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INDONESIA
Indonesian Journal of Cardiology
Published by Indonesian Heart Association
ISSN : 28303105     EISSN : 29647304     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Indonesian Journal of Cardiology (IJC) is a peer-reviewed and open-access journal established by Indonesian Heart Association (IHA)/Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI) [www.inaheart.org] on the year 1979. This journal is published to meet the needs of physicians and other health professionals for scientific articles in the cardiovascular field. All articles (research, case report, review article, and others) should be original and has never been published in any magazine/journal. Prior to publication, every manuscript will be subjected to double-blind review by peer-reviewers. We consider articles on all aspects of the cardiovascular system including clinical, translational, epidemiological, and basic studies. Subjects suitable for publication include but are not limited to the following fields: Acute Cardiovascular Care Arrhythmia / Cardiac Electrophysiology Cardiovascular Imaging Cardiovascular Pharmacotherapy Cardiovascular Public Health Policy Cardiovascular Rehabilitation Cardiovascular Research General Cardiology Heart Failure Hypertension Interventional Cardiology Pediatric Cardiology Preventive Cardiology Vascular Medicine
Arjuna Subject : Kedokteran - Cardiology and Cardiovascular Medicine
Articles 24 Documents
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Search results for , issue "online first" : 24 Documents clear
Myocarditis Mimicking STEMI Complicated by Complete Atrioventricular Block: Diagnostic and Therapeutic Insights Rido Mulawarman; Hiradipta Ardining; Celly Anantaria Atmadikoesoemah; Dony Yugo Hermanto; Bambang Widyantoro; Rarsari Soerarso
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1921

Abstract

Background: Myocarditis, or myocardial inflammation, may share similar characteristics to Acute Coronary Syndrome (ACS), particularly ST-Elevation Myocardial Infarction (STEMI). This condition is further augmented when a Complete Atrioventricular Block (CAVB) is present. Despite being rare, this condition may pose additional diagnostic and therapeutic challenges. Case Illustration: We report a 54-year-old woman with fatigue, dyspnea, fever, nausea, and watery diarrhea for three days. Upon admission, she experienced hypotension, pulmonary congestion, and a complete Atrioventricular (AV) block, with ST-segment elevation seen on the lateral leads. Initial laboratory results revealed markedly elevated high-sensitivity troponin T and C-reactive Protein (CRP). Bedside echocardiography showed a prominently reduced Ejection Fraction (EF) (40%) alongside the presence of regional wall motion abnormalities. Urgent coronary angiography revealed only non-obstructive coronary disease and no obstructive coronary disease. A temporary pacemaker and inotropic support were initiated. Given the presence of systemic prodromal symptoms and the absence of coronary obstruction, myocarditis was strongly suspected. High‑dose intravenous methylprednisolone was given as an anti‑inflammatory treatment in suspected fulminant myocarditis with cardiogenic shock and complete AV block. Recognizing that immunosuppressive therapy is not routinely recommended for all myocarditis cases, especially without biopsy confirmation. Cardiac magnetic resonance imaging subsequently confirmed myocarditis, demonstrating myocardial edema and subepicardial late gadolinium enhancement. The patient was discharged after receiving guideline-directed medical therapy and tapering corticosteroids, with preserved ventricular function on follow-up 1 month after discharge. Conclusions: This report illustrates the importance of a stepwise diagnostic approach to differentiate myocarditis from STEMI, particularly when complicated by conduction disturbances such as CAVB. Early recognition and timely initiation of immunosuppressive therapy can lead to favorable outcomes.
Cardiac Tamponade due to Purulent Pericarditis Jessica Anastasia Setiawan; Danayu Sanni Prahasti
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1963

