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"Latar belakang: Stenosis mitral (SM) berat gradien rendah didefinisikan dengan mitral valve area (MVA) <1.5 cm2 dan gradien transmitral <10 mmHg. Perubahan fungsi atrium kiri merupakan salah satu mekanisme yang mendasari SM berat gradien rendah, dimana dapat dianalisis dengan strain atrium kiri. Komisurotomi Mitral Transkateter Perkutan (KMTP) adalah pilihan utama pasien dengan SM berat tanpa kontraindikasi. Tujuan: Membandingkan perubahan nilai strain atrium kiri dengan Peak Atrial Longitudinal Strain (PALS) antara pasien SM berat gradien rendah dan tinggi pasca KMTP. Metode: Pasien SM berat yang berhasil dilakukan KMTP dibagi menjadi dua kelompok, yaitu gradien rendah dan gradien tinggi. Dengan menggunakan ekokardiografi speckle tracking, nilai PALS diukur pada 24-48 jam sebelum KMTP dan 7-14 hari setelah KMTP. Kemudian nilai PALS antara kedua kelompok dianalisis menggunakan uji statistik Mann-Whitney. Hasil: Terdapat 32 pasien (46%) pada kelompok gradien rendah dan 39 pasien (54%) pada kelompok gradien tinggi. Subjek dengan SM berat gradien rendah cenderung lebih tua, memiliki irama jantung fibrilasi atrium, memiliki baseline MVA yang lebih besar, dan memiliki nilai net atrioventricular compliance (Cn) yang lebih tinggi. Nilai PALS rendah pada kedua kelompok dan mengalami perbaikan pasca KMTP [8%(2–23) vs. 11%(3–27), p<0.0001]. Tidak terdapat perbedaan antara PALS sebelum KMTP, setelah KMTP, dan perbedaannya (delta) antara kedua kelompok. Analisis subgrup pasien dengan irama jantung sinus menunjukan perbedaan nilai PALS antara kelompok gradien rendah dan tinggi pre KMTP (15±4% vs. 11±5%, p=0.030) dan post KMTP (19±4% vs. 15±4%, p=0.019). Analisis multivariat menemukan bahwa irama jantung merupakan variabel independent terkuat dalam mempengaruhi nilai PALS. Kesimpulan: Fungsi reservoir atrium kiri, yang dinilai dengan PALS mengalami penurunan pada pasien SM berat dan meningkat pasca KMTP, tanpa dipengaruhi oleh baseline MVG.

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Background: Low gradient severe mitral stenosis (LGMS) is defined as mitral valve area (MVA) less than ≤ 1.5 cm2 and mitral valve gradient (MVG) < 10 mmHg. Functional changes in the left atrium (LA) are one of the mechanisms that follow LGMS, which can be assessed using strain analysis. Balloon Mitral Valvotomy (BMV) is the treatment of choice for suitable MS patients without contraindications. Objective: This study compared changes in Peak Atrial Longitudinal Strain (PALS) following BMV between low- and high-gradient severe MS patients. Methods: We included MS patients who underwent a successful BMV and divided into LGMS group and high-gradient mitral stenosis (HGMS) group. Using speckle tracking echocardiography, PALS was assessed 24–48 hours before and 7–14 days after BMV procedure. Then, the PALS values were compared between those two groups using Mann- Whitney. Results: There were 32 patients (46%) in the low-gradient MS group and 39 patients (54%) in the high-gradient MS group. Subjects with LGMS were older, had more atrial fibrillation, had a larger baseline MVA, and had higher net atrioventricular compliance (Cn). The PALS values were low in both groups and improved significantly following BMV [8%(2–23) vs. 11%(3– 27), p<0.0001]. There were no differences in PALS values before, after BMV, and its absolute changes between the groups. Subgroup analysis in subjects with sinus rhythm revealed PALS differences between low and high-gradient MS pre (15±4% vs. 11±5%, p=0.030) and post- BMV (19±4% vs. 15±4%, p=0.019). Multivariate analysis identified heart rhythm as the strongest independent variable for PALS values. Conclusion: Left atrial reservoir function, as assessed by PALS, was reduced in patients with severe MS and was increased following BMV, irrespective of their baseline MVG."

