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Heart Science Journal
Published by Universitas Brawijaya
ISSN : 27219976     EISSN : 27219984     DOI : http://dx.doi.org/10.21776/ub.hsj.2020.001.01
Core Subject : Health, Science,
Health Professions Immunology & microbiology Medicine & Pharmacology
HEART SCIENCE is the official open access journal of Brawijaya Cardiovascular Research Center, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. The journal publishes articles three times per year in January, May, and September. The journal is a peer reviewed publication and accepts articles for publication from across the world. HEART SCIENCE accepts and publishes articles in the English language only. The primary goal of this journal is to publish clinical and basic research relevant to cardiovascular medicine. The journal covers the following topics: clinical cardiology, interventional cardiology, intensive and acute cardiovascular care, vascular diseases, non-invasive cardiology, pediatric cardiology, cardiac nuclear medicine imaging, arrhythmia, cardiac prevention and rehabilitation, and cardiac surgery. Animal studies are also considered for publication in HEART SCIENCE. To serve the interest of both practicing clinicians and researchers, the journal provides platform or forum for research scholars, intellectuals, and cardiologists to reveal their views and research work for dialogue, education, and interaction to the entire world. HEART SCIENCE publishes original research, reviews, brief reports, case reports, case series, editorial, and commentary. HEART SCIENCE also publishes the special issues and abstracts of papers presented at the annual meeting of the Cardiological Society of Malang.
Arjuna Subject : Kedokteran - Cardiology and Cardiovascular Medicine
Articles 363 Documents
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Antiarrhythmic properties and mechanisms of SGLT2 inhibitors in managing atrial fibrillation patients with metabolic syndrome Rahmawati, Novi; Rizal, Ardian; Putri, Diana Yuswanti
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.3

Abstract

Atrial fibrillation (AF) frequently occurs in patients with metabolic syndrome (MetS), a cluster of cardiometabolic abnormalities including obesity, hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM), which collectively promote adverse atrial electrical and structural remodeling. These intertwined conditions significantly complicate AF management and contribute to disease progression. Sodium–glucose cotransporter 2 (SGLT2) inhibitors, initially developed as glucose-lowering agents, have demonstrated robust cardiovascular and renal benefits beyond glycemic control. Accumulating clinical evidence from post-hoc analyses, real-world studies, and large meta-analyses indicates that SGLT2 inhibitors significantly reduce the incidence of new-onset and recurrent AF, particularly in patients with MetS and T2DM. Mechanistic studies revealed that the antiarrhythmic effects of SGLT2 inhibitors arise from pleiotropic actions targeting key arrhythmogenic pathways. These include restoration of intracellular Na⁺ and Ca²⁺ homeostasis via inhibition of the Na⁺/H⁺ exchanger and CaMKII signaling, suppression of oxidative stress and inflammation through modulation of NADPH oxidase and NLRP3 inflammasome activity, attenuation of atrial fibrosis by inhibiting the TGF-β/Smad pathway, and improvement of mitochondrial function and bioenergetics through activation of the PGC-1α/NRF-1/Tfam axis. Additional systemic benefits, such as weight reduction, improved hemodynamics, decreased epicardial adipose tissue, and autonomic nervous system modulation, further contribute to atrial electrical stability. This review summarizes current clinical and mechanistic evidence supporting the role of SGLT2 inhibitors as a promising upstream therapeutic strategy for AF prevention and management in patients with MetS.
Tp-e/QTc ratio as a potential non-invasive marker of coronary lesion severity assessed by SYNTAX score in non-ST segment elevation myocardial infarction Ginting, Yehezkiel Bastanta; Sitepu, Andika; Ketaren, Andre Pasha; Hasan, Harris; Lubis, Anggia Chairuddin; Haykal, Teuku Bob; Ginting, Daniel
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.8

