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"Latar belakang: Beberapa studi telah melaporkan terdapat disfungsi sistolik ventrikel kiri yang diukur oleh global longitudinal strain (GLS) pada pasien dengan stenosis mitral. Penelitian ini bertujuan untuk mengetahui perubahan fungsi sistolik intrinsik ventrikel kiri menggunakan penilaian global longitudinal strain (GLS) segera sesudah tindakan balloon mitral valvuloplasty (BMV) dan pada observasi jangka panjangMetode: Dilakukan pemeriksaan ekokardiogafi dasar dan GLS pada pasien stenosis mitral yang akan BMV, lalu dievaluasi segera sesudah BMV yang berhasil (48 jam sampai 1 minggu), dan jangka panjang (6 bulan sampai 1 tahun). Hasil: Dari 36 pasien yang diuji, rerata usia adalah 43.41±10.04 tahun, mayoritas perempuan (72%), mayoritas mempunyai irama fibrilasi atrial (56%), dengan median mitral valve area (MVA) sebelum BMV adalah 0.6 (0.2-1.3) cm2dan rerata mitral valve gradient (MVG) sebelum BMV adalah 12.95 ± 5.29 mmHg. Terdapat perbaikan singifikan fungsi sistolik intrinsik ventrikel kiri yang diukur dengan GLS antara sebelum BMV, segera sesudah dan pada observasi jangka panjang sesudah BMV (-14.34± 3.05%, -15.84 ±3.11%, dan -17.29 ± 2.80% p<0.05).Kesimpulan: Terdapat perbaikan yang signifikan pada GLS sesudah BMV dan semakin membaik pada pengamatan jangka panjang yaitu 6 bulan - 1 tahun sesudah BMV.

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Background: Severeal studies have reported left ventricular systolic dysfunction as measured by the global longitudinal strain in patient with mitral stenosis. This study aims to determine changes in left ventricular systolic function using global longitudinal strain immediately after) balloon mitral valvuloplasty (BMV) and on long term observation.

Methods: Baseline echocardiography data and GLS will be taken before BMV, and will be followed up immediately after (48 hours to 7 days), and on long term (6 months to 1 year) after BMV

Result: Among 36 patients, the mean age was 43.41±10.04 y.o, female dominant (72%), majority have atrial fibrillation (56%), with median of mitral valve area (MVA)before BMV was 0.6 (0.2-1.3) cm2and mean of mitral valve gradient before BMV was 12.95 ± 5.29 mmHg. There is an significant improvement in instrinsic left ventricular systolic function as measured by GLS between before BMV and immediately after BMV (-14.34 ± 3.05%, -15.84 ±3.11% , and -17.29± 2.80% p<0.05).

Conclusions: There is a significant improvement in GLS before BMV compared to immediately after BMV. GLS immediately after BMV is still significantly improved in the long term evaluation (6 months until 1 year) after BMV"

