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Validation of Self-Assessment-Based Chest Pain Algorithm (DETAK) as An Early Identification Tool for Acute Coronary Syndrome Nugraha, Krishna Ari; Rohman, Mohammad Saifur; Rahimah, Anna Fuji; Anjarwani, Setyasih; Rizal, Ardian; Astiawati, Tri; Adi, Andi Wahjono; Haryati, Lina
Heart Science Journal Vol 4, No 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac C
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.5

BackgroundThe most common reason of prehospital delay in ACS patients is inability to pay attention to symptoms in order to act fast and effectively. Patient oriented machine learning algorithms has the opportunity to reduce the total ischemic time, that determines the clinical outcome of ACS patients.AimAssessing the accuracy of the chest pain self-assessment algorithm (DETAK) in identifying ACS.MethodThis study included seven hospitals, five PCI capable hospitals and two of non-PCI capable hospitals. The study was conducted from August 2021 to June 2022. The study included all patients with chest pain who visited the hospital and used the DETAK algorithm. Patients were interviewed after being confirmed hemodynamically stable. Patients with UAP, as well as those who died or declined to participate in this study were excluded. The area under the curve receiver operating characteristic (AUROC) was used to verify DETAK's performance in identifying SKA. We compare the DETAK algorithm's diagnosis with the definitive diagnostic based on ECG and/or troponin results.ResultsA total of 539 patients (mean age 58 years) with a higher proportion of male patients (n=424). An AUC value of 0.854 was obtained, where the cut of point accuracy of DETAK in identifying ACS for the entire sample had a sensitivity of 89.5% and a specificity of 81.2%. The algorithm's specificity decreased in certain subgroups, including type 2 diabetes (79.4%), women (77.3%), and hypertensive patients (80.9%). Algorithm reliability test obtained moderate to strong level of agreement values.ConclusionDETAK's self-assessment-based chest pain algorithm offers an excellent diagnostic performance in early identification of ACS.

Managing a Challenge Case: Transesophageal Echocardiography-Guided Transcatheter Closure of a Large Secundum Atrial Septal Defect in a Pregnant Woman Fathoni, Emil; Martini, Heny; Rahimah, Anna Fuji; Putri, Valerinna Yogibuana Swastika
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.12

Background: The management of complex cardiovascular conditions during pregnancy poses unique challenges, and in the case of a large secundum atrial septal defect (ASD), achieving successful closure through a transcatheter approach guided by transesophageal echocardiography (TEE) requires careful navigation and expertise. This study sought to present a case that exemplifies the contemporary approach of using TEE guidance for the closure of an ASD in pregnant womenCase presentation: A 31-year-old woman with multigravida, diagnosed with secundum ASD and pulmonary hypertension, underwent TEE. The TEE examination revealed a significant ASD measuring 2.8-3.1 cm with inadequate surrounding rims. Subsequently, our intention was to employ a device to address this defect. TEE was utilized to guide the placement of a 14F delivery sheath into the left upper pulmonary vein and left atrium. Using a catheter, we successfully deployed a 40 mm ASD Occluder (MemoPart), concluding the intervention without any complications. Given the concerns regarding the potential risks of radiation exposure and teratogenic effects on fetal development, particularly in young patients and during pregnancy, it is crucial to prioritize TEE-guided closure of ASD for the safety of both the mother and the fetus.Conclusion: Closure of ASD with zero fluoroscopy proved to be a safe and effective procedure, demonstrating feasibility and significant benefits for pregnant women with ASD.

The Complexity of Premature Coronary Artery Disease Noverike, Nikhen; Rahimah, Anna Fuji; Rohman, Mohammad Saifur
Heart Science Journal Vol 5, No 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.2

Premature Coronary Artery Disease presents a significant health concern globally, characterized by the onset of coronary atherosclerosis at an early age, typically before the age of 55 in men and 65 in women. This review provides a comprehensive examination of the various aspects of premature CAD, ranging from its underlying pathophysiology to diagnostic modalities such as coronary angiography. Beginning with an overview of the risk factors contributing to premature CAD, including genetic predispositions, lifestyle factors, and metabolic disorders, the review delves into the intricate mechanisms involved in the initiation and progression of atherosclerosis. Furthermore, the review discusses the clinical manifestations and challenges associated with diagnosing premature CAD, particularly in asymptomatic individuals. It examines the utility of non-invasive imaging techniques, stress testing in identifying coronary artery stenosis, cardiovascular risk and the principles of coronary angiography. The review outlines the principles of coronary angiography, including patient preparation, procedural techniques, and interpretation of angiographic findings. In conclusion, this comprehensive review provides insights into the multifaceted nature of premature CAD, elucidating its pathogenesis, clinical presentation, and diagnostic evaluation, with a focus on the pivotal role of coronary angiography in guiding therapeutic interventions and optimizing patient outcomes.

