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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 39 Documents
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Search results for , issue "online first" : 39 Documents clear
Correlation Between Six-Minute Walk Test and Treadmill Exercise in Post-Coronary Artery Bypass Phase II Rehabilitation Patients: A Cross-Sectional Study Tresia Fransiska Ulianna Tambunan; Audrey Witari; Helisa Rachel Patricie Sianipar
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1969

Abstract

Background: Coronary Artery Bypass Grafting (CABG) improves survival in advanced Coronary Artery Disease (CAD) but is often associated with reduced functional capacity during recovery. Phase II cardiac rehabilitation improves physical performance, yet accessible and reliable tools are needed to monitor progress. Treadmill Cardiopulmonary Exercise Testing (CPET) is the gold standard for assessing aerobic capacity, but it is resource-intensive and not widely available in many settings. The Six-Minute Walk Test (6MWT) is a simple alternative, but its validity compared with treadmill testing in Indonesian post-CABG patientsremains underexplored Methods: This cross-sectional study was conducted at the National General Hospital Dr. Cipto Mangunkusumo in Jakarta between May 2023 and October 2024. Post-CABG patients who completed an eight-week Phase II cardiac rehabilitation program, were clinically stable, and able to perform both assessments were included. Functional capacity was determined by estimated VO2Max from the 6MWT and directly measured VO2Max from a symptom-limited treadmill test using the Modified Bruce protocol. Descriptive statistics summarized baseline characteristics. Spearman correlation coefficient was used to evaluate the relationshipbetween the two tests, with statistical significance set at p<0.05. Results: Fifteen post-CABG patients completed the study. Most were male (73.3%) with a mean age of 59 years. Overweight status was common (46.7%), with hypertension (80.0%), dyslipidemia (66.7%), and diabetes mellitus (53.3%) as frequent comorbidities. Mean 6MWTdistance increased from 307.8 ± 85.7 m pre-rehabilitation to 498.5 ± 140.7 m post-rehabilitation. The estimated VO2Max from the 6MWT followed a normal distribution and is reported as a mean of 18.9 mL/kg/min (SD = 4.2). In contrast, the treadmill-measured VO2Max was nonnormally distributed and is therefore reported as a median of 21.4 mL/kg/min. A significant moderate positive correlation was found between 6MWT and treadmill VO2Max (r = 0.689, p = 0.005). Conclusion: The 6MWT demonstrated a strong, significant correlation with treadmill-based VO2Max, supporting its use as a practical and cost-effective alternative for functional capacity assessment in post-CABG Phase II rehabilitation. Routine integration of the 6MWT may facilitate individualized exercise prescription and enhance patient monitoring, particularly in resource-limited settings.
Utilization of Neuromuscular Electrical Stimulation as a Rehabilitation Treatment in Heart Failure with Reduced Ejection Fraction: A Systematic Review and Meta-Analysis Bima Diokta Alparisi; Samira Amanda; Daniel Herman; Rosmaliana Rosmaliana; Irwan Irwan; Haryadi Haryadi
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1997

