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

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

"Latar belakang: Stenosis mitral (SM) merupakan peyempitan dari orifisium katup mitral, dimana SM berat didefinisikan sebagai area katup mitral (AKM) <1 cm² dan biasanya berhubungan dengan gradien transmitral >10 mmHg. Pada praktik klinis, ketidaksesuaian antara hasil pengukuran AKM dan gradien transmitral sering ditemukan. Pasien SM berat dengan gradien transmitral rendah (≤10 mmHg) memiliki kecenderungan menetapnya gejala klinis paska tindakan pembedahan katup mitral dan kurangnya perbaikan klinis paska tindakan komisurotomi mitral transkateter perkutan (KMTP). Namun hingga saat ini, belum banyak studi mengenai faktor yang berhubungan dengan gradien transmitral rendah pada SM berat. Tujuan:Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan gradien transmitral rendah pada SM berat. Metode: Studi potong lintang pada 322 pasien SM berat. Dilakukan evaluasi catatan rekam medik dan hasil pemeriksaan ekokardiografi transtorakal. SM berat didefinisikan sebagai SM dengan AKM <1 cm² yang diukur secara planimetri dan gradien transmitral rendah didefinisikan sebagai gradien transmitral ≤10 mmHg. Hasil: Dari 322 subjek penelitian, sebanyak 36% memiliki gradien transmitral ≤10 mmHg, 68,9% perempuan dan 72% memiliki irama fibrilasi atrium (FA). Berdasarkan analisis multivariat, didapatkan faktor independen gradien transmitral rendah pada SM berat adalah net atrioventricular compliance (IK 95% 3,57–11,02, OR 6,27), maximal tricuspid regurgitation velocity (IK 95% 0,14–0,45, OR 0,26), irama fibrilasi atrium (IK 95% 1,20–4,91, OR 2,43) dan jenis kelamin perempuan (IK 95% 1,07–3,69, OR 1,99). Kesimpulan: Net atrioventricular compliance, maximal tricuspid regurgitation velocity, irama fibrilasi atrium dan jenis kelamin perempuan berhubungan dengan gradien transmitral rendah pada stenosis katup mitral berat.

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Background: Mitral stenosis (MS) is the narrowing of mitral valve orifice, in which severe MS is defined as planimetered mitral valve area (MVA) <1 cm² with transmitral gradient >10 mmHg. However, discrepancy between planimetered MVA and transmitral gradient is not uncommon in patients with severe MS, suggesting the presence of low gradient (LG) severe MS. Patients in this group display less benefit from valvuloplasty and a greater risk for persistent symptoms after mitral valve replacement (MVR). Yet, factors associated with LG severe MS has not been studied extensively. Objective: Aim of this study is to determine factors associated with LG severe MS. Methods: This is a cross-sectional study in 322 patients with severe MS. Medical records and transthoracic echocardiography examination results were evaluated. Severe MS was defined as planimetered MVA <1 cm² and LG was defined as transmitral gradient ≤10 mmHg. Results: Of 322 subjects, 36% had transmitral gradient ≤10 mmHg, 68,9% were women, and 72% had atrial fibrillation. According to multivariate analysis, several independent factors to LG severe MS were net atrioventricular compliance (95% CI 3,57–11,02, OR 6,27), maximal tricuspid regurgitation velocity (95% CI 0,14–0,45, OR 0,26), atrial fibrillation (95% CI 1,20–4,91, OR 2,43) and women (95% CI 1,07–3,69, OR 1,99). Conclusion: Net atrioventricular compliance, maximal tricuspid regurgitation velocity, AF and women were associated with LG severe MS."

"Latar Belakang: Kondisi MS akan menyebabkan terjadinya peningkatan tekanan atrium kiri secara progresif dan menyebabkan remodelling serta dilatasi atrium kiri. Proses ini akan berakhir dengan penurunan komplians dari atrium kiri dan menyebabkan perubahan secara morfologis dan fungsional. Beberapa studi menunjukkan pengukuran Strain atrium kiri pada pasca tindakan balloon mitral valvuloplasty (BMV) menunjukkan perbaikan yang bermakna. Namun belum ada yang menilai hubungan antara perubahan Strain atrium kiri dengan perbaikan kapasitas fungsional pada pasien MS pasca tindakan BMV.Tujuan: Tujuan penelitian ini adalah untuk mengevaluasi hubungan antara perubahan Strain atrium kiri dengan perubahan kapasitas fungsional pada pasien MS pasca tindakan BMV.Metode: Desain penelitian yang digunakan adalah studi dengan one group pre-post design. Penelitian ini menggunakan data pemeriksaan ekokardiografi dan data kapasitas fungsional pasien mitral stenosis yang dilakukan tindakan BMV pada Maret 2019 hingga April 2020. Dilakukan pengukuran strain atrium kiri dengan metode speckle tracking echocardiography. Data sebelum dan sesudah BMV dianalisis untuk mencari hubungan variabel terhadap perubahan kapasitas fungsional.Hasil: Pasca tindakan BMV, terjadi perbaikan signifikan kapasitas fungsional yang ditandai dengan perbaikan median lama latihan (241 (18 – 1080) ke 606 (80 – 1900) detik, p <0.0001) dan perbaikan median nilai VO2max estimasi (18,8 (10,2 – 51,4) ke 33(12,6-83,2) mlO2/kg/menit, p <0.0001). Strain atrium kiri mengalami perubahan signifikan pasca tindakan BMV dari median 8(2-23)% ke 11(4-27)%. Dari uji korelasi didapatkan bahwa pre-MVG (r 0,23, adjusted R2 = 4,9%) berkorelasi terhadap perubahan kapasitas fungsional. Pada analisis bivariat dan multivariat didapatkan bahwa perubahan strain atrium kiri tidak berhubungan dengan perubahan kapasitas fungsional. Nilai pra MVA >1 cm2 (OR 7,37, IK 95% 1,0-54,35; p = 0,05) pra MVG > 10 mmHg (OR 6,6, IK 95% 1,71-25,5; p = 0,006) dan pra mPAP < 25 mmHg (OR 5,96, IK 95% 1,37-25,9; p = 0,017) berkorelasi terhadap perbaikan lama latihan pasca tindakan BMV.Kesimpulan: Perubahan strain atrium kiri tidak berhubungan dengan perubahan kapasitas fungsional pada pasien MS pasca tindakan BMV.

