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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 779 Documents
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Patent Ductus Arteriosus Recanalization in Tricuspid Atresia with Restrictive Ventricular Septal Defect and Moderate Pulmonary Valve Stenosis: A Minimally Invasive Strategy in a Critical Case Gede Dewagama M.; Eka Gunawijaya; Veny K. Yantie
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1973

Abstract

Background : Tricuspid Atresia (TA) is a severe cyanotic Congenital Heart Disease (CHD) characterized by the absence of the tricuspid valve, resulting in Right Ventricular (RV) hypoplasia and dependence on interatrial and extracardiac shunts for pulmonary blood flow. In cases of restrictive Ventricular Septal Defect (VSD) with pulmonary outflow tract obstruction, the pulmonary circulation becomes duct-dependent. Closure of the Patent Ductus Arteriosus (PDA) may therefore lead to life-threatening hypoxemia. Prostaglandin E1 (PGE1) infusion is commonly used to maintain ductal patency; however, in emergency situations where PGE1 is unavailable or ineffective, catheter-based PDA recanalization can serve as a minimally invasive rescue strategy. Case Illustration : A 4-month-old female with known TA presented with progressive cyanosis and respiratory distress. Echocardiography demonstrated TA, hypoplastic RV, large Atrial Septal Defect (ASD), restrictive VSD, and a ductal tunnel without detectable flow. After initial stabilization, the patient developed recurrent severe desaturation below 70% despite maximal medical and ventilatory support. Urgent cardiac catheterization revealed a functionally closed PDA. Recanalization was successfully performed using balloon dilatation followed by implantation of a 4.0 × 20 mm drug-eluting stent, restoring pulmonary blood flow and improving oxygen saturation from 55% to 91%. Conclusion : PDA recanalization with stent implantation is a viable and life-saving minimally invasive option in critically ill patients with duct-dependent CHD when pharmacologic support fails and may serve as a bridge to staged surgical palliation.
Efficacy and Safety of Mesenchymal Stem Cell Therapy in Chronic Limb-Threatening Ischemia: A Meta-analysis of Randomized Controlled Trials Nabil Athoillah; Arya Marganda Simanjuntak; Mitsla Chusnica Aulia As’Ar; Dimas Widyadhana Bhanu Aryasatya; Lunggita Arabela Sugiarto; Hazna Fridella Utomo; Meutia Citra Aisya; Kevin Sanjaya Listiono; Ayu Diajeng Sekar Negari; Yusfik Helmi Hidayat; Aditha Satria Maulana
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1990

Abstract

Background: Chronic Limb-Threatening Ischemia (CLTI) represents the terminal stage of peripheral artery disease, carrying substantial morbidity and mortality. Despite various therapeutic strategies, clinical outcomes remain unsatisfactory, highlighting the urgent need for novel treatments. While Mesenchymal Stem Cells (MSCs) show promise at the cellular level, human studies are limited, preventing generalizable conclusions at this time. This study aimed to systematically assess the efficacy and safety of MSCs implantation in CLTI. Methods: PRISMA 2020-guided meta-analysis of intervention. Various databases were searched using keywords based of the PICOS framework. The PICOS framework guided our approach: Patients (CLTI), Intervention (MSCs), Comparison (Placebo OR Control), Outcome (Amputation, Ulcer Healing Rate, Rest Pain Change, Ankle-Brachial Index, Adverse Effect), and Study (Randomized Controlled Trial [RCT]). Statistical analysis was performed using Review Manager (RevMan 5.4.1) and RStudio (R.4.4.3). An Independent Risk-of-Bias 2 (RoB2) risk of bias assessment was performed. Results: Seven RCTs were included with a total of 270 patients. Meta-analysis showed that MSCs were more effective than the control group on suppressing the amputation rate (Odds Ratio [OR] = 0.40, 95% Confidence Interval [CI] = 0.17–0.95, p = 0.04). Ulcer healing rate was significantly higher in the MSCs therapy group compared to the control group (OR = 9.79, 95% CI = 2.59–36.98, p = 0.0008). Moreover, MSCs therapy markedly improved clinical outcomes, including rest pain score (Mean Difference [MD] = –1.88, 95% CI = –2.93 to –0.84, p = 0.0004) and ankle-brachial index (MD = 0.16, 95% CI = 0.09–0.22, p < 0.00001). Interestingly, MSCs therapy showed an excellent safety profile, with negligible gastrointestinal-hepatobiliary events and only 4% mild infections or musculoskeletal effects. Conclusion: This review shows that MSCs therapy offers a transformative approach for CLTI, significantly improving limb outcomes and perfusion while maintaining an excellent safety profile.
Expert Opinion on the Use of Inclisiran in Post-Acute Coronary Syndrome Patients in Indonesia Dafsah Arifa Juzar; Sunanto Ng; Isman Firdaus; Akhtar Fajar Muzakkir; Bambang Widyantoro; Faisal Habib; Hendry Purnasidha Bagaswoto; Siska Suridanda Danny; Erwinanto Erwinanto; Anwar Santoso
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1991

