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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 302 Documents
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Efficacy and Safety of Apixaban vs. Warfarin in Atrial Fibrillation Patients: Systematical Review and Meta-Analysis Mokhamad Fahmi Rizki Syaban; Khadijah Cahya Yunita; Icha Farihah Deniyati Faratisha; Nabila Erina Erwan; Yoga Waranugraha; Adrian Rizal
Heart Science Journal Vol 3, No 1 (2022): Assesment and Outcome of Coronary Artery Disease in the Reperfusion Era
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.01.5

Abstract

Background: Various treatment strategies to treat AF and reduce its complications have been developed, including anticoagulant administration. Non-Vitamin K antagonist oral anticoagulants (NOAC) are recommended by current guidelines. Different anticoagulants revealed different safety and efficacy characteristic. The real-world evidence-based recommendation is still needed to improve AF management. This study aimed to disclose apixaban safety and efficacy profile compared with warfarin in a real-world population.Methods: We collected data from articles around the world studies comparing Apixaban and Warfarin in NVAF patients recorded online from studies published around 2015 to 2020 that we were taking from a scientific database such as Embase ProQuest, PubMed, and Cochrane based on inclusion criteria. Data analysis was carried out using Review Manager Version 5.4.1 (Cochrane, Copenhagen, Denmark) using Mantel-Haenzel statistical method for categorical data to measure Relative Risk (RR) and 95% Confident Interval (CI). We use a random-effect analysis model if P for heterogeneity (pHet <0.1) and a fixed-effect analysis model if pHet ≥0.1.Results: Apixaban show a benefit in preventing ischemic stroke (RR = 0.51; 95% CI=0.40-0.66; p = <0.00001) ischemic stroke/systemic embolism (RR = 0.63; 95% CI=0.50-0.81; p = <0.0002), and all-cause mortality (RR = 0.54; 95% CI=0.40-0.74; p = <0.0001) relative to Warfarin. Apixaban also show benefit to prevent major bleeding (RR = 0.49; 95% CI=0.41-0.58; p = <0.0001), GI bleeding (RR = 0.46; 95% CI=0.36-0.60; p = <0.0001), and intracranial hemorrhage (RR = 0.45; 95% CI=0.36-0.57; p = <0.0001) relative to Warfarin.Conclusions: Apixaban is over warfarin in efficacy and safety. Apixaban has a safer profile in reducing the risk of major bleeding, GI bleeding, and intracranial hemorrhage in AF patients. 
Poor Outcome of Right Bundle Branch Block Coexist with ST-Elevation Myocardial Infarction Arifta Devi Anggraeni; Andrianto Andrianto; Ivana Purnama Dewi; Eka Prasetya Budi Mulia; Anudya Kartika Ratri
Heart Science Journal Vol 3, No 1 (2022): Assesment and Outcome of Coronary Artery Disease in the Reperfusion Era
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.01.7

Abstract

BACKGROUND: The incidence of new-onset right bundle branch block (RBBB) coexistence with ST-elevation myocardial infarction (STEMI) has been associated with higher in-hospital mortality compared with those without RBBB.CASES: We present three cases of new-onset RBBB coexist with STEMI. Case I: a 64 years old male presented Killip I STEMI inferior-anterior with RBBB as new-onset. Rescue percutaneous coronary intervention (PCI) after failed thrombolytic was performed. New-onset atrial fibrillation (AF) with rapid ventricular response worsened his hemodynamic profile, leading to cardiogenic shock. Case II: an 80 years old male presented Killip IV late-onset anterior STEMI with new-onset RBBB. Cardiogenic shock got worsened after PCI stent. Case III: a 65 years old male presented Killip II extensive anterior STEMI with new-onset RBBB who underwent a primary PCI stent. Recurrent ventricular tachycardia (VT), worsening cardiogenic shock, and transient AV block occurred after PCI. The right bundle branch blood supply is mainly provided by a septal branch of left descending artery (LAD). Therefore, it may indicate proximal LAD occlusion and extensive infarction. Thus, catastrophic events may occur, which including acute heart failure, AV block, malignant ventricular arrhythmia, new-onset AF, and mostly cardiogenic shock, despite initiate reperfusion was performed without delay once the diagnosis is confirmed.  CONCLUSION: New RBBB suggests poor short-term prognosis due to its complication. Higher mortality is mostly linked to worsening cardiogenic shock.
Correlation of Ischemic Time with Diastolic Dysfunction and Correlation of Diastolic Dysfunction with 6 Minute Walk Test Distance in STEMI Patients Receiving Percutaneus Coronary Intervention Imelda Krisnasari; Anna Fuji Rahimah; Mohammad Saifur Rohman; Setyasih Anjarwani; Indra Prasetya
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.5