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Background: MS conditions will cause a progressive increase in left atrial pressure, remodelling and left atrial dilatation. This process will end with a decrease of left atrial compliance, causing morphological and functional changes. Several studies have shown that left atrial strain measurements after the BMV procedure showed significant improvement. However, no study has assessed the relationship between changes in left atrial strain and improvements in functional capacity in MS patients after the BMV procedure.

Objectives: This study aimed to evaluate the association between left atrial strain changes and functional capacity changes in MS patients after BMV procedures

Method: This is a one group pre-post design using retrospective data. This study used echocardiographic and functional capacity data of mitral stenosis patients who underwent BMV procedures from March 2019 to April 2020. Left atrial strain was measured using the speckle tracking echocardiography method. Data before and after BMV were analyzed to find the association of variables to changes in functional capacity.

Results: After the BMV procedure, there was a significant improvement in functional capacity as indicated by an improvement in the median length of exercise (241 (18 – 1080) to 606 (80 – 1900) seconds, p <0.0001) and an improvement in the median estimated VO2max value (18.8 (10.2). – 51.4) to 33(12.6-83.2) mlO2/kg/min, p < 0.0001). The left atrial strain underwent a significant change after the BMV procedure from a median of 8(2-23)% to 11(4-27)%. From the correlation test it was found that pre-MVG (r 0.23, adjusted R2 = 4.9%) correlated with changes in functional capacity. In bivariate and multivariate analysis, it was found that changes in left atrial strain were not associated with changes in functional capacity. Pre MVA value >1 cm2 (OR 7.37, CI 95% 1.0-54.35; p = 0.05) pre MVG > 10 mmHg (OR 6.6, CI 95% 1.71-25.5 ; p = 0.006) and pre mPAP < 25 mmHg (OR 5.96, CI 95% 1.37-25.9; p = 0.017) correlated with the improvement in duration of exercise after the BMV action.

Conclusion: Changes in left atrial strain are not associated with changes in functional capacity in MS patients after the BMV procedure."

"ABSTRAKLatar belakang: Studi sebelumnya menyimpulkan bahwa mitral valve gradient (MVG) merupakan parameter selain area katup mitral (AKM) yang berhubungan dengan perbaikan gejala pasca komisurotomi mitral transkateter perkutan (KMTP). Oleh karena itu, studi diperlukan untuk menjelaskan hubungan MVG terhadap perbaikan gejala secara objektif, dalam bentuk kapasitas fungsional.Tujuan: Studi ini bertujuan untuk mengevaluasi hubungan MVG terhadap perubahan kapasitas fungsional pasca KMTP.Bahan dan Metode: Studi quasi experimental dengan one group pre-post design terhadap 78 subjek. Pemeriksaan ekokardiografi dan treadmill Bruce termodifikasi dilakukan 1-2 hari sebelum dan 1-2 minggu setelah KMTP. Data sebelum dan setelah KMTP dianalisis untuk mencari hubungan variabel terhadap perbaikan kapasitas fungsional pasca KMTP. Perbaikan kapasitas fungsional didefinisikan sebagai perubahan lama latihan > 180 detik pasca KMTP.Hasil: Rerata usia adalah 42 tahun, mayoritas perempuan (3,6:1) dengan rerata IMT 22,27 kg/m2. Sebesar 5,1% pasien merokok dengan komorbid stroke sebesar 14,1%. Sebelum KMTP, 53% memiliki irama sinus dengan mayoritas memiliki fungsi ventrikel kiri yang baik (rerata ejeksi fraksi 62%) dan fungsi ventrikal kanan yang baik (median tricuspid annular plane systolic excursion (TAPSE) 20 mm). Sebesar 97% pasien datang dengan kelas NYHA II sebelum KMTP dan mengalami perbaikan signifikan kapasitas fungsional pasca KMTP berupa perbaikan median lama latihan (241(18-1080) ke 603(30-1900) detik, p < 0,001) dan perbaikan median nilai VO2max estimasi (18,8(10,2-51,4) ke 32,8(10,6-83,2) mlO2/kg/menit, p<0,001). Dari uji korelasi, didapatkan variabel usia (r -0,23, adjusted R2=4,1%), pre-MVG (r 0,23, adjusted R2=4,2%), Δ MVG (r 0,31, adjusted R2= 9,0%) , dan pre-TR Vmax (r 0,3, adjusted R2=1,3%) berkorelasi terhadap perubahan kapasitas fungsional. Perbaikan kapasitas fungsional segera pasca KMTP tidak berhubungan dengan AKM pasca KMTP ≥ 1,5 cm2 (p= 0,14) dan perubahan AKM ≥ 200% pasca KMTP (p= 0,18). Penurunan MVG > 50 % pasca KMTP (OR 2,89, IK 95% 1,06-7,92; p = 0,038) dan TR Vmax sebelum KMTP > 3,4 m/s (OR 3,42, IK 95% 1,19-9,83; p = 0,023) merupakan prediktor perbaikan kapasitas fungsional segera pasca KMTP.Kesimpulan: Penurunan MVG lebih dari 50% pasca KMTP berhubungan dengan perbaikan kapasitas fungsional segera pasca KMTP.