Abstract

Elevated low-density lipoprotein cholesterol (LDL-C) levels are an independent risk factor for the progression of atherosclerotic cardiovascular disease (ASCVD). Achieving substantial LDL-C reduction is recognized as a primary therapeutic goal, particularly for those at the highest risk of future cardiovascular events. Statin-based lipid-lowering therapy remains the cornerstone of secondary prevention in acute coronary syndrome (ACS). However, many high-risk individuals require combination therapy with non-statin agents to achieve guideline-recommended LDL-C targets. A novel, long-acting small interfering RNA (siRNA)-based proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, inclisiran, has emerged as a therapy that provides rapid and sustained LDL-C reduction. Despite these therapeutic advancements, various hurdles continue to hinder optimal lipid management in Indonesia. To address these challenges, an expert meeting involving cardiologists from multiple cities across Indonesia was convened, and the resulting consensus opinion of experts aimed to provide insights into the current hurdles in managing post-ACS and the potential use of inclisiran following high intensity statin or highest tolerated dose statins, with or without ezetimibe, in post-ACS patients in Indonesia.
Demographic Profile and Clinical Characteristics of Newly Diagnosed Mitral Stenosis Patients February–September 2024 at Brebes General Regional Hospital, Indonesia Dwiana Rosida; Jagaddhito Probokusumo
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1996

Abstract

Background: Mitral Stenosis (MS) is a common valvular manifestation of Rheumatic Heart Disease (RHD) and remains prevalent in low- and middle-income countries. Data describing the demographic, clinical, and echocardiographic characteristics of newly diagnosed MS patients in low socioeconomic settings in Indonesia are limited. This study aimed to describe the demographic profile, clinical characteristics, and echocardiographic findings of newly diagnosed MS patients at Brebes General Regional Hospital. Methods: This observational, descriptive, cross-sectional study was conducted at the cardiology outpatient clinic of Brebes General Regional Hospital in Central Java, Indonesia, from 1 February to 30 September 2024. Adult patients with a first-time diagnosis of MS confirmed by transthoracic echocardiography were included. Demographic and socioeconomic data were obtained through structured interviews, while clinical and echocardiographic data were collected from medical records. Results: A total of 56 patients were included. Most patients were female (69.7%) and middle-aged (mean age 50 ± 16.3 years), with the majority having low socioeconomic status. Non-isolated (mixed) MS was observed in most patients. Echocardiographic evaluation showed reduced left ventricular systolic function (mean LVEF 42.8 ± 11.2%) and impaired Right Ventricular (RV) systolic function (mean TAPSE 16.6 ± 2.6 mm). The mean tricuspid regurgitation Maximum Velocity (TR Vmax) was 2.89 ± 0.61 m/s. Despite these findings, most patients presented with mild functional limitation (New York Heart Association [NYHA] class I–II). Conclusion: Newly diagnosed MS patients at Brebes General Regional Hospital were predominantly middle-aged women with low socioeconomic status and mixed valvular involvement. Quantitative echocardiographic assessment demonstrated impaired left and RV function, underscoring the importance of early detection and comprehensive echocardiographic evaluation in low-resource settings.
Prevalence and Determinants of Left Ventricular Hypertrophy among Nigerian Adults with Hypertension: A Systematic Review Abdulhamid Ayomide Alamu
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2034

