sux016.pdf - Oxford Academic

Abstracts of the 26th Annual Scientific Meeting of Indonesian

Heart Association 2017 (26th ASMIHA),

Jakarta, Indonesia, April 20–23, 2017

Oral iron therapy improves functional capacity of heart failure patients with irondeficiency anaemia

L.D. Suryani, S.B. Raharjo, R. Sagita, H. Angkasa, F.D. Suyatna, N. Hersunarti,R. Soerarso, and B.B. SiswantoFaculty of Medicine, Department of Cardiology and Vascular Medicine,National Cardiovascular Center Harapan Kita Hospital, University of Indonesia,Indonesia

Background: Anaemia is a common morbidity in heart failure patients. Intravenousiron therapy is known to improve patient’s condition. However, it is expensive and in-vasive. This study investigated the effectiveness and safety of oral iron therapy inimproving ferritin, transferrin saturation (Tsat), haemoglobin (Hb), and functional ca-pacity in systolic heart failure patients with iron-deficiency anaemia (IDA).Methods: Double blind randomized controlled trial was conducted in National CardiacCentre, Jakarta. Fifty four subjects (age 18–75 years) suffering from heart failure (ejec-tion fraction< 50%) and IDA with eGFR> 30ml/min/1.73m2 were enrolled and random-ized to either placebo(n¼ 27) or oral Ferrous Sulphate (FS;n¼ 27) for 12weeks.Primary outcome was functional capacity measured by 6-minute walk test distance(6MWT). Ferritin, transferrin saturation (Tsat), haemoglobin (Hb), NT-proBNP, ejectionfraction (EF), global longitudinal strain (GLS), and side effects were documented.Results: Forty one subjects (placebo n¼ 19;FS n¼ 22) completed the study, 3 died and 9dropped out. We measured the change in variable levels (D) against baseline and acrossgroups. Over 12weeks, against baseline: DHb: �0.026360.743g/dl (placebo;P¼ 0.879)and 1.059161.432g/dL (FS; P¼ 0.002); DFerritin: �11.64652.42ng/mL (placebo;P¼ 0.346) and 102.78674.93ng/mL (FS; P¼ 0.000); DTsat: 2.99611.99% (placebo;P¼ 0.575) and 14.1369.66% (FS; P¼ 0.000); D6MWT: �16.84640.05m (placebo;P¼ 0.083) and 46.23635.93 m (FS; P¼ 0.000). Between groups: DHb: 1.08560.365(P¼ 0.005); DFerritin: 114.42620.52ng/mL (P¼ 0.000); DTsat: 11.1463.38%(P¼ 0.002); D6MWT: 63.07611.87 m (P¼ 0.000). Little change was seen in NT-proBNP,EF, and GLS. Adverse effects (2 vs. 1, placebo vs. FS; P¼ 0.588) and gastrointestinal sideeffects were experienced by both groups (9 vs. 6, placebo vs. FS; P¼ 0.211).Conclusion: Oral FS therapy for 12weeks increased ferritin, Tsat, and Hb levels.Importantly, treatment with oral FS improved the functional capacity of HF patientswith acceptable minimal side effects. Oral FS might be a cheaper alternative to in-travenous iron for low-to-middle income countries.Keywords: Oral ferrous sulphate • Heart Failure • Iron-deficiency anaemia •Functional capacity

The effect of resistance training on pro-protein convertase subtilisin kexin-9level in post-coronary artery bypass graft surgery patients who undergo Phase IIcardiac rehabilitation

B. Dwiputra, A. Santoso, O. Lilyasari, B. Setianto, B. Radi, and A. AmbariFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita Hospital, University of Indonesia, Jakarta,Indonesia

Background: Pro-protein Convertase Subtilisin Kexin 9 (PCSK-9) is a protein that playsa role in the process of degradation of low density lipoprotein (LDL) receptor so that itsdrop can lower LDL levels and cardiovascular risk. As part of secondary prevention, re-sistance training is recommended in patients after coronary artery bypass surgery(CABG) as a complement to aerobic exercise component. The safety and benefits inmuscle strength and endurance have been demonstrated. Nevertheless, there are nostudies that examined the effects of resistance training on PCSK-9 levels.Objective: To determine the effects of additional resistance training on PCSK-9 lev-els and lipid profile in post-coronary artery bypass graft surgery patients who un-dergo phase II cardiac rehabilitation.Methods: A single-blinded randomized clinical trial was performed to 87 post-CABGpatients, divided into 2 groups. The control group (n¼ 43) consisted of patients whoreceived standard Phase II cardiac rehabilitation program. In the another group, theintervention group (n¼ 44) consisted of patients who receive standard Phase II car-diac rehabilitation program with an addition of supervised resistance training. Thisincrimental training consisted of 3 phase during the program. PCSK-9 level and lipidprofile examination were performed in every patients pre- and post-training.Results: After completion of Phase II cardiac rehabilitation, mean PCSK9 levels in in-tervention group decrease significantly compared to control group (control vs. inter-vention, 377.1 (SD 125) vs. 316.6 (111.1) ng/mL, b¼�60.5 ng/mL, 95% CI� 7.5

to� 113.4), P¼ 0.026). Nonetheless, there are still no significant changes in terms ofLDL level (P¼ 0.07), total cholesterol (P¼ 0.99), high density lipoprotein (P¼ 0.44)and triglyseride levels (P¼ 0.56) pre- and post-intervention between two groups.Conclusion: The additional resistance training can reduce significantly PCSK-9 levels in pa-tients after coronary artery bypass surgery who underwent phase II cardiac rehabilitation.Keywords: Coronary artery bypass surgery • Resistance training • PCSK-9

Drug utilization evaluation of antithrombotic agents in ischaemic stroke withatrial fibrillation based on ATRIA score