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ABSTRACTIntroduction: Previous studies had shown that mitral valve gradient (MVG) was other parameter than mitral valve area (MVA) which had correlation with symptom improvement post baloon mitral valvuloplasty (BMV). However, further study is needed to illuminate the assocation of MVG with clinical improvement objectively, in term of functional capacity.Objective: This study aimed to determine the association between MVG and functional capacity alteration after BMV.Material and Methods: Quasi exsperimental study with one group pre-post design was applied in 78 subjects. Echocardiography and Modified Bruce Protocol assessment were done 1-2 days before and 1-2 weeks after BMV. Pre and post data were analized to obtain association of variables with functional capacity alteration immediately after BMV. Improvement of functional capacity was defined as alteration of exercise time more than 180 seconds after KMTP.Results: The mean age was 42 y.o, female dominant (3,6:1), mean BMI was 22,27 kg/m2. Of 5,1% patient were smoker with most commonly observed comorbidities include stroke (14,1%). Majority 53% had sinus rhythm with dominant good left ventricular function (mean ejection fraction 62%) and good right ventricular function (median tricuspid annular plane systolic excursion (TAPSE) 20 mm). Of 97% patients presented with NYHA class II before BMV with significant improvement of functional capacity after BMV such as median exercise time alteration (241(18-1080) to 603(30-1900) s, p < 0,001) and median estimate VO2 max value alteration (18,8(10,2-51,4) to 32,8(10,6-83,2) mlO2/kg/minute, p<0,001). From correlation test, age (r -0,23, adjusted R2=4,1%), pre-MVG (r 0,23, adjusted R2=4,2%), Δ MVG (r 0,31, adjusted R2= 9,0%), and pre-TR Vmax (r 0,3, adjusted R2=1,3%) were corelated with functional capacity alteration. Improvement of functional capacity did not significantly associate with post MVA>1,5 cm2 (p= 0,14) and AKM alteration after BMV ≥ 200% (p= 0,18). Reduction of MVG > 50 % after BMV (OR 2,89, 95% CI 1,06-7,92; p = 0,038) and TR Vmax before BMV > 3,4 m/s (OR 3,42, 95% CI 1,19-9,83; p = 0,023) were predictor of functional capacity improvement immediately after BMV.Conclusions: Reduction of MVG more than 50% had association with immediate improvement of functional capacity post BMV."

"Latar belakang. Stenosis mitralis (SM) masih merupakan masalah kesehatan di Indonesia, dan fibrilasi atrium merupakan penyakit penyerta yang akan meningkatkan emboli sistemik, stroke dan mortalitas pasien. Diduga umpan balik mekano elektris dan remodeling elektris mempunyai peranan yang penting dalam mekanisme terjadinya tibrilasi atrium (FA) pada penyakit katup jantung. Untuk menguji hipotesis bahwa telah tejadi remodeling elektris intrinsik pada pasien SM, dan remodeling tersebut bersifat reversibel, malta telah dilakukan penelitian mengenai perubahan elektrotisiologis sesudah tindakan komisurotomi mitral transvena perkutan (KMTP). Bahan dan cara kerja. Tigapuluh satu pas ien SM yang dilakukan KMTP, 20 dengan irama sinus (IS) dan ll dengan FA persisten serta 10 pasien dengan jantung normal sebagai kelompok kelola dimasukkan dalam penelitian ini. Pemeriksaan hemodinamik dan elektrotisiologi dilakukan sebelum dan segera sesudah KMTP. Semua pasien FA, dilakukan kardioversi eksternal sinkron sebelum dilakukan KMTP. Sebelum pemeriksaan elektrofisiologis, diberikan propranolol iv, 0,2 mg/kgbb dan sulfas atropin 0,004 mg/kbb untuk mem-blok aktiiitas saraf autonom. Pemeriksaan elektrofisiologi meliputi pemeriksaan periode refrakter efektif (PRE) di 6 tempat di atrium, waktu koduksi (WK) di atrium kanan dan kiri dan pengukuran elektrogram atrium di I8 tempat atrium kanan dan kiri. Hasil. Tidak terdapat perbedaan umur, dan jenis kelamin antara kelompok pasien SM dan kelompok kelola. PRE keselunlhan pada kelompok SM dan kelola yang diperoleh pada pacuan 600 milidetik tidak menunjukkan perbedaan bermakna Demikian pula pada pacuan 400 milidetik, tidak menunjukkan kemaknaan statistik Secara regional, PRE atrium lcanan dan kiri tidak menunjukkan perbedaan yang bermakna pada kelompok pasien SM dan kelola. Tetapi kelompok pasien SM mempunyai dispersi PRE lebih lebar dibanding dengan kelompok kelola. WK atrium kanan dan kiri kelompok pasien SM menunj ukkan perlambatan yang bermaltna dibanding dengan kelompok kelola. Di sebagian besar tempat atrium kanan dan kiri, voltase elektrogram atrium juga menunjukkan penurunan yang sangat bermakna. Tidak ada perbedaan dalam durasi elektrogram pada kedua kelompok. Potensial ganda dan elektrogram yang terpecah-pecah tidak ditemukan pada kedua kelompok. Tidak Lerdapat perbedaan bermakna dalam variabel hemodinamik antara kelompok SM disertai IS dengan disertai FA, namun terdapat perbedaan bermakna dalam variabel elektroflsiologi (re-modeling elektris) PRE rerata Secara keseluruhan yang diukur pada interval pacuan 600 milidetik pada kelompok FAjauh lebih pendek dibanding dengan kelompok IS yang secara statistik berbeda bermakna. Demikian pula bila diukur pzlda interval pacuan 400 milidetik. Secara regional, PRE atrium kanan dan kiri kelompok FA lebih pendek dibanding dengan kelompok IS dan perbedaannya seeara statistik bermakna. Sedang dispersi PRE pada kedua kelompok tersebut tidak menunjukkan kemaknaan statislik. WK di atrium kanan dan kiri pada kelompok FA lebih lambat dibandingkan dengan kelompok IS, dan perbedaannya secara statistik bermalma. Sebagian besar tempat di atrium tidak menunjukkan perbedaan voltase elektogram antara kelompok IS dan FA. Remodeling elektris ini bersifat reversibel setelah dilakukan KMTP. PRE rerata secara keseluruhan yang diukur pada interval pacuan 600 milidetik sebelum dan sesudah dilakukan KMTP ialah 240,51-_39,2 milidetik vs 248,2i36,l mi1idetik(p=0,003). Demikian pula pada pengukuran dengan interval 400 mi1idetik(da.ri 228,2i35,3 milidetik vs 238,l i319 milidetik, p=0,000). Reversibilitas hanya terjadi terutama pada sebagian besar PRE atrium dan WK di atrium kiri, sedang besamya vol tase elektrogram lidak demikian halnya. Remodeling elektris atrium tersebut bersifat intrinsik, tidak dipengaruhi oleh susunan saraf autonom. Di samping pembuktian hipotesis di atas ditemukan pula variabel prediktor terhadap kejadian FA pada penderita SM yakni diameter atrium kanan medial-lateral yang diukur dengan ekokardiograti 2 dimensi (rasio odds 1,128 dengan KI 95% berkisar antara 1,012 sampai l,466), serta PRE atrium kanan bawah (rasio odds 0,952 dengan KI 95% anlara 0,907 - l,000). Kesimpulannya pada pasien SM telah terjadi remodeling elekuis yang mengarah texjadinya FA. Bilamana telah terjadi FA, maka remodeling elelctris akan makin memburuk. Walaupun demikian remodeling elektris yang terjadi bersifat reversibel dengan mengurangi regangan dinding atrium melalui KMTR Remodeling elektris dan reversibilitasnya bersifat intrinsik, tidak dipengaruhi oleh saraf autonom. Oleh karena itu intervensi dini dengan KMTP perlu dilakukan pada setiap pasien SM dengan keluhan, atau bilamana clijumpai pembesaran dimensi atrium kanan mediallateral.