Abstract

Background: Minimizing the time between ischemia and reperfusion in STEMI patients is critical for salvaging ischemic myocardium and limiting residual injury. One of the methods for determining the impact of ischemic time on the myocardium and correlating the findings to the outcomes is by using echocardiography.Objectives: To evaluate the correlation of ischemic time to diastolic dysfunction and also the correlation of diastolic dysfunction to functional capacity by 6-minute walk distance in STEMI patients. Methods: The study was a retrospective cohort, with all STEMI patients who underwent PCI at RSUD Dr. Saiful Anwar Malang between January 2018 and November 2021 being eligible. All patients underwent PCI, echocardiography, and a 6-minute walk test before being discharged. We defined significant diastolic dysfunction as grade 2 or 3 diastolic dysfunction, according to the 2016 American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines. The distance of 6-minute walk test was divided into three categories: less than 300m, 300-400m, and more than 400m.Results: From total 258 patients, 92 patients (35.7%) had significant diastolic dysfunction. The significant diastolic dysfunction was correlated with ischemic time > 12 hours (r = 0.51, p = 0.000), Killip class (r= 0.46, p = 0.000), culprit artery (r= 0.203, p=0,001), and peak toponin I levels (r=0.35, p=0.000). We identified that the ischemic time (odds ratio / OR 6.78; 95% Confidence Interval / CI 3.27 – 14.09; p  = 0.000), Killip class (odds ratio 4.62, 95% CI 2.53 to 8.48, p = 0.000), and infarct size by peak troponin I levels (OR 1.12, 95% CI 1.06 to 1.18, p  = 0.000) as independent predictors of significant diastolic dysfunction. There was inversely correlation of diastolic dysfunction with 6-minute walk test distance. (r = -0,422 dan p=0,000), with E/e’ as independent predictors of level of 6 minute walk distance (OR -1.126, 95% CI -1.78 to -0.48, p = 0.001).Conclusion: Ischemic time is one of the independent predictors of significant diastolic dysfunction. LV diastolic dysfunction was inversely correlated with 6-minute walk test distance in STEMI patient.
Percutaneous Coronary Intervention as Clinical Outcome Predictor for in-Hospital Adverse Events in STEMI Patients Anita Surya Santoso; Mohammad Saifur Rohman; Ardian Rizal; Setyasih Anjarwani; Heny Martini; Indra Prasetya
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.3

Abstract

Background : Limited resources and the concurrent COVID19 pandemic hinders the appropriate time to achieve reperfusion in Infarct-related artery (IRA). The number of patients receiving late primary PCI (PPCI) and without revascularization are steadily increase within 2 years into the pandemic. The impact of PCI timing in this setting has not been fully elucidated.Objective : This study was conducted to evaluate the effect of early PPCI vs late PPCI vs non revascularization groups towards in-hospital mortality and complications. This study also aimed to determine whether PPCI is the main predictor for in-hospital adverse events in STEMI patients.Method : Data of STEMI patients registered in Saiful Anwar General Hospiital ACS registry were collected between 2018-2021 Patients were subdivided into early PPCI if receiving PCI within the recommended time of the 2017 ESC STEMI management guideline, late PPCI if receiving PCI outside the timeframe provided by the guideline, and optimal medical therapy group if not receiving any means of revascularization. Patients undergoing thrombolysis were excluded. Afterwards, the incidence of in-hospital adverse event were calculated as primary endpoints, development of immediate complications during hospitalizations were analyzed as secondary endpoints. Stratification of baseline characteristics and PCI categorizations were performed using multivariate analysis to determine the main predictor of in-hospital mortality between STEMI patients.Results :  568 STEMI patients were included in the study with 387 in early PPCI, 107 in late PPCI, and 74 in optimal medical therapy group. Incidence of in-hospital mortality were significantly higher in optimal medical therapy group and lowest in early PPCI group (32.4% and 7.5% respectively, P 0.00). Mortality odds ratio between early PPCI group and optimal medical therapy group were significantly lowest (OR 0.17, 95% CI 0.13 – 0.41). Complications between each treatment groups were significantly different with early PPCI had the lowest incidence of in-hospital complications of cardiogenic shock, cardiac arrest, and VT/VF. Stratification of baseline characteristics and PCI category reveals that timing PPCI is the main predictor for in-hospital adverse events (HR 4.506, 95% CI 2.487-6.662, P 0.00). Conclusion : Percutaneous coronary intervention is the main predictor for the incidence of in hospital mortality and complications in STEMI patients.Keyword : STEMI, PCI, mortality, complications, in-hospital adverse events.
Left Atrial Emptying Fraction as Precictor Parameter of Major Adverse Cardiovascular Events (MACE) and Decrease of Functional Capacity in Patients With STEMI Treated by Primary Percutaneous Coronary Intervention Harris Kristanto; Budi Satrijo; Anna Fuji Rahimah
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.4