Management of Pregnant Women with Atrial Septal Defect and Pulmonary Hypertension: A Case Report Wicaksono, Arif; Martini, Heny; Rizal, Ardian; Rahimah, Anna Fuji
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.13

Backgrounds:Pulmonary Hypertension (PH) is a condition where there is an increase in Pulmonary Vascular Resistance (PVR) and an increase in the mean Pulmonary Arterial Pressure (mPAP) to more than 20 mmHg. PH can occur in someone with Congenital Heart Disease (CHD). PH conditions can aggravate pregnancy in women with CHD. So that women with PH are recommended not to undergo pregnancy. However, it is possible for women with CHD with PH conditions to undergo pregnancy. In these conditions, optimizing PH therapy is important so that pregnant women with PH do not experience a worsening of the condition and can carry out their pregnancy well until delivery. Case Presentations:A 38-year-old female patient with a history of Atrial Septal Defect-Pulmonary Hypertension came for routine control to the cardiac clinic with the condition of pregnancy of her 4th child who was just discovered when she was 6 months pregnant. Since giving birth to her third child, the patient began to complain of being easily tired when doing activities accompanied by swollen legs that disappeared with rest. At that time, the patient went to a cardiologist for an echocardiography examination and was diagnosed as Atrial Septal Defect (ASD)-Pulmonary Hypertension (PH). Since then, the patient has been routinely treated at a cardiologist with Pulmonary Hypertension drugs, including Phospodiesterase5 (PDE5) inhibitors (Sildenafil) and Prostacyclin Analogue (Dorner). The patient had done Transesophageal Echocardiography (TEE) with the results of ASD secundum suitable for closure by device. Patients with Right Heart Catheterization (RHC) results, ASD secundum with PH High Flow High Resistance reactive to Vasoreactivity Test. Since the patient was found to be pregnant, the patient continued to use Sildenafil and discontinued the use of Dorner. The patient then continued treatment in a multidisciplinary team. Conclusion :Management of pregnant women with CHD and PH is important because the condition of PH itself further aggravates the condition of pregnancy. Medical management for PH in pregnant women follows the guidelines for the safety of drugs in pregnancy. So that the choice of therapy is crucial related to the goal of treatment to control the PH condition in the patient but still pay attention to safety in pregnancy conditions.

Impact of Strict and Lenient Heart Rate Control on Six-Minute Walk Test and Quality of Life in Atrial-Fibrillation Patients with Rheumatic Mitral Stenosis : Randomized Control Trial Dwigustiningrum, Nur Kaputrin; Rizal, Ardian; Putri, Valerinna Yogibuana Swastika; Rahimah, Anna Fuji; Rohman, Mohammad Saifur; Wikananda, Adhika Prastya; Waranugraha, Yoga; Astiawati, Tri; Laitupa, Fitranti Suciati
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.8

Background: Recent studies showed no outcome difference between strict and lenient rate control in the general Atrial Fibrillation (AF) population. However, for AF and Rheumatic Mitral Stenosis (RMS) patients, evidences were lacking.Objective: To assess the impact of strict and lenient heart rate control on the Six-Minute Walk Test (SMWT) and Health Related Quality of Life (HRQoL) in patients with AF and RMS.Material and Methods: A prospective multicenter trial across tertiary hospitals in East Java assessed strict and lenient heart rate control's impact on the SMWT and HRQoL in AF and RMS patients. Sixty-one participants were randomized into strict and lenient groups over six months from March to August 2023. Medications were adjusted to achieve target heart rates, and HRQoL was assessed using SF-36 and SMWT at baseline and three months post-target heart rate attainment.Result: In our study, 29 patients were under strict heart rate control, and 32 were under lenient control. We found a decrease in HRQoL across all subscales, with significant differences observed in general health perception and physical function among those under strict control (p=0.002 and 0.03, respectively). However, no significant disparity was found in the SMWT distance difference between lenient and strict groups (p=0.529), nor in METs (p=0.326).Conclusion: In the study, lenient heart rate control demonstrates significant effects on the general health perception and physical function subscales compared to strict heart rate control.