I.P. Dewi1, K.P. Dewi1, and R.T. Pinzon1,21Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia,2Bethesda Hospital, Yogyakarta, Indonesia

Background: Antithrombotic therapy is recommended in atrial fibrillation (AF) man-agement due to high risk of stroke. However, antithrombotic therapy is often underu-tilized. The assessment of stroke risk as well as bleeding risk can help clinicians tomake optimal management decisions. The aims of this study were to assess thestroke and bleeding risk using ATRIA score, also to compare the utilization pattern ofantiplatelet and anticoagulant therapy in post ischaemic stroke patients with AFcomorbidity.Methods: This study is single centre, retrospective, and observational study. We col-lected patient’s data with diagnosis of ischaemic stroke from June 2009 to May 2016.The presence of AF event, anticoagulant, and antiplatelet prescription on dischargewas recorded. ATRIA Stroke Risk score and ATRIA Bleeding Risk score were used to as-sess risk of stroke among post ischaemic stroke patients with AF comorbidity.Results: We enrolled 107 post ischaemic stroke patients with AF comorbidity (meanage 68 years; 46.7% female). Seventy four patients were first stroke patients and 33were recurrent stroke patients. Total 14 (13.1%) patients were not prescribed anyantithrombotic drugs. Antiplatelet was predominantly prescribed (n¼ 65, 60.7%) amongischaemic stroke patients with AF comorbidity. Out of 65 patients prescribed with anti-platelet, 34 (31.8%) patients had high ATRIA Stroke Risk score while as per ATRIABleeding Risk score, 42 (39.3%) patients had low score. Conversely, anticoagulant wasrarely prescribed. Total only 28 (26.1%) patients prescribed with anticoagulant,whether it is a single or combination prescription. Out of 28 patients, anticoagulantcommonly prescribed in high ATRIA Stroke Risk score patients (n¼ 11, 10.3%; n¼ 14,13%). While as per ATRIA Bleeding Stroke score, anticoagulant commonly prescribedamong low bleeding risk patients (n¼ 22, 20.5%).Conclusion: Oral antiplatelet drugs are the most commonly prescribed antithrom-botic drugs in post ischaemic stroke patients with AF comorbidity. However, the useof oral anticoagulation in still limited. ATRIA Stroke Risk score and ATRIA BleedingRisk score are easy simple schemes to assess stroke risk and helps the physicians andpatients to choose most suitable antithrombotic therapy.Keywords: Atrial fibrillation • Stroke • Antiplatelet • Anticoagulant • ATRIA score

Factors affecting autologous bone marrowmononuclear cell number inischaemic heart disease patients who underwent stem cell therapy

C. Primasari, R. Sukmawan, E. Listyaningsih, M. Silalahi, and A.S. KuncoroFaculty of Medicine, Department of Cardiology and Vascular Medicine, Harapan KitaNational Cardiovascular Center, Universitas Indonesia, Jakarta, Indonesia

Background: Many studies in stem cell therapy for myocardial regeneration haveshown mixed results on their successful outcomes. Number of bone marrow mononu-clear cell (BMMC) was one of determinant factor of the successful results for bonemarrow source of cell therapy. Left ventricle (LV) systolic function has becoming oneof determinant factor in selection of stem cell patient. The influence of decreasedLV systolic function or other cardiac risk factors to the numbers BMMC from bonemarrow aspirates were not clearly defined.Aim: Evaluating correlation of LV systolic function and other risk factors of coronaryheart disease to the number BMMC in ischaemic heart disease patients who under-went stem cell therapyMethods: Subjects were patients with coronary heart disease who have left ventricu-lar ejection fraction (EF) <35%. Subjects were selected consecutively among pa-tients who already scheduled for stem cell therapy. About 180 cc bone marrow aspi-rate was obtained from each patient for the therapy. After separation and

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European Heart Journal Supplements (2017) 19 (Supplement E), E17–E17The Heart of the Matterdoi:10.1093/eurheartj/sux016

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purification, samples of BMMC were analysed using Flowcytometer FACS-ARIA to getthe number of BMMC.Results: There were 20 patients recruited on this study that undergo stem cell ther-apy due to ischaemic heart diseases. Factors that being analysed were LV systolicfunction and risk factors of coronary heart disease including hypertension, diabetesmellitus, and history of cigarette smoke. There were significant correlation of BMMCcounts on each cc of bone marrow aspirates, with LV systolic function, body mass in-dex, and hypertension (P< 0.05 each).Conclusion: Body mass index, hypertension, and LV systolic function may affect thenumber of bone marrow mononuclear cells that will be used for stem cell therapy.These factors should be considered to obtain optimal cell counts for cell therapy.Keywords: Endothelial progenitor cell • Bone marrow mononuclear stem cell • Leftventricle systolic function

Shock index as a clinical independent predictor of in-hospital major adversecardiac events in non-STelevation myocardial infarction patients presentingwith heart failure

A. Handayani, K. Kaban, M. Nasri, Z. Mukhtar, and A.A. SiregarFaculty of Medicine, Departement of Cardiology and Vascular Medicine, Haji AdamMalik General Hospital, University of Sumatera Utara, Medan, Indonesia

