011 OR = 20.53 CI 95% 1.985-212.36), creatinine level (p = 0.37 OR = 0.2 CI 95% 0.043-0.907),QRS duration (p = 0.02 OR = 0.048, CI 95% 0.007-0.339) as independent variables.According to each OR of these variables, we set the new scoring system of hospital mortality for AHF with good calibration by Hosner-lemeshow test ( p 0.533) and discrimination by AUC 0.956 (p < 0.01 CI 95 % 0.922-0.989). The optimal cutt off for prediction mortality was total 6 points, sensitivity 73% and specificity 95%. We divided the patients with AHF as low risk whom total score 0-3 points (mortality in hospital 0,4-20%), moderate risk whom total score 4-5 points (mortality in hospital 48-77%), and 6-12 point as high risk. In the validation cohort indicated that SMASH score as new scoring system was effective with AUC of ROC (0.950 p<0.01) and p 0.998 (p>0.05) with Hosner-lemeshow test. Conclusion The SMAHS Score is a new scoring system of hospital mortality for AHF can predict with high sensitivity and specificity, also good performance in terms of discrimination and calibration. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com
TI - Original Research
JF - European Heart Journal Supplements
DO - 10.1093/eurheartj/suw027
DA - 2016-04-08
UR - https://www.deepdyve.com/lp/oxford-university-press/original-research-GNWpQYb8Od
SP - B19
VL - 18
IS - suppl_B
DP - DeepDyve
ER -