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"Latar Belakang : Infeksi COVID-19 dewasa ini telah diketahui memiliki implikasi jangka panjang meski periode akut telah tertangani, suatu fenomena yang dinamakan long COVID syndrome atau sindrom pasca COVID-19. Patofisiologi dari kejadian ini masih belum diketahui dengan jelas. Studi melaporkan bahwa sindrom pasca COVID-19 melibatkan beberapa organ, diantaranya adalah sistem kardiovaskular. Pemeriksaan nilai LV GLS dan RV LS pada ekokardiografi dinilai akurat dalam mendeteksi disfungsi miokard dan fibrosis endomiokardial. Selain itu, hingga saat ini, data mengenai faktor-faktor saat admisi sebagai prediktor terhadap kejadian sindrom pasca COVID-19 masih terbatas. Tujuan : Mengetahui nilai parameter ekokardiografi LV GLS dan RV LS sebagai penanda disfungsi miokard dan fibrosis jantung serta mengidentifikasi faktor-faktor saat admisi yang berpengaruh terhadap kejadian sindrom pasca COVID-19.Metode : Penelitian ini adalah deskriptif-analisis menggunakan metode potong lintang. Pemilihan subjek dilakukan dengan metode consecutive sampling. Pemeriksaan ekokardiografi termasuk pemeriksaan global longitudinal strain (GLS) dilakukan oleh dua orang observer 4 bulan pasca perawatan rumah sakit. Selanjutnya, analisis multivariat berupa regresi linear dilakukan untuk mengetahui faktor admisi yang berpengaruh terhadap perbedaan nilai GLS pada kelompok penelitian. Hasil : 100 subjek dengan komorbiditas kardiovaskular dan riwayat COVID-19 memenuhi kriteria dan syarat penelitian. Ditemukan nilai penurunan nilai LV-GLS pada kelompok ini. Subjek dengan komorbiditas kardiovaskular tanpa riwayat COVID-19 (n=31, kontrol 1) yang telah melalui proses matching berdasarkan usia, gender, dan faktor resiko, serta subjek sehat (n-31, kontrol 2) sebagai pembanding validitas GLS. Terdapat perbedaan signifikan rerata nilai LV GLS antar 3 kelompok (p<0.05, rerata ±SB -16.17 ± 3.379, -19.48 ± 1.141, -21.48 ± 1.777 berturut-turut untuk kelompok kasus, kontrol 1, kontrol 2), dengan nilai paling rendah pada kelompok kasus. Faktor saat admisi yaitu status CAD memiliki hubungan yang signifikan (p 0.038) dengan penurunan LV GLS pada pasien post covid-19 dengan komorbid kardiovaskular. Kesimpulan : Terdapat penurunan nilai LV GLS yang signifikan pada sindrom pasca COVID-19 disertai komorbiditas kardiovaskular. CAD merupakan prediktor penurunan fungsi maupun fibrosis jantung sebagai manifestasi sindrom pasca COVID-19.

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Background : Recently, COVID-19 infection has been known to have a longer implication, even after the initial acute phase has been managed, a phenomenon termed as long COVID syndrome or “sindroma pasca COVID-19”. The exact pathophysiological mechanism of this event is still unknown. Previous studies reported that long COVID syndrome involves multiple organs, one of which is the cardiovascular system. Measurement of echocardiography LV GLS and RV LS values are reported to be accurate to detect myocardial dysfunction and endomyocardial fibrosis. Moreover, up until now, data regarding admission factors as predictors for long COVID syndrome incidences are still limited.

Objective : Assessing echocardiography LV GLS and RV LS values as a marker for myocardial dysfunction and heart fibrosis and identifying admission factors which may predict the incidence of long COVID syndrome

Methods : This is an observational study with a cross-sectional using a consecutive sampling method. Echocardiography including global longitudinal strain (GLS) measurement was done by two examiners 3 months after initial hospitalization. Multivariate analysis linear regression was subsequently used to investigate admission factors which are associated with differences in GLS measurement.

Results : Total of 100 subjects with cardiovascular comorbidities and prior COVID-19 infection were enrolled. Echocardiography examination showed lower GLS values in this group compared to the normal population. Age, sex and risk factors-matched subjects with cardiovascular comorbidity without a history of COVID-19 (n=31, Control 1) and healthy subjects (n-31, Control 2) were subsequently used as comparisons to validate GLS results. There were significant differences in LV-GLS levels between the three groups, with the lowest values measured in the case group (p<0.05, mean ±SD -16.17 ± 3.379, -19.48 ± 1.141, -21.48 ± 1.777 respectively for case, control 1, and control 2 groups). A history of coronary artery disease upon admission was found to be associated with decreased LV GLS values in recovered COVID-19 patients with cardiovascular comorbidity.