Background: Identification of non-ST elevation myocardial infarction (NSTEMI) pa-tients at higher risk of in-hospital complications is very important as it will gives cru-cial information for determining treatment strategy. One of the simple and emergingpredictor for short term prognosis in acute coronary syndrome is shock index (SI)which is the ratio of heart rate over systolic blood pressure on admission. Only a fewstudies had conducted to evaluate the usefulness of SI in NSTEMI patients, especiallythose presenting with heart failure. The aim of this study was to evaluate the SI com-pared with other routine clinical and laboratory examination as a predictor of in-hospital major adverse cardiac events (MACEs) in NSTEMI patients presenting withheart failure.Methods: We collected the data of NSTEMI patients presenting with heart failure ad-mitted to Haji Adam Malik General Hospital in Medan from January 2014 until July2015. SI was calculated as the ratio of heart rate over systolic blood pressure on pre-sentation. Patients presenting with cardiogenic shock were excluded.Result: There were 55 patients eligible to this study. In-hospital MACEs were found in24 patients (44%) compared with 31 (56%) without in-hospital MACEs. Patients within-hospital MACEs were older (60.66 10.8 vs. 57.26 7.9, P¼ 0.178), had less historyof dyslipidaemia [8 (33%) vs. 19 (61%), P¼ 0.032], faster heart rate (111.46 35.8 vs.96.56 24.3, P¼ 0.032], higher GRACE score [139 (98–187) vs. 120 (91–148);P¼ 0.001], and higher SI [0.83 (0.57–1.5) vs. 0.67 (0.38–1.27), P¼ 0.013). SI> 0.8was the only independent predictor of MACEs in NSTEMI patients presenting withheart failure (OR¼ 4.3, CI¼ 1.247–14.328, P¼ 0.048). SI also had strong correlationswith GRACE score (r: 0.546, P<0.0001).Conclusion: Beyond other routine examination, SI was the only independent predic-tor of in-hospital MACEs in NSTEMI patients presenting with heart failure.Keywords: NSTEMI • Shock index • In-hospital MACEs

Allogeneic mesenchymal stem cells ameliorate atherosclerosis in rats

U. Bahrudin1,2, F. Taufik2, A.A. Abbasie2, B. Surastri3, A.A. Prasetyo4, and Y. Herry11Department of Cardiology and Vascular Medicine, Faculty of Medicine, DiponegoroUniversity, Semarang, Indonesia, 2Post Graduate School Master of BiomedicalScience, Faculty of Medicine, Diponegoro University, Semarang, Indonesia,3Department of Pharmacotherapy, Faculty of Medicine, Diponegoro University,Semarang, Indonesia, 4Department of Anatomy, Faculty of Medicine, DiponegoroUniversity, Semarang, Indonesia

Background: Atherosclerosis is the leading cause of morbidity and mortality in theworld. Mesenchymal stem cells (MSCs) are implicated in a variety of physiologicaland pathological processes. They may able to ameliorate atherosclerosis by interfer-ing IL-1a, IL-6, and TGF-b1 expression. However, the effect of MSCs on their expres-sion in atherosclerotic vessel wall has never been reported.Objective: To investigate the effect of intravenous administration of allogeneic MSCson atherosclerotic vessel wall.Method: Sprague Dawley (SD) rats were divided into negative control group (standarddiet, n¼ 6), positive control group (atherosclerotic diet, n¼ 6), and MSC treatmentgroup (atherosclerotic diet and treated by single dose of 5� 106 MSCs, n¼ 8). MSCswere isolated by plastic adherent method from umbilical SD rats. Atheroscleroticevent in abdominal aorta was stained by haematoxilin- eosin, while IL-1a, IL-6 andTGF-b1 expression were observed by immunohistochemistry.Results: Atherosclerotic plaque in the MSC treatment group was significantly lowerthan in the positive control group (P¼ 0.006). Expression of IL-1a and IL-6 in endo-thelia, smooth muscle, and macrophage were not different in all groups. Expressionof TGF-b1 in the vessel wall macrophage was lower in MSC treatment group thanthat of in the positive control group (P¼ 0.046), but there was no different of inboth endothelia and smooth muscle.

Conclusion: MSCs may have role in ameliorating atherosclerotic plaque in SD ratsmediated, in part, by reducing of macrophage TGF-b1 expression, but not by IL-1aand IL-6.Keywords: Mesenchymal stem cells • Atherosclerosis • IL-1a • IL-6 • TGF-b1

Simvastatin inhibits synthesis of type I collagen in patients with rheumatic heartdisease

D. Setiadi, U. Bahrudin, S. Herminingsih, and Y. HerryFaculty of Medicine, Department of Cardiology and Vascular Medicine, Dr. KariadiGeneral Hospital, Diponegoro University, Semarang, Indonesia

Background: Increasing of collagen synthesis plays a role in the progresivity of fibro-sis, thickening and calcification of cardiac valves in patients with rheumatic heartdisease (RHD). Statin is known to have a pleiotropic anti-fibrotic effect by inhibitingthe collagen synthesis. The main collagen component of human cardiac valves is typeI collagen. The purpose of this study was to know the effect of simvastatin on thesynthesis of type I collagen in patients with RHD.Methods: This clinical experimental study was done in the Dr. Kariadi GeneralHospital, Semarang, Indonesia from March to May 2016. A total of 31 RHD patientswere randomized into 2 groups. Treatment and control groups received a standardmedical therapy with (16 patients) and without (15 patients) simvastatin 40mg/dayfor 4weeks, respectively. Two patients in the control group were dropped out.Carboxy-terminal propeptide of type I procollagen (PICP) is used as a marker of typeI collagen synthesis. PICP serum was taken from peripheral vein blood and measuredby ELISA method prior and post treatment.Results: There were no significant difference in baseline clinical and echocardio-graphic paramaters between treatment and control groups. Levels of PICP priortreatment between two groups were not different significantly (708.96 269.4 and671.36 242.0 ng/mL for treatment and control groups, respectively, P¼ 0.699).However, PICP level post treatment in the treatment group was significantly lowerthan that of the control, 582.506 236.11 and 878.776 316.49 ng/mL, respectively,(P¼ 0.008). No any serious treatment side effect was found in all patients.Conclusion: Simvastatin may inhibit synthesis of type I collagen in patients withRHD. This data may give an insight into the management of RHD particularly to re-duce the progression of fibrosis in cardiac valves.Keywords: Rheumatic heart disease • Collagen • Simvatatin

