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"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."

"Introduksi: Belum banyak studi yang meneliti parameter laboratorium sederhana sebagai prediktor trombus di atrium kiri pada subset stenosis mitral rematik. Selain itu, saat ini masih sangat sedikit studi yang menjelaskan patomekanisme trombus atrium kiri yang berkaitan dengan komponen hemorheologi pada pasien dengan mitral stenosis rematik. Tujuan: menilai hubungan parameter hemorheologi dari laboratorium sederhana Red Cell Distribution Width, Mean Platelet Volume, hematokrit, dan jumlah trombosit dengan kejadian trombus atrium kiri pada stenosis mitral rematik. Metode: Dilakukan studi potong lintang analitik LAMIA Study dengan pengumpulan data terhadap pasien stenosis rematik yang signifikan dimulai dari tanggal 1 Januari 2018 hingga 31 Juli 2021. Evaluasi trombus ditegakkan dari ekokardiografi transtorasik atau transesofagus. Pemeriksaan lab diperiksa dalam waktu 10 hari sebelum evaluasi ekokardiografi. Subjek dengan regurgitasi mitral yang signifikan akan dieksklusi. Hasil: Dari 318 subjek dengan stenosis mitral rematik signifikan yang diikutsertakan dalam penelitian, didapatkan sebanyak 102 pasien (32%) memiliki trombus di atrium kiri. Dari seluruh pasien, diketahui subjek dengan ritme atrial fibrilasi sebanyak 63.8% dan ritme sinus 36.2%. Hematokrit ≥ 45.15 % (OR 2.98; IK 95% 1.27 - 6.98, p = 0.012), Irama atrial fibrilasi (OR 2.39; IK 95% 1.10-5.20, p = 0.028), fraksi ejeksi ventrikel kiri ≥ 56.68 % (OR 0.42; IK 95% 0.23 - 0.77, p = 0.005), dan TAPSE ≥ 18.10 mm (OR 0.44; IK 95% 0.230 - 0.83, p = 0.011) berhubungan secara signifikan dengan kejadian trombus atrium kiri dari hasil analisis multivariat. Kesimpulan: Peningkatan hematokrit berhubungan secara signifikan dengan kejadian trombus atrium kiri, sedangkan nilai RDW dan jumlah platelet tidak berhubungan dengan kejadian trombus di atrium kiri pada stenosis mitral rematik. Kata kunci: LAMIA study, hematologi sederhana, trombus atrium kiri, stenosis mitral rematik

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Introduction: Only few studies have investigated simple laboratory parameters as predictors of left atrial thrombus in subset of rheumatic mitral stenosis. In addition, there are currently very few studies describing the pathomechanism of left atrial thrombus related to the hemorheological component in patients with rheumatic mitral stenosis. Objective: A study was conducted to assess the causal relationship of hemorheological parameters from a simple laboratory Red Cell Distribution Width (RDW), Mean Platelet Volume (MPV), hematocrit, and platelet count with the incidence of left atrial thrombus in rheumatic mitral stenosis. Methods: A cross-sectional analytical, LAMIA Study, was conducted with data collection on patients with significant rheumatic stenosis starting from 1 January 2018 to 31 July 2021. Thrombus evaluation was established by transthoracic or transesophageal echocardiography. Lab tests were performed within 10 days prior to the echocardiographic evaluation. Subjects with significant mitral regurgitation will be excluded. Results: Of the 318 subjects with significant rheumatic mitral stenosis included in the study, 102 patients (32%) had a thrombus in the left atrium. Of all the patients, it was known that subjects with atrial fibrillation rhythm as much as 63.8% and sinus rhythm 36.2%. Atrial fibrillation rhythm (OR 2.39; 95% CI 1.10-5.20, p = 0.028), left ventricular ejection fraction ≥56.68 % (OR 0.42; 95% CI 0.23 - 0.77, p = 0.005), TAPSE ≥18.10 mm (OR 0.44; 95% CI 0.230 - 0.83, p = 0.011), and hematocrit ≥45.15% (OR 2.98; 95% CI 1.27 - 6.98, p = 0.012). Conclusion: Increased hematocrit was significantly associated with the incidence of left atrial thrombus, whereas RDW and platelet count were not associated with the incidence of left atrial thrombus in rheumatic mitral stenosis. "

"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."