"Latar Belakang: Kompleks prematur ventrikel (KVP) dikaitkan dengan risiko penurunan fungsi ventrikel dan gagal jantung, dan meningkatkan mortalitas jangka panjang. Variasi sirkadian yang rendah merupakan salah satu prediktor terjadinya kardiomiopati yang diinduksi oleh KVP. KVP idiopatik tipe independen merupakan salah satu bentuk dari KVP dengan gambaran distribusi variasi sirkadian yang rendah. Namun tidak semua KVP independen memiliki variasi sirkadian yang rendah. Belum ada studi yang menilai perbedaan fungsi sistolik intrinsik VKi menggunakan global longitudinal strain (GLS) pada KVP idiopatik independen dengan KVP idiopatik non-independen.Tujuan: Mengetahui hubungan antara kompleks ventrikel prematur idiopatik tipe independen dengan GLS ventrikel kiri melalui ekokardiografi speckle tracking pada pasien tanpa penyakit jantung struktural.Metode: Penelitian ini merupakan studi potong lintang dengan menggunakan data pasien aritmia ventrikel idiopatik yang dikumpulkan di RSPJD Harapan Kita Jakarta pada bulan Februari 2021- Mei 2021. Evaluasi KVP idiopatik dilakukan dengan EKG 12 sandapan, pemeriksaan Holter monitoring 24 jam. Data dasar ekokardiografi diambil dan penilaian fungsi sistolik intrinsik ventrikel kiri (Vki) dilakukan menggunakan ekokardiografi speckle tracking dengan global longitudinal study (GLS).Hasil: Dari 67 pasien KVP idiopatik yang disertakan dalam penelitian, didapatkan sebesar 27 pasien (40,2%) dengan KVP tipe independen dan 40 pasien (59,8%) dengan KVP non-independen. Sebanyak 31 (46,3%) pasien memiliki disfungsi sistolik ventrikel kiri pada pemeriksaan GLS (kurang dari -18). KVP tipe independen (OR 5,3; IK 95% 1,10-33,29; p = 0,038), beban KVP 9% (OR 16; IK 95% 1,58-163,61; p = 0,019), jenis kelamin laki-laki (OR 6,58; IK 95% 0,80-0,99; p = 0,029), dan episode TV non-sustained (OR 13,88; IK 95% 1,77-108,53; p = 0,012) berhubungan secara signifikan dengan penurunan fungsi sistolik intrinsik Vki.Kesimpulan: Kompleks ventrikel prematur idiopatik tipe independen berhubungan dengan penurunan sistolik intrinsik ventrikel kiri melalui ekokardiografi speckle tracking. Evaluasi tipe KVP idiopatik perlu dilakukan karena berhubungan dengan prognosis pasien dalam praktik klinis.

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Background: Premature ventricular complexes (PVC) was associated with a risk of decreased ventricular function and heart failure, and increased long-term mortality. Low circadian variation is one of the predictors of PVC-induced cardiomyopathy. Independent-type-PVC (I-PVC) is a form of PVC with a low distribution of circadian variation. However, not all I-PVC show low circadian variation. No studies have been performed to examine differences in intrinsic systolic function of left ventricle (LV) using global longitudinal strain (GLS) in independent versus non-independent idiopathic PVC.

Objective: To determine the relationship between I-PVC and intrinsic systolic function of LV using speckle tracking echocardiography in patients without structural heart disease.

Methods: A cross-sectional study was conducted using data from patients with idiopathic ventricular arrhythmias collected at RSPJD Harapan Kita Jakarta in February 2021-May 2021. Evaluation of idiopathic PVC was carried out using a 12-lead ECG, 24-hour Holter monitoring. Basic echocardiography was performed then LV intrinsic systolic function was assessed using speckle tracking echocardiography with global longitudinal study (GLS).

Results: Of the 67 patients with idiopathic PVC included in the study, 27 (40.2%) patients included in independent PVC group and 40 (59.8%) patients in non-independent PVC group. A total of 31 (46.3%) patients had LV systolic dysfunction on GLS examination (less than -18). Independent-type-PVC (OR 5.3; 95% CI 1.10-33.29; p = 0.038), PVC burden of 9% (OR 16; 95% CI 1.58-163.61; p = 0.019), male gender (OR 6.58; 95% CI 0.80-0.99; p = 0.029), and non-sustained VT episodes (OR 13.88; 95% CI 1.77-108.53; p = 0.012) was significantly associated with a decrease in LV intrinsic systolic function.

Conclusion: Independent-type-PVC was associated with decreased in LV intrinsic systolic function assessed by speckle tracking echocardiography. Evaluation of the type of idiopathic PVC needs to be considered since it is related with patient's prognosis in clinical practice."

"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."