Conclusion : LV GLS values significantly decrease in long COVID syndrome with cardiovascular comorbidities. Having a previous history of CAD upon admission may serve as predictors of deteriorated functions or heart fibrosis as manifestations of long COVID syndrome. "

"Latar Belakang : Infeksi COVID-19 telah diketahui masih dapat menyebabkan gejala sampai 90 hari dan bahkan lebih, meski infeksi akutnya telah berlalu. Hal ini disebabkan karena adanya fenomena sindroma pasca COVID-19. Mekanisme kejadian tersebut sampai saat ini masih belum diketahui pasti. Hal tersebut diduga kuat akibat adanya fibrosis di beberapa organ, terutama jantung dan paru. Sementara itu, beberapa studi telah menyebutkan bahwa sST2 merupakan penanda fibrosis jantung. Meskipun demikian, sampai saat ini belum ada penelitian yang mencoba mengetahui faktor-faktor apa saja yang memiliki hubungan dengan kejadian fibrosis pasca infeksi COVID-19. Kadar sST2 pada pasien komorbid kardiovaskular tanpa COVID-19 dan populasi orang sehat, khususnya di Indonesia juga belum diketahui.Tujuan : Mengetahui perbandingan kadar sST2 pada pasien komorbid kardiovaskular 12 minggu pasca infeksi COVID-19 dengan pasien komorbid kardiovaskular tanpa COVID-19 dan populasi orang sehat, serta hubungannya dengan faktor-faktor admisi.Metode : Penelitian ini merupakan studi observasional potong lintang. Kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19 dibandingkan dengan komorbid kardiovaskular akan dibandingkan dengan kelompok kontrol, yaitu kontrol 1 yang merupakan pasien komorbid kardiovaskular tanpa COVID-19 dan kontrol 2 yang merupakan populasi orang sehat. Kelompok kontrol dipilih menggunakan metode matching. Hubungan faktor klinis dan laboratoris saat dengan kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19 dianalisis menggunakan analisis multivariat.Hasil : Terdapat 162 subjek yang menyelesaikan rangkaian penelitian yang terdiri atas 100 subjek dengan penyintas COVID-19 disertai komorbiditas kardiovaskular (kelompok kasus), 31 subjek dengan komorbiditas kardiovaskular tanpa COVID-19 (kelompok kontrol 1), dan 31 subjek sehat tanpa riwayat COVID-19 dan komorbiditas kardiovaskular (kelompok kontrol 2). Ketiga kelompok memiliki karakteristik yang sama. Terdapat perbedaan signifikan rerata nilai sST2 antara kelompok kasus dibandingkan kontrol 1 dan kontrol 2 (2786 ± 73 vs 2666 ± 162 pg/l, p <0.001 dan 2786 ± 73 vs 2517.15 ± 321 pg/l, p < 0.001), serta kontrol 1 dibandingkan kontrol 2 (2666 ± 162 pg/l vs 2517.15 ± 321 pg/l, p < 0.001). Analisis multivariat menunjukkan PaO2 (p < 0.001) dan nilai CT (p = 0.04) memiliki hubungan dengan kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19.Kesimpulan : Terdapat perbedaan signifikan antara kadar sST2 sebagai penanda fibrosis jantung pada ketiga kelompok subjek penelitian, dengan kadar sST2 lebih tinggi pada subjek dengan penyintas COVID-19 disertai komorbiditas kardiovaskular. Terdapat hubungan PaO2 dan nilai CT saat admisi dengan kadar sST2.

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Background : Recent findings showed that symptoms associated with COVID-19 infection may persist up to 90 days even after the acute disease period has passed. This condition is now termed as post COVID-19 syndrome. Several pathophysiologic mechanisms of this event had been proposed, all of which still needed further elaboration. One of the proposed mechanisms involves fibrotic processes in several organs, especially heart and the lungs. SST2 has been suggested as a novel biomarker for cardiac fibrosis. However data are still needed to further elucidate the factors which are associated with the incidence of fibrosis post COVID-19 infection. Furthermore, data regarding sST2 levels in patients with cardiovascular comorbidities and in healthy subjects are still limited.

Objective : Knowing the differences on sST2 levels between subjects with cardiovascular comorbidities 12 weeks post COVID-19 infection, those without history of COVID-19 but with cardiovascular comorbidities, and healthy population, as well as knowing its relationship with admission factors.

Methods : This study is a cross-sectional observational study on patients 3 months after COVID-19 infection presented with cardiovascular comorbidities. Age and sex-matched control groups were used as comparison. The results were compared with a group without history of COVID-19 and healthy populations. Relationship between admission factors was assessed using multivariate analysis

Results : 162 subjects completed the study series, consisting of 100 subjects with COVID-19 survivors with cardiovascular comorbidities (case group), 31 subjects with cardiovascular comorbidities without COVID-19 (control group 1), and 31 healthy subjects without a history of COVID-19 and cardiovascular comorbidities (control group 2). All three groups had similar characteristics. There was a significant difference in the mean sST2 value between the case groups compared to control 1 and control 2 (2786 ± 73 vs 2666 ± 162 pg/l, p < 0.001 and 2786 ± 73 vs 2517.15 ± 321 pg/l, p < 0.001 respectively), and control 1 compared to control 2 (2666 ± 162 pg/l vs 2517.15 ± 321 pg/l, p < 0.001). Multivariate analysis revealed PaO2 (p < 0.001 and CT values (p = 0.04) as admission factor associated with increased sST2 3 months after initial COVID-19 infection.