Abstract

Background: Purulent pericarditis, though uncommon in the antibiotic era, remains highly fatal when diagnosis or drainage is delayed. Its presentation often mimics viral hepatitis, sepsis, or parasitic infections—particularly in endemic, low-resource regions—leading to underrecognition. This case reported the development of purulent pericarditis with initial equivocal signs and symptoms, followed by progressive hemodynamic deterioration. Case Illustration: A 40-year-old previously healthy man presented with fever, dyspnea, stabbing chest and abdominal pain, and dark urine. Examination revealed jaundice, pericardial friction rub, and hepatosplenomegaly. Laboratory tests showed leukocytosis, hyperbilirubinemia, and elevated liver enzymes. Initial echocardiography demonstrated a 2-cm circumferential effusion without signs of tamponade. Two days later, despite stable symptoms, he developed hypotension with new fibrinous effusion and right atrium collapse. Emergency pericardiocentesis drained 1.7 L of thick, purulent fluid. Hemodynamics improved rapidly after drainage. Prednisone and colchicine were initiated once infection control was achieved to limit fibro-inflammatory response and reduce the risk of constriction. Liver function normalized, and follow-up echocardiography showed minimal residual effusion. At follow-up, the patient remained asymptomatic. Conclusion: This case highlights that purulent pericarditis can occur in immunocompetent individuals without typical risk factors, possibly from overlooked infection in low-resource settings. Hemodynamic collapse may occur even with small increases in pericardial effusion volume, owing to fibrin-induced pericardial stiffness and reduced compliance. Serial echocardiography is therefore critical when symptoms appear stable. Early pericardiocentesis is both diagnostic and therapeutic, reducing bacterial and inflammatory load, while carefully selected adjunctive anti-inflammatory therapy may prevent chronic constrictive sequelae.
One-Year Outcomes of Major Adverse Cardiac Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Delayed PCI in a Type-B Hospital Nova Maryani; Gagah Buana Putra; Farhan Hanifati; Muhammad K. Abdillah
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2038

Abstract

Background: Delayed Percutaneous Coronary Intervention (PCI) remains common in resource-limited hospitals due to system-related delays, often resulting in prolonged ischemic time. Although early reperfusion is the standard of care for ST-segment Elevation Myocardial Infarction (STEMI), delayed PCI may still be performed in selected, clinically stable patients. This study aimed to evaluate the one-year incidence of Major Adverse Cardiac Events (MACE) among STEMI patients undergoing PCI in a Type-B hospital, where delayed PCI was the predominant treatment pattern. Methods: This retrospective cohort study included adult STEMI patients who underwent PCI at PKU Muhammadiyah Gamping Hospital, Yogyakarta, Indonesia, between September 2018 and December 2020. Patients with incomplete medical records or loss to follow-up were excluded. Baseline clinical characteristics, comorbidities, infarct location, and door-to-wire-crossing time were collected. MACE included all-cause mortality, acute pulmonary edema, non-ST-segment elevation myocardial infarction, stroke, and rehospitalization due to reinfarction or acute heart failure within one year after PCI. Kaplan-Meier survival analysis and Mann-Whitney testing were applied. Results: Among 130 STEMI patients who underwent PCI, 123 (94.6%) received delayed PCI, with a median door-to-wire-crossing time of 10 hours 34 minutes. During one-year follow-up, MACE occurred in 10 patients (7.7%), corresponding to a 92.3% event-free survival rate. No significant association was observed between door-to-wire-crossing time and one-year MACE (p = 0.927). Conclusions: In this single-center study conducted at a Type-B hospital, one-year MACE occurred in 7.7% of STEMI patients undergoing PCI, most of whom received delayed PCI. No significant association was observed between door-to-wire-crossing time and MACE occurrence. Given the observational design and the limited number of events, these findings should be interpreted with caution. Delayed PCI appears feasible in selected patients, but should not be considered equivalent to guideline-recommended early PCI.
Coronary Vulnerable and High-Risk Plaque: Current Concepts, Selective Preventive PCI, and an ISIC Position Statement Muhammad Munawar; Aninka Saboe; Achmad Fauzi Yahya; Teguh Santoso; Abdul Hakim Alkatiri; Sunanto Ng; Sunarya Soerianata; Sodiqur Rifqi; Yudi Her Oktaviono; Nahar Taufiq; Janry Pangemanan; Sasmojo Widito; Muhammad Saifur Rohman; Muhammad Syukri; Doni Firman
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2316

