Indonesian Journal of Cardiology

Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights

Jessica Putri Natalia Simbolon — 2024-07-03

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Valvular heart diseases (VHD), regardless of the arrhythmic problems, increase the risk of thromboembolism, which are even higher in those with associated atrial fibrillation. The EHRA (Evaluated Heartvalves, Rheumatic or Artificial) classification categorised AF patients with significant VHD into type 1 and type 2. Unfortunately, there are currently very limited data on risk prediction in stroke-related valvular AF, particularly in the Asian population.

Aims: To investigate the clinical and echocardiographic risk factors for ischaemic stroke prediction in patients with EHRA type 2 VHD.

Methods: This retrospective study enrolled 695 AF patients with EHRA type 2 VHD. The data were collected from patients' medical records who met the inclusion and exclusion criteria from 2015 until 2020. The primary outcome was ischaemic strokes within observation period.

Results: There were 67 ischaemic stroke events (9,6%) of the total sample. Our analysis found that none of the analysed variables proved to be statistically significant risk factors in predicting the occurrence of ischaemic stroke. The median CHA2DS2-VASc risk prediction in the sample was 3, with an accuracy of AUC 0.502 (CI 95%; 0.429 – 0.576), sensitivity 56.7% and specificity 44.7%.

Conclusion: Based on the parameters analysed in this study, no factor was statistically well-predictive to predict the ischaemic stroke incidence in EHRA type 2 VHD AF. In addition, the CHA2DS2-VAS accuracy was low in this population. Further exploration is needed to build an accurate ischaemic stroke risk prediction for EHRA type 2 VHD.

Transcatheter Closure for Ventricular Septal Defect (VSD): Unveiling Key Predictors in Pediatric Interventions

natal ria — 2024-07-03

Background: Transcatheter closure of specific types of VSD has been widely performed, especially in developing countries, with encouraging follow-up results. Nevertheless, adverse outcomes and failure of closure may occur, which requires sufficient attention. Although transcatheter closure is still the preferable and safest procedure, the risk of failure can lead to the surgical VSD closure procedure.

Methods: A retrospective cohort study was done in patients who underwent transcatheter VSD closure in the presence of AVP with or without AR at Integrated Cardiac Service Prof. Dr. I G N G Ngoerah General Hospital between July 2009 to June 2022. Failure to close was defined as a device failing to be implanted. Patient demographic and clinical data were collected.

Results: Thirty-eight subjects were enrolled, 10 failed to close, where 8 out of 10 of the failure group were with aortic regurgitation, and 7 of the said group were SADC type. There were 16 males and 22 females. Among 38 subjects, 23 have perimembranous outlet VSD, and 15 have subarterial doubly committed VSD. Aortic regurgitation was found in 25 of 38 subjects. Transcatheter closure was done either by a retrograde technique using the Amplatzer Duct Occluder-II or an antegrade technique using the NIT occlude and MFO in 11, 3, and 24 subjects, respectively. The failure happened in 10 patients, 3 of them had minor complications, and 7 had no complications. There are 2 patients out of 10 with membranous septal aneurysms that failed to close. The final analysis identified VSD type SADC (RR 3.578; 95%CI 1.093 to 11.711; p = 0.030) as an independent factor associated with predictors of transcatheter closure failure in pediatric patients with VSD.

Conclusion: Failure to close in transcatheter closure is higher in the SADC type compared to the PMO type. Transcatheter closure appears to be feasible but still challenging in our center.

Keywords: transcatheter closure outcome, baseline demographic, ventricular septal defect, sub-arterial doubly committed, perimembranous outlet

Modified STEMI protocol for PPCI during COVID-19 Pandemic: Does it prolong Door-To-Balloon performance?

astri yuniarsih putranto — 2024-07-03

Background

COVID-19 became a main health problem and causes heavy impact, especially for healthcare system. Managing ST-Segment Elevation Myocardial Infarction (STEMI) patients before COVID-19 pandemic was already challenging enough for Healthcare Professionals (HCP) to pursue time-sensitive treatment. After COVID-19 pandemic, the time-sensitive treatment of pursuing door-to-balloon (DTB) time put a lot more burden to HCP. In this study, We sought to analyze how a change in protocol of PPCI in STEMI patients before and during the pandemic influence the performance of DTB in the hospital.