"Latar belakang: Aritmia ventrikular idiopatik, baik kompleks ventrikel prematur (KVP) maupun takikardia ventrikel (TV), dapat menyebabkan terjadinya penurunan fungsi sistolik ventrikel kiri (VKi) yang akan menimbulkan kardiomiopati dan meningkatkan mortalitas. Banyak faktor yang berkontribusi menyebabkan terjadinya kardiomiopati akibat KVP (KA-KVP) meskipun mekanisme terjadinya belum sepenuhnya dipahami. Variasi sirkadian KVP dilaporkan berhubungan dengan terjadinya penurunan fraksi ejeksi VKi. Deteksi dini adanya disfungsi sistolik intrinsik Vki dapat dilakukan melalui pemeriksaan speckle tracking ekokardiografi dengan mengukur nilai global longitudinal strain (GLS). Sampai saat ini belum diketahui apakah variasi sirkadian KVP berhubungan dengan penurunan fungsi sistolik intrinsik ventrikel kiri.Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara variasi sirkadian aritmia ventrikular idiopatik dengan fungsi sistolik intrinsik ventrikel kiri melalui speckle tracking ekokardiografi.Metode: Penelitian ini adalah studi potong lintang dengan total subjek 67 pasien (17 laki-laki [25,4%]; usia rata-rata 46.5 + 9.8 tahun; fraksi ejeksi ventrikel kiri 63,2% + 7,5%) dengan KVP yang berasal dari jalur keluar ventrikel dari pemeriksaan elektrokardiogram 12 sadapan. Semua pasien menjalani pemeriksaan Holter monitoring 24 jam dan speckle tracking ekokardiografi. Dilakukan perhitungan variasi sirkadian beban KVP dan nilai global longitudinal global (GLS) kemudian dilakukan analisis statistik untuk menilai hubungan kedua variabel tersebut.Hasil: Sebanyak 31 pasien (46.3%) mengalami gangguan fungsi sistolik Vki (GLS lebih buruk dari -18%). Pasien dengan gangguan fungsi sistolik VKi memiliki GLS yang kurang negatif (-15.1% + 1.8% vs -21.3% + 2.0%; p=<0,001), beban KVP yang lebih tinggi (22.2% + 11.1% vs 13.9% + 8.3; p=0,001), variasi sirkadian beban KVP yang rendah (koefisien variasi beban KVP per 6 jam 26.8% + 15.6 vs 52.0 % + 28.2%; p=<0,001), dan episode TV non-sustained yang lebih sering (10 pasien [76.9%] vs 3 pasien [23.1%]; p=0,019). Sebanyak 70.6% pasien dengan jenis kelamin laki-laki mengalami gangguan disfungsi sistolik VKi (p=0,002). Pada analisis multivariat didapatkan beberapa prediktor terhadap gangguan fungsi sistolik Vki antara lain variasi sirkadian beban KVP yang rendah dengan [(koefisien variasi beban KVP per 6 jam < 35%), odds ratio (OR)=3.89 interal kepercayaan (IK)95%=1.09-13.80 p=0.036], episode TV non-sustained (OR=14.4, IK 95%=2.36-88.55, p=0.008), beban KVP > 9% (OR=6.81, IK 95%=1.35-34. Kesimpulan: Variasi sirkadian aritmia ventrikular idiopatik yang rendah berhubungan dengan penurunan fungsi sistolik intrinsik ventrikel kiri melalui speckle tracking ekokardiografi. Variasi sirkadian beban KVP per 6 jam < 35% memiliki risiko 3.89 kali lebih tinggi untuk terjadinya disfungsi sistolik ventrikel kiri

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Background: Idiopathic ventricular arrhythmias (AVI) including premature ventricular complex (PVC) or ventricular tachycardia (VT) can cause left ventricular (LV) dysfunction which may lead to cardiomiopathy. The mechanisms of this cardiomyopathy remain elusive, many factors are believed to contribute. PVC burden is influenced by circadian rhythmicity and lack of PVC circadian variability was proposed as one mechanism of LV dysfunction. Since early detection of LV systolic dysfunction can be done by speckle tracking echocardiography examination, further studies are needed to assess intrinsic left ventricular systolic function and its correlation with PVC circadian variation in patients with idiopathic ventricular arrhythmias.

