European Heart Journal Supplements (2016) 18 (Supplement B), B19– B50
The Heart of the Matter
doi:10.1093/eurheartj/suw027
Original Research
Abstracts
Hypertension in rural area: The determinants of left ventricular geometric
alteration among hypertensive patients at Kubu Village, Karangasem, Bali
A. Yasmin 1 and R. Widiana2
1
Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia,
2
Nephrology and Hypertension Division, Internal Medicine Department, Udayana
University, Bali, Indonesia
Background: Hypertension is one of the commonest cardiovascular risk factors,
whose prevalence in Indonesia is 25.8%. Uncontrolled hypertension leads to altered
geometric pattern of left ventricle, which is associated with a greater cardiovascular
risk.
Methods: This study was conducted in conjunction with the annual social work clinic
arranged by Department of Cardiology and Vascular Medicine, Udayana University on
21 November 2015. This cross-sectional study was performed in all patients who attended
the social work clinic at Kubu Village and was diagnosed with hypertension. The subjects
underwent electrocardiography examination and echocardiography examination to
asses LV geometry, systolic function, and diastolic function.
Results: There were 28 subjects with hypertension enrolled in this study with
median age 62 (range 40-83) year old with slight female predominance (53.6%).
Among them, 60.7% have history of hypertension, but only 2 patients who had been re-
ceiving treatment. From electrocardiography examination, we found high LV voltage
and LV strain pattern in 10 (35.7%) patients. Echocardiography results show that the
prevalence of left ventricular geometric alteration was 57.1%, diastolic dysfunction
grade I was 78.6%, and 1 patient was found to have systolic dysfunction. Bivariate ana-
lysis revealed that known history of hypertension [PR 8.67 (CI 95% 1.53-49.22, p ,
0.05)] and duration of hypertension ≥ 5 years [PR 2.71 (CI 95% 1.57-4.89, p , 0.05)]
were related with left ventricular geometric alteration among hypertensive patient
in Kubu Village.
Conclusion: The prevalence of left ventricular geometric alteration and diastolic dys-
function is high among hypertensive patients at Kubu Village. Our study also found that
majority of patient with known history of long-standing hypertension also have evidence
of left ventricular geometry alteration. This result warrants the need for improved
achievement of blood pressure goals alongside with aggressive screening for end organ
damage in hypertensive patients, especially at rural area.
Keywords: Hypertension † Left Ventricular Geometry † rural area
Effectiveness comparison between lisinopril and amlodipine in Melanesian
patients with hypertension
A. Aryadi1,2, Y. A. Porotuo1,2, N. Hersunarti 1,2, S. Dharma1,2, and A. M. Soesanto 1,2
1 The descriptive study at Kubu Village, Karangasem, Bali
Faculty of Medicine Universitas Indonesia, 2National Cardiovascular Center Harapan Kita
Background: The success of antihypertensive treatment are influenced by many factors,
one of which are genetic factors, including differences in race and plasma renin activity
(PRA). Racial differences, regarding PRA, may give different response to antihyperten-
sive drugs. Plasma renin activity and comparison of the effectiveness of antihypertensive
medications (lisinopril and amlodipine) in the Melanesian race in the province of Papua
have not been investigated.
Objectives: To measure plasma renin activity and compare the effectiveness of lisinopril
and amlodipine in melanesian hypertensive patients to reduce blood pressure.
Methods: Sixty eight subjects were randomly assigned into 2 groups, those receiving
lisinopril 5 mg (34 subjects) and amlodipine 2.5 mg (34 subjects). Blood pressure,
PRA and other baseline characteristics were measured before the intervention, and
then evaluated every week. Dose of lisinopril and amlodipine will be increased in sub-
jects who have not achieved blood pressure target, 10 mg to 20 mg and 5 mg to 10 mg,
respectively. At the end of the fourth week, blood pressure is measured as the main clin-
ical outcome. Seven subjects were drop out, four from lisinopril group and three from
amlodipin group.
Results: Plasma renin activity in this study population was 1.6 ng/ml/h (normal).
Baseline characteristics did not differ between two groups, including blood pressure
and PRA before intervention. Significant decrease in blood pressure occurred in both
group after the intervention, including systolic blood pressure (SBP), diastolic (DBP)
and mean arterial pressure (MAP). However, there are no differences in blood pressure
reduction between lisinopril and amlodipine groups. (SBP 24.6 + 9.3 vs 25.9 +
8.9 mmHg, p ¼ 0.56; DBP 13.3 + 5.5 vs 11.4 + 4.8 mmHg, p ¼ 0.15; MAP 17.1 + 5.6
vs 16.3 + 5.0 mmHg, p ¼ 0.55).
Conclusion: Plasma renin activity in melanesian hypertensive patients was normal
and administration of lisinopril showed no difference in blood pressure reduction
compared with amlodipine.
Keywords: hypertension † plasma rennin activity † melanesian † lisinopril †
amlodipine
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An experimental study of b-D-Glucans exctract of Ganoderma lucidum
polysaccharide peptides as anti-inflammation and anti-oxidant in patients at
high-risk of atherosclerosis
A. Widya1, N. Ubaidillah 1, Vittryaturida 1, K. Siwi1, M. Failasufi 1, F. Ramadhan 1,
H. Wulandari 1, Y. Waranugraha 1, D.H. Putri1, and D. Sargowo 2
1
Faculty of Medicine, University of Brawijaya, Malang, Indonesia, 2Department of
Cardiology and Vascular Medicine, Faculty of Medicine, University of Brawijaya,
Dr Saiful Anwar General Hospital, Malang, Indonesia
Background: Polysaccharide peptide (PsP) of Ganoderma lucidum mycelium extract has
anti-inflammatory and anti-oxidant activities. The inflammatory process and oxidative
stress must play causal role in the initiation and progression of atherosclerosis. This
study was aimed to evaluate the anti-inflammation and anti-oxidant effects of Gano-
derma lucidum PsP in patients at high-risk of atherosclerosis.
Methods: This is a true clinical trial experimental study on 37 high-risk patients based on
Framingham Risk Score, with pre-test and post-test design without control. The patients
were given PsP 3x250 mg for 3 months, while continuing the previous medications. Para-
meters measured were the level of High-sensitivity C-Reactive Protein (HS-CRP), Inter-
leukin-6 (IL-6), Tumor Necrosis Factor-a (TNF-a), malondialdehyde (MDA) and
Superoxide dismutase (SOD). The data was analyzed by paired t-test for parametric
data and Wilcoxon test for non-parametric data.
Results: After PsP administration for three months, HS-CRP statistically significant
reduced from 25329 + 8682.10 mg/dl to 2659 + 89 mg/dl (p ¼ 0.000). IL-6 significantly
reduced from 279.75 + 120.76 mg/dl to 29.32 + 26.44 mg/dl (p ¼ 0,000). The level of
TNF-a also significantly reduced from 13447.84 + 2199.46 mg/dl to 544.85 +
292.06 mg/dl (p ¼ 0.000). MDA significantly reduced from 114.13 + 24.56 mg/dl to
36.84 + 28.39 mg/dl (p ¼ 0.000). The level of SOD slightly increased from 3.12 +
0.70 mg/dl to 3.62 + 4.26 mg/dl. However, there was no statistically significant differ-
ence between the pre and post-test means of SOD level (p ¼ 0.219).
Conclusions: PsP of Ganoderma lucidum when given to high-risk patients with on-
going medications has anti-inflammation activities that significantly reduce HS-CRP,
IL-6 and TNF-a during atherosclerosis process, moreover, can be used as antioxidant
by reducing MDA, although statistically SOD not increased. Thus, PsP could be used
as complementary therapy for patients suffering from those who are at high risk of
atherosclerosis.
Keywords: Ganoderma lucidum † polysaccharide peptides † anti-inflammation †
anti-oxidant
Echocardiographic findings among hypertensive patients in rural area:
A. P. Suwirya1, A. Yasmin1, K.B Nadha 1, and R. Widiana 2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana
University, 2Nephrology and Hypertension Division, Internal Medicine Department,
Faculty of Medicine, Udayana University
Background: Based on data from Global Burden of Disease (GBD), 50% of heart disease
were caused by hypertension and mortality rate from heart disease increased by 46% in
hypertensive patients. Prevalence of hypertension according to RISKESDAS 2013 in Indo-
nesia is 26.5%, but only 9,5% hypertensive patients were detected by healthcare provider
and received hypertension treatment. In Bali, prevalence of hypertension reached 18.3%
by 2013. From rural area in Bali, such as Kubu Village, Karangasem, hypertension was still
included in ten most common disease in community.
Methods: This study was held together with social work clinic which were performed by
Department of Cardiology and Vascular Medicine Udayana University at Kubu Village, Kar-
angasem on November 21st, 2015. In this cross-sectional study, we included all hyperten-
sive patients who attended the social work clinic. All subjects underwent transthoracic
echocardiography with GE Vivid E Portable Ultrasound Machine. The demographic char-
acteristics were obtained using structured questionnaire
Result: In this study, the prevalence of hypertension in Kubu Village was 24.3% (28 out of
115 patients). Among them, 60.7% had known history of hypertension, with duration ,5
years in 67.9% patients. Only 2 (7,1%) patients with known hypertension that already had
treatment. From echocardiography results, we found the prevalence of altered LV geo-
metric was 57.1%, which were predominated by concentric remodeling type. Further-
more, from this study we also found that 1 (3.5%) patient had systolic dysfunction and
22 (78.6%) had diastolic dysfunction grade I.
Conclusion: The prevalence of LV geometry alteration and diastolic dysfunction in hyper-
tension patients at Kubu Village Karangasem is quite high. Hence, the primary healthcare
provider should put more attention to the primary and secondary prevention for hyper-
tension especially in rural area.
Keywords: Hypertension † LV study † rural area
 B20
Addition of left ventricular ejection fraction to the GRACE score in prediction of
short term prognosis in patients with non ST-elevation myocardial infarction
A. Handayani 1, K. Kaban 1, N. Z. Akbar 2, Z. Mukhtar2, and A. A. Siregar 2
1 study has been conducted to evaluate the correlations between GRACE score and spatial
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Departement of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia
Background: Identification of patients with NSTEMI at higher risk of in-hospital MACE is very
important. It will gives crucial information for determining treatment strategy. GRACE was
the most powerful risk score of recently used. LVEF demonstrated highly significant in
several previous studies. The aim of this study is to see the value of LVEF as a predictor of
in-hospital MACE in NSTEMI and see the incremental value if added to the GRACE score.
Methods: We collected the data of NSTEMI patients admitted to Haji Adam Malik General
Hospital in 2014 that had been done echocardiography during hospitalization. Patients
with other severe comorbidity such as sepsis and COPD were excluded. There was
83 patients eligible to this study.
Result: In bivariate analysis, GRACE Score .140, LVEF ≤35%, hemoglobin levels ,12 mg/
dl, and glomerular filtration rate (GFR) ,60 mL/min were significantly associated with
in-hospital MACE. There is a moderate correlation between GRACE with LVEF (r: -0496,
p ,0.0001). In the multivariate study shows that the LVEF ≤35% (OR 3.36, 95% CI 1.04
to 10.83, p 0.042) and GRACE score. 140 (5.39, 95% CI 1.54 to 18.45, p 0.008) had a
significant association with in-hospital MACE. In all risk groups based of GRACE score,
adding LVEF did not give incremental value. But in comparative analysis between
group of LVEF ≤35% with GRACE score .140 versus other patients shows significant dif-
ference with p value 0.001 and OR 9.833 (95%CI 2.54-37.97).
Conclusion: These data show that LVEF is a strong predictor for the occurrence of in-hos-
pital MACE. In the subgroup analysis, adding LVEF did not give incremental value.
However, in patients with both LVEF ≤35% and GRACE Score .140 had a higher risk of oc-
currence of MACE during hospitalization.
Keywords: LVEF † NSTEMI † in-hospital † MACE
Effect of colchicine on HsCRP and mean platelet volume in acute myocardial
infarction
A. Yasa’, R. Myrtha, and W. Trisulo
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Sebelas Maret, Dr. Moewardi Hospital, Surakarta
Background: Coronary artery disease (CAD) was still highly prevalent. Its mortality was
high. Despite optimal standard therapy, coronary artery disease patients still face the risk
for further cardiovascular events due to inability of standard therapy in blocking certain
inflammatory pathways and thrombocyte aggregation. This study aimed to determine
the effects of Colchicine on HsCRP and MPV level in acute myocardial infarction.
Methods: This was a randomized experimental study with pre and post design. A total of
32 patients were included and divided into two groups. Patients were randomized to
receive colchicine 0,5 mg for five days (n ¼ 16) or not (control, n ¼ 16). Dependent t-
test or Mann-Whitney test were used to compare means between two groups. Independ-
ent t-test or Wilcoxon test were used to compare paired means between two groups. All
statistical analysis was carried out using SPSS version 22 for windows.
Results: HsCRP level and MPV were significantly lower in colchicine group compare to
placebo (2,30 + 2,01 vs 4,21 + 3,93; p ¼ 0,019); (7,14 + 1,014 vs 7,98 + 1,08; p ¼
0,031). HsCRP level and MPV after treatment were significantly lower compare to base-
line in colchicine group [Delta HsCRP (-3,82 + 2,20 vs -0,57 + 3,12; p ¼ ,0,001), delta
MPV ( -2,01 + 1,16 vs -0,64 + 0,83; p ¼ 0,001)].
Conclusion: This study showed that colchicine decreased HsCRP level and MPV in acute
myocardial infarction patients.
Keywords: colchicine † HsCRP † MPV † acute myocardial infarction
Correlation between GRACE score with spatial QRS-T angle in non-ST elevation
myocardial infarction patients
A. Hidayatullah 1, A. Purnomowati 1, S. Hidayat1, and T.M. Aprami 1,2
1 Conclusion: The frequencies of ACS patients who get inappropriate initial treatment
Faculty of Medicine, University of Padjajdaran, Bandung, Indonesia, 2Dr. Hasan Sadikin
Hospital, Bandung, Indonesia
Background: Non-ST elevation myocardial infarction (NSTEMI) is one of the spectrum of
acute coronary syndromes. Myocardial infarction may cause distorsions of normal
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Abstracts
excitation of the heart. Alteration of depolarization and repolarization would widened
spatial QRS-T angle which increased risk of mortality, particularly sudden cardiac
death (SCD).GRACE score is the most accurate risk statification tool in NSTEMI patient.No
QRS-T angle.
Methods: This cross-sectional study was conducted in hospitals around Bandung,
Sumedang, and Tasikmalaya with NSTEMI patients as the subject. GRACE score was cal-
culated by GRACE ACS Risk Score software. Spatial QRS-T angle was based on ECG
recording on patient admission and measured by independent investigator. Pearson’s
correlation was used to analyze the correlation between GRACE score and spatial
QRS-T angle.
Results: There was 29 NSTEMI patients that has been included into this study (male 69%,
mean age 60 + 11 years old). Mean GRACE score was 138 + 37 and mean spatial QRS-T
angle was 102 + 42o. There was a significant correlation between GRACE score and
widened spatial QRS-T angle (r ¼ 0.44; p ¼ 0.008). Heart rate (r ¼ 0.54; p ¼ 0.001)
and ST segment depression (r ¼ 0.62; p , 0.001) were two GRACE score component
which strongly associated with spatial QRS-T angle.
Conclusion: GRACE score was significantly correlate with spatial QRS-T angle in NSTEMI
patients.
Keywords: GRACE score † non-STelevation myocardial infarction † spatial QRS-Tangle
Prevalence of Impaired Kidney Function in Hospitalized Hypertensive Patients in
Agoesdjam General Hospital, Ketapang, West Borneo, Indonesia
A. Sudharsono 1, B. Effendi2, and D.A. Hanafy 3
1
General Practitioner, Agoesdjam General Hospital, Ketapang, West Borneo, 2Depart-
ment of Epidemiology, Faculty of Public Health,Universitas Indonesia, 3Department of
Cardiology and Vascular Medicinie, Faculty of Medicine, Universitas Indonesia
Background: Hypertension related kidney disease accounts for a large percentage of the
population requiring renal replacement therapy worldwide. According to National Basic
Health Research 2013, 25.8% of people ≥18 years in Indonesia are diagnosed with hyper-
tension, which could lead into kidney disease.
Objective: Our aim in this study was to determine the burden of impaired kidney func-
tion among the hypertensive population in West Borneo especially Agoesdjam general
hospital.
Method: In the period from January to December in 2015 we studied the hospital records
and documented the demographic data of patients with hypertension which was defined
as blood pressure equal or greater than 130/90 mmHg. We exclude a patients with a pre-
vious history of kidney disease. The hypertensive patients were classified into the normal
or elevated serum creatinine (.1.5 mg/dl) groups.
Results: There were 252 patients were included in this study, 55% were male. Based on
age distribution 54.8% were 41-60 years, 32.5% were 61-80 years, 9.9% were 20-40
years, and others were . ¼ 51 years. The mean serum creatinine was 2.435 +/-
3.158 mg/dl with 43.5 % of the patients having elevated serum creatinine. The differ-
ence in age between the normal elevated creatinine groups was significant. (P ¼ 0.007,
95% CI 1.621-9.655).
Conclusion: Impaired kidney function occurs frequently among the hospitalized hyper-
tensive population in Agoesdjam General Hospital as a rural area. Proactive community
based preventive measures; screening and treatment of all patients with hypertension
and kidney damage are urgently needed.
Inappropriate initial treatment in acute coronary syndrome patients: A gap in
cardiovascular care
A.A. Nursidiq and T. Wasyanto
Departement of Cardiology and Vascular Medicine, Faculty of Medicine Universitas
Sebelas Maret/Dr Moewardi Hospital, Surakarta, Indonesia
Background: Acute coronary syndrome (ACS) still become main problem in cardiovascu-
lar field because the high of morbidity and mortality. Treatment for patient with ACS has
many progressions. Initial treatment for ACS patient should be given as soon as posible in
first medical contact. We studied the frequency and factors associated with inappropri-
ate initial treatment in acute coronary syndrome patients.
Methods: Retrospective study was conducted between June-November 2015 in patient
who referred to Dr Moewardi General Hospital due to ACS. Data were collected from re-
ferral letter and medical record. They were divided into two groups according to appro-
priateness of initial treatment from previous health care facilities.
Results: 110 patients were included in this study. There were 64 patients received
appropriate initial treatment and 46 patients received inappropriate initial treat-
ment. Among 46 patient, 26 (56%) did not receive aspirin or adenosine diphosphate
receptor inhibitor, 12 (26%) received NSAID other than aspirin, 4 (9%) received inad-
equate drug dose and 4 (9%) have more than one kind of inappropriate treatment.
Multivariate analysis shown that patient with ACS more likely to receive inappropriate
initial treatment if referred from primary health facilities, odds ratio (OR) 2.97, 95%
confidence interval 1.26-7.02; p ¼ 0.01 or have atypical symptom OR 3.09, 95%
CI 1.20-7.99; p ¼ 0.02.
is remain high. Inappropriate initial treatments are associated with the type of health
care facilities and clinical features of ACS. Efforts to reduce this problem should be
endorsed.
Keywords: acute coronary syndrome † inappropriate initial treatment
 Abstracts
Correlation between plasma histamine level and atherosclerosis severity based
on carotid intima media thickness (CIMT) measurement in patients with stable
coronary artery disease
A.I. Sadiati, D. Soemantri, and J.N.E. Putranto
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga
University, Surabaya, Indonesia
Background: Atherosclerosis is a systemic disease and carotid and coronary arteries are
the two most common sites on involvement of atherosclerosis. Histamine, a
low-molecular-weight amine, has been suggested it is produced in the atherosclerotic
lesion although the activity of histamine has not been clarified completely. The source
of histamine in atherosclerotic lesion should be clarified in details; however, it could
be macrophage, endothelial cells, and mast cells. Intima media thickness of the
common carotid artery is a surrogate marker of atherosclerosis and associated with car-
diovascular events.
Objective: To prove a symmetrical relationship between plasma histamine level and ath-
erosclerotic severity based on CIMT measurement in patients with stable coronary artery
disease (CAD).
Methods: Twenty-one patients collected by purposive sampling determined by standard
diagnostic criteria in Cardiology outpatient clinic of Dr Soetomo Hospital Surabaya. Vein
whole blood were drawn and centrifuged immediately after collection. The level of
plasma histamine were measured using Histamine ELISA-Kit and then carotid intima
media thickness were measured by vascular ultrasonography GE General Vivid 7.
Results: The mean values of plasma histamine level in this study were 18.30 + 5.31 ng/ml.
The mean value of CIMT were 1.14 + 0.32 mm. Inferential analysis using Pearson cor-
relation test showed a positive, moderate and significant correlation between plasma his-
tamine level and atherosclerosis severity based on CIMT measurement, r ¼ +0.504 and
p ¼ 0.02 (p ,0.05).
Conclusion: There were significant, positive and moderate correlations between plasma
histamin level and atherosclerosis severity based on CIMT in patients with stable CAD.
Keywords: Plasma Histamine level † Atherosclerosis † Carotid Intima Media Thickness
Clinical characteristics, management and outcome of patients with ST elevation
myocardial infarction in Pekanbaru city: Preliminary result of single center
experience
A.A. Alkatiri1,2, Y. Kurnia 1, B. Y. Siregar 1, D. Siswanti 1, and D. A. Sinaga 1
1
Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia, 2National Cardiovascular Center
Harapan Kita Hospital, Jakarta, Indonesia
Backgound: ST-elevation myocardial infarction (STEMI) is a time-critical emergency re-
quiring prompt reperfusion. Acute myocardial infarction system of care at Indonesia
capital city of Jakarta has been developed and under constant improvement for
better outcome of STEMI patients. However in the other parts of the country, such
system has not been made similarly. This report is our early preliminary result
and the first study in our province to evaluate the effectiveness and outcome of
STEMI management.
Method: We prospectively collected all STEMI patients managed in our hospital from
January 2014 until December 2015. One month major adverse cardiac events (MACE)
were collected from the medical record or by telephone calls.
Result: During the study period, 165 STEMI patients were admitted,mean of age 55 + 10
years old, predominantly male (87%) with active smoking as the highest risk factor
(64%). Onset of infarction to hospital admission was less than 12 hours in 57% cases.
There were 74% of the patients received reperfusion therapy, most of them were
more likely to undergo Primary percutaneous coronary intervention (PCI) (73%) or
received fibrinolysis (27%). Median door-to-balloon and door-to-needle time were
150 and 67 minutes, respectively. The remainder (26%) did not receive any reperfusion
therapy. In-hospital mortality was almost 3 times higher in patient who did not receive
any reperfusion therapy (20%) compared with patients receiving acute reperfusion
therapy (7.1%). One month follow up revealed heart failure as the highest (14.5%)
adverse event.
Conclusion: Despite a high utilization rate of reperfusion therapy (74%), the time to
reperfusion therapy exceeds the length of time recommended by current guidelines.
Almost half of patients were admitted as late presenters, indicating needs of more
optimal referral system and accurate diagnosis, as well as more awareness of cardiac
symptoms in the community.
Keywords: STEMI † Reperfusion † Outcome
Patient distribution from Pekanbaru STEMI Registry
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B21
Phase II cardiac rehabilitation program increases functional capacity in post
atrial septal defect surgical closure in adult patients
A. Mahavira 1, D. Yaniarti1, R. Myrtha 2, B. Radi1, A. Meidian 1, A. Santoso 1, D. Kusmana1,
and B. Setianto 1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indo-
nesia – National Cardiovascular Center Harapan Kita, Jakarta, Indonesi, 2Department of
Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sebelas Maret,
Surakarta, Indonesia
Background: Cardiac rehabilitation refers to a structured program of exercise and
education purposed to help patients to return to their optimal fitness and function following
cardiac surgery, including adult patient of atrial septal defect (ASD). We therefore aim to
restrospectively assess the functional capacity after surgical ASD closure in adult patients.
Methods: This was an observational retrospective study to evaluate the benefit of phase II
cardiac rehabilitation program after ASD surgical closure in adult patients from January
2013 until December 2013 in National Cardiovascular Center Harapan Kita, Jakarta. All
patients attended 12 sessions exercise training consisted of warming-up, core exercise,
and cooling down. The 6 minute walk distance (6MWD) was compared before and after
cardiac rehabilitation program.
Results: Thirty two of 39 post ASD surgical closure patients were eligible for analysis.
Mean age was 34.9 + 11.3 year old. Most of them were female (68.7%). After completing
the cardiac rehabilitation program, the 6MWD significantly improved from 358.5 + 59.1
to 431.5 + 53.3 meters (p , 0.001). The mean improvement 6MWD was 72.9 + 54.2
meters. Age, gender, ejection fraction had no significant correlation to 6MWD.
Conclusion: There was significant 6MWD improvement after phase II cardiac rehabilita-
tion program for post ASD surgical closure in adults. The phase II cardiac rehabilitation
program had important role to improve functional capacity for these patients.
Keywords: atrial septal defect † cardiac rehabilitation † 6 minute walk distance
The identification of human telomerase catalytic subunit in cervical cancer
patients and its potential usage as strategy to reawaken hibernating myocardium
post myocardial infarction
A. B. Wijaya1, F. Hidayatullah 1, M. R. Indra2, and T. Nurseta 3
1
Faculty of Medicine, Brawijaya University, Malang, Indonesia, 2Department of Physio-
logic, Faculty of Medicine, Brawijaya University, Malang, Indonesia, 3Department of
Gynaecologic and Oncologic of Saiful Anwar General Hospital, Faculty of Medicine,
Brawijaya University, Malang, Indonesia
Background: Post myocardial infarction, fibrotic tissue will replenish loss cardiomyocytes
irreversibly. In the other hand, dedifferentiated preexisting cardiomyocytes of zebrafish
will replenish dead cardiomyocytes after infarction, not by stem cells. Zebrafish cardio-
myocytes can regenerate efficiently because of its telomerase hyperactivation. Telomer-
ase is well known for its role in carcinogenesis and lymphocyte replicative life span control.
Its activity is influenced by telomerase catalytic subunit (TERT) transcriptional regulation
and post-transcriptional alternative splicing. In fact, 95% telomerase activity is associated
with cervical cancer’s malignancy. Therefore, it is important to identify human TERT
(hTERT) in cervical cancer tissue, and compare it to zebrafish TERT (zTERT), refer to its po-
tential usage as strategy to reawaken hibernating myocardium post myocardial infarction.
Methods: Biopsytissueofcervicalcancer patients,normal cervicalsmears,andnormal lympho-
cyte, were characterized using SDS-PAGE and Western Blot. Fifteen biopsy tissue of cervical
cancer patients and 15 normal cervical smears were measured for its hTERT level using ELISA.
Results: There was an inline band at 108 kDa between biopsy tissue of cervical cancer
patient and lymphocyte cell extract. Western Blot showed that telomerase antibody
only recognized 108 kDa protein in biopsy tissue of cervical cancer patient, identified
as hTERT. No such identical band in normal cervical smear and lymphocyte extract.
There was significant difference (p ¼ 0.01) of hTERT level between biopsy tissue of cer-
vical cancer patients and normal cervical smears.
Discussion and Conclusion: Human TERT was identified at 108 kDa in biopsy tissue of
cervical cancer patient, and its level was significantly higher than normal cervical
smear. It is assumed that hTERT splice variant; abg-Deleted hTERT, might be dominant in
normal cell, rather than Full-Length hTERT. Zebrafish TERT (AA 367-1094) has 39%
similarity, in comparison with human TERT (AA 356-1127). In the other hand, abg-Deleted
hTERT from gastrointestinal cell lines have still showed few similar structure with zTERT.
Keywords: Telomerase † TERT † Zebrafish † Myocardial Infarction † Cervical Cancer
Figure 1 (A) Protein Profilling of Cervical Cancer Biopsy Tissue Extract and Normal Lympho-
cyte Extract Showed Inline Band at 108 kDa (A. Standard marker, B. Cervical cancer biopsy
extract, C. Normal lymphocyte extract, D. Normal ectocervical smear extract, E. Normal
endocervical smear extract). (B) Western Blooting Showed 108 kDa Protein in Cervical
Cancer Tissue Extract, Suggested as Telomerase Catalytic Subunits (hTERT).
 B22
Figure 2 (A) Protein Structure Between Full Length hTERT (green colour) and Its Splice
Variant, abg-deleted hTERT (blue colour). (B) Conserved region between zebrafish
hTERT(blue colour) and Human TERT (green colour). zTERT (AA 367-1094) has 39% simi-
larity, in comparison with hTERT (AA 356-1127).
Could EURO heart risk score predict the severity of coronary lesion?
A. Sumargo 1, B. Setiadi1, B. Budiono2, J. Pangemanan1, A.L. Panda1, Johan 1, Y. Arthur 1,
and H. Hasbulah 1
1
Cardiology and Vascular Medicine Department of Faculty of Medicine Sam Ratulangi
University, Manado, 2Cardiovascular Department of Awal Bros Private Hospital, Makassar
Background: Among four EURO Heart risk score’s algorithms, chart based on total chol-
esterol in population at high risk cardiovascular disease is most frequently used in Asia;
however study comparing the performance of four charts in Asian population is still
limited. In addition, several studies indicate that ratio of lipid parameters have better
correlation to severity of coronary artery lesion compared to any single lipid parameter.
Methods: Patients with diagnosis of stable angina pectoris who underwent coronary angi-
ography were included in this study. The exclusion criteria include known malignancy,
current statin treatment, diagnosis of acute coronary syndrome and incomplete data.
EURO Heart Risk Score based on the four available charts were calculated for each
patient. The severity of coronary artery lesion was evaluated by modified Gensini Score.
The correlation between EURO Heart Risk Scores and modified Gensini Score was analyzed.
Results: A total 102 patients were included in this study. Majority were male
(77 patients [75.5%]) with mean age 56,76 + 8,85. Although total cholesterol/HDL
ratio correlate better with the modified Gensini Score compared to total cholesterol
alone, however EURO Heart Score calculated using chart based on total cholesterol
have better correlation to the modified Gensini Score; with the strongest correlation
was found between EURO Heart Risk Score calculated using chart based on total choles-
terol in population at high risk cardiovascular disease (Table 1).
Conclusion: EURO Score calculated using chart based on total cholesterol in high risk
population have strongest correlation to the severity coronary artery lesion compared
to other algorithms and thus should be the chart of choice in Asian population.
Keywords: EURO Heart Score † Modified Gensini Score † Total Cholesterol † HDL
Table 1 Correlation between EURO Heart Risk Score Algorithms to the Modified
Gensini Score
Variables r p value
Total Cholesterol 0.219 0.013
Total Cholesterol/HDL Ratio 0.360 ,0.001
EURO Score-Total Cholesterol in High Risk Population 0.575 ,0.001
EURO Score-Total Cholesterol in Low Risk Population 0.553 ,0.001
EURO Score-Total Cholesterol/HDL in High Risk Population 0.506 ,0.001
EURO Score-Total Cholesterol/HDL in Low Risk Population 0.514 ,0.001
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Abstracts
Pericardial effusion in systemic lupus erythematosus
A. Kurniawan and N. P. H. Lugito
Internal Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang,
Banten, Indonesia
Background: Pericardial effusion is considered as one of criteria to diagnose systemic
lupus erythematosus (SLE) based on American Rheumatism Association (ARA) criteria.
There is limited data about the incidence and characteristic pericardial effusion in SLE
patients in our country. The aim of this study is to report and assess the incidence of
and characteristic pericardial effusion in SLE as a cardiac manifestation of the disease.
Methods: This is cross-sectional study conducted in secondary referral hospital in Tanger-
ang county, west part of Jakarta, capital city of Indonesia. We evaluated from medical
record and echocardiogram data from 2013-2015 patients diagnosed with SLE according
to ARA criteria. Clinical characteristic of SLE and cardiac symptoms related to pericardial
effusion were recorded.
Results: From 33 SLE medical records reviewed, we found 13 patients (40%) with pericar-
dial effusions. All patients were in active stage. Clinical assessment and transthoracic
echocardiogram were used to diagnose pericardial effusions. Eighty percent pericardial
effusion positive patients had minimal effusion. The others had moderate effusion. No
tamponade patients were recorded. Ninety six percent patients were female with
median age 24(13-51) years old. Three patients were reported having pulmonary arterial
hypertension. One patient had thrombus in left ventricle. All patients had clinical symp-
toms of cardiac such as heart failure and chest pain.
Conclusion: The incidence of pericardial effusion in SLE patient was 40 percent. Eighty
percent patients had minimal effusion. All patients had cardiac symptoms related.
Keywords: pericardial effusion † systemic lupus erythematosus
Intracardiac metastasis of hepatocellular carcinoma
A. Kurniawan and N. P. H. Lugito
Internal Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang,
Banten, Indonesia
Background: Cardiac metastases are not as low as expected and range from 2.3% to
18.3%. There were several cases reported hepatocellular carcinoma as the secondary
cancer in cardiac, especially in Asian country. There is limited data about the type and
characteristic of intracardiac metastasis in our country. The aim of this study is to
know the type and characteristic of intracardiac metastasis.
Methods: This is cross-sectional study conducted in secondary referral hospital in Tanger-
ang county, west part of Jakarta, capital city of Indonesia. We evaluated from medical
record and echocardiogram data from 2013-2015. The type of cancer, characteristic
and survival of cancer patients were recorded. Clinical symptoms related to cardiac
also recorded.
Results: There were 5 patients recorded having intracardiac metastasis. All patients had
hepatocellular carcinoma as primary tumor. All patients were male with median age
56(53-61) years old. Three patients had tumor in right atrial and the other 2 patients
had tumor in right ventricle. Four patients were diagnosed using transthoracic echocar-
diograph and the rest using multi sliced CT scan. All patients were having continuous
thrombus from inferior cava vein until right atrial. All patients were recorded died just
several weeks after diagnosed. All patients had clinical heart failure especially right
heart failure. No arrhythmias symptoms and sign were reported.
Conclusion: Hepatocellular carcinoma patients were reported as the cause of intracar-
diac metastasis in our county. All patients were in late stage.
Keywords: Hepatocellular carcinoma † Intracardiac † metastasis
Myocardial bridging assessed by computed tomography scan: A cause of chest pain
in patients without obstructed coronary arteries
A. Parlautan, T. M. Haykal, K. B. Aji, W. Saragih, N. Salim, N. Elen, C. A. Atmadikoesoemah,
and M. Kasim
Department of Cardiology and Vascular Medicine, Faculty of Medicine,University of
Indonesia – National Cardiovascular Heart Center Harapan Kita, Jakarta, Indonesia
Background: Myocardial bridging is an anomaly in which a segment of one of the major
coronary arteries takes intramyocardial route. Several studies showed that this
anomaly can cause hemodynamic changes that may be associated with angina. Myocar-
dial bridging classified as superficial or deep with respect to the depth (≤ 1 or .
1 mm). Recently, computed tomography scan appears to have a higher sensitivity than
coronary arteriography for detecting this anomaly.
Methods: A total of 1066 Harapan Kita Hospital patients in 2015 with chest pain and sus-
pected coronary disease but without previous coronary artery disease underwent MSCT
using a 128-slice instrument. The results were retrospectively reviewed by Cardiovascu-
lar Imaging Team in National Cardiovascular Center, Harapan Kita hospital.
Results: Of the 1066 patients (mean age 55 years, 54.7 % male), normal coronary arteries
and non obstructed coronary arteries were found in 609 of 1066 (57.1%) patients. Myocar-
dial bridging was observed in 31 of 690 patients (4.4%). Superficial type was found in 17 of
31 (54.9%) cases and deep type was found in 14 of 31 (45.1%) cases. Most of the myocardial
bridging found in the mid left anterior descending (LAD) (77.4%), followed by distal LAD
(16.1%), and proximal LAD (6.5%). No myocardial bridging was seen in the left circumflex
or right coronary arteries. The mean length of a tunneled segment for superficial type was
14.3 + 6.7 mm. The mean length and depth of a tunneled segment for deep type were
 Abstracts
20.4 + 7.8 mm and 2.0 + 0.6 mm, respectively. Atherosclerotic plaques were found in
32.2% patients proximal to tunneled segment. There were significant differences in
pain characteristic between superficial and deep type of myocardial bridging. Typical
angina was more often found in deep type than superficial type (P ¼ 0.045).
Conclusion: MSCT can be used to detect myocardial bridging in patients presented
with chest pain. Further evaluation are needed to optimize therapy and prevent
coronary event.
Keywords: myocardial bridging † computed tomography (CT) † chest pain
Correlation between resting heart rate and 6-Minute Walk Test distance in systolic
heart failure patients
A. Tobing, H. William, D. Yulianda, A.H. Raynaldo, and A.A. Siregar
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Sumatera Utara, Haji Adam Malik General Hospital Medan, Indonesia
Background: Earlier studies showed that resting heart rate (HR) to be an independent
predictor of cardiovascular events and mortality. 6-Minute Walk Test (6-MWT) distance
reflects the functional capacity and has prognostic value to predict the mortality of sys-
tolic heart failure (HF) patients.
Methods: A retrospective study involving 40 patients who were admitted to the
cardiac care unit at RSUP H Adam Malik Medan with systolic HF during February
until May 2015. A 6-minute walk test was done before the patients were discharged
from the hospital. Resting HR was measured by palpation and cardiac auscultation
at resting state before the test, then we count the distance that the patient can
reach in 6-MWT.
Results: A total of 40 patients, 33 males (82,5%) and 7 females (17,5%) with systolic
heart failure (EF ≤ 35%) were included in this study. Mean age 55,4 + 9,01 years, Mean
resting HR 83,22 + 12,15 bpm, mean 6-MWT distance 29,44 + 82,80 meters. Resting
HR has significant moderate negative correlation (r ¼ 0,461) with the 6-minute walk dis-
tance (p ¼ 0,003).
Conclusions: There is significant negative correlation between the resting HR and
6-minute walk distance of the systolic heart failure patients.
Keywords: resting heart rate † 6-MWT † systolic heart failure
Severe pulmonary hypertension is a predictor of mortality in pregnant unoperated
atrial septal defect
A.B. Hartopo 1, D.W. Anggrahini 1, K. Nakayama 2, N. Emoto 2,3, Y. Suzuki 3,
and L. Krisdinarti 1
1 Hasan Sadikin Hospital, Bandung on March 2015 – August 2015. The inclusion criterias
Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah
Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia, 2Division of Cardiovascular Medicine,
Department of Internal Medicine Kobe University School of Medicine, Kobe, Japan,
3 perform revascularization procedures and complete all cycles of ESMR therapy. Base-
Department of Clinical Pharmacy Kobe Pharmaceutical University, Kobe, Japan
Background: Atrial septal defect (ASD) mostly affects woman and pregnancy in this
illness associates with increased maternal risk especially in those with pulmonary hyper-
tension (PH). Undiagnosed, therefore unoperated, ASD not uncommonly comes with
severe symptom excacerbate by pregnancy.
Aims: To investigate the predictor of mortality among pregnant unoperated ASD patients.
Methods: Registry of ASD-PH was initiated in 2012 in Dr. Sardjito Hospital Yogyakarta
Indonesia. The data of pregnant ASD is retrieved. Demographic, clinical, obstetrics
and echocardiography data is collected and compared between two groups, i.e.
survive and non-survive. Student’s T test and chi square test are constructed to
analyse the data between two groups. Statistical significance is determined when
p value , 0.05.
Results: Forty-two pregnant ASD patients are analysed. Most of them (55 %) have severe
PH. Six patients are died in hospital (non-survive). The non-survive group has a signifi-
cantly higher tricuspid valvular gradient (112 mmHg versus 63 mmHg, p ¼ 0.002),
higher RV systolic pressure (120 mmHg versus 70 mmHg, p ¼ 0.002) and higher WHO func-
tional class as compared with survive group. Among non survive, four patients (67%) are
primigravida with mean gestational age 31,2 weeks at time of first encounter and all
patient chief complaints are dispnea . The mode of delivery is sectio caesarea (5
patients), while 1 patient undergo pervaginam delivery. All non survive have severe PH
and 5 of them (83 %) are Eisenmenger syndrome. Mode of death are associated with de-
saturation and respiratory failure.