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Background: Mitral stenosis (MS) is one of the major health problems in developing countries. In addition, atrial fibrillation (AF) is one of the MS complication and had a consequence of higher systemic embolic rate including stroke and mortality. Mechano-electrical feedback and electrical remodeling in patients with valvular heart disease might be play an important role in the mechanism of atrial fibrillation (AF). To test the hypothesis that there was an intrinsic electrical remodeling in MS and this remodeling might be reversible, we investigated electrophysiological changes after percutaneous transvenous mitral commissurotomy (PTMC). Material and methods. Eleven MS patients with persistentAF and 20 patients with sinus rhythm (SR) were undergoing PTMC included in this study. Ten patients who underwent electrophysiologic study or ablation involving left atrial study were as control group. Autonomic nervous system was blocked using propranolol 0.2 mg/kgbw and atropine 0.04 mgfkgbw. Atrial effective refractory period (AERP) was measured at 2 sites in the right and 4 sites in the left atrium. The conduction time (CT) was measured at the right and left atrium using decapolar catheter. Atrial electrogram was measured on its amplitude, duration and number of fragments of the electrogram at 18 sites of the atrium. Results. There were no statistically differences in age and sex among the MS group and the control group. No significant difference in the overall AERP between the MS group and control group, but the MS group had a higher AERP dispersion tha.n the control group. The MS group had a lower conduction time (CT) than the control group and its difference was statistically significant. Most of the sites in the MS group were smaller than the control group. The duration of electrogram of both groups were similar. No double potential and fractionated electrograms were found in both groups. There were no statistical difference in the hemodynamic variables between the MS patients with SR (SR group) and AF group. The AF group had shorter overall AERP than the IS group and the difference was statistically significant- In most sites of the atrium, the voltage of the an-ial electrogram was lower in the AF group compared with the IS group. There was no significant difference in CT between both groups. The voltage of the atrial electrogram in both groups were similar. The overal AERP and the AERP of most sites of the atrium was increased after PTMC. The CT in left atrium not the right was shortened after PTMC. And the voltage of atrial electrogram became higher after PTMC. In addition, beside the above hypothesis tested, there were 2 independent predictors for AF in patients with MS, i.e. the medial-lateral right atrial dimension (OR 1.128 and 95% Cl 1.012 - l.466) and AERP of the low right atrium (OR 0.952, 95% CI 0.907 - L000). Conclusion: Patients with MS have an electrical remodeling due to atrial stretch. Atrial remodeling also occurs when the patients are getting atrial fibrillation. But fortunately these electrophysiological changes will be reversible when PTMC is performed. The electrical remodeling and its reversibility is an intrinsic atrial property, not influenced by the autonomic nervous system. Earlier intervention should he performed to prevent AF for every symptomatic MS patient or asymptomatic with increased medial-lateral right atrial dimension."