Abstract

Heart Failure with Reduced Ejection Fraction (HFrEF) is associated with substantial functional impairment, and many patients are unable to participate in conventional exercise-based cardiac rehabilitation. Neuromuscular Electrical Stimulation (NMES) has been proposed as an alternative rehabilitation treatment, but its clinical effectiveness remains uncertain. This review aims to evaluate the effectiveness of NMES in improving cardiac function and exercise capacity in patients with HFrEF. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing NMES with standard medical therapy, exercise training, or no intervention in adult patients with HFrEF were identified through major electronic databases. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Pooled effects were calculated as Mean Differences (MD) with 95% Confidence Intervals (CIs) using Review Manager (RevMan) version 5.4. Twelve RCTs involving 636 participants were included. NMES significantly improved peak oxygen uptake (VO2 peak) (MD 2.03 mL/kg/min; 95% CI 1.21 to 2.84; p < 0.00001), systolic blood pressure (MD −2.02; 95% CI −3.97 to −0.06; p = 0.04), Left Ventricular Ejection Fraction (LVEF) (MD −1.38%; 95% CI −2.73 to −0.03; p = 0.05), and Heart Rate (HR) (MD 2.19 beats/min; 95% CI 0.44 to 3.95; p = 0.01). A borderline significant improvement was observed in the Six-Minute Walk Test (6MWT) distance (MD −11.40 m; 95% CI −23.04 to 0.24; p = 0.05). No significant effects were found for diastolic blood pressure (MD −0.12; 95% CI −3.30 to 3.06; p = 0.94) or Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (MD 1.97; 95% CI −9.06 to 13.01; p = 0.73). NMES is associated with meaningful improvements in exercise capacity and selected parameters of cardiac function in patients with HFrEF, supporting its role as a potential adjunct rehabilitation treatment.
SYNTAX Score 2020 Risk Estimates Between PCI and CABG in Coronary Artery Disease : A Descriptive Study Alysa Masytha Masyhudi; Sanggap Indra Sitompul; Karina Yesika Manalu; Refiansyah Tri Anggoro; Yusuf Galenta
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2050

Abstract

Background: The SYNTAX Score 2020 is a validated tool that combines anatomical and clinical parameters to estimate long-term outcomes in CAD and guide revascularization decisions between PCI and CABG. Although its components are well defined, further studies are needed to clarify how clinical variables influence risk predictions in diverse populations, including Indonesia. Methods: This cross-sectional study enrolled 115 patients with angiographically confirmed CAD at dr. Doris Sylvanus Regional General Hospital, Palangka Raya, Indonesia, between January and June 2025. The SYNTAX Score 2020 and anatomical SYNTAX Score I were calculated using the official application. Statistical analyses included bivariate non-parametric tests, Spearman correlations, and multivariate linear regression to identify independent clinical determinants of the SYNTAX Score 2020–predicted 10-year mortality and 5-year MACE following PCI and CABG. Results: PVD and DM were strongly associated with a higher SYNTAX Score 2020–predicted 5-year MACE and 10-year mortality after both PCI and CABG, with a stepwise increase in risk from no DM to insulin-treated DM. LMCAD was associated with a higher CABG-predicted risk than 3VD, whereas smoking was not associated with predicted outcomes. Age and SYNTAX Score I were positively correlated with all risk estimates, whereas CrCl and LVEF were inversely correlated. In the multivariate models, age, PVD, DM, and lower LVEF remained independent predictors for both strategies; SYNTAX Score I remained significant only for PCI, and CrCl was no longer independently associated with risk. Conclusion: Age was the main independent predictor of a higher SYNTAX Score 2020 that predicted long-term risk, followed by PVD and diabetes (highest in insulin-treated DM). Higher LVEF was protective, and left main disease carried a higher predicted risk than three-vessel disease.
Predischarge Lung Ultrasound B-Lines as a Robust Predictor of 90-Day Rehospitalization in Heart Failure with Reduced Ejection Fraction (HFrEF): Evidence from Clinical and Classification and Regression Tree (CART)-Based Risk Stratification Akhtar Fajar Muzakkir; Yogi Andrew Taruk Padang; Peter Kabo; Ali Aspar Mappahya; Andi Alfian Zainuddin
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2051