Objective: This study aimed to investigate the correlation between circadian variation of IVA and left ventricular intrinsic systolic function assessed by speckle tracking echocardiography.

Methods: The subjects of this cross sectional study were 67 consecutive patients (17 men [25.4%]; mean age 46.5 + 9.8 years; left ventricular ejection fraction 63.2% + 7.5%) with PVC originated from ventricular outflow tract based on 12 lead electrocardiogram. All patients underwent 24-hour Holter monitoring and speckle tracking echocardiography examinations. The circadian variation of PVC burden and global longitudinal strain (GLS) were determined and statistical analysis was conducted to evaluate their correlation. Results: A total 31 patients (46.3%) had impaired LV systolic function by GLS ( worse than -18%). Patients with impaired LV systolic function had a less negative GLS (-15.1% + 1.8% vs -21.3% + 2.0%; p=<0.001), a higher PVC burden ((22.2% + 11.1% vs 13.9% + 8.3; p=0,001), less variation in circadian PVC distribution (coefficient of variation 6 hourly 26.8% + 15.6 vs 52.0 % + 28.2%; p=<0.001), and more frequent episode of non-sustained VT (10 patients [76.9%] vs 3 patients [23.1%]; p=0.019). Total 70.6% patient with male gender experienced impaired LV systolic function (p=0.002). Independent predictors for impaired systolic LV function were less variation in circadian PVC distribution [(coeficient of variation < 35%), odds ratio (OR)=3.89, 95% confidence interval (CI)= 1.09-13.80, p=0.036)], episode of non-sustained VT (OR=14.4, 95%CI=2.36-88.55, p=0.008), PVC burden > 9% (OR=6.81, CI 95%=1.35-34.41, p=0.020), and male gender (OR=14.4, CI 95%=2.02-101.1, p=0.004).

Conclusion: Lack of circadian variation of IVA is associated with impaired LV systolic function by GLS. Coefficient of variation PVC burden < 35% has 3.89 times higher risk for development of left ventricular systolic dysfunction."

"ABSTRAK Latar belakang. Pada pasien SA fraksi ejeksi ventrikel kiri dapat normal bahkan supra normal untukjangka waktu yang lama walaupun proses remodeling ventrikel kiri sudah mulai terjadi..Ekokardiografi speckle tracking dua dimensi (EST) mempunyai kelebihan untukdigunakan dalam menilai penurunan fungsi kontraktilitas miokard subklinis, dimanakeadaan tersebut dapat mempengaruhi prognosis pasien SA. sST2 merupakan biomarkeryang relatif baru, dapat meningkat pada regangan otot jantung (myocardial stretch),fibrosis, inflamasi, dan injuri miokard, apakah berhubungan dengan disfungsi diniventrikel kiri masih belum diketahui.Tujuan. Mengetahui korelasi sST2 terhadap nilai GLS EST pada pasien SA berat denganFEVK normalMetode. Merupakan studi potong lintang. Evaluasi dilakukan pada 29 pasien stenosisaorta berat dengan fraksi ejeksi normal yang datang ke poliklinik RS Jantung HarapanKita periode Februari 2015 sampai November 2015. Dilakukan pengambilan figurekokardiografi untuk menilai severitas SA dan untuk perhitungan nilai global longitudinalstrain speckle tracking kemudian dilakukan pengambilan sampel darah di laboratoriumRS Jantung Harapan Kita untuk menilai sST2.Hasil Penelitian. Dua puluh sembilan subjek ikut dalam penelitian ini dengan rerata usiaadalah 59.7±12.1 tahun. Fungsi intrinsik ventrikel kiri pasien SA berat pada penelitian inimengalami penurunan dengan nilai rerata GLS -11±4.5%. Hasil uji korelasi menunjukanterdapat korelasi positif dengan kekuatan korelasi sedang yang bermakna (r=0.429,p=0.02). Analisis multivariat tetap menunjukkan adanya hubungan antara kadar sST2dengan nilai GLS EST (r=0,282 p=0.036). Kesimpulan. Terdapat korelasi sST2 dengan global longitudinal strain speckle trackingpada pasien SA berat dengan fraksi ejeksi normal.ABSTRACT Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. "

