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A case report: successful percutaneous coronary intervention (PCI) in unprotected left main and three-vessel coronary artery disease Kahadi, Cik; Rohman, Mohammad Saifur
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.2024.005.04.14

Background: Left Main Coronary Artery (LMCA) Disease is the highest-risk lesion of coronary artery disease and is related to cardiovascular morbidity and mortality compared to other types of obstructive Coronary Arterial Disease (CAD). Previously, coronary artery bypass grafting (CABG) was the preferred method for revascularization in significant LMCA lesions; however, results from several trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) to CABG showed PCI was non-inferior to CABG in highly selected LMCA patients. This report was to describe the contemporary evidence for PCI to CABG in LMCA Disease.Case Presentation: A diabetic and hypertensive 59-year-old man with stable angina pectoris and Canadian Cardiovascular Society (CCS) Score III was referred to Saiful Anwar Hospital for elective PCI consideration. The patient was diagnosed with left main and three-vessel coronary artery disease from CCTA in 2009 and angiography in 2023, then suggested to CABG for revascularization. However, the patient refused CABG surgery and decided to perform PCI with high-risk criteria after an adequate consultation. Considering the high-risk category and reduced ejection fraction, an elective PCI was performed with intra-aortic balloon pump (IABP) support. Then it implanted 2 DES at distal-LM until distal-LCx. In the following procedure, the patient also implanted 1 DES at mid-distal RCA and was discharged with significant improvement in his quality of life.Conclusion: In selected left main and three-vessel coronary artery disease, PCI is successfully improves the patient's quality of life

Atrial myopathy: a pathogenic mechanism linking atrial fibrillation and ischemic stroke Kahadi, Cik; Rizal, Ardian
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.2

Atrial myopathy (AM) has become a topic of study for many years. Atrial Myopathy is characterized as "any variety of architectural, structural, electrophysiological, or contractile abnormalities altering the atria, which can result in clinically significant manifestations," and is associated with atrial dysfunction and dilatation. Evidence shows that atrial myopathy (AM) contributes to atrial fibrillation and embolic strokes of unknown origin. Atrial myopathy or disease provides a substrate leading to atrial fibrillation (AF) and contributes to a chance of atrial thrombus development and, finally, stroke. However, following clinical trials have opposed this point of view. Additionally, ischemic strokes are categorized as cryptogenic when an embolic stroke occurs without a known related etiology (embolic stroke of undetermined source, ESUS). This led to the concept of atrial myopathy, showing that a dysfunctional atrium may result in stroke without the incidence of atrial fibrillation. Atrial interstitial fibrosis, extracellular matrix deposition, and inflammation may trigger and perpetuate atrial myopathy, resulting in blood stasis inside the atria and potentially resulting in stroke without any intervening atrial fibrillation. This paper describes an overview of Atrial Myopathy in pathogenic mechanisms linking atrial fibrillation and ischemic stroke. Atrial myopathy is not only a substrate for atrial fibrillation and makes thrombus formation cause ischemic stroke, but also leads to blood stasis within the atria and makes ischemic stroke without intervening atrial fibrillation.

The relationship between atrial myopathy with and without atrial fibrillation to cryptogenic stroke Kahadi, Cik; Rizal , Ardian; Rohman, Mohammad Saifur
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.9

Background: Ischemic stroke is the second most common cause of mortality globally, with some cases classified as cryptogenic strokes (CS) where the cause is unknown. Traditionally, atrial fibrillation (AF) has been considered the primary cause of ischemic stroke, but recent clinical trials and the occurrence of CS have led to the concept of atrial myopathy (AM). AM not only serves as a substrate for AF, promoting thrombus formation, but also causes blood stasis in the atrium, resulting in stroke without AF. Objective: The relationship between AM with and without AF to CS incidences at Saiful Anwar Hospital, Malang was evaluated in this study. Methods: Retrospectively analyzed medical records of patients from January 2023 to December 2024. Univariate analysis for baseline characteristic, bivariate analysis with Chi square, t-test and Mann Whitney u-test and multivariate analysis for predictive model using logistic regression were used for determine the relationship among variable in this study. Result: 112 patients were included in this study. AM has a statistically significant (OR 31.762, 95% CI: 3.965-254.427, p=0.001) as a predictor of CS, but AF did not (OR: 1.666, 95% CI: 0.414-6.707, p=0.473). A better predictive value was achieved with CHA2DS2-VASC ≥2 combined with AM (OR 7.948, 95% CI: 2.628-24.034, p<0.001), compared with CHA2DS2-VASC ≥2 alone (OR 1.909, 95% CI: 0.651-5.598, p=0.239) or CHA2DS2-VASC ≥2 combined with AF and AM (OR 3.600, 95% CI: 0.985-13.159, p=0.050). Conclusion: Atrial myopathy with and without atrial fibrillation had association to increasing the risk of cryptogenic stroke. Combining AM with the CHA2DS2-VASC score can improve stroke cryptogenic risk prediction

Non-invasive multimodality cardiac stress test imaging: Role of echocardiography, cardiac computed tomography, cardiac magnetic resonance, and nuclear medicine Kahadi, Cik; Handari, Saskia Dyah
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.3

Coronary artery disease, or CAD, is the major cause of mortality and morbidity globally, with significant socioeconomic impact. Based on European Society of Cardiology or ESC guidelines in Chronic Coronary Syndrome (CCS), multimodality imaging strategies are highly suggested in evaluating the patient who suspected CAD. Non-invasive imaging modalities can assess the anatomy of coronary artery by using Coronary Computed Tomography Angiography (CCTA) or assess functional stress testing with inducible myocardial ischemia by using Stress Echocardiography (SE), Myocardial CT Perfusion (CTP), Cardiac Magnetic Resonance (CMR), Single Photon Emission Computed Tomography (SPECT), or Positron Emission Tomography (PET). Nowadays, it’s important to recognize the limitations and capabilities of each imaging method, especially before selecting a functional testing focused on ischemia compared to an anatomy of coronary imaging. This paper describes an overview of non-invasive imaging modalities for the general diagnosis of CAD patients. Non-invasive multimodality cardiac stress test imaging is enhancing the diagnosis of significant stenosis of the coronary artery. Understanding the benefits and limits of each imaging is essential for determining the best modality we used.

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