Conclusion: Severe PH and high WHO functional class are predictors of mortality in preg-
nant ASD patients.
Keywords: Pulmonary hypertension † atrial septal defect † pregnancy † mortality
High plasma level of soluble ST2 associated with adverse outcomes during acute
phase of ST-elevation myocardial infarction
A.B. Hartopo 1, I. Sukmasari 2, I. Puspitawati 2, and B.Y. Setianto1
1 as additional R wave (R’) or a notch in nadir S wave, or manifestation of .1 R’, various
Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah Mada
– Dr. Sardjito Hospital Yogyakarta, Indonesia, 2 Department of Clinical Pathology Faculty of
Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
Background: Soluble ST2, a myocardial stretched biomarker, was released during acute
myocardial infarction by cardiomyocites. Its role on adverse outcomes during acute
phase needs to be corroborated.
Aims: To investigate the role of soluble ST2 on predicting in-hospital adverse outcomes
during acute phase of ST-elevation myocardial infarction.
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B23
Methods: Cohort study enrolling 95 consecutive patients with ST-elevation acute myo-
cardial infarction was performed. The inclusion criteria were ages 30-75 years and
onset , 24 hour. The exclusion criteria were chronic kidney disease, chronic heart
failure, acute infection, acute stroke and preadmisi reperfusion. Soluble ST2 level was
measured from peripheral blood taken on admission, before reperfusion procedure com-
menced, with Aspect-PLUS ST2 rapid test. Follow-up during intensive hospitalisation
were performed to detect in-hospital adverse outcomes, i.e. death, acute heart
failure, cardiogenic shock and rescucitated ventricular arrhytmia. For analytical
purpose, two groups were constructed based on soluble ST2 level, i.e supramedian
group and inframedian group. The incidence of adverse outcome between groups was
compared. Logistic regression analysis was performed for multivariable analysis.
A p value , 0.05 was deemed statistically significant.
Results: Using Aspect-PLUS ST2 with detection limit 12.5 ng/ml – 250 ng/ml, the median
soluble ST2 level was 152.1 ng/ml. Supramedian group (n ¼ 47) had higher incidence of
adverse outcome as compared with inframedian (n¼ 48), i.e 38.3 % versus 12.5 %,
p ¼0.004. Fatal outcome did not significantly differ between groups. No significant dif-
ference of baseline characteristics, such as Killip class, gender, diabetes mellitus, hiper-
tension, previous ischemic heart disease, anterior STEMI, coronary artery disease extent
and reperfusion strategy, between groups. Multivariable analysis showed that suprame-
dian ST2 level independently associated with high incidence of of adverse outcome
(adjusted OR 8.3, 95% CI 1.8-36.9, p 0.005).
Conclusion: High level of soluble ST2 independently associated with adverse outcomes
during acute phase of ST-elevation acute myocardial infarction.
Keywords: soluble ST2 † ST-elevation myocardial infarction † adverse outcomes
Effect of extracorporeal shockwave myocardial revascularization on spatial
QRS – T angle resolution in stable coronary artery disease patients
A. Saboe1, K. P. Surjadi 2, B.B. Tiksnadi 1, E. Martanto 1, A. Purnomowati 1, and
T. M. Aprami 1
1
Department of Cardiology and Vascular Medicine, Universitas Padjadjaran/Hasan
Sadikin Hospital, Bandung, Indonesia, 2Santosa International Hospital, Bandung,
Indonesia
Background: Extracorporeal shockwave myocardial revascularization (ESMR) may con-
tribute to angiogenesis and improve symptoms of ischemia in patients with refractory
angina. Spatial QRS – Tangle (spQRSTa) predict potently arrhythmic events and mortality
in various patients groups. The objective of this study was to determine the effect of ESMR
on spQRSTa in stable coronary artery disease (CAD) patient.
Methods: A retrospective cohort study of serial cases was conducted in ESMR division
were patients who sent to ESMR division with Canadian Cardiovascular Society (CCS)
class III – IV angina despite medical therapy scan who can’t performed or refused to
line echocardiography and nuclear scan were performed in all patients. Baseline ECG
and spQRSTa was measured before and 4 months after completion of therapy. The ex-
clusion criterias were patients who didn’t complete full cycle of ESMR therapy and
patients with incomplete data. We treated the patients with our cardiac shock wave
therapy (100 shots/spot, 3 to 6 spots, 3 times a week) with 4 weeks interval on week
1, 5, and 9.
Results: Five patients (4 men, 1 woman; median age 68.8 years, range 44-80) were
included in this study. All patients had documented ischemia on nuclear scan and abnor-
mal regional wall motions on echocardiography. There was reduction on spQRSTa angle in
all patients, and the most significant reduction was found in patient with the largest
spQRSTa baseline.
Conclusion: All patients showed improvement of spQRSTa on serial ECG. This demon-
strates the potential efficacy of ESMR on reducing ischemic burden in symptomatic
stable CAD patients. A larger study is supposed to be done to conclude analyze
whether spQRSTa changes is in tune with improvement in ischemic after ESMR.
Keywords: ExtracorporealShockwave Myocardial Revascularization † Spatial QRS – Tangle
Fragmented QRS study, does it have any structural abnormality relation?
A. Damarkusuma, H.P. Bagaswoto, H. Mumpuni, and E. Maharani
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada
University, Yogyakarta
Background: As one of the ECG markers, fragmented QRS (fQRS) is proposed to have diag-
nostic value to show myocardial fibrosis or scar on the patient and numerous cardiac dis-
eases. This study was done to know whether the ECG markers show any structural
abnormalities in heart failure patients.
Methods: Cohort retrospective study of the association between fQRS in heart failure
patients who went to Sardjito General Hospital in 2015 was performed. FQRS is defined
RSR patterns such as more than R waves (R’’) or more than two notches in a R wave, or
more than 2 notches in S wave in 2 adjacent leads. Afterwards, two independent inves-
tigators analysed these ECGs blindly before assess the echocardiogram.
Results: Total 104 patients were included in this study with mean of age are 58.38 + 9.43
years old in which 75 (72.1%) of them are male and 29 (29.1%) are female. Sixty one
(58.7%) patients had fQRS feature on the EC. Then, fQRS feature in anterior-segment
was found in 4 (3.8%), 1 (1%) in lateral-segment, 35 (33.7%) in inferior-segment, and 21
(20.2%) in infero-lateral. Structural abnormalities were analysed with result LA
 B24
Dilatation (RR: 1.078, 95% CI 0.67-1.73; p: 0.84), Septal hypertrophy (RR: 0.71, 95% CI
0.46-1.08; p: 0.16), Reduced EF (RR: 0.81, 95% CI 0.52-1.25; p: 0.42), RV Disfunction
(RR: 1.007, 95% CI 0.58-1.77; p: 1.00), and PH (RR: 1.67, 95% CI: 0.68- 1.06). These
results show no evidence of association between fQRS and abnormalities heart structure.
Conclusion: FQRS has no evidence to show any abnormalities heart structure in the heart
failure patients.
Keywords: Fragmented QRS † heart failure † structural abnormality
Risk of coronary artery lesions severity to erectile dysfunction incidence in stable
coronary heart disease patients
A.B. Kurniawan, I. Andiarso, and N. Taufiq
Department of Cardiology and Vascular Medicine, Faculty of Medicine Gadjah Mada
University/dr Sardjito General Hospital, Yogyakarta
Background: Atherosclerosis is the underlying process of coronary heart disease. Athero-
sclerosis is preceded by endothelial dysfunction caused by systemic mechanical and
chemical stressors that may occur throughout the blood vessels. Erectile dysfunction
(ED) is a clinical manifestation might be caused by atherosclerosis in iliaca or pudendal
artery. It can be also due to other factors such as neurogenic, psychogenic, endokrinogenic,
and fibroelasticity. The most responsible factor cause of ED has not been known in patients
with coronary heart disease. Previous studies have established the relationship between
coronary artery involvement and the incidence of ED, but the odds of risk has not been
well established.
Methods: This was an age matched-paired case-control study. Erectile dysfunction in
CHD patients who had undergone coronary angiography was checked by IIEF - 5 question-
naire. The severity of coronary artery lesion was assessed with a Syntax score that were
assessed by a single experienced observer, blind method and were shown consistency
test. Then, the risk of coronary artery lesion severity of the ED was analyzed by chi
square test using SPSS version 20 .
Result: There are 86 subjects consist of 57 subjects in the case group and 29 subjects in
the control one. Stable CHD patients with high Syntax scores had 2.746 times risk for de-
velopment of ED compare with low Syntax scores patients ( OR : 2.746, 95 % CI : 1.08 to
6.95, p ¼ 0.031 ). The severity of coronary artery lesions were not statistically significant
as an independent factor as the incidence of ED.
Conclusion: Stable CHD patients with higher severity of lesions in coronary artery have a
higher risk of ED than patients with lower severity of the lesion but was not statistically
significant as an independent factor on the incidence of ED.
Keywords: Severity of coronary artery lesions † erectile dysfunction † stable coronary
heart disease
Clinical profiles and outcomes of patients with ST-Elevation Acute Coronary
Syndrome (STE-ACS) in non-primary PCI capable hospital
A. Rezeki 1 and B. Widyantoro 1,2
1
Division of Cardiology, Sentra Medika Cibinong Hospital, Bogor, Indonesia, 2National Car-
diovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Background: Despite an aggressive treatment, patients with ST Elevation - Acute Coron-
ary Syndrome (STE-ACS) still have high mortality, especially for those who were not get
revascularization. The aim of this study was to analyze clinical profiles, complication
and outcomes in patients with STE-ACS admitted to Cardiac Intensive Care Unit in
Sentra Medika Cibinong Hospital, a rural non-primary PCI capable hospital.
Methods: This study was a retrospective cohort study with a total of 34 patients with
STE-ACS who registered in Cardiovascular Intensive Care Unit in our hospital in 2015. We
obtained data from medical record and analyze using bivariate and multivariate analysis.
Results: A total of 149 patients admitted to emergency room with ACS, and 51 (34.2%)
presented with STE-ACS. Thirty four of STE-ACS patient admitted to ICCU. Demographic
data showed that most of patients were men (82.4%), less than sixty-five years old (70,6%)
and 97.1% patients are survived. Diabetes Mellitus (DM) (26,5%), hypertension (52.9%),
smoking (76.5%), history of chronic heart disease (38.2%) are analyzed as risk factors.
Twenty two patients (64.7%) present with onset of symptom less than 12 hours, and
among those, 14 patients (63.6%) received fibrinolytic therapy, three patients (13.6%)
treated with fibrinolytic and followed by early PCI (pharmaco-invasive strategy), and
another 5 patients refused revascularization. The others received optimal medical
therapy without revascularization due to late onset of presentation. Complications are
arrhythmia (11.8%), Acute Heart Failure (AHF) during hospitalization (20.6%), and cardio-
genic shock (11.8%) in this hospital. Hypertension is associated with cardiogenic shock (p
,0.05) but we could not get the value of OR. One patient with cardiogenic shock was not
survive during hospitalization.
Conclusion: Hypertension is associated with incident of cardiogenic shock as one of com-
plication in STE-ACS. Among all risk factors analyzed, we are not able to find independent
predictor for all complication, which may due to limited number of patients.
Keywords: ST Elevation - Acute Coronary Syndrome † arrhythmia † acute heart failure
† cardiogenic shock † predictors
Correlation between QTc and QTcD with all caused in-hospital mortality after
thrombolytic theraphy in Dr.Moewardi Hospital, Surakarta
A. K. Martiana 1, P. Septiani1, A. Jalaludinsyah 1, H. Arifianto 1, and T. Wasyanto2
1
Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia, 2Department of
Cardiology and Vascular Medicine, Dr.Moewardi Hospital, Surakarta, Indonesia
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Abstracts
Background: Both a prolonged QT interval (QTc) and increased QT interval dispersion
(QTcD) have been proposed as surface ECG markers of vulnerability to ventricular
arrhythmias and potential predictors of mortality. QTcD is equal to longer QTc minus
shorter QTc measured by 12-lead electrocardiogram (ECG). QTcD reflects inhomogen-
eity in repolarization of ventricular myocardium.The aim of this study is to evaluate
the correlation between QTc and QTcD with all caused in-hospital mortality after
thrombolytic theraphy.
Methods: We retrospectively measured the QTc and QTcD on the 12 standard surface
ECG leads in 28 patients with ST Elevation Myocardial Infarction (STEMI) underwent
thrombolytic theraphy, who admitted to Department of Cardiology and Vascular Medi-
cine, Dr. Moewardi General Hospital, Solo from December 2015 – January 2016. Strepto-
kinase was the thrombolytic agent uses in all patients.The 12-lead ECG was recorded an
hour after receiving streptokinase. We calculated the QTc according to the Bazett’s
formula, then we counted the QTcD, and the data were observed with all caused in_hos-
pital mortality as primary end point. Spearman Correlation analyses was used with p
,0.05 significant.
Results: Among died patient prolonged QTc were found (484 + 63 ms), and shorter
QTcD were found in discharged patient (56 + 16 ms), while longer QTcD were found
in died patients (118 + 44 ms). This study demonstrated that they were moderately
positive correlation between QTc and in-hospital mortality (p ¼ 0.004, r ¼ 0.531),
and moderately positive correlation between QTcD and in-hospital mortality
(p ¼ 0.000, r ¼ 0.686).
Conclusion: Prolonged QTc and increased QTcD were correlated with all caused
in-hospital mortality after thrombolytic theraphy.
Keywords: QTc † QTcD † STEMI † Thrombolytic † in-hospital mortality
Functional capacity improvement after newly-modified cardiac rehabilitation
programe in post-revascularized coronary artery disease patients
B. B. Tiksnadi 1, M. Aziz 1, M.S. Chesario1, M. Renaldi1, S. B. Sastradimaja 2,
A. Purnomowati1, and T. M. Aprami 1
1
Department of Cardiology and Vascular Medicine, Padjadjaran University, Hasan Sadikin
Hospital, Bandung, Indonesia, 2Department of Physical and Rehabilitation Medicine, Pad-
jadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia
Background: Improved functional capacity might has a better prognostic for
post-revascularized-cardiac patients. We studied the effects of newly-modified Cardiac
Rehabilitation Programe in improvement of functional capacity and its correlation with
some factors that might influence it.
Methods: The study was observational, consecutive, without control group, in post-
revascularization CAD patients, who attended Phase II Cardiac Rehabilitation Programe in
Cardiac Rehabilitation Gymnastium, Hasan Sadikin Hospital Bandung, from October
2014-May 2015. The program lasts for 4-8 weeks (twice weekly), consisted of 6-12 education
session and supervised aerobic exercises (using ergocycle and/or treadmill). Aerobic exercise
was held for 30 minutes of moderate intensity [50-80% Heart Rate Reserve (from entrance
maximal treadmill test) and/or Borg scale 11-15] with continuous training method. All patients
were also prescribed home exercise program. Functional capacity and high-sensitive-C React-
ive Protein (hs-CRP) was measured before and after the program. Functional capacity was
assessed by maximal treadmill test, and VO2 max was determined from reference table.
Results: Fourty four patients were enrolled to this study with 7 of them were excluded (4
drop-out, 1 loss to follow-up and 2 incomplete procedure). A total 37 patients were ana-
lyzed, consisted mainly of men (81%); mean age 56.05 years; and 78.4% of them were
post PCI. Our study showed that after this newly-modified cardiac rehabilitation
program, the functional capacity increased significantly from mean 6.75 to 8.67 METs; in-
creasing 28,4 % with p ¼ 0.000. The median of METs differences was 1.68 METs. After a
linear regression analysis, the improvement of fitness was associated with baseline METs
(p ¼ 0.000) and baseline hs-CRP (p ¼ 0.006), and not influenced by age, gender, ejection
fraction and type of procedure.
Conclusions: Newly-modified exercise-based cardiac rehabilitation program significant-
ly increases functional capacity in post-revascularized CAD patient, and more prominent
in patient with low functional capacity and high hs-CRP at baseline.
Acute heart failure and diabetes are predictors for mortality in 6 months follow up
after acute coronary syndrome
B. Widyantoro, D.A. Juzar, I. Firdaus, S.S. Danny, D. Zamroni, S. Dharma, Irmalita, and
D.P.L. Tobing
Department of Cardiology and Vascular Medicine, Universitas Indonesia – National Car-
diovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Background: Despite aggressive intervention, morbidity and mortality of patients with
acute coronary syndrome (ACS) remain high. Various clinical condition may contribute
to the outcomes during hospitalization and after discharge. The aim of this study was
to analyze predictor of mortality after follow up of 6 months in patient with ACS.
Methods: We examined 1315 consecutive patients admitted to CVCU with ACS in National
Cardiovascular Center Harapan Kita Hospital during September 2014 to September 2015.
After discharge, patients were followed up to 6 months for the clinical condition and
cardiac event. Various clinical parameters were analyzed with multivariable logistic re-
gression as predictors for mortality after 6 months follow up.
Results: Among 1315 patients, 786 (59.8%) were diagnosed as STEMI and 529 patients
were UA or NSTEMI. In hospital mortality were 76 out of 1315 patients (5.7%), including
47/786 (5.9%) of STEMI patients and 29/529 (5.4%) of UA/NSTEMI patient. We followed
1268 patients and after 6 months, we observed 20 patients died from all cause (1.57%).
 Abstracts
STEMI patients who failed to survive during 6 months follow up most likely suffered
from acute heart failure (AHF) and diabetes. However, after multivariable risk adjust-
ment, only AHF remain independent predictors (odds ratio 6.32; 95% CI 1.66-24.05).
Almost similar findings were observed in UA/NSTEMI population, with diabetes and AHF
become strong predictor for mortality after 6 months (odds ratio 0.12; 95% CI 0.01-1.01
and odds ratio 10.59; 95% CI 1.3-85.8). We also observed interesting findings that 9
patients with UA/NSTEMI complicated with cardiogenic shock who survived during hospi-
talization remain alive after 6 months.
Conclusion: We observed AHF and diabetes as independent predictors for mortality
among ACS patients in our center after 6 months of follow up.
Respiratory training as adjuvant of phase 2 exercise program decreased systolic
pulmonary artery pressure in post mitral valve surgery patients with residual
pulmonary hypertension
B. Suryaatmaja, B. Radi, A. S. Kuncoro, A. H. Joesoef, and A. M. Soesanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indo-
nesia, National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Background: Pulmonary hypertension (PH) is an independent factor for mortality, car-
diovascular mortality, and heart failure in four years observation of patients underwent
mitral valve operation. In patient with open chest surgery, lung physiology and mechanic
function deteriorates. This leads to ventilation perfusion mismatch and hypoxia induced
pulmonary vasoconstriction, causing problems in recovery post operatively. Respiratory
training give beneficial effect on PH.
Aims: To study the effect of respiratory training as an adjuvant to structured physical ex-
ercise in the decrease of pulmonary artery systolic pressure in patient with pulmonary
hypertension post mitral valve surgery.
Methods: A double blind randomized trial was done. Patients who underwent mitral valve
operation with residual pulmonary hypertension were taken consecutively and were ran-
domized to be given respiratory training of 50% of maximum inspiratory volume (MIV) as
an adjuvant intervention to the current phase 2 rehabilitation program in intervention
group vs control group. Systolic pulmonary artery pressure (sPAP) was measured by echo-
cardiography before and after intervention was performed.
Result: A total of 43 subjects were divided in 2 groups. 21 patients were given respiratory
training and 22 patients were in the control group. At the end of study, sPAP in the inter-
vention group was significantly lower compare to the control group (35 [29-39] mmHg vs
43 [40-51] mmHg; p , 0.001) and DsPAP in the intervention group was significantly higher
compare to the control group (16 [12-30] mmHg vs 3.5[2-4] mmHg; p , 0.001).
Conclusion: The decrease of sPAP was significantly higher in the intervention group than
in the control group.
Keywords: Pulmonary Hypertension † Post Mitral Valve Surgery † Respiratory Training
† Systolic Pulmonary Artery Pressure
Correlation between Tricuspid Regurgitation Duration with Pulmonary Pressure
in Heart Failure Patients
C. Kurniawan, H.P. Bagaswoto, H. Mumpuni H, and L. Krisdinarti
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada
University, Yogyakarta
Background: Patient with left heart failure could be accompanied by right ventricular dys-
function due to pulmonary hypertension. In previous study, tricuspid regurgitation duration
(TRDc) could be a useful echocardiographic surrogate marker for predicting RV dysfunction
in patients with pulmonary artery hypertension, but correlation between TRDc and severity
of pulmonary hypertension in heart failure was unclear. This study was aimed to investigate
that TRDc is related to severity of pulmonary hypertension is heart failure.
Methods: We conducted a cross sectional study between November 2014-December
2015. We enrolled 50 patients with chronic heart failure. Tricuspid regurgitation duration
was defined as the time between the onset and the cessation of TR flow. RR interval was
measured in seconds using electrocardiographic tracing. TR duration was corrected for
p
heart rate using a previously described correction formula: TRDc¼ TR duration/ (RR
interval). We used cut off point TRDc at 400 ms as described in previous study. Pulmonary
pressure was measured by tricuspid valvular gradient sum with estimated right atrial
pressure by IVC using echocardiography machine.
Results: The study was done in 32 males (64%) and 18 females (36%), with average age of 56 +
9.07 years old. By Pearson correlation, tricuspid regurgitation duration corrected for heart
rate showed positive correlation with pulmonary artery systolic pressure in heart failure
patients, but not statistically significant (r ¼ 0.116, p ¼ 0.421). Additionally we found
group with TRDc ≥ 400 ms has mean pulmonary pressure higher than group with TRDc ,
400 ms, but not statistically significant (44.72 + 15.69 mmHg vs 26.33 + 9.12; p ¼ 0.05).
Conclusion: There is no correlation between tricuspid regurgitation duration with pul-
monary pressure in heart failure patients.
Keywords: Heart failure † tricuspid regurgitation duration † pulmonary hypertension
Compatibility of myocardial damage observed by echocardiography to MSCT
coronary assessment of arterial stenosis in acute coronary syndrome
C. Perthy and S. Surin
Harum Sisma Medika Hospital, Jakarta, Indonesia
Background: Myocardial damage is occured after diminishing oxygen supply to the heart
muscle, which is called acute coronary syndrome (ACS). Coronary arterial stenosis is the
underlying pathophysiology of ACS. Speckle Tracking Echocardiography (STE) is an
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assessment tool to see the extent of myocardial damage, while Multislice Computed Tom-
ography (MSCT) Coronary is used to assess the existence of coronary arterial stenosis.
Method: A cross sectional study was conducted in a year, between January to December
2015, in patients who admitted to Harum Sisma Medika Hospital due to ACS. Both examina-
tions, STE and MSCT Coronary, were conducted in each patients after their condition were
stable, usually after three days of hospitalization. The area of myocardial damage observed
by STE then was compared to the area of arterial stenosis assessed by MSCT Coronary.
Results: A total 58 patients were included. The sensitivity and specificity of STE com-
pared to MSCT coronary were 93% and 43%, respectively. This means that STE 93%
detected the area of myocardial damage which concordant to the location of coronary
arterial stenosis, however its low specificity means it could show false positive for a
number of patients with good coronary artery. The positive predictive value (PPV) and
negative predictive value (NPV) were 64% and 86%, respectively.
Conclusion: Since STE had high sensitivity and poor specificity, a person with negative
result was very unlikely to have CAD. From the predictive value, subject who was
shown not having myocardial damage by STE only had a 14% chance of having arterial sten-
osis assessed by MSCT coronary. STE was very helpful when showed negative result.
Keywords: MSCT Coronary † speckle tracking echocardiography † acute coronary syn-
drome † coronary artery disease
Hypolipidemic effect and antioxidant activity of Tamarindus indica (Tamarind)
leaves in hypercholesterolemic-fed rats
C.A. Aprilia, G. Ninditasari, and D. Waluyo B.R
Faculty of Medicine, University of Pembangunan Nasional “Veteran”, Jakarta, Indonesia
Background/Aims: Higher cost and side effects that made by some anticholesterol drugs
which used in long time is the reason why some people change to herb therapy. One of the
herb is Tamarindus indica (Tamarind) leaves. This research aims to determine hypolipi-
demic effect and antioxidant activity of Extract of Tamarind Leaves (ETL).
Methods: Samples used 25 rats, divided into 5 groups: negative control (CMC 0.5 %), posi-
tive control (Ezetrolw (Ezetimibe 1.26 g/KgBW)), ETL 1st, 2nd, and 3rd dose in a row
0,93 g/KgBW, 1,86 g/KgBW, and 3,73 g/KgBW.
Results: Paired-samples T-test showed ETL significantly lower total cholesterol (TC) and
triglyceride level when compared with both control groups (p,0.05), but Low-density
Lipoprotein Cholesterol (LDL-C) and High-density Lipoprotein Cholesterol (HDL-C)
level had no significant difference (p.0.05). TC level also were analyzed with Kruskal-
Wallis test, and triglyceride and LDL-C level were analyzed with one-way ANOVA test.
ETL exhibited the significant reduction between groups (p,0.05), but in triglyceride
and HDL-C level had no significant difference (p.0.05). Furthermore, the data of TC
level were analyzed with Post Hoc test and there was a significant difference between
negative control with positive control group and all variance ETL doses (p , 0,05); In
LDL-C level there was a significant difference between negative control group with posi-
tive control, ETL 1st and 2nd Dose. For antioxidant activity, ETL exhibited the significant
reduction in the levels of Malondialdehyde (MDA) (p,0.05). The data of antioxidant ac-
tivity were also analyzed with one-way ANOVA test, ETL exhibited no significant differ-
ence in MDA and Superoxide Dismutase (SOD) level (p.0.05).
Conclusion: All variance ETL doses h ave hypolipidemic effect and antioxidant activity.
ETL also has similar effect with ezetimibe. Saponin, flavonoid, and tanin that is contained
likely contribute to these pharmacologic effects.
Keywords: Extract of Tamarind Leaves (ETL) † hypercholesterol † hypolipidemic
effect † antioxidant activity
Correlation between pulmonary hypertension and functional tricuspid regurgita-
tion in Cimacan General Hospital
R.S.D. Gill 1 and D.R. Syawaluddin2
1
Cimacan General Hospital, Cianjur, Indonesia, 2East Belitung General Hospital, Manggar,
Indonesia
Background: Functional Tricuspid Regurgitation(FTR) is a common result of Pulmonary
Hypertension(PH). But other factors play a role in determining FTR. The objectives of
our study were to determine the distribution of FTR severity in relation to PH and its se-
verity in Cimacan General Hospital.
Methods: It was a crossectional study conducted from March to August 2015, echocardi-
ography were performed to 22 patients with PH (classified into mild,moderate,severe).
An echocardiographic parameter of functional Tricuspid Regurgitation were assessed and
patients with FTR devided into 3 groups (mild, moderate, severe TR) .
Results: From all 22 patients with PH (mild 22.7%, moderate 9.1 %, severe 68.2%),21
patients (95.4%) have FTR ( moderate 36.4%, severe 59.1%,)and 1 patient (4.5%) was
normal. A strong positive correlation (r ¼ 0.450, P value 0.018 , 0.05) was shown
between PH severity and FTR severity.
Conclusion: Pulmonary hypertension has a strong positive correlation with Tricuspid
Regurgitation.
Keywords: Pulmonary hypertension † Functional Tricuspid Regurgitation
Correlation knowledge and attitude regarding behaviour of controlling blood
pressure in elderly hypertension patient in Manggar District
D.R. Syawaluddin, E.C. Azlina, and N. Ruth
East Belitung General Hospital, Manggar, Indonesia
Background: The world prevalence of hypertension is 15-37% of the adult population.
Half of the population itself are people above 60 years old suffering hypertension.
 B26
Hypertension in Indonesia is as high as 25.8%, the highest in Bangka Belitung (30%). Hyper-
tension is a stern matter, as people do not take them seriuosly. Aim of this study was to
analyze the correlation between knowledge and attitude regarding behaviour in
elderly hypertension patients in Manggar District.
Methods: A cross sectional design was used in this corelational study, and conducted from
April through September 2015. The subject were elderly above 60 years old suffering
hypertension and attended the community health center within the area of manggar
community health center. Questioner was used as the instrument
Result: From 170 participants, 148 respondents (87.1%) represent good knowledge, 142
respondents (83.5%) represent positive attitude, 93 respondents (54.7%) represent good
behaviour. Respondent that acquired good knowledge and good behaviour were as much
as 93 people (54,7%), respondents that acquired low level of knowledge and bad behav-
iour were 22 people (12,9%), respondent that represent positive attitude and good be-
haviour shows 93 respondent (54.5%), respodent that represent negative attitude and
bad behaviour were 28 people (16,5%). The correlation result of Spearman rank
showed p ¼ 0.000, r ¼ 0.424 for the correlation between knowledge and behaviour,
p ¼ 0.000, r ¼ 0,488 for the correlation between attitude and behaviour. From the logis-
tic regretion result showed p ¼ 0.000, r¼ 0,879 for the correlation between knowledge
and attitude regarding the behaviour of controlling blood pressure.
Conclusion: There was a significant correlation between knowledge and attitude regard-
ing behaviour of controlling blood pressure of elderly hypertension patients in Manggar
District.
Keywords: Knowledge † attitude, behaviour † hypertension
Correlation of lipid profile and high sensitivity C-reactive protein among young
people
D. Budiono1, J. H. Surentu 1, M. Melatunan 1, M. Mailangkay 1, and J. A. Pangemanan 2
1 nancy, current statin treatment, diagnosis of acute coronary syndrome and incom-
Faculty of Medicine, University of Sam Ratulangi, Manado, Indonesia, 2Department of
Cardiology and Vascular Medicine, Faculty of Medicine, University of Sam Ratulangi,
Prof Dr. R.D.Kandou General Hospital, Manado, Indonesia
Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. The
most frequent forms of CVD, coronary heart disease is almost always due to presence of
atherosclerotic plaque. Necropsy studies have demonstrated that the development of
atherosclerosis plaque begins early in life. Induced by dyslipidemia, inflammation
plays a crucial role in the pathogenesis of the different stages of atherosclerosis. High
sensitivity C-reactive protein (hs-CRP) is a biomarker of low grade inflammatory state,
which characterizes an atherosclerotic process. This study aimed to know the correlation
of lipid profile and Hs-CRP levels among young people.
Methods: A cross sectional study involved 34 young people aged 16 to 20 years. They
didn’t have infectious, malignancy, or another chronic disease. They didn’t smoke,
take lipid-lowering drug, and drink alcohol regularly. The correlation of lipid profile
and hs-CRP were analyzed using Spearman’s correlation Test.
Results: In this study, the mean of lipid profile were following: LDL 117.65 + 26.558 mg/
dL; HDL 46.32 + 8.02 mg/dL; triglyceride 90.53 + 35.22 mg/dL; total cholesterol 173 +
27.25 mg/dL. The mean of Hs-CRP level 1.291 + 1.33 mg/L. The correlation of Hs-CRP
level and lipid profile were following, Total cholesterol: r ¼ 0.18 and p ¼ 0.307; HDL
cholesterol: r ¼ -0.366 and p ¼ 0.033; LDL cholesterol: r ¼ 0.364 and p ¼ 0.034; Trigly-
ceride : r¼ 0.214 and p ¼ 0.223.
Conclusion: High density lipoprotein cholesterol level and low density lipoprotein
cholesterol level have weak correlation with Hs-CRP level, meanwhile triglyceride level
and total cholesterol level have no correlation with Hs-CRP level. Low-grade chronic
inflammation which characterizes an atherogenesis is happening at young age.
Keywords: Atherosclerosis † lipid profile † high sensitivity c-reactive protein † young
people
Increased in-hospital mortality associated with hyponatremia in acute heart
failure patients
D.K. Firmasyah, D.R. Desandri, R.S. Pratikto, N. Hersunarti, B.B. Siswanto, and
A.M. Soesanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indo-
nesia – National Cardiovascular Centre Harapan Kita (NCCHK), Jakarta, Indonesia
Backround: Hyponatremia presents in 10-20% of hospitalized patients with heart
failure (HF) and has been identified as predictor of mortality and re-hospitalization.
Despite its important prognostic value, there has not been any data showing correlation
between hyponatremia with in-hospital mortality and length of hospital stay (LOS) in
our center.
Methods: Analytical cross sectional study involving 969 data of patients with HF as
primary diagnosis (ICD I50.0-9) admitted from Emergency Room National Cardiovascu-
lar Centre Harapan Kita has conducted from January to August 2015. Hospitalization
was defined as hospital admission more than 24 hours. We evaluated baseline demo-
graphic characteristic, serum sodium level, osmolality, in-hospital mortality, and LOS.
Results: Median age was 60 years old. Hypertension was the most encountered comorbid
(30.1%), followed by diabetes (23%), Coronary Artery Disease (12.9%), atrial fibrillation
(11,8%), and Chronic Kidney Disease (11.6%). Hyponatremia was present in 32%
patient, but only 5.4% is true hyponatremia (hypoosmolal-hyponatremia). From multi-
variate analysis, we found a significant association between hyponatremia and
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Abstracts
in-hospital mortality (Adjusted Odds Ratio [OR] 4.08; 1.38-11.99). Moderate and
severe hyponatremia was associated with increased in-hospital mortality (p , 0.01 for
both) but not mild hyponatremia (p ¼ 0.16). In patient with true hyponatremia, we
found mortality rate 5.8%, all attributed to the severe case. Median value for LOS was
six days (2-40 days). However, we cannot prove there was a significant correlation
between hyponatremia and LOS (p ¼ 0.15).
Conclusion: Heart failure patient with hyponatremia has four times increased risk of
in-hospital mortality compared to patients with normal sodium level. The risk is
increased with increase in hyponatremia severity. No association between hyponatremia
and LOS was proven in this study.
Keywords: Hyponatremia † acute heart failure † in-hospital mortality † length
of stay
The association between different criteria of obesity to the severity of coronary
artery lesion
D. Tiolung 1, A. Purabaya 1, B. Budiono2, J. Pangemanan1, A.L. Panda1, and B. Setiadi 1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi
University, Manado, 2Cardiovascular Department of Awal Bros Private Hospital, Makassar
Background: Obesity was one of the important traditional risk factors of Coronary Artery
Disease (CAD). Waist circumference (WC) and Body Mass Index (BMI) were the most
common criteria used to define obesity; however study regarding the association
between these criteria to the severity of coronary artery lesion is still limited. The aim
of this study is to analyze the association between obesity defined by WC and BMI to
the coronary artery lesion severity.
Methods: Patients with diagnosis of stable angina pectoris who underwent coronary
angiography were included in this study. The exclusion criteria include known malig-
plete data. Obesity was determined by measuring WC and BMI. Central obesity was
defined as waist circumference ≥ 90 cm in men and ≥ 80 cm in women. In 2000 the
Western Pacific Regional Office of WHO (WPRO) proposed an alternative definition
obesity (BMI ≥ 25.0) for Asian populations. Severity of coronary artery lesion was
determined by using ACC/AHA lesion classification. Statistical analysis was done to
analyze the risk of obesity based on WC criteria and BMI criteria in developing type
C lesion classification.
Results: A total 117 patients with diagnosis of stable angina pectoris were included
in this study. Obesity based on WC criteria was found in 44 patients; while obesity
based on BMI criteria was found in 83 patients. From the statistical analysis, obesity
based on WC criteria and BMI criteria were both associated with an increased risk of
developing type C lesion classification (Odd Ratio [OR] ¼ 5.316, p¼ 0.021 and OR¼
6.05, p¼ 0.014).
Conclusion: Obesity based on WC criteria and BMI criteria are both associated with
increased risk of type C lesion classification.
Keywords: Obesity † coronary artery disease † type C lesion classification
Predictor postoperative arrhythmias after pediatric cardiac surgery using aortic
cross clamp and cardiopulmonary bypass
D.A. Paramita1, T. Wasyanto 2, and G. M. Harimurti 3
1
Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia, 2Dr. Moewardi
General Hospital, Surakarta, Indonesia, 3National Cardiovascular Center Harapan Kita
Hospital, Jakarta, Indonesia
Background: Early postoperative arrhythmias are a known complication of cardiac
surgery; however, little data exists specific to pediatrics. The purpose of this study was
to determine the incidence and risk factors associated with the emergent of arrhythmias
immediately after surgery using aortic cross clamp (AOX) and cardiopulmonary bypass
(CPB) in a pediatric population.
Methods: Data were collected in a retrospective observational format from pediatric
patients undergoing cardiac surgeries that were using aortic cross clamp between
January and December 2015. This format included age, weight, oxygen saturation, sur-
gical repair, pulmonary hypertension (PH), CPB and AOX times. Patients that had arrhyth-
mias that need intervention to become normal sinus rhythm were reviewed from medical
record.
Results: Arrhythmias occurred in 84 (13.8%) of 610 patients enrolled including 14 (0.02%)
with TAVB, 36 (0.06%) with VT/VF, 3 (0.005%) with new atrial fibrillation, 4 (0.006%) with
supraventricular tachycardia, and 27 patients (0.04%) with other arrhythmias. Signifi-
cant differences were found using bivariate analysis between the arrhythmia and non-
arrhythmia groups with regard to age (p:0.04); weight (p:0.001); oxygen saturation
(p:0.035); PH (p:0,002); CPB time (p:0.001) and AOX time (p:0.001). Operations that
carried an increased risk were complete closure of acyanotic congenital heart disease,
valve replacement, TOF correction, and atrioventricular septal defect repair. Multivari-
ate analysis showed that three variables — aortic cross clamp time, weight, and PH, were
independent predictors of postoperative arrhythmias.
Conclusions: Postoperative arrhythmias are a frequent complication of pediatric cardiac
surgery. Age, weight, oxygen saturation, PH, and CPB and AOX times are risk factors for
arrhythmia. Aortic cross clamp time, weight, and PH were independent predictors of
postoperative arrhythmias after pediatric cardiac surgery.
Keywords: arrhythmias † pediatric cardiac surgery † aortic cross clamp † CPB
 Abstracts
Table 1 Mean of Variable Affecting the Emergent of Postoperative Arrhythmias
Variable Arrhythmias Non-arrhythmia
Age 69,12 + 67,35 50,13 + 53,39
PH 35 163
Weight 16,25 + 13,76 12,0 + 9,77
Oxygen saturation 90,18 + 11,87 85,86 + 18,13
CPB time 121,09 + 75,68 96,46 + 55,36
AOX time 70,3 + 47,03 50,68 + 37,76
Profile of hyperthyroid heart disease patients in National Cardiac Center
Harapan Kita : A descriptive study
D.Y. Hasanah, R. Soerarso, N. Hersunarti, and B.B. Siswanto
Division of Clinical Cardiology, Department of Cardiology and Vascular Medicine, Faculty
of Medicine Universitas Indonesia – National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
Background: It is well established that common signs and symptoms of thyroid disease
are those that result from the effects of thyroid hormone on the heart and cardiovascular
system.1 The wide range of hemodynamic changes and cardiovascular complications that
accompany hyperthyroidism serve to emphasize the role of thyroid hormone in the
physiology of the cardiovascular system.2,3 This study aims to describe patients profile
with hyperthyroid heart disease admitted to National Cardiovascular Center Harapan
Kita.
Methods: This is a descriptive study analyzing medical report data of thyroid patients
admitted to National Cardiovascular Center Harapan Kita, Jakarta, Indonesia from
2014 to 2015. We described patients profile with hyperthyroid heart disease admitted
in NCCHK and we also analyzed association between compliance in thyroid medication
and readmission related to thyroid disturbance on the heart and cardiovascular
system .