Abstract

The concept of coronary vulnerable plaque has evolved from a histopathological concept into a potential therapeutic target for precision cardiovascular prevention. Recent evidence has expanded this paradigm beyond the traditional vulnerable-plaque construct towards the broader concept of high-risk plaque, encompassing rupture-prone plaques, erosion-prone plaques, calcified nodules, plaque burden, inflammatory activity, healing capacity, and patient-level susceptibility to thrombosis.Advances in Coronary Computed Tomography Angiography (CCTA), Intravascular Ultrasound (IVUS), Optical Coherence Tomography (OCT), Near-Infrared Spectroscopy (NIRS), molecular imaging, and Artificial Intelligence (AI) have substantially improved the detection and characterization of high-risk plaque. Circulating lipid, inflammatory, metabolic, and renal biomarkers provide complementary information regarding patient vulnerability. Concurrently, contemporary pharmacological therapy has substantially improved the natural history of coronary atherosclerosis by promoting plaque stabilization, fibrous cap thickening, lipid core regression, and attenuation of vascular inflammation.The emergence of preventive Percutaneous Coronary Intervention (PCI) for non-flow-limiting vulnerable plaques, particularly following the PREVENT trial, has reignited interest in focal treatment before clinical destabilization. Nevertheless, important uncertainties remain regarding patient selection, diagnostic thresholds, imaging strategies, device selection, long-term durability, cost-effectiveness, and applicability in resource-limited healthcare systems. Drug-Eluting Stents (DES) remain the most established device platform, whereas next-generation bioresorbable scaffolds and Drug-Coated Balloons (DCB) may offer future approaches to local plaque treatment without permanent metallic implantation. Although Coronary Artery Bypass Grafting (CABG) does not directly treat vulnerable plaques, it may indirectly protect selected patients with diffuse multivessel disease by bypassing plaque-bearing coronary segments.For Indonesia and other resource-constrained healthcare systems, future implementation should emphasize pragmatic implementation rather than widespread adoption of advanced technologies. Emphasis should remain on aggressive Optimal Medical Therapy (OMT), selective use of advanced imaging, careful identification of patients at the highest absolute cardiovascular risk, structured operator training, national registries, and rigorous evaluation of cost-effectiveness. The ultimate objective is not simply to detect more vulnerable plaques but to prevent more myocardial infarctions and cardiovascular deaths through efficient use of healthcare resources.The Indonesian Society of Interventional Cardiology (ISIC) recommends that aggressive systemic prevention, centered on OMT, should remain the foundation of care. Advanced plaque imaging and preventive PCI should be reserved for carefully selected patients with converging high-risk plaque characteristics, high patient-level risk, and a favorable benefit–risk profile.
Competence with Integrity: Guarding Public Trust in Cardiology Muhammad Munawar
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2323

Abstract

Cardiology is living through an unprecedented era of scientific and technological advancement. Artificial intelligence, advanced cardiovascular imaging, catheter-based interventions, structural heart therapies, and precision medicine continue to redefine what physicians are capable of achieving. Clinical practice guidelines evolve continuously, appropriate use criteria are regularly revised, and innovations that once seemed extraordinary have quietly become part of everyday practice. Yet amid these remarkable achievements, one fundamental principle remains unchanged. The legitimacy of the medical profession has never rested on scientific excellence or technical mastery alone. It has always depended on the trust that society places in physicians. Technology may transform how disease is diagnosed and treated, but only integrity sustains the confidence that patients place in those entrusted with their lives. This reflection is adapted from an address delivered at the convocation of newly graduated cardiology specialists and cardiovascular subspecialists within the Indonesian Heart Association (PERKI). On such an occasion, scientific accomplishment deserves celebration, but even more important is the reminder that competence must always walk hand in hand with integrity. Public trust in cardiology will endure only when professional excellence is inseparable from ethical responsibility
Prevalence and Lipid Profile Associations of Elevated Lipoprotein(a) Among Indonesian Adults: A Cross-Sectional Study Jason Wirandy Haryanto; Kevin Jonatan Sandi; Surya Sinaga Immanuel; Angely Christie Rumayar; Leonardo Paskah Suciadi
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1846