Survival benefit of early intra-aortic balloon pump insertion as haemodynamicsupport strategy pre-revascularization in cardiogenic shock complicating acutemyocardial infarction

R.A. Nugraha1, M.L. Jonatan1, F.F. Alkaff1, T.N. Octora1, A. Simon1, R.C. Susilo2,B.P. Semedi1,2, and C. Sumartono1,21Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, 2Department ofAnesthesiology and Reanimation, Dr. Soetomo General Hospital, Surabaya, Indonesia

Background: Conflicting reports on the early use of intra-aortic balloon pump (IABP)as well as LVAD and ECMO for haemodynamic support of acute myocardial infarctionbefore undergoing revascularization (primary PCI or emergency CABG) has increasedsignificantly during the recent years, but without sufficient evidence for a survivalbenefit. Early IABP insertion may increase door-to-balloon time, thus we should prop-erly insert IABP only when there is necessity and clear advantages in improving sur-vival rates.Aim: It was our objective to evaluate the benefit of early IABP insertion in patientswith acute myocardial infarction before undergoing revascularization in the term ofsurvival rate, periprocedural bleeding event, restenosis event, revascularizationevent, and stroke event.Methods: We did a hand-searched literatures from Pubmed, Medline, Cochrane, andEmbase databases using the terms ‘intra-aortic balloon pump, percutaneous coronaryintervention, myocardial infarction, acute coronary syndrome’. Eligibility criteriawere randomized clinical trials comparing cardiogenic shock patients, who receivedIABP vs. control (no IABP) before primary and urgent PCI. Primary outcome was 30-days mortality rate, whereas secondary outcomes included 6-months mortality rate,periprocedural bleeding event, restenosis event, revascularization event, and strokeevent.Results: A total of 14 randomized trials enrolling 1855 patients were included.Identified indicated that the 30-days and 6-months mortality rate were superior inIABP groups compared to control groups IABP was associated with reduced mortality[pooled RR 0.43; 95% confidence interval (CI) 0.24–0.82]. IABP compared to controlgroup was also associated with shorter intensive care unit (WMD �1.44 days; 95% CI:�1.78 to� 1.14 days; P< 0.001) and hospital length of stay (WMD �3.21 days; 95%CI: �5.13 to� 1.39 days; P¼ 0.009). Nevertheless, early IABP insertion may in-creased the risk of severe bleeding requiring blood transfusion during revasculariza-tion procedure (pooled RR 1.95, 95% CI: 1.21–3.31, P¼ 0.002). The restenosis event,revascularization event, and the stroke rate at 30 days of follow-up were not signifi-cantly different between the two groups. However, there were significant bias andlimitations due to heterogeneity among included studies.

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Conclusion: Early IABP insertion in AMI patients experiencing cardiogenic shock is asso-ciated with improved overall survival, reduce 30-days and 6-months mortality rate onlywhen used before PCI. Higher incidence of severe bleeding may be challenging duringrevascularization procedure, however this fact doesn’t conquer the advantages of IABP,especially in the absence of ECMO and LVAD/PVAD in low-resources setting.Keywords: Acute myocardial infarction • Cardiogenic shock • IABP • Survivalbenefit

Pattern of left ventricular diastolic properties in trained soldier during their 1st,2nd, and 3rd years of military training

K. Rizky, H. Indratno, P.K. Dewi, Y. Herry, and M.A. NugrohoFaculty of Medicine, Department of Cardiology and Vascular Medicine, DiponegoroUniversity, Dr. Kariadi General Hospital, Semarang, Indonesia

Background: Chronic physical training may cause structural and functional heart ad-aptations with important haemodynamic implications. It appears that highly trainedathletes in previous study develop a left ventricular (LV) fair combination of cavitydilatation and increased wall thickness. In spite of these changes, the LV systolic anddiastolic function remain normal, and sometimes supernormal in the case of diastolicfunction. The aim of this study was to investigate LV diastolic properties in trainedsoldier who has finished the 1st, 2nd, and 3rd years of military training compared tountrained controls.Methods: This was a cross sectional descriptive study, taken in July to September2016. Subjects are 19–25-years-old male soldier divided into 3 groups according totheir duration of military training (1, 2, and 3 years of training) compared to controlgroup. LV diastolic properties studied with standard two-dimensional echocardiogra-phy, Doppler echocardiography, and Doppler tissue imaging. Mean differences be-tween each group analysed using independent t-test with significance of 0.05 and95% of confidence interval.Results: The study enrolled 92 subjects, 23 (25%) are in the 1st year of traininggroup, 24 (26.1%) in the 2nd year of training group, 25 (27.1%) in the 3rd year oftraining group and 20 (21.7%) in the control group. All subjects have a normal dia-stolic function. All trained group compared to control had a significantly higher E/Aratio (P¼ 0.000), lower A velocity (P¼ 0.000) and higher E’ septal velocity(P¼ 0.000). All trained group also have a higher LAVI but only the 1st and 2nd yearsgroup shows statistically significant differences (P¼ 0.000 and P¼ 0.028). Only the1st year group had a statistically significant higher E velocity (85.96 m/s vs. 76.25m/s, P¼ 0.031). There are no significant differences in deceleration time, E/E’ and E’lateral velocity compared to control.Discussion: Important structural heart adaptations found in trained soldier. Theseadaptations show LV hypertrophy with a preponderance of eccentric hypertrophy.However, unlike pathologic LV hypertrophy, the LV diastolic function in the trainedsoldier in our study was completely normal, yet clearly different from that in thecontrol group. There are significant increases of E/A ratio, without any sign of in-crease LAP. This correlates with other previous study that shows supernormal dia-stolic function in athlete.Conclusion: In trained soldier, we found normal LV diastolic function but different LVdiastolic properties pattern compared to control group.Keywords: Athlete heart • Diastolic function • Trained soldier • Echocardiography