"Latar belakang. Stenosis mitralis (SM) masih merupakan masalah kesehatan di Indonesia, dan fibrilasi atrium merupakan penyakit penyerta yang akan meningkatkan emboli sistemik, stroke dan mortalitas pasien. Diduga umpan balik mekano elektris dan remodeling elektris mempunyai peranan yang penting dalam mekanisme terjadinya tibrilasi atrium (FA) pada penyakit katup jantung. Untuk menguji hipotesis bahwa telah tejadi remodeling elektris intrinsik pada pasien SM, dan remodeling tersebut bersifat reversibel, malta telah dilakukan penelitian mengenai perubahan elektrotisiologis sesudah tindakan komisurotomi mitral transvena perkutan (KMTP). Bahan dan cara kerja. Tigapuluh satu pas ien SM yang dilakukan KMTP, 20 dengan irama sinus (IS) dan ll dengan FA persisten serta 10 pasien dengan jantung normal sebagai kelompok kelola dimasukkan dalam penelitian ini. Pemeriksaan hemodinamik dan elektrotisiologi dilakukan sebelum dan segera sesudah KMTP. Semua pasien FA, dilakukan kardioversi eksternal sinkron sebelum dilakukan KMTP. Sebelum pemeriksaan elektrofisiologis, diberikan propranolol iv, 0,2 mg/kgbb dan sulfas atropin 0,004 mg/kbb untuk mem-blok aktiiitas saraf autonom. Pemeriksaan elektrofisiologi meliputi pemeriksaan periode refrakter efektif (PRE) di 6 tempat di atrium, waktu koduksi (WK) di atrium kanan dan kiri dan pengukuran elektrogram atrium di I8 tempat atrium kanan dan kiri. Hasil. Tidak terdapat perbedaan umur, dan jenis kelamin antara kelompok pasien SM dan kelompok kelola. PRE keselunlhan pada kelompok SM dan kelola yang diperoleh pada pacuan 600 milidetik tidak menunjukkan perbedaan bermakna Demikian pula pada pacuan 400 milidetik, tidak menunjukkan kemaknaan statistik Secara regional, PRE atrium lcanan dan kiri tidak menunjukkan perbedaan yang bermakna pada kelompok pasien SM dan kelola. Tetapi kelompok pasien SM mempunyai dispersi PRE lebih lebar dibanding dengan kelompok kelola. WK atrium kanan dan kiri kelompok pasien SM menunj ukkan perlambatan yang bermaltna dibanding dengan kelompok kelola. Di sebagian besar tempat atrium kanan dan kiri, voltase elektrogram atrium juga menunjukkan penurunan yang sangat bermakna. Tidak ada perbedaan dalam durasi elektrogram pada kedua kelompok. Potensial ganda dan elektrogram yang terpecah-pecah tidak ditemukan pada kedua kelompok. Tidak Lerdapat perbedaan bermakna dalam variabel hemodinamik antara kelompok SM disertai IS dengan disertai FA, namun terdapat perbedaan bermakna dalam variabel elektroflsiologi (re-modeling elektris) PRE rerata Secara keseluruhan yang diukur pada interval pacuan 600 milidetik pada kelompok FAjauh lebih pendek dibanding dengan kelompok IS yang secara statistik berbeda bermakna. Demikian pula bila diukur pzlda interval pacuan 400 milidetik. Secara regional, PRE atrium kanan dan kiri kelompok FA lebih pendek dibanding dengan kelompok IS dan perbedaannya seeara statistik bermakna. Sedang dispersi PRE pada kedua kelompok tersebut tidak menunjukkan kemaknaan statislik. WK di atrium kanan dan kiri pada kelompok FA1ebih lambat dibandingkan dengan kelompok IS, dan perbedaannya secara statistik bermalma. Sebagian besar tempat di atrium tidak menunjukkan perbedaan voltase elektogram antara kelompok IS dan FA. Remodeling elektris ini bersifat reversibel setelah dilakukan KMTP. PRE rerata secara keseluruhan yang diukur pada interval pacuan 600 milidetik sebelum dan sesudah dilakukan KMTP ialah 240,51-_39,2 milidetik vs 248,2i36,l mi1idetik(p=0,003)_ Demikian pula pada pengukuran dengan interval 400 mi1idetik(da.ri 228,2i35,3 milidetik vs 238,l i319 milidetik, p=0,000). Reversibilitas hanya terjadi terutama pada sebagian besar PRE atrium dan WK di atrium kiri, sedang besamya vol tase elektrogram lidak demikian halnya. Remodel ing elektris atrium tersebut bersifat intrinsik, tidak dipengaruhi oleh susunan saraf autonom. Di samping pembuktian hipotesis di atas ditemukan pula variabel prediktor terhadap kejadian FA pada penderita SM yakni diameter atrium kanan medial-lateral yang diukur dengan ekokardiograti 2 dimensi (rasio odds 1,128 dengan KI 95% berkisar antara 1,012 sampai l,466), serta PRE atrium kanan bawah (rasio odds 0,952 dengan KI 95% anlara 0,907 - l,000). Kesimpulannya pada pasien SM telah teijadi remodeling elekuis yang mengarah texjadinya FA. Bilamana telah terjadi FA, maka remodeling elelctris akan makin memburuk. Walaupun demikian remodeling elektris yang terjadi bersifat reversibel dengan mengurangi regangan dinding atrium melalui KMTR Remodeling elektris dan reversibilitasnya bersifat intrinsik, tidak dipengaruhi oleh saraf autonom. Oleh karena itu intervensi dini dengan KMTP perlu dilakukan pada setiap pasien SM dengan keluhan, atau bilamana clijumpai pembesaran dimensi atrium kanan mediallateral.