Results: We analysed 44 patients with hyperthyroid heart disease. The majority of those
patients are women (61.36%) with the average age of 51.93 year old. There are other co-
morbidities concerned in this study such as Hypertension (HT), Diabetes Mellitus (DM),
and Dyslipidemia (DL). HT is the most frequent comorbidity in our group of patients,
reaching up to 22 patients (50%). Then, among all patients, there are 2 patients
(4.55%) suffered from stroke. From echocardiographic findings the average EF value
for all patients is 53.86 + 17.41 and 11 patients (25.00%) with concentric left ventricular
hypertrophy. Binomial test is applied to compare proportions among categories. For
gender in hyperthyroid patients, proportion of women, which is 61%, is significantly
higher than men (p-value 0.002). As for the rhythm, there is no significant difference
between those with Atrial Fibrillation (46.51%) and with Sinus rhythm (53.49%)
(p-value 0.242). Proportion of Potassium level, known to be reduced in thyroid patients,
seemed to be equal between those with normal and lower potassium level (p-value
0.338). The most interesting thing is that most of our patients were diagnosed during hos-
pitalization (64%), despite all the sign and symptoms they’ve had. Heart failure is the
most frequent cardiovascular manifestations related to hyperthyroidism (38.6%) and pal-
pitation (29.5%). Propityourasil (PTU) is the most prescribed medicine mostly used for
hyperthyroid (63.6%). Finally, among 29 patients without rehospitalisation, 27 patients
(93.1%) have good compliance, meanwhile 15 patients who have hospitalization were
mainly because of arrhythmia (AF Rapid Ventricular Response 3%) and non adherence
to the thyroid medicine (3%).
Conclusion: In this study we found that there was a significant different proportion in
hyperthyroid heart disease patients in term of gender, potassium level, and timing the
diagnosed is performed.
Keywords: Hyperthyroid † cardiovascular system symptoms † rehospitalization
Effect of cardiac rehabilitation programs on functional capacity of post coronary
revascularization patient with decrease ejection fraction using Six Minute
Walk-Test
D. Yaniarti 1, A. Mahavira 1, F. Handayani 2, B. Radi1, A. Meidian 1, A. Santoso1, D. Kusmana 1,
and B. Setianto 1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indo-
nesia/National Cardiovascular Center, Jakarta, Indonesia, 2Department of Cardiology
and Vascular Medicine, Faculty of Medicine, Universitas Diponegoro/Karyadi Hospital,
Semarang, Indonesia
Background: Coronary artery bypass graft surgery (CABG) is a well-established proced-
ure worldwide due to its safety and effectiveness in treating patients with coronary
artery disease.1 Despite the undeniable efficiency, recovery of functional capacity of
patients in the postoperative period of cardiac surgery is one of the important
aspects.1,2 This study was aimed to compare the improvement of functional capacity
using six-minutes walking test (6MWT) after cardiac rehabilitation program in patients
with low ejection fraction (EF) having CABG surgery.
Methods: This is a retrospective study analizing a database of patients who participating
in cardiac rehabilitation program after coronary artery bypass surgery with EF , 40%, in
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia from 2013 to 2014. We
compared pre and post cardiac rehabilitation functional capacity evaluation using 6MWT.
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We also compared its’ relations with patients characteristics such as gender, age, dia-
betes mellitus (DM), and body mass index (BMI).
Results: There are 90 selected data of patients after CABG, with EF lower than 40%.
Among those patients, 87 patients are men and 3 patients are women. Average age of
men is 56.67 + 7.87 years old, while average age of women is 60 + 6.56 years old. The
average distance of 6MWT1 is 238.32 + 139.08 and average distance of 6MWT2 is
290.89 + 143.29 (p-value ¼ 0.000). Among all men patients, 60 patients (68.97%) are
smoker, 37 patients (42.53%) have Diabetes Mellitus (DM), 45 patients (51.72%) have
Hypertension (HT), 48 patients (55.17%) have dislipidemia. Average weight of patients
is 64.03 + 23.41 kg. Average BMI of patients is 25.05 + 5.04. According to result of re-
gression, factors significantly affecting the increase of 6MWT distance are age and DM,
whereas the value of BMI does not significantly affect the increase of 6MWT. A one year
addition of age reduces the increase of distance by 2.54 (p-value ¼ 0.000) and DM risk
factor significantly reduces the increase of distance by 43.60 meters (p-value ¼
0.000),meaning that patients with DM have increase of 6MWT shorter than patients
without DM by 43.60 meters.
Conclusion: In this study we found that there was a significant difference in terms of
functional capacity using six minute walk test before and after 6MWT in CAD patients
after CABG surgery with decrease ejection fraction. Eldery and Diabetes Mellitus groups
found to have lower improvement in six minutes walk test after cardiac rehabilitation.
Keywords: Cardiac rehabilitation † six minute walk test
Association of postoperative hyperglycemia with in-hospital mortality in patients
undergoing on pump coronary artery bypass grafting
D. Yulianda, T.W. Siagian, M. Nasri, J. Sugandi, Marshal, D. Pohan, Z. Mukhtar, and
A.A. Siregar
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Sumatera Utara/Adam Malik Hospital, Medan, Indonesia
Background: The roles of postoperative hyperglycemia and diabetes in the risk stratifi-
cation of patients undergoing on pump coronary artery bypass graft surgery are unclear.
The aim of this study is to explore the association of postoperative hyperglycemia with
in-hospital mortality.
Methods: This was a retrospective study of 64 patients who undergoing on pump CABG
between January 2012 – June 2015 at Haji Adam Malik General Hospital. The studied
patients were divided into two groups according to the level of serum blood glucose. Post-
operative hyperglycemia defined as increase of serum blood glucose . 180 mg/dl after
CABG procedure. All patients were investigated for in-hospital mortality after on pump
CABG. Data were analyzed with SPSS version 17.0 software and presented in percentage.
Univariate analysis was performed and p value , 0.05 was considered to indicate statis-
tical significance.
Result: There were 42 patient with postoperative serum blood glucose . 180 mg/dl. A
total of 19 patients died during hospitalization (29.7%). Mortality was significantly higher
in the hyperglycemic population (odd ratio 6.800; 95% CI 1.402 – 32.972; p ¼ 0.009).
Conclusion: Postoperative hyperglycemia is associated with increased in-hospital mor-
tality after on pump coronary bypass graft surgery.
Keywords: postoperative † hyperglycemia † hospital mortality † diabetes † on
pump CABG
A comparison successful reperfusion with and without fibrinolytic therapy in acute
ST-segment elevation myocardial infarct patients
D. Ashrinda 1, M. F. Sarahazti1, M. Komaria1, Z. Syahputra 1, E. Hasibuan1, Z. Mukhtar 2,
I. N. Kaoy2, and A.A. Siregar 2
1
Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia
Background: Patients with acute ST-Elevation Myocard Infarct (STEMI) who present onset
12 hours of symptom, should receive coronary reperfusion therapy, either primary percu-
taneous coronary intervention (PCI) or fibrinolysis. Intravenous fibrinolytic agents are the
most widely used for reperfusion of vessel thrombus occlusion. It remains an important
therapeutic modality, due in part to limited availability of primary PCI, and an experi-
enced operator. Successful reperfusion after fibrinolytic therapy proved by coronary
angiography, as TIMI Flow 2/3. TIMI flow 2/3 was also associated with decreased incidence
of recurrent chest pain, heart failure and mortality than without reperfusion therapy.
Methods: This was a cohort retrospective study, from January 2014 to December 2015, we
found 69 patients with STEMI onset less than 12 hours who came to Adam Malik General
Hospital, 31 patients got fibrinolytic agent (case) and 38 patients did not get fibrinolytic
agent (control). All of the patients got five days of anticoagulant. Then the TIMI Flow was
assesed.
Results: From fibrinolytic group, we found 5 (9.9%) patients with TIMI flow 0/1 and 26
(55.3%) patients with TIMI flow 2/3. In the non fibrinolytic group 17 (77.3%) patients
had TIMI flow 0/1 and 21 (44.7%) patients had TIMI flow 2/3 (spontaneus reperfusion).
Statistical analysis (Pearson Chi-square), successful reperfusion result from two groups
was significant difference, p ¼ 0.01, Fisher’s exact test found 95% Confidence Interval
(1,33 - 13,30). For long term follow up, there were no difference from two groups in re-
current chest pain, heart failure, and mortality.
Conclusion: Fibrinolytic therapy had better successful reperfusion (TIMI flow 2/3).
However, successful reperfusion did not influence in events of episode in recurrent
chest pain, heart failure and mortality.
Keywords: STEMI † fibrinolytic † angiography † TIMI Flow
 B28
Factors influencing ventricular function in repaired Tetralogy of Fallot
(mid-term evaluation)
D. Paramita, I. Uddin, A. Priyatno, and S. Rifqi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro Univer-
sity - dr. Kariadi Central General Hospital Semarang
Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart
defect. Total corrective surgery on has been shown to increase survival rate among
patients, nevertheless the morbidity and mortality rate is still high in repaired TOF,
due to impaired left and right ventricular function. The aim of this study was to evaluate
factors influencing mid-term ventricular function in repaired TOF.
Methods: A retrospective cohort study was performed in DR. Kariadi General Hospital Se-
marang in TOF patients underwent total corrective surgery in National Cardiovascular
Center Harapan Kita in 2008-2013. Data from medical records, cardiac catheterization
and surgery report were obtained, and patients underwent echocardiography examin-
ation to evaluate left and right ventricular function. Statistical analysis was done using
Fisher-exact test.
Result: There were 10 subjects fit the inclusion criteria, with 5 patients (50%) had
impaired left ventricular function, and 6 patients (60%) had impaired right ventricular
function. Factors influencing left ventricular function were age at operation more than
10 years old and previous BT shunt. While no factors influencing right ventricular func-
tion were found significant. Other factors such as left ventricular end diastolic volume
index, the use of transannular patch, CPB duration more than 120 minutes dan AoX more
than 90 minutes could not be excluded yet as risk factors for impaired both ventricular
function.
Conclusion: Factors influencing left ventricular function in mid-term evaluation were
age at operation more than 10 years old and previous BT shunt in patients with smaller
pulmonary arteries size compared to half size. While no factors influencing right ven-
tricular function were found significant.
Keywords: tetralogy of fallot † total corrective surgery † impaired left ventricular
function † impaired right venticular function
Correlation between tricuspid regurgitation duration with right ventricular
dysfunction in atrial septal defect patients
D. Krisnawati, D.W. Anggrahini, and L. Krisdinarti
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada
University, Yogyakarta
Background: Patient with uncorrected atrial septal defect often complicated with right
ventricular dysfunction and pulmonary arterial hypertension. A decrease in the duration
of tricuspid regurgitation corrected for heart rate (TRDc) has recently been shown to be
associated with advanced right ventricular failure in patients with pulmonary arterial
hypertension. The aim of the present study was to investigate whether TRDc correlates
with right ventricular dysfunction parameter assessed using echocardiography in
patients with atrial septal defect (ASD).
Methods: We conducted a cross sectional study between September 2012- November
2015. We enrolled 54 patients with ASD. We used tricuspid annular plane systolic excur-
sion (TAPSE) as parameter of right ventricular function. Tricuspid regurgitation duration
corrected for heart rate and TAPSE were measured on echocardiography. Tricuspid regur-
gitation duration was defined as the time between the onset and the cessation of tricuspid
regurgitation flow. Tricuspid regurgitation duration was corrected for heart rate using
p Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University,
correction formula: TRDc ¼ TR duration / RR interval. RR interval was measured in
seconds using electrocardiographic tracing.
Results: Fifthy- four consecutive patients with ASD (41 females (75,9%) and 13 males
(24,1%), mean age 37 + 14 years) underwent echocardiography. The mean TRDc and
TAPSE were 491.07 + 55.79 ms and 22.98 +5.84 mm, respectively. The correlation
between TRDc and TAPSE was assessed using linear regression analysis using SPSS 20.
Tricuspid regurgitation duration corrected for heart rate was not correlated with
TAPSE (r ¼ -0.136, p¼ 0.328) in atrial septal defect patients.
Conclusion: Tricuspid regurgitation duration corrected for heart rate was not correlated
with right ventricular dysfunction in patients with atrial septal defect.
Keywords: Atrial septal defect † tricuspid regurgitation duration † right ventricular
function
The effect of therapy Spiritual Emotional Freedom Technique (SEFT) changes
on blood pressure in elderly hypertension experience in Rejosari Karangan
Trenggalek 2015
D.S. Wijaya
Brawijaya University, Malang, Indonesia
Background: Period elderly is the last period of human development. Where a person has
decreased physical function and social in nature. One method to treat hypertension that
is the method of Spiritual Emotional Freedom Technique (SEFT) is by tapping on the 18 key
points along the body’s 12 energy pathways. This study aims to determine the effect on
blood pressure SEFT method especially in the elderly with hypertension in the Rejosari
Karangan Trenggalek Year 2015.
Methods: The method used is pre experiment with one group pretest posttest design.
The level of blood pressure before and after the therapy is given in the measure for 6
sessions in 2 weeks. That each session takes 20 minutes and blood pressure measured
again. Sampling is done by simple random sampling with a sample of 16 people. Analysis
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Abstracts
of data using Shapiro Wilk test Paired T Test and analyzed using computer software
obtained results r value (0,000) , (a ¼ 0.05).
Result: These results indicate that SEFT therapy effective in lowering blood pressure.
The analysis results showed that the therapy SEFTeffectively to changes in blood pressure
with values (r value ¼ 0.000).
Conclusion: Therefore SEFT therapy can be used as alternative therapy to lower blood
pressure in elderly hypertensive patients. By doing non-pharmacological therapy is
expected to reduce the patient’s physical complaints and can enrich the knowledge
and skills.
Keywords: Hypertension † SEFT † Elderly
Hyponatremia as a predictor of rehospitalization in patients with acute
decompensated heart failure
D.R. Desandri, D.K. Firmansyah, R.S. Pratikto, B.B. Siswanto, N. Hersunarti, and
A.M. Soesanto
Department of Cardiology and Vascular Medicine Universitas Indonesia, National
Cardiovascular Center Harapan Kita
Background: Hyponatremia is known as one of the predictor of mortality in patients ad-
mitted with acute decompensated heart failure (ADHF). Whether this factor is a predict-
or of ADHF rehospitalization is not well established.
Methods: Cross sectional study were conducted from January until August 2015 in
National Cardiovascular Center Harapan Kita, Indonesia. We collected 1153 ADHF
cases of all causes from 969 adult patients who were admitted from emergency
room. We evaluated baseline demographic characteristics, serum sodium level, osmo-
lality, comorbid factors (such as coronary artery disease (CAD), diabetes mellitus (DM),
hypertension, chronic kidney disease (CKD), atrial fibrillation (AF)), and the risk of
rehospitalization within eight months. Rehospitalization is defined as more than
one admission during follow up period. We calculated the risk of rehospitalization
associated with serum sodium on admission and other comorbid factors using bivariate
analysis.
Result: The median length of stay is six days, median age is 60 years old.
Hyponatremia was found in 312 patients (32%), 61 of them (5.3%) was true hyponatre-
mia (hypoosmolar hyponatremia). During eight months follow up, there were 124
patients (13%) rehospitalized at least once. Hyponatremia increases the risk of rehos-
pitalizatio with odds ratio 2.38 (95% confidence interval 1.63 – 3.49, p , 0.001).
Other comorbid factors, such as CAD (p 0.773), DM (p 0.574), hypertension (p 0.894),
CKD (0.422), AF (p 0.673) have no relationship with the risk of rehospitalization
based on bivariate analysis.
Conclusion: Acute decompensated heart failure with hyponatremia has two times
increased risk of rehospitalization compared to patients with normal sodium level.
Keywords: hyponatremia † rehospitalization † acute decompensated heart failure
Effect of sildenafil therapy to functional capacity in congenital heart disease
patient with severe pulmonary hypertension in Sardjito Hospital
D. A. Kusumastuti 1, D. W. Anggrahini 1, L. Krisdinarti2, and I. A. Arso 3
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah
Mada University, Yogyakarta, Indonesia, 2Echocardiography Division, Department of
Yogyakarta, Indonesia, 3Prevention and Rehabilitation Division, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogya-
karta, Indonesia
Background: Sildenafil therapy was given as therapy to congenital heart disease patient
with severe pulmonary hypertension. In some study, sildenafil is associated with improv-
ing exercise capacity in Eisenmenger syndrome patient. This study was designed to evalu-
ate functional capacity by six minute walk test in patient with severe pulmonary
hypertension due to congenital heart disease who get sildenafil therapy.
Methods: A retrospective cohort study was established between November 2014 – De-
cember 2015 in Sardjito Hospital. We enrolled patients with severe pulmonary hyperten-
sion due to congenital heart disease, as diagnosed with echocardiography, who get
sildenafil therapy. Functional capacity then measured by six minute walk test before
given sildenafil and evaluated 3 months after therapy. Echocardiography was also done
before therapy and 3 months after therapy.
Results: 24 patients (mean age 36.79 + 11, 100% female, 23 ASD secundum, 1 PDA) were
recruited. After 3 months evaluation, there was improvement in six-minute walk test dis-
tance (334.83 + 49.59 meters to 358.47 + 79.20 meters, p¼ .0.05), decreased of tri-
cuspid valvular gradient (TVG) (87.17 + 31.98 mmHg to 85.13 + 28.69 mmHg, p¼
.0.05), decreased right ventricular systolic pressure (RVSP) (92.17 + 32.3 to 89.33 +
28.69 mmHg, p¼ .0.05) but decreased of oxygen saturation (94.38 + 4.61% to
92.46 + 5.97%, p¼ .0.05) but all not statistically significant.
Conclusion: In congenital heart disease patient with severe pulmonary hypertension,
there is a trend of increased walking distance from six-minute walk test and decreased
of TVG and RVSP after 3 months treatment. Longer time of follow up maybe needed to
determine the effect of sildenafil therapy to exercise capacity in congenital heart
disease patient with severe pulmonary hypertension.
Keywords: Congenital Heart Disease † Pulmonary Hypertension † Sildenafil †
Six-minute walk test
 Abstracts B29

Eisenmenger syndrome is more prevalence in young female patients with
uncorrected atrial septal defect: Result of a single-center registry
D.W. Anggrahini, A.B. Hartopo, and L. Krisdinarti
Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada/RSUP dr.
Sardjito, Yogyakarta, Indonesia
Introduction: Eisenmenger syndrome (ES) is the most advanced form of PAH related to
congenital heart disease. The natural history of ASD rarely causes PH, thus ES in ASD
often questionable as natural history or the PAH with ASD coincidence. Our hospital
based registry, however, showed that among adult patients with uncorrected ASD, 69%
were suffer from PH with various degrees. Therefore, in this study we aim to report
the prevalence and characteristics of ES among ASD patients.
Methods: We performed a single-center registry of adult patients with uncorrected ASD
in RSUP dr. Sardjito since 2012. The diagnosis of Eisenmenger Syndrome was performed
using criteria of having bidirectional/right-to-left shunt with resting sianosis.
Results: One hundred eighty four adult patients with uncorrected ASD from the
hospital-based registry in Sardjito Hospital were analyzed. The mean age of the
patients was 36.3 + 12.9 year-old. The prevalence of ES was 31 (16.1%) patients. 30
of them are having secundum type ASD and only 1 patient has multiple ASDs. The
mPAP of ES patients was 65 + 16.8mmHg; mean PVRI was 10.8 + 1.2 WU; and Qp/Qs
was 0.84 + 1.1. Furthermore, ES was significantly associated with younger age,
female, lower SpO2, lower 6MWD, higher mPAP, and TVG as compared to other non
PH and PH patients. Interestingly, the ES was more prevalence in young female age
20-40 y.o as compared to the older ones or to male patients (73.4%vs26.9%, p ,
0.05). Moreover, they had similar defect size (2.4 + 0.6vs2.5 + 0.7mm) showing that
the occurrence of ES was not associated with ASD size.
Conclusion: We reported that the prevalence of ES among uncorrected adult ASD
patients was high and independent of defect size. Given that the incidence of ES was
in younger female, the nature of ES among ASD were needed further study of genetic
background or other factors for excluding other type of PAH.
Leuko-glycemic index as an in-hospital prognostic marker in patients with
ST-segment elevation myocardial infarction in Haji Adam Malik General Hospital
E. Hasibuan1, Z. Syahputra 1, M. F. Sarahazti1, D. Ashrinda 1, D. Komaria1, A. Sitepu2,
H. Hassan 2, and A. A. Siregar2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia
Background: Blood glucose and white blood cell count on admission have demonstrated
prognostic significance in patients with myocardial infarction; leuko-glycemic index
(LGI), a recently proposed marker, still lacks enough knowledge about its value. The
aim of this study was to analyze the prognostic value of LGI in patients with ST-elevation
myocardial infarction (STEMI).
Methods: A retrospective study was carried out in 88 patients with ST-segment
elevation myocardial infarction, who were admitted on January to October 2015 in
Haji Adam Malik General Hospital. Clinical and laboratory data were collected, in-
cluding glucose and white blood cell count on admission, we calculated the LGI, then
divided LGI into two groups according to the median value of LGI and evaluated the
prognostic value.
Results: LGI was correlated with several variables such as KillipIII-IV (r¼ 0.623, p ,
0.001), heart rate on admission (r¼ 0.235, p ¼ 0.027) and sistolic blood pressure on ad-
mission (r¼ -0.429, p , 0.001). Patients who had a poor outcome such as death and Killip
III-IV showed higher values of LGI (p , 0.001). In multivariate analysis, LGI was an inde-
pendent predictor for death (OR 0.023, 95% CI 0.003-0.215, p ¼ 0.001).
Conclusions: The LGI was an independent predictor for adverse outcome in STEMI
patients (death or Killip III-IV), adding prognostic value to the TIMI risk score.
Keywords: Myocardial Infarction † leuko-glycemic index
during hospitalization. Statistical analysis used is descriptive analysis of univariate and
bivariate with Chi Square test, considered significant if p ,0.05.
Results: Obtained 80 subjects with acute coronary syndrome patients, Mean of Level
uric acid was 8.6 mg / dl. In this study, subjects with high uric acid levels get complica-
tions of pulmonary edema 25% subjects, 18.18% heart failure, cardiogenic shock 4.55%,
9.09% and arrhythmias. Medium In the group of high uric acid did not experience com-
plications of pulmonary edema 19.44%, 11.11% heart failure, cardiogenic shock,
arrhythmias 0% and 5.56%. Statistical analysis show that no significant association
between uric acid levels with the incidence complications of acute coronary syndrome
(p. 0.05).
Conclusion: In this study, subjects with high uric acid levels, had higher incidence of com-
plications, but statitistik meaningless.
Keywords: Levels of uric acid † Incidence of Complications † Acute coronary syndrome
Anticoagulant therapy in heart failure patients with sinus rhythm
F.P. Apriansyah, B.B. Siswanto, B.B. Rizki, Y. Iskandar, F. Tedjasukmana, R.S. Pratikto,
N. Hersunarti, and A.M. Soesanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indo-
nesia National Cardiovascular Center Harapan Kita, Jakarta
Background: Anticoagulant treatments in heart failure (HF) patients in the absence of
atrial fibrillation (AF), intra-cardiac thrombus and venous thromboembolism (VTE)
remain controversial. However, the prevalence of patients who received this treatment
is quite high. The objective of this study is to figure out the prevalence of oral anticoagu-
lant (OAC) treatments and which factors that might influence the decision to give OAC
therapy in such patients.
Methods: We performed a cross sectional study based on 2012 HF registry conducted in
National Cardiovascular Center Harapan Kita, Indonesia. Only sinus rhythm patients
were selected, with no other indications for OAC, such as intra-cardiac thrombus, pros-
thetic valves, or VTE. We compare patients who received OAC to the remaining
patients.
Results: Five hundred forty four patients were included, of which 71% were male and
mean age was 61 years. Ischemic etiology was reported in 63% patients. Twenty four
percent patients were admitted for de novo HF and 76% for chronic HF. Mean ejection
fraction (EF) was 37%. The most frequent comorbidity was hypertension found in 63%
patients, followed by diabetes (47%) and chronic kidney disease (30%). Mean length of
stay was 5.9 days. More than 25% of patients were treated with OAC. Multivariate analysis
revealed that elderly (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.404-0.895),
EF ≤ 35% (OR 2.11; 95% CI 1.358-3.289), and functional class III-IV (OR 2.5; 95% CI
1.327-4.723) were factors that influence the decision to give OAC.
Conclusions: There are more than 25% of HF patients received OAC therapy despite lack
of indication. Lower EF and more advanced disease were the main factors in deciding
whether to give anticoagulant therapy. Paradoxically, those who received OAC had
lower prevalence of hypertension and diabetes, well-known factors associated with
high risk of thromboembolism.
Keywords: Heart failure † sinus rhythm † oral anticoagulant

Serum uric acid levels as predictors of incident complications in acute coronary

syndrome
E. Marfianti1 and U. Setiasih 2
1
Department of Internal Medicine, Faculty of Medicine, Islamic University of Indonesia
Yogyakarta Indonesia, 2Faculty of Medicine, Islamic University of Indonesia Yogyakarta
Indonesia
Background: Cardiovascular disease is the highest cause of morbidity and mortality. One of
the important cardiovascular disease is a disease of acute coronary syndrome. The role of
serum uric acid as a risk factor for cardiovascular disease remains controversial, and not
much is known that serum uric acid as a prognostic factor of disease mortality in congestive
heart failure and stroke. Several studies have reported an increase in serum uric acid levels
associated with the progression of the disease acute coronary syndrome.
Objective: To determine whether uric acid levels are predictors of complications in the
acute coronary syndrome.
Methods: The study design was cross-sectional. Data was collected with consecutive
sampling method of medical record patients with acute coronary syndrome in PKU
Muhammadiyah Yogyakarta Hospital and Gramedika Hospital . Acute coronary syndrome
patients are patients with a diagnosis of angina pectoris unstable, acute myocardial in-
farction (myocardial infarction with ST-elevation and myocardial infarction without
ST-elevation. Uric acid levels used are uric acid levels were first measured when entering
the hospital. Complications of acute coronary syndrome note of complications that occur

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Epicardial fat thickness is related to the blood pressure response abnormalities Results: Thirty patients were enrolled in this study. The mean ages was 29.5 + 6,4 years
in exercise stress testing old. FMD was improved after delivery, 5.46 + 0.27 % (before delivery) & 8.14 + 2.48 % (
p ,0.001) 40-60 days after delivery. Bivariates analysis showed that after delivery,
F. Anditasari, P. Kabo, and I. Mappangara
there was an inverse correlation between UPCR with FMD (r ¼ -0,735 p, 0,0001).
Department of Cardiology and Vascular Medicine, Hasanuddin University, Makassar
UPCR prior to delivery also has inverse correlation with FMD after delivery (r¼
Background: Blood Pressure response abnormalities on exercise stress testing known as -0.55.p ¼ 0.002) and with the change of FMD before and after delivery (r¼ -0.45 with
risk factors for future onset of hypertension, where epicardial fat, a new cardiometabolic p ¼0.01). Multivariate analysis showed that correlation between UPCR after delivery
risk factor, associated to hypertension in various recent studies. In this study, we tested with FMD after delivery was independent.
the primary hypothesis suggesting that the epicardial fat thickness (EFT) is related to Conclusion: This study demonstrated there was moderate-strong correlation between
altered BP responses to treadmill exercise testing. We also evaluated the sensitivity urinary protein prior and after delivery with flow mediated vasodilatation of brachial
and specificity of the EFT as a predictor of hypertensive response to peak exercise. artery after delivery.
Methods: Normotensive subjects underwent to treadmill stress testing and transthoracic Keywords: preeclampsia † endothelial dysfunction † FMD † urine protein-creatinine
echocardiography. BP abnormality defined as either, hypertensive response defined as ratio
BP ≥ 210/105 mmHg and ≥ 190/105 mmHg at peak exercise in males and females, re-
spectively or BP recovery index (BPRI) .0,91. Twenty-eight subjects with hypertensive
response constituted Group 1 and 20 subjects into Group 2.
Results: The mean EFT of subjects with abnormality of BP was significantly higher (
7,09 + 1,51 mm vs 5,05 + 1,43 mm; p ¼ 0,0001). In correlation analysis, EFT found sig-
nificantly correlated with BPRI and Peak SBP (p , 0,05). An EFT of ≥ 5,15 mm predicted
the BP abnormality to peak exercise with 92,9% sensitivity and 65% specificity (95% CI:
0,714- 0,949, p , 0,001). Based on the futher linear analysis BPRI and Peak SBP were
the only independent variables related to EFT.
Conclusions: EFT was found to be related to altered BP responses to exercise stress
testing. The echocardiographic measurement of EFT may serve as a useful non-invasive
indicator of heightened risk of future hypertension.
Keywords: Hypertension † epicardial fat † exercise test † echocardiography
Figure 1 Boxplots of mean differences of FMD prior to delivery, 48 hours after delivery and
Remote ischemic conditioning prior to primary percutaneous coronary 40 –60 days after delivery (There were statistically significant differences of mean of FMD
intervention: The effect on Six Minutes Walk Test distance and serum among all of time measurements from reapated ANNOVA and post hoc analysis, but dif-
NT-ProBNP level ferent of means of FMD between prior delivery and 48 hours after delivery was
clinically not significant)
F. A. Muslim, L. N. Waliy, S. Soerianata, B. Radi, and A. M. Soesanto
Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indo-
nesia, Nasional Cardiovascular Center Harapan Kita
Background: Reperfusion injury has been recognized to cause cell damage and death. As
consequence, it contributes about 50% of infarct size. Remote ischemic condiotioning
(RIC) has been identified as a noninvasive, low-cost, and easy to performed method to
prevent it, so cardioprotective effect such as reducing infarct size and ventricular con-
traction improvement could be achieved. Meanwhile, myocardial function can be clinic-
ally assessed bymeasuring 6 minutes walk test (6MWT) and serum NT-proBNP level. Many
studies showed association and correlation between 6MWT, NT-proBNP level and infarct
size and myocardial function.
Aims: To assess the effect of remote ischemic conditioning in ST-Elevation Myocardial In-
farction (STEMI) patients prior to primary percutaneous coronary intervention (PPCI) to
their 6 MWT distance and serum NT-proBNP level.
Methods: Eighty seven subjects were randomly assigned into 2 groups, those receiving
RIC intervention (4 to 5 minutes cycles of cuff inflation/deflation on lower extremity)
or control (uninflated cuff for 40 minutes) protocols prior to primary PCI. All subjects
underwent 6MWT and NT-proBNP level evaluation, before discharge from hospital.
Results: 6MWT distance was not significantly different between RIC group compared to Figure 2 Scaterred plots of corelation between urine-protein creatinin ration 40 – 60 days
control group (316 +46 m vs. 289 + 66 m, p ¼ 0.06 [CI: -0.6 – 55.1]). However, serum after delivery with fMD (%) 40 –60 days after delivery. (Spearman test for bivariate corrla-
NT-ProBNP level was significantly lower in RIC group compared to control group (1073 tion showed strong inverse correlation between them with r = 0.735 and p , 0.001 and
(328-3974) pg/mL vs. 1514 (205-10696) pg/mL, p¼ 0.05 ). multivatiate analysis with linear regression showed at 40 – 60 days UPCR has independent
Conclusion: RIC intervention did not improve 6MWTcompared to control group. However, correlation with FMD adjusted R square was 0.60)
serum NT-ProBNP level was significantly lower in RIC group compared to control group.
Keywords: reperfusion † myocardial reperfusion injury † remote ischemic condition-
ing † six minutes walk test † NT-proBNP
Impact of high hsCRP level on adverse cardiovascular events and mortality in
ST-elevation acute myocardial infarction undergoing fibrinolysis
Correlation between urinary protein and vascular dysfunction before and after
Faizin 1, A.B. Hartopo 1, I. Puspitawati2, N. Taufiq1, and B.Y. Setianto1
Delivery in preeclamptic women 1
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah
F. Habib1, F. Shahab 1, I. Sunu 1, J. Sedyawan1, H. Sjarbaini2, and A. M. Soesanto 1 Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia, 2Department of Clinical Pathology
1
Department of Cardiology & Vascular medicine, Faculty of Medicine Universitas Indo- Faculty of Medicine Universitas Gadjah Mada - Dr. Sardjito Hospital Yogyakarta, Indonesia
nesia /National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, 2Department
Background: Plaque rupture is an active process and inflammatory component appears to
of Obstetry and Gynecology, Woman and Children Hospital of Harapan Kita, Jakarta,
be associated with the development of acute coronary syndrome (ACS). C-reactive protein
Indonesia
is an acute phase protein that appears in the circulation in response to inflammation.
Background: Endothelial dysfunction was associated with both of the predisposition of Aims: To investigate the association between high sensitivity C-Reactive potein (hsCRP)
preeclampsia and the later development of vascular disease. Flow mediated vasodilation on predicting in-hospital mortality in patients with ST-elevation myocardial infarction
(FMD) was reduced in preeclamptic women and persist after delivery in several cases. (STEMI) undergoing fibrinolysis.
Proteinuria in preeclampsia was also a manifestation of endothelial dysfunction in Methods: This is a cohort study including 54 patients with STEMI and threated with fibrin-
kidney, but there was no data untill now showing the correlation of FMD and the level olysis. The exclusion criteria are chronic kidney disease, chronic heart failure, acute in-
of proteinuria in preeclamptic woman. fection, acute stroke and preadmisi reperfusion. The hsCRP is measured from peripheral
Aim: To asses the correlation between urine protein-creatinine ratio and flow mediated blood taken on admission, before fibrinolysis is performed and patients are allocated into
dilation (FMD) before and after delivery in preeclamptic women. two groups, i.e. high hsCRP and low hsCRP based on median value. Assessment after fi-
Methods: Women with a diagnosis of preeclampsia and planned for termination were en- brinolysis and observation during intensive hospitalisation is conducted. The incidence
rolled for the study. History of hypertension before 20 weeks of gestation, diabetes mel- of failed fibrinolysis, major adverse cardiovascular events and mortality between
litus, chronic kidney disease became exclusion criterias. The FMD was studied through groups is compared. Chi-square is performed for statistical analysis. A p value , 0.05 is
the use of high resolution vascular ultrasound examination of brachial artery for 3 determined as statistical significance.
times; before delivery, 48-72 hours after delivery and 40-60 days after delivery. Urine Results: The median hsCRP level is 0.265 mg/l. Of 54 patients who undergoing fibrinoly-
protein-creatinine ratio (UPCR) was measured twice; prior to delivery and 40-60 days sis, 13 patients are failed. High hsCRP group has similar incidence of failed fibrinolysis as
after delivery. Correlation between them was then evaluated. compared with low hsCRP group. The incidence of major adverse cardiovascular events is

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 Abstracts
also comparable between group. The mortality is significantly higher in high hsCRP group
as compared to low hsCRP,i.e 37 % versus 11,1 %, p ¼0.027.
Conclusion: High sensitivity C-Reactive potein (hsCRP) does not influence the fibrinolysis
outcome and major adverse cardiovascular events but increases mortality rate following
STEMI undergoing fibrinolysis.
Keywords: hsCRP † STEMI † fibrinolysis † adverse cardiovascular events
Correlation between baseline soluble ST2 and global longitudinal strain 2D Speckle
tracking echocardiography with left ventricle remodeling post acute myocardial
infarction
F. S. Hasibuan and M. Aminuddin
Departement of Cardiology and Vascular Medicine, Soetomo General Hospital-Faculty of
Medicine, University of Airlangga, Surabaya, Indonesia
Background: Left Ventricle remodelling is the most prognostically consequence of acute
myocardial infraction (AMI). Soluble ST2 is a novel biomarker for myocardial fibrosis and
also LVremodelling. Global longitudinal Strain (GLS) reflects subendocardial longitudinal
layer of heart muscle is impaired at the early phase of ischemia, and confirmed a predict-
ive role of LV remodelling following AMI.
Methods: This is an analytic observasional pra experimental study with one group pretest
and posttest design. Fourty five (45) patients of AMI during August until December 2015
from ICCU and cardiology ward were analyzed and followed up after therapy for
12 weeks. Soluble ST2 and Global Longitudinal Strain (GLS) were measured after AMI
(2-5 days after AMI) and 12 weeks after therapy. Mann Whitney U Test is used to
examine the difference between subject with LV remodelling and no LV remodelling.
Spearman correlation is used to examine correlation between soluble ST2 and GLS,
with LV remodeling.
Results: There were 45 subjects, 82.2% males and 17.8% females. Proportion of AMI was
84.4% STEMI and 15.6% NSTEMI. There were 27 subject (60%) with LV Remodelling founded
after AMI. There were significant difference of LVEDV baseline 76 + 29.69 ml/m2 become
98.11 + 36.84 ml/m2 after 12 week follow up (p ¼ 0.003) and LVESV baseline 40.89 +
23.89 ml/m2 become 51.96 + 26.43 ml/m2 after 12 weeks follow up (p ¼ 0.006) .
There were strong correlation between high baseline soluble ST2 and D ST2 with LV re-
modelling (p ¼ 0.0001 r ¼ +0.723) and (p ¼ 0.0001 r ¼ +0.639) using Spearman correl-
ation test. There were correlation between low baseline GLS with LV remodelling (p ¼
0.015 r ¼ +0.362).
Conclussion: LV remodelling is found relatively significant number after AMI, high base-
line soluble ST2 and low GLS may provide important predictive value in LV remodelling
Keywords: Left Ventricle Remodelling † soluble ST2 † GLS † post AMI
Difference of peripheral P Selectin level between univalvular and multivalvular of
rheumatic heart disease
F. Filianovika, A. Lefi, and R. Romdoni
Departement of Cardiology and Vascular Medicine, Soetomo General Hospital, Airlangga
University, Surabaya, Indonesia
Background: Rheumatic Heart Disease (RHD) was sequelae of acute rheumatic fever,
bacterial infection Group A beta Hemolitiycus streptococci (GAS) in the pharynx,
lesions of heart valves progressive and permanent, cause of morphological changes
and hemodynamic causing damage Endothelial and increased platelet activation, illu-
strated with elevated levels of P selectin
Objective: To prove the existence of a comparison between the levels of P selectin of per-
ipheral blood in multivalve and univalve (mitral stenosis) in rheumatic heart disease
Methods: The study was observational analytic cross sectional shape There are 37 patient
samples were analyzed RHD, where the group univalve (mitral stenosis) and multivalve
respectively 18 and 19 people with 22 healthy controls. Samples obtained from the
poly P selectin heart, space echocardiography, and cardiac inpatient room, while the
patient is diagnosed RHD, through echocardiography. a comparison between two vari-
ables using comparison test independent sample t-test to determine differences in
average levels of P selectin of peripheral blood between two variables with an estimated
risk and a value of p , 0.05 was considered statistically significant.
Results: Peripheral P selectin in multivalve group was higher than univalve group
(2,384 ng/mL vs 2,028 ng/mL; r , 0,05).
Conclusion: High levels of peripheral P selectin in rheumatic mitral stenosis heart
disease due to ongoing chronic inflammation in these patients. This study proves that
there is a difference of peripheral blood levels of P selectin between multivalve with uni-
valve (mitral stenosis). P selectin plays an important role in relation multivalve and uni-
valve (mitral stenosis) rheumatic heart disease.
Keywords: Peripheral P selectin † rheumatic heart disease † univalve (mitral stenosis)
† multivalve
Correlation between the severity of hyperthyroidism with increased of systolic
blood pressure in hyperthyroidism patients
Firdawati1, Purnawarman 1, and Krishna W. Sucipto 2
1
Department of Cardiovascular Medicine dr.Zainoel Abidin General Hospital / Faculty of
Medicine Syiah Kuala University, Aceh, Indonesia, 2Divison of Endocrinology Metabolism &
Diabetic, Department of Internal Medicine, Faculty of Medicine dr.Zainoel Abidin
General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia
Background: Hyperthyroidism (an overactive thyroid gland) is a condition in which
excess thyroid hormone is produce and change hemodynamic system. Hyperthyroidism
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increases systolic blood pressure by decreasing systemic vascular resistance, increasing
heart rate, and raising cardiac output. In diagnosis of hyperthyroidism FT4 laboratory
measurement is to assess severity. The purpose of this study is to determine the correl-
ation between the severity of hyperthyroidism with increased systolic blood pressure
in patients with hyperthyroidism.