Conclusion : SST2 levels were found to be significantly different between the three groups, with the highest level on the case group (subjects with history of COVID-19 and cardiovascular comorbidities). Factors upon admissions which include Arterial oxygen partial pressure (PaO2) (p < 0.001) and CT value (p = 0.04) were found to be associated with increased sST2 levels."

"Latar Belakang: Studi sebelumnya telah menyebutkan bahwa kontraksi ventrikel prematur (KVP) beban tinggi dapat menjadi faktor resiko terhadap kejadian disfungsi ventrikel kanan, sebagaimana kejadian disfungsi ventrikel kiri atau kardiomiopati terkait KVP (KM-KVP) pada umumnya. Sampai saat ini masih belum terdapat penelitian khusus sebelumnya yang menganalisa antara besar persentase beban KVP idiopatik aksis inferior terhadap penurunan fungsi ventrikel kanan.Tujuan: Mengetahui hubungan antara besar persentase beban KVP idiopatik aksis inferior terhadap disfungsi ventrikel kanan menggunakan ekokardiografi speckle tracking.Metode: Studi observasional potong lintang pada 24 pasien dengan KVP idiopatik aksis inferior beban tinggi yang didiagnosis di Poliklinik Aritmia dan dilakukan pemeriksaan ekokardiografi speckle tracking (global longitudinal strain / GLS dan free wall longitudinal strain / FWLS) di Poliklinik Ekokardiografi di Rumah Sakit Jantung dan Pembuluh Darah (RSJPD) Harapan Kita sejak 1 Januari - 31 Maret 2023. Analisis statistik dilakukan untuk mengetahui hubungan antara besar persentase beban KVP terhadap disfungsi ventrikel kanan menggunakan ekokardiografi GLS dan FWLS ventrikel kanan.Hasil: Dari 24 subjek penelitian, proporsi jenis kelamin perempuan lebih tinggi dibandingkan laki-laki (17 orang berbanding 7 orang), dengan mayoritas morfologi KVP adalah blok berkas cabang kiri (BBCKi) aksis inferior sebanyak 83.3%. Rerata besar beban persentase KVP pada populasi penelitian ini adalah 18.6 ± 9.6%. Besar persentase beban KVP secara bivariat ditemukan berhubungan dengan disfungsi ventrikel kanan melalui parameter GLS ventrikel kanan (p = 0.031), namun dari analisis multivariat tidak didapatkan hubungan secara independen terhadap disfungsi ventrikel kanan (p = 0.063, OR 1.18, 95% CI 0.99 - 1,41). Besar persentase beban KVP tidak berhubungan terhadap disfungsi ventrikel kanan melalui parameter FWLS ventrikel kanan dari analisis bivariat dan multivariat.Kesimpulan: Tidak terdapat hubungan antara persentase beban KVP terhadap disfungsi ventrikel kanan pada populasi pasien KVP idiopatik aksis inferior beban tinggi di RSJPD Harapan Kita.

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Background: Previous studies have proved that high burden premature ventricular contractions (PVC) can be a risk factor for right ventricular dysfunction as similar to left ventricular dysfunction or PVC-induced cardiomyopathy (PIC) in general. There has been no previous specific study that analyzed how large percentage of idiopathic inferior axis PVC burden that could lead to right ventricular dysfunction.

Aim: To evaluate the association between idiopathic inferior axis PVC burden percentage and right ventricular dysfunction using speckle tracking echocardiography examination.

Methods: A cross-sectional observational study on 24 patients with high burden of idiopathic inferior axis PVC underwent right ventricular global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) using speckle tracking echocardiography in outpatient clinic of National Cardiovascular Center Harapan Kita (NCCHK) from January 1st - March 31st, 2023. Statistical analysis performed to find out the association between the percentage of idiopathic inferior axis PVC burden and right ventricular dysfunction using right ventricular GLS and FWLS.

Results: From the 24 study subjects, the proportion of female sex was higher than male (17 people compared to 7 people), with the majority of PVC morphology was inferior axis and left bundle branch block (LBBB) pattern as much as 83.3%. The average of the percentage of PVC burden in this study population is 18.6 ± 9.6%. The percentage of PVC burden was found to be associated bivariately with right ventricular dysfunction through the right ventricular GLS parameter (p = 0.031), but there is no independent association with right ventricular dysfunction from multivariate analysis (p = 0.063, OR 1.18, 95% CI 0.99 – 1.41). The percentage of PVC burden had no association to right ventricular dysfunction through right ventricular FWLS parameters from both bivariate and multivariate analysis.