Abstract

Background: HF is common following ST-elevated myocardial infarction (STEMI) and aasociated with morbidity and mortality. Echocardiography is routine examination and commonly utilized for risk stratification. In current guideline. Enlarged LA volume, doppler parameter, and tissue doppler imaging were used for diastolic dysfunction. However, they have several limitation. LAEF may be superior to LAVI, doppler parameter, or TDI  as markers of cardiac function in acute phase after AMI. This study conducted to assess the LAEF in predicting death, rehospitalization of heart failure (HF), and decrease functional capacity after STEMI.Methods and Results: Between January 2018 and January 2021, 391 patients with STEMI who got primary percutaneous coronary intervention were included. After STEMI, patients had echocardiography within 48 hours. All of the patients were subjected to standardized 2-dimensional echocardiography procedures. The LAEF was determined by dividing the maximal LA volume by the minimal LA volume. The primary endpoint of this study was a Major Adverse Cardiovascular Events that consisting of all-cause death and rehospitalization because decompensation of heart failure within 12 months. The secondary end point was decline of functional capacity within 12 months. During the 12-month follow-up period, 162 individuals developed MACE. Only LAEF remained an independent predictor of MACE after adjusting for clinical, biochemical, and echocardiographic factors. (P = 0.000, Odds Ratio 15,46 (CI 95%: 9,264 – 26,409)). For secondary end point, there was a significant difference in the number of patients experiencing decreased functional capacity between the groups with LAEF ≥37.5% and LAEF <37.5% (based on cut off value)  in the 6-month range (p=0.000 ) and was consistent within 12 months (p=0.000).Conclusion: LAEF can be a predictor of MACE and decline functional capacity of STEMI patients who have undergone primary PCI within 12 months.
Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention: How to Predict Bayu Aji; Mohammad Saifur Rohman; Budi Satrijo; Arief Wibisono
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.7

Abstract

Background: Intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention (PCI) is an uncommon event that results in a poor outcome including STEMI and sudden cardiac death. Concerns about an increased risk of stent thrombosis with drug-eluting stents (DES) continue, even though the incidence, timing, and predictors of stent thrombosis with DES have not been identified.Objective: This study aimed to describe the diagnosis and management of Intraprocedural Stent Thrombosis.Case presentation: We will discuss a 49 year-old male brought to our hospital because of chest pain while doing moderate activity. One month prior to admission, he had history of acute coronary syndrome and 1 DES on right coronary artery was placed. Ticagrelor and aspirin were routinely consumed as dual antiplatelet therapy. The patient was diagnosed with intraprocedural stent thrombosis during PCI with the evidence of intra-catheter thrombosis and ST segment elevations seen in the ECG monitor. We treat the patient with Ticagrelor 180 mg loading dose and intracoronary unfractionated heparin (UFH) during procedure continued with continuous infusion until 24 hours. No event of subsequent acute coronary syndrome was observed.Conclusion: Intraprocedural Stent Thrombosis was a strong predictor of mortality in STEMI patients. This case showed that the present widespread use of DES instead of BMS for coronary implantation although decreased the future risk of repeat revascularization, increased the risk of thrombosis. Prior risk stratification, potent early antiplatelet treatment and anticoagulant of choice with UFH might be used to reduce the risk of thrombosis in STEMI patients undergoing stent implantation.
A Risk Factor which Can Induced Premature CAD in Women with Positive Family History : A Case Report Arif Wicaksono; Mohammad Saifur Rohman; Evit Ruspiono; Cholid Tri Tjahjono
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.8