"Latar belakang: F-HR-PVC merupakan KVP yang kemunculannya berbanding lurus dengan peningkatan laju nadi. Mekanisme yang mendasarinya adalah adanya variasi sirkadian sistem saraf autonom dan kadar katekolamin darah. Adanya variasi sirkadian tersebut membuka peluang untuk intervensi KVP secara kronoterapi.Tujuan: Meneliti efektivitas kronoterapi bisoprolol pada pasien KVP idiopatik terhadap beban KVP dan variabilitas beban KVP selama 24 jam. Metode: Penelitian ini merupakan uji klinik crossover acak tersamar ganda dengan total subjek 23 pasien dengan tipe F-HR-PVC (beban KVP 24 jam ≥5% dan variabilitas beban KVP >35%). Subjek penelitian dibagi menjadi dua kelompok. Kelompok sekuens 1 diberikan bisoprolol pagi hari (1 minggu pertama), dilakukan crossover, dilanjutkan pemberian bisoprolol malam hari (1 minggu kedua) sedangkan kelompok sekuens 2 menerima perlakuan sebaliknya. Evaluasi Holter 24 jam dilakukan pada akhir minggu pertama dan kedua dan dianalisis untuk membandingkan efektivitas pemberian bisoprolol sesuai kronoterapi terhadap beban KVP dan variabilitas beban KVP selama 24 jam. Hasil: Pemberian bisoprolol baik pagi hari (p=0,018) maupun malam hari (p=0,014) dapat menurunkan beban KVP secara signifikan. Namun hanya pemberian bisoprolol pagi hari yang dapat meningkatkan variabilitas beban KVP selama 24 jam (p=0,028). Tidak ada perbedaan penurunan beban KVP antara pemberian bisoprolol pagi hari atau malam hari (treatment effect -0,06 [-4,12 – 4,00]; IK 95%, p = 0,976). Selain itu, variabilitas beban KVP juga tidak berbeda antara kedua kelompok perlakuan (treatment effect 6,34 [-10,41 – 23,08]; IK 95%, p = 0,439). Kesimpulan: Tidak ada perbedaan efektivitas pemberian bisoprolol pada pagi hari dibanding malam hari terhadap beban KVP maupun variabilitas beban KVP selama 24 jam

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Background: F-HR-PVC is one of PVC circadian variation which occurrence increases linearly with baseline heart rate. The mechanism involved is considered related to the circadian mechanism which includes autonomic nerve system and catecholamine levels. The presence of circadian variation in PVC raise the potential of chronotherapeutic approach in treating PVC.

Methods: This is a double-blind randomized crossover trial with a total subject of 23 patients who have F-HR-PVC with 24-hr PVC burden ≥5% and PVC burden variability >35%. Subjects were divided into two sequences. Those in sequence 1 were given bisoprolol in the morning in the first week, crossed over then followed by the administration of evening bisoprolol in the second week. Meanwhile, those in sequence 2 received alternate treatment. 24-hour holter evaluation was done and analyzed to compare the efficacy of bisoprolol administration with chronotherapeutic approach toward PVC burden and its variability in 24-hr.

Results: Either morning or evening administration of bisoprolol significantly reduced the PVC burden (morning vs. evening; p=0,018 vs. p=0,014). However, only morning administration which increases the PVC burden variability in 24-hr (p=0,028). There is no significant difference between morning and evening administration of bisoprolol on both PVC burden (treatment effect -0,06 [-4,12 – 4,00]; CI 95%, p = 0,976) and PVC burden variability (treatment effect 6,34 [-10,41 – 23,08]; CI 95%, p = 0,439) for 24 hours.