Conclusion: There is no independent association between the percentage of PVC burden and right ventricular dysfunction in patients with high burden of idiopathic inferior axis PVC"

"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: 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."

"ABSTRAKLatar belakang: External Counter Pulsation (ECP) dapat diaplikasikan sebagai pilihan terapi pada pasien dengan angina refrakter yang tidak adekuat dikendalikan dengan terapi medis, angioplasti perkutan (IPK) ataupun bedah pintas arteri koroner (BPAK). Hasil bervariasi masih diperoleh pada perbaikan fraksi ejeksi ventrikel kiri pada pasien yang menjalani ECP. Metode 2D-Speckle Tracking Echocardiography (2D-STE) dianggap lebih unggul menilai perbaikan klinis, namun hingga kini belum ada penelitian yang mengevaluasi mekanikal ventrikel kiri dengan menggunakan 2D-STE pada pasien yang menjalani protokol standar ECP (35 sesi).Tujuan: Mengetahui perubahan mekanik ventrikel kiri sesudah dilakukan 35 protokol standar ECP dibandingkan dengan kontrol/sham pada pasien angina refrakter yang tidak ideal menjalani revaskularisasi konvensional (IPK/BPAK).Metode: Pasien dengan angina refrakter yang tidak dapat dilakukan revaskularisasi lebih lanjut secara konvensional (IPK/BPAK) dirandomisasi menjadi 2 kelompok: kelompok terapi standar ECP (300 mmHg) dan kelompok placebo/sham (75 mmHg). Terapi standar ECP diberikan selama 35 sesi, durasi 1 jam/hari/sesi, selama 5 hari/minggu, selama 7 minggu. Data 2D-STE mencakup strain longitudinal dan post systolic index (PSI) diambil sebelum dan sesudah terapi (dengan double-blind).Hasil: Terdapat 46 subjek ikut serta dalam penelitian dan tidak ada subjek yang mengalami drop-out. Tiga pasien dieksklusi karena kualitas ekokardiografi sub-optimal. Dua puluh dua subjek disertakan dalam Grup Terapi ECP dan 21 subjek dalam Grup Kontrol (sham). Karakteristik dasar strain homogen sebelum dilakukan perlakuan baik secara global (Grup Terapi 12,42±4,55 vs Grup Sham 12,00±4,92; p 0,774) maupun secara segmental/regional (Grup Terapi 12,63 (0,01-25,16) vs Grup Sham 12,43 (0,01-27,20); p 0,570). Setelah perlakuan tidak didapatkan perbedaan bermakna secara statistik antar kelompok pada parameter mekanik ventrikel kiri baik secara global (p 0,535) maupun regional (p 0,434). Parameter PSI mengalami perbaikan pada grup Terapi (p 0,049) dan segmen dengan PSI≥20% cenderung mengalami perbaikan strain longitudinal pada grup Terapi dibanding grup Sham (p 0,042).Kesimpulan: Terapi ECP sebanyak 35 sesi tidak memberikan perbaikan mekanik ventrikel kiri secara global maupun regional/segmental pada pasien angina refrakter yang tidak ideal menjalani revaskularisasi konvensional (IPK/BPAK) dibanding sham.

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ABSTRACTBackground: External Counterpulsation (ECP) can be applied as a therapeutic option in patients with debilitating refractory angina inadequately controlled by medical therapy, percutaneous angioplasty (PCI), or coronary artery bypass surgery (CABG). Varied results are still obtained in the improvement of the left ventricular ejection fraction in patients undergoing ECP. The 2D-Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement, but there has been no study evaluating mechanical parameters of the left ventricle using 2D-STE in patients undergoing the standard ECP protocol (35 sessions).Objective: To determine the effect of ECP on left ventricular mechanical parameters changes after performing 35 ECP standard protocols compared with sham (control) in patients with refractory angina who are not ideal for conventional revascularization (PCI/CABG).Methods: We conducted a double-blind randomized control trial. Patients with refractory angina who could not be further revascularized conventionally (PCI/CABG) were randomized into 2 groups: the ECP group (300 mmHg) and the Sham group (75 mmHg). ECP standard therapy was given for 35 sessions, duration of 1 hour/day/session, for 5 days/week, for 7 weeks. 2D-STE data including strain and post systolic index (PSI) were obtained before and after therapy.Results: There were 46 subjects included in the study without any drop-out. Three patients were excluded due to suboptimal echocardiographic images. Twenty-two subjects were included in the ECP group and 21 subjects into the sham group. A homogenous baseline strain was found either globally (ECP group 12.42 ± 4.55 vs Sham group 12.00±4.92; P=0.774) or segmentally/regionally (ECP group 12.63 (0.01-25.16) vs the Sham group 12.43 (0.01-27.20); P=0.570). After treatment, there was no statistically significant improvement between groups in the mechanical function of the left ventricle both globally (P=0.535) or regionally/segmentally (P=0.434). There were improvements in the PSI parameters found in the ECP group (P=0.049) and segments with PSI ≥20% tended to improve longitudinal strains in the Therapy group compared to the Sham group (p 0.042).Conclusion: 35 sessions of ECP therapy did not improve the global nor regional/segmental left ventricular mechanical parameters in patients with refractory angina who were not ideally suited for conventional revascularization (PCI/CABG) compared to Sham."