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Background: Mitral stenosis (MS) is one of the major health problems in developing countries. In addition, atrial fibrillation (AF) is one of the MS complication and had a consequence of higher systemic embolic rate including stroke and mortality. Mechano-electrical feedback and electrical remodeling in patients with valvular heart disease might be play an important role in the mechanism of atrial fibrillation (AF). To test the hypothesis that there was an intrinsic elec-trical remodeling in MS and this remodeling might be reversible, we investigated electrophysiological changes after percutaneous transvenous mitral commissurotomy (PTMC). Material and methods. Eleven MS patients with persistentAF and 20 patients with sinus rhythm (SR) were undergoing PTMC included in this study. Ten patients who underwent electrophysiologic study or ablation involving left atrial study were as control group. Autonomic nervous system was blocked using propranolol 0.2 mg/kgbw and atropine 0.04 mgfkgbw. Atrial effective refractory period (AERP) was measured at 2 sites in the right and 4 sites in the left atrium. The conduction time (CT) was measured at the right and left atrium using decapolar catheter. Atrial electrogram was measured on its amplitude, duration and number of fragments of the electrogram at 18 sites of the atrium. Results. There were no statistically differences in age and sex among the MS group and the control group. No significant difference in the overall AERP between the MS group and control group, but the MS group had a higher AERP dispersion tha.n the control group . The MS group had a lower conduction time (CT) than the control group and its difference was statistically significant. Most of the sites in the MS group were smaller than the control group. The duration of electrogram of both groups were similar. No double potential and fractionated electrograms were found in both groups. There were no statistical difference in the hemodynamic variables between the MS patients with SR (SR group) and AF group. The AF group had shorter overall AERP than the IS group and the difference was statistically significant- In most sites of the atrium, the voltage of the an-ial electrogram was lower in the AF group compared with the IS group. There was no significant difference in CT between both groups. The voltage of the atrial electrogram in both groups were similar. The overal AERP and the AERP of most sites of the atrium was increased after PTMC. The CT in left atrium not the right was shortened after PTMC. And the voltage of atrial electrogram became higher after PTMC. In addition, beside the above hypothesis tested, there were 2 independent predictors for AF in patients with MS, i.e. the medial-lateral right atrial dimension (OR 1.128 and 95% Cl 1.012 - l.466) and AERP of the low right atrium (OR 0.952, 95% CI 0.907 - L000). Conclusion: Patients with MS have an electrical remodeling due to atrial stretch. Atrial remodeling also occurs when the patients are getting atrial fibrillation. But fortunately these electrophysiological changes will be reversible when PTMC is performed. The electrical remodeling and its reversibility is an intrinsic atrial property, not influenced by the autonomic nervous system. Earlier intervention should he performed to prevent AF for every symptomatic MS patient or asymptomatic with increased medial-lateral right atrial dimension."

"ABSTRAKLatar Belakang. Stenosis Mitral (SM) tinggi prevalensinya di negara berkembang karena erat terkaitdengan prevalensi penyakit jantung demam rematik (PJR). Pasien SM sedang-berat terdapatpeningkatan regio turbulensi dan shear stress mengakibatkan kerusakan endotel pembuluh darahsehingga meningkatkan resiko tromboemboli. P-selectin merupakan molekul adhesi berperan dalamproses inflamasi dan sebagai faktor protrombotik yang diekspresikan secara cepat. Indeks volumeatrium kiri (IVAK) merupakan parameter superior untuk mengukur fungsi atrium kiri denganekokardiografi.Metode. Penelitian potong lintang melibatkan 20 pasien SM sedang-berat dengan MVA <1.5 cm2yang menjalani Komisuratomi Mitral Transvena Perkutan (KMTP) yang diambil secara konsekutifpada bulan Mei 2013 sampai Oktober 2013 di Pusat Jantung Nasional Harapan Kita Jakarta. Pasiendiambil sampel darah pra dan pasca KMTP untuk diperiksa kadar P-Selectin. Kemudian hasilnyadianalisa secara statistik.Hasil. Dalam studi ini, tidak didapatkan asosiasi antara IVAK dengan ekspresi kadar P-selectin pradan pasca KMTP. Hal ini ditunjukkan dengan nilai pra KMTP β= -0.103 (95% CI -0.251,0.045)p=0.16 dan pasca KMTP β= 0.009 (95% CI -0.155,0.172) p=0.91. Setelah dilakukan regresilinier dengan penyesuaian (adjusted) terhadap variabel perancu yakni usia, jenis kelamin, dan atrialfibrilasi tetap tidak didapatkan asosiasi antara IVAK dengan kadar P-selectin dengan nilai pra KMTPβ= -0.154 (95% CI -0.340,0.032) p=0.09 dan pasca KMTP β= -0.049 (95% CI -0.250,0.152)p=0.61.Kesimpulan. Tidak ada perbedaan nilai P-selectin pra dan pasca KMTP. Nilai IVAK yang sudahjelek tidak berhubungan dengan kadar P-selectin pra dan pasca KMTP pada pasien SM.

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ABSTRACTBackground. The prevalence of Mitral stenosis (MS) remains significant in developingcountries related to prevalence of Rheumatic Heart Disease (RHD).In moderate-severe MSpatients enormous increase in turbulent region and shear stress causing dysfunction ofvascular endothelial, as consequence it increase the risk of thromboembolic complication. Pselectinis an adhesion molecule that play role in inflammation process, it express rapidly inminutes. Left Atrial Volume Index (LAVI) is superior parameter compare with otherechocardiography two dimension method to assess left atrial function.Methods. Study was designed as cross-sectional study involving 20 MS moderate-severepatients with MVA< 1.5 cm2 who performed successful Percutaneous transvenous BalloonMitral Valvulotomy (PBMV). Samples were taken consecutively from May 2013 to October2013 at the National Cardiovascular Center Harapan Kita Jakarta. Blood samples of Pselectinwere collected pre and post PBMV. The result was statistically analyzed by usingechocardiography data of LAVI prior PBMV to describe any association between expressionof P-selectin and atrial function.Result. In our study, we found no association between LAVI and expression of P-selectinlevel pre and post PBMV MS patient. This data describe in each of value of pre PBMV β= -0.103 (95% CI -0.251,0.045) p=0.16 and post PBMV β= 0.009 (95% CI -0.155,0.172) p=0.91After we performed linear regression with adjusted confounding variable including sex, age,and atrial fibrillation, still we found no association between LAVI and P-selectin level. Thisdata describe in each of value of pre PBMV β= -0.154 (95% CI -0.340,0.032) p=0.09 andpost PBMV β= -0.049 (95% CI -0.250,0.152) p=0.61.Conclusion. We found there is no difference in P-selectin level pre and post PBMV. There isno association between poor LAVI value and expression of P-selectin pre and post PBMV inMS."