Abstract

Background: Left Ventricular Hypertrophy (LVH) is a structural adaptation of the heart linked to increased cardiovascular morbidity and mortality. It occurs in response to chronic pressure or volume overload and varies in pattern across populations. This study aimed to systematically evaluate the prevalence, geometric patterns, and determinants of LVH among Nigerian adults. Methods: A systematic review was conducted using PubMed, Google Scholar, African Journals Online (AJOL), and Directory of Open Access Journals (DOAJ) to identify studies published between 2004 and 2025. The research question focused on the prevalence, pattern, and determinants of LVH in Nigerian adults aged ≥18 years. Studies were eligible if they reported LVH prevalence, Left Ventricular (LV) geometry, or associated determinants in hospital-based or community populations, including hypertensive, prehypertensive, and Sickle Cell Anemia (SCA) cohorts. Data extracted included study population, sample size, diagnostic method, and LVH-related outcomes. Results: Seventeen studies were included, with sample sizes ranging from 80 to 450 participants. LVH prevalence ranged from 18% in prehypertensives to 45% in hypertensives and 47% in adults with SCA. Concentric hypertrophy was most common in hypertensives, and eccentric hypertrophy in SCA. Key factors associated with LVH included elevated Systolic Blood Pressure (SBP), age, male sex, Body Mass Index (BMI), family history of hypertension, and comorbid conditions such as diabetes. Conclusion: LVH is highly prevalent among Nigerian adults, with geometric patterns reflecting underlying hemodynamic stress. Identification of key factors associated with LVH can guide early detection and targeted interventions to reduce cardiovascular morbidity and mortality.
Unveiling Cardiac Amyloidosis: A Case Report Exploring The Role of Multimodal Imaging Yosua Cristo Reynaldo Napitupulu; Hilfan Ade Putra Lubis; Cut Aryfa Andra; Anggia Chairuddin Lubis
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2076

Abstract

Background: Cardiac Amyloidosis (CA) is a condition caused by the deposition of amyloid fibrils in the heart. The diagnosis of CA can be challenging and requires a high index of suspicion. Multimodality imaging, including echocardiography and Cardiac Magnetic Resonance (CMR), plays a crucial role in the diagnosis, evaluation, and management of CA. This case report presents a patient with suspected CA and highlights the role of multimodality imaging in diagnosis. Case Illustrations: A 49-year-old male with previously diagnosed hypertension came with progressive dyspnea, fatigue, and lower extremity edema. Initial clinical suspicion for Heart Failure with preserved Ejection Fraction (HFpEF) with increased thickness in the Interventricular Septum (IVS) was raised. Electrocardiography showed Left Ventricular Hypertrophy (LVH). Further diagnostic work-up revealed evidence of CA. Both multimodal imaging, including echocardiography and cardiac Magnetic Resonance Imaging (MRI), were used to confirm the diagnosis. The patient underwent comprehensive multimodal imaging, which included: 1) Echocardiography showed LVH with diastolic dysfunction (E’ <5), myocardial sparkling, and cherry on top appearance in Global Longitudinal Strain (GLS) analysis with reduced GLS, suggestive of amyloid infiltration; 2) Cardiac MRI demonstrated diffuse subendocardial Late Gadolinium Enhancement (LGE) patterns typical of amyloid deposition. The combination of imaging findings led to the diagnosis of CA. There was no Endomyocardial Biopsy (EMB) needed to reveal amyloid deposits. The patient was started on symptomatic management for heart failure. Conclusion: This case highlights the importance of multimodality imaging in the diagnosis of CA. Echocardiography, CMR, and nuclear imaging are complementary tools that enhance diagnostic accuracy and guide treatment decisions. Early recognition of CA is crucial for appropriate management and better prognosis.
Effect of Dapagliflozin Administration on the Apoptosis Levels and Myocardial Work of Patients with Acute Myocardial Infarction (DAPOPTOSIS-MI) – A Randomized Controlled Trial Yoga Yudhistira; Ahmad Yasa; Risalina Myrtha; Habibie Arifianto; Alfa Alfin Nursidiq; Trisulo Wasyanto; Heru Sulastomo
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2090