"Latar Belakang: Disfungsi saluran cerna berhubungan dengan luaran klinis yang lebih buruk pada pasien sakit kritis. Kadar albumin serum yang rendah merupakan salah satu faktor yang dapat meningkatkan risiko disfungsi saluran cerna. Hubungan kadar albumin dengan disfungsi saluran cerna masih inkonklusif karena pendekatan diagnostik disfungsi saluran cerna yang belum terstandarisasi dengan baik. Gastrointestinal dysfunction score (GIDS) instrumen dengan subjektivitas minimal dan reproduktifitas maksimal, diharapkan dapat menegakkan diagnosis disfungsi saluran cerna dengan objektivitas yang lebih baik. Penelitian ini dilakukan untuk mengetahui hubungan antara kadar albumin saat admisi dengan terjadinya disfungsi saluran cerna yang dinilai menggunakan GIDS. Metode: Penelitian ini merupakan penelitian kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di ruang rawat intensif Rumah Sakit Umum Pusat Nasional (RSUPN) dr. Cipto Mangunkusumo dan Rumah Sakit Universitas Indonesia (RSUI). Karakteristik subjek penelitian berupa usia, jenis kelamin, status gizi, penyakit komorbid, diagnosis admisi intensive care unit (ICU), waktu inisiasi pemberian nutrisi oral atau enteral, kebiasaan mengonsumsi alkohol, dan skor sequential organ failure assessment (SOFA). Dilakukan analisis bivariat untuk menilai hubungan kadar albumin saat admisi dengan disfungsi saluran cerna. Hasil: Diperoleh 64 subjek, kelompok kadar albumin rendah 32 subjek dan kelompok kadar albumin normal 32 subjek. Rerata usia subjek 50,2±15,7, laki-laki 64,1%, 26,6% subjek dengan status gizi berat badan normal berdasarkan indeks massa tubuh (IMT), 50% subjek dengan malnutrisi secara klinis,  21,9% subjek dengan diagnosis komorbid diabetes melitus dan 3,1% subjek dengan parkinson, 34,4 % subjek dengan diagnosis admisi bedah, 95,3% subjek mendapatkan nutrisi oral atau enteral ≤ 48 jam, median skor SOFA 3 (0-12). Rerata kadar albumin  subjek dengan disfungsi saluran cerna 2,7±0,6 g/dL, rerata kadar albumin  subjek tidak disfungsi saluran cerna 3,7±0,7 g/dL. 31,3% subjek mengalami disfungsi saluran cerna. Terdapat hubungan signifikan secara statistik antara kadar albumin saat admisi dengan disfungsi saluran cerna RR 9 (95%CI 2,3-35,6; p <0,001) dan skor GIDS, p<0,001. Kesimpulan: Terdapat hubungan bermakna antara kadar albumin saat admisi dengan disfungsi saluran cerna. Pemeriksaan kadar albumin saat admisi ICU idealnya dilakukan secara rutin dan diikuti dengan koreksi kadar albumin apabila ditemukan kondisi hipoalbuminemia.

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Background: Gastrointestinal dysfunction is associated with worse clinical outcomes in critically ill patients. Low serum albumin levels are one factor that can increase the risk of gastrointestinal dysfunction. The relationship between albumin levels and gastrointestinal dysfunction is still inconclusive because the diagnostic approach to gastrointestinal dysfunction is not yet well standardized. Gastrointestinal dysfunction score (GIDS) is an instrument with minimal subjectivity and maximum reproducibility, which is expected to provide a diagnosis of gastrointestinal dysfunction with better objectivity. This research was conducted to determine the relationship between albumin levels at admission and the occurrence of gastrointestinal dysfunction as assessed using GIDS. Methods: This study is a prospective cohort study of subjects aged ≥18 years who were treated in the intensive care unit at RSUPN dr. Cipto Mangunkusumo and RSUI. Characteristics of research subjects included age, gender, nutritional status, comorbid diseases, ICU admission diagnosis, time of initiation of oral or enteral nutrition, alcohol consumption habits, and SOFA score. Bivariate analysis was carried out to assess the relationship between albumin levels at admission and gastrointestinal dysfunction. Results: There were 64 subjects, 32 subjects in the low albumin level group and 32 subjects in the normal albumin level group. Mean age of subjects 50.2 ± 15.7, 64.1% male, 26.6% subjects with normal weight nutritional status based on BMI, 50% subjects with clinical malnutrition, 21.9% subjects with comorbid diagnosis of diabetes mellitus and 3.1%  subjects with Parkinson's, 34.4%  subjects with surgical admission diagnosis, 95.3% subjects received oral or enteral nutrition ≤ 48 hours, median SOFA score 3 ( 0-12). The mean albumin level of subjects with gastrointestinal dysfunction was 2.7 ± 0.6 g/dL, the mean albumin level of subjects without gastrointestinal dysfunction was 3.7 ± 0.7 g/dL. 31.3% of subjects experienced gastrointestinal dysfunction. There was a statistically significant relationship between albumin levels at admission and gastrointestinal dysfunction RR 9 (95%CI 2.3-35.6; p <0.001) and GIDS score, p<0.001. Conclusion: There is a significant relationship between albumin levels at admission and gastrointestinal dysfunction. Albumin levels examination during ICU admission should ideally be carried out routinely and followed by correction of albumin levels if hypoalbuminemia is found."