Abstract

Background: Heart failure is a major global health burden, with high morbidity, mortality, and substantial rehospitalization rates. Residual pulmonary congestion at discharge is a key determinant of early readmission but is often underestimated using clinical assessment alone. Lung Ultrasound (LUS) offers an objective, bedside tool for detecting pulmonary congestion through B-line quantification. This study aimed to evaluate whether predischarge B-line measurements predict 90-day rehospitalization due to all cardiovascular causes in patients with Heart Failure with reduced Ejection Fraction (HFrEF). Methods: This retrospective cohort study included 107 adults hospitalized with HFrEF at Wahidin Sudirohusodo Hospital from March to July 2023. LUS was performed prior to discharge using an eight-zone protocol, and total B-line counts were recorded. Clinical, laboratory, and echocardiographic variables were obtained from the Heart Failure Registry and electronic medical records. Patients were followed for 90 days to identify heart failure–related rehospitalization. Statistical analyses included independent t-test, Mann–Whitney U tests, chi-square test, ROC curves, multivariate logistic regression, and a Classification and Regression Tree (CART) model to identify the strongest predictors of rehospitalization. Results: Among 107 patients (mean age 58.52 ± 12.16 years; 74.77% male), 48 (44.86%) experienced 90-day rehospitalization due to all cardiovascular causes. Rehospitalized patients had significantly higher predischarge B-line counts (25.98 ± 8.23 vs. 17.63 ± 8.03, p <0.0001). A B-line cutoff of ≥20 predicted rehospitalization with 75.7% accuracy, 77.08% sensitivity, 74.58% specificity, and an AUC of 0.754. Renal dysfunction (eGFR 58.72 ± 29.32 vs. 75.43 ± 27.49 mL/min/1.73 m², p = 0.003; creatinine 1.86 ± 2.01 vs. 1.21 ± 0.76 mg/dL, p = 0.021), lower EF (31.6 ± 8.15% vs. 36.64 ± 9.05%, p = 0.004), and higher filling pressures (PCWP, E/e′) were also significantly associated with rehospitalization. The CART model identified B-line ≥20 as the strongest primary classifier, with additional risk contributed by renal impairment and reduced EF, yielding an accuracy of 90.65% and an AUC of 0.966. Conclusion: Predischarge B-line quantification is a strong predictor of 90-day rehospitalization in HFrEF. Integration of B-line assessment with renal function and cardiac parameters substantially improves risk stratification. LUS provides a practical, noninvasive tool for optimizing predischarge evaluation and may guide interventions to reduce early rehospitalization.
A Triple Disaster Phenomenon For the Coronary Artery An Impressive Case of No-reflow and Complication Management Emirhan Çakır; Çağlar Kaya; Kenan Yalta
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1823

Abstract

Background: Coronary no-reflow is characterized by very slow or absent epicardial blood flow. It results in inadequate myocardial perfusion and is an independent predictor of mortality due to malignant arrhythmias and heart failure. Case Illustration: This case describes a patient who underwent angiography due to a reperfused inferior myocardial infarction. Following the diagnostic procedure, a decision was made to perform a primary percutaneous intervention on the Circumflex (Cx) artery. When the stent balloon was inflated to the optimal pressure, it burst. The control image revealed the development of no-reflow after the Left Main Coronary Artery (LMCA). This potentially fatal condition was successfully treated with the administration of Intracoronary (IC) adrenaline. Conclusion: No-reflow is a significant factor affecting mortality. The occurrence of this phenomenon in multiple vessels further increases this risk, but it can be effectively managed with IC adrenaline, and multiple-vessel no-reflow can be treated.
Changes in N-Terminal Pro-B-Type Natriuretic Peptide Levels According to Estimated Plasma Volume Variation in Patients with Acute Decompensated Heart Failure Wulan Prisilla; Yose Ramda Ilhami; Citra Kiki Krevani; 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.1934