Abstract

Background: Premature Coronary Artery Disease (CAD) was defined as the incidence of CAD in males younger than 45 years of age and in women younger than 55 years of age. Many factors can cause a woman under the age of 55 to develop a CAD. One of the major roles is the patient's family history associated with the occurrence of CAD which is then associated with one or more other CAD-related risk factors such as hypertension, history of Cerebrovascular Accident (CVA), obesity or dyslipidemia.Objective: This case report was made to elaborate on the importance of family history of PCAD on CAD diagnosis.Case Presentation: A 47-year-old woman who has not yet experienced menopause comes with complaints of Dyspneu on Effort (DOE). She had multiple history of CVA. She is the 2nd child of 3 siblings. Her father has died due to liver problem. Her mother had a CVA at the age of 62 with history of hypertension. Her uncle from different grandmothers, also had a history of sudden death. She was diagnosed with a coronary artery disease and percutaneous coronary intervention was performed.Conclusion: The mortality rate of women with CAD is higher than that of men, confirming that CAD in women who appear at the age of less than 55 years should receive more attention, and the task of health workers here is to strengthen history taking related to family history in women with traditional risk factors who have the possibility of developing CAD in the future.  
Myocardial Bridging, A Neglected Anomaly in Acute Coronary Syndrom: Case Report Gita Pangestu Hapsari; Gabriel Riadhy Tanok Harmany; Daniel Dionisius Sianipar; Adityo Nugroho Kalandoro; A. Sari Sri Mumpuni
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.6

Abstract

ABSTRACT Background: Myocardial Bridging (MB) is an anomaly characterized by an intra-myocardial route of a segment of one of the major coronary arteries. Functional myocardial bridging is less commonly observed on angiography (0.5–16%) and can range from 4 to 80 mm in length. This case report elaborates about a case of a symptomatic MB occurrence in a patient manifesting as an acute coronary syndrome.Case presentation: A 66 years old female presented to ER with a typical angina gradually increasing since 1 week ago. Associated symptoms were episodic syncope, dyspnea, and dyspepsia. physical examination reveals, vital signs  are within normal limits. The cardio-pulmonary examination was unremarkable. Electrocardiogram (ECG) showed inverted T waves on V1-V4, cardiac biomarker enzymes were not increased, chest X-ray revealed an enlarged heart, echocardiography showed a left ventricular hypertrophy (LVH) with normal left ventricle ejection fraction (LVEF). Nitrate, aspirin, and P2Y12 inhibitor were then administered in the ER, and the patient was then transferred to catheterization lab. CT-Angiography showed a MB in the middle left anterior descending (LAD), the patient was then treated with bisoprolol as a maintenance therapy.Conclusion: MB, if presenting symptomatically, especially as an acute coronary syndrome (ACS), may become lifeŧhreatening if not recognized and treated appropriately. Flow normalization and symptom management in such circumstances are best achieved through revascularisation via percutaneous coronary intervention (PCI) and drug therapy by using beta-blocker.Keywords: Acute coronary syndrome, case report, epicardial artery, myocardial bridging
Diastolic Dysfunction Following Acute Myocardial Infarction with ST Segment Elevation Imelda Krisnasari; Anna Fuji Rahimah; Sasmojo Widito; Cholid Tri Tjahjono
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.2

Abstract

ST segment elevation myocardial infarction (STEMI) caused by atherosclerotic vulnerable plaque rupture or plaque erosion, resulting in activation of the coagulation cascade. It causes a temporal sequence known as the “ischemic cascade,” which first involves the metabolic process, the diastolic dysfunction, and then systolic dysfunction. Diastolic dysfunction in STEMI patient is an independent predictor for long-term outcome. Rapid and early restoration of blood flow is critical to ensure cell recovery and prevent additional damage. 
Primary Percutaneous Intervention for ST-Elevation Myocardial Infarction Patients: A State of The Art Budi Satrijo
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.1

Abstract

Primary PCI is the preferred reperfusion strategy in patients with STEMI within 12 h of symptom onset. Angiographically successful PPCI was defined as less than 30% residual stenosis by visual assessment and grade 3 TIMI flow achievement. Radial access is preferred over femoral access. Drug eluting stent (DES) implantation is more superior than bare metal stent (BMS) implantation or balloon angioplasty. In STEMI patients with cardiogenic shock, non-infarct related artery PCI during the index procedure should be considered.

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