"Tujuan : Menilai korelasi antara kelentutan atrioventrikular (Cn) dengan tekanan sistolik arteri pulmonal dan besarnya penurunan tekanan arteri pulmonal segera setelah dilakukan komisurotomi mitral transvena perkutan (KMTP). Latar Belakang : Pada pasien stenosis mitral (SM) terjadinya peningkatan tekanan arteri pulmonal dan beratnya gambaran klinis tidak selalu berkaitan dengan area efektif katup mitral (MVA) serta perbedaan tekanan transmitral (MVG) karena beberapa penelitian menunjukkan bahwa kelenturan atrioventrikular (Cn) juga mempengaruhi. Metode : Merupakan studi potong lintang yang dilakukan pada 30 pasien SM berat yang menjalani KMTP di PJNHK dari bulan Januari 2008 s/d oktober 2010. Pasien dibagi 2 kelompok, yakni kelompok I dengan Cn ::; 4 ml/mmHg dan kelompok II dengan Cn > 4 ml/mmHg. Pemeriksaan ekokardiografi dengan Vivid 7 dilakukan sebelum KMTP dan dalam 24 sampai 72 jam setelah KMTP. Cn ditentukan dengan persamaan : Cn = 1,270 (MV A I E-wave downslope), dan tekanan sistolik arteri pulmonal (sPAP) =Tricuspid valve gradient (TVG) + 10 mmHg. Hasil : Dari 194 subjek yang menjalani KMTP didapatkan sampel 30 orang yang memenuhi kriteria inklusi dan eksklusi. Proporsi kasus SM pada penelitian ini lebih banyak pada perempuan yaitu 70% dan usia rata- rata 36 tahun. Perbandingan sPAP pada kedua kelompok, baik sebelum ( 66,8 ± 21,7 mmHg V s 71,5 ± 31,5 mmHg, P = 0,64) maupun setelah KMTP ( 49,3 ± 10,8 mmHg Vs 56,4 ± 19,9 mmHg, P = 0,31) tidak berbeda bermakna, demikian pula besamya penurunan sPAP setelah KMTP pada kedua kelompok tidak berbeda bermakna ( 17,7 ± 15 mmHg Vs 15,7 ± 15,8 mmHg, P = 0,60). Kesimpulan : Kelenturan atrioventrikular (Cn) tidak mempengaruhi tekanan arteri pulmonal dan besamya perubahan tekanan arteri pulmonal segera setelah KMTP.

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Objectives : The purpose of this study is to evaluate the correlation beetwen Cn with systolic artery pulmonal and the magnitude of decreasing systolic pulmonary pressure after balloon mitral valvuloplasty. Background : In patients with mitral stenosis (MS), the increase in pulmonary arterial pressure and severity of the clinical symptom are not only related to the mitral valve area and mitral vave gradient, but also related to the atrioventricular compliance (Cn). Methods : This is a cross sectional study in Thirty patients with severe mitral stenosis underwent Balloon Mitral Valvuloplasthy (BMV) procedure in NCCHKfrom January 2008 until October 20 I I. The patients were divided into two group, group I with Cn ~ 4 ml/mmHg and group II with Cn > 4 ml/mmHg. Echocardiograpy was done before BMV and 24 unti/72 hours after BMVwith vivid 7. Cn was derivedfrom the equation that has been previously validated (ie, Cn = I270 x [MV area by PHT I mitral Ewave downslope] and systolic pulmonary artery pressure(sPAP) = Tricuspid valve gradient (TV G) + I 0 mmHg. Results : There were I94 patients underwent BMV, but only 30 patients meet the inclusion and exclusion criteria. The women proportion were 70% and average of ages were 36 years old. The systolic pulmonary artery pressure in both group were not difference before ( 66,8 ± 2I, 7 mmHg Vs 7I,5 ± 3I,5 mmHg, P = 0,64) and after BMV ( 49,3 ± I0,8 mmHg Vs 56,4 ± I9,9 mmHg, P = 0,3I) and also the magnitude of decreasing systolic pulmonary artery pressure after BMV not difference between the groups. Conclusion: In patients with severe mitral stenosis, atrioventricular compliance was not affected systolic pulmonary artery pressure before and after BMV nor the magnitude of systolic pulmonaty artery pressure after BMV."

"Latar belakang. Timbulnya stasis darah dan pembesaran atrium kiri menyebabkan peningkatan angka kejadian trombus di atrium kiri dan apendiks atrium kiri (Left Atrial Appendage-LAA) pada SM. Diameter atrium kiri yang membesar disebutkan sebagai faktor terjadinya pembentukan LASEC dan meningkatkan angka kejadian tromboemboli. Selain itu adanya stasis darah yang dibuktikan dengan penurunan ejeksi fraksi LAA dan kecepatan aliran darah LAA dapat mencetuskan timbulnya trombus. Perubahan moluker adhesi sICAM-1 dan sVCAM-1 berhubungan dengan kejadian tromboemboli. Tetapi apakah terdapat hubungan antara peran hemodinamik, terutama terhadap diameter, fraksi ejeksi dan kecepatan aliran darah pada LAA dengan kadar molekul adhesi seperti sICAM-1 dan sVCAM-1 belum terjawab. Metode. Pasien SM derajat sedang-berat (tanpa adanya regurgitasi mitral signifikan) yang menjalani pemeriksan ekokardiografi transesofageal diikutsertakan secara konsekutif sejak Januari-April 2014. Penilaian fungsi apendiks atrium kiri dilakukan dengan pemeriksaan transesofageal ekokardiografi. Kadar sICAM-1 dan sVCAM-1 dari vena perifer diukur dengan teknik enzyme-linked immunosorbent assay. Hasil. Sebanyak 26 subyek penelitian dengan rerata usia 38,92±11,93 tahun, 65,3% berjenis kelamin perempuan, dan 46,1% memiliki irama fibrilasi atrium. Dengan sampel tersebut, didapatkan tidak ada hubungan antara komponen fungsi apendiks atrium kiri, baik diameter, ejeksi fraksi, dan kecepatan aliran darah LAA dengan kadar sICAM-1. Tidak terdapat hubungan antara fungsi LAA pada variabel diameter dengan kadar sVCAM-1. Terdapat hubungan terbalik antara ejeksi fraksi LAA dengan kadar sVCAM-1 (-0,21, p=0.038, 95%KI -0,41- -0,01) dan hubungan terbalik antara kecepatan aliran darah LAA dengan kadar sVCAM-1 (-0,29, p=0,048, 95%KI -0,59- -0,003). Kesimpulan. Semakin rendah ejeksi fraksi dan kecepatan aliran darah LAA maka semakin tinggi kadar sVCAM-1.