"[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)]"

"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. Pada stenosis mitral sering timbul komplikasi hipertensi pulmoner dan disfungsi ventikel kanan. Belum ada penelitian yang menghubungkan antara resistensi vaskular paru sebelum operasi dengan fungsi jantung kanan saat pasca operasi serta perubahannya pasca operasi stenosis mitral rematik.Metode. Studi ini merupakan studi kohort prospektif pada 31 pasien stenosis mitral rematik yang menjalani operasi katup mitral di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita sejak April 2014 sampai Maret 2015. Pasien menjalani pemeriksaan ekokardiografi sebelum operasi, sebelum pulang perawatan pasca operasi serta saat follow up mid term di poliklinik. Dilakukan analisa statistik untuk melihat hubungan antara resistensi vaskular paru (RVP) pra operasi dengan strain longitudinal ventrikel kanan saat follow up mid term serta perubahan strain longitudinal ventrikel kanan pasca operasi (delta strain).Hasil. Tidak terdapat korelasi antara RVP pra operasi dengan strain longitudinal speckle tracking ventrikel kanan saat follow up mid term pasca operasi (r 0,199 p 0,264) serta dengan perubahan strain longitudinal ventrikel kanan pasca operasi atau delta strain (r 0,174 p 0,350).Kesimpulan. Resistensi vaskular paru pra operasi tidak berhubungan dengan strain longitudinal speckle tracking ventrikel kanan saat follow up mid term pasca operasi serta dengan perubahan strain longitudinal ventrikel kanan pasca operasi atau delta strain.

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ABSTRACTBackground. In MS right ventikel (RV) dysfunction and pulmonary hypertension often occur as complication. There is no research that connects the pulmonary vascular resistance before surgery with RV function and its changes in the case of rheumatic mitral stenosis who underwent mitral valve surgery.Methods. This study is a prospective cohort study which involves 31 patients with rheumatic mitral stenosis who underwent surgery at National Cardiovaskular Center Harapan Kita Hospital from April 2014 to March 2015. Patients underwent echocardiography before surgery, after surgery pre-hospital discharge and mid-term follow-up at clinic. Statistical analysis was performed to see the relationship between preoperative pulmonary vascular resistance (PVR) with RV function at mid term follow up, which is assessed using echocardiographic parameters right ventricular longitudinal speckle strain, and also with right ventricle longitudinal speckle strain postoperative changes (delta strain).Results. There is no correlation between pre operative PVR with RV longitudinal speckle strain at mid term follow-up (r 0,199 p 0,264), and post operative changes or delta strain (r 0.174 p 0.350).Conclusion. RVP before surgery is not associated with right ventricle longitudinal speckle strain at follow up mid term and post operative changes or delta strain., Background. Acute rheumatic fever and rheumatic heart disease is still regarded as animportant public health problem especially in developing countries. Mitral stenosis (MS) is asequale of rheumatic fever which are most commonly found. In MS right ventikel (RV)dysfunction and pulmonary hypertension often occur as complication. The right ventricle hasa smaller muscle mass so it is more sensitive to changes in pressure loads. There is noresearch that connects the pulmonary vaskular resistance before surgery with RV functionand also changes in the case of rheumatic mitral stenosis who underwent mitral valvesurgery.Methods. This study is a prospective cohort study which involves 31 patients with rheumaticmitral stenosis who underwent surgery at National Cardiovaskular Center Harapan Kita Hospital from April 2014 to March 2015. Patients underwent echocardiography before surgery, after surgery pre-hospital discharge and mid-term follow-up at clinic. Statisticalanalysis was performed to see changes in RV function with longitudinal speckle strain, aftersurgery pre-hospital discharge and mid-term follow-up at clinic. Analysis also performed tosee the relationship between preoperative pulmonary vascular resistance (PVR) with RVfunction at mid term follow up, which is assessed using echocardiographic parameters rightventricular longitudinal speckle strain, and also with right ventricle longitudinal specklestrain postoperative changes (delta strain). Results. Right ventricular function after surgery seen with longitudinal speckle strainimproved from -12.94 ± 3.63 preoperatively into -13.06 ± 3.63 after surgery pre hospitaldischarge, and -15.25 ± 3.75 at follow-up evaluation (p 0.007). There is no correlationbetween pre operative PVR with longitudinal speckle strain at mid term follow-up (r 0,199 p0,264), and RV longitudinal speckle strain post operative changes or delta strain (r 0.174 p0.350). Conclusion. After mitral valve surgery, right ventricle longitudinal speckle strain improves.RVP before surgery is not associated with right ventricle longitudinal speckle strain at follow up mid term and right ventricle longitudinal speckle strain post operative changes or deltastrain. ]"