Factors influencing early outcome following the Fontan procedure: 10-yearsexperience in Indonesia

M. Fitra1,2, P.S. Roebiono1,2, O. Lilyasari1,2, R. Prakoso1,2, A.U. Rahajoe1,2, I.Sakidjan1,2, Y. Kurniawati1,2, B. Rahmat1,2, D. Fakhri1,2, and G.M. Harimurti1,21Faculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasIndonesia, Indonesia, 2Faculty of Medicine, Department of Cardiology and VascularMedicine, National Cardiovascular Center Harapan Kita Hospital, University ofIndonesia, Jakarta, Indonesia

Background: Fontan operation has become the most common procedure performedfor univentricular anatomy. Early outcomes after Fontan operation is still a matter ofconcernAim: This study aimed to evaluate the clinical outcome of intra hospital and 1monthafter Fontan operation at National Cardiovascular Center Harapan Kita, as the ter-tiary cardiovascular care in Indonesia.Methods:We included 148 consecutive patients that underwent Fontan operation be-tween April 2006 and August 2016. Total of 148 patients old with median age at oper-ation 6 (3–22) years were included. Factors influencing death and rehospitalizationwithin one month were analysed using bivariate and multivariate analysis.Results: The early survival rate after Fontan was 90%. Six patients required a reoper-ation and 24 (16.2%) patients was rehospitalized within one month. Age, sex, pre-Fontan oxygen saturation, and low-ejection fraction were not associated with mor-tality and rehospitalization rate. Mean CPB time was longer in those who died, butshowed non-significant association (172.26 81.1 vs. 138.36 57.7min, P¼ 0.74). Pre-Fontan ventricle end diastolic pressure and pulmonary artery pressure between twogroups were not different. On multivariate analysis, mortality was adversely

influenced by recurrent pelural effusion/protein loosing enteropathy (P¼ 0.003,OR¼ 7.8 on bivariate analysis). Meanwhile, rehospitalization was not significantlyinfluenced by any factors mentioned above.Conclusion: Early outcome of the Fontan circulation is encouraging. Recurrent pelu-ral effusion/protein loosing enteropathy has an adverse influence on early mortality.Keywords: Fontan operation • Early outcomes

Coffee consumption improves histomorphology of coronary artery leading toprotect against atherosclerosis in periodontitis rat model

I.D.A. Susilawati1, Suryono2, T. Ermawati1, Purwanto1, and R. Chriestedy11Biomedic Department, Dentistry Faculty University of Jember, Indonesia,2Department of Cardiology Faculty of Medicine University of Jember, Indonesia

Background: Recently, several epidemiological studies reported the beneficial effectof coffee consumption on cardiovascular health, evidence from experimental studies,however, are still lacking.Aim: This study purposed to conduct an experiment to prove inhibitory effect of cof-fee on coronary atherosclerosis, in periodontitis rat model.Methods: Twenty one rats (Rattus norvegicus) were divided into three groups, i.e. (i)periodontitis, (ii) periodontitisþ coffee, and (iii) control group. Single dose of groundcoffee decocta (representing one cup) was given once/day/rat by stomach sondation.Periodontitis was conditioned chronically. The experiment was conducted for 5weeks.At the end of experiment, all of rats were sacrificed. Their hearts that contain coronaryarteries were removed, trimmed crossectionally and prepared for histochemistry assayusing Collagen Staining Kit. Sample analysis was focused on the morphology of coronaryarteries namely, intima-media thickness (IMT), quality of intimal collagen (intact anddisintegrated), the existence of atheroma, and stenosis/occlusion.Results: Coronary arterial wall of rats that consumed coffee demonstrated moresymmetric IMT, intimal collagen showed more intact, denser, and thicker. Stenosis/occlusion and atheroma were rare identified in coffee group.Conclusion: One cup of coffee consumption per day improves morphology of coro-nary arteries leading to protect against atherosclerosis. Coffee effect on morphologi-cal improvement of intimal collagen is a novel perspective, it might provide the re-sistance of vasculature against rupture and thrombosis. The action mechanism mightbe due to antioxidants effect of coffee to inhibit collagen degrading enzymes matrixmetalloproteinases.Keywords: Atherosclerosis • Coffee • Collagen • Periodontitis • Rat

Correlation between left atrial volume index and early successful rate of surgicalablation in patients with chronic atrial fibrillation undergo mitral surgery

D.L. Munawar1, D.A. Hanafy2, A.B. Adji2, M. Munawar3, and A.M. Soesanto21Faculty of Medicine, University of Indonesia, Jakarta, Indonesia, 2NationalCardiovascular Heart Center Hospital, Jakarta, Indonesia, 3Binawaluya CardiacHospital, Jakarta, Indonesia