Abstract

Background: Acute Decompensated Heart Failure (ADHF), often caused by fluid retention and elevated left ventricular filling pressure, is the most common form of acute heart failure, accounting for 50-70% of cases. It carries high morbidity and mortality, with in-hospital death up to 11% and one-year post-discharge mortality reaching 36%. Rehospitalization rates range from 22-30% within 1-3 months to 65% within one year. In Indonesia, the 2013 prevalence of physician-diagnosed heart failure was 0.13%, affecting approximately 230,000 people. Methods: This prospective observational study was conducted on ADHF patients admitted to the Cardiology Department of Dr. M. Djamil General Hospital, Padang, during July-August 2025. Blood and N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) assessments were obtained at admission and upon discharge. Participants were divided into two categories based on their estimated Plasma Volume Variation (ePVV) results (<0% and ≥0%). The Mann-Whitney test was used to compare NT-proBNP variations between these groups. Results: A total of 33 participants were included, the majority being male, with pneumonia as the most prevalent comorbidity and ischemic heart disease as the primary underlying cause. Patients with ePVV <0% showed a median change in NT-proBNP of 21.06%, whereas those with ePVV ≥0% showed a median change of 9.58%. The Mann-Whitney test indicated that this difference between groups was statistically significant (p = 0.012). Conclusion: The observed variation in NT-proBNP levels across ePVV categories suggests that ePVV may be a valuable non-invasive marker for assessing congestion status in ADHF. Combining ePVV measurements with NT-proBNP monitoring could enhance clinical assessment and management strategies for patients with heart failure.
Evaluating Risk Profiles and Treatment Modalities for Hypertension: Factors Associated with Uncontrolled Blood Pressure at a Primary Health Center Afif Luthfi Aprianto; Rooshinta Bahar; Narulita Brillianti Fajariani Putri; Noor Chamidah
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1935

Abstract

Background: Hypertension remains a significant global health challenge, with approximately 31.1% adults worldwide suffering from it. In Indonesia, community health centers are at the forefront in controlling hypertension. However, the prevalence of hypertension in Indonesia remains high. Identification of risk factors and treatment-related issues is needed to predict uncontrolled hypertension. This study aimed to evaluate the relationships between various risk factors, adherence to therapeutic evaluation guidelines, and hypertension control status. Furthermore, this study examines factors associated with uncontrolled hypertension among patients at community health centers. Methods: A cross-sectional analytic study involved 295 adult hypertensive patients from community health centers. Data included demographic characteristics, cardiovascular risk factors, lifestyle factors, hypertension risk classification, and therapy evaluation adherence based on established guidelines. Inadequate therapeutic evaluations include withholding combination therapy. Bivariate analyses (Pearson Chi-square and Mann-Whitney) were performed, followed by multivariate binary logistic regression to identify significant odds ratios. Results: The prevalence of uncontrolled hypertension was 64.7%. In multivariate analysis, factors that increased the odds of uncontrolled hypertension were older age (aOR 1.082; 95% CI 1.042-1.124; p<0.001), higher hypertension risk classification (aOR 2.156; 95% CI 1.142-4.069; p=0.018), hypertension family history (aOR 2.925; 95% CI 1.409-6.072; p=0.004), and especially inadequate therapy (aOR 4.902; 95% CI 2.353-10.212; p<0.001). Conversely, salt restriction (aOR 0.352; 95% CI 0.179-0.694; p=0.002) was protective against uncontrolled hypertension. Other clinical factors (hypercholesterolemia, hyperuricemia, and diabetes mellitus) were not significant in the model. Conclusion: Inadequate therapy, family history, risk classification, and age are significant factors associated with uncontrolled hypertension. Salt restriction was associated with lower odds of uncontrolled hypertension. Treatment concordance has the highest odds ratio. This demonstrates that the importance of community health centers extends beyond lifestyle change agents; guideline-based therapy monitoring is also crucial.
Association Between Diabetes Mellitus and In-Stent Restenosis at a Military Hospital in Jakarta Alrio Fransisco Hamonangan Hutapea; Taureni Hayati; Ardhestiro Harnindyo Putro
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1939