"Latar Belakang. Banyak faktor yang memengaruhi derajat berat infeksi dan mortalitas dari infeksi Corona Virus Disease 2019 (COVID-19). COVID-19 menyebabkan kerusakan sel beta pankreas, namun sampai saat ini mekanisme kerusakan ini belum banyak diketahui. Metode untuk menilai fungsi sekresi dari sel beta pankreas adalah Homeostatic Model Assessment- β (HOMA-β) dan C-peptide. Tujuan. Mengetahui hubungan antara HOMA-β dan C-peptide saat admisi dengan luaran buruk pada pasien terkonfirmasi COVID-19 yang dirawat inap. Metode. Penelitian ini merupakan studi kohort retrospektif yang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Pasien terkonfirmasi COVID-19 (derajat ringan/sedang) berusia > 18 tahun, yang dirawat inap di RSCM Kiara dalam periode waktu September 2020 – Maret 2021, dengan HbA1c <6,5% serta tanpa riwayat diabetes sebelumnya, menjalani pemeriksaan HOMA-β dan C-Peptide. Ditentukan nilai titik potong keduanya untuk kemudian dilihat hubungannya dengan luaran buruk selama perawatan tersebut. Hasil. Dari 232 subyek yang memenuhi kriteria, terdapat 10(4,3%) subyek dengan luaran buruk. Median HOMA-β pada luaran buruk adalah 70,28% (RIK 32,25 – 132,11), sementara itu pada luaran baik adalah 121,6% (RIK 82,39 – 174,23). Median C-peptide pada luaran buruk dan baik berturut-turut adalah 2059 (RIK 1508 – 2762) dan 1647 (RIK 1107 – 2461). Nilai titik potong HOMA-β 80%, dengan AUC 0,702 (IK 95% 0,526-0,879) menunjukkan sensitifitas 60% dan spesifisitas 71,4%. Nilai Hazard Ratio (HR) dari HOMA-β <80 adalah 4,660 (p=0,017). Nilai titik potong C-peptide tidak dapat ditentukan karena AUC 0,555. Kesimpulan. Terdapat hubungan antara nilai HOMA-β saat admisi dengan luaran buruk selama perawatan pada pasien terkonfirmasi COVID-19, namun hubungan C-Peptide tidak didapatkan kemaknaannya dengan luaran buruk selama perawatan. Kata Kunci. COVID-19, C-Peptide, HOMA-β, Luaran buruk.

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Background. Many factors affect the severity of infection and mortality of Corona Virus Disease 2019 (COVID-19) infection. COVID-19 virus linked to pancreatic beta cells damage, yet the mechanism is still unclear. A method to assess the secretory function of pancreatic beta cells is based on Homeostatic Model Assessment- (HOMA-β) and C-peptide. Aim. Determine the relationship between HOMA-β and C-peptide values during admission in hospitalized confirmed COVID-19 patients with poor outcomes. Method. This is a retrospective cohort study conducted at Cipto Mangunkusumo Hospital (RSCM). Patients with confirmed COVID-19 (mild/moderate) who were hospitalized at the RSCM Kiara Hospital during the period September 2020 – March 2021, with HbA1c <6.5%, and without history of diabetes underwent HOMA-β and C-Peptide examination. The cut-off point for both was evaluated, furthermore the relationship with poor outcomes during hospitalization was assessed. Result. From 232 subjects met the inclusion and exclusion criteria, there were 10 (4.3%) subjects with poor outcomes. Median of HOMA-β in poor outcome group was 70.28% (IQR 32.25 – 132.11) while in good outcome group was 121.6% (IQR 82.39 – 174.23). The median of C-peptide on poor and good outcome were 2059 (IQR 1508 – 2762) vs. 1647 (IQR 1107 – 2461), respectively. The HOMA-β cut- off point was 80% showed AUC 0.702 (95% CI 0.526-0.879), with sensitivity 60% and specificity 71.4%. The Hazard Ratio (HR) of HOMA-β value <80% was 4.660 (p=0.017). The C-peptide cut-off point could not be determined because the AUC was 0.555. Conclusion. There is a significant relationship between the HOMA-β during admission and the poor outcome of hospitalized patients with confirmed COVID- 19 yet there is no significant relationship between C-Peptide and poor outcome."