Background: Surgical ablation is commonly done in patients with chronic atrial fibril-lation (AF) undergo mitral valve surgery. This study was designed to identify the rela-tionship between pre-operative and post-operative left atrial volume indices (LAVi)and short-term success of restoration sinus rhythm after surgical AF ablation concom-itant with mitral valve surgery.Methods: Data were collected retrospectively from our hospital medical record.These included electrocardiograms, laboratory, echocardiography before and aftersurgical ablation in all patients. Each patient was evaluated at the outpatient hospi-tal clinic. The AF recurrence was evaluated from the ECG recording within 1monthafter surgery. Left atrial volume was calculated using modified Simpson’s method.Volume was corrected by surface area.Results: From March 2012 through January 2015, there were 46 patients who under-went surgical AF ablation concomitant with mitral valve surgery. The mean age was42.76 9.6-years old. [males were 19 (41.3%) and females were 27 (58.7%)]. Earlymortality was found in 5 patients (8.7%). Sinus rhythm (SR) was restored and main-tained within first month in 30 patients (65.2%) of the 46 patients. The pre-operativeLAVi was smaller in patients who was successfully restored in SR compared with thosewho was unsuccessfully restored in sinus rhythm, but statistically insignificant(156.836 84.3 vs. 189.46 92mL/m2, P¼ 0.256). However, post-operative LAVi wassmaller and statistically significant in those patients who was successfully restored inSR compared with those who was unsuccessfully restored in SR (95.26 55.4 vs.1266 43.9mL/m2, P¼ 0.029). Multivariate analysis using logistic regression analysisshowed post-operative LAVi [odds ratio (OR) was 1.02 95% confidence interval (CI)1.001–1.04, P¼ 0.043] and beta blocker usage early post hospitalization [OR was 0.02(95% CI 0.001–0.364, P¼ 0.008] were independent predictor of maintaining SR aftersurgical AF ablation concomitant with mitral valve surgery.Conclusion: Short-term success rate of the surgical AF ablation in patients withchronic AF and concomitant mitral valve surgery was 65.2%. Post-operative LAVi andpost-operative beta blocker therapy were independent predictors of maintaining SRafter surgical AF ablation concomitant with mitral valve surgery.

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Keywords: Atrial fibrillation • Mitral valve disease • Surgical AF ablation • Leftatrial volume index

The effect of cardiac telemonitoring on home-based exercise adherenceprogram in post coronary artery bypass surgery patient

A. Imasanti, B. Radi, and S. DharmaFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita Hospital, University of Indonesia, Jakarta,Indonesia

Background: Cardiac rehabilitation (CR) program in patient who had coronary arterybypass surgery (CABG) surgery could be institution-based or home-based, but therewere many barriers for home-based CR program that influences the patient’s adher-ence to the program. As an effort to overcome the barrier of distance, confidence,and safe feeling, electrocardiography telemonitoring (ECGTM) could be used. Butthere were no data regarding the effect of the electrocardiography telemonitoringto the adherence to the home-based CR program in Indonesia.Aim: To assess the effect of electrocardiography telemonitoring to the adherence tohome-based CR program for the patients who have had CABG surgery.Methods: Patients after having CABG surgery in National Cardiovascular CenterHarapan Kita Jakarta who have finished Phase II CR program were recruited consecu-tively and were randomized to the intervention group which used ECGTM and to thecontrol group which did not use ECGTM for 3months home-based CR program. Home-based exercise was based on the result of exercise stress testing using BruceProtocol. Adherence was defined as compliance to the minimum of 3 sessions perweek for 12weeks CR program.Results: A total of 44 patients completed the study, The adherence to the CR pro-gram of the intervention group (n¼ 20) and control group (n¼ 24) was not different(95% vs. 70.8% P¼ 0.054), and neither was the exercise testing duration (57.96 81.1vs. 21.76 61.2 s, P¼ 0.099), and the improvement of functional capacity (0.776 1.2vs. 0.336 1.05 METS, P¼ 0.193)Conclusion: The application of electrocardiography telemonitoring did not increasethe patients adherence to home-based CR program.Keywords: Coronary artery bypass surgery • Home-based CR • Electrocardiographytelemonitoring • Adherence

Effect administration of captopril on high-sensitive C-reactive protein in postcoronary artery bypass graft surgery patient

W. Aditya, N. Hersunarti, R. Zahara, A. Kekalih, R. Soerarso, and B.B. SiswantoFaculty of Medicine, Department of Cardiology and Vascular Medicine, University ofIndonesia, Jakarta, Indonesia

Background: Postoperative morbidity of coronary artery bypass surgery (CABG) isfairly high. This is due to increased of inflammatory response 48–72 h after surgeryand increased of renin angiotensin aldosteron system (RAAS). ACE inhibitors areknown to inhibit inflammation and RAAS. However, no study has proved that ACE in-hibitors can reduce inflammation in postoperative CABG.Objective: To determine the effect of captopril in reducing hsCRP post CABG surgeryMethods: This is a cohort prospective study that was conducted in Harapan KitaHospital, on postoperative elective CABG subjects on May until October 2016.Subject divided into two groups, the group with captopril and the other is withoutcaptopril. High sensitive CRP was measured 3 times: Day 0 before surgery, Day 3 postCABG, and Day 6 post CABG.Results: There are total 85 subjects, 49 subjects with captopril and 36 subjects with-out captopril. There was no difference in hsCRP results before surgery and Day 3 postCABG. In Day 6 post CABG, hsCRP examination in captopril group is lower than thegroup without captopril [31.4mg/L (10.5–154) vs. 46.7mg/L (10.3–318)] with P¼ 0.018Conclusion: Subjects with captopril has lower hsCRP at Day 6 post CABG than thesubjects without captoprilKeywords: Captopril • Coronary artery bypass graft surgery • High sensitive C-reac-tive protein (hsCRP)

Role of metformin in endothelial dysfunction: a randomized control trial studyby using nitric oxide and flow mediated dilation measurement

K. Bayu Aji1 and T. Wasyanto21Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia, 2Department ofCardiology and Vascular Medicine, Dr Moewardi Hospital, Sebelas Maret University,Surakarta, Indonesia