Methods: A cross sectional study was done on 33 accidental hyperthyroidism patients visit-
ing endocrine outpatient clinic of dr. Zainoel Abidin General Hospital, Banda Aceh in
November 2015. The severity was available by free thyroxine (FT4) laboratory measure-
ment using enzyme link fluorescence assay (ELFA) method then classified them into
normal, mild, moderate, and severe levels. The blood pressure measurement was available
in patient’s medical record. Appropriate statical analysis were use to determine the correl-
ation of the hyperthyroid severity and increased of systolic blood pressure.
Result: Study subject were 78.8 % females and 21.2% males. A total of 33 hyperthyroidism
samples mean of systolic blood pressure 129.7 + 9.18 mmHg and mean of diastolic blood
pressure 81.82 + 4.64 mmHg. FT4 by laboratory measurement was 35.46 + 25.02 pmol/
L. Using Spearman’s test, there was a correlation between increased the hyperthyroidism
severity with increased of systolic blood pressure. (r ¼ +0.529; p , 0.05).
Conclusion: The current study revealed a significant correlation between increased the
severity of hyperthyroidism with increased of systolic blood pressure in hyperthyroidism
patients.
Keywords: Hyperthyroidism † Systolic Blood Pressure † FT4
Correlation of red cell distribution width with the severity of coronary artery
disease in patients with stable coronary artery disease
F. Leksmono, P. Kabo, I. Mappangara, and R. Setiadji
Department of Cardiology and Vascular Medicine, Hasanuddin University, Makassar
Background: It has been reported that increased red blood cell distribution width (RDW)
is a marker associated with the presence and adverse outcomes of various cardiovascular
diseases. The aim of the present study was prospectively evaluate the severity of coron-
ary artery disease (CAD) and RDW in a stable coronary artery disease patients.
Methods: A total of 121 consecutive individuals who underwent coronary angiography
due to the presence of angina and diagnosed with stable coronary artery disease were en-
rolled in this study. The clinical information including classical CAD risk factors and RDW
were analyzed to identify their relationship to CAD. The severity of CAD was evaluated by
Gensini score and its relationship with RDW was also analyzed.
Results: There was a significant positive correlation between RDW and the Gensini score
(P ,0.001). In logistic regression analysis, RDW was demonstrated to be an independent
predictor for a higher Gensini score (.13, OR ¼ 1.6, P ,0.001) In a receiver operating
characteristic (ROC) curve analysis, an RDW value of 13.5% was identified as an effective
cut-point in predicting the presence of severe coronary artery stenosis with a sensitivity
of 0.69 and a specificity of 0.52.
Conclusion: RDW is associated with severity of coronary artery stenosis, suggesting that
it might be a readily available low cost marker for the prediction of CAD severity.
Keywords: red blood cell distribution width † coronary artery disease † Gensini score
Chest pain presentation on acute coronary syndrome patients in Dustira Hospital
F.N. Habibi 1, P. Pujowaskito 2, and E. Mansoor3
1
Faculty of Medicine,Jendral Achmad Yani University, Bandung, Indonesia, 2Cardiovascu-
lar Departement Dustira Hospital, Bandung, Indonesia, 3Radiology Departement, Jendral
Achmad Yani University, Bandung, Indonesia
Background: chest pain on Acute Coronary Syndrome (ACS) patients have many variety
symptomps in type and location. This condition cause delay for prompt recognition and
treatment. Delay could impact on the high mortality rate in the world. This study aims
to describe the chest pain symptoms on ACS patients at Dustira Hospital during Septem-
ber to Desember 2011.
Methods: this study was conducted by descriptive method. Data were collected from
medical record and interview hospitalized patients at cardiology departement of
Dustira Hospital. The result was analyzed using SPSS version 20.0 which presented in
the form of graphs and tables.
Results: the result showed patients (43,5%) felt pressure pain, stabbing (38,7%), and
burning sensation (17,7%). Duration of chest pain reported by most of patients (69,4%)
more than 3 hours, lesser than 20 minutes (19,4%), and during 1 until 3 hours (11,3%).
Most of patients (45,2%) have referred pain more than two location, in two location
(14,5%), and only in epigastric region (14,5%).
Conclusion: most of patients felt pressure pain (43,5%). The duration of chest pain most
happened in patients more than 3 hours (69,4%). Most of patients have referred pain more
than two location (45,2%).
Keywords: Acute coronary syndromes † chest pain
Result of exercise stress testing after cardiac rehabilitation program after
coronary artery bypass grafting surgery
F. Handayani1, I.F. Yuwono 1, D.Y. Hasanah2, B. Radi2, A. Meidian 2, A. Santoso2,
D. Kusmana2, and B.S. Purwowiyoto 2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Dipo-
negoro, Semarang, Indonesia, 2Department of Cardiology and Vascular medicine, Faculty
of Medicine Universitas Indonesia- National Cardiovascular Center Harapan Kita, Jakarta,
Indonesia
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Background: Coronary artery bypass grafting (CABG) surgery is an effective treatment of
patients with coronary artery disease. Eventhought 80% of patients are still free from
angina at 5 years and 63% after 10 years, graft occlusion can occurs in 8-12% in first
month. The main aim of the this study is to assess the result of exercise stress testing
after cardiac rehabilitation program for patients after coronary artery bypass graft
surgery.
Methods: We performed a cross sectional study among patients undergoing cardiac
rehabilitation after CABG in National Cardiovascular Center Harapan Kita (NCCHK)
between July until Desember 2014. All patients were undergoing exercise test
with treadmill or ergocycle test after 12 visits of cardiac rehabilitation program with
exercise.
Results: A total 125 patients were included in this study. Of 125 patients, 34 patients
(27.2%) had ischemic response in exercise test. There were 26,4% (n ¼ 33) of patients
that used both saphenous vein and left internal mammary artery, and 0,8% (n ¼ 1)
patients used only saphenous vein as grafts had positive ischemic response (p ¼
0.809). Baseline RPP value in ischemic group was similar with non ischemic group
(9.32 + 0.32 vs 9.61 + 0.21 mmHg beats/min x 10 3 (p ¼ 0.420). Peak RPP value in
both groups was also similar (20.25 + 0.75 vs 20.37 + 0.47 mmHg beats / min × 10
(p ¼ 0.067). There were unsignificant correlation between ischemic response to total
risk factors, ejection fractions, functional class, Mets, exercise duration, grafts type,
number of coronary lesion. There were significant correlation between body mass
index 18.0-22.9 (n ¼ 32, p ¼ 0.029).
Conclusions: There were 27.2% patients with ischemic response on exercise stress
testing after cardiac rehabilitation program, with similar baseline and peak rate pressure
product. Patients with normoweight BMI had significant correlation with ischemic
response.
Keywords: ischemic response † exercise test
Relationship between plasma level of Endothelin-1 with major adverse cardiac
event in ST-elevation myocardial infarction undergoing percutaneous coronary
intervention
G.B. Putra 1, A.B. Hartopo 1, I. Puspitawati 2, N. Taufiq1, and B.Y. Setianto 1
1 the complexity of coronary artery lesions based on SYNTAX Score
Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah
Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia, 2Department of Clinical Pathology
Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta,
Indonesia
Background: Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor
peptide and elevated systemic ET-1 levels predict a poor prognosis in patients with
ST-segment elevation myocardial infarction (STEMI).
Aims: To investigate the relationship between systemic ET-1 plasma levels with major
adverse cardiac events (MACE) in STEMI patients treated with a primary percutaneous
coronary intervention (PCI), .
Methods: This was a cohort study enrolling 69 consecutive patients with STEMI that
undergoing primary PCI. The inclusion criteria were ages 30-75 years and onset , 24
hour. The exclusion criteria were chronic kidney disease, chronic heart failure,
acute infection, and acute stroke. Endothelin-1 was measured from peripheral blood
taken on admission, before primary PCI, with ELISA method. With median ET-1 value
as cut-off to divide patients into two groups, i.e ET-1 supramedian and ET-1 inframe-
dian. Observation during intensive hospital care were done with outcome of interest
was in-hospital MACE (death, acute heart failure, cardiogenic shock and rescucitated
ventricular arrhytmia). The incidence of MACE between these two groups was com-
pared. Chi-square was performed for analysis. A p value of , 0.05 was set as statistical
significance.
Results: Supramedian ET-1 groups (n ¼ 34) had higher MACE as compared with inframe-
dian ET-1 group (n ¼ 35), which is 47.1% versus 22.9% with p ¼ 0,031. The mortality rate
did not significantly differ between these two groups (14,3% versus 14,7% with
p ¼ 0,614). Furthermore, the extent of diseased coronary vessels did not associate
with plasma ET-1 level.
Conclusion: High level of plasma ET-1 associated with higher incidence of MACE in STEMI
patients treated with primary PCI.
Keywords: Endotelin-1 † ST-elevation myocardial infarction † primary percutaneous
coronary intervention † major adverse cardiac event
Controlled clinic blood pressure lowers the risk of left ventricular hypertrophy:
An internship study among hypertensive Indonesians in rural areas
G. Lilihata 1, R. Andriyati 1, C.K. Simanjuntak1, C.T. Handjaya 1, A. Kristanto 2, F.C. Fredy 3,
and D. Pravian 1
1
Tanjung General Hospital, Tanjung, Indonesia, 2Robert Wolter Mongisidi General Hos-
pital, Manado, Indonesia, 3Sangatta General Hospital, Sangatta, Indonesia
Background: Left ventricular hypertrophy (LVH) is a well-known predictor for morbidity
and mortality of hypertension. Studies have showed that LVH is greatly affected by blood
pressure control, and best reflected by ambulatory blood pressure monitoring (ABPM).
However, ABPM and echocardiography are difficult to be performed in rural areas in Indo-
nesia due to lack of health facilities. Although clinic blood pressure (CBP) and electrocar-
diography (ECG) are inferior to ABPM and echocardiography, but they can be used as
alternatives. We sought to evaluate whether CBP correlates with risk of LVH.
Methods: Cross-sectional study was conducted in three primary hospitals in rural areas in
Indonesia, from April to September 2013. Hypertensive patients admitted to ERor outpatient
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Abstracts
were classified into controlled CBP and uncontrolled CBP. Diagnosis of LVH was based on ECG
using combination of five voltage-based and point score criteria (Sokolow-Lyon, Cornell
voltage, Lewis, Minnesota code, and Romhilt-Estes point-score) to increase sensitivity. Bi-
variate and multivariate analysis were performed to evaluate significance between CBP
and electrocardiographic LVH before and after adjusted with other factors.
Result: Of 145 hypertensive patients included (46,2% male; mean age 56 years), 35
patients (24.1%) had controlled CBP. Prevalence of electrocardiographic LVH was 40 %.
LVH was significantly higher in patients with uncontrolled CBP (48,2% vs 14.3% p¼
0.001) than controlled CBP (Odds Ratio 5.5; 95% CI 2.016-15.440). Multivariate analysis
showed that CBP remained significant as predictor for electrocardiographic LVH (OR
3.9, 95% CI 1.228-12.163) after adjusted to duration of known hypertension, smoking,
diabetes, dyslipidemia, and body-mass index.
Conclusion: CBP correlates with risk of LVH. Controlled CBP predicts lower risk of elec-
trocardiographic LVH. CBP can be used as an alternative when ABPM is difficult to be per-
formed in rural areas.
Keywords: Left ventricular hypertrophy † hypertension † clinic blood pressure † am-
bulatory blood pressure monitoring
Correlation of CHA2DS2-Vasc-HS scores with coronary artery lesions complexity
based on SYNTAX score
G.A.R. Prawisanthi and Y.H. Oktaviono
Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Background: CHADS2 (Congestive heart failure, hypertension, age ≥75 years, diabetes
mellitus and stroke), and CHA2DS2-VASc (Congestive heart failure, hypertension, age
≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category)
score are the clinical predictor of the risk of stroke in non-valvular atrial fibrillation,
which consists of the same risk factors for the development of CAD. Therefore, this
score can provide important information about the severity of coronary artery lesions.
To increase the likelihood of determining the CHD severity, CHA2DS2-Vasc-HS is formed
by adding hyperlipidemia (HL) and smoking (S) as well as using the male gender in sex vari-
able category (Sc). The purpose of this study is to describe the mean of SYNTAX score in
CHA2DS2-Vasc-HS score and analyze the correlation between CHA2DS2-Vasc-HS score with
Methods: This is a cross sectional study. Forty-five patients who underwent elective cor-
onary angiography were collected by purposive sampling. CHA2DS2-Vasc-HS scores from
patient risk factors and SYNTAX score from the coronary angiogram were calculated.
Results: The mean CHA2DS2-Vasc-HS score in this study was 4 + 1.34 and the mean
SYNTAX score was 27.47 + 12.47. There is a positive, moderate and significant correl-
ation between CHA2DS2-Vasc-HS score with SYNTAX score, r ¼ 0.682 and p ¼ 0.000 (p
,0.05). Patients with CHA2DS2-Vasc-HS score ≥4 had a mean SYNTAX score. 33. While
patients with CHA2DS2-Vasc-HS score ,4 had a mean SYNTAX score ,22
Conclusion: Patients with CHA2DS2-Vasc-HS score ≥4 had a mean SYNTAX score. 33.
While patients with CHA2DS2-Vasc-HS score ,4 had a mean SYNTAX score ,22. There
were significant, positive and moderate correlations between CHA2DS2-Vasc-HS Score
and SYNTAX score.
Keywords: CHA2DS2-Vasc-HS score † SYNTAX score † the complexity of coronary artery
lesions
The correlation between body mass index and diastolic indices in non-diabetic
hypertensive male subjects
H. A. Kuncoro, J. Winata, I. Suhartono, M. Rotty, K. Elka, S. Widjaja, J. A. Pangemanan,
and A. L. Panda
Department of Cardiology and Vascular Medicine, Faculty of Medicine Sam Ratulangi Uni-
versity, Prof. Dr. R.D. Kandou Manado General Hospital
Background: Obesity is a major public health epidemic and is associated with increased
risk of heart failure and mortality. On the other hand left ventricular diastolic dysfunction
which is usually asymptomatic and associated with future heart failure is still underdiag-
nosed. We evaluated the correlation between body mass index (BMI) and diastolic indices
in non-diabetic hypertensive male subjects.
Methods: The study population consisted of 40 consecutive asymptomatic non-diabetic
hypertensive male, aged 40-60 years old, BMI was calculated by dividing weight in kilograms
by height in meters square (BMI ¼ kg/m2). We performed echocardiography to evaluate dia-
stolic indices. The correlations between BMI and diastolic indices were analyzed.
Results: BMI was associated with higher left ventricular end-diastolic pressure (E/E’)
(r ¼ 0.320, p ¼ 0.044), higher E’/A’(r ¼ -0.433, p ¼ 0.005), higher left ventricular end
diastolic diameter (LVEDD) (r ¼ 0.414, p ¼ 0.008), thicker interventricular septum dia-
stolic diameter (IVSDd) (r ¼ 0.219, p ¼ 0.251).
Conclusion: BMI is significantly associated with E’/A’, E/E’, LVEDD and IVSDd in non-
diabetic hypertensive male subjects.
Keywords: body mass index † diastolic indices † hypertension
Risk of traditional cardiovascular risk factor for the development of erectile
dysfunction in stable coronary artery disease patients
H. Hernawan, I.A. Arso, and E. Maharani
Departement of Cardiology and Vascular Medicine/dr Sardjito General Hospital, Gadjah
Mada University, Yogyakarta
Background: Erectile Dysfunction (ED) is defined as the inability to achieve or maintain
an erection sufficient to permit satisfactory sexual intercourse. Erectile dysfunction
 Abstracts
affects more than 150 million men worldwide and impairs psychological well-being and
personal relationships and hence quality of life. Epidemiological study showed clearly
role of traditional cardiovascular risk factors such as diabetes, hypertension, dyslipide-
mia and smoking in CAD.
Erectile dysfunction and vascular diseases share a similar risk factors and pathogenic
involvement of nitric oxide (NO)-pathway leading to impairment of endothelium-
dependent vasodilatation (early phase) and structural vascular abnormalities (late
phase). This study was conducted to determine whether the stable CAD patients who
have traditional cardiovascular risk factors has a higher risk for ED compared with
stable CAD patients without traditional cardiovascular risk factors.
Method: We performed an age matched-paired case control study. Men with CAD docu-
mented by angiography were evaluated for ED. Erectile function was assessed by a
5-item version of the International Index of Erectile Function (IIEF-5). Traditional cardio-
vascular risk factors such as diabetes, hypertension, dyslipidemia and cigarette smoking
were assesed. Depression and anxiety were screened using Indonesian version of Hospital
Anxiety and Depression Scale (HADS). Basic demographic and other variables were also
collected.
Result: This study evaluated 127 men, 96.8% of them had traditional cardiovascular risk
factors, 25.2% had diabetes melitus, 77.2% had dyslipidemia, 55.9% had hypertension and
64,6% were smoker. Traditional cardiovascular risk factors was strongly associated with
ED (odds ratio [OR] ¼ 10.67 [1.25-232.83]). ED was independently associated with dia-
betes melitus (OR ¼ 4.17[1.14-15.24]), hypertension (OR ¼ 2.64 [1.07-6.49]) and cigar-
ret smoking (OR ¼ 2.26 [1.01-5.75]).
Conclussion: CAD patients with traditional cardiovascular risk factor had more risk for
developing ED than those with no traditional cardiovascular risk factor.
Keywords: erectile dysfunction † stable coronary artery disease † traditional cardio-
vasculars risk factor
Relationship between left ventricle ejection fraction and submaximal exercise
capacity in cardiovascular patients
H.W. Parlindungan, Y. Saragih Y, A.H. Raynaldo, S. Kasiman, A.A. Siregar, and Z. Mukhtar
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
Background: The measurement of left ventricular ejection fraction (LVEF) plays a
key role in many strategies for managing cardiovascular patients. We tested the hypoth-
esis that exercise capacity provides additional information in patients with a low LVEF.
The purpose of this study was to examine the relationship between left ventricular
ejection fraction with distance and metabolic equivalent (METs) in cardiovascular
patients.
Methods: One hundred and thirty all cardiovascular patients were assessed with com-
monly 6-minute walk distance as submaximal exercise capacity measurement in Haji
Adam Malik Hospital Medan. Pretest clinical variables, including age, Body Mass Index
(BMI), and ejection fraction (EF), comorbid disease, family history were also considered.
Result: All variables obtained in 6MWT proved to be significant with high correlation;
METs and distance (r ¼ 0.992, p , 0,0001), METs and heart rate at beginning (r¼ -2,26,
p , 0,0001). In turn, LVEF showed significant and weak correlation with METs and dis-
tance; (r ¼ 0,184, p ¼ 0,037 and r ¼ 0,189, p ¼ 0,32).
Conclusion: We found that ejection fraction is not the only factor affect variables in dis-
tance and METs in our sample. Probably because there are too many group of sample, and
many factor include in measurement of ejection fraction.
Keywords: cardiac rehabilitation † 6MWT † LVEF † METs † submaximal exercisecapacity
Relationship between type 2 diabetes mellitus with poor heart rate autonomic
response in post acute myocardial infraction patients
I.G.B.G.P. Putra, W. Wita, and K.B. Nadha
Department of Cardiology And Vascular Medicine, Faculty Of Medicine, Udayana University
Background: DM with cardiovascular disease are very closely related. Heart rate recov-
ery (HRR) and resting heart rate (resting HR) is an investigative tool that is both reliable
and easy to measure in evaluating the cardiac autonomic regulation and as a strong
predictor factor for all cause mortality in healthy adults as well as in someone with
cardiovascular disease. This study aims to determine that type 2 diabetes mellitus as
factors that worsen heart rate at rest and recovery heart rate after treadmill exercise
test in patients with post myocardial infarction is an important variable factors as
predictors of incidence of morbidity and mortality in patients with post acute myocardial
infarction.
Methods: The research is observational analytic study. Study subjects consisted of 70
people who will be divided into two groups: exposed (with diabetes mellitus) and the un-
exposed group. Samples taken consecutively in the inpatient unit Integrated Cardiac Ser-
vices Sanglah then at the time before discharge from hospital, the patient undergone
treadmill using the modified Bruce protocol with target submaximal or symptom
limited. To determine the relationship between heart rate autonomic response and dia-
betes mellitus, bivariate analysis were done with Chi Square and to see the relationship
between the dependent variable to another variable with logistic regression with signifi-
cance level (a) at p ,0.05.
Results: In the bivariate analysis, patients with type 2 diabetes mellitus and without dia-
betes mellitus type 2 differ significantly worsen the autonomic response of the heart rate
(heart rate at rest and recovery heart rate) in patients post-AMI with a value of p ,0.01.
And from multivariate analysis didn’t found the relationship of the other variables : age,
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gender, family history, dyslipidemia, hypertension, smoking, physical activity, and beta
blockers on poor heart rate autonomic response in diabetic patients post-AMI (p. 0.05).
Conclusion: Observational studies have been conducted to prove the type 2 diabetes
mellitus in worsening heart rate autonomic response consist of high resting heart rate
(RR 7.00; 95% CI 2.74-17.87; p ,0,001) and abnormal heart rate recovery (RR 5,17;
95% CI 2.47-10.81; p ,0,001).
Keywords: Type 2 diabetes mellitus † acute myocardial infarction † heart rate at rest
† heart rate recovery † treadmill
The ECG features among hypertensive patients in rural area: A descriptive study at
Kubu Village, Karangasem, Bali
I.B.K. Wisasmita 1, A. Yasmin 1, R. Widiana2, and W. Wita1
1
Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia,
2
Nephrology and Hypertension Division, Internal Medicine Department, Udayana Univer-
sity, Bali, Indonesia
Background: Hypertension is the most common condition seen in primary care and leads
to morbidity and mortality if not detected early and treated appropriately. In hyperten-
sion, the presence of left ventricular hypertrophy (LVH) is associated with increased risk
of both cardiovascular morbidity and mortality. Since hypertension is an insidious
disease, early ECG signs for cardiac electrical remodeling provide a wealth of information
for disease stratification.
Methods: This is a cross-sectional study which was performed as a part of social work
clinic by Department of Cardiology and Vascular Medicine, Udayana University on 21 No-
vember 2015 at Kubu village, Karangasem, Bali. All patients who attended the social work
and diagnosed with hypertension were included in this study. All subjects underwent
electrocardiography examination and the results were analyzed by Cardiologist. Demo-
graphic data were obtained using structured questionnaire.
Result: The overall prevalence of hypertension in the study was 24,3% (28 out of 115
patients), The subjects were between 40-83 year old, about 54 % of them was female.
Among the subjects, about 39% still not aware of having hypertension, and the other
hand, about 32% had hypertension for more than 5 years. The ECG abnormalities was
found in 50% patient, among them high LV voltage was found in 32.1 %, LV strain
pattern in 3.6%, complete RBBB in 7.1%, LAFB in 3.6%, and AV block grade I in 3.6% sub-
jects.
Conclusion: The prevalence of ECG abnormalities in our study relatively high. The major-
ity of the ECG abnormalities was high LV voltage that indicates the presence of LV hyper-
trophy. Although, the use of the ECG in the diagnosis of LVH is somewhat limited by its poor
sensitivity but it is still useful in detecting LV remodeling related to hypertension espe-
cially for primary health care in rural area.
Keywords: electrocardiography † hypertension † rural area
Chronotropic incompetence in coronary artery bypass graft and heart valve
surgery patients: The role of b-blocker
I.F. Yuwono 1, R. Myrtha 2, F. Handayani 1, B. Radi3, A. Meidian 3, A. Santoso 3, D. Kusmana 3,
and B. S. Purwowiyoto 3
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Diponegoro Uni-
versity, Semarang, Indonesia, 2Department of Cardiology and Vascular Medicine, Faculty
of Medicine, Sebelas Maret University, Solo, Indonesia, 3Department of Cardiology and
Vascular Medicine, Faculty of Medicine,University of Indonesia, Jakarta, Indonesia/Na-
tional Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Chronotropic Incompetence (CI) is an independent predictor of major
adverse cardiovascular events and overall mortality. Although b-blocker may improve
patients’ clinical status and reduce risk of death, it may cause pharmacologically
induced CI. There is uncertainty about the use of b-blocker regarding its effect to CI.
This study aimed to describe the relationship of b-blocker use and CI in Coronary
Artery Bypass Graft (CABG) and Heart Valve (HV) surgery patients.
Methods: Four hundred and twelve consecutive patients who had exercise stress test for
evaluation after Cardiac Rehabilitation Program for CABG (n ¼ 277) or HV Surgery (n ¼
135) at National Cardiovascular Center Harapan Kita, Jakarta, Indonesia between July
2014 and December 2014 were evaluated. Failure to achieve ≥ 80% of the Age Predicted
Heart Rate Reserve (APHRR) or . 62% of APHRR for patients taking b-blockers consti-
tuted CI.
Results: No difference of prevalence of CI was found in CABG and HV surgery patients (57%
vs 52,2%, p ¼ 0.451). There was similar proportion of patients with Digitalis (p ¼ 0.071),
non-dihydropyridine Calcium Channel Blocker (p ¼ 0.695) and Amiodarone (p ¼ 0.364)
between group with and without CI. Patients with Diabetes Mellitus (DM) had greater per-
centage to develop CI (32% vs 19%, p ¼ 0.016). Meanwhile, patients treated with
b-blocker (76.7% vs 87.6%, p ¼ 0.021) and patients with NYHA functional class I (32.7%
vs 46.3%, p ¼ 0,022) had smaller percentage of CI. At multivariate analysis, Diabetes Mel-
litus (DM) was independently positively associated with CI and b-blocker use was nega-
tively associated with CI.
Conclusion: There was no difference found in CI between CABG and HV surgery patients.
Diabetes mellitus related to CI. The use of b-blocker may improve chronotropic response
in these patients.
Keywords: Chronotropic incompetence † coronary artery bypass graft surgery † heart
valve surgery † b-blocker
 B34
Correlation between fibrinogen and low density lipoprotein (LDL) cholesterol
levels with acute myocardial infarction
I.S. Warno and J.N.E. Putranto
Department of Cardiology and Vascular Medicine, Soetomo General Hospital, Airlangga
University, Surabaya, Indonesia
Background: Fibrinogen has been identified as a risk factor for cardiovascular disease es-
pecially acute myocardial infarction (AMI). Role of elevated fibrinogen in thrombosis sug-
gests that it may be on the causal pathway for their effect. Elevated Low density
lipoprotein (LDL) cholesterol plasma also can induce development of atherosclerosis
and associated with AMI events.
Objectives: To determine correlation between fibrinogen and low density lipoprotein
cholesterol levels with acute myocardial infarction.
Methods: Cross sectional study in Dr. Soetomo Hospital Surabaya on August-November
2015. In 67 subjects were divided into 49 subjects with acute myocardial infarction
and 18 subjects as control. Evaluating at age, sex, diagnose, and management as a base-
line characteristics. In each of groups were measured fibrinogen and LDL cholesterol
levels. The statistical analysis was done with the software packages SPSS.
Result: 47 males and 20 females were studied. In AMI subjects, 28 patients underwent
revascularization procedure with PCI and thrombolytic strategy. The statistic analysis
revealed significant differences ( p , 0.05) between plasma fibrinogen and LDL choles-
terol levels at AMI patient than control. Significant correlation also showed between fi-
brinogen levels with LDL cholesterol levels on subjects.
Conclusions: Fibrinogen was associated with AMI risk factors as well as LDL cholesterol.
Elevation of fibrinogen were revealed almost of all AMI events. Also, fibrinogen and LDL
cholesterol levels were higher among subjects with AMI compared with those without
disease. The statistic test showed an association between fibrinogen and LDL cholesterol
levels with AMI.
Keywords: Fibrinogen levels † LDL cholesterol levels † Acute myocardial infarction
Cardiac rehabilitation use among patients with coronary artery disease on
July –December 2015 in Dr. Hasan Sadikin General Hospital Bandung
I. Marita1, B. B. Tiksnadi 2, and S. B. Sastradimaja 3
1 genic shock and rescucitated ventricular arrhytmia. Patients were divided into 2 groups
Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 2Department of Car-
diology and Vascular Medicine, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia,
3 brinolysis and MACE between groups was compared with Chi square test. Significancy was
Department of Physical Medicine and Rehabilitation, Dr. Hasan Sadikin General Hospital,
Bandung, Indonesia
Background: Cardiac rehabilitation (CR) programs is underutilized despite the well
documented benefits in reducing mortality and morbidity rate for patients with coronary
artery disease (CAD). The purpose of this study is to assess the rates of CR enrollment in
patients with CAD in Dr. Hasan Sadikin General Hospital Bandung.
Methods: A retrospective medical record review was performed for all CAD patients on
July –December 2015 who were hospitalized in Cardiac Unit Services and were referred
to CR programs in Cardiac Rehabilitation Gymnasium, Dr. Hasan Sadikin General Hospital,
Bandung. CR enrollment was ascertained by documentation in the CR program clinical
database and was defined as attendance at 1 or more CR sessions.
Results: There were 379 CAD patients referred to the CR program, consisting of 161
(42.48%) patients with CAD post Acute Coronary Syndrome and 218 (57.52%) patients
with CAD non post Acute Coronary Syndrome. Among these patients, 43 (11.35%) patients
enrolled in the CR programs. There were 298 (78.63%) males and 81 (21.37%) females.
Fourteen patients aged ≤40 years old, 77 patients aged 41 –50 years old, 136 patients
aged 51– 60 years old, 119 patients aged 61– 70 years old, and 33 patients aged ≥71
years old. In general, these results was not much different from the study in other coun-
tries.
Conclusion: Participation of coronary artery disease patients in cardiac rehabilitation
programs continue to be disappointingly low.
Keywords: Cardiac rehabilitation † coronary artery disease † enrollment
Differences of plasma histamine level between acute coronary syndrome and
stable coronary artery disease patients
I.S. Prihatiningsih 1,2, J. N. E. Putranto1,2, and D. Soemantri 1,2
1 patient clinic Dr. Soetomo General Hospital Surabaya from August 2015 until November
Department of Cardiology and Vascular Medicine Faculty of Medicine, Airlangga Univer-
sity, Surabaya, Indonesia, 2Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Atherosclerosis may cause angina in Coronary Artery Disease (CAD) patients
either in Acute Coronary Syndrome (ACS) or Stable Coronary Artery Disease (SCAD). His-
tamine is a mast cell-preformed mediator which was suspected to play a role in athero-
sclerosis but the mechanism is still not clearly understood and data in CAD population is
lacking. We hypothesized that plasma histamine level is different between Acute Coron-
ary Syndrome and Stable Coronary Artery Disease patients.
Methods: This was an observational analytic study with transversal study design in 49 CAD
patients by purposive sampling. We identified 25 ACS patients (72% men, mean age
55.6 + 9.66 years) and 24 SCAD patients (83.3% men, mean age 52.71 + 8.03 years) as
determined by standard diagnostic criterias. Vein whole blood were drawn and centri-
fuged immediately after collection. The level of plasma histamine were measured
using Histamine Enzyme-linked Immunosorbent Assay (ELISA) Kit.
Results: Plasma histamine level median values in ACS group and in SCAD group were
30.79 ng/ml (range 5.85-36.09 ng/ml) and 26.42 ng/ml (range 0.30-41.39 ng/ml),
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Abstracts
respectively. Statistically significance differences in plasma histamine level median
values were observed between the two groups using Mann-Whitney U Test (p ¼ 0.011).
Based on the severity of angina as described by Canadian Cardiovascular Society (CCS),
plasma histamine level median values in patients with CCS I, CCS II, CCS III and CCS IV
were 26.26 ng/ml, 26.44 ng/ml, 30.62 ng/ml and 32.08 ng/ml, respectively. Subanalysis
using Spearman Rank Correlation Test showed moderate-positive correlation between
plasma histamine level with the severity of angina (r(49) ¼ +0.379, p ¼ 0.007, two-
tailed).
Conclusion: There were significant differences of plasma histamine level between Acute
Coronary Syndrome and Stable Coronary Artery Disease patients.
Keywords: histamine † acute coronary syndrome † stable coronary artery disease
High Endothelin-1 plasma level gives a tendency toward increasing rate of
in-hospital major adverse cardiovascular outcomes in ST-elevation myocardial
infarction undergoing fibrinolysis
I.W. Nugraha1, A.B. Hartopo 1, I. Puspitawati2, N. Taufiq 1, and B.Y. Setianto 1
1
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah
Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia, 2Department of Clinical Pathology
Faculty of Medicine Universitas Gadjah Mada - Dr. Sardjito Hospital Yogyakarta, Indonesia
Background: Endothelin1 (ET-1) is a potent vasocontrictor that are increased in the acute
phase of myocardial infarction. An elevated plasma ET-1 level previously known to be
associated with poor outcome in patient with ST-Elevation Myocardial Infarction (STEMI).
Aims: To investigate the association between ET-1 plasma level with the outcome of fi-
brinolysis and subsequent in-hospital major adverse cardiovascular event (MACE) and
mortality in patient with STEMI.
Methods: This was a cohort study enrolling 56 consecutive patients with STEMI undergo-
ing fibrinolysis. The inclusion criteria were ages 30-75 years and onset , 24 hour. The ex-
clusion criteria were chronic kidney disease, chronic heart failure, acute infection, and
acute stroke. Endothelin-1 was measured from peripheral plasma taken on admission,
before fibrinolysis. Observation was done during and after fibrinolysis therapy to deter-
mine whether the fibrinolysys succeeded or failed. Follow-up during intensive treatment
were also performed to record in-hospital MACE, i.e. death, acute heart failure, cardio-
based on ET-1 plasma level, i.e High ET-1 and Low ET-1 group. The incidence of failed fi-
tested as p value , 0.05.
Results: The median ET-1 plasma level was 3.445 pg/mL. The rate of failed fibrinolysis did
not significantly differ between groups. High ET-1 group (n ¼ 28) had a higher incidence
of MACE as compared with Low ET-1 group (n ¼ 28), i.e 32.1% versus 17.9%, but that dif-
ference was not statistically significant (p ¼ 0.217). Mortality rate did not significantly
differ between groups either.
Conclusion: High ET-1 plasma level had a tendency toward increased incidence of
in-hospital major adverse cardiovascular outcome following STEMI treated with fibrinoly-
sis.
Keywords: Endothelin-1 † ST-Elevation Myocardial Infarction † Fibrinolysis † Major
Adverse Cardiovascular Event
Correlation between serum p53 levels and vascular age determined by carotid
intima media thickness (CIMT) in patients with intermediate cardiovascular risk
factor
J.R.S. Tengor, J. Nugroho, and D. Soemantri
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Cardiovascular risk factors accelerate normal biological aging of vessels,
resulting in premature vascular aging. Vascular age in patients with cardiovascular risk
factors is greater than chronological age. Carotid intima media thickness (CIMT) is one
of the non - invasive method that has been used to determine the vascular age. Protein
p53 is one of the biological aging marker, but the research for p53 is limited. Whether
p53 is associated with vascular age determined by CIMTremains to be further evaluated.
Methods: This study was a cross sectional study which conducted at cardiovascular out-
2015. This study enrolled 38 patients with intermediate cardiovascular risk factor symp-
tomatically free from atherosclerotic cardiovascular disease. Serum p53 levels were
measured with human p53 ELISA kit (Bender MedSystems, Austria). CIMT was measured
by B - Mode ultrasound. The composite CIMT was used to determine vascular age based
on nomograms from the Atherosclerosis Risk in Communities Study (ARIC study). Spear-
man rank test was used to analyze the correlation between serum p53 levels and vascular
age.
Results: There were 19 males and 19 females included in this study. The mean chrono-
logical age was 51.11 + 6.47 years. The mean vascular age using CIMT was 54.34 + 8.5
years. Significant correlation between serum p53 levels and vascular age determined
by CIMTwas found by using Spearman Rank Test. Serum p53 levels were positively corre-
lated with vascular age in this group of participants (p , 0.001; r ¼ 0.58).
Conclusion: Serum p53 levels were significant correlated with vascular age determined
by CIMT in patients with intermediate cardiovascular risk factor.
Keywords: serum p53 † carotid intima media thickness † vascular age † chronologic-
al age † intermediate cardiovascular risk factor
 Abstracts
Clinical significance of precordial ST segment depression on admission
electrocardiogram in patients with acute inferior myocardial infarction
J. Suganti1, K. Kaban 1, A. Handayani1, E. J. H. Sinaga 1, Agustina 1, Hasinah 1, A. A. Siregar 2,
H. Hasan 2, Z. Mukhtar 2, and N. Z. Akbar 2
1 protein extraction and Real-Time PCR were performed in order to have the mean of
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia
Background: The clinical significance of precordial STsegment depression (PSTD) during
acute inferior myocardial infarction (AIMI) has been an area of debate, and still under in-
vestigation with conflicting results. Previous studies have suggested that PSTD in patients
with AIMI is a marker of a more extensive myocardial damage. Despite of these results,
others still considered this ECG findings as benign electrical phenomena. The aim of
this study is to investigate the clinical significance of PSTD during AIMI.
Methods: A total of 60 AIMI patients admitted from December 2013-2015 at Haji Adam
Malik General Hospital were divided into two groups and retrospectively analyzed.
Group I consisted of 30 patients with PSTD, Group II consisted of 30 patients without
PSTD. Patients with history of myocardial infarction and heart failure were excluded.
All patients were investigated with admission ECG, cardiac biomarkers, echocardiog-
raphy, coronary angiography. Statistic analysis was performed, p value ,0.05 was consid-
ered statistically significance.
Results: There were no significant differences in mean age, the proportion of sex and cor-
onary artery disease risk factors in both groups. Group I has an early onset of chest pain
(19 + 18 vs 43 + 46 hours, p ¼ 0.025), higher troponin T (1.46 + 0.5 vs 0.97 + 0.6 ug/L,
p ¼ 0.002) and CKMB level (204 + 129 vs 99 + 100 U/L, p , 0.001), more severe regional
wall motion abnormality (70% vs 30%, p , 0.001), lower EF (48 + 8% vs 54 + 7%, p ¼
0.001) than group II. In group I, LAD lesion was not statistically significant (63% vs 46%,
p ¼ 0.118), but multivessel disease was significantly more frequent (70% vs 30%, p ¼
0.037) with higher Gensini score (47 + 34 vs 32 + 25, p ¼ 0.045) than group II.
Conclusion: Patient with AIMI who have PSTD have greater global and regional left ven-
tricular dysfunction due to a more extensive myocardial damage, they also have a greater
extent of coronary artery disease.
Keywords: Precordial ST Segment depression † inferior myocardial infarction
Postprocedural high sensitivity C-reactive protein and the risk of recurrent
ischemic events after percutaneous coronary intervention in patients with
stable angina pectoris
J. W. Purba, A. A. Nasution, S. M. N. Silaban, Syaifullah, Z. Mukhtar, and A. A. Siregar
Department of Cardiology and Vascular Medicine, Medical Faculty, University of
Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia
Background: High sensitivity C-reactive protein (hsCRP) has been identified as a predict-
or of adverse cardiovascular outcomes. Whether hsCRP is a useful biomarker for risk
stratification in patients with angina undergoing percutaneous coronary intervention
(PCI) remains unknown.
Methods: We conducted a prospective study among 50 patients undergoing non-
emergency percutaneous coronary intervention and examined the relationship
between hsCRP after PCI and recurrent ischemic events during follow-up of 6 months.
Patients were divided according to the postprocedural hsCRP levels (0.3 mg/dL). Recur-
rent ischemic events was defined as occurrence of cardiac death, recurrent angina re-
quiring repeat PCI or coronary artery bypass graft (CABG), and acute coronary
syndrome (ACS).