"Latar Belakang: Restenosis katup mitral didefinisikan sebagai penurunan mitral valve area (MVA) <1,5 cm2 atau penurunan MVA >50% pasca KMTP. Restenosis katup mitral bersifat time-dependent dan dikaitkan dengan major adverse cardiovascular events (MACE), seperti gagal jantung kongestif, kematian, operasi penggantian katup dan KMTP ulangan. Mekanisme penyebab restenosis katup mitral belum diketahui secara pasti tetapi diduga berkaitan dengan proses inflamasi kronik. Tujuan: Mengetahui hubungan inflamasi kronik dengan restenosis katup mitral pasca KMTP. Metode: Total 40 pasien stenosis katup mitral yang telah menjalani tindakan KMTP dikelompokkan menjadi kelompok kasus (n=20) dan kelompok kontrol (n=20) berdasarkan matching. Diambil data sekunder dari rekam medis berupa karakteristik pasien (jenis kelamin, usia dan profilaksis sekunder), data ekokardiografi pre KMTP (Skor Wilkins dan MVA pre KMTP), dan data ekokardiografi post KMTP (MVA pasca KTMP). Dilakukan pemeriksaan ekokardiografi (MVA follow-up) dan pemeriksaan lab (kadar IL-6). Kemudian dilakukan analisis statistik untuk mencari hubungan antara kadar penanda inflamasi kronik serta variabel bebas lainnya dengan restenosis katup mitral. Hasil: Median konsentrasi IL-6 adalah 2,39 (0,03 - 11,4) pg/mL. Tidak terdapat perbedaan statistik yang bermakna kadar IL-6 pada kedua kelompok (nilai p >0,05). Penurunan MVA adalah 0,13 (0 - 0,62) cm2/tahun dengan laju penurunan MVA ≥0,155 cm2/tahun merupakan prediktor kejadian restenosis katup mitral (nilai p <0.001, OR = 46,72, 95% CI 6,69 - 326,19). Simpulan: Inflamasi kronik yang dinilai dengan IL-6 tidak berhubungan dengan restenosis katup mitral.

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Background: Mitral valve restenosis is defined as decreased mitral valve area (MVA) <1.5 cm2 or decreased MVA >50% after PTMC. It is time-dependent and associated with major adverse cardiovascular events (MACE), such as congestive heart failure, cardiac death, mitral valve replacement, and redo PTMC. The mechanism is not yet known; however, chronic inflammation may have a role.

Objective: To know the association between chronic inflammation and mitral valve restenosis after PTMC.

Methods: A total of 40 patients with mitral valve stenosis who underwent successful PTMC were matched and classified into restenosis/case group (n=20) and no restenosis/control group (n=20). Secondary data was taken from electronic medical records such as patient characteristics (gender, age & 2nd prophylaxis), echocardiography data before PTMC (Wilkins’ score and MVA before PTMC), and echocardiography data after PTMC (MVA after PTMC). Follow-up echocardiography examination (follow-up MVA) and laboratory assessment of chronic inflammation marker (IL-6) were done on all patients. Statistical analyses were done to look for an association between the level of chronic inflammation marker & other independent variables with mitral valve restenosis.

Results: Median IL-6 concentration was 2.39 (0.03 - 11.4) pg/mL. There was no statistically significant difference in IL-6 levels between both groups (p-value >0.05). MVA decrement was 0.13 (0 - 0.62) cm2/year with rate of MVA decrement ≥0.155 cm2/year was predictor of mitral valve restenosis (p-value <0.001, OR = 46.72, 95% CI 6.69 - 326.19).