Background: Cardiovascular disease (CVD) is a leading cause of mortality and mor-bidity among aging-related chronic diseases with atherosclerosis as the manifesta-tion, where endothelial dysfunction is the key of it and early event in atherogenesis.Therefore non-invasive tests of endothelial function has been developed with flowmediated dilation (FMD) as the most common used method to measure endothelial

dysfunction beside using nitric oxide level. Metformin has been widely used for firstline therapy of type 2 diabetes mellitus for more than 50 years, but there is still apaucity of information describing the cardiovascular benefits (pleiotropic effect) ofmetformin and more studies are needed. The aim of this study is to analyse metfor-min effect in nitric oxide level and flow mediated dilation in ischaemic heart failurepopulation.Methods: This study was a randomized controlled trial (RCT) in 15 consecutive pa-tients with heart failure with ischaemic heart disease outpatient population in DrMoewardi Hospital Surakarta. The eligible patients were randomized into two groups:Treatment group (standard therapy and metformin 500mg twice a day for 2weeks,n¼ 7) and control group (standard therapy and plasebo for 2weeks, n¼ 8). Serumconcentrations of NO and FMD will be checked in both group. Normal distributeddata were compared using independent t-test between group and paired t-test atsame group. P< 0.05 was considered statistically significant.Results: There was significant mean difference in NO (P¼ 0.026) and FMD (P¼ 0.043)level in treatment group compare to control group, where those levels were higherin treatment group.Conclusion: Metformin 500mg twice a day for 2weeks improves nitric oxide and flowmediated dilation level in ischaemic heart failure population.Keywords: Flow mediated dilation • Nitric oxide • Metformin • Heart failure

Associated lesion and natural history of congenitally corrected transposition ofthe great arteries patients at National Cardiovascular Centre Harapan Kita,Jakarta

A. Gabriella, G.M. Harimurti, P.S. Roebiono, A.U. Rahajoe, I. Sakidjan, R. Prakoso,Y. Kurniawati, and O. LilyasariFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasIndonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

Background: Congenitally corrected transposition of the great arteries (ccTGA) is arare form of congenital heart disease (CHD) characterized by atrio-ventricular andventriculo-arterial discordance and is associated with a variety of intra-cardiac de-fects. Most patients are asymptomatic, unless there is associated lesion which aggra-vates symptoms.Aim: The aim of this study was to review the associated lesions and natural historyof patients with ccTGA.Methods: A retrospective study was performed to review all patients with ccTGA atNational Cardiovascular Centre Harapan Kita, Jakarta, as a tertiary cardiovascularcare in Indonesia, from January 2014 until December 2016.Results: There were 32 ccTGA patients with age range from 5months to 52 yearsold, 21 (65.6%) male and 11 (34.3%) female included in this study. Dextrocardia wasfound in 10 (31.3%) patients. The associated lesions were isolated ventricular septaldefect (VSD) in 7 (21.8%) patients, VSD with pulmonary stenosis (PS) in 12 (37.5%) pa-tients, and VSD with PS and atrial septal defect (ASD) in 3 (9.4%) patients. Ebstein’sanomaly with severe tricuspid regurgitation (TR) was detected in 3 (9.4%) patients,and VSD with total anomalous pulmonary venous drainage (TAPVD) and patent ductusarteriosus (PDA) in 1 (3.1%), double inlet left ventricle (DILV) with VSD in 1 (3.1%) pa-tient, while 5 (15.6%) patients had no associated lesion. Twenty five percent patientswith age range from 4 to 52 years had already presented with congestive heart fail-ure (CHF). Of those with CHF, 62.5% were isolated ccTGA and 37.5% with VSD. All iso-lated ccTGA were presented with CHF, and had poor-systemic right ventricular func-tion proved by echocardiography or magnetic resonance imaging.Conclusion: The most associated lesion in ccTGA was VSD wheather isolated or asso-ciated with other lesions. A quarter of our patients presented with CHF due to poorright ventricular function in accordance with their natural history.Keywords: ccTGA • Associated lesion

Acute kidney injury diagnosis in acute heart failure, does furosemide stress testmake sense?

H. Arifianto1, T. Wasyanto1, and B. Purwanto21Faculty of Medicine, Department of Cardiology and Vascular Medicine, Dr. MoewardiGeneral Hospital, Sebelas Maret University, Surakarta, Indonesia, 2Division ofNephrology, Department of Internal Medicine, Dr. Moewardi General Hospital,Sebelas Maret University, Surakarta, Indonesia

Background: Acute kidney injury (AKI) is the most frequent complication on the first48 h during acute heart failure hospitalization. Beside of complex pathophysiologyand the needs of multispeciality care, detection of AKI was took 48 h by serial serumcreatinine test, which can make permanent damage of glomerulus. Furosemide stresstest (FST), a new diagnostic modality for AKI, only need 2 h after administration offurosemide which is the main decongestive agent for heart failure patient, but unfor-tunately, there was no research about FST on heart failure patients.Aim: To examine whether FST can be used as diagnostic marker for AKI on acuteheart failure patient, compare with serum creatinine.Methods: This is was experimental diagnostic study with cross sectional design. Fiftypatients with acute heart failure on Cardiovascular Department of Dr. MoewardiGeneral Hospital, Surakarta, consecutively enrolled in this study, initial check of

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creatinine serum and Cystatine-C (CyC) was performed as baseline, following withfurosemide stress test. On 48 h of hospitalization, serum creatinine was recheckedfor diagnosing AKI. Chi square test was performed to find sensitivity, specificity, PPV,and NPV of FST, the strength of this diagnostic tool was measured by area under ROCcurves, with P< 0.05 significant.Results: We found that there were 16 patients (32%) progress into AKI on 48 h afterhospitalization, and it was linear with CyC levels. Furosemide stress test can be usedas diagnostic marker for acute kidney injury on acute heart failure patients, withspecificity of 81.3% and sensitivity of 91.2%, PPV 91.2%, and NPV 81.3%. Value of areaunder the ROC curves 86.2% (95% CI 0.736–0.988, P< 0.001).Conclusion: Furosemide stress test can be used as diagnostic marker for acute kidneyinjury on acute heart failure patients.Keywords: Acute kidney injury • Acute heart failure • Furosemide stress test