"Latar Belakang: Telah diketahui infeksi COVID-19 dapat menetap menjadi sindroma pasca COVID-19. Magnetic Resonance Imaging (MRI) kardiak memiliki nilai diagnostik tinggi untuk menilai karakteristik jaringan miokard. Belum diketahui secara pasti efek jangka panjang COVID-19 terhadap jaringan miokardium serta faktor-faktor admisi yang memiliki pengaruh terhadap prevalensi sindroma pasca-COVID-19 pada populasi dengan penyakit kardiovaskular. Tujuan: Mengevaluasi prevalensi fibrosis miokardium dengan MRI kardiak pada pasien dengan penyakit kardiovaskular dan riwayat COVID-19 1 tahun pascaperawatan, serta mengidentifikasi faktor admisi yang berpengaruh terhadap fibrosis miokardium. Metode: Kohort prospektif dengan menilai parameter MRI kardiak pada pasien terkonfirmasi COVID-19 dengan penyakit kardiovaskular 1 tahun pascaperawatan. Selanjutnya, dilakukan analisa temuan MRI kardiak terhadap kelompok kontrol tanpa riwayat COVID-19 yang telah di-matching berdasarkan umur, jenis kelamin, dan faktor resiko. Analisa multivariat dilakukan untuk mengetahui faktor admisi yang memiliki hubungan dengan kejadian fibrosis miokardium. Hasil: Total 32 subjek dengan penyakit KV dan riwayat COVID-19 1 tahun pascaperawatan dengan 49 subjek kontrol disertakan dalam studi ini. Terdapat peningkatan yang signifikan pada parameter MRI kardiak yaitu proporsi abnormal T1 relaxation time (65,5% vs 36,7%; p-value=0,011) serta late gadolinum enhancement (LGE) skar noniskemik 62,5% vs 29,8%;p-value=<0,001) pada kelompok dengan riwayat COVID-19 dibanding kontrol. Tidak ditemukan faktor admisi yang berpengaruh terhadap peningkatan LGE noniskemik/T1 abnormal. Kesimpulan: Terdapat peningkatan prevalensi fibrosis miokardium pada pasien dengan penyakit KV dan riwayat COVID-19 1 tahun pascaperawatan dibanding kontrol dinilai melalui MRI kardiak. Tidak terdapat hubungan antara faktor admisi dengan fibrosis miokardium 1 tahun pascaperawatan COVID-19.

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Background: Presently, it has been acknowledged that COVID-19 infection may persist longer as Post-acute COVID-19 Syndrome. Cardiac Magnetic Resonance Imaging (cMRI) possesses a high diagnostic value to evaluate myocardial tissue characteristics. Data are still limited regarding longer implications of COVID-19 infection towards myocardial tissues and predictive admission factors in patients with Cardiovascular Diseases (CVD).

Aim(s): To evaluate the prevalences of myocardial fibrosis using cMRI in patients with CVD and one year post-COVID-19 hospitalization and identifying admission factors in correlation with myocardial fibrosis. 

Method(s): Prospective cohort to assess cMRI parameters in patients with CVD and history of COVID-19 one year post-hospitalization. The results were then compared with the age-, sex-, risk factors-matched control group without prior of COVID-19 infection. Lastly, multivariat analysis was done to identify relations between admission factors and myocardial fibrosis. 

Result(s): A total of 32 subjects with CVD one year post-COVID-19 hospitalization and 49 controls were included in this study. Significant increases of cMRI parameters, namely abnormal T1 relaxation time (65.5% vs 36.7%; p-value=0.011) and non-ischemic late gadolinum enhancement (LGE) (62.5% vs 29.8%;p-value=<0.001) were observed in the population with prior COVID-19 infection compared to control. No admission factors were found to be related with the increases in nonischemic LGE/abnormal T1.