Results: Patients with high hsCRP had significantly more adverse outcomes. Postproce-
dural hsCRP was a predictor of recurrent ischemic events in 6 months (OR 7.5 [95% con-
fidence interval, 0.945-59.504]; P ¼ 0.032). In multivariate analysis, predictors of the
occurence of events (obesity, previous MI, impaired renal function, and hsCRP) were
not significant (p ¼ 0.239; p ¼ 0.509; p ¼ 0.425; p ¼ 0.081).
Conclusion: High postprocedural hsCRP levels were significantly associated with
increased risk of cardiac death, recurrent angina requiring repeat PCI or CABG, and
ACS, but was not an independent predictor of recurrent ischemic events post PCI.
Larger studies with longer-term follow-up are needed to confirm the relationship.
Keywords: hsCRP † recurrent ischemic events † PCI
The messenger ribonucleic acid expression of B-type natriuretic peptide,
natriuretic peptide receptor type-A and type-C in cardiomyocytes of obese
population
J. Ulaan, S. Adiarto, A. Santoso, and A.M. Soesanto
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas
Indonesia/ National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Background: Obesity is presenting as a significant health problem across the world.
Obesity is a risk factor for cardiovascular diseases. The plasma level of B-type natriuretic
peptide (BNP) has been identified to be lower in obese people compare to normal. As we
know, BNPis one of the cardiac hormones synthesized by atrial myocyte that plays a role in
hemodynamic regulations. In addition, BNP exerts its anti fibrotic and anti hypertrophic
effects in the heart. It has been hypothesized that one of the possible mechanism respon-
sible for this inverse relationship is the impaired synthesize of BNP by cardiomyocytes.
Therefore, the aim of our study is to evaluate the mRNA expression profile of BNP, Natri-
uretic peptide receptor type-A (NPR-A) and Natriuretic peptide receptor type-C (NPR-C)
in cardiomyocytes of obese population.
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B35
Method: A cross-sectional study was conducted in Rumah Sakit Jantung dan Pembuluh
Darah Harapan Kita (RSJPDHK). Cardiomyocytes that have been performed the RNA ex-
traction proses were divided into 2 groups, Obese group (BMI ≥27) and Normal group
(BMI ,27), according to BMI and inclusion and exclusion criteria. Synthesize cDNA,
DCt. Livak method was used to determine the relative expression mRNA value. SPSS 20
for Windows was used for the purpose of statistical analyses.
Results: 48 patients were included in this study that consist of 34 patients in normal group
and 14 patients in obese group. The mRNA expression of BNP, NPR-A and NPR-C were lower
in obese group compared to normal group. However, there was no significant difference
between groups.
Conclusion: In conclusion, there is no significant difference of mRNA expression of BNP,
NPR-A and NPR-C between obese and normal group.
Keywords: obesity † mRNA expression of BNP † mRNA expression of NPR-A † mRNA
expression of NPR-C † human cardiomyocytes
The correlation between serum galectin-3 level with wall motion score index in
patietns with ST-segment elevation myocardial infarction
K. Halid 1,2 and M. Aminuddin1,2
1
Department of Cardiology and Vascular Medicine Faculty of Medicine, Airlangga Univer-
sity, Surabaya, Indonesia, 2Dr.Soetomo General Hospital, Surabaya, Indonesia
Background: Inflammation plays a key role in atherosclerosis and reparative response
following myocardial infarction. Galectin-3 is a macrophage and endothelium derived
mediator actively involved in the regulation of many aspects in inflamatory cell behav-
iour. Up-regulation of galectin-3 has a role in fibrosis and scar formation of the maladap-
tive cardiac response to injury. Correlation between level of galectin-3 with decrease
myocardial contractility which assessed by Wall Motion Score Index (WMSI) in patient
with ST-Segment Elevation Myocardial Infarction (STEMI) was unknown yet.
Methods: Cross-sectional study was enrolled 35 patients with ST-Segment Elevation
Myocardial Infarction by purposive sampling. Anamnestic data was collected as
baseline characteristics. Galectin-3 levels were measured by using R & D System ELISA
Quantikinew Human galectin-3 Immunoassay with units ng/mL. WMSI measured by
2D-echocardiography.
Results: Patients with ST-Segments showed significantly high serum galectin-3
level (12.545 + 6.504 ng/mL, p ¼ 0.01) and moderate postive corellation with WMSI
(r ¼ + 0.429).
Conclusion: There is positive significant correlation between serum galectin-3 level with
WMSI in patient with STEMI.
Keywords: Galectin-3 † ST-Elevation Myocardial Infarction † Inflammation † Fibrosis
† Wall Motion Score Index
Risk factors of atrial fibrillation in patients with chronic heart failure
K.N. Pratiwi1, E. Hoetama2, and O. Lilyasari 3
1
Mitra Plumbon Hospital, 2dr. H. Marsidi Judono Belitung General Hospital, 3National
Cardiovascular Heart Centre Hospital
Introduction: Atrial fibrillation (AF) and Chronic Heart Failure (CHF) are common and
related conditions, each promoting the other and both associated with increased mortal-
ity. AF is a common atrial arrhythmia in patients with CHF caused by left ventricular dys-
function. The mechanism by which CHF promotes AF are still confusing. There seem to be
trigger – and substrate – dominant mechanisms and this study was provide to assessing
the risk factors leading to AF in patients with CHF.
Methods: All patients who admitted to hospital were recorded through a year period with
history of chronic heart failure and atrial fibrillation event. This study was a retrospective
study referred to consecutive patients’ medical records meeting all the inclusion cri-
teria. The analyses comprised 89 patients with history of chronic heart failure.
Result: During the study period there were 89 patients with chronic heart failure regis-
tered in our database. Factors that were independently associated with AF were Age
(P ¼ 0.001, OR 5.25 (1.95 – 14.1)), Hypertension (P ¼ 0.02, OR 2.95 (1.17 – 7.43)), Dia-
betes (P ¼ ,0.001, OR 6.47 (2.42 – 17.32)), Obesity (P ¼ ,0.001, OR 8.62 (3.12 –
23.75)), Gender (P ¼ 0.008, OR 3.43 (1.34 – 8.74)). In multivariate analyses, the
results showed that Obesity (Adjusted OR 0.14, 95%CI 0.04 – 0.49), Diabetes (Adjusted
OR 0.18, 95%CI 0.05 – 0.64), Age . 65 years old (Adjusted OR 0.20, 95%CI 0.05 – 0.78)
were independent risk factors for chronic heart failure leading to atrial fibrillation.
Conclusion: Obesity, Diabetes, and Age . 65 years old are independent risks of patients
with chronic heart failure leading to atrial fibrillation.
Keywords: Chronic heart failure † atrial fibrillation † CHF † AF
QT interval prolongation after non-ST elevation myocardial infarction in type 2
diabetic compared with nondiabetic patients
K. Kaban 1, A. Handayani1, J. Suganti 1, A. A. Siregar 2, and Z. Mukhtar2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Departement of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia
Background: The clinical profile of patients with Non-ST Elevation Myocardial Infarction
(NSTEMI) is highly heterogenous and widely insidence of serious adverse events . NSTEMI
patients with Diabetes type 2 known to have poorer outcome than nondiabetic population
that is why we need early and simple predictor’s tools. QT interval parameters have been
 B36
suggested as simple bedside predictors of lethal arrhytmias and mortality in acute myo-
cardial infarction. The aim of this study is to compare QT interval in between NTSEMI
patients with type 2 DM and non-DM and the association with Mayor Adverse Cardiac
Event (MACE).
Methods: This study evaluated QT interval parameters in 102 patients (40 diabetic and 62
nondiabetic) diagnosed with NSTEMI between January 2014 and December 2014. From
that population 3 were exluded because of non sinus rhytm ecg. The following QT inter-
vals indices were compared between diabetic and nondiabetic patients: maximum(max)
and minimum(min) QT interval; max and min corrected QT interval(QTc); QT dispersion
and QTc dispersion. QT interval parameter that has significant difference between the
two groups was used in bivariat and multivariat analysis to see the significance in MACE
during hospitalization.
Result: There were no significant differences in clinical characters between DM and
Non-DM group. There was significant difference in QTc max between two groups (p ¼
0.024). When compare QT interval between NSTEMI patients with MACE and without
MACE there was sinificant difference in QTc max (p , 0,001), but when compare in sub
group MACE in Diabetic and Nondiabetic patient show no significant difference of QTc
max (p ¼ 0.459)
Conclusions: Type 2 diabetics with NSTEMI have prolonged QTc max. NSTEMI patients
with MACE also show prolonged QTc max interval, but there’re many comorbids in
NSTEMI patients that make QTc max between DM and NonDM show poor differences.
Keywords: QT interval † NSTEMI † Diabetes type-2
The novel effect of polysaccharide peptides of Ganoderma lucidum to endothelial
disfunction and dislipidemia in high risk groups of atherosclerosis
K.S. Proboretno
Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya Univer-
sity – Dr Saiful Anwar General Hospital, Malang, Indonesia
Background: Endothelial disfunction and dislipidemia have an important role in the de-
velopment of atherosclerotic cardiovascular disease. Ganoderma lucidum is a mushroom
that effects of antiinflamation, immunomodulator, antioxidant and anti-lipid. High level
of circulating endothelial cells (CECs) and low level of endothelial progenitor cells (EPCs)
predict poor outcome of endothelial damage. This study was aimed to explore the effects
of polysaccharide peptides (PSP) of Ganoderma lucidum on CECs, EPCs, and lipid profile
at high-risk of atherosclerosis patients.
Methods: This study used true experimental study in vivo on 34 High Risk patients of car-
diovascular event based on Framingham Risk Score, with pre-test and post-test design.
The patients consumed PSP 3x250 mg for 3 months, as an additional therapy of their
regular medications. The data was analyzed by paired t-test for parametric data and Wil-
coxon test for non-parametric data.
Results: Post test were performed after administration of PsP for 3 months. The results
shows that, total cholesterol level reduced from 219,46 + 49,49 mg/dl to 201,43 +
81,63 mg/dl (P ¼ 0,193). There were no significant reduction of total cholesterol. The
level of CECs significantly reduced (2,07 + 1,54 % to 0,6457 %, p ¼ 0.000), and did the
EPCs level (3,28 + 3,66 % to 1,72 + 2,24 %, p ¼ 0.000).
Conclusion: The result shows Ganoderma lucidum polysaccharide peptides significantly
reduced the level of CECs. But, the increasing of EPCs which are biomarkers of repair with
therapeutic potential and the level of total cholesterol does not show significant differ-
ences between pre test and post test.
Keywords: High risk patients † Ganoderma lucidum † polysaccharide peptides †
anti-lipid † dyslipidemia † CEC and EPC
Relation of Left Atrial Spontaneous Echocardiographic Contrast to Neutrophil/
Lymphocyte Ratio in Patient With Mitral Stenosis
Komaria1, Zunaidi 1, D. Ashrinda 1, M.F. Sarahazti 1, E. Hasibuan1, A.A. Siregar, 2, H. Hasan 2,
N. Z. Akbar 2, and A.P. Ketaren 2
1 patients. This study aims to evaluate the incidence of severe PH complicating ASD in
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia
Background: Left Atrial Spontaneous Echocardiographic Contrast (LASEC) is a risk
factor for left atrial thrombus formation and an important indicator of potential sys-
temic embolism. The role of systemic and chronic inflammatory processes in the patho-
physiology of rheumatic heart valve disease is well-known. Neutrophil/Lymphocyte
ratio (N/L ratio) was shown to be an indicator of systemic inflammation. The purpose
of our study was to determinate the association between N/L ratio and LASEC in
patients with mitral stenosis (MS).
Methods: Retrospective study was conducted between January 2014 to December 2015
in patient who admitted to Haji Adam Malik Hospital due to symptomatic MS. Blood exam-
ination and transthoracic echocardiography were performed to all patients. They were
divided into two groups according to presence of LASEC.
Results: From 104 patients, 41 (mean age 42 + 11 years; 79% women) were in the
LASEC-negative group and 38 patients (mean age 40 + 12 years; 73% women) were in
the LASEC-positive group. The neutrophil levels (60.5 + 9.8 vs 72.6 + 10.7, p ,
0.001) were significantly greater in the LASEC-positive group, and the lymphocyte
level (25.2 + 6.9 vs 14.5 + 6.9, p , 0.001) were significantly greater in the LASEC-
negative group. The N/L ratio was significantly higher in patient with LASEC-positive
group [2.6(1.0-6.1) vs 5.0(1.7-33), p , 0.001]. N/L ratio was divided into two sub-
groups for bivariate analysis, more than 3.1 and below according to previous study.
Higher level N/L ratio was associated with presence of LASEC, odds ratio (OR): 9.025,
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95% confidence interval (CI) 3.604-22.598; p , 0.001. In multivariate analysis, N/L
ratio (OR: 8.917, 95% CI 3.064-25.947; p , 0.001), mitral valve area (OR: 16.796, 95%
CI 3.095-91.142; p ¼ 0.001), atrial fibrillation (OR: 4.321, 95% CI 1.024-18.225; p ¼
0.046) and RV basal (OR: 3.759, 95% CI 1.332-10.608; p ¼ 0.012) were independent pre-
dictors of LASEC.
Conclusion: These study show that higher level of N/L ratio associated with presence
of LASEC and an independent risk factor of LASEC formation in patient with MS. N/L
ratio is an easily available and cheap method, it can easily be used in daily clinical
practice.
Keywords: Left atrial spontaneous echo contrast † mitral stenosis † neutrophil/
lymphocyte ratio
Analysis of characteristic of atrial fibrillation versus not atrial fibrillation in
hospitalized heart failure patients
L. D. Suryani1, A. Pramudita 2, A. Basuki2, A. W. Siemann 2, D. P. Sari2, B. B. Siswanto 1,
R. S. Pratikto1, and N. Hersunarti 1
1
National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia, 2Medical
Research Unit, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
Background: Atrial fibrillation (AF) is the most common arrhythmia in heart failure (HF);
it increases the risk of thrombo-embolic complications and may lead to worsening of
symptoms. Both conditions shared some common risk factors. However, the causative re-
lationship between the two has not been fully determined and the number of study is
limited. This study aims to find the associations between AF and several demographical
and clinical parameters among hospitalized HF patients.
Methods: A total of 937 hospitalized patients with HF in National Cardiovascular Center
Harapan Kita from January 2012 to September 2013 were included in this cross-
sectional study. The patients were categorized based on whether had AF (group 1) or
not (group 2) when the data was taken. The parameters examined were sex, age,
heart rate, systolic blood pressure, diastolic blood pressure, smoking status, diabetes
mellitus, history of angina, history of prior CHF hospitalization, history of hypertension
treatment, NYHA functional class, length of stay, ejection fraction, BUN, and serum
creatinine levels.
Results: Among 937 patients, 187 (19.96%) were in group 1 and 750 (80.04%) were in group
2. There was an association between AF in HF patients with sex (p ¼ 0.008), smoking
status (p ¼ 0.036), history of angina (p ¼ 0,000), and history of prior CHF hospitalization
(p ¼ 0.047). Heart rate (p ¼ 0.000), age (p ¼ 0.002), and EF (p ¼ 0.002) were significant-
ly higher in group 1. Meanwhile, serum creatinine level was significantly lower compared
to group 2 (p ¼ 0.010). Other parameters were comparable between the groups.
Conclusion: In addition to shared common risk factors (sex, age, and history of angina);
other parameters such as smoking status, history of prior CHF hospitalization, heart rate,
EF, and serum creatinine level also have a role in the presence of AF in HF patients.
Further study is needed to get the exact causative relationship among them.
Keywords: Atrial fibrillation † heart failure † characteristics
Pulmonary hypertension features in adult atrial septal defect at RSUP Dr. Sardjito
L. Krisdinarti1, D.W. Anggrahaeni 1, A.B. Hartopo 1, K. Nakayama 2, N. Emoto 2,3, and
B.Y. Setianto 1
1
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Gadjah Mada/Rumah Sakit Sardjito, Yogyakarta, Indonesia, 2Department of Cardiovascu-
lar Medicine, Kobe University Japan, 3Department of Clinical Pharmacy, Kobe Pharma-
ceutical University Japan
Baclground: Unestablished childhood screening for congenital heart disease along
with inadequate medical technologies for heart surgery have become critical issues
in Indonesia. As a result, severe PH complicating ASD may lead to mortality in adult
adults.
Methods: Previously, the hospital’s data have showed increased incidence of ASD
patients attending out-patient clinic from year to year. Thus, we conducted a single
center-hospital based registry from July 2012. Newly diagnosed patients came to our
cardiac center in Sardjito Hospital Yogyakarta, Indonesia were recorded.
Results: During the last 3 years we registered 360 new cases of uncorrected ASD in adult,
the median age was 34 years old and 79% were female. The majority of the cases were
secundum-ASD (94%), then SVD and ASD primum (2.5% and 1.75%; respectively); while
1.75% cases were having multiple ASDs. Among those who were performed RHC (n ¼
220), 43.6% surprisingly has moderate-severe PH with mPAP . 40 mmHg. This group
has larger RV diameter, lower TAPSE, SpO2, and 6MWD. There was no correlation
between age and defect size with mPAP and PVRI. However, interestingly, the incidence
of moderate-severe PH was highest in the ≤20-40 years-old group (36.8%). Moreover, in
the younger female group the risk for having moderate-severe PH higher than the older
one; OR ¼ 2.865 (p , 0.05). During this study, there were 37 mortalities (10.3%); in which
30 cases were having severe PH.
Conclusion: Our registry data showed that the incidence of PH was high in uncorrected
adult ASD. In addition, younger age and female gender have increased risks of having
PH. The early incidence of PH raised questions about the factors behind severe PH. The
high mortality rate due to severe PH requires further attention for better management
and childhood screening in Indonesia.
Keywords: pulmonary hypertension † atrial septal defect † adult † mortality
 Abstracts
The association between plasma tryptase with ventricular remodeling after 1
month in patients with acute coronary syndrome
L.D. Yuni, J.N.E. Putranto, and D. Soemantri
Faculty of medicine Airlangga University Surabaya
Background: Acute Coronary Syndrome was initiated by the rupture or erosion of athero-
sclerotic plaque triggered by the release of inflammatory mediators of mast cell degranu-
lation one of which is tryptase. Ventricular remodeling occurs immediately after Acute
Coronary Syndrome and can be evaluated by echocardiography. Tryptase plays a role in
the ventricular remodeling, especially in infarct healing phase where tryptase can modu-
late the expression of endothelial chemokine and induce fibroblast proliferation and col-
lagen through the activation of matrix metalloproteinase
Objectives: Analyze association between the levels of tryptase with ventricular remod-
eling after 1 month in patients with acute coronary syndrome
Methods: This study is observational analytic research with cohort approach. 37 patients
with Acute Coronary Syndrome. At the end of observation periode 25 patients were col-
lected. Tryptase levels and echocardiography examined when patient was admitted.
Echocardiography re-examination were performed after1 month.
Result: There is a non-significant differences of total ventricular remodeling experinced
patients after 1 month between tryptase group, p ¼ 0.668. There is no significant inter-
dependency between groups of tryptase with a ventricular remodeling, p . 0.05. Logis-
tic regression test analysis showed levels of tryptase and tryptase group categories have
no significant effect on ventricular remodeling but they tend to be a risk factor for ven-
tricular remodeling. Multiple linear regression analysis showed multicollinearity
between variables left ventricle end diastolic volume and left ventricle end systolic
volume when admitted to hospital and after 1 month discharge to the the relationship
between tryptase and ventricular remodeling,VIF ≥ 10, tolerance ≤0,10 .
Conclusion: There is no significant association between tryptase with ventricular remod-
elling after a month in Acute Coronary Syndrome patients.
Keywords: Tryptase † acute coronary syndrome † ventricle remodeling
The correlation of plasma histamine and tryptase with ST-elevation acute
myocardial infarction in acute coronary syndrome patients
M. Sukmana, J.N.E. Putranto, and D. Soemantri
Faculty of medicine Airlangga University Surabaya
Background: Mechanisms of Acute Coronary Syndrome included thrombosis and vasocon-
striction in atherosclerosis lesions. Acute Coronary Syndrome can be triggered by the
release of inflammatory mediators derived from Tryptase mast cell degranulation and
histamine plays a role in the process of atherogenesis and plaque rupture process of
atherosclerosis. Acute Coronary Syndrome clinically may include unstable angina, non-
ST Elevation Myocardial Infarction and ST Elevation Myocardial Infarction. Heart
failure is one of the most frequent complications of Acute Coronary Syndrome
Objectives: Analyze the relationship between histamine and tryptase levels with the
incidence of ST Elevation acute myocardial infarction in patients with acute coronary
syndrome
Methode: This study is observational analytic research with cross sectional approach.
Samples of 40 patients with Acute Coronary Syndrome were collected by purposive sam-
pling. Histamine and tryptase levels are examined. Myocardial infarction diagnosis based
on universal definition of myocardial infarction
Result: The mean of histamine levels at ST Elevation Myocardial Infarction group was dif-
ferent than non- ST Elevation Acute Coronary Syndrome group but not significant
(29.05 + 9.14vs28.33 + 8.19, p . 0.05) ng/ml. The mean of typtase levels at ST Eleva-
tion Myocardial Infarction group was different than non- ST Elevation Acute Coronary
Syndrome group but not significant (14.30 + 7.12 vs 12.69 + 9.29, p . 0.05) ng/ml .
Conclusion: There are differences in the levels of histamine and tryptase in the group of
ST Elevation Myocardial Infarction and non- ST Elevation Acute Coronary Syndrome group
but not significant
Keywords: Histamine † tryptase † acute coronary syndrome
Acute kidney injury after coronary artery bypass graft surgery: Incidence and pre
operative risk profile
M. Hendrata, A. Willianto, L. Yuliando, U. Abshor, S. Sakasasmita, and C.N. Wingardi
Siloam Heart Institute, Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia
Background: Acute Kidney Injury (AKI) is a common complication following Coronary
Artery Bypass Graft (CABG) surgery and is related to increased mortality and prolonged
length of stay in hospital. Objective of this study is to evaluate risk factors for acute
kidney injury in post CABG patients.
Methods: Sixty three patients who underwent CABG surgery in Siloam Hospitals Kebon
Jeruk from January to December 2015 were reviewed. Thirteen patients were excluded
from the sample because of incomplete data. AKI incidence after CABG surgery were
identified. AKI was defined as an increase of serum creatinine ≥ 50% or ≥0.3 mg/dL
according to AKI network (AKIN) classification. In this study, we analyze association
between AKI with diabetes mellitus, hypertension, pre existing Chronic Kidney Disease
(CKD), and reduced Ejection Fraction (EF) as a single or multiple risk factors and also
the correlation of AKI incidence to prolonged length of stay.
Result: Out of 50 patients, 45 patients (90%) were male and 5 patients (10%) were female.
The mean age of our patients was 58.2 years old (38-80 years old). Acute kidney injury was
observed in 36 patients (72%). Patients with multiple risk factors (.1 risk factor) had a
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B37
significantly higher incidence of AKI (CI 95%; p ¼ 0.02). However, no significant correl-
ation between single risk factor and AKI incidence after CABG surgery were found. The
overall length of stay was significantly longer in patients who developed AKI after
CABG surgery (CI 95%; p ¼ 0.012).
Conclusion: AKI is highly prevalent after CABG surgery. Patients with multiple risk factors
are at a higher risk to develop AKI after CABG surgery which implicate in a prolonged
length of stay. Further study with a larger sample are required to predict mortality in
patients with AKI after CABG surgery.
Keywords: AKI † CABG † risk factors † length of stay
The effect of diabetes mellitus on in-hospital mortality and major complications
after isolated coronary artery bypass grafting surgery
M. Nasri1, T.W. Siagian1, S. Saragih 1, D. Yulianda1, Z. Mukhtar 2, A.A. Siregar2, and D.Pohan3
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia,
3
Department of Thorax and Cardiovascular Surgery,Haji Adam Malik General Hospital,
Medan, Indonesia
Background: Coronary Artery Bypass Graft (CABG) is the choice of revascularization mo-
dality in multi-vessel diseases with Diabetes Mellitus (DM). This study was conducted to
determine whether DM is a predictor of in-hospital mortality and major complications
after CABG.
Methods: This study was a retrospective study of 64 patients who underwent CABG
surgery between January 2012- June 2015. The pre-operative, intra-operative and post-
operative risk factors as well as complications and in hospital mortality were compared in
diabetics and non-diabetics. Among 64 patients; 30 patients (46.8%) were in diabetic
group and 34 patients (53.1%) were in non-diabetic group.
Result: No significant difference was observed between diabetic group and non-diabetic
groups on in-hospital mortality (36.7% vs 20.6%; P ¼ 0.15). Incidence of major complica-
tions; Atrium fibrillation (AF) (16.7% vs 8.8%; P ¼ 0.45), stroke (10% vs 8.8%; P ¼ 1), acute
myocardial infarction (AMI) (10% vs 11.8%; P ¼ 1), and infection (30% vs 13.7%; P ¼ 0.224)
after CABG did not differ significantly between the two groups
Conclusion: No significant difference on in-hospital mortality and major complications
after CABG between diabetic and non-diabetic groups.
Keywords: CABG † DM † in-hospital mortality † post operatif complications
Factor those influence return to woek after CABG revascularization on coronary
artery disease patients
M. Ardiana1, D. Yaniarti2, I.F. Yuwono 3, B. Radi2, A. Meidian 2, A. Santoso 2, D. Kusmana 2,
and B. Setianto.2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Airlangga Univer-
sity, Surabaya, Indonesia, 2Department of Cardiology and Vascular Medicine, Faculty of
Medicine Indonesia University/National Cardiovascular Center Harapan Kita, Jakarta,
Indonesia, 3Departmen of Cardiology and Vascular Medicine, Faculty of Medicine Dipone-
goro University, Semarang, Indonesia
Background: Return to work is one kind of succesfull revascularization therapy with
CABG parameter for patient with coronary artery disease. There are some factors
those can infuence patients to return to work, like clinical symptom and signs, psycholo-
gic factors, socio-demographic, socio-proffesional, fitness level, the job before, physical
activity related with work and ejection fraction of left ventricle. The rehabilitation pro-
gramme was needed to increase the life quality of CAD patient who experienced CABG
revascularization based on some factors above.
Objectives: Accordingly, we conducted a study to determine some factors whose
influenced patients post CABG revascularization decision to return to work, which
are taken at Harapan Kita Heart and Vascular Hospital Jakarta from July, 1st 2014 to
June, 30th 2015, in order to give optimal cardiac rehabilitation programme to
support it.
Method: A retrospective, population based, analytical descriptive study was
done. Through a consecutive sampling which are taken from medical record and inter-
view with patients post CABG, 78 individuals were selected to be enrolled to this
study. The data contains of cardiac risk factors, ejection fraction, cardiac functional
capacity, and job statue before CABG, whose described by frequency, percent and
standard deviation. Chi square test was used to analize the significances of factors
data.
Result: Socio proffesional job statue “white collar job” and regular salary were signifi-
cantly affected patients decision to return to work (p value 0.000, 95% CI). Moreover,
another factor that also affecting return to work at 10% significance level was level of
stress. White-collar workers tend to return to work 27.8 times higher than another
type of employment and patients who previously received a regular salary (permanent
workers) has also a tendency to return to work by 15 times higher compared with the
others who had not received regular salary. Furthermore, patients who did not experi-
enced stress have a tendency to return to work by 3.7 times higher than the others
who experienced it.
Conclusion: Factors those affected the decision to return to work for patients who
experienced CABG revascularization found in this study based on the job type, its
salary and stress level at work. Multiple intervention were needed in cardiovascular reha-
bilization programme to raise psychologic and physiologic statue CAD patients to return
to work optimally in the right time.
Keywords: CABG † return to work factors † cardiovascular rehabilitation programme
 B38
The correlation of pulmonary vein endothelin-1 level with pulmonary vascular
resistance before and after mitral valve surgery with pulmonary hypertension
M. Ginanjar, O. Lilyasari, D. Firman, and A.M. Soesanto
Department Cardiology and Vascular Medicine Universitas Indonesia- National Cardiovas-
cular Centre Harapan Kita, Jakarta, Indonesia
Background: The increased of Pulmonary Vasculaar Resistance (PVR) in mitral stenosis
(MS) patient occurs in reactive pulmonary hypertension, and it affects clinical
outcome after mitral valve surgery. Endothelin-1 (ET-1) as vasoconstrictive agent have
important role in reactive pulmonary hypertension so far there is no study that corelate
pulmonary vein (PV) ET-1 with PVR in MS.
Objectives: To study the correlation of PV ET-1 level with PVR measured by echo before
and after mitral valve surgery in patient MS with pulmonary hypertension.
Methods: Twenty eight MS patients with moderate and severe pulmonary hypertension
who underwent mitral valve surgery at National Cardiovascular Centre Harapan Kita
from April to November 2014. Statistical analysis was done to see the correlation of PV
ET-1 level with PVR before and after mitral valve surgery. Blood sample was taken from
VP in the operating room and analyzed with Quantikinew ELISA ET-1 Immunoassay. PVR
was measured by PVR-AMS formula by echocardiography.
Result: There was a correlation between PV ET-1 and PVR pre surgery (r ¼ 0,49, p ¼
0,008), whereas, there was no significant correlation with PVR post surgery (r ¼ 0,204,
p ¼ 0,32). Linear regression analysis was performed, PV ET-1 and PVR pre surgery were
adjusted to confounding variables hypertension, diabetes mellitus, atrial fibilation,
use of beta blocker and diuretic; r ¼ 0,5 b coefisien level 1,04 with confidance interval
(CI) 95 % (0,401-1,691), p ¼ 0,003. PVR post surgery was adjusted to confounding vari-
ables hypertension, dislipidemia, use of ACE-I/ARB, beta blocker, vasodilator, cross
clamp time, r ¼ -0,08 b coefisien level -0,2 with CI 95 % (-0,99-0,5), p ¼ 0,5.
Conclusion: There was a moderate positive correlation between PV ET-1 with PVR pre
surgery, the increased of PV ET-1 level 1 pg/ml, would increase PVR level 1,04 WU.
There was no significant correlation between PV ET-1 with PVR post surgery.
Keywords: Pulmonary Vascular Resistance † Mitral Stenosis † Endotelin-1 † Pulmon-
ary Hypertension
Mitral valve E-Point septal separation as an independent predictor for in-hospital
mortality after acute ST-elevation myocardial infarction
M. F. Sarahazti 1, Z. Syahputra 1, D. Ashrinda 1, E. Hasibuan1, Komaria 1, J. Suganti 1,
N. Z. Akbar 2, A. P. Ketaren2, Z. Safri 2, and A. A. Siregar2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Departement of
Cardiovascular, Haji Adam Malik General Hospital, Medan, Indonesia
Background: It has long been known that Left Ventricluar Ejection Fraction (LVEF) is a
predictor for mortality in ST-elevation Myocardial Infarction (STEMI). Recent studies
show that wall motion abnormality in acute STEMI make it difficult to obtain true
global systolic function. Mitral valve E-point Septal Separation (EPSS) is a simple
M-Mode measurement and has been studied as a bedside tool to assess true LVEF in
many cardiac disease, this study carried out to see if there was any association
between EPSS and mortality in acute STEMI patient.
Methods: We performed echocardiography to measured EPSS and LVEF from 52 adult
subject diagnosed with acute STEMI who were admitted to Haji Adam Malik General Hospital
from May 2015 until November 2015. Patients with other comorbidity such as chronic kidney
disease, cerebrovascular disease, chronic obstructive pulmonary disease and sign of infec-
tion or malignancy was excluded. Patients then were divided into normal EPSS(,10) and ab-
normal EPSS(.10), each group was followed during the hospitalization.
Result: Bivariate analysis showed among the LVEF biplane Simpson’s methode (LVEFs)
(OR ¼ 13.42, 95% CI 1.60 to 112.64, p ¼ 0.004), LVEF Teicholz’s methode (LVEFt) (OR ¼
11, 95% CI 2.16 to 55.92, p ¼ 0.001) and EPSS (OR ¼ 18.75, 95% CI 2.23 to 157.51, p ¼
0.007) were associated with in-hospital mortality. In all patient with LVEFs and LVEFt
value ,40 there was 85,3% and 96,4% had EPSS value .10, respectively. In multivariate
analysis, EPSS . 10 remained significantly associated and had 94,9% probability for
in-hospital mortality (OR 18,7, 95% CI 2.23 to 157.51, p ¼ 0.007).
Conclusion: Our data show that EPSS .10 appears to be an independent predictor for
in-hospital mortality in patient with acute STEMI. This simple M-Mode bedside objective
tool measurement can help the physician for futher appropriate management planing.
Keywords: EPSS † LVEF † STEMI † mortality
Effects of allopurinol on complications of post coronary artery bypass graft (CABG)
surgery in coronary artery disease’s patient with left ventricular dysfunction
N. M. Suryana, S. F. Supari, N. Haryono, and A. M. Soesanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indo-
nesia, National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Background: Reperfusion of coronary blood flow is important to resuscitate the ischemic
or hypoxic myocardium. However the return of blood flow to the ischemic area can result
paradoxical cardiomyocyte dysfunction, this is referred to as “reperfusion injury”. Clin-
ical manifestations of reperfusion injury post CABG surgery are arrhythmias, decrease
cardiac output and perioperative myocardial infarct. Oxidative stress has been con-
firmed as one of the main initiator in myocardial injury at ischemic and reperfusion
state. Allopurinol as an effective inhibitor of xanthine oxidase (XO) can reduce the oxida-
tive stress by blocking the formation of reactive oxygen species (ROS). Pre-operative allo-
purinol on CAD’s patient with LV dysfunction is expected reduce the complications of post
CABG surgery.
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Abstracts
Objective: To analyze effects of pre-operative administration of allopurinol on compli-
cations of post CABG surgery (low cardiac output syndrome which is measured by the use
of post-surgery inotropic and IABP, hospital mortality, perioperative myocardial infarc-
tion and arrhythmias) in CAD’s patient with LV dysfunction.
Methods: This study is a double randomized clinical trial, 34 CAD’s patients with LV dys-
function were randomly selected by consecutive sampling methods from September-
November 2015. They were divided into two groups. Sixteen patients were given
600 mg dose of allopurinol per oral one day before and 6 hours before surgery, and the
rest received placebo. Complications of post CABG surgery were observed since the
aortic cross clamp off until discharged.
Results: The use of post-surgery inotropic and IABP found significantly lower in allopur-
inol group (p 0.047). There was no significant difference in proportion of death in post-
operative hospitalization period in both groups, 6.25% vs 5.6% (p 1.000). While for the in-
cidence of arrhythmias was found significantly different in the two groups (31% vs 66%; p
0.039), with atrial fibrillation as the most common arrhythmia. No perioperative myocar-
dial infarction was found in this study, therefore effects of allopurinol to the event is
unknown.
Conclusions: Pre-operative administration of allopurinol may reduce the complications
of post CABG, especially the use of inotropic and IABP, and occurrence of arrhythmias.
Keywords: allopurinol coronary artery bypass graft † left ventricular dysfunction †
post surgery complication † reperfusion injury
Maternal and fetal outcomes of pregnancy with valvular heart disease
N. Virginia1, M. B. A. Pramono 2, and Y. Herry3
1
Faculty of Medicine, Diponegoro University, Semarang, Indonesia, 2Department of
Obstetrics and Gynecology, Faculty of Medicine Diponegoro University – Dr. Kariadi
Central General Hospital Semarang, 3Department of Cardiology and Vascular Medicine,
Faculty of Medicine Diponegoro University – Dr. Kariadi Central General Hospital
Semarang
Background: Valvular heart disease (VHD) is the most common cardiovascular disease in
pregnancy found in developing countries. Pregnancy with VHD remains a challenge for
the clinicians due to high maternal and fetal morbidities and its complex management.
Objective: The aim of this study was to evaluate maternal and fetal outcomes of preg-
nancy with VHD.
Methods: An observational descriptive study done retrospectively in a cross-sectional
manner involving pregnant patients with valvular heart disease who underwent labor
and delivery in dr. Kariadi Central General Hospital Semarang in the period of January
2013 to September 2015.
Result: From a total of 13 study subjects, 6 subjects (46,2%) had mitral stenosis as the pre-
dominant valve disease, while the other 7 (53,8%) had predominant mitral regurgitation.
92,3% of patients had worsening NYHA functional class and all subjects had worsening
stages of progression of VHD. Maternal complication in the form of pulmonary edema
was seen in 30,8% subjects, while arrhythmia was seen in 15,4% subjects. Maternal mor-
tality was not found in this study. Mode of delivery was vaginal in 7 subjects (53,8%), while
the rest of the subjects had Caesarean section. 4 of 6 Caesarean sections were done for
obstetric reasons. Fetal complications in the form of prematurity, small for gestational
age, low APGAR score, and intrauterine fetal death (IUFD) occurred in 46.2%, 23.1%,
15.4%, and 7.7% cases, respectively.
Conclusion: This study showed that pregnancy with VHD is associated with high maternal
and fetal morbidities, thus it should be managed by a capable multidisciplinary team.
Keywords: pregnancy † valvular heart disease † maternal outcome † fetal outcome
QRS duration in ST elevation myocardial infarction patients undergoing a primary
percutaneous intervention
Nani, M. Fadil, M. Syukri, Y. Karani, and M. Syafri
Department of Cardiology and Vascular Medicine, Faculty of Medicine Andalas University
of Andalas Djamil Hospital Padang
Background: STelevation myocardial infarction (STEMI) generally results from intralum-
inal thrombus formation and occlusion of a ruptured or an unstable plaque. The main goal
of therapy in STEMI is to restore microvascular flow and sustain the myocardial perfusion.
A variety of markers including ECG and coronary angiography have been utilized to assess
myocardial reperfusion. In the present study, we identify of QRS duration in the patients
with STEMI treated with primary percutaneous coronary intervention.
Material and methods: This study enrolled 30 patients with a diagnosis of STEMI within 12
hours of symptom who undergoing primary percutaneous intervention from July until
Desember 2015. The diagnosis of STEMI was made on the basis of the presence of at
least two of the following: chest pain lasting longer than 30min, increase in the creatinine
kinase myocardial band, and new STelevation of at least 0.1mV in two or more contiguous
leads. All patients were administered 320 mg aspirin and 600 mg clopidogrel loading dose
before the procedure. Blood samples were obtained on admission, and patients with
normal creatinine levels were included in the present study.
Result: Total STEMI within 12 hours of symptom who undergoing primary percutaneous
intervention from July until Desember 2015 in Dr.M. Djamil Hospital Padang from July
until Desember were 30 patients. In this study, male was dominant (88%) patients with
mean age of 51 + 1 years. Smoking as a major risk factor in 22 (72%) patients. Average
time of ischemic time in this study was 61 hours. Left ascending diagonal (LAD) was the
main culprit of lesion (54%). Most of patients had 2 vessel disease (54%). QRS duration
pre procedure (88 + 18) and post procedure (86 + 72) showed a reduction of time.
 Abstracts
Conclusions: STEMI was more common in adult males with smoking being the major risk
factor. Shortening of QRS duration was showed in patients who undergoing primary PCI
and could be a marker of microvascular perfusion.
Keywords: STEMI † QRS duration † reperfusion therapy
Knowledge of resident medical officers on hypertensive emergency: A descriptive
study
N.P.H. Lugito, A. Kurniawan, T.A. Yanto, I. Wijaya, M.M. Tjiang, R. Setiadinata,
S. Sumantri, and E. Seto
Internal Medicine Department, Faculty of Medicine, Pelita Harapan University
Background: Nearly one billion of world population has hypertension but hypertensive
emergency occurred in less than 1%. Hypertensive emergency is a life-threatening
state because of acute damages of target organs. The primary aim of hypertensive emer-
gency management is to safely reduce blood pressure within hours. The success of the
management is dictated by the health personels first in contact with the patient. This
study aimed to assess the knowledge of resident medical officers (RMOs), physicians
attending patients in the emergency unit, wards, and intensive care in Siloam General
Hospital, Karawaci, Banten, Indonesia.