Comparison of mangosteen peel extract (Garcinia mangostana), tomato extract(Lycopersicum esculentumMill), and both extract combinations efficacy inlowering the total blood cholesterol of white mice were fed by high-fat diet

K.A. Karim1, T. Mamfaluti2, F. Meutia3, M. Ridwan4, and Buchari51Faculty of Medicine, University of Syiah Kuala, Banda Aceh, Indonesia, 2Departmentof Internal Medicine, University of Syiah Kuala, Banda Aceh, Indonesia, 3Departmentof Opthalmology, University of Syiah Kuala, Banda Aceh, Indonesia, 4Department ofCardiology, University of Syiah Kuala, Banda Aceh, Indonesia, 5Department of ClinicalPathology, University of Siah Kuala, Banda Aceh, Indonesia

Background: Unhealthy lifestyle such as poor activity and consuming high-fat food arethe risk factors of hypercholesterolemia that is closely associated to the atherosclerosis.Phytochemical compounds contained in the extract of mangosteen peel and tomato maydecrease the blood cholesterol levels without harmful side effects to the body. The pur-pose of this study was to compare the effect and efficacy differences between the ex-tract of mangosteen peel, tomato, and both extract combinations in lowering total bloodcholesterol levels of the white mice (Rattus norvegicus) were fed by high-fat diet.Methods: This research was a laboratory experimental research with pretest–posttestcontrol group design and completely randomized design. The subjects were 30 micewere divided into 6 groups: negative control (NC), positive control (PC), 1st treatment(T1) (10mg/day extract of mangosteen peel), 2nd treatment (T2) (10mg/day extractof tomato), 3rd treatment (T3) (10mg/day both extract combination), 4th treatment(T4) (0.18mg/day simvastatin), each group consist of 5 mice and treated every day for45 days. The total blood cholesterol level was examined at 45th day. The data wereanalysed by one way analysis of variance (ANOVA) test and then post hoc LSD test.Results: This study shows the average elevation of total blood cholesterol levels be-tween 6 groups after 45 days treatment of NC (7.86 1.3), PC (119.46 25.2), T1(58.26 25.8), T2 (22.66 10.8), T3 (21.86 21.3), and T4 (20.66 14.4). The datawere analysed statistically to compare the treatment groups to the control groups,and each treatment groups show the significant differences (P< 0.05) to the controlgroups. The best result consecutively showed by T4, followed by T3, T2, and T1.Conclusion: This study shows that all extracts may lowering the total blood choles-terol, the extract of both combinations showed the best efficacy than the other one.Keywords: Mangosteen peel extract • Tomato extract • Both extract combina-tion • Hypercholesterolaemia

Association between four types of single-nucleotide polymorphisms in PLA2G7gene and risk of clinical atherosclerosis

A. Santoso1, T. Heriansyah2, R. Maulana3, F. Alzahra’3, I. Maghfirah3, andA.D. Putrinarita31Faculty of Medicine, Department of Cardiology & Vascular Medicine, University ofIndonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, 2Faculty ofMedicine, Department of Cardiology & Vascular Medicine, University of Syiah Kuala, BandaAceh, Indonesia, 3Faculty of Medicine, University of Muhammadiyah, Jakarta, Indonesia

Background: Previous studies suggested that some types of single nucleotide poly-morphisms (SNPs) in PLA2G7 gene, coding Lp-PLA2 have been reported to exert anantiatherogenic effect, but other studies mentioned otherwise. Thus, a comprehen-sive study to investigate the effect of SNPs in PLA2G7 gene (V279F, A379V, R92H,I198T) towards clinical atherosclerosis need to be conducted.Methods: We searched eligible studies from PubMed, EBSCO, ProQuest, Science Direct,Springer, and Cochrane databases for case-control studies to evaluate the relationshipbetween four types of SNPs in PLA2G7 gene with risk of clinical atherosclerosis (CVD,CAD, PAD, ischaemic stroke, hypertension). All studies were assessed under Hardy–Weinberg Equilibrium, additive model. This meta-analysis was performed by RevMan5.3 to provide pooled estimate for odds ratio (ORs) with 95% confidence intervals (CIs).Results: Fifteen clinical studies met our inclusion criteria. Those included 12 177 pa-tients with clinical atherosclerosis and 10 080 were controls. We found that ORs oftwo variants SNPs (V279F, R92H) were associated with clinical atherosclerosis [V279F,OR¼ 0.88 (95% CI, 0.81–0.95); P¼ 0.0007, I2¼ 40%], [R92H, OR¼ 1.29 (95% CI, 1.09–1.53); P¼ 0.003, I2¼ 73%]. Meanwhile, there was no significant association betweenthe other two, A379V [OR¼ 1.05 (95% CI, 0.90–1.22); P¼ 0.55, I2¼ 78%] and I198T[OR¼ 1.12 (95% CI¼ 0.79–1.59); P¼ 0.53, I2¼ 81%].

Conclusion: These results suggested that V279F polymorphism in PLA2G7 gene hasprotective effect for clinical atherosclerosis, whereas R92H polymorphism contrib-utes towards increased risk of clinical atherosclerosis.Keywords: Lipoprotein-associated phospolipase A2 (LP-PLA2) • Single-nucleotidepolymorphisms (SNPs) • Atherosclerosis • PLA2G7

Correlation increasing carotid intima-media thickness and cardiovascular eventsin patient with moderate cardiovascular risk factor

R. Mawarti, J.N.E. Putranto, and D. SoemantriFaculty of Medicine, Department of Cardiology and Vascular Medicine, University ofAirlangga, Surabaya, Indonesia

Background: Clinical cardiovascular disease (CVD) events generally occur when ath-erosclerosis progresses. Measurement of carotid intima-media thickness (CIMT) withB-mode ultrasound is a noninvasive, sensitive, and reproducible technique for identi-