Conclusion: Chronic inflammation assessed by IL-6 was not associated with mitral valve restenosis"

"Latar belakang: Demam rematik dan komplikasinya masih merupakan masalahkesehatan pada banyak negara berkembang. Katup mitral merupakan katup yang palingsering terlibat oleh proses rematik, dengan derajat keparahan yang tinggi (60-70%pasien), baik stenosis dan/atau regurgitasi. Tatalaksana pada pasien dengan stenosis katupmitral berat telah digunakan sebagai modalitas terapi sejak hampir tiga dekade terakhir.Pemilihan kandidat KMTP yang telah umum digunakan adalah dengan Skor Wilkins.Skor Wilkins yang dinilai dari TTE memiliki beberapa kelemahan dibandingkanmodalitas TEE. Keterbatasan lain Skor Wilkins adalah terdapat variabel morfologi katupmitral yang tidak dimasukkan dalam Skor Wilkins antara lain area katup mitral, morfologikomisura, kalsifikasi komisura, dan area katup mitral awal. Selain itu angka keberhasilandini KMTP di Indonesia masih tergolong rendah dibandingkan dengan negara lain didunia.Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan morfologi katup mitral(area katup mitral, ketebalan katup, tebal fusi komisura, tebal kalsifikasi komisura, fusikorda) terhadap luaran keberhasilan dini KMTP.Metode: Penelitian ini merupakan studi potong lintang pada pasien stenosis mitral beratakibat penyakit jantung rematik yang menjalani tindakan KMTP. Luaran keberhasilandini yang optimal adalah tercapainya ukuran area katup mitral ≥ 1,5 cm2 tanpa disertairegurgitasi mitral sedang atau lebih yang dievaluasi paska tindakan KMTP denganekokardiografi. Penilaian katup mitral dilakukan secara detil dengan TEE meliputi SkorWilkins dari TEE (pliabilitas, ketebalan ketup, kalsifikasi, fusi korda), area katup mitral(AKM) 3D pra tindakan, tebal fusi komisura anterolateral dan posteromedial, tebalmaksimal kalsifikasi komisura. Semua variabel dilakukan uji statistik bivariat, danselanjutnya dilakukan analisis multivariat.Hasil: Total terdapat 41 pasien yang menjalani KMTP. Sebanyak 18 (43,9%) pasienmencapai hasil luaran dini optimal. Didapatkan rerata AKM 3D pra 0,6 cm2 pada sampel.Dari uji analisis multivariat didapatkan AKM 3D pra dan tebal fusi komisura anteriormerupakan faktor morfolgi katup yang secara independen berhubungan dengankeberhasilan dini KMTP.Kesimpulan: Pada populasi dengan Skor Wilkins yang rendah, AKM pra KMTP danketebalan komisura anterolateral berhubungan dengan keberhasilan dini KMTP.Sedangkan Skor Wilkins yang rendah itu sendiri tidak lagi berhubungan dengankeberhasilan dini KMTP.

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Background: Rheumatic fever and its complication is still a major health problem indeveloping countries. The mitral valve is the most commonly and severely affected (65%-70% of patients) by rheumatic process by stenosis and/or regurgitation. PercutaneousTranscatheter Mitral Comisurotomy (PTMC) has been used for almost 3 last decades.Wilkins Score has been used for choosing candidates for PTMC. There are several mitralvalve features that is not included in the Wilkins score. Nevertheless, the success rate ofPTMC in Indonesia still considered lower than other countries.Aim: This study aims to know the association of mitral valve morphology (mitral valvearea, valve thickness, thickness of commissural fusion, thickness of commisurecalsification, subvalvar involvement) with immediate success of PTMC.Methods: This is a cross-sectional study, data was taken procpectively in patients withrheumatic heart disease whom undergone PTMC. Optimal immediate success wasdefined as mitral valve area ≥ 1,5 cm2 without mitral regurgitation moderate or more,which was evaluated after PTMC using echocardiography. Detailed assessment of mitralvalve using TEE including Wilkins Score from TEE (pliability, valve thickness,calsification, chordal fusion), mitral valve area (MVA) 3D, thickness of anterolateral andposteromedial commissural fusion, maximum thickness of commissural calsificationwere taken before the PTMC procedure. All morphological variables undergone bivariateanalysis and whichever is eligible to multivariate analysis.Results: Forty-one patients undergone PTMC procedure. Eighteen patients (43,9%)achieved optimal immediate result. Mean MVA by 3D echo before PTMC was 0,6 cm2.After multivariate analysis, MVA 3D and thickness of anterolateral commisure were theonly morphological features which independently associated with early success ofPTMC.Kesimpulan: In population with low Wilkins score, the score is no longer associatedwith the immediate optimal outcome of PTMC. Instead, MVA 3D pre-PTMC andthickness of anterolateral commissure are associated with immediate optimal outcome ofPTMC."