Conclusion: There is a significant increase of myocardial fibrosis prevalence in patients with CVD one year post-COVID-19 hospitalization compared to control assessed through cMRI parameters. No relationships were found between admission factors and myocardial fibrosis. "

"Latar belakang Kardiotoksisitas subklinis merupakan kondisi yang sering terjadi pada anak dengan keganasan yang mendapat kemoterapi, tetapi belum dapat terdeteksi menggunakan pemeriksaan ekokardiografi konvensional. Pemeriksaan global longitudinal strain menggunakan ekokardiografi speckle tracking dilaporkan dapat mendeteksi disfungsi ventrikel kiri lebih awal dibandingkan ekokardiografi konvensional. Namun, belum banyak penelitian terkait pemeriksaan kuantitatif fungsi jantung dengan ekokardiografi speckle tracking pada anak dengan keganasan. Studi ini diharapkan dapat membantu deteksi dini gangguan fungsi jantung. Metode Penelitian ini merupakan studi potong lintang di RSUPN dr. Cipto Mangunkusumo Jakarta terhadap 49 subyek anak berusia 6 bulan sampai 17 tahun 10 bulan pada September-November 2022. Subyek penelitian adalah anak yang baru terdiagnosis keganasan, tidak memiliki masalah jantung sebelumnya, dan mendapatkan kemoterapi kemudian dievaluasi pemeriksaan kuantitatif fungsi jantung dengan pemeriksaan kuantitatif ekokardiografi (konvensional, Doppler jaringan, speckle tracking) sebelum dan sesudah mendapat kemoterapi 3 bulan. Pasien yang mengalami reduksi relatif GLS >15% dilakukan pemeriksaan lanjutan berupa biomarker jantung troponin I. Hasil ekokardiografi speckle tracking dapat dipertimbangkan untuk deteksi disfungsi sistolik ventrikel kiri lebih dini dengan sensitivitas 100% (IK 95% 82,35-100) dan spesifisitas 60% (IK 95% 40,60-77,34). Subyek yang mengalami kardiotoksisitas subklinis didapatkan sebanyak 63,3% ditandai dengan reduksi relatif GLS>15% setelah kemoterapi 3 bulan. Didapatkan penurunan bermakna nilai LPSS ventrikel kiri segmen mid dan segmen apikal serta GLS dari median -18,4 (RIK -17,3 sd. -19,6) % sebelum kemoterapi menjadi -15,3 (RIK -13,65 sd. -17,85) % (p<0,0001) sesudah kemoterapi 3 bulan dengan median dosis kumulatif antrasiklin 150 (RIK 120-300) mg/m2. Reduksi relatif GLS>15% ini ditemukan di saat yang bersamaan belum ditemukan penurunan EF/FS sampai di bawah batas normal. Tidak terbukti usia, jenis kelamin, status nutrisi, dan regimen kemoterapi memengaruhi kardiotoksisitas subklinis pada pasien anak dengan keganasan yang mendapat kemoterapi selama 3 bulan pada penelitian ini. Kesimpulan Pemeriksaan ekokardiografi speckle tracking dapat dipertimbangkan untuk dilakukan dalam mendeteksi kardiotoksisitas subklinis. Pemeriksaan ini memiliki sensitivitas 100% (IK 95% 82,35-100) dan spesifisitas 60% (IK 95% 40,60-77,34).

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Background Subclinical cardiotoxicity is a condition that often occurs in children with malignancy who receive chemotherapy, but it has not been frequently detected using conventional echocardiography. Global longitudinal strain examination using speckle tracking echocardiography is reported to be able to identify left ventricular dysfunction earlier than conventional echocardiography. However, there are not many studies related to quantitative examination of cardiac function by speckle tracking echocardiography in children with malignancy. This study is expected to help early detection of impaired heart function. Methods This research is a cross sectional study at RSUPN dr. Cipto Mangunkusumo Jakarta on 49 child subjects aged 6 months to 17 years 10 months in September-November 2022. The research subjects were children who had just been diagnosed with malignancy, had no previous heart problems, and received chemotherapy. Then they were evaluated by quantitative echocardiography (conventional, tissue Doppler, speckle tracking) before and after 3 months of chemotherapy. Patients who experienced a relative reduction of GLS > 15% underwent further examination of troponin I.Results Speckle tracking echocardiography can be considered for early detection of left ventricular systolic dysfunction with 100% sensitivity (95% CI 82.35-100) and 60% specificity (95% CI 40.60-77.34). Children with subclinical cardiotoxicity were found to be 63.3% characterized by a relative reduction in GLS>15% after 3 months of chemotherapy, with a significant decrease in mid and apical segment left ventricular LPSS values and GLS from a median -18.4 (IQR -17.3 sd. -19.6) % before chemotherapy to -15.3 (IQR -13.65 sd. -17.85) % (p<0.0001) after 3 months of chemotherapy with a median cumulative dose of anthracycline 150 (IQR 120-300) mg/m2. This relative reduction of GLS> 15% was found at the same time that there was no decrease in EF/FS below normal limits. There was no evidence that age, gender, nutritional status, and chemotherapy regimen had an effect on subclinical cardiotoxicity in pediatric patients with malignancy who received chemotherapy for 3 months in this study. Conclusion Speckle tracking echocardiography can be considered for detecting subclinical cardiotoxicity. This examination has a sensitivity of 100% (95% CI 82.35-100) and a specificity of 60% (95% CI 40.60-77.34)."