Methods: This descriptive cross sectional study was performed in January 2016 using a
questionnaire about the characteristics and knowledge of RMOs. The questionnaire
about the knowledge consisted of open question about the definition, target organ,
drug therapy, and target management of hypertensive emergency according to the
2013 ESH/ESC Guidelines for the Management of Arterial Hypertension. Data is presented
as mean + standard deviation and percentage.
Results: Twenty six RMOs participated in survey, with mean age of 27.42 + 0.32 year-old,
65.4% were female. Mean time since graduation was 4.38 + 1.74 years, mean working ex-
perience in hospital was 3.08 + 0.37 years. Definition about target organ damage was
correct in 92.30%, with 53.84% and 42.31% correct about systolic and diastolic blood pres-
sure threshold. Above 80% knows the brain, heart, kidney and eyes as target organ. Ap-
proximately 69.23% would use intravenous nicardipine for drug therapy, but only 7.69%
and none would use beta blockers and diuretics. The target of decreasing mean arterial
pressure was correct in 80.76%. All RMOs know that patient has to be admitted to inten-
sive care unit.
Conclusion: The knowledge of the RMOs about the definition, clinical signs, and manage-
ment of hypertensive emergency is quite sufficient, but still needs update in certain
aspects.
Keywords: resident medical officers † knowledge † hypertensive emergency
Hyperuricemia and its association with incident of congestive heart failure in
Madurese population
N. Rahmy1, I. Maghfirah 2, R. Maulana3, F. Alzahra’ 4, A. Putrinarita 2, A. Lestari 2, V. Tandy 2,
I.D. Sanjaya 2, Y. Nurina 2, L. Lidjaja 2, L. Agustin 2, D. Listiarini 2, E. Pradyta 2, A. Aulani 2,
and A. Pramudya 2
1
Faculty of Medicine Padjadjaran University, 2Faculty of Medicine Airlangga University,
3
Faculty of Medicine Muhammadiyah Jakarta University, 4Faculty of Medicine Gadjah
Mada University
Background: Congestive heart failure as one of the leading cause of mortality and mor-
bidity worldwide, has trigger researches about the etiology and pathophysiology of the
disease. Current study about metabolic imbalances occurring in CHF has leads to show
that hyperuricemia could be a prognostic indicator of the disease. However, the relation-
ship between hyperuricemia and the risk for incidence of CHF remains uncertain. The ob-
jective of this study was to examine the strength of correlation between hyperuricemia
and CHF in RSUD Sampang, Madura.
Methods: Data were taken from patients who admitted to RSUD Sampang Policlinic
between July to December 2015 as a cross sectional study. Samples consist of 117 subjects
who fulfilled inclusion and exclusion criteria. Data were analyzed by Chi-Square test and
Fisher’s as an alternative test with 95% confidence interval.
Result: Among the 117 patient, 38.5% (n ¼ 45) were men and 61.5% (n ¼ 72) were
woman. The mean age was 53.71 ranging from 23-92 years which predominated by age
group of 51-55 years old (23.1%). Congestive heart failure were diagnosed in 60 subjects
(51.3%) and 57 (48.7%) were normal. There was no significant relationship between
hyperuricemia (p ¼ 0.2) towards congestive heart failure. The odd ratio was 1.78 (95%
CI:0.64 to 4.91).
Conclusion: This present study show there was no significant relationship between
hyperuricemia towards congestive heart failure in RSUD Sampang, Madura.
Keywords: hyperuricemia † congestive heart failure † madurese population
Diagnostic value of Duke Treadmill Score in predicting coronary lesions severity in
patients with suspecter stable coronary artery diseases
N.M.E. Mayasari, I.A. Arso, and E. Maharani
Department of Cardiology and Vascular Medicine, Faculty of Medicine Gadjah Mada Uni-
versity Yogyakarta
Background: Duke Treadmill Score (DTS) is a well known score to stratify prognosis with
good diagnostic value in predicting number of diseased coronary arteries in ischemic
heart disease patient. DTS has also been shown to have a strong correlation with the se-
verity of coronary lesion based on the Syntax score. This study aim to know the diagnostic
value of DTS in predicting the coronary lesions severity based on Syntax score.
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Methods: Cross sectional study was performed in Dr. Sardjito General Hospital. Patients
who had positive exercise test result, already had coronary angiography and met the
inclusion and exclusion criteria, were included in the study. DTS was calculated
based on the assessment of the exercise test result and Syntax score was measured
from the coronary angiography result. Statistical analysis was performed to determine
the diagnostic value of DTS in predicting coronary lesions severity based on Syntax
Score.
Result: There were 76 patients with average age of 56.64 + 7.41 year old. Subjects with
high Syntax score and the low Syntax score were found in 30 subjects (39.5%) and 46 sub-
jects (60.5%) respectively. In this study, the DTS diagnostic value in predicting high
Syntax score was determined by the value of area under the curve based on the the Re-
ceiver Operating Characteristic (ROC) curve analysis was 92% (95% CI: 86%-97%, p:
,0.0001). Moreover, DTS with value -8.5 had sensitivity 83%, specificity 82%, positive
predictive value 75%, negative predictive value 88%, and accuracy 83% to predict
high Syntax score.
Conclusion: DTS has a good diagnostic value in predicting coronary lesions severity, par-
ticularly in patients with suspected stable coronary artery diseases. DTS value of -8.5 has
shown to have the best cut point in this study.
Keywords: Stable coronary artery disease † treadmill exercise testing † Duke Tread-
mill Score † Syntax score † severity of coronary lesions
Relationship of plasma glucose levels and troponin-I in patiens with acute myo-
cardial infarction
N.A. Putri 1, A. Purnawarman1, and H. Zufry2
1
Division of Cardiac Intervention, Department of Cardiovascular Medicine dr. Zainoel Abidin
General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia, 2Division of
Endocrinology, Methabolism & Diabetic, Department of Interna Medicine, dr. Zainoel
Abidin General Hospital / Faculty of Medicine Syiah Kuala University, Aceh, Indonesia
Background: Myocardial infarction takes the first place in the 10 leading causes of death
in the world. Positive correlation between blood plasma glucose value of the incident and
mortality from Acute Myocardial Infarction (AMI) has been researched. Troponin becomes
one biomarker of unknown myocardial damage.
Objective: To evaluate the correlation of increased plasma glucose levels and troponin-I
in patients with AMI.
Methods: This study was an observational analytic study with cross sectional survey, in 46
patients with AMI from July to September 2015 in the Intensive Cardiac Care Unit (ICCU)
dr. Zainoel Abidin General Hospital Banda Aceh. We collect diagnostic, troponin-I value,
plasma glucose value in medical records. Analysis statistical were performed using
Fisher’s exact test with p value of , 0.05 indicated statistical significance.
Results: Man (76.1%) with the age range of 40-60 years (69.6%) highest incidence of AMI.
Patients with disorders plasma glucose when they got into the hospital, they all (100%)
had abnormal levels of troponin-I with a mean + SD value blood glucose of 214.47 +
105.93 mg/dl. This showed that the disturbances of plasma glucose is associated with
troponin-I in patients with AMI (p ¼ 0.001, RP ¼ 0.533).
Conclusion: The current study revealed a significant relationship of plasma glucose
levels and troponin-I in patients with AMI.
Keywords: Acute Myocardial Infarction (AMI) † plasma glucose † troponin-I
The novel effect of polysaccharide peptides ganoderma lucidum in endothelial
dysfuction on stable angina patients
N. Ubaidillah 1, A. Widya1, Vittryaturida 1, K. Siwi1, M. Failasufi 1, F. Ramadhan 1,
H. Wulandari 1, Y. Waranugraha 1, D. Hayuning Putri 1, and D. Sargowo 2
1
Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya Uni-
versity – Dr Saiful Anwar General Hospital, Malang, Indonesia, 2Department of Cardiology
and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar
General Hospital, Malang, Indonesia
Background: Endothel dysfunction and dyslipidemia are cornerstone and independent
contributing factor to development of atherosclerotic cardiovascular disease. Stable
angina pectoris as common problem for atherosclerotic cardiovascular disease. Gano-
derma lucidum is a mushroom that is known for its numerous pharmacological effects
such as immunomodulator, anti-tumour, antioxidant, anti diabetic and anti-lipid. This
study was aimed to evaluate the effects of polysaccharide peptides (PsP) of Ganoderma
lucidum on inhibits CECs, EPCs as the hallmark of endothel vascular injury and effects as
anti lipid in stable angina pectoris patients.
Methods: This is a true clinical trial experimental study on 34 Stable Angina patients in
Saiful Anwar General Hospital was determined based on ESC Stable CAD guidelines,
with pre-test and post-test design without control. Parameter measured were CECs,
EPCs, total cholesterol and LDL. The patients were given PsP 750 mg/day in divided
dose for 90 days, while continuing the previous medications as directed by guidelines.
The data was analyzed by paired t-test for parametric data and Wilcoxon test for non-
parametric data.
Results: After PSP administration for three months found significantly reduce the level of
CECs from 2,52 + 3,05% to 0,71 + 1,41% (p ¼ 0.000) and did the EPCs level from 5,16 +
4,59% to 1,19 + 1,76% (p ¼ 0.000) and total cholesterol level reduced from 205,49 +
48,49 mg/dl to 182,11 + 73,81 mg/dl (p ¼ 0.081).
Conclusion: Ganoderma lucidum polysaccharide peptides have potent protective
vacular effect and anti lipid in stable angina pectoris and promising as additional drug
in the treatment of coronary artery disease caused by atherosclerotic process.
Keywords: Ganoderma lucidum † polysaccharide peptides † anti-lipid † dyslipide-
mia † CECs and EPCs
 B40
The correlation between serum galectin-3 level with the echocardiographic par-
ameter of left ventricular diastolic function (E/e’ ratio) in patients with heart
Failure with preserved ejection fraction
N. Widiawanto and M. Aminuddin
Department of Cardiology Faculty of Medicine, Airlangga University, Surabaya, Indo-
nesia; Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous
syndrome with many potential pathophysiological contributors. Myocardial fibrosis is a
major pathophysiological component of HFpEF. Galectin-3 is a marker of myocardial fi-
brosis, but its correlation with pathological processes against HFpEF has not been
widely studied. Left ventricular diastolic dysfunction is considered as the cause of abnor-
malities in the pathophysiology HFpEF. E/e’ ratio is an echocardiographic parameter of
left ventricular diastolic function in patients HFpEF. The aim of this research is to deter-
mine the correlation between galectin-3 serum level with the echocardiographic param-
eter of left ventricular diastolic function (E/e’ ratio) in HFpEF patients.
Methods: Analytic observational with cross sectional study enrolling 35 patients with
HFpEF obtained by purposive sampling. The serum levels of galectin-3 was measured
with ELISA (R&D Systems ELISA Quantikinew Human Galectin-3 Immunoassay). E/e’ is a
ratio between the peak value of the E wave divided by the peak value of the septal e’
as measured by examination of pulsed wave Doppler and tissue Doppler on transthoracal
echocardiography. Statistical analysis using Pearson correlation test because the data
have a ratio scale and normally distributed
Result: There is a strong and significant positive correlation between serum galectin-3
level and the E/e’ ratio (r ¼ +0.681 and p , 0.0001) in HFpEF patients.
Conclusion: The mean of galectin-3 serum level was 10,8471 + 4,820 ng/ml. There is a
strong and significant positive correlation between serum galectin-3 level with echocar-
diography parameter of left ventricular diastolic function (E/e’ ratio) in HFpEF patients.
There is a potential role of galectin-3 serum as a biomarker of diastolic dysfunction in
HFpEF patients.
Keywords: Galectin-3 † E/e’ ratio † Heart Failure † HFpEF
Correlation between soluble Suppression of Tumorigenicity 2 (sST2) and creatine
kinase-myocardial band level: Study on percutaneous coronary intervention
N. Sitorus, A. Nugroho, and Y. Herry
Departement of Cardiology and Vascular Medicine, Medical Faculty of Diponegoro Univer-
sity Dr. Kariadi Hospital, Semarang – Indonesia
Background: Elevated level of creatine kinase-myocardial band (CK-MB) affects the long
term outcome for patients underwent PCI (Per Cutaneous Intervention) and this eleva-
tion of CK-MB was reported as high as 25% from all PCI procedures and known as myocar-
dium injury related to PCI. soluble Suppression of Tumorigenicity2 (sST2), a new cardiac
marker is released as a respon to myocardial stress. Its correlation with CK-MB in patients
undergoing PCI never been investigated.
Objective: To asses the correlation between sST2 and CK-MB level in patients undergoing
PCI.
Methods: This is a cross-sectional study conducted, using the ASPECT-PLUS ST2 Assay Kit
to measure the sST2 level and ELISA methode for CK-MB level measurement. All subjects
had their CK-MB level measured before and 18-24 hours after PCI along with their sST2
level.
Result: A total of 30 subjects were enrolled. Mean level of CK-MB before, after PCI and
changes (delta CK-MB level) were 20,1 + 5,04 U/L, 26,0 + 20,80U/L, 7,03 + 20,39U/
L. Mean level of sST2 was 27,5 + 52,03 ng/ml, with minimum and maximum level were
10 ng/ml and 260 ng/ml. There were three subjects who had myocardial injury related
to PCI, with levels of sST2 were 25.753 ng/ml, 30.570 ng/ml and 260 ng/ml. There was
a positive moderate correlation between sST2 level with CK-MB level after PCI and
with delta CK-MB.
Keywords: soluble Supression of Tumorigenicity (sST2) † Creatine Kinase-Myocardial
Band (CK-MB) † Percutaneous Coronary Intervention (PCI)
Platelet to lymphosite ratio is a predictor of in-hospital mortality patient with
acute myocardial infarctionion
N. Meriedlona 1, R.K. Marsam1, A.N. Famila 1, I. Christina1, and T. Wasyanto 2
1
Resident. Cardiology and Vascular Medicine. University of Sebelas Maret. Surakarta.
Indonesia, 2Cardiologist. Cardiology and Vascular Medicine. University of Sebelas
Maret. Moewardi Hospital. Surakarta. Indonesia
Background: There was limited data regarding relationship between Platelets to
Lymphocyte Ratio (PLR) and mortality patient with acute myocardial infarction. High
level of platelet triggered atherosclerosis and lymphocyte was a modulator of immune
response. The aim of this study is to investigate relationship between platelet to lympho-
cyte ratio and in-hospital mortality of acute myocardial infarction.
Methods: We collected 79 patients between July 2015 to December 2015 in Moewardi
Hospital. This study is retrospective observational analytic. Inclusion criteria was
patiens with acute myocardial infarction and exclusion criterias were valvular heart
disease, malignancy, advanced renal or liver disease, active infection, and autoimmune
disease. Platelet and differentiated leucocyte count were measured by automated
hematology analyzer.
Result: 79 patients with mean age 59.97 + 11.78 years (64.4% male) were enrolled in this
study. In-hospital mortality was significantly higher in PLR . 224(n ¼ 13, 16.45%)
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Abstracts
compared to PLR , 224(n ¼ 4, 5.06%). According to bivariate analysis, PLR, age,
creatinin, smoking, ejection fraction, type of myocardial infarction, and dyslipidemia
with p , 0.25 were included to multivariate analysis. PLR (OR:0.029, 95% CI:
0.03-0.275) was independet predictor of in-hospital mortality together with creatinin
(OR:0.07, CI 95%:0.057-0.967), determine by multiple logistic regression analysis. The
PLR cut off point 224 from receiver operating characteristic analysis predicted
in-hospital mortality with sensitivity 82.4% and spesitivity 74.2% (area under curve.
83.8%, p-value , 0.001, and CI 95%:0.709-0.966).
Conclusion: We found that the PLR was significant to predict in-hospital mortality
patients with acute myocardial infarction. Platelet to lymphocyte ratio can be used for
cardiac risk stratification acute myocardial infarction.
Keywords: acute myocardial infarction † platelet to lymphocyte ratio † in hospital
mortality
Effect of depression on erectile dysfunction in stable coronary heart disease
patients
N.A. Sulistyo, I. Andiarso, and H. Hariawan
Department of Cardiology and Vascular Medicine, Faculty of Medicine Gadjah Mada
University Yogyakarta
Background: Coronary heart disease (CHD) is ranked first as morbidity and cause of
death in Indonesia. Atherosclerosis is a systemic disease and may involve atheroscler-
osis of the arteries in penis and produce erectile dysfunction (ED) in patients with CHD.
Depression and ED are common in patients with CHD. Depression can affect normal
erectile function. The aim of this study was to determine whether stable CHD patients
with depression have a higher risk for the incidence of ED when compared with them
without depression.
Methods: This paired case-control study was conducted in Dr. Sardjito Hospital, from
April to July 2015. Stable CHD patients diagnosed with coronary angiography who
make regular visit were investigated the risk factors for the occurrence of ED. The assess-
ment of ED using the IIEF-5 questionnaire (Indonesian version) and depression with the
HADS questionnaire (Indonesian version). Stable CHD patients with ED was a group of
cases. The control group was stable CHD patients without ED with age matching of the
case group.
Results: Eighty six patients were included in the study, with 57 patients as cases and 29
patients as controls. Depression was present in 5 stable CHD patients with ED (8.7%). The
odds ratio for incidence of ED in stable CHD patients with depression was 2.692, but not
statistically significant (CI 95% 0.300-24.192; p: 0.306).
Conclusion: Stable CHD patients with depression have a higher risk of ED when compared
with them without depression, however it was not statistically significant.
Keywords: Erectile dysfunction † stable coronary heart disease † depression
The correlation betwen the electroniccardiographic findings based on Seattle
criteria and the left ventricular mass index of the football players
Nurhikmawati 1, M. Amir1, I. Mappangara 1, I.J. Ganda 2, P. Tandean1, and K. Saleh 1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Hasanuddin
University, Makassar, 2Department of Pediatric, Faculty of Medicine Hasanuddin
University, Makassar
Background: Exercise and regular physical exercise associated with process of remodel-
ing in the form of Left Ventricular Hypertrophy which is we have known that the increase
of ventricular mass index will increase the risk of sudden cardiac death. This research
aimed to assess the correlation between between Seattle Criteria and the increase of
left ventricular mass index of a football player.Thus, it was hoped that the Seattle Criteria
could be used to predict the increase of the left ventricular mass index. The research was
a cross-sectional observational study design.
Methods: The study was conducted in Hasanuddin University Teaching Hospital from No-
vember 2015 through December 2015. The respondents comprised 46 people, and the re-
search population included the football players of Makassar football club. The
assessment was performed using the questionnaire, then the examinations of ECG and
echocardiography were carried out. The data were analyzed with correlation coeffi-
cients Kontingesia.
Results: The research results indicated that there 34 players (73.9%) had the normal var-
iants, 5 players (10.9%) had the normal pictures, and 7 players (15.2%) had the abnormal
pictures. The research also indicated that there was a significant correlation between the
Seattle Criteria and the left ventricular mass index – the value of the correlation coeffi-
cient being 0.401, p ,0.05.
Conclusion: From the research we found that the finding of the normal variant of Seattle
Criteria showed the normal left ventricular mass index.
The development model of Ganoderma lucidum polysaccharide peptides as
antioxidant and anti-inflammation in patients with atherosclerosis
O. Handayani, N. Ubaidillah, A. Widya, Vittryaturida, K. Siwi, M. Failasufi, F. Ramadhan,
H. Wulandari, Y. Waranugraha, D.H. Putri, and D. Sargowo
Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya Univer-
sity – Dr Saiful Anwar General Hospital, Malang, Indonesia
Background: Ganoderma lucidum is a type of mushroom that has been used for thousand
years throughout Asia, and has been known for its numerous health benefiting properties
 Abstracts
including antioxidant, anti-inflammatory, and anticancer properties. This study was con-
ducted to demonstrate the efficacy of Ganoderma lucidum polysaccharide peptides
(PSP) as anti-inflammation and antioxidant in cardiovascular disease.
Methods: In a prospective, randomized trial, with pre- and post-test design, we assigned
72 patients with atherosclerosis, 37 high-risk patients based on the Framingham Risk
Score and 35 patients with stable angina, to receive polysaccharide peptides (PSP) 3 x
250mg for three months as adjuvant to their previous medications. The primary end
points were the changes in biomarkers of inflammation and oxidative stress, including
interlukin-6 (IL-6), TNF-alpha, C-reactive protein (CRP), malondialdehyde (MDA) and
superoxide dismutase (SOD).
Results: There were significant reductions in inflammatory biomarkers IL-6, TNF-alpha
and CRP levels (p ¼ 0.000) in both high-risk patients and patients with stable angina.
The greatest reduction was shown in CRP level, from 20158.88 + 8968.08 ng/ml to
25329 + 8682.10 ng/ml (p ¼ 0.000) in stable angina patients. Moreover, PSP could
reduce MDA level (from 114.13 + 24.56 uM to 36.48 + 28.39 uM and 95.63 + 21.27 uM
to 44.84 + 50.95 uM, p ¼ 0.000, in high-risk and stable angina patients respectively),
and increase SOD level, which is the primary internal antioxidant from 3.41 + 0.46 U/
ml to 5.97 + 4.19 U/ml (p ¼ 0.001) in patients with stable angina. The efficacy of PSP ad-
ministration on the levels of SOD, MDA, TNF-alpha, CRP and IL-6 was most significantly
shown on SOD levels (r ¼ 0.392, p , 0.05).
Conclusion: Ganoderma lucidum PSP as adjuvant therapy has significantly demonstrated
its benefits as anti-inflammation and antioxidant in high-risk patients and patients with
stable angina.
Keywords: Ganoderma lucidum † polysaccharide peptide † atherosclerosis † anti-
oxidant † stable angina
Hypertension knowledge, awareness, and attitudes in hypertensive patients in
primary health center in Mataram, Lombok island, Indonesia
P. A. Syah 1 and M.E. Sanif 2
1
General Practicioner, Arjawinangun Public Hospital, West Java, Indonesia, 2Cardiolo-
gist, Permata Cirebon Hospital, West Java, Indonesia
Background: Hypertension (HTN) is one of the most common world’s most common
health condition and a leading risk factor to mortality. A good understanding of the im-
portance of the HTN is the key factor for the primary and secondary prevention of HTN
among the patients. The aim of this study is to investigate HTN knowledge, awareness,
and attitudes in hypertensive patients in primary health center in Mataram, West Nusa
Tenggara, Indonesia.
Methods: We identified patients with HTN (n ¼ 30) in primary health care in Mataram,
West Nusa Tenggara, Indonesia from Mei-October 2015. Hypertension was defined as a
mean systolic and/or diastolic blood pressure of 140 ≥ 90 mmHg and/or antihyperten-
sive medication use during the last two weeks.
Results: Only 36.7% of all patients correctly identified the meaning of HTN as “high blood
pressure”. All of the patients (100%) were not able to identified systolic blood pressur-
e(SBP) as the “top number” of the reading and diastolic blood pressure (DBP) as the
“bottom number” of the reading. Most of the patients (93.3%) knew that they have hyper-
tension. Eighty sevent percent of the patients agreed that taking medicine was very im-
portant to keep the blood pressure under control. When asked whether a hypertension
was a life long disease or not, more than a half of the patients (56.7%) agreed that hyper-
tension was a life long disease.
Conclusion: These results suggest that, although perception and awareness of HTN are
adequate, but patients do not have a complete understanding of the knowledge of the
disease, for an example only 36.7% patients correctly identified the meaning of HTN as
“high blood pressure”. This observation suggest that a public health approach is neces-
sary to improve the patients’s knowledge of HTN.
Keywords: hypertension † public health † mataram † primary health center
Right ventricular dysfunction as an independent predictor of longer hospital stay in
patients with acute decompensated heart failure
P.P. Yamin, S.B. Raharjo, V.K.P. Putri, R. Soerarso, B.B. Siswanto, and N. Hersunarti
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indo-
nesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Hospital length of stay (LOS) is a key determinant of heart failure hospital-
ization costs. Longer LOS is associated with lower performance on quality of care mea-
sures and higher rates of subsequent readmission and mortality. Right ventricular (RV)
dysfunction predicted poor outcomes in patients with stable chronic HF, however, its
prognostic value in the setting of acute decompensated heart failure (ADHF) patients
has not been sufficiently clarified.
Purpose: To investigate the prognostic value of RV dysfunction in predicting longer LOS in
ADHF patients.
Methods: A prospective cohort study was conducted in our hospital to all patients admit-
ted with ADHF and had data on baseline RV functions assessed by tricuspid annular plane
systolic excursion (TAPSE). Detailed clinical, laboratory and echocardiographic data
were collected on admission. Clinical comorbidities including malnutrition, concomitant
pneumonia and worsening renal function (WRF) were monitored during hospitalization.
The primary outcome was hospital LOS. Cox regression analysis were used to identify in-
dependent predictors for longer LOS.
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Results: Two hundred and fifty-nine patients presenting to the emergency department
with the diagnosis of ADHF were included in this cohort study. On time-to-event analysis,
diastolic blood pressure (HR 1.011, 95% CI 1.004-1.018, p ¼ 0.002), hemoglobin levels
(HR 1.102, 95% CI 1.045-1.162, p , 0.001), RV dysfunction (measured by TAPSE) (HR
0.659, 95% CI 0.506-0.857 p ¼ 0.002), WRF (HR 2.015, 95% CI 1.520-2.670, p , 0.001)
and malnutrition (HR 5.965, 95% CI 4.402-8.082, p , 0.001) were associated with
longer LOS. In a multivariate Cox regression model, RV dysfunction (HR 0.515, 95% CI
0.303-0.874, p , 0.02), WRF (HR 2.989, 95% CI 2.160-4.135, p , 0.001) and malnutrition
(HR 8.211, 95% CI 5.883-11.459, p , 0.001) were the sole independent predictors of
longer length of hospital stay.
Conclusions: Right ventricular dysfunction is an important predictor of longer length of
hospital stay. Routine assessment of the right ventricle should be considered in the evalu-
ation of patients with ADHF.
Keywords: acute decompensated heart failure † right ventricle † tricuspid annular
systolic excursion † length of stay
Correlation of cardiac T2* magnetic resonance imaging, left ventricular ejection
fraction, and serum ferritin level in patients with Beta-Thalasemia
P. Almazini, A. Kristyagita, and T.M. Haykal
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indo-
nesia, Jakarta, Indonesia
Background: Myocardial hemosiderosis still remains as one of the serious leading causes
of death in patients with thalassemia. Early detection of iron overload may lead to more
effective tratment but it still challenging. The aim of this study was to evaluate
correlation of cardiac T2* Magnetic Resonance Imaging (MRI), left ventricular ejection
fraction (LVEF) measured by echocardiography, and serum ferritin level in patients
with beta-thalasemia.
Methods: This was a cross-sectional retrospective study identified 36 patients with
beta-thalasemia who underwent cardiac T2* MRI, echocardiography, and serum ferritin
level assessment in Cipto Mangunkusumo Hospital. Data were analyzed using SPSS
version 17.0 software.
Results: Of 36 patients with beta-thalasemia, mean age of patient was 13.7 + 12.9 ms.
Mean value of LVEF was 67.1 + 5.2%. Median value of serum ferritin was 3066.5 ng/mL, at
the range 1031-5188 ng/mL. Statistical analysis showed there was no significant correl-
ation between LVEF and cardiac T2* MRI (r ¼ 0.273, p ¼ 0.107). No significant correlation
was observed between LVEF and serum ferritin level (r ¼ -0.012, p ¼ 0.946). However, a
significant negative correlation was observed between cardiac T2* MRI and serum ferritin
level (r ¼ -0.346, p ¼ 0.039).
Conclusion: Our study showed LVEF is not alternative parameter for detection iron de-
position in patient with beta-thalasemia. However, serum ferritin level is still feasible
method to estimate iron burden in patien with beta-thalasemia.
Keywords: Cardiac T2* MRI † LVEF † Ferritin † Thalasemia
Association between risk factors of acute myocardial infarction and QTc dispersion
after streptokinase administration in Dr.Moewardi Hospital, Surakarta
P. Septiani1, A. K. Martiana1, A. Jalaludinsyah 1, and T. Wasyanto2
1
Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia, 2Department of
Cardiology and Vascular Medicine, Dr.Moewardi Hospital, Surakarta, Indonesia
Background: Cardiovascular risk factors and acute myocardial infarction (AMI) can
impair mechanical and electrical activity of the heart. A better ventricular repolariza-
tion is expected after administration of fibrinolytic. QTc dispersion (QTcd) is a parameter
that can be used to evaluate the ventricular repolarization heterogeneity. It is the differ-
ence between the longest and the shortest QTc interval in the electrocardiogram (ECG).
The aim of the study is to evaluate the association between risk factors of AMI and QTc
dispersion after streptokinase administration.
Methods: In this retrospective sudy, we collected data from the medical records of 73 AMI
patients who were treated with streptokinase from January 2014 – December 2015. The
12-lead ECG was recorded before receiving streptokinase and an hour after receiving
streptokinase. We measured the QT interval using a digital caliper and calculated the
QTc according to the Bazett’s formula, then we counted the QTc dispersion. Data analysis
was performed using Chi square test.
Results: Among the male (82%) patients, shorter QTcd (30.515 + 24.322 ms) after
streptokinase administration was found in 55%; while among the female (18%)
patients, shorter QTcd (29.400 + 11.371 ms) was found in 38%. Among discharged
patients (80%), shorter QTcd (32.781 + 24.925 ms) was found in 54%; while
among died (in hospital) patient (20%), longer QTcd (37.500 + 22.633 ms) was found
in 58%. There were no association between hypertension and QTcd (OR ¼ 0.657,
95% CI ¼ 0.258-1.674, p ¼ 0.377), between diabetes and QTcd (OR ¼ 0.700, 95%
CI ¼ 0.233-2.100, p ¼ 0.524), and between smoking and QTcd (OR ¼ 0.987, 95% CI ¼
0.381-2.555, p¼ 0.979).
Conclusion: After streptokinase administration, QTcd shortening was more likely in male
patients and discharged patients. There was no association between hypertension, dia-
betes, and smoking with QTcd.
Keywords: QTc dispersion † acute myocardial infarction † streptokinase † hyperten-
sion † diabetes † smoking
 B42
Use of anticoagulants and antiplatelet agents in patients with stable coronary
artery disease and atrial fibrillation in outpatient clinic RSUP Dr. M.Djamil Padang
P. Yeantesa, M. Fadil, T. Daindes, D. Puspita, R. Musritha, C.K. Krevani, Y. Karani, and
M. Syafri
Division of Cardiology and Vascular Medicine, Faculty of Medicine, Andalas University,
General Hospital of Dr. M. Djamil Padang
Background: Patients with atrial fibrillation (AF) and stable coronary artery disease
(CAD) remain a therapeutic challenge because of the different antithrombotic therapies
for these conditions and the increase in bleeding with concomitant antiplatelet and anti-
coagulant medications. Current guidelines extrapolated data from studies of antithrom-
botic regimens of each condition separately but there is limited evidence for the optimal
regimen in patients with atrial fibrillation and stable coronary artery disease beyond the
first year after an acute coronary syndrome or stent implantation. The aim of this study is
to describe the prevalence of AF and its antithrombotic management in a contemporary
population of patients with stable coronary artery disease.
Methods: Data were collected between July 1st, 2015 – December 31st, 2015. We studied
outpatients with stable coronary artery disease, defined as prior (≥12 months) myocar-
dial infarction, revascularization procedure, or chest pain associated with evidence of
myocardial ischemia.
Result: We recruited 289 patients to be screened, and 16 of them were excluded. Fur-
thermore, we found 31 (11%) patients had a history of AF and mostly are male (70.9%)
with mean age 59.9 + 11.8. Among patients with CAD and AF, 93% of the patient required
antithrombotic treatment according to the CHA2DS2-VASc score (≥2). Oral anticoagula-
tion alone was used in 38.8%, antiplatelet therapy alone in 38.5% (single 22.3%, dual
16.2%), and both in 22.5%. OAC use was independently associated with permanent AF
(p , 0.001), CHA2DS2-VASc score (p , 0.001), and longer history of coronary artery
disease (p , 0.001). History of percutaneous coronary intervention (p ¼ 0.004) was asso-
ciated with reduced oral anticoagulant use.
Conclusion: Patients with stable coronary artery disease and AF, who are theoretical can-
didates for anticoagulation as the appropriate medication, apparently only used in 61.3%
of all the samples. One-third of the patients received antiplatelet therapy alone and one-
fifth received both antiplatelet and oral anticoagulants. Efforts are needed to improve
the knowledge and adherence to guidelines in treat these patients.
Keywords: atrial fibrillation † stable coronary artery disease † anticoagulant †
antithrombotic
Prevalence of overweight and obesity among hypertensive patients in a rural area:
A descriptive study at Kubu Village, Karangasem, Bali
P. Nugiaswari 1, A. Yasmin 1, P. Antara1, R. Widiana 2, and W. Wita1
1
Department of Cardiology and Vascular Medicine, Udayana University, Bali, Indonesia,
2
Nephrology and Hypertension Division, Internal Medicine Department, Udayana Univer-
sity, Bali, Indonesia
Background: Hypertension and obesity are major risk factors of cardiovascular morbidity
and mortality in developing countries. According to the Regional Health Department
Survey 2015 in Bali, the prevalence of hypertension was 28% and 12% of excess body
weight. This study was carried out to establish the prevalence of overweight and
obesity among hypertensive patient at Kubu Village, Karangasem District of Bali Prov-
ince.
Methods: The study included 115 subjects from Kubu Village who attended the social
work clinic held by the Department of Cardiology and Vascular Medicine, Udayana Univer-
sity. Hypertension was defined as systolic blood pressure ≥ 140 and/or diastolic blood
pressure ≥ 90mmHg or being on any hypertensive therapy. All subjects underwent an-
thropometric measurement such as body weight, height, and waist circumference.
Demographic data were obtained using structured questionnaire. Subjects considered
overweight were those with a body mass index (BMI) of 25 kg/m2 or greater, and those
considered obese as having a BMI of 30 kg/m2 or greater.
Results: The overall prevalence of hypertension in the study was 24.3% (28 out of 115
patients). The prevalence was higher in women (54%) than in men (46%). Among these
subjects, the prevalence of overweight, obesity, and central obesity were found to be
25%, 3.6%, and 32% respectively. The majority of subjects had low educational profile
(71%) and half of them had regular fish consumption.
Conclusion: The prevalence of hypertension was high as expected, meanwhile central
obesity seems to be much higher compared to data from the regional survey. The findings
confirm the growing concern about hypertension and central obesity as a public health
problem, especially in rural areas such as Kubu Village. This warrants for good control
of cardiovascular risk factors in those populations.
Keywords: Hypertension † Obesity † Central Obesity † Rural Area
Pulmonary hypertension : Echocardiographic characteristics in Cimacan General
Hospital
R.S.D. Gill 1 and D. R. Syawaluddin2
1 Methods: We conducted a cross-sectional study of AMI patients presenting within 3-24
Cimacan General Hospital, Cianjur, Indonesia, 2East Belitung General Hospital, Manggar,
Indonesia
Background: Pulmonary hypertension defined as an increase in mean pulmonary arterial
pressure ≥ 25 mm at rest and is more often diagnosed in its advanced stage because of
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Abstracts
the nonspecific early symptoms and signs. Echocardiography is a key screening tool in
the diagnostic algorythm.
Objectives: Objectives of this study is to know pulmonary hypertension echocardio-
graphic characteristic in Cimacan general hospital as a rural hospital.
Methods: This study was a crossectional study, 22 consecutive patients with pulmonary
hypertension referred for echocardiography were evaluated.
Result: Echocardiographic characteristics of the patients with pulmonary hypertension can
be seen in table 1. 16 patients (72.7%) shows right atrium enlargement, 1 patient (4.5%)
shows anterior wall hypertrophy, 14 patients (63.6%) shows posterior wall hypertrophy,
16 patients (72.7%) shows septal hypertrophy, 8 patients (36.4%) shows moderate tricuspid
regurgitation,and 13 patients (59.1%) shows severe tricuspid regurgitation. 9 patients
(40.9%) have pericardial effusion, and 1 patient (4.5%) shows thrombus in the right atrium.
Conclusion: Right atrium enlargement is usually found in patients with pulmonary hyper-
tension as seen in the result. In this study we found right atrium enlargement and septal
hypertrophy in 72.7% of the patients. Correlation study shall be done in order to investi-
gate what causes both of the cardiac anatomy changes.
Keywords: Echocardiography † characteristic † pulmonary hypertension
Clinical profile and risk factor of congestive heart failure patients in Subang
General Hospital, West Java
R.S.D. Gill1, G. C. Massie 2, N. Y. Nasser3, and A. A. Hartono 4
1
Subang General Hospital, West Java, Indonesia, 2Kembangan District General Hospital,
Jakarta, Indonesia, 3Faculty of Medicine, Airlangga University, Surabaya, Indonesia,
4
Koja General Hospital, Jakarta, Indonesia
Background: Congestive heart failure (CHF) has become an increasingly frequent reason
for hospital admission and clearly represents a major health problem. In general popula-
tion, CHF is the most common complication of hypertensive and coronary heart disease. It
is a growing health problem in most countries and yet there is not enough data available in
Indonesia. Objectives of this study are to investigate clinical profile and risk factors of
CHF patients in Subang General Hospital.
Methods: This was a crossectional study, carried out in Subang General Hospital, con-
ducted from July – December 2015.
Results: A total of 29 patients presented with CHF were included in the study. There were
21 males (72. 4 %) and 8 females (27.6%). Majority of patients (n ¼ 20, 69.0%) were aged
.50 years old. Dyspneu on effort was the most common symptom found in 24 patients
(82.8%), followed by cough (n ¼ 20, 69.0%), orthopneu (n ¼ 17, 58.6%), fatique (n ¼
12, 41.4%), oedeme extremities and weight loss (n ¼ 10, 34.5%), chest pain and tachycar-
dia (n ¼ 8, 27.6%), Paroxysmal nocturnal dyspnea (n ¼ 7, 24.1%), palpitation (n ¼ 5,
17.2%%). Patients risk factors can be seen in figure 1.
Conclusion: Hypertension is the leading cause and dyspneu on effort is the most common
symptom found in CHF patients in Subang General Hospital. Patients also came in late
stages, as can be seen in the severe symptoms shown. These results can be explained
by considering the remote location of Subang itself, limited access to healthcare, and
low level of knowledge of the patients.
Keywords: clinical profile † risk factors † congestive heart failure
Correlation between troponin T and plasma magnesium level in acute myocardial
infarction patient
R. H. Wibowo, S. Hidayat, and A. Purnomowati
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran Uni-
versity, Bandung, Indonesia
Background: Ischemic heart disease still the main cause of death worldwide. Magnesium
(Mg) status is often ignored in Acute Myocardial Infarction (AMI). The reduction of Mg level
in AMI occurs due to migration of Mg from extracellular to intracellular space caused by
increased catecholamine level in acute stress condition. There are limited studies
regarding correlation between cardiac enzym biomarker and Mg level in AMI, however
there were inconsistency in research results. The objective of this study is to analyze cor-
relation between troponin T and plasma Mg level in AMI patients.
hour of symptom onset in Hasan Sadikin Hospital. Electrocardiograms were collected
during admission and and blood samples were collected within 16-24 hour of symptom
onset. Correlation between troponin Tand plasma Mg level were analyzed with Spearman
correlation.
 Abstracts
Results: A total of 46 patients (73.9% male, 59 + 11 years old) were included in the ana-
lysis. Median for symptom onset was 8 (3-24) hours. The median troponin T level was 0.99
(0.10-2.00) ng/ml and the average Plasma Mg level was 2.02 + 0.24 mg/dL. There was a
moderate significant negative correlation between troponin T and Mg level (r ¼ -0.510,
p ¼ ,0.001). In the present study, plasma Mg level was found to have a significant rela-
tionship with the infarct size assessed by troponin T.