Abstract

Background: Accurate assessment of coronary lesion burden in the initial stage is the basis for appropriate therapy in NSTEMI patients. As a parameter derived from the ECG that reflects ventricular repolarization variability, the Tp-e/QTc ratio is suggested as a noninvasive predictor for assessing anatomical complexity. Objective: Investigating the relationship of Tp-e/QTc with the severity of coronary lesions on angiography assessed using the SYNTAX score, in patients with NSTEMI. Methods: Utilized a retrospective cohort approach with a cross-sectional design. In total, 141 patients were selected by utilizing purposive sampling. The Tp-e and QTc intervals were manually measured from 12-lead ECGs using the tangent method, and the Tp-e/QTc ratio was calculated. SYNTAX scores were independently determined by two interventional cardiologists. Data were analyzed using bivariate and multivariate analyses. Result: Higher SYNTAX group (0.26 ± 0.047) had higher Tp-e/QTc than lower SYNTAX group (0.21 ± 0.052). Tp-e/QTc showed a positive correlation with SYNTAX score (r = 0.395; p < 0.001) and remained an independent predictor (β = 0.332; p = 0.001). The ROC curve displayed strong discrimination (AUC = 0.817), a cut-off of 0.24 yielded 82.7% sensitivity and 76.4% specificity. Conclusion: Tp-e/QTc is associated with angiographic complexity in NSTEMI and may support early risk stratification prior to angiography.
Atrial septal defect with pulmonary arterial hypertension in pregnancy : A case series Valerinna Yogibuana; Martini, Heny; Gultom, Yosafat Hasiholan Marthin
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.14

Abstract

Background: Congenital heart disease (CHD) ranked among the most frequently encountered structural abnormalities in humans. Acyanotic congenital heart disease (CHD) persists as a global issue, with atrial septal defect (ASD) constituting the second most prevalent form, accounting for around 10% of all CHD cases and occurring more frequently in females than in males. Pregnancy physiologically modifies the cardiovascular system and may exacerbate the clinical condition of people with atrial septal defect and pulmonary hypertension, potentially resulting in heart failure. Case Presentations: We documented five examples of pregnant patients with ASD and pulmonary hypertension (PH).  Two patients had established medical records and attended regular follow-up, one of whom underwent ASD closure.  All patients had dilation of the right atrium and ventricle, with two individuals presenting right ventricular (RV) systolic dysfunction.  All patients exhibited normal left ventricular (LV) systolic function.  Notwithstanding the oversight of a multidisciplinary heart team and intensive care management, one of our patients succumbed following cesarean section delivery.  The patient exhibited diminished right ventricular systolic function, a bidirectional shunt lesion, a significant maximal pressure gradient, and lacked any documented cardiovascular or obstetric medical history, presenting with a poor mWHO classification.   She experienced unresolved postoperative shock and bleeding. Conclusions: Managing PH secondary to CHD among pregnant patients presents significant challenges for multidisciplinary teams. Intensive perioperative care is essential to minimize mortality and morbidity in pregnant women with PH. Careful planning of optimal medical therapy, timing and delivery method, and post-natal approach is vital to improve outcomes.
Supervised cardiac rehabilitation in patients with severe left ventricular dysfunction : Case series on functional and structural improvements Pratiwi, Bunga Bella; Mayangsari, Veny
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.15

Abstract

Background: Patients with coronary artery disease (CAD) frequently develop severe left ventricular (LV) dysfunction, which can lead to a worsening quality of life due to disease-related symptoms. Recently, cardiac rehabilitation (CR) has been recommended by international clinical guidelines to improve survival and functional recovery in these high-risk patients. Case Presentations: Two patients with CAD and heart failure with reduced ejection fraction (HFrEF) underwent supervised cardiac rehabilitation. First patient is a 43-year-old man with a left ventricular ejection fraction (LVEF) of 30% with risk factor as smoker and family history of heart disease, 6-minute walk test (6MWT) only 532 meters, VO2 max 19.94 mL/kg/min, and MET 5.69 has completed 89 sessions of cardiac rehabilitation (treadmill, calisthenics, and ergometer exercise). His 6MWT to 630 meters, VO₂ max improved to 22.58 mL/kg/min, and METs improved to 6.40. Before CR, the left ventricle (LV) was 7.5 cm long and had a biplane ejection fraction (EF) of 32%. After CR, structural improvements were found, increasing the LV length to 9.3 cm and the biplane EF to 58.4%. with improvements in execise capacity and symptoms. In Patient 2, a 50-year-old man with ST-elevation acute anterior myocardial syndrome (STEACS) (Killip I) with an LVEF of 20% with history of smoking and alcoholism, 6MWT 214 meters, VO2 mac 10.40 mL/kg/min, and MET 3.00 has completed 50 CR sessions ((treadmill, calisthenics, and ergometer exercise), demonstrating improvements in his 6MWT to 465 meters, VO₂ max to 17.93 mL/kg/min, and MET to 5.10. Echocardiography before CR found EF 20% and LV end-systolic volume index (LVESV) 20.7 ml and after eight months of rehabilitation showed improvement in EF to 47% and LVESV 53 ml with significant reduction in clinical symptoms. Conclusions: Supervised intensive cardiac rehabilitation resulted in functional and clinical improvements in high-risk CAD patients, including improved cardiac function in the context of heart failure. These findings demonstrate the important role of supervised rehabilitation programs in managing CAD patients with comorbid heart failure as the primary non-pharmacological management.
Cardiopulmonary exercise testing in heart failure and chronic coronary syndromes: From mechanistic diagnosis to CPET-guided management and prognosis in cardiac rehabilitation rakhmadhani, irzal; Mayangsari, Veny; Tri Tjahjono, Cholid
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.4