Methods

This is a single-centered retrospective observational study among STEMI patients which was treated by PPCI. Secondary data from the medical record were collected consecutively from April 2018 to January 2022 (46 months). We compared DTB performances before and during the pandemic.

Result

During 46 months period, the total population of this research was 880 patients. There were total 358 patients underwent PPCI before the pandemic and 522 patients after the pandemic. Modified protocol with the addition step to prevent the spread of COVID-19 had been implemented since April 2020. DTB increased significantly during the pandemic (90 (70-124) minutes vs 97 (76-135) minutes, p 0.002). The proportion of the patients who achieved DTB under 90 min was also significantly decreasing (56.4% vs 47.9%, p 0.0013).

Conclusion

It is necessary for PPCI center to modify PPCI workflow during the pandemic. A decent workflow should consider practicality and simplicity without compromising HCP and patient safety. Implementing modified PPCI workflow during the pandemic significantly increased DTB time but it is still within the limit of being reasonable and acceptable for the benefit of the patients.

Utility of Ischemic Signs from Initial ECG in Detecting Culprit Vessels in NSTE-ACS Patients

Michael Asby Wijaya — 2024-07-03

ABSTRACT

Background: Non-ST-Elevation ACS (NSTE-ACS) is a part of ACS which require some special attentions. Multivessel coronary disease (MVD) is common in patients with NSTE-ACS and associated with difficulties in determining the main target of revascularization. ECG is the first-line diagnostic tool in the assessment of patients with suspected ACS. However, the utility of the ECG in localizing coronary culprit lesions in NSTE-ACS is not well established. This study was conducted to evaluate whether the pattern of the ischemic signs in ECG can be used to identify the coronary culprit vessel in patients with NSTE-ACS.

Methods: This is a single-centered cross-sectional study using secondary data. The data of all 101 patients with NSTE-ACS who were planned for revascularization procedure between January 2021 and December 2021 were collected from medical record. ECG with ischemic signs were classified to three locations of suspected coronary vessel with culprit lesions and it will be compared to its corresponding angiographic data. The accuracy data will be presented including both sensitivity and specificity.

Results: This study involved 75 men (74.3%) and 26 women (25.7%) with mean age 61.2±9.1 years old. There were 72 patients presented with ischemic signs form ECG with identifiable culprit vessel to be suspected. The sensitivity and specificity of ischemic signs ECG in localizing culprit vessels from angiography were 37.0% and 85.5% in LAD distribution, 38.1% and 81.3% in LCX distribution, and 41.1% and 85.1% in RCA distribution, respectively.

Conclusion: Overall ischemic signs in ECG gave impression of modest accuracy with conspicuous key points that ECG distribution have high specificity in detecting culprit vessels but with low sensitivity. Thus, ischemic signs from initial ECG can be used to detect culprit vessels in NSTE-ACS patients.

Keyword: Culprit Lesion, ECG, NSTEMI, UAP, PCI

Consensus Statements on the Use of High-Sensitivity Troponin I as the Assessment of Cardiac Risk in Apparently Healthy Population in Indonesia

Ade Meidian Ambari — 2024-07-03

Cardiovascular disease (CVD) is a growing burden in Indonesia, making primary prevention of utmost importance. High sensitivity cardiac troponin I (hsTnI) has been known as one of the biomarkers of choice for diagnosing acute myocardial infarction. Nonetheless, recent studies indicate that hsTnI assay has potential as a predictor of cardiac risk in asymptomatic individuals. An advisory board consisting of renowned cardiologists from the Indonesian Heart Association was convened in Jakarta in March 2023. The meeting aimed to explore the appropriate use of hsTnI for cardiovascular (CV) risk stratification in apparently healthy adults in Indonesia. The board reviewed relevant literature and developed key consensus statements, including hsTnI cut-off for identifying high-risk asymptomatic patients, the proposed algorithm, and monitoring after aggressive risk factor control. This article presents the resulting consensus statements to provide clinicians with a practical tool for planning primary prevention strategies. Furthermore, it is expected to raise awareness and advocacy among stakeholders in the healthcare infrastructure regarding the use of hsTnI as a guide for assessing CV risk in Indonesia.