Conclusion: There was a moderate significant negative correlation between troponin T
and plasma Mg level in AMI patients.
Keywords: plasma magnesium † acute myocardial infarction † troponin
Effect of atorvastatin loading prior to fibrinolysis on nitric oxide levels in patients
with acute myocardial infarction
R. K. Marsam, N. Purwaningtyas, and T. Wasyanto
Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
Background: Incidence of acute myocardial infarction as a form of coronary heart
disease (CHD) is increasing. Reperfusion as definitive therapy aims to relaunch the blood-
stream and improve endothelial dysfunction. Previous studies have demonstrated the
beneficial effect of additional therapy prior to reperfusion to improve endothelial dys-
function. Statins as lipid-lowering therapy have pleiotropic effects that have been
shown to improve endothelial dysfunction. Giving statins before primary percutaneous
coronary intervention shown to increase levels of nitric oxide (NO). Data on statin
before fibrinolysis action is still lacking.
Aims: To determine the effect of atorvastatin 80 mg immediately prior to fibrinolysis on
nitric oxide levels in patients with acute myocardial infarction.
Methods: This study was a randomized controlled trial (RCT). 30 consecutive patients
with acute myocardial infarction undergoing fibrinolysis at Intensive Cardiovascular
Care Unit (ICVCU) Dr Moewardi Hospital Surakarta were included in the study. The eligible
patients were randomized into two groups : Treatment group (atorvastatin 80 mg prior to
fibrinolysis, n ¼ 15) and Control group (without atorvastatin prior to fibrinolysis, n ¼ 15).
Venous blood samples were collected from all patients prior to and 24 hours after fibrin-
olysis. Serum concentrations of NO were measured using colorimetric assays. Normally
distributed data were compared using independent t-test. p , 0.05 was considered to in-
dicate a statistically significant difference.
Results: NO levels in treatment grup was higher than the control group (6.18 + 2.48 vs
4.50 + 2.52; p ¼ 0.077). Elevation of NO levels in the treatment group was higher than
the control group and statistically significant (3.18 + 1.52 vs 1.88 + 1.55; p ¼ 0.028).
Conclusions: Administration of atorvastatin 80 mg immediately prior to fibrinolysis
increases levels of nitric oxide in patients with acute myocardial infarction with ST
segment elevation
Keywords: Atorvastatin † fibrinolysis † nitric oxide † acute myocardial infarction
Cardiovascular manifestation after long-term glucocorticoid abusers from
traditional herbal drinks: A population based-study
R.A. Nugraha1, R.B. Wicaksono1, D. Octavia 1, D.P. Zennita 1, W. Sudihardjo 1, I. Yunita 1,
G. Anggiridiaksha1, H. Hekmatyar 1, N. Salsabilla 1, V. Wati1, I. Wahyuni2, N. Widajanti3,
L. Djuari 4, and S. Prayitno4
1 PCI or fibrinolytic in CVCU of M. Djamil hospital from July 2015 to Desember 2015 were
Faculty of Medicine, Airlangga University, Surabaya – Indonesia, 2Ophtalmology Depart-
ment, Dr. Soetomo Hospital – Airlangga University, 3Geriatric Division, Internal Medicine
Department, Dr. Soetomo Hospital – Airlangga University, 4Public Health Department,
Faculty of Medicine, Airlangga University, Surabaya – Indonesia
Background: Glucocorticoid misuse is a common problem in Indonesia, especially in rural
area. Many unofficial traditional herbal drinks containing glucocorticoid are commonly
found in Indonesia, especially at Mojoagung District, Jombang. Many corticosteroid
drugs and their derivatives drugs are easy to get in drugstores. Nevertheless, there is
very few published literature regarding the magnitude of glucocorticoid misuse and
their long-term effect in developing countries on South East Asia.
Objective: Analyze the relationship between long-term glucocorticoid abusers with car-
diovascular manifestation in pre-elderly and elderly population at Mojoagung District,
Jombang.
Methods: Cross-sectional study was conducted at Mojoagung District, Jombang with
multi-stage cluster random sampling, collecting 63 samples. Data were collected by
questionnaire to access history of consuming glucocorticoid from traditional herbal
drinks and/or medication. Statistical analysis applied Pearson’s correlation, Independ-
ent Sample t-test, Chi-square test with Coefficient Contigency. 63 subjects were com-
posed of 19 pre-elderly (55-64 years old) and 44 elderly subjects ( . 65 years old),
28.6% men and 71.4% women, with a mean age of 69.65 (+10.07) years.
Results: 18 subjects(28.6%) were steroid abusers for more than 30 years. Of the 18
abusers subjects, hypertension were found in 15 subjects(83.33%), whereas in 45 non-
abusers subjects, hypertension were only found in 16 subjects (35.56%). There is a mod-
erate relationship between long-term glucocorticoid abusers with hypertension (p ¼
0.001, r ¼ +0.396, PR 2.344 [1.503-3.655; 95%CI]). Results showed a significant increase
in systolic and diastolic blood pressure (SBP and DBP) in glucocorticoid abusers which
associates with duration of abuse (p ¼ 0.02 and p ¼ 0.03, respectively). No significant
electrocardiography changes had been found. No major cardiovascular complication,
ASCVD, Stroke, and Cardiomyopathy, and Hypoadrenal Crisis had been found during
observation.
Conclusion: Increase in SBP or DBP is a common complication of long-term glucocorticoid
abusers which can lead serious cardiovascular manifestation. Glucocorticoid misuse is an
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B43
important problem which has been inadequately addressed in the rural and semi-urban
communities of Mojoagung District, Jombang.
Keywords: Elderly † Hypertension † Glucocorticoid † Steroid Abusers † SBP † DBP
Association between sex differences with congestive heart failure in Madurese
population, Sampang, Madura
R. Maulana 1, I. Maghfirah 2, F. Alzahra’ 3, A. Putrinarita 2, N. Rahmy4, A. Lestari2, V. Tandy 2,
I.D. Sanjaya 2, Y. Nurina 2, L Lidjaja 2, L. Agustin 2, D. Listiarini2, E. Pradyta 2, A. Aulani 2, and
A. Pramudya 2
1
Faculty of Medicine Muhammadiyah Jakarta University, 2Faculty of Medicine Airlangga
University, 3Faculty of Medicine Gadjah Mada University, 4Faculty of Medicine Padjajaran
University
Background: Congestive heart failure represents a major heart problem for the aging
population, particularly among women. According to the Framingham Study, the risk of
heart failure is increased by two fold in men and 3 fold in women.
Objective: The objective of this study was to examine the strength of evidence available
for gender differences in the etiology of congestive heart failure in Madurese population,
Sampang, Madura.
Method: A cross sectional study was conducted between July to Desember 2015 from
medical records of outpatient department, RSUD Sampang. Samples were 137 subjects
who fulfilled inclusion and exclusion criteria. Data were analyzed by Chi-Square test
and Fischer’s as an alternative test with 95% confidence interval.
Result: Among the 137 patients, 38% (n ¼ 52) were men and 62% (n ¼ 85) were woman.
The mean age was 52.94 raging from 23-92 years, which predominated by age group of
50-54 years old (24.1%). Congestive heart failure was diagnosed in 61 subjects (44.5%)
and 76 (55.5%) were normal. There was a significant relationship between sex differences
(p ¼ 0.03) towards congestive heart failure. The odds ratio was 2.08 (95% CI:1.03 to
4.21), female has greater risk than male.
Conclusion: This study shows that there is a relationship between sex of the participants
and the incidence of congestive heart failure, as female are more at risk by 2.08 times
compared to male.
Keywords: sex † congestive heart failure † madurese population
Reperfusion strategy for acute myocardial infarction : Comparing in-hospital
outcome between primary PCI and fibrinolytic in M. Djamil Hospital Padang
R. Yandriani, M. Syafri, and M. Fadil
Acute Cardiac and Intensive Care Division, Department of Cardiology and Vascular Medi-
cine, Faculty of Medicine Andalas University of Andalas/ ICCU M. Djamil Hospital Padang
Background: Reperfusion is the key strategy in acute ST-segment elevation myocardial
infarction (STEMI) care. Primary PCI is the preferred reperfusion strategy for patients
with STEMI if it can be performed in a timely manner. Fibrinolytic therapy is the alterna-
tive to primary PCI. The objective of this study was to analyze in-hospital outcome in
STEMI patients who underwent primary PCI or fibrinolytic in Cardiovascular Unit Care
of M. Djamil Hospital.
Material and Methods: STEMI patients within 12 hours of onset who underwent primary
analyze. Patients underwent primary PCI received aspirin and clopidogrel. Heparin was
administrated in conjuction with PCI. Patients who underwent fibrinolytic received
aspirin and clopidogrel followed by streptokinase infusion for 60-90 minutes. Patients
with failed fibrinolytic and then underwent PCI were excluded from Primary PCI group.
The clinical profile, length of stay and in-hospital outcome in these two group were com-
pared.
Result: Total STEMI patients within 12 hours of onset hospitalized in CVCU of Dr.M. Djamil
Hospital Padang from July until Desember were 106 patients. This study was predomin-
antly male dominated (86% in PPCI and 72% in fibrinolytic) patients with mean age of
56 +4 years in PPCI and 58 +5 years in fibrinolytic. Cigarette smoking was identified
as a major risk factor in these two group (56% in PPCI and 58% in fibrinolityc).The mean
time from hospital admission to start of streptokinase infusion was 56 + 15 min and
door to balloon time was 65 + 25 min. There was no significant difference between the
groups in the number in-hospital mortality. The major bleeding is higher in fibrinolytic
group (8,8%). The most complication of STEMI were KILLIP II and there were no difference
in these group. There was difference in the length of stay in hospital ( primary PCI group
4,2 days, fibrinolysis group 5,6 days).
Conclusions: The most common reperfusion strategy in STEMI patients was fibrinolityc.
Patients who underwent primary PCI have shorter length of stay in hospital. Fibrinolytic
was associated with significantly higher risk of major bleeding.
Keywords: STEMI † reperfusion therapy † primary PCI † fibrinolytic † in-hospital
outcome
Knowledge, attitude, and practice of primary health care providers in prevention
and management towards hypertension in Morotai Island, North Maluku
R. Istisakinah, R.G. Aurora, R.U. Setiany, T.K. Perdamaian, H.D. Tjipto, D.R. Amalia,
A. Makmur, and M.M. Lubis
Morotai Island Government Health Office, North Maluku, Indonesia
Background: Morotai Island has high hypertension prevalence. Evaluation for prevention
and management of hypertension is still scarce especially in remote area. Thus, we
 B44
decide to study knowledge, attitude, and practice of health workers in primary care set-
tings toward prevention and management of hypertension.
Methods: A cross sectional study was conducted in all public health centers of Morotai
Island. The respondents were asked to fill questionnaire consisting of knowledge, atti-
tude, and practice questions that had been tested for its reliability using Cronbach
Alpha with value of 0.862. Level of knowledge, attitude, and practice was considered
poor if the percentage of correct answers was less than 50%, moderate if between
50-75%, and good if more than 75%. We performed univariate and bivariate analysis
using SPSS 17.0.
Results: From 113 respondents, 82 (72.6%) were female. The mean age was 28 + 4.36
years old. Only eight of them were medics, the rest were paramedics. Most respon-
dents had D3 degree (75.25%). Only five (4.4%) respondents had participated in
seminar associated with hypertension. Most respondents (57.5%) had moderate knowl-
edge about prevention and management of hypertension. Most of them had positive
attitude (70.8%) and more than half of respondents had adequate practice towards
prevention and management of hypertension. Knowledge of respondents was not asso-
ciated significantly with profession, length of work, and history of attending hyperten-
sion seminar or workshop, but it was associated significantly with education degree
(p¼ 0.013). Both attitude and practice were not associated significantly with all
four factors.
Conclusion: Most of the primary health care providers in Morotai Island had moderate
knowledge, positive attitude, and adequate practice towards hypertension prevention
and management. Knowledge was associated significantly with education degree. Atti-
tude and practice did not have association with profession, length of work, and history
of attending hypertension seminar or workshop.
Keywords: Hypertension † KAP † health provider † primary care † Morotai Island
Correlation between tricuspid regurgitation duration with severity of pulmonary
arterial hypertension in atrial septal defect patients.
R.P. Kaneko 1, D.W. Anggrahini1, A.B. Hartopo 1, and L. Krisdinarti 2
1 tionnaire written in Indonesian. The inclusion criterion is all patients diagnosed with
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada Uni-
versity, Yogyakarta, 2Echocardiography Division, Department of Cardiology and Vascular
Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta
Background: Pulmonary arterial hypertension (PAH) is characterized by abnormally ele-
vated pressure in the pulmonary circulation that are the result of progressive vascular re-
modeling, increased pulmonary vascular resistance and increased pulmonary arterial
pressure (PAP). Gold standard for measuring PAP is using Right Heart Catheterization
(RHC). It was recently reported that profound right ventricular dysfunction, that reflects
deteriorate PAP, could be assessed using Tricuspid Regurgitation (TR) duration. Decrease
in TR duration may predict poor deterioration of the PAP. Therefore we aimed to investi-
gate whether TR duration correlates with severity of PAP in Atrial Septal Defect patients.
Methods: We conducted a cross sectional study using hospital based registry in Dr. Sard-
jito Hospital Yogyakarta between September 2012 – November 2015. All patients under-
went echocardiography and RHC to measuring mean PAP (mPAP). PAH was defined as a
mPAP ≥ 25 mmHg measured by RHC. TR duration was defined as the time between
onset and cessation of TR flow. TR duration was corrected for heart rate using formula
p
TR duration (TRDc) ¼ TR duration/ (R-R interval). R-R interval was measured in
seconds using electrocardiography tracing.
Results: Thirty nine consecutive patients with ASD, 30 female (76.9%) and 9 male (23.1%).
Mean age of this population is 39.9 + 13.6 years old. These patients underwent echocar-
diography and right heart catheterization with result mean TRDc and mPAP are 498.23 +
52.5 ms and 43.85 + 20.64mmHg respectively. Afterwards, mPAP was divided into three
categories in which mild, moderate, and severe PAH to show the PAH severity. Correlation
between TRDc and PAH severity were assessed using ANOVA by SPSS 20. In this study, PAH
severity was correlated with the TRDc (r: 0.555; P: ,0.0001). The higher the TRDc, the
more likely the patient has more severe PAH.
Conclusion: Our study confirms In Our study confirms the correlation between TRDc with
PAH severity among ASD population. Thus, TRDc may surrogate the determination of PAH
severity using noninvasive methods, and the degree may reflects more of PAP than the en-
largement of right heart chambers in ASD.
Keywords: Atrial septal defect † right heart catheterization † pulmonary arterial
hypertension † tricuspid regurgitation duration
Comparison of functional capacity between atrial fibrillation and sinus rhythm
patients after mitral valve surgery
R. Myrtha 1, I.F. Yuwono 2, A. Mahavira 3, A.M. Ambari 3, B. Radi3, A. Santoso3, and
B.S. Purwowiyoto3
1 lar ejection fraction (LVEF) and myocardial injury marker (cardiac troponin). All
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sebelas Maret, 2Department of Cardiology and Vascular Medicine, Faculty of Medicine,
Universitas Diponegoro, 3Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Indonesia
Background: Atrial fibrillation (AF) is associated with a reduction in functional capacity
in healthy subjects and in patients with different pathological conditions such as post
valvular surgery. The aim of this study is to evaluate the impact of atrial fibrillation on
functional capacity among patients after mitral valve surgery.
Methods: We performed a cross sectional study among patients undergoing cardiac re-
habilitation after mitral valve surgery in National Cardiovascular Center Harapan Kita
between January until December 2013. We compared functional capacity of AF patients
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Abstracts
to sinus rhythm. Six minute walking test distance (6MWD) was used to measure functional
capacity.
Results: A total 151 patients were included in this study. There were 84 (55.3%) male. Of
151 patients, 67 patients (44.1%) were atrial fibrillation. Baseline 6MWD in AF was signifi-
cantly lower compared to sinus rhythm group (292.1 + 68.5 vs 322.7 + 85.2, p ¼ 0.02).
After phase II cardiac rehabilitation, 6MWD in AF group was still significantly lower com-
pared to sinus rhythm group (365.5 + 70.8 vs 412.7 + 83.3, p ¼ 0.001). But both groups
showed similar improvement after phase II cardiac rehabilitation (Delta 6MWD 72.5 +
65.5 vs 90.9 + 70.3, p ¼ 0.122). At multivariate analysis, 6MWD was negatively asso-
ciated with age (p , 0.001).
Conclusion: Post mitral valve surgery patients with AF had lower baseline functional cap-
acity, however cardiac rehabilitation program improved their capacity and the improve-
ment was comparable to their counterparts with sinus rhythm.
Keywords: functional capacity † 6MWD † atrial fibrillation
Knowledge, attitude and perception (KAP) of patients with hypertension about
hypertensive disease in Baso Primary Health Center, Agam District, West Sumatera
on 2014
R. U. Setiani1 and G.A. Temi2
1
Baso Primary Health Center, Agam District, West Sumatera, 2The Faculty of Medicine,
University of Indonesia
Background: Untreated hypertension can cause premature complications. About
one-third of hypertensive patients late-diagnosed with hypertension, resulting in mul-
tiple organ complications such as stroke and myocardial infarction. West Sumatera Prov-
ince has high prevalence of hypertension. Therefore; we tried to identify the level of
knowledge, attitude and perception (KAP) of hypertensive patients in one of common
treating facility, Baso Primary Health Center, so that we could optimize the prevention
of hypertension complications.
Methods: This study use cross-sectional design, using modified and validated KAP ques-
hypertension (SBP ≥ 140 mmHg and DBP ≥ 90 mmHg) at least three months previously.
The data analyzed with regression-linear to find relationship between level of education
and patient’s KAP.
Results: There are 31 subjects involved, 64,5% of them are female. Average age of sub-
jects is 61,29 years old. The level of education shows that 58,1% of subjects has low edu-
cation level (not educated or not graduated from elementary school). We also found that
19,4% and 35,5% of subjects has obesity and abdominal obesity respectively. From the
analysis, we found that 67,8% of subjects has good and average knowledge, 87,1% of sub-
jects has good and average attitude, and all subjects has good and average perception.
However, the regression test does not show any relationship between the level of educa-
tion and the level of KAP (p . 0,05).
Conclusion: This study shows that almost all subjects have good KAP on hypertension and
its complications although over half of them have low education level. This also shows
that health education has been distributed equally in rural areas despite the low educa-
tion level. We hope that this could be an example to increase our awareness of hyperten-
sion and its complications.
Keywords: Hypertension † KAP † Level of Education † West Sumatera
Readmission rate of chronic heart failure patient and it’s characteristic in Meilia
Hospital Cibubur, Depok, West Java : A descriptive study
R. Hendiperdana1 and Sugiantoro2
1
Meilia Hospital, Cibubur, West Java, 2Cardiologist at Al-Islam Hospital, Bandung, West Java
Background: Acute decompensated heart failure is one of the most often case which
need for hospitalization. Re-hospitalization in heart failure patient indicate poor progno-
sis, bad Quality of Life and unsuccessful treatment. One of two chronic heart failure
patient will have hospital re-admission in 6 months. Euro Heart Failure Survey Program
have found 24 % patient with heart failure were admitted within 12 weeks post-
discharge. The significant morbidity associated with heart failure is reflected in hospital
readmission rates. This study aim to describe hospital readmission rate in chronic heart
failure patient that present to emergency department (ED) at Meilia hospital based on
patient medical record.
Methods: This was a cross-sectional descriptive study from medical record in June until
December 2015. The study take place from hospitalized adult patient due to heart failure
in Meilia Hospital Cibubur. The study describe time between last hospital admission with
recent hospitalization in patient due to heart failure syndrome. Patient comorbid also de-
scribe in this study. Comorbid variables are hemoglobin, serum creatinine, left ventricu-
documented data present by descriptive method.
Result: There 35 patients with CHF hospital admission were documented form June until
December 2015. seven patients (20 %) have hospital readmission due to heart failure
symptom less than 1 month post-discharge, 4 patient (11.5 %) have hospital readmission
in less than 6 months post-discharge, and 24 patient (68.5 %) have hospital readmission
more than 6 months periode post-discharge. From those data, 8 patients ( 22.85 %)
have Hb level , 12 g/dL, 10 patients (28.5 %) have serum creatinine . 1.2 mg/ dL, 21
patients ( 60 %) have reduced LVEF , 50 %, and 6 patients ( 17.2 %) have high serum
cardiac troponin T . 100 ng/L.
Conclusion: In Meilia hospital from June-December 2015, readmission from CHF was still
high. Twenty percent patient readmitted in less than 1 months post-discharge. Patient
 Abstracts
comorbid of CHF admission like anemia, azotemia, low LVEF, and high cardiac troponin
levels accompany patients profile in more than 15 % patients.
Keywords: Heart failure † readmission
Predictors of prolonged length of stay in acute heart failure patients based on 2012
Heart Failure Registry of National Cardiovascular Centre Harapan Kita
Rizki, B.B. Siswanto, F.P. Apriansyah, F. Tedjasukmana, R.S. Pratikto, N. Hersunarti, and
A.M. Soesanto
Departement of Cardiology and Vascular Medicine, Universitas Indonesia / National Car-
diovascular Centre Harapan Kita, Jakarta, Indonesia
Background: Hospitalizations due to acute heart failure caused a huge economic burden
on our health care system. Little amount of data is known from Indonesia. Predicting the
length of stay (LOS) and knowing factors that influenced it may help clinicians to manage
their patient, and the government to arrange a well-defined insurance policy.
Methods: This study was based on heart failure registry of National Cardiovascular Centre
Harapan Kita in 2012. We identified local demographic, previous medical history and
medications, clinical profiles on admission, laboratory data, and use of intravenous
(IV) therapy that were associated with hospital LOS. Prolonged hospitalizations was
defined as more than seven days, based on previous studies. From 27 parameters ana-
lyzed using bivariate analysis, 16 of them (p ,0.25) were included in the multivariate
analysis using logistic regression.
Results: This study included 1207 patients in our registry. Median LOS was 5 (ranged from
1 to 29) days, 24.7% patients were hospitalized more than seven days. Variables asso-
ciated with prolonged LOS from multivariate analysis (p ,0.05) were history of diabetes
mellitus (adjusted odds ratio [OR] 1.68; 95% confidence interval [CI] 1.26-2.24); use of IV
inotropic (OR 5.72; 95% CI 3.08-10.63) and IV nitrates (OR 1.99; 95% CI 1.26-3.15) on ad-
mission; and hiponatremia (OR 1.57; 95% CI 1.14-2.16).
Conclusion: We identified four predictors of prolonged LOS in our acute heart failure
patients. The use of IV inotropic drugs and nitrates on admission were the two strongest
predictors. Patients with high-risk profiles who benefit from this kind of treatment should
be treated more aggressively to minimize the LOS.
Keywords: Heart Failure † predictors † length of stay
Transcatheter closure of large patent ductus arteriosus with severe pulmonary
hypertension: A three year experience form national refferal center in
Indonesia
R.M. Candrasatria, R. Prakoso, P.S. Roebiono, I. Sakidjan, Y. Kurniawati, O. Lilyasari,
A.U. Rahajoe, and G. M. Harimurti
Department of Cardiology and Vascular Medicine Universitas Indonesia, National Cardio-
vascular Center Harapan Kita-Indonesia
Background: Transcatheter closure is an established procedure for patent ductus arter-
iosus (PDA). However, it carries higher risk in large PDA with severe pulmonary hyperten-
sion. This study aims to evaluate the early and follow-up results in such population.
Methods: Retrospective study has been conducted from January 2013 until December
2015 in National Cardiovascular Center Harapan Kita, Jakarta-Indonesia. Sixteen
patients with PDA diameter ≥5mm and mean pulmonary arterial pressure (mPAP)
.50 mmHg without other major structural heart disease underwent transcatheter
closure with device.
Results: The mean age was 17.4 + 10.7 years old. The mean smallest duct diameter was
11.5 + 4.2mm. The median flow ratio (FR) was 1.7 (0.5-6.6) and mean pulmonary arterial
resistance index (PARi) was 6.5 + 4.4 WU. Fourteen patients underwent oxygen test with
subsequent mean FR was 6.7 + 5.2 and median PARi was 0.9 (0.4-6) WU. After PDA
closure, the mean mPAP decreased from 58.9 + 5.8 mmHg to 40.4 + 14.9 mmHg (p ,
0.001). Immediately after closure, 9 patients (56.3%) had minimal central residual
PDA. Upon follow-up to 6 months (median of one week), no residual PDA was detected.
One patient experienced major bleeding requiring transfusion. One patient experienced
dislodged device and underwent uneventful emergency surgery accordingly.
Conclusions: Transcatheter closure is feasible, effective and safe in patients with PDA
and associated reversible severe pulmonary arterial hypertension.
Keywords: Large PDA † severe pulmonary hypertension † transcatheter closure
Correlation between P wave dispersion and left atrial volume in obese
young adults
S. Sinambela, M.R. Akbar, C. Achmad, A. Purnomowati, and T.M. Aprami
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran Uni-
versity/ dr. Hasan Sadikin General Hospital, Bandung, Indonesia
Background: The prevalence of obesity tends to increase including in young adults.
Obesity increases the risk of cardiovascular diseases, including atrial fibrillation (AF).
Previous studies showed that remodeling in the left atria, i.e. electrical remodeling
and structural remodeling, predate AF. Both remodeling can be quantified, using P
wave dispersion (PWd) for electrical remodeling, and left atrial volume (LAV) for struc-
tural remodeling. No previous studies have analyzed the correlation of both parameters
in obese young adults. The objective of this study is to analyze the correlation between
PWd and LAV in obese young adults.
Methods: This was a cross-sectional study in obese young adults population, performed at
Installation of Cardiovascular Services at dr.Hasan Sadikin General Hospital Bandung, May
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1st, 2015– August 30th, 2015. The Body Mass Index (BMI) was measured, subjects also
underwent electrocardiography (ECG) procedure for PWd assessment, and echocardiog-
raphy to assess LAV. Pearson correlation analysis was used to determine the correlation
between PWd and LAV.
Results: A total of 46 subjects [mean age 30.3 + 4.6 years, 67.4% male, median BMI 30.8
(27.05-39.03) kg/m2], were enrolled in this study. Mean PWd was 62.9 + 15.9 ms and
mean LAV was 39.2 + 7.7 mL. Analysis showed a positively weak correlation (r ¼
0.398; p , 0.05) between PWd and LAV.
Conclusion: There is a positively weak correlation between PWd and LAV in obese young
adults. In this population, electrical remodeling predates structural remodeling.
Keywords: atrial fibrillation † left atrial volume † obesity † P wave dispersion †
young adults
Correlatioon between waist circumference and blood pressure in patients of
Cardiology Department Policlinic in General Province Hospital of West Nusa
Tenggara
S.S. Fitri, Y. Pintaningrum, and R. Cholidah
Medical Faculty of Mataram University, Indonesia; 2Department of Cardiology, Medical
Faculty of Mataram University, Indonesia
Background: The prevalence of obesity continues to increase. Obesity is one of the
risk factor of cardiometabolic diseases such as diabetes, hypertension, dislypidemia,
and coronary heart disease. Waist circumference is one of the method that is used for
anthropometric measurements of the body which can be used as a screening for
obesity.
Objective: To find the corelation between waist circumference and blood pressure.
Method: This study was an observational research with cross sectional design. Samples
were taken by consecutive sampling. Respondents of this study were patients aged 25
years or over in cardiology department policlinic at general province hospital of west
nusa tenggara. Subjects that meets the inclusion and exclusion criteria had their blood
pressure and waist circumference measured. The collected data were statistically
tested using Spearman correlation test.
Result: The statistical analysis indicated a significant association between waist circum-
ference and systolic and diastolic blood pressure (p , 0,05). A positive correlation was
found between waist circumference and systolic and diastolic blood pressure. The
strength of the correlation between waist circumference and systolic and diastolic
blood pressure was moderate (R ¼ 0,509; R ¼ 0,459).
Conclusion: There is a correlation between waist circumference and systolic and diastol-
ic blood pressure
Keywords: Waist circumference † systolic blood pressure † diastolic blood pressure †
obesity
Relationship between total bilirubin concentration with Gensini Score as severity
level of coronary atherosclerotic in stable coronary disease
S. Mariani, Erwinanto, P. Tedjokusumo, A. Purnomowati, and T. M. Aprami
Department of Cardiology and Vascular Medicine, Padjadjaran University, Dr. Hasan
Sadikin Hospital, Bandung, Indonesia
Background: Stable coronary artery disease happen because of supply and demand myo-
cardial oxygen imbalance. Oxygen myocardial supply decrease because of stenotic cor-
onary artery with atherosclerosis Oxidative stress is important role in atherosclerotic
that can make endothelial dysfunction. Oxidative stress happen when oxidant is more
radical than endogenous antioxidant, like total bilirubin. There is no previous studies
that examine the relationship between total bilirubin concentration with severity of cor-
onary atherosclerotic in stable coronary disease.
Methods: This study is a cross-sectional to adult patients with stable coronary disease. It
was performed at invasive diagnostic of dr.Hasan Sadikin General Hospital Bandung, Juli
1, 2015 – August 15, 2015. Subject underwent coronary angiography examination to
assess severity of coronary atherosclerotic and laboratory examination to assess total
bilirubin serum. Severity of coronary atherosclerotic was calculated using Gensini
score. Correlation between total bilirubin serum and Gensini score was analyzed using
Kendall’s tau correlation.
Results: Total of 30 subjects with mean age 57 + 9 year and 86,7% males were enrolled in
this study. Mean total bilirubin serum was 0,61 + 0,26 mg/dl and Gensini score was
72,5 + 44,82. Analysis showed a significant negative and moderate correlation (r¼
-0.555; p , 0.001) between bilirubin total and Gensini score.
Conclusion: Lower total bilirubin in stable coronary disease patients may indicate higher
severity of coronary atherosclerotic which is marked by higher Gensini score.
Keywords: Stable coronary disease † total bilirubin † Gensini score † atherosclerotic
High plasma level of hsCRP associated with mortality and major adverse cardio-
vascular effect (MACE) after percutaneous coronary intervention in STEMI patients
S. Widodo, A.B. Hartopo, and B.Y. Setianto
Department Cardiology and Vascular Medicine Faculty of Medicine Universitas Gadjah
Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
Background: High sensitive C-reactive protein (hsCRP) is an acute phase protein that
appears in the circulation in response to inflamatory. hsCRP, a marker for cardiovascular
co-morbidities
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Aims: To investigate the role of hsCRP to predicte MACE and mortality after percutaneous
coronary intervention in STEMI patients.
Methods: Cohort study enrolling 61 patients with ST-elevation acute myocardial infarc-
tion that performed PCI. The inclusion criteria were ages 30-75 years and onset , 24
hour. The exclusion criteria were chronic kidney disease, chronic heart failure, acute in-
fection, acute stroke and preadmisi reperfusion. hsCRP was measured from peripheral
blood taken on admission STEMI patients, before Percutaneous Coronary Intervention .
Follow-up after to investigate mortality and MACE after PCI. For analytical purpose,
subject devide into two groups based on mean with High and low hsCRP. The incidence
of mortality and MACE was compared between these group. Chi-square was performed
for analysis. A p value , 0.05 was deemed statistically significant.
Results: Using Chi-square, the mean hsCRP level was 0.41, High hsCRP group (n ¼ 30) and
low hsCRP group(n¼ 31). Incidence mortality 16.7 % versus 9.7 %, p ¼ 0.473; MACE 40%
versus 25.8%, p ¼ 0.238 Fatal and MACE outcomes did not significantly differ between
groups.
Conclusion: High level of hsCRP not associated with mortality and cardiovascular adverse
outcomes post percutaneous coronary intervention in STEMI patiens
Keywords: hsCRP † ST-elevation myocardial infarction † MACE
Association between hypoxemia in cyanotic congenital heart disease with post
catheterization arterial thrombosis
S.N. Siagian, S. Adiarto, I. Sakidjan, and I. Sunu
Department of Cardiology and Vascular Medicine, Universitas Indonesia – National
Cardiac Centre Harapan Kita, Jakarta, Indonesia
Background: Arterial thrombosis is one of complication that can happen to congenital
heart disease patient post catheterization which consequence can be life threathening.
According to many studies, the incidence varies between 1% to 30% and the risk factors
are related to catheterization procedure, age and weight. Hypoxemia in cyanotic stimu-
lates various abnormalities which based on Trias Virchow will increase the risk for throm-
bosis which are change in blood flow, blood composition and endothelial integrity.
Whether this predisposition factor is the main factor causing post catheterization throm-
bosis is still uncertain. Therefore, the purpose of this study is to find the association
between hypoxemia in cyanotic and the occurrence of post catheterization arterial
thrombosis.
Methods: This cross sectional study is conducted in National Cardiovascular Center
Harapan Kita (NCCHK) to congenital heart disease patients undergoing catheterization.
The subjects are divided into 2 groups: cyanotic and acyanotic based on the abnormality
of the heart and the degree of saturation that measured directly from the blood and per-
ipheral oxygen saturation with oximetry. Hypoxemia was defined as oxygen saturation
less than 95%. Duplex sonography is conducted post chateterization to find the arterial
thrombosis. Thrombosis is diagnosed with the appearance of thrombus and the change
of Doppler waveform from proximal to distal extremity.
Results: There are 86 post catheterization congenital heart disease patients involved in
this study. They are subsequently divided into 2 groups: 53 (61.6%) in cyanotic group, and
33 (38.4%) in acyanotic group. Post catheterization arterial thrombosis is found in 24.4%
of cyanotic subjects, and 4.7% in that of acyanotic subjects. Significant association
between hypoxemia in cyanotic congenital heart disease and post catheterization arter-
ial thrombosis is found. The risk for cyanotic congenital heart disease with hypoxemia to
have arterial thrombosis is high. (OR 4.758; 95% IK 1.460-15.505; p¼ 0.006).
Conclusion: This prospective study has demonstrated the significant association
between hypoxemia in cyanotic congenital heart disease with post catheterization arter-
ial thrombosis. The risk for having thrombosis is high in cyanotic congenital heart disease.
Keywords: hypoxemia † cyanotic † congenital heart disease † arterial thrombosis †
heart catheterization
Gender differences on cardiovascular risk perception and heatlh-care seeking
behaviour among patients surviving myocardial infarction
S.S. Danny, D.A. Juzar, I. Firdaus, D. Zamroni, B. Widyantoro, Irmalita, and D. Tobing
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia - National Cardiovascular Center Harapan Kita Jakarta, Indonesia
Background: Cardiovascular disease remains a major cause of death among men
and women worldwide, but its significance in women has been traditionally underappre-
ciated. Many studies showed that women fared worse than men when hospitalized for
acute coronary syndrome, with higher morbidity and mortality rates. Lack of awareness
among women might contribute to this worse outcome. We aim to investigate gender dif-
ferences on cardiovascular health perception and health care seeking behavior among
patients admitted with ST elevation myocardial infarction (STEMI).
Methods: The study was conducted in National Cardiovascular Center Harapan Kita
Jakarta, Indonesia. We collected data from consecutive patients with STEMI during No-
vember 2014-June 2015. Data collected by questionnaire-guided interview before the
patient was discharged.
Results: From 448 STEMI patients discharged alive during the study period, 377 (84.2%)
were male and 71 (15.8%) were female. Women were older (mean age 60 and 57 years
old, p , 0.001) and presented with more coronary risk factors (69.7% women and
48.1% men with . 3 risk factors, p , 0.001). Chest pain was the main chief complaints
in both genders (86.3% in women and 83.7% in men, p ¼ 0.783). Women presented to
our hospital much later compared to men (240 min and 180 min, respectively, p ¼
0.005). There were significant differences in socio-economic status; only 64.9% women
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Abstracts
compared with 84.4% men (p , 0.001) graduated senior high school or higher, and
women also reported lower income than men. Prior knowledge on signs and symptoms
of heart attack were low in both genders; only 26.8% women and 41.4% of men reported
that they had had received some information on this subject. Only 11.3% women com-
pared to 31.8% men suspected their initial symptoms to be cardiac in origin (p ¼
0.001). Both genders thought that men are more likely to die out of heart attack than
women (80.3% women and 76.4% men, p ¼ 0.57) and that cancer is the main cause of
death in women (53.5% women and 57.8% men, p ¼ 0.46). More men stated their
ability to make an independent decision for emergency medical procedures like
primary percutaneous coronary intervention or coronary artery bypass grafting
without waiting for approval from another family member, although this did not reach
statistical significance (32.4% in men and 21.1% women, p ¼ 0.08)
Conclusion: Female STEMI patients in our study had lower level of education, had lower
income, and showed more pronounced lack of awareness and prior knowledge on signs,
symptoms and risks of heart attack than men, and this might contribute to the delayed
admission to healthcare facilities.
Keywords: myocardial infarction in women † gender differences in STEMI
Upper-limb artery anomalies found during transradial approach coronary
angiography and intervention
S. Widjaja1, H.A. Kuncoro 1, Ronaldi1, G. Yoga 1, H. Wijaya1, B. Budiono 2, and
J.A. Pangemanan 1
1
Department of Cardiology and Vascular Medicine Faculty of Medicine University of Sam
Ratulangi, Prof R.D.Kandou Hospital, Manado, Indonesia, 2Department of Cardiology and
Vascular Medicine Faculty of Medicine University of Sam Ratulangi, Awal Bross Hospital,
Makassar, Indonesia
Background: Transradial Approach (TRA) for diagnostic catheterization and percutan-
eous coronary intervention (PCI) has become popular over the last few years. Increased
use of TRA compared to Transfemoral Approach (TFA) is related to patient preference and
comfort, low risk of vascular and bleeding complications and better clinical outcomes
associated with TRA. However, upper-limb arterial anomalies are sometimes encoun-
tered during transradial coronary procedures. Challenging anatomy must be avoided to
minimise the risk of complications and shorten the duration of both the procedure and
radiation exposure. For this reason, a systematic preliminary angiogram of the arteries
of the upper-limb has been suggested by some experts. We investigated the frequency
of upper-limb arterial anomalies using retrograde arteriography in patients undergoing
transradial approach coronary angiography or intervention.
Methods: We studied 187 consecutive patients who underwent right transradial coronary
angiography or intervention from May 2014 to September 2014. Following the transradial
procedure, we performed retrograde transradial arteriography of right upper-limb arter-
ies in these patients and investigated the frequency and anatomy of arterial anomalies.
Results: A total of 40 upper-limb arterial anomalies were observed in 36 patients. These
included 8 small caliber radial artery (4.2%), 7 radial artery stenosis (3.7%), 6 high
take-off Ulnar (3.2%), 4 radial tortuosity (2.1%), 4 lusoria artery (2.1%), 2 small caliber
ulnar artery (1%), 2 small radio-ulnar (1%), one case (0.5%) for each of the following anom-
alies : high take-off radial, no ulnar artery, radial loop, radial-ulnar tortuosity, brachial
tortuosity, brachial artery occlusion, and ulnar artery disease. Some methods were
used to overcome the anomalies such as the use of soft-tipped hydrophilic wire,
Balloon-Assisted Tracking technique, specialized catheter for loop and tortuosity,
small diameter, and lusoria artery respectively.
Conclusion: Upper-limb arterial anomalies cause of transradial procedure failure even
for experienced transradial operators. Retrograde radial arteriography helps to delin-
eate underlying anomalies and identify patients with unfavourable anatomy, thereby
informing the operator to plan a strategy to overcome the anomaly or change access
route with the potential to save time and avoid vascular complications. This can be per-
formed with a minimum of contrast and should be considered part of a routine transradial
procedure.
Keywords: Transradial approach † upper-limb artery anomalies
The relationship between fragmented QRS complexes and severity of coronary
artery disease in patients with acute coronary syndrome
S. Hendyanto, Sheila, A.H. Alkatiri, and P. Kabo
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Hasanuddin,Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
Background: Fragmented QRS (fQRS) complexes on 12-lead electrocardiography (ECG)
have been reported to be predictors of cardiac events and all-cause mortality in coronary
artery disease (CAD) and acute coronary syndrome. It also can be used to estimate cardiac
injury and infarct size; therefore fQRS complexes would help physicians to make treat-
ment strategies.