Conclusion: There was no difference in the efficacy of giving bisoprolol in the morning compared to the evening dosing on the PVC burden and the variability of PVC burden for 24 hours."

"ABSTRAKLatar Belakang: Studi menunjukkan pasien dengan gangguan fungsi ventrikel kanan VKa perioperasi, memiliki luaran mortalitas dan morbiditas yang kurang baik. Akan tetapi, studi yang menilai prediktor disfungsi VKa masih sedikit dan belum pernah dilakukan di Indonesia. Tujuan: Mengidentifikasi faktor-faktor yang apa saja yang dapat menjadi prediktor disfungsi sistolik VKa pada pasien yang menjalani pembedahan katup mitral. Metode: Studi kasus kontrol dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita RSJPDHK . Subyek penelitian adalah pasien yang menjalani operasi katup mitral sejak Januari 2016 sampai Februari 2017. Karakteristik dasar, data operasi, pemeriksaan ekokardiografi sebelum dan pasca operasi pre- discharge , serta catatan ruang intensif yang diperoleh dari rekam medis dicatat. Data kemudian diolah dengan analisis bivariat dan multivariat. Hasil Penelitian: Subyek sebanyak 282 pasien dengan 75 mengalami disfungsi Vka dengan TAPSE pascapembedahan

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ABSTRACT

Background Studies have shown that patients with right ventricle RV dysfunction perioperatively have worse mortality and morbidity outcomes. Yet studies evaluating predictors of RV dysfunction are still scarce and have never been carried out in Indonesia. Objectives To identify which factors may predict the occurence of postoperative RV systolic dysfunction in patients undergoing mitral surgery. Method Case control study taking place in National Cardiovascular Center Harapan Kita NCCHK . Subjects are patients who underwent mitral surgery in NCCHK from January 2016 until February 2017. Data consisting of basic characteristics, surgical data, echocardiography parameters before and after surgery predischarge , and intensive care unit integrated records acquired from medical records are gathered. Bivariate and multivariate analyses are carried out. Results 282 patients were included in the study, 75 having RV dysfunction with postoperative TAPSE of..."

"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."

"Aliran darah koroner terjadi terutama pada fase diastolik. Stenosis arteri koronaria menimbulkan iskemia miokard. Iskemia miokard dapat menimbulkan gangguan diastolik. Gangguan diastolik mengakibatkan penurunan aliran darah koroner pada sepertiga awal diastolik, baik pada waktu istirahat maupun selama takikardia. Angina pektoris merupakan gejala iskemia miokard. Tujuan penelitian ini untuk membuktikan bahwa ditemukan gangguan diastolik ventrikel kiri, dan angina pektoris akan lebih berat bila disertai dengan gangguan diastolik ventrikel kiri pada pasien stenosis arteri koronaria. Pada penelitian ini dilakukan pemeriksaan variabeI diastolik ventrikel kiri, dengan ali ran mitral gelombang pulsa doppler ekokardiografi saat istirahat, pada pasien yang terbukti mengalami stenosis arteri koronaria dari pemeriksaan angiografi koroner. Pada penelitian ini, yang memenuhi kelima variabel diastolik dan diklasifikasikan sebagai fungsi diastolik normal adalah 3,3%, relaksasi abnormal 10%, sementara 86,7% menunjukkan perubahan beberapa variabel diastolik.