"Latar Belakang: Infeksi COVID-19 merupakan penyakit dengan komplikasi multi-organ, salah satunya komplikasi kardiovaskular. Dengan kejadian gagal jantung akut sebagai komplikasi COVID-19 dengan mortalitas dan morbiditas yang tinggi, perlu dilakukan identifikasi faktor-faktor yang berhubungan dengan terjadinya gagal jantung akut pada pasien COVID-19, khususnya pada derajat sedang – berat.Tujuan : Mengetahui prediktor gagal jantung akut pada pasien COVID-19 yang dirawat, khususnya derajat sedang – beratMetode : Metode penelitian bersifat kohort retrospektif. Luaran primer adalah kejadian gagal jantung akut saat perawatan. Terdapat 15 faktor klinis dan laboratoris yang dianalisis secara bivariat dan multivariat.Hasil: Dari total 208 subjek sesuai kriteria inklusi dan eksklusi, sebanyak 73 subjek (35%) mengalami episode gagal jantung akut saat perawatan. Riwayat gagal jantung kronik memiliki risiko 5,39 kali (95% IK: 1,76 – 16,51; p = 0,003) mengalami kejadian gagal jantung akut. Pasien dengan nilai TAPSE < 17 mm memiliki risiko 4,25 kali (95% IK: 1,13 – 16,07; p= 0,033) mengalami gagal jantung akut. Sedangkan pemakaian ACE-i/ARB memiliki risiko 0,16 kali (95% IK: 0,05 – 0,51; p = 0,002) untuk mengalami gagal jantung akut intraperawatan dibandingkan kelompok tanpa pemakaian ACE-i/ARB.Kesimpulan: Riwayat gagal jantung kronik, TAPSE < 17 mm, dan pemakaian ACE-i/ARB diidentifikasi sebagai prediktor kejadian gagal jantung akut pada pasien COVID-19.

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Introduction: COVID-19 infection is a disease with multi-organ complications, including cardiovascular organ. As heart failure is one of COVID – 19 complications that has high morbidity and mortality, we need to identify factors that can predict acute heart failure in COVID – 19, especially in moderate to severe patients.

Objective : to determine predictors of acute heart failure in hospitalized COVID -19 patients

Method : This was a retrospective cohort study. The primary outcome was acute heart failure that happened during hospitalization. There were total of 16 clinical (age, sex, body mass index, hypertension, diabetes, smoking history, coronary artery disease, chronic kidney disease, chronic heart failure, chronic obstructive pulmonary disease, PaO2/FiO2 ratio, non-cardiogenic shock at admission, use of ACE-inhibitors/ARBs during hospitalization, ejection fraction, TAPSE) as well as 6 laboratory parameters (neutrophil - lymphocyte ratio, platelet - lymphocyte ratio, eGFR, D-Dimer, procalcitonin, CRP) that were used in statistical analysis.

Result: From total of 208 subjects with moderate – severe COVID-19, 73 (35%) had acute heart failure. The median time of developing heart failure is 4 ( 1 - 27) days. On multivariate analysis, patients with history of chronic heart failure exhibited a 5.39-fold higher risk of acute heart failure compared with no history of chronic heart failure (95% CI: 1.76 – 16.51; p = 0.003). The risk of acute heart failure was multiplied by 4.25 in patients that was presented with TAPSE <17 mm (95% CI: 1.13 – 16.07; p= 0.033). In contrast, use/continuation of ACE-inhibitors/angiotensin receptor blockers during hospitalization showed reduced risk of acute heart failure (16% of the risk developing acute heart failure compared with patients with no use of ACE-inhibitors/angiotensin receptor blockers). In subjects developing acute heart failure, the mortality rate was 67%, compared with 57% in subjects without acute heart failure (p = 0,028).