Abstract

Cardiopulmonary exercise testing (CPET) provides an integrated physiological assessment to explain exercise intolerance at the individual-patient level. By integrating breath-by-breath gas exchange with ECG, blood pressure, and symptom monitoring during graded exertion, CPET helps differentiate impaired oxygen delivery (e.g., limited stroke volume augmentation, chronotropic limitation, or ischemia-limited reserve) from ventilatory inefficiency, pulmonary constraint, peripheral deconditioning, or mixed phenotypes—mechanistic information that is directly actionable in heart failure (HF) and chronic coronary syndromes (CCS). In HF, key CPET variables such as peak oxygen uptake (peak VO₂) and ventilatory efficiency consistently reflect clinical severity and are associated with outcomes, supporting decisions from optimization of guideline-directed medical therapy to advanced care planning in selected patients. In CCS, CPET is particularly useful when symptoms are disproportionate to resting findings, when conventional testing is inconclusive, or when microvascular dysfunction or vasospastic angina is suspected; CPET patterns can help refine the dominant mechanism and individualize cardiac rehabilitation intensity and symptom-limited training thresholds. This review proposes a pragmatic workflow aligned with routine practice: (1) mechanism-based interpretation using a compact CPET panel, (2) translation into management and rehabilitation prescriptions, and (3) prognosis and follow-up supported by serial reassessment. Tables 1–2 translate CPET outputs into practical interpretation and exercise-prescription steps, and Figures 1–2 provide worked visual examples of the trajectories discussed in the text. 
Severe diffuse multivessel coronary calcification in first-degree relatives: A case series Suryo Baskoro, Shalahuddin; Ramadhiani, Risa; Filano, Marco; Saifur Rohman, Muhammad
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.16

Abstract

Background: Coronary artery disease (CAD) in first degree relatives may represent a clinical pattern associated with diffuse calcification, extensive vessel involvement, and increased procedural complexity. Such cases often present with severe multivessel disease that may require advanced revascularization strategies. Case Presentations: Three related patients aged 66–71 years, consisting of three first-degree relatives, presented with progressive angina despite optimal medical therapy. Hypertension was present in all, dyslipidemia in two, and one male had heart failure with mildly reduced ejection fraction (41%). None had diabetes, chronic kidney disease, or a smoking history. Coronary angiography revealed diffuse, heavily calcified three-vessel disease in two patients and two vessel disease in one patient. The first case (71F) underwent drug-eluting stent (DES) implantation in the left anterior descending (LAD) artery; right coronary artery (RCA) lesion preparation/atherectomy was attempted but definitive RCA stenting was not performed, and the RCA was managed conservatively. The second case (66M) had chronic total occlusions of the RCA and LCx, with rotablator-assisted DES implantation performed on the target lesion. The third case (68F) had a critical OM1 lesion treated with DES; a moderate LAD lesion was assessed with diastolic hyperemia-free ratio (DFR) and confirmed ischemia prior to staged LAD DES implantation. All procedures were completed without periprocedural complications. Conclusions: These related cases demonstrated a recurring angiographic pattern of diffuse, calcified multivessel CAD, suggesting complex interplay between metabolic risk factor and potential hereditary component.
Acute pulmonary embolism following radiofrequency catheter ablation in a young asian female on hormonal contraceptive injection Triatmojo, Nicodemus; Rizal, Ardian; Wikananda, Adhika Prastya; Kurnianingsih, Novi; Anjarwani, Setyasih
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.17