"Latar belakang: Stenosis mitral SM akibat penyakit jantung reumatik PJR memiliki disfungsi sistolik ventrikel kiri VK secara subklinis bila menggunakan parameter global longitudinal strain GLS walaupun rata-rata pasien memiliki fraksi ejeksi FE baik. Pada PJR, inflamasi kronis menyebabkan terjadinya nekrosis fibrinoid, pada akhirnya menjadi fibrosis miokard. Berdasarkan teori ini, fibrosis miokard merupakan salah satu dasar teori yang mendasari disfungsi sistolik VK pada SM. Namun hingga kini penelitian yang menilai hubungan ini belum ditemukan.Tujuan: Mengetahui hubungan GLS sebagai parameter fungsi sistolik dengan volume fibrosis VK pada SM akibat PJR.Metode: Studi potong lintang melibatkan pasien SM akibat PJR akan menjalani pemeriksaan MRI jantung untuk mengevaluasi fibrosis miokard dengan metode LGE dan ekokardiografi untuk menilai GLS. Kedua data diolah menggunakan analisa korelasi.Hasil: Terdapat 36 pasien subjek penelitian. Volume fibrosis miokard rata-rata VK 4,9 2,7 . Walaupun FE baik median 62 , nilai GLS menurun dibandingkan nilai rujukan normal 13,5 3,9 . GLS memiliki korelasi sedang dengan volume fibrosis VK r = -0,432; p 0,009 . Tidak ada korelasi antara GLS dengan area katup mitral maupun gradien tekanan transmitral rata-rata. Tidak didapatkan juga korelasi antara FE dengan volume fibrosis.Kesimpulan: GLS memiliki korelasi sedang dengan volume fibrosis VK pada pasien SM akibat PJR.

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Abstract Background. The correlation between the extent of myocardial fibrosis and subclinical LV systolic dysfunction in rheumatic mitral stenosis MS has not been widely studied. We sought to evaluate the correlation between the extent of LV myocardial fibrosis quantified by Late Gadolinium Enhancement LGE CMR and Global Longitudinal Strain GLS by Speckle Tracking Echocardiography STE in these patients.Methods. We prospectively evaluated 36 consecutive rheumatic MS patients who were planing to undergo intervention in our center. Then we evaluate the correlation between the extent of LV myocardial fibrosis quantified by Late Gadolinium Enhancement LGE CMR and Global Longitudinal Strain GLS by Speckle Tracking Echocardiography STE Results. Thirty six patients showed mean of LGE was 4,9 2,7 . Despite good ejection fraction median 59.5 , IQR 28 68 , the LV GLS was reduced mean 13.5 3.9 compared to normal reference value. There was moderate correlation between GLS and LGE r 0,432 p 0,009 . There are no correlations between GLS with mitral valve area MVA and mean mitral valve gradient mean MVG . No significant correlation was found between ejection fraction and LGE.Conclusion. There was moderate correlation between LGE and GLS in patients with rheumatic MS. Keywords Myocardial fibrosis global longitudinal strain late gadolinium enhancement CMR rheumatic mitral stenosis "