Abstract

Background: Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein and an independent risk factor for Atherosclerotic Cardiovascular Disease (ASCVD). While 20–30% of adults worldwide have elevated Lp(a), data from Indonesia remain scarce. Given reported differences by sex and metabolic profile, this cross-sectional study aimed to determine the prevalence of elevated Lp(a) and its associations with lipid parameters and Hemoglobin A1c (HbA1c) among adults undergoing routine health screening at a tertiary hospital in Indonesia. Methods: This cross-sectional study analyzed data from 904 adults who underwent routine health screening at Siloam Hospitals Kebon Jeruk, Jakarta (2021–2024). Data on Lp(a), lipid profile, and HbA1c were extracted from the medical records. The normality of data was assessed using the Shapiro–Wilk test. Group comparisons were performed using the Mann–Whitney U test, and correlations between log-transformed Lp(a) and metabolic parameters were evaluated using Spearman correlation and simple linear regression. Results: Among 904 participants, 18.8 % had elevated Lp(a) levels (> 30 mg/dL). Females showed significantly higher Lp(a) concentrations than males (p = 0.008). Low-Density Lipoprotein Cholesterol (LDL-C) levels were slightly higher in participants with elevated Lp(a) but did not differ significantly (p = 0.19). On linear regression, LDL-C was positively associated with log-transformed Lp(a) (B = 0.002, p < 0.001), whereas triglycerides were inversely associated (B = −0.001, p = 0.029); no significant relationships were observed for High-Density Lipoprotein Cholesterol (HDL-C) or HbA1c. Conclusion: Nearly one in five adults undergoing routine health screening in this Indonesian cohort had elevated Lp(a) levels. Females exhibited significantly higher Lp(a) concentrations than males, and LDL-C showed a modest positive association with Lp(a). These findings reinforce the relevance of Lp(a) as an important, genetically influenced cardiovascular risk marker and support routine Lp(a) screening for improved risk stratification in clinical practice.
A Ticking Time Bomb in the Heart: A Case Report of Cardiac Myxoma Reynold Siburian; Teuku Muhammad Haykal Putra; Ismail Dilawar; Gusti Reza Ferdiansyah; Meilana Saraswati
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1857

Abstract

Background: Cardiac myxoma is the most common primary cardiac tumor and is frequently found in the left atrium. Symptoms and signs are most often non-specific, making diagnosis difficult. We present a case report of an atrial cardiac myxoma with an atypical presentation. Case Illustration: A 55-year-old man presented to our outpatient clinic with recurrent and intermittent chest discomfort that had lasted for months. No other cardiac symptoms such as dyspnea or palpitations were noted. The patient’s medical history was positive for hypertension and smoking. Thorough chest pain evaluations were conducted, there were no ST-T changes on electrocardiogram. However, Transthoracic Echocardiography (TTE) revealed an incidental finding of a 2.1 x 2.6 cm mass, located in the Right Atrium (RA), with the stalk attached to the interatrial septum. Subsequently, patient was consulted to cardiothoracic surgeon and underwent successful tumor resection via median sternotomy. The tumor was confirmed histopathologically. Conclusion: The nonspecific symptoms of cardiac myxomas pose a diagnostic conundrum to clinicians. TTE plays a pivotal role in diagnosis, and surgical removal of the mass should be undertaken as soon as possible. Early detection and intervention remain imperative to rid the risk of this cardiac pathology.
Reviving the Atrial Switch: A Case Report of Successful Senning Procedure in a 13-Year-Old with Late-Presenting d-Transposition of the Great Arteries Rido Mulawarman; Sonya Aprelladiva; Indira Kalyana Makes; Adnan Rhafif; Ahmad Yani Mansur; Ericko Ongko Joyo; Della Fergina; Ruth Sabathani Ayuningtyas; Hiradipta Ardining; Muhammad Adrin Aefiansyah; Sisca Natalia Siagian
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1922

Abstract

Background: d-Transposition of the Great Arteries with an Intact Ventricular Septum (d-TGA-IVS) is a severe congenital cardiac anomaly typically necessitating an Arterial Switch Operation (ASO) during the neonatal stage. In late presenters with a regressed Left Ventricle (LV), ASO becomes high-risk or infeasible, making atrial switch procedures such as the Senning procedure a potential salvage option, particularly in resource-limited settings. Case Illustration: We report a 13-year-old boy with lifelong cyanosis who developed progressive exertional dyspnea. Echocardiography and cardiac catheterization confirmed d-TGA-IVS with secundum atrial septal defect, severe Right Ventricular Hypertrophy (RVH), and preserved Pulmonary Vascular Resistance (PVR) (1.93 WU). Due to LV regression and the limited feasibility of late ASO, a Senning atrial switch was performed. Postoperative recovery was clinically stable, with oxygen saturation improving from 73% to 91%. Early postoperative echocardiography showed reduced systemic Right Ventricular (RV) function (Tricuspid Annular Plane Systolic Excursion [TAPSE] 7 mm), which subsequently improved on follow-up. Conclusion: The Senning procedure remains a valuable salvage option for very-late presenting d-TGA-IVS with favorable pulmonary hemodynamics when ASO is not feasible. This case underscores the importance of periodic reassessment of operability in patients initially deemed inoperable and highlights the need for lifelong follow-up to monitor systemic RV function, arrhythmia risk, and baffle integrity.
Soluble ST2 as a Marker of Subclinical Right Ventricular Dysfunction in Pulmonary Hypertension Associated With Congenital Heart Disease Fadhil Alfino Azmi; Mefri Yanni; Kino Kino; Hirowati Ali
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1930

Abstract

Background: Congenital Heart Disease with Pulmonary Hypertension (CHD-PH) increases Right Ventricular (RV) afterload, which may lead to subclinical myocardial impairment before overt systolic dysfunction becomes apparent. Early detection is crucial to prevent progression to right heart failure. Global Longitudinal Strain (GLS) by echocardiography is sensitive for identifying subclinical RV dysfunction despite preserved conventional systolic parameters, but the role of molecular biomarkers remains unclear. Soluble Suppression of Tumorigenicity 2 (sST2) has been proposed as a potential biomarker for subclinical RV dysfunction. This study aims to compare sST2 levels in CHD-PH patients with and without subclinical RV dysfunction as assessed by RV-Global Longitudinal Strain (RV-GLS). Methods: This cross-sectional study included adult CHD-PH patients (≥18 years) at the Integrated Heart Center, RSUP M. Djamil Padang, from January to June 2025. All participants underwent right heart catheterization and had preserved RV systolic function, as assessed by conventional echocardiography (Three-Dimensional Right Ventricular Ejection Fraction [3D RVEF] ≥45%). RV-GLS was assessed using Speckle-Tracking Echocardiography (STE), and serum sST2 levels were measured. Patients were categorized into subclinical RV dysfunction (GLS > –20%) and without subclinical RV dysfunction (GLS ≤ –20%) groups. Statistical analysis was performed to compare sST2 levels between groups. Results: Thirty-four patients were included (82% female, mean age 37.8 ± 15.6 years), with secundum Atrial Septal Defect (ASD) as the most common etiology (71%). Median sST2 levels in patients with CHD-PH without subclinical RV dysfunction were 15.65 (6.05–40.90) ng/mL, with a GLS of –20.50 (–27.20 to –20.00)%. In patients with CHD-PH with subclinical RV dysfunction, median sST2 was 15.15 (5.25–47.60) ng/mL, with a GLS of –11.80 (–19.90 to –6.20)%. No statistically significant difference in sST2 levels was observed between groups (p = 0.89). In contrast, patients with CHD-PH with subclinical RV dysfunction exhibited significantly higher indexed Pulmonary Arterial Resistance (PAR) and pulmonary-to-Systemic Vascular Resistance ratio (PAR/SVR ratio), indicating increased pulmonary vascular load despite preserved conventional RV systolic function. Conclusion: sST2 levels did not differ significantly between CHD-PH patients with subclinical RV dysfunction and those without. Subclinical RV dysfunction was associated with higher pulmonary vascular load, as reflected by increased indexed PAR and PAR/SVR ratio, despite preserved conventional RV systolic function. From this may conclude that subclinical RV myocardial impairment in CHD-PH is more closely related to hemodynamic afterload than to molecular stress biomarkers alone. These findings suggest that sST2 alone may have limited utility as a biomarker for detecting subclinical RV myocardial impairment in this population.
A Big Challenge in a Tiny Heart: Right Ventricular Outflow Tract (RVOT) Stenting in a Premature Infant with Pentalogy of Fallot Adnan Rhafif; Radityo Prakoso; Aditya Agita Sembiring
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1937

Abstract

Background: Pentalogy of Fallot (POF) is a cyanotic congenital heart defect characterized by five anatomical abnormalities: Ventricular Septal Defect (VSD), pulmonary stenosis, Right Ventricular Hypertrophy (RVH), an overriding aorta, and an Atrial Septal Defect (ASD). The presence of the additional ASD alongside the classic features of Tetralogy of Fallot (TOF) can further exacerbate right-to-left shunting and worsen systemic desaturation. Management of POF in premature infants is particularly challenging due to low birth weight, underdeveloped pulmonary vasculature, and increased surgical risks. In high-risk neonates, traditional surgical options such as the modified Blalock–Taussig shunt may not be feasible. Right Ventricular Outflow Tract (RVOT) stenting has emerged as a minimally invasive palliative alternative to improve oxygenation and promote pulmonary artery growth, serving as a bridge to definitive surgical repair. This case highlights the technical considerations of RVOT stenting in high-risk neonates, emphasizing its role as a bridge to definitive surgical repair. Case Illustration: An 11-day-old premature infant presented with progressive central cyanosis, desaturation episodes (<70%), and shortness of breath. Physical examination revealed respiratory distress, central cyanosis, and an ejection systolic murmur. Imaging showed a boot-shaped heart and oligemia, while echocardiography confirmed POF with severe RVOT obstruction, hypoplastic pulmonary arteries, and reduced Right Ventricular (RV) function. The patient was initially managed for a hypoxic spell but later developed periodic apnea and cardiac arrest, prompting additional diagnosis of apnea of prematurity and admission to the Intensive Care Unit (ICU) for further management. Despite treatment, worsening respiratory effort necessitated intubation. After clinical stabilization and extubation, persistent hypoxia led to RVOT stenting at 32 days of age. After initial difficulty, balloon pre-dilation allowed successful stent deployment, resulting in improved oxygen saturation. Conclusion: This case demonstrates the feasibility and effectiveness of RVOT stenting as a palliative strategy in a premature infant with POF. The intervention led to immediate improvement in oxygenation and allowed time for clinical stabilization and potential pulmonary artery growth. This highlights that, in selected high-risk neonates where conventional surgical options may be unsuitable, catheter-based palliation can serve as a critical bridge to definitive surgical repair.

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