Abstract

Background: Acute pulmonary embolism (APE) is an uncommon yet severe complication following radiofrequency catheter ablation (RFCA) for arrhythmic disorders, with reported incidences ranging from 0% to 1.7%. Hormonal contraceptive injections, specifically Depot Medroxyprogesterone Acetate, significantly increase the risk of venous thrombosis. Early identification of APE is challenging due to non-specific symptoms, but critical indicators include sudden shortness of breath, chest pain, and loss of consciousness. Timely and tailored treatment, including weight-based dose adjustments for fibrinolytic therapy in Asian patients, is crucial for optimal outcomes. Case Presentation: We present the case of a 23-year-old Asian female with no prior history of thromboembolic diseases, who was on Depot Medroxyprogesterone Acetate for contraception. She underwent an uncomplicated RFCA procedure for frequent premature ventricular contractions. Patient was immobilized for nine hours post-procedure, upon her first attempt to mobilize and walk to the bathroom, she suddenly experienced shortness of breath, chest pain, and a brief loss of consciousness. Her vital signs were unstable, with a blood pressure of 85/55 mmHg, heart rate of 133 bpm, respiratory rate of 32 breaths/minute, and oxygen saturation of 88%. Echocardiography revealed right ventricular dilatation and a positive McConnell sign. A CT pulmonary angiography confirmed a filling defect in the left pulmonary artery, leading to an APE diagnosis. Considering her Asian ethnicity and low BMI, the patient was successfully treated with a reduced dose of alteplase (50 mg) administered over two hours to minimize bleeding risk. Her vital signs stabilized during fibrinolytic therapy, with no hemorrhagic complications. Following three months of oral rivaroxaban treatment, a follow-up CT pulmonary angiography revealed complete resolution of the embolism. Conclusions: This case underscores that APE, though rare, is a serious complication of RFCA, especially when combined with prolonged immobilization and hormonal contraceptive use. The abrupt onset of symptoms, including shortness of breath and loss of consciousness upon initial mobilization, is a critical indicator of Acute PE. Early mobilization within 2-4 hours post-RFCA is indicated to minimize embolic risk. Individualized treatment strategies, such as weight-based fibrinolytic dosing, are essential for managing APE in specific patient populations to optimize efficacy and safety. Clinicians should exercise caution with patients using hormonal contraception undergoing procedures involving vascular puncture.
Caspase-3 and beclin-1 in patients with and without intra-aortic balloon pump after cardiac arrest: Study of apoptosis and autophagy Firdaus, Isman; Bunga Dewanggi; Kartika, Gloria; Andriantoro, Hananto; Yuniadi, Yoga; Boom, Cindy Elfira; Harimurti, Kuntjoro
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.11

Abstract

Background: Ischemic and reperfusion injuries occur during cardiac arrest and after successful resuscitation, potentially triggering apoptosis and autophagy, which can cause irreversible cell damage or death. Beclin-1 and Caspase-3 are proteins that play roles in autophagy and apoptosis pathways. However, it remains unclear whether the insertion of an IABP influences the serum levels of these proteins in patients with cardiac arrest and acute coronary syndrome (ACS). Objective: To investigate the Caspace-3 and Beclin-1 serum levels after Intra-Aortic Balloon Pumps (IABP) in cardiac arrest survivors with ACS. Methods: This is a single-center prospective randomized control trial (RCT) study using an unpaired t-test and a Mann-Whitney U-test to analyze the data (p-value<0.05). Result: This study included sixty subjects: 48 males and 12 females, with a mean age of 60.3 ± 9.85 years. The result showed there’s no significant difference in Beclin-1 and Caspase-3 serum levels before and after the insertion of IABP in both survival and non-survival groups (p=0.676). Caspace-3 serum level was higher in non-survival group. ROC curve analysis showed the caspase-3 level has a predictive value for mortality in cardiac arrest survivors with ACS (p=0.012). Conclusion: IABP insertion in cardiac arrest patients with ACS doesn’t significantly affect Beclin-1 and Caspase-3 levels. Caspase-3 serum levels may predict mortality in these patients, with a sensitivity of 64% and a specificity of 66.7%.
Predictor for premature coronary artery disease (PCAD) in Asian populations: a meta‑analysis Baskoro, Shalahuddin Suryo; Adelathifa Rahma, Oktivani; Arthalia, Virra Dennisa Rahmandasari; Maulana, Muhammad Zacky Hafiyyan; Waranugraha, Yoga; Rohman, Mohammad Saifur
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.5