Abstract

Background: Acute myocardial infarction (AMI) is a common cardiovascular disease and a leading cause of morbidity and mortality. Cellular death during AMI involves apoptosis (80%) and necrosis (20%). Apoptosis contributes to infarct size, Left Ventricular (LV) remodeling, and heart failure post-AMI. Previous studies suggest that dapagliflozin can reduce myocardial apoptosis, marked by decreased caspase-3 levels (preclinical study) and echocardiographic parameters (preclinical and clinical studies). However, human studies evaluating the effects of dapagliflozin on caspase-3 and myocardial work (MW) in AMI patients are not yet available. This study aims to evaluate the effect of dapagliflozin administration on caspase-3 levels and MW in AMI patients. Methods: This was a single-center experimental study with a double-blind randomized controlled trial (RCT) design conducted among 40 AMI patients at Dr. Moewardi General Hospital, Surakarta (September–November 2024). Patients were divided into two groups: dapagliflozin and placebo. Caspase-3 levels and MW parameters (Global Work Index [GWI], Global Constructive Work [GCW], Global Wasted Work [GWW], Global Work Efficiency [GWE]) were measured at admission before and on day 14 post-treatment. Statistical analysis was performed using independent t-tests or Mann-Whitney tests, with p < 0.05 considered significant. Results: The mean pre-test caspase-3 levels were not significantly different between the intervention group, 51.05±36.53ng/ml, and the control group, 56.44±31.01ng/ml (p=0.618). However, post-test caspase-3 levels showed a significant difference: intervention group, 29.55±28.33 ng/ml, compared with control group, 51.97±31.16 ng/ml (p=0.007). There were no significant differences in the pre-test or post-test MW parameters between the two groups (p>0.05). Conclusions: There was a significant reduction in caspase-3 levels in AMI patients following dapagliflozin administration compared to placebo. However, there was no significant improvement in the MW parameters.
Multimarker Assessment of Cardiovascular Risk in Type 2 Diabetes: Role of Inflammation, Myocardial Injury, and Glycaemic Control Atul Khajuria; Gagandeep singh
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2105