Effect of β-1,3-1,6-D-glukan (polysaccharide peptide) from miselia ganoderma lucidum extract as antioxidant and antiinflammation towards left ventricular systolic function in cardiometabolic patients Aryanugraha, Teguh; Sargowo, Djanggan; Rahimah, Anna Fuji
Heart Science Journal Vol 5, No 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.9

Background: Cardiometabolic disease (CMD) describes a metabolic condition often associated with cardiovascular disease. It has been revealed that the Ganoderma lucidum polysaccharide peptide (GLPP) possesses anti-inflammatory and antioxidant qualities. Objective: This study aimed to find out how GLPP affected oxidative stress, inflammation, and left ventricular function in individuals with cardiometabolic syndrome.Methods: A multicenter double-blinded randomized controlled trial was carried out. Subjects with cardiometabolic syndrome received either GLPP or a placebo for ninety days. Before taking the initial treatment and one day following the last treatment intake, blood samples were taken from every participant. The enzyme-linked immunosorbent assay was used to evaluate the levels of serum tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), malondialdehyde (MDA), and high-sensitivity-C-Reactive Protein (hs-CRP) while the colorimetric test was used to measure the levels of superoxide dismutase (SOD). Global longitudinal strain (GLS) and Left ventricle ejection fraction (LVEF) were measured by single echocardiographer expert validation.Results: The MDA level was decreased in the GLPP treatment group (mean 56.0 ± 71.4 ng/mL to 27.7 ± 12.0 ng/mL, p= 0.023) compared to the control group (mean 39.3 ± 29.2 ng/mL to 38.3 ± 17.7 ng/mL, p= 0.719). However, the SOD level remained constant in the GLPP treatment (mean 122.2 ± 176.1 U/mL to 93.0 ± 40.9 U/mL, p=0.925) instead of significantly declining in the control group (mean 102.0 ± 67.3 U/mL to 64.0 ± 52.0 U/mL, p=0.016). The marker of TNF-α and hsCRP were significantly decreased in all groups (both p<0.05), but IL-6 was only significantly decreased in the control group (mean 1149.3 ± 581.7 pg/mL to 744.8 ± 336.5 pg/mL, p=0.010). The GLS was significantly decreased in the GLPP treatment group (-16.1 ± 4.1 to -17.5 ± 4.8, p=0.048) but there was no difference in LVEF in both groups (p>0.05).Conclusion: Patients with cardiometabolic syndrome may benefit from GLPP treatment for 90 days in terms of reduced inflammation, oxidative stress, and improved systolic left ventricular performance.

Successful Management in Unprovoked Upper Extremity Deep Vein Thrombosis: Case Report Noverike, Nikhen; Kurnianingsih, Novi; Rizal, Ardian; Rahimah, Anna Fuji
Heart Science Journal Vol 5, No 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.14

BackgroundOne to four percent of all cases of deep vein thrombosis (DVT) occur in the upper extremities. Effective thrombolysis for upper extremity deep vein thrombosis (UEDVT) can be achieved with a combination of vascular interventions such as angioplasty, which is continued with catheter-directed thrombolysis (CDT) and anticoagulant therapy.Case IllustrationWe presented the case of a 40-year-old man who developed sudden pain and swelling in his right upper extremity. The thrombus was located in the right subclavian vein, confirmed by duplex ultrasonography. Laboratory results were normal. The patient was diagnosed with unprovoked UEDVT. He underwent venography, which showed an acute-on-chronic lesion at the right subclavian vein. We decided to use double access, tried to inflate the balloon to fragment the thrombus, several times of thrombo-suction, and then continued with Catheter-directed thrombolysis (CDT) using Alteplase. The patient continued oral anticoagulant therapy with Rivaroxaban. After 6 months of follow-up, there wasn’t any complaint. Evaluation of Duplex ultrasonography showed normal results without any recurrent thrombusConclusionThis case revealed how to treat acute-on-chronic lesions of unprovoked UEDVT with a comprehensive management method not only with balloon fragmentation and CDT but also anticoagulant therapy and showed a good outcome and no signs of bleeding complication.

Clinical Features and Multimodality Diagnostic Tools of Pulmonary Hypertension Galuh, Lukitasari Ayu; Rahimah, Anna Fuji; Martini, Heny; Rizal, Ardian
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.4