Methods: Sixty-three patients with ACS whom underwent coronary angiography were
included. ECG performed on admission, then fQRS complexes were manually calculated.
SYNTAX scores were calculated based on angiographic findings. Patients were divided
into two complexity lesion groups according to their Syntax scores: low SYNTAX score
(,22) and moderate to high SYNTAX score (≥22); two vessel groups: one or no vessel
disease and multivessel disease (2/3 vessels); also two left main groups: no left main
disease or equivalent and with left main disease or equivalent.
Results: There was significant correlations between two SYNTAX groups and the presence
of fQRS (Spearman’s rho, r ¼ 0.503, p ¼ 0.0001), also number of fQRS (2.57 + 1.88 vs.
 Abstracts
0.7 + 1.54, p ¼ 0.0001). Correlation analysis showed a significant and positive relation-
ship between number of fQRS and SYNTAX score (Pearson, r ¼ 0.550, p ¼ 0.0001). There
was significant correlations between two vessel groups and the presence of fQRS (Spear-
man’s rho, r ¼ 0.479, p ¼ 0.0001), also number of fQRS (1.95 + 1.97 vs. 0.32 + 1.13, p ¼
0.001). There was significant correlations between left main groups and the presence of
fQRS (Spearman’s rho, r ¼ 0.326, p ¼ 0.009), also number of fQRS (2.75 + 2.32 vs.
0.91 + 1.47, p ¼ 0.0001).
Conclusion: The present study indicates that the presence and fQRS number on 12-lead
ECG on admission is associated with severity of CAD in patients with ACS. Moreover, the
fQRS might be useful to identify high-risk patients.
Correlation between tricuspid regurgitation duration corrected for heart rate and
right ventricular dysfunction in heart failure patients
Sudiyoko, H. P. Bagaswoto, H. Mumpuni, and L. Krisdinarti
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada Uni-
versity, Yogyakarta
Background: The physiology of right ventricular contraction is different and more dif-
ficult to be described than that of left ventricular. A decrease in the duration of tricus-
pid regurgitation corrected for heart rate (TRDc) has recently been shown as a useful
surrogate marker for predicting RV dysfunction in PAH patients. The aim of this study
was to investigate whether TRDc correlates with RV dysfunction in heart failure
patients.
Methods: We conducted a cross sectional study between November 2014-December
2015. We enrolled 50 patients with chronic heart failure. Tricuspid regurgitation duration
was defined as the time between the onset and the cessation of TR flow. RR interval was
measured in seconds using electrocardiographic tracing. TR duration was corrected for
p
heart rate using a formula: TRDc ¼ TRduration/ (RR interval). Right ventricular dys-
function was defined by TAPSE ,16 mm using echocardiography.
Results: The study was done in 32 males (64%) and 18 females (36%), with average age of
56 + 9.07 years old. The mean RVSP, TAPSE and TRDc was 46.62 + 15.93 mmHg, 17.34 +
4.64 mm and 518.20 + 65.67 ms, respectively. By Pearson correlation, tricuspid regurgita-
tion duration corrected for heart rate has negative correlation with TAPSE in heart failure
patients, but not statistically significant (r ¼ -0.189, p ¼ 0.188). Additionally we found
group with TAPSE ,16 mm has mean TRDc higher than group with TAPSE ≥16 mm, but
not statistically significant (525.71 + 51.73 ms vs 512.30 + 75.24 ms; p ¼ 0.479).
Conclusion: Tricuspid regurgitation duration corrected for heart rate was not correlated
with RV dysfunction in heart failure patients.
Keywords: Heart failure † tricuspid regurgitation duration † RV dysfunction
Correlation of small dense low density lipoprotein with conventional lipid levels:
An interesting fact finding
Sugiri, S.A. Wiyono, M A. Nugroho, and U. Bahrudin
Department of Cardiology and Vascular Medicine, Diponegoro University Faculty of Medi-
cine – Dr. KariadiGeneral Hospital, Semarang, Indonesia
Background: Dyslipidemia is known as a risk factor for coronary artery disease (CAD).
Patients with high level of small dense low density lipoprotein (sdLDL) have an increasing
cardiac event despite their normal level of LDL cholesterol.However, correlation
between sdLDL and conventional lipid levels remains elusive.
Purpose: To know the correlation between sdLDL and conventional lipid levels in patients
with CAD.
Methods: This is an observational analytic study with cross sectional approach in the Car-
diovascular Center, Dr. Kariadi General Hospital Semarang. The patients with proven CAD
by angiography and receiving 20 mg simvastatin orally for more than 2 weeks were
involved. Measurement of levels of sdLDL, LDL, HDL, total cholesterol, and triglyceride
was performed for all patients. SPSS computer program was used for statistical analysis.
Results: A total of 30 CAD patients with mean of age 55 years old were enrolled in this
study. Risk factors for CAD were dyslipidemia (93.33%), overweight(76.67%), metabolic
syndrome (66%), smoking (46.67%), and diabetes mellitus (26.67%). Mean of sdLDL
level was 28.67 + 15.34 mg/dL. sdLDL had a strong correlation with both triglyceride
(r ¼ 0.757, p , 0.001) and total cholesterol (r ¼ 0.682, p , 0.001), moderate correl-
ation with LDL (r ¼ 0.548, p ¼ 0.002), but had no correlation with HDL cholesterol
level (r ¼ 0.100, p ¼ 0.601).
Conclusion: Level of sdLDL is strongly correlated with both triglyceride and total choles-
terol, on the other hand correlation with LDL cholesterol level is moderate.
It seems that the term “small dense lipoprotein” is better than “small dense low
density lipoprotein”.
Keywords: small dense low density lipoprotein † conventional lipid † coronary artery
disease
Detailed precision of computed tomography angiography compared to invasive
angiography in different coronary vessels: Overestimate, underestimate, or
concordance? late experience in National Cardiovascular Center Harapan Kita
T.M. Haykal, P. Almazini, A. Parlautan, W.M. Saragih, Elen, C.A. Atmadikoesoemah, and
M. Kasim
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, National Cardiovascular Center Harapan Kita
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Background: Quantitative analysis of stenosis lesion by Multi-Detector Computed
Tomography (MDCT) coronary angiography show good correlation with stenosis
detected by Invasive Coronary Angiography (ICA). However, detailed precision
whether MDCT angiography overestimate or underestimate have not been explored
thoroughly.
Method: There are 195 patients examined by both MDCT angiography and ICA from
October 2014 until December 2015 in our hospital. ECG-gated MDCTangiography was per-
formed by using a 128-sliced MDCT scanner with a standardized protocol. CT coronary
angiography was analyzed by a team of cardiovascular imaging cardiologists. Quantita-
tive grading of stenosis in each lesion was determined visually using 2014 SCCT guidelines
classification. Quantitative measurement of stenosis during ICA was classified with the
same criteria so that it can be comparable. The final comparison of both test was classi-
fied as concordance, overestimate and underestimate.
Results: The mean age of our sample population is 59.19 + 9.79 (126 men and 66
women). Lesion of stenosis was found in 573 coronary vessels. Coronary vessels are sig-
nificantly associated with detailed precision of quantitative analysis comparison in
MDCTangiography and ICA. LM coronary stenosis quantification from MDCTangiography
is predominantly overestimate (concordance in 6% vessels and overestimate in 75.9%
vessels), while stenosis analysis by MDCT angiography in other major coronary vessels
is spread without conspicuous domination (p , 0.001). Calcified plaque is prominently
noticeable among vessels with overestimate analysis, however it is not statistically sig-
nificant. Sensitivity, specificity, PPV, and NPV of MDCT coronary angiography to detect
obstructive lesion (stenosis ≥ 50%) found by ICA is 81.4%, 80.4%, 73.9%, and 86.3%, re-
spectively (780 vessels).
Conclusion: Degree of stenosis in LM is predominantly overestimate by MDCT
angiography. This finding should give better understanding to clinician that the preci-
sion of stenosis grading in MDCT angiography in different coronary vessels is not the
same.
Keywords: CT angiography,invasive coronary angiography (ICA) † precision
Preoperative serum creatinine level as a predictor of acute kidney injury in patient
undergoing coronary artery bypass graft
T.W. Siagian1, J. Suganti 1, M. Nasri 1, D. Yulianda1, Z. Mukhtar 2, A.A. Siregar 2, Marshal 3,
and D. Pohan 3
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia,
3
Department of Thorax and Cardiovascular Surgery,Haji Adam Malik General Hospital,
Medan, Indonesia
Background: Elevation in postoperative creatinine or acute kidney injury (AKI) after cor-
onary artery bypass grafting (CABG) surgery has been consistently shown to be a predictor
of increase short term mortality and poor postoperative outcomes. However, only few
data are available concerning the prognostic preoperative serum creatinine related to
AKI post CABG. The aim of this study is to prove the association between preoperative cre-
atinine with AKI after CABG.
Methods: This was a retrospective study of 56 patients undergoing CABG between
January 2012- June 2015 with a preoperative serum creatinine , 1.8 mg/dl at Adam
Malik General Hospital. Patients were divided into two groups according to preoperative
serum creatinine level. AKI defined as increase serum creatinine ≥ 1.5 fold compare to
baseline. The baseline serum creatinine was 1.2 mg/dl according to the laboratory
Adam Malik Hospital. Preoperative serum creatinine was the last measurement before
undergoing CABG. Bivariate and multivariate analysis was performed and p value ,
0.05 was considered to indicate statistical significance.
Result: There were 42 patients with normal serum creatinine , 1.2 mg/dl and 14 patient
with mildly increase serum creatinine 1.2-1.8 mg/dl. From all patients, 28 patients ( 50%)
had AKI post CABG during hospitalization. From the analysis of the chi-square test found a
significant correlation between serum creatinine levels and AKI post CABG (p ¼
0.014,(95% CI 1.307 – 22.25)). Multivariate analysis using logistic regression confirmed
that preoperative serum creatinine 1.2 – 1.8 mg/dl (p ¼ 0.02; OR 5.39; 95% CI 1.307 –
22.25) as independent predictor of AKI post CABG.
Conclusion: Preoperative serum creatinine level is an important predictor of AKI in
patient undergoing CABG.
Keywords: Preoperative serum creatinine † AKI † CABG
Circulating uric acid links to metabolic syndrome: A population study in urban area
of Indonesia
U. Bahrudin1, B. Dayana2, V. Amalia2, I. Sholeh 2, B. Surastri 3, Y. Herry1, and I. Hisatome 4
1
Department of Cardiology and Vascular Medicine, Diponegoro University Faculty of
Medicine – Dr. Kariadi General Hospital, 2Department of Physiology, Diponegoro Univer-
sity Faculty of Medicine, 3Department of Pharmacology, Diponegoro University Faculty of
Medicine, Semarang, Indonesia, 4Division of Regenerative Medicine and Therapeutics,
Tottori University Graduate School of Medical Science, Yonago, Japan
Background: Hyperuricemia is strongly associated with cardiovascular disease, kidney
disease, and hypertension, increasing the risk of mortality, but it is not commonly consid-
ered a true risk factor for metabolic syndrome (MetS). Purpose of this study was to know
the correlation between the level of circulating uric acid and MetS in urban adult (≥40
years old) Indonesian population.
Methods: We determined the prevalence of MetS in the general population in Semarang,
Central Java, Indonesia by a cross-sectional study. Prevalence of MetS was determined by
 B48
the existence of a combination of 3 or more factors: central obesity (waist circumference
≥90 cm for male or ≥80 cm for female), hypertension, abnormal fasting glucose metab-
olism (fasting blood sugar ≥110 mg/dl), high triglyceride ≥150 mg/dl), and low HDL
cholesterol level (,40 mg/dl for male or ,50 mg/dl for female).
Results: This study involved 196 adults (126 females), who were 40 years of age or
older (mean: 57.4 years old). The incidence of MetS was 33.67%; women had a
higher incidence (34.92%) than men (31.43%). Hyperuricemia (serum uric acid level
.7.0 mg/dl for men or .6.0 mg/dl for woman) was found in 32% subject with MetS.
There was a significant association between hyperuricemia and MetS (p ¼ 0.035). Ab-
normal fasting glucose metabolism had a significant correlation with hyperuricemia
(p ¼ 0.001), while other factors of MetS had no significant correlation statistically,
i.e. hypertension p ¼ 0.084, low HDL level p ¼ 0.109, central obesity p ¼ 0.220,
high triglyceride p ¼ 0.473, and waist circumference p ¼ 0.220. In addition, in the
subject with MetS, uric acid level was correlated with intensity of physical activity
(p ¼ 0.004).
Conclusion: Data of this study showed that hyperuricemia was associated with metabolic
syndrome in Indonesian urban population, particularly with a factor of syndrome meta-
bolic abnormal fasting glucose metabolism.
Keywords: hyperuricemia † metabolic syndrome † Indonesian population
The Neutrophil/Lymphocyte Ratio (NLR) as predictor of poor coronary collateral in
patients with coronary chronic total occlusion
U. Malik and M. Amir
Department of Cardiology and Vascular Medicine, Hasanuddin University, Makassar
Background: Coronary collateral circulation (CCC) is the adaptation mechanisms of the
heart to ischemia in order to maintain tissue perfusion and correlate with inflammation.
Neutrophil-Lymphocyte ratio (NLR) value has been proposed as a inflammation marker
for chronic total occlusion (CTO). This study aims was to evaluate The Neutrophil/
lymphocyte Ratio (NLR ) as Predictor of Poor Coronary collateral in patients with
chronic total occlusion (CTO).
Methods: A nested case control on 69 patients with CTO from August to November 2015.
Patients then classified according to their Rentrop collateral grades as either poor collat-
eral (Rentrop grades 0-1) or good collateral (Rentrop grades 2-3). The NLR was calculated
based on the complete blood count.
Results: The NLR values of the patients with poor CCC (3.77 + 0.43) were higher than of
those with good CCC (2.69 + 0.32) p , 0.001). In ROC curve analysis, the cut-off value of
NLR to predict poor CCC was 3.05 with 82.9% sensitivity and 90% specificity (95% CI;
0.958-1.005, p ,0.001). In the binary linear regression, it was found that a high NLR
has a percentage of 120 times to predict poor coronary collateral. There is a strong cor-
relation between NLR as a predictor and the degree of collateral circulation (spearman,
r:-0.763; p : , 0.001).
Conclusion: NLR can be considered a significant predictor of poor Coronary collateral cir-
culation in CTO.
Keywords: Neutrophil-lymphocyte Ratio † Coronary collateral circulation
Association between waist circumference to body height ratio and blood pressure
in cardiology clinic
U. Hasanah 1, I.L. Harahap 2, and Y. Pintaningrum 3
1 two groups in terms of NT-proBNP and 6MWT, (D NT proBNP 59 (-6747) – 2145) vs (-166)
Medical Faculty of Mataram University, Indonesia, 2Department of Anatomy, medical
faculty of Mataram University, Indonesia, 3Lecturer, department of cardiology, medical
faculty of Mataram University, Indonesia
Background: Overweight and obesity are established risk factors for hypertension, and
hypertension is approximately twice as prevalent in the obese than in the nonobese.
The prevalence of overweight and obesity has been increasing in the United States for
at least the past 2 decades. This risk has been estimated by the Framingham Heart
Study that suggests that approximately 78% of the hypertension cases in men and 65%
in women can be directly attributed to obesity. The Framingham Heart Study revealed
that a 5% weight gain increases hypertension risk by 30% in a 4-year time period. Waist
to height ratio (WHtR) is one of the indicator of obesity which is effective to evaluate
the distribution of body fat.
Objective: To find the association between waist to height ratio and blood pressure.
Methods: Cross-sectional population-based observational analytical study using con-
secutive sampling. The subjects were 51 patients aged . 25 years in cardiology clinic
government hospital of west nusatenggara, Lombok, Indonesia, in August 2015. Hyper-
tension was defined according to the disease history, the use of anti-hypertensive
drugs or the mean of three consecutive measures, in mm/Hg, ≥ 140 for systolic and ≥
90 for diastolic blood pressure. Waist- to- height ratio (WHtR) is defined as their waist cir-
cumference divided by their height, both measured in the same units. AWHtR of over 0.5
is an increased risk. The collected data were statistically tested using Spearman correl-
ation test.
Result: The results showed a significant association between WHtR and systolic - diastolic
blood pressure, p , 0.05 (systolic p ¼ 0.004 and diastolic p ¼0.013). A positive correl-
ation was found between WHtR and systolic - diastolic ratio, with the strength of correl-
ation was low (systolic r ¼ 0.393, diastolic r¼ 0.347).
Conclusion: Increase in waist to height ratio is associated with high blood pressure in
Lombok, Indonesia.
Keywords: Waist to height ratio † WHtR † obesity † blood pressure † hypertension
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Abstracts
Validated-internally Kidney Protection Program (VKPP) scoring system as a
predictor of worsening renal function among hospitalized acute decompensated
heart failure patients
V. K. P. Putri, P.P.D. Yamin, N. Hersunarti, D.P.L. Tobing, R. Soerarso, and B.B. Siswanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indo-
nesia, National Cardiovascular Center Harapan Kita
Background: Worsening renal function (WRF) is associated with worse outcomes among
patients who are hospitalized with acute decompensated heart failure (ADHF). Clinical
characteristics at admission may help identify patients at increased risk of WRF. The
aim of this study was to create in admission scoring system to simplify identification
patients at risk of WRF in ADHF setting.
Methods: A retrospective data of 614 patients admitted with ADHF was analyzed. By the
definition WRF occurred when serum Creatinin increased at anytime during hospitaliza-
tion by ≥ 0.3 mg/dL or by ≥ 25% from admission.
Results: Worsening renal function developed in near 26% patients. The independent pre-
dictors of WRF analyzed with backward selection logistic regression were: age . 75 years
old (p , 0.0001), female (p ¼ 0.034); history of hypertension (p ¼ 0.001); anemia (p ¼
0.005); and in admission serum Creatinin (p ¼ 0.013). A scoring system was generated
from this final model. An internal validation with bootstrap method showed good opti-
mism (0.01088808).
Conclusion: A new scoring system could predict in-hospital worsening renal function
among patients hospitalized with acute decompensated heart failure.
Keywords: scoring system † worsening renal function † acute decompensated heart
failure
Effect of low dose ace inhibitor towards Six Minute Walk Test and NT-ProBNP in
mitral stenosis patients without hypotension
V.G. Rejeki, B.B. Siswanto, R. Sukmawan, and N. Hersunarti
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indo-
nesia – National Cardiovascular Center Harapan Kita
Background: Mitral stenosis (MS) is an obstructive lesion in which the definitive therapy is
mechanical intervention. The prevalence of MS in developed countries has been decreas-
ing due to the development of mechanical intervention. In Indonesia the prevalence
remains high especially in the era of national health coverage, there are too many
patients queuing for mitral valve operation. By this situation, we want to know if the
angiotensin converting enzyme (ACE) inhibitor could reduce the burden of symptoms
and other neurohormonal activation such as NT-proBNP in MS patients. There are many
controversies to the use of ace inhibitor in MS patients, questioning the benefit and
safety of ace inhibitor to these patients.
Objective: To study the safety and efficacy of low dose ACE inhibitor towards six minute
walk test (6MWT) and N-Terminal pro B type natriuretic peptide (NT-proBNP) in Mitral
Stenosis Patients without Hypotension.
Methods: This study is a double blind randomized control trial. Sample was taken con-
secutively, and randomized to be given lisinopril 2.5mg or placebo. Every patient was
assigned for echocardiography evaluation, 6MWT, and laboratory examination before
and after intervention.
Result: 37 patients were included in the analysis; 19 was in the intervention group, 18
patient was in the placebo group. No significant difference were found between the
(-1495 – 1664) pg/mL; p ¼ 0.443) dan (D 6 MWT 11.66 + 73 vs 21.37 + 47; p ¼ 0.638).
In terms of blood pressure and stroke volume, there was also no significant difference
between the two groups after intervention, median for stroke volume in intervention
group and control group were 54 (34 – 74) vs45 (34 – 94), p ¼ 0.126.
Conclusion: Low dose ACE inhibitor is safe to be given in MS patient without hypotension,
however, it did not increase functional capacity measured by 6MWT, neither improve
NT-proBNP.
Keywords: Mitral stenosis † ACE inhibitor † 6MWT † NT-proBNP
Correlation of the platelet to lymphocyte ratio with cardiac enzyme in male
patients with acute coronary syndrome
V.A. Damay, A. Albertus, A. Budiman, T. Veony, S. C. Aprianti, Yerssenia, Silvia, M. Tiofan,
and A.A. Lukito
Faculty of Medicine, Universitas Pelita Harapan - Siloam Hospitals, Karawaci, Banten,
Indonesia
Background: Acute inflammatory reaction is part of the chains during acute coronary
syndrome’s (ACS) mechanism. Platelets and inflammatory cells including lymphocytes
are among acute inflammation’s puzzles. Platelet and differential count in blood panel
are relatively easy, quickly and widely found in almost every hospital. Cardiac enzymes
-in the other hand- should be ordered whenever we have a appropriate suspicion
of ACS. Cardiac enzymes relatively more expensive and need more time for the
result. Perhaps we could use this simple blood examination to warn consideration of pos-
sible ACS .
Methods: Hospitalized male patients with acute coronary syndrome during January until
December 2015 were evaluated for the PLR, CKMB, and Troponin T. Correlation between
CKMB, and Troponin Twith PLR were analyzed using Spearman Correlation Test. Data was
analyzed with SPSS 22.0.0.0 software.
 Abstracts
Results: There were 124 patients collected in this study period. The mean of age of the
patients is 58.5 + 10.9. Diagnosis of Unstable Angina Pectoris (UAP) was found in 23
(18.5%) patients, Non-ST-segment Elevation Myocardial Infarction (NSTEMI) in 28 (22.6
%) patients, and ST-segment Elevation Myocardial Infarction (STEMI) in 73 (58.9 %)
patients. There are 83 (66.9%) patients who have history of smoking, 75 (60.5%) patients
have hypertension, 32 (25.8%) patients have dyslipidemia, and 30 (24.2%) patients have
diabetes mellitus. Median of PLR is 14.77 (1.46 – 72.25). CKMB, and Troponin Twere sig-
nificantly correlated with PLR (p , 0.05). Spearman’s correlation coefficient (r) was 0.3
for CKMB, and 0.28 for Troponin T
Conclusion: There was a significant correlation between Troponin T, and CKMB with PLR
in male patients with ACS.
Keywords: acute coronary syndrome † platelet to lymphocyte ratio
The novel effect of b-D-Glucans exctract of Ganoderma lucidum as
antiinflammatory and antioxidative in stable angina patients
Vittryaturida 1, N. Ubaidillah 1, A. Widya1, K. Siwi1, M. Failasufi 1, F. Ramadhan1,
H. Wulandari 1, Y. Waranugraha1, D. H. Putri1, and D. Sargowo 2
1
Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya Uni-
versity – Dr Saiful Anwar General Hospital, Malang, Indonesia, 2Department of Cardiology
and Vascular Medicine – Faculty of Medicine Brawijaya University – Dr Saiful Anwar
General Hospital, Malang, Indonesia
Background: Atherosclerotic is the most common cause of stable angina pectoris. Ath-
erosclerosis is a systemic inflammatory process characterized by the accumulation of
lipids and macrophages within the intima of vessel. New insight into the atherosclerotic
pathology is endothelial damage and reactive oxygen species. This study was aimed to
evaluate b-D-Glucans of the extract of Ganoderma Lucidum as an anti-inflammatory
and antioxidative activities that inhibit atherogenesis in Stable Angina.
Matherial and methods: 37 stable angina pectoris patients was included in this clinical
trial experimental study with pre test and post test design without control. Stable
angina patients were given Ganoderma Lucidum caps dose 3x250 mg/day during 90
days on top of guideline directed optimal medical treatment. Parameters used are
level of Interleukin-6 (IL-6), high sensitivity C-reactive protein (hsCRP), TNF-alpha,
(Superoxyde dismutase (SOD) and Malondialdehyde (MDA).
Results: After 90 days of treatment, we found significant decreased level of IL-6 (p ¼
0.0000), TNF-alpha (p ¼ 0.0000), hsCRP (p ¼ 0.0000), MDA (p ¼ 0.0000) and significant
increased level of SOD (p ¼ 0.0001) descriptively in stable Angina Pectoris patients
Conclussion: Based on study, b-D-Glucans of the extract of Ganoderma lucidum is prom-
ising novel antiinflammatory and antioxidant effect to inhibit atherogenesis in Stable
Angina.
Keywords: Stable Angina † b-D-Glucans † Ganoderma lucidum † Anti-inflammatory
† Antioxidative † Atherogenesis
Risk factors contributing to myocardial hypoperfusion detected by cardiac
magnetic resonance
W. M. Saragih, T. M. Haykal, A. Parlautan, K. B. Aji, I. S. Waty, Elen,
C. A. Atmadikoesoemah, and M. Kasim
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia
Background: Microvascular dysfunction (MVD) or microvascular obstruction can be
detected by cardiac magnetic resonance (CMR) seen as hypoenhanced area within the
first 2 minute of contrast administration. Often, patients with nonsignificant coronary
stenosis revealed hypoperfusion area by CMR indicating MVD. This study aimed at
finding cardiovascular risk factors that contribute to MVD detected by CMR in patients
with normal or nonsignificant coronary stenosis.
Methods: Subjects were chosen from all patients who underwent CMR at Harapan Kita
Hospital in 2015. Patients must have either coronary multi-detector computed tomog-
raphy (MDCT) data or coroangiography data in the same year. There were 107 patients
who met the criteria. The variables were divided according to each coronary artery seg-
ments: left anterior descending (LAD), left circumflex (LCx), and right coronary artery
(RCA). Every coronary segment with significant stenosis (.50%) was excluded. CMR
data was then screened by each coronary territory focused on the presence of hypoper-
fusion (hypoenhanced) area. Independent variables were sex, age, diabetes, hyperten-
sion, dyslipidemia, and smoking history.
Results: There were 138 coronary segments that fulfill the criteria normal or nonsignifi-
cant stenosis ( , 50 %). There were 69 (50%) segments revealing hypoperfusion by CMR
and 69 (50%) with no hypoperfusion. Men found more frequent than women in
no-hypoperfusion subgroup, with p value 0,54. Chi-square test shows no association
between the four classical cardiovascular risk factors: diabetes (p ¼ 0,33), hypertension
(p ¼ 0,86), dyslipidemia (p ¼ 0,39), and smoker history (p ¼ 0,48). More segments with
hypoperfusion were in age 40-59 years old (75,4 %), age 20-39 (2,9 %), and age 60-80 (21,7
%) with significant p value (p ¼ 0,03). An experimental study has proved that myocardial
fibrosis in human begin after 40 years of age. Animal model experiments have also demon-
strated increased collagen deposition in the aging heart.
Conclusion: Aging factor contributes to MVD detected by CMR in normal or nonsignificant
stenosis coronary artery. There were no significant association with sex and any classical
risk factors: diabetes, hypertension, dyslipidemia, and smoker. CMR with T-1 mapping
method is suggested to evaluate myocardial tissue more accurately and precisely.
Keywords: CMR † hypoperfusion † microvascular † nonsignificant stenosis
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B49
Corelation between clinical factors and autonomic outcome after coronary artery
bypass graft surgery
Y.B. Hartanto 1, R. Putra 1, U. Bahrudin 1, M. Ardiana 2, A.M. Ambari 3, and B. Radi3
1
Department of Cardiology and Vascular Medicine Faculty of Medicine, Diponegoro
University, Semarang, Indonesia, 2Dr. Soetomo Hospital, Surabaya, Indonesia, 3National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Heart rate recovery over 1 minute (HRR-1) after graded exercise is one
techniques that reflects autonomic activity. Despite of overall improvement, there are
groups of post coronary artery bypass graft (CABG) surgery patients with HRR-1 after
cardiac rehabilitation. This study aimed to search clinical factors that related to abnor-
mal HRR-1 after cardiac rehabilitation for CABG surgery.
Methods: A retrospective analysis of post CABG surgery patients who underwent exercise
test from June 2014 until August 2015 after completion of phase II cardiac rehabilitation.
Gender, age, ejection fraction, risk factors such as hypertension, diabetes mellitus,
smoking, and HRR-1 were analyzed
Result: 276 post CABG patiens underwent treadmill test with Bruce protocol at the end of
phase II cardiac rehabilitation. There were 105 (38%) patients with HRR-1 , 12. Of them,
59 subjects (56.2%) had diabetes mellitus compared with 65 subjects (38%) in the normal
HRR-1 group, p ¼ 0.003. There were 50 (47.6%) patiens .60 years old with abnormal
HRR-1 compared with 54 (31.6%) patients in their counterparts, p ¼ 0.008.
Risk estimation demonstrated that diabetes mellitus (OR 2.092; 95% CI 1.276-3.428)
and age . 60 years old (OR 1.970; 95% CI 1.194-3.250) were associated with decrease
HRR-1 in post CABG surgery patients.
Conclusion: After cardiac rehabilitation for CABG surgery, there were association
between diabetes mellitus and age . 60 years old with abnormal HRR-1. Further analysis
is needed to find predictor of autonomic balance after CABG surgery.
Keywords: Autonomic balance † heart rate recovery † CABG surgery
Correlation between NYHA functional class with TNF- a/IL-10 ratio in patients with
heart failure
Y.Y. Patra, J.N.E. Putranto, and D. Soemantri
Faculty of Medicine Airlangga University
Background: Pro-inflammatory mediator activation TNF-a, lead to endothelial dysfunc-
tion, ventricular remodelling and apotosis caused worsening heart failure. In patients
with heart failure, as a counter balance, there is also an increase of anti-inflammatory
mediator IL-10. TNF-a works as a stimulus for the production of the IL-10. IL-10 inhibits
synthesis of TNF-a, ROS generation and apoptosis which in turn provide a protective
effect.
Methods: This is a correlational study. 29 patients with heart failure were collected by
purposive sampling.
Results: The results showed that the concentrations of TNF-a and IL-10 increase with in-
creasing NYHA class. Mean TNF-a in NYHA class II is 3.52 pg/mL. Mean TNF-a in NYHA class
III is 4.50 pg/mL. In NYHA class IV, mean concentration of TNF-a is 7.07 pg/mL. Mean IL-10
in NYHA class II is 2.33 pg/mL. Mean IL-10 in NYHA class III is 2.61 pg/mL. In NYHA class IV,
mean concentration of IL-10 is 3.04 pg/mL. The minimum value of TNF-a / IL-10 ratio in
NYHA class II is 1.00 and the maximum value is 2.18 with mean value 1.52. The minimum
value of TNF-a / IL-10 ratio in NYHA class III is 1.10 and the maximum value is 2.03
with mean value 1.74. The minimum value of TNF-a / IL-10 ratio in NYHA class IV is
1.59 and the maximum value is 2.84 with mean value 2.36. There were a positive,
strong and significant correlation between NYHA class with TNF-a/IL-10 ratio. (r ¼
0.72; p ,0.001)
Conclusion: There were a positive, strong and significant correlation between NYHA class
with TNF-a/IL-10 ratio in patients with heart failure.
Keywords: TNF-a † IL-10 † heart failure
Effects of local intracoronary adjunctive therapy cocktail improved microvascular
perfusion and left ventricle function in primary percutaneous intervention
Z. Mukhtar, S. Kasiman, A. Lubis, and N. Akbar
Cardiology Department Faculty of Medicine, University of Sumatera Utara / Adam Malik
General Hospital/Murni Teguh Memorial Hospital, Medan, Indonesia.
Background: The purpose of this study is to investigate the effect of local intracoronary
bolus administration of combination eptifibatide and streptokinase to dissolve occlusive
thrombus (TIMI grade 0 / 1) in patients with acute and subacute STEMI.
Methods and Results: The study design is a cohort, control nonrandomised and approved
by Health Research Ethical Committee, Medical Faculty of Universitas Sumatera Utara /
Adam Malik Hospital. Patients with acute and subacute STEMI after having been recana-
lized by the use of a small diameter (1.25 – 2.0 mm) balloon dilation or thrombectomy
with manual thrombus aspiration device-TAD, successive administration of local intra-
coronary slow bolus 3.75 mg eptifibatide diluted with 5 ml saline via TAD in IRA vessel
for 3 minutes, subsequent flushing of TAD with 2 ml saline, after 3 minutes followed by
100 kU streptokinase diluted with 5 ml saline for 3 minutes. Three minutes later per-
formed angiography then inserted long stent (2 – 4 mm more than length size stenosis),
finally stent deployment on culprit lesion in IRA vessel and occasionally continued with
local intracoronary bolus nitroglycerine-NTG. Assessment of postprocedural TIMI and
myocardial blush grade-MBG is graded by two independent intervention cardiologists
who were blind to all data apart from coronary angiogram. Angioplasty procedure for
case of patients was performed by single operator. Samples were collected from March
 B50
2015 – 27 January 2016, 68 patients (case group) fulfilled the inclusion criteria. Patients
aged between 31 to 78 years, 63 males and 5 females. All patients received local intracor-
onary slow bolus eptifibatide 3.75 mg and continuing with 100 kU streptokinase. Local
bolus NTG doses 100, 200 and 300 mg was 7, 15 and 14 patients consecutively. Symptom
to procedural time was 4.5 – 384 hours. The infarct location was 40 anterior and 28 inferior
wall. Recanalized by balloon 62 and TAD 6 patients. Diagnostic coronary angiography
showed TIMI and MBG 0 was 55 patients. TIMI and MBG 1 were 13 patients. After PCI, cor-
onary angiography showed TIMI 3 was found in 60 patients (88.2 %), TIMI 2 in 8 patients
(11.8 %), MBG 3 in 59 patients ( 86.8 %) and MBG 2 in 9 patients (13.2 %). In echocardiography
finding, there was elevation of LVEF 7.88 – 17.69 %. A control group 44 colleagues’ patients
was treated with standard therapy, aged 42 to 75 years, 37 males and 7 females, infarct lo-
cation was 29 anterior, 15 inferior and symptom to procedural time was 2 – 218 hours. Diag-
nostic coronary angiography showed TIMI and MBG 0 was 39 patients. TIMI and MBG 1 were 5
patients. After PCI, coronary angiography showed TIMI and MBG 3 was found in 25 patients
(56.8 %), TIMI and MBG 2 in 17 patients (38.6 %), TIMI and MBG 1 in 2 patients (4.5 %). Stat-
istical analysis ( Pearson Chi-Square) reperfusion result after PCI from two groups (case and
control) was significant difference, p ¼ 0.001, Fisher’s exact test found 95% confidence
interval (0.068 – 0.453). There were no effects of hypotensive intracoronary bolus NTG,
allergic reaction, minor and major bleeding.
Conclusions: The use of intracoronary combination bolus 3.75 mg eptifibatide and 100 kU
streptokinase showed a successful dissolve of occlusive thrombus in patients with acute
and subacute STEMI and improvement of LV function.
The role of Mitral Leaflets Length Index ( MLLI ) as a simple parameter in
determining the severity of mitral stenosis
Z. Syahputra 1, E. Hasibuan 1, E. Komariah1, N. Akbar2, A.P. Ketaren 2, Z. Mukhtar 2, and
A.A. Siregar2
1 0.017-1.157), diastolic BP (p ¼ 0.003 OR ¼ 16 CI 95% 2.6-105.515), systolic BP (p ¼
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia
Background: Determining the severity of mitral stenosis is important for both prognostic
and therapeutic reasons. TTE is the gold standard method for assessment of severity
mitral stenosis by using planimetry and pressure half time (PHT). Planimetry is accurate
but is highly operator dependent. PHT is affected by changes in preload or left ventricular
compliance. In this study, we evaluate Mitral Leaflets Length Index (MLLI) as a new simple
parameter that can be used in peripheral by using common ultrasound to assess the sever-
ity of MS.
Methods: Fifty two patients with rheumatic MS who evaluate echocardiography in Adam
Malik Hospital from January to December 2015 were enrolled for this cross-sectional
study. The severity MS were classified by planimetry and PHT. MLL index was obtained
by dividing posterior mitral valve leaflet length to anterior mitral valve leaflets lenght
in the PLAX views at the end diastole.
Results: Severe MS(59.3%), moderate (29.6%), mild ( 7.4 %). There was strong correlation
with MLLI and Mitral valve area by planimetry in spearman correlation (r ¼ 0.920,
p 0.000). ROC analysis of the MLLI with cut-off point , 0.68cm can predict severe MS
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Abstracts
with sensitivity 93%, specificity 95%, positive predictive value 96%, LR (+) 18,6.
Intra-observer and intre-observer variability of MLLI is good (Kappa value 0.709 –
0.877) and significant (p , 0.001).
Conclusion: The Mitral Leaflets Length Index (MLLI) , 0.68 cm can be used as a simple
parameter in determining the severity of mitral stenosis.
Keywords: Mitral Stenosis † Mitral Leaflets Length Index (MLLI) † Planimetry
A new scoring system of hospital mortality for acute heart failure syndrome
(SMAHS Score)
Z. Syahputra 1, M.F. Sarahazti 1, D. Ashrinda1, H. Hassan2, H.A.P. Lubis 2, A. Sitepu 2, and
A.A. Siregar 2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department of
Cardiology and Vascular Medicine, Adam Malik Hospital, Medan, Indonesia
Background: The prognosis of patients hospitalized with acute heart failure (AHF) is poor
and risk stratification may help clinicians guide care. Patients with a poor prognosis may
benefit from more aggressive treatment and closer follow-up. Unfortunately, the use of
risk scoring systems for patients with AHF is limited. The aim of this study was to design a
simple, bedside clinical prognostic scoring model and validate its ability to predict hos-
pital mortality for patients with AHF.
Method: 169 patients with AHF were enrolled, divided randomly into training (n ¼ 127)
and validation (n ¼ 42) cohorts. The data were collected from January 2014 to December
2015. The inclusion criteria for the database were in conformance to the European guide-
lines for AHF set in 2005. Multivariable analysis was applied to determine independent
risk factors and develop the scoring system.
Results: In the training cohort, multivariate logistic regression analysis, hospital mortal-
ity was employed as dependent variable, while age (p ¼ 0.068 OR ¼ 0.142 CI 95%
0.004 OR ¼ 11 CI 95% 2.216-62.060), heart rate (p ¼ 0.005 OR¼ 0.092 CI 95%
0.017-0.489), haemoglobin (p ¼ 0.040 OR ¼ 5.76 CI 95% 1.083-30.731), arrhytmia (p ¼
0.011 OR ¼ 20.53 CI 95% 1.985-212.36), creatinine level (p ¼ 0.37 OR ¼ 0.2 CI 95%
0.043-0.907),QRS duration (p ¼ 0.02 OR ¼ 0.048, CI 95% 0.007-0.339) as independent
variables.According to each OR of these variables, we set the new scoring system of hos-
pital mortality for AHF with good calibration by Hosner-lemeshow test ( p 0.533) and dis-
crimination by AUC 0.956 (p , 0.01 CI 95 % 0.922-0.989). The optimal cutt off for
prediction mortality was total 6 points, sensitivity 73% and specificity 95%. We divided
the patients with AHF as low risk whom total score 0-3 points (mortality in hospital
0,4-20%), moderate risk whom total score 4-5 points (mortality in hospital 48-77%),
and 6-12 point as high risk. In the validation cohort indicated that SMASH score as new
scoring system was effective with AUC of ROC (0.950 p,0.01) and p 0.998 (p.0.05)
with Hosner-lemeshow test.
Conclusion: The SMAHS Score is a new scoring system of hospital mortality for AHF can
predict with high sensitivity and specificity, also good performance in terms of discrimin-
ation and calibration.
Keywords: Scoring System † Acute Heart Failure † Hospital mortality