Conclusion: History of chronic heart failure, TAPSE <17 mm, and the use of ACE-inhibitors/angiotensin receptor blockers were identified as predictors of acute heart failure in hospitalized COVID-19 patients."

"Latar Belakang: COVID-19 menyebabkan respon inflamasi sistemik dan ganguan koagulasi yang memperberat disfungsi endotel dan destablisasi plak intrakoroner yang berhubungan dengan beban trombus tinggi sehingga menyebabkan morbiditas dan mortalitas yang tinggi. Pasien dengan COVID-19 dengan infark miokard akut dengan elevasi segmen ST (IMAEST) yang memiliki beban trombus tinggi dihubungkan dengan mortalitas jangka pendek yang lebih besar namun pengaruhnya terhadap mortalitas dengan waktu yang lebih lama masih belum jelas.Tujuan: Mengetahui hubungan COVID-19 dengan mortalitas 6 bulan pada pasien IMAEST dengan beban trombus tinggi (BTT) intrakoroner yang menjalani intervensi koroner perkutan (IKPP).Metode: Terdapat 124 pasien dengan IMAEST yang memiliki BTT intrakoroner yang menjalani IKPP pada periode April 2020 hingga November 2021 dianalisis secara retrospektif. BTT intrakoroner berdasarkan kriteria TIMI. Status COVID-19 positif atau negatif berdasarkan pemeriksaan laboratorium dan variabel lainnya dilihat hubungannya terhadap mortalitas 6 bulan dengan analisis kesintasan dan cox regresi.Hasil: Terdapat mortalitas tinggi pada pasien COVID-19 positif (31%) dibanding pasien COVID-19 negatif (4,2%) sampai dengan 6 bulan sejak admisi rumah sakit. Pasien dengan COVID-19 cenderung meninggal lebih besar dalam 6 bulan dibanding pasien tanpa COVID-19 (HR 8.45 IK95% 2.6- 27.5). Pada model akhir multivariat analisis, status COVID-19 positif merupakan prediktor independen terhadap kematian 6 bulan sejak admisi (HR 12,89 ; IK95%:3,34 – 49,76 ; p ≤ 0,001). Status COVID-19 positif pada pasien IMAEST dengan BTT intrakoroner yang menjalani IKPP ini juga mempengaruhi level kesintasan (survival rate) yang lebih rendah dalam 6 bulan.Kesimpulan: Terdapat hubungan antara COVID-19 dengan mortalitas 6 bulan pada pasien dengan IMAEST dengan BTT intrakoroner yang menjalani IKPP.

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Background: COVID-19 causes systemic inflammatory response and disturbance in coagulation function which might give detrimental effect on endothelial dysfunction and instability of coronary plaque leading to high thrombus burden and affecting morbidity and mortality. Patients with COVID-19 with ST Elevation Myocardial Infarction (STEMI) that have Intracoronary High Thrombus Burden (IHTB) is reported to have higher intrahospital mortality but its impact on long-term mortality is still not known.

Objective: To determine whether COVID-19 is affecting 6 months mortality in STEMI patients with IHTB who undererwent Primary Percutanoeus Coronary Intervention (PPCI).

Methods: There were 124 patients with STEMI with IHTB who underwent PPCI form April 2020 to November 2021 from retrospective analysis. IHTB were classified according TIMI thrombus grade. COVID-19 status (positive or negative) were obtained according to laboratory results and other variables were analysed with cox regression analysis and survival analysis.

Results: Higher 6 months mortality rate from admission was found among COVID 19 patients compared to COVID-19 negative patients (31% vs 4,2%). The risk of death within 6 months from admission was higher in COVID-19 positive patients compared to COVID-19 negative patients ( HR 8.45 CI95% 2.6 -27.5, p < 0.001). In multivariate analysis, COVID-19 positive was independent predictor for 6 months mortality from admission ( HR 12.89 CI95% 3.34- 49.7 , p ≤ 0,001). Patients with COVID-19 positive were also had lower survival rate within 6 months from admission.

Conclusion: COVID-19 is associated with 6 months mortality from admission in patients with STEMI with IHTB who underwent PPCI."