Pulmonary hypertension (PH) is characterized by an increase in mean pulmonary artery pressure (mPAP) above normal, which is > 20 mmHg and an increase in pulmonary vascular resistance (pulmonary vascular resistance / PVR) above normal, in resting conditions.The pathophysiology of PH involves remodeling of the pulmonary vessels, from the main pulmonary arteries, lobar arteries, segmental arteries, distal arteries, pulmonary arterioles, capillaries to the postcapillary pulmonary veins. In general, the epidemiological figures for PH are not known with certainty. The UK reported a PH prevalence of 97 cases/1,000,000 population with a female:male ratio of 1.8. The diagnostic approach to PH is mainly focused on two things. The primary goal is to raise the initial suspicion of PH and ensure fast-track referral to a PH center in patients with a high probability of PAH, CTEPH, or other forms of severe PH. The second aim is to identify the underlying disease, particularly left heart disease (Group 2 PH) and lung disease (Group 3 PH), as well as comorbidities, to ensure appropriate classification, risk assessment, and treatment. The Gold Standard diagnosis and classification of pulmonary hypertension is by examining the right heart catheterization (RHC). Clinical scoring in the form of shortness of breath without any obvious cause accompanied by physical examination, ECG and Thorax X-ray images which depict an enlarged right heart have good sensitivity and specificity for the diagnosis of pulmonary hypertension in patients with congenital heart disease. A high right ventricular pressure, mean PAP, and BNP values during observation, as well as heart size on chest X-ray can be predictors of a poorer prognosis in this population.

Unveiling The Diagnosis Pitfall: Complete Heart Block Presenting In Acute Coronary Syndromes Without Chest Pain And Non-Ischemic Electrocardiography In A Young Adult Suprayoga, Imam Mi'raj; Rizal, Ardian; Widito, Sasmojo; Rahimah, Anna Fuji
Heart Science Journal Vol 4, No 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac C
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.8

Background: The majority of studies indicate that the asymptomatic or atypical presentation of acute coronary syndrome (ACS) as a significant manifestation of coronary artery disease (CAD) is associated with a poor prognosis.Objective: The purpose of this study was to characterize the clinical characteristics and management of ACS patients who presented without chest pain and non-ischemic electrocardiogram (ECG).Case presentation: A 31 years old man with syncope was brought to our hospital. ECG revealed total AV block (TAVB) without ST segment changes. First, he was diagnosed with cardiac syncope because his ECG showed no ischemic sign. He had a strong familial history of CAD, so we examined his cardiac enzymes and found an increase in serial cardiac enzymes. Then, he was diagnosed with non-ST elevation myocardial infarction (NSTEMI). Early invasive strategy with chronic total occlusion (CTO) at osteal right coronary artery (RCA) and acute total occlusion at mid RCA with implantation of 1 DES at osteal-proximal RCA was selected for this patient. After five days of hospitalization, he discharged home with medicines. Conclusion: In order to significantly lower their morbidity and mortality, this group of high-risk patients needs to receive improved early diagnostic and treatment choices.

Impact of clinical features on in-hospital outcomes in premature coronary artery disease patients post percutaneous coronary intervention Noverike, Nikhen; Rohman, Mohammad Saifur; Rahimah, Anna Fuji; Rizal, Ardian; Prasetya, Indra
Heart Science Journal Vol 5, No 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.11

Background: Premature coronary artery disease (PCAD) is a significant health concern globally, characterized by the onset of coronary atherosclerosis at an early age. The development of PCAD is influenced by a variety of risk factors and leading to substantial morbidity and mortality. Despite advancements in interventions, the clinical and angiographic characteristics influencing in-hospital outcomes for these patients remain underexplored.Objective: This study aims to investigate the relationship between clinical features and in-hospital outcomes in patients with premature CAD post-percutaneous coronary intervention (PCI) at Dr. Saiful Anwar Hospital.Method: A retrospective cohort study was conducted on 1279 patients who underwent PCI for premature CAD from January 2022 to December 2023. Clinical data, including risk factors and angiographic findings, were collected from medical records. Statistical analyses were conducted using SPSS 22, employing univariate, bivariate, and multivariate logistic regression analyses to determine correlations.Result: The study included 1279 patients, with 438 in the premature CAD group and 841 in the non-premature CAD group. Significant differences were observed in age, sex distribution, BMI, lipid profiles, smoking status, and family history between the groups. Premature CAD patients were younger (mean age 50 vs. 64.8, p<0.001) and had higher rates of smoking and dyslipidemia. Angiographic analysis showed significant differences in LAD and LCx involvement and occlusion rates. In-hospital outcomes indicated higher incidences of shock, cardiac complications, and in-hospital mortality in the non-premature CAD group.Conclusion: Clinical and angiographic characteristics significantly influence in-hospital outcomes for premature CAD patients. Younger age, smoking, and dyslipidemia were prevalent risk factors. Enhanced management strategies focusing on these factors could improve patient outcomes.Keywords: Premature coronary artery disease, percutaneous coronary intervention, clinical characteristics, angiographic findings, in-hospital outcomes.

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