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Background: Blood stasis and left atrial enlargement increase the incidence of thrombus in the left atrium and left atrial appendage (LAA). Enlargement of left atrial diameter is a factor for LASEC formation and increase the incidence of thromboembolism. Blood stasis which evidenced by a decrease in ejection fraction and LAA blood flow velocity can trigger the presence of thrombus. Changes in soluble adhesion molecules sICAM-1 and sVCAM-1 associated with thromboembolic events. But relationship between the role of hemodynamics, especially the ejection fraction and blood flow velocity in the LAA with the levels of adhesion molecules such as sICAM-1 and sVCAM-1 is not well understood.

Methods: Patient with moderate-severe Mitral Stenosis (in the absence of significant mitral regurgitation) underwent transesophageal echocardiography from January to April 2014. Levels of sICAM-1 and sVCAM-1 from peripheral vein were measured by enzyme-linked immunosorbent technique assay.

Results: A total of 26 subjects with a mean age of 38.92 ± 11.93 years, 65.3% female, and 46.1% had atrial fibrillation. We found no association between components of left atrial appendage function: diameter, ejection fraction and blood flow velocity of LAA with sICAM-1 levels. There was no relationship between the LAA function in the variable diameter of LAA with sVCAM-1 levels. There is an inverse relationship between ejection fraction of LAA and levels of sVCAM-1 (-0.21, p = 0.038, 95% KI -0,41- -0,01) and an inverse association between LAA blood flow velocity and levels of sVCAM-1 (-0 , 29, p = 0.048, 95% KI -0.59 - 0.003).

Conclusion: Low ejection fraction of LAA is associated with higher the levels of sVCAM-1. Low LAA blood flow velocity is associated with higher the levels of sVCAM-1."

"[ABSTRAKLatar belakang : Stenosis mitral (SM) masih merupakan masalah kesehatan yang penting di Indonesia. Pada SM terjadi peningkatan kadar P selectin karena disfungsi endotel dan aktivasi platelet. Komisurotomi mitral transvena perkutan (KMTP) merupakan tatalaksana baku untuk penderita SM yang dapat memperbaiki kemampuan aktivitas fisik yang pada akhirnya akan mempengaruhi kadar P selectin. Belum ada penelitian yang menghubungkan antara tingkat aktifitas fisik dengan kadar P Selectin 3 bulan pasca KMTP pada SM rematik.Metode : Penelitian ini merupakan penelitian potong lintang. Dari 56 subyek penelitian yang menjalani KMTP sejak bulan Mei 2013 sampai Februari 2014 di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, didapatkan 35 sampel yang memenuhi kriteria penerimaan . Data klinis dan data ekokardiografi sebelum dan 3 bulan pasca KMTP diambil dari catatan medis. Dilakukan wawancara 3 bulan pasca KMTP. Tingkat aktivitas fisik dibagi menjadi 2 kelompok: kelompok 1 1-4 METs, kelompok 2 > 4 METs. Kadar P selectin diambil 3 bulan pasca KMTP. Selanjutnya dilakukan analisa statistik untuk mengetahui hubungan antara tingkat aktivitas fisik dengan kadar P Selectin 3 bulan pasca KMTP pada SM rematikHasil : Pasien yang akan menjalani KMTP memiliki rerata usia 40,00±11,58 tahun dengan proporsi perempuan lebih tinggi daripada laki-laki (74,3%) dan dengan proporsi irama sinus yang lebih tinggi daripada irama atrial (57,1%). Dari uji T didapatkan ada perbedaan bermakna rata-rata kadar P selectin 3 bulan pasca KMTP pada tingkat aktivitas fisik 1-4 METs dan > 4 METs, dimana rerata kadar P selectin 3 bulan pasca KMTP pada tingkat aktivitas fisik > 4 METs lebih rendah secara bermakna dibandingkan 1-4 METs (p=0,003). Setelah dilakukan analisa multivariat terlihat tingkat aktivitas fisik pasca KMTP tetap berpengaruh terhadap kadar P Selectin 3 bulan pasca KMTP (p=0,001). Area Katup Mitral (AKM) pasca KMTP berpengaruh terhadap kadar P selectin 3 bulan pasca KMTP (p=0,018), namun tingkat aktivitas fisik pasca KMTP lebih besar pengaruhnya dibandingkan AKM.Kesimpulan : Terdapat hubungan antara tingkat aktivitas fisik dengan kadar P selectin 3 bulan pasca KMTP dimana pada tingkat aktivitas yang lebih tinggi ( > 4 METs) kadar P selectin lebih rendah 10,489 ug/ml dibandingkan tingkatan aktivitas fisik 1-4 METs.

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ABSTRACTBackground: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml);Background: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml), Background: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml)]"