Abstract

Background: Diabetes mellitus, particularly Type 2 Diabetes (T2DM), has become a major public health concern globally, especially in low- and middle-income countries like India. The prevalence of T2DM in India is rising, with Punjab showing particularly high rates due to dietary patterns, sedentary lifestyles, and genetic predisposition. T2DM is strongly linked to Cardiovascular Disease (CVD), and inflammatory markers such as high-sensitivity C-Reactive Protein (hs-CRP), fibrinogen, and Hemoglobin A1c (HbA1c) may be associated with higher cardiovascular risk in diabetic patients. This study aims to evaluate the role of hs-CRP, fibrinogen, HbA1c, and other biomarkers in assessing cardiovascular risk in patients with T2DM in Punjab, North India, and to examine whether these biomarkers show additional associations with higher cardiovascular risk strata beyond traditional markers like Low-Density Lipoprotein Cholesterol (LDL-C). Methods: A cross-sectional observational study was conducted from January 2024 to June 2025, involving 1,200 patients diagnosed with T2DM from both urban and rural areas of Punjab. Participants aged 30–70 years were selected using stratified random sampling. Data collection included demographic, clinical, and biochemical information. Fasting blood samples were analyzed for hs-CRP, fibrinogen, HbA1c, LDL-C, and other biomarkers. Cardiovascular risk was assessed using the Framingham Risk Score (FRS), which, in this South Asian diabetic cohort, was applied as a comparative risk stratification tool rather than as a fully validated prognostic model. Multivariable logistic regression and Receiver Operating Characteristic (ROC) curve analysis were used to assess associations between biomarkers and higher cardiovascular risk categories and the presence of CVD. Results: The study found significant differences in biomarker levels between urban and rural populations, with rural participants showing higher levels of hs-CRP, fibrinogen, HbA1c, LDL-C, and other markers of myocardial injury, including troponins and B-type Natriuretic Peptide (BNP). Elevated hs-CRP (>3 mg/L), fibrinogen (>400 mg/dL), and HbA1c (>9%) were associated with higher FRS-defined cardiovascular risk categories and with CVD presence, and logistic regression identified hs-CRP and LDL-C as independently associated with CVD after adjustment for conventional risk factors. Biomarkers such as High-Sensitive Troponin I (hs-TnI) and Lipoprotein-associated Phospholipase A2 (Lp-PLA2) were also strongly associated with prevalent CVD. Conclusions: This cross-sectional study highlights that inflammatory and cardiac biomarkers are strongly associated with higher cardiovascular risk strata and prevalent CVD in T2DM patients, particularly in rural populations where biomarker levels and calculated risk scores are higher. The findings support the potential role of these biomarkers in multimarker risk stratification in diabetic populations, especially in resource-limited settings, while underscoring that longitudinal studies are required before inferring prognostic or predictive value or implementing biomarker-guided interventions.
National Trends and Recurrence of Hospitalized Acute Myocardial Infarction in Indonesia, 2019–2024: A Population-Based Claims Analysis Gita Yolanda; Arditya Damarkusuma
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2131

Abstract

Background: Acute Myocardial Infarction (AMI) and recurrent AMI remain major contributors to cardiovascular morbidity and mortality in Indonesia. However, national data describing trends in hospitalized AMI incidence and recurrent AMI, particularly during the Coronavirus Disease 2019 (COVID-19) pandemic, are limited. Methods: We conducted a population-based analysis using nationally representative Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan, Social Health Insurance Administration Body) claims sample data from 2019 to 2024, excluding 2021 due to incomplete data. Hospitalized AMI incidence and temporal trends were evaluated using a repeated cross-sectional design, whereas recurrent AMI was examined using longitudinal patient-level linkage. AMI episodes were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes (I21–I22). Survey-weighted analyses estimated the incidence of hospitalized AMI, and survey-weighted logistic regression examined factors associated with recurrent AMI. Results: We identified 9,494 AMI episodes among 7,618 unique patients. Hospitalized AMI incidence per 100,000 insured population declined from 58.1 in 2019 to 49.8 in 2020, followed by a sustained increase, reaching 80.5 in 2024 and exceeding pre-pandemic levels. Overall, 13.5% of patients experienced recurrent AMI. Recurrent AMI was independently associated with heart failure (OR 3.72; 95% CI 2.84–4.88), hypertension (OR 3.00; 95% CI 2.27–3.96), diabetes mellitus (OR 1.61; 95% CI 1.19–2.17), and male sex (OR 1.57; 95% CI 1.20–2.05). Older age (≥65 years) was not independently associated with recurrent AMI. Conclusions: Hospitalized AMI incidence in Indonesia rebounded from the early COVID-19 decline and reached its highest level observed in 2024. Recurrent AMI clustered around modifiable cardiometabolic conditions, highlighting critical gaps in secondary prevention. Within a universal health coverage system, recurrent AMI may be a measurable, potentially preventable population-level outcome.

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