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Coronary blood flow occurs mainly in the diastolic phase. Arterial stenosis The coronary artery gives rise to myocardial ischemia. Myocardial ischemia can cause diastolic disorders. Diastolic disorders result in decreased blood flow coronary in the first third of diastolic, both at rest and during tachicardia. Angina pectoris is a symptom of myocardial ischemia. The purpose of this study to prove that diastolic disorders of the left ventricle, and angina were found Pectoris will be more severe when accompanied by diastolic disorders of the left ventricle in patients with coronary artery stenosis. In this study, a variabeI examination was carried out diastolic left ventricle, with ali ran mitral pulse wave Doppler echocardiography at rest, in patients who have been shown to have coronary artery stenosis of coronary angiography examination. In this study, a variabeI examination was carried out diastolic left ventricle, with ali ran mitral pulse wave Doppler echocardiography at rest, in patients who have been shown to have coronary artery stenosis of coronary angiography examination. In this study, which meets all five variables diastolic and classified as normal diastolic function is 3.3%, relaxation abnormal 10%, while 86.7% showed changes in several diastolic variables.

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"Latar Belakang: Stenosis vena sentral adalah salah satu permasalahan utama yang dihadapi dalam penggunaan akses hemodialisis FAV. Kondisi ini dapat ditangani dengan tindakan single balloon angioplasty. Namun, tatalaksana ini memiliki angka patensi yang tidak memuaskan akibat respon pembuluh darah terhadap barotrauma. Mengetahui risiko yang mempengaruhi patensi pasca tindakan single baloon angioplasty pada penderita stenosis vena sentral penting untuk memprediksi prognosis pasien. Penelitian ini bertujuan untuk mengetahui faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Metode: Sebuah penelitian kohort retrospektif multicenter pada Januari 2018 – September 2022 di empat rumah sakit dilakukan untuk menilai faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Faktor yang diteliti mencakup derajat stenosis, panjang stenosis, jumlah stenosis, lokasi stenosis, residual stenosis, ukuran balon, dan tekanan balon. Hasil: Terdapat total 76 pasien pada penelitian ini. Pada penelitian ditemukan faktor yang berpengaruh pada patensi 6 bulan pasca single balloon angioplasty adalah jenis kelamin laki – laki (78.4% vs 46.2%; p 0.004), panjang stenosis ≥ 2 cm (85.7% vs 56.5%; p 0.042), lokasi stenosis pada vena innominata (75% vs 39.3%; p: 0.002),derajat stenosis ≥ 80% (83.3% vs 42.5%; p : 0.001), dan residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). Tidak ditemukan faktor yang berpengaruh pada patensi 12 bulan pasca single balloon angioplasty. Kesimpulan: Terdapat hubungan antara panjang stenosis, lokasi stenosis, derajat stenosis, dan residual stenosis terhadap patensi single balloon angioplasty

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Background: Central venous stenosis is one of the main problems encountered in AVF hemodialysis access. This condition can be treated with a single balloon angioplasty. However, this treatment has a low patency rates due to the response of the vessels to barotrauma. Knowing the risks that affect patency after single balloon angioplasty in patients with central venous stenosis is important to predict the patient's prognosis. This study aims to determine the factors influencing 6 and 12 months patency after single balloon angioplasty in central venous stenosis patient. Methods: A multicenter retrospective cohort study in January 2018 – September 2022 in four hospitals was conducted to assess factors that affect 6 and 12 months patency after single balloon angioplasty in patients with central venous stenosis. Factors studied included the degree of stenosis, length of stenosis, number of stenosis, location of stenosis, residual stenosis, balloon size, and balloon pressure. Results: There were a total of 76 patients in this study. In this study, it was found that the factors that affected the patency 6 months after single balloon angioplasty were male gender (78.4% vs 46.2%; p 0.004), stenosis length ≥ 2 cm (85.7% vs 56.5%; p 0.042),stenosis at the innominate vein (75% vs 39.3%; p: 0.002), stenosis degree ≥ 80% (83.3% vs 42.5%; p : 0.001), and residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). There were no factors that had an effect on patency 12 months after single balloon angioplasty. Conclusion: There is a relationship between the length of the stenosis, the location of the stenosis, the degree of stenosis, and the residual stenosis on the patency of single balloon angioplasty"