Abstract

Background: Premature coronary artery disease (PCAD) is a major cause of heart disease in Asian populations, where coronary events happen at younger ages than in Western populations. Evidence concerning PCAD risk factors is inconsistent, in part due to variability in comparator selection among studies. Objective: To assess clinical and metabolic risk factors linked to PCAD in Asian populations through comparator-specific meta-analysis Method: According to the PRISMA 2020 guidelines, we did a systematic review and meta-analysis. We searched PubMed/MEDLINE, Cochrane, Scopus, and Web of Science for studies published from 2020 onwards. We included studies that looked at risk factors for PCAD in Asian groups with either non-CAD or older/later-onset CAD comparators. We used random-effects models to combine mean differences for continuous variables and odds ratios for categorical variables. We used I² statistics, funnel plots, and Egger's regression test to look at publication bias and heterogeneity. Results: Sixteen studies comprising 187,591 participants, including 28,943 patients with PCAD, were included. In pooled analyses, smoking (OR 2.18, 95% CI 1.74–2.72; p<0.001) and family history of premature cardiovascular disease (OR 2.11, 95% CI 1.74–2.55; p<0.001) were significantly associated with PCAD, while hypertension (OR 0.75, 95% CI 0.63–0.90; p=0.002) showed an inverse association. In the non-CAD comparator subgroup, stronger associations were observed for smoking (OR 2.56, 95% CI 1.83–3.58; p<0.001), hypertension (OR 2.34, 95% CI 1.63–3.35; p<0.001), male sex (OR 1.90, 95% CI 1.34–2.69; p<0.001), and family history (OR 3.99, 95% CI 1.10–14.51; p=0.040). HDL levels were consistently lower (MD −4.34 mg/dL and −9.52 mg/dL in both comparator groups), while triglycerides and non–HDL-C were higher. Elevated fasting blood glucose and C-reactive protein were observed only in non-CAD comparisons. LDL-C showed no significant difference across analyses. Conclusion: Predictors linked to PCAD in Asian populations differ based on the choice of comparators. Traditional cardiovascular risk factors, especially smoking and familial history, exhibit the most significant correlations, underscoring the necessity of early risk detection and prevention in younger populations.
To seal or to vent? Hemodynamic-guided decision-making in an older patient with borderline large secundum atrial septal defect and pulmonary hypertension Tambunan, Daniel; Valerinna Yogibuana
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.18

Abstract

Background: Determining whether an atrial septal defect (ASD) should be closed in older patients who already have pulmonary hypertension may present a clinical dilemma. This is particularly true when pulmonary vascular resistance (PVR) approaches commonly used operability thresholds. Case Illustrations: A 59-year-old woman was referred to our center because of progressive exertional dyspnea and declining functional capacity. Echocardiography evaluation showed a large secundum ASD with a significant left-to-right shunt and right-sided chamber enlargement. Right heart catheterization revealed a mean pulmonary artery pressure of 46 mmHg and a pulmonary vascular resistance of 7.1 Wood units. Following oxygen test, PVR decreased to 3.4 Wood units and the Qp/Qs ratio increased from 1.5 to 2.65, suggesting preserved pulmonary vascular responsiveness. Based on these findings,  transcatheter ASD closure without fenestration was performed successfully. The intervention was completed without complications, and early follow-up showed improvement in symptoms along with more favorable hemodynamic findings. Conclusions: This case highlights how comprehensive hemodynamic and physiological assessment, including dynamic vasoreactivity testing, can guide operability decisions in older patients with ASD and elevated PVR. Reassessment of pulmonary vascular responsiveness may refine risk stratification and support individualized management.

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