Abstract

Background: In-Stent Restenosis (ISR) refers to the recurrence of luminal narrowing within the stented segment after Percutaneous Coronary Intervention (PCI) and continues to pose a clinical challenge, especially in individuals with Diabetes Mellitus (DM). Elevated blood glucose levels lead to endothelial injury, persistent inflammation, and excessive neointimal tissue growth, all of which increase the likelihood of ISR. Methods: This research employed an analytical observational approach with a cross-sectional design and was conducted at a military hospital in Jakarta. Data were collected from the medical records of patients diagnosed with Coronary Artery Disease (CAD) who underwent PCI between January 2021 and December 2023. A total sampling method was applied to all patients who underwent PCI and had a clinically indicated follow-up coronary angiography during the study period, yielding 66 eligible patients. Bivariate analysis was performed using the Chi-square test, followed by multivariable logistic regression to adjust for relevant clinical covariates. Results: Of the 66 patients included in this study, 44 (66.7%) were diagnosed with DM, and 44 (66.7%) had ISR. Bivariate analysis showed that DM was significantly associated with ISR (OR 4.08; 95% CI: 1.36–12.21; p = 0.0097). Multivariate analysis showed that poor glycemic control remained independently associated with ISR (OR 5.39; 95% CI: 1.04–27.84; p = 0.044), while diabetes status alone was no longer independently associated. Conclusion: DM is associated with higher ISR after PCI, with poor glycemic control independently associated, underscoring the importance of optimized glycemic management.
Myotomy for Severe Left Anterior Descending Myocardial Bridging: A Case Report Maria Elfana; Teuku Muhammad Haykal Putra; Ismail Dilawar; Andri Kurnia; Jemmy Tanod; Wishnu Aditya Widodo
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1948

Abstract

Background: Myocardial Bridging (MB) is defined as a segment of a coronary artery that courses within the myocardium, which may result in systolic compression of the tunneled segment and compromise coronary blood flow. The Left Anterior Descending (LAD) artery is the most commonly affected vessel, with a reported incidence of 70-97%. This case report describes the incidental identification of MB in a patient scheduled for cardiac surgery and outlines the subsequent surgical management. Case illustration: A 53-year-old male was referred to our center with severe Mitral Regurgitation (MR). He had recurrent hospitalizations for symptoms of heart failure without any complaint of angina. Echocardiography revealed preserved Left Ventricular (LV) ejection fraction and severe MR. A positive ischemic response was observed on treadmill stress testing. Preoperative Coronary Angiography (CAG) demonstrated severe MB in the distal LAD, without evidence of coronary plaque. The patient underwent Mitral Valve (MV) repair with concomitant myotomy, resulting in improved LAD-MB without residual compression. Postoperative CAG confirmed complete resolution of the MB, with no evidence of a milking effect. Conclusion: The management of MB remains challenging, and treatment strategies should be tailored to individual patient characteristics. Surgical myotomy is a viable treatment option, as demonstrated by the favorable outcome in this case.
Twelve-Month Clinical Outcomes of Robotic PCI vs Manual PCI: A Systematic Review Putri Ayu Suciati; Izza Tunisa; Evira Agustina Putri
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1962

Abstract

Robotic-assisted Percutaneous Coronary Intervention (R-PCI) has been developed to improve procedural precision and reduce operator radiation exposure compared with Manual Percutaneous Coronary Intervention (M-PCI). Although short-term safety and feasibility have been well demonstrated, evidence on 12-month clinical outcomes remains limited. This systematic review evaluated 12-month clinical outcomes of R-PCI versus M-PCI in adult patients with coronary artery disease. Relevant literature published between January 2015 and April 2025 was identified through searches in Scopus, ScienceDirect, PubMed, Cochrane Library, and Google Scholar. Eligible studies directly compared R-PCI and M-PCI and reported 12-month clinical outcomes, including Major Adverse Cardiovascular Events (MACE), Myocardial Infarction (MI), stroke, mortality, and Target Vessel Revascularization (TVR). Four cohort studies were included, involving 915 patients, of whom 334 underwent R-PCI, and 581 underwent M-PCI. At 12 months, MACE rates ranged from 0% to 10.5% after R-PCI and 1.4% to 8.1% after M-PCI. Mortality, MI, and TVR were low and comparable between groups. Although fluoroscopy time varied among studies, procedural success remained high, and adverse events were similar between groups. Studies that utilized Intravascular Ultrasound (IVUS) guidance reported particularly favorable outcomes. Overall, the available observational evidence suggests that R-PCI is associated with 12-month clinical outcomes comparable to those of M-PCI. However, given the limited number of studies, their observational design, and the absence of randomized data, these findings should be interpreted with caution. Further large-scale randomized controlled trials with longer follow-up are warranted to more definitively establish the clinical effectiveness and cost-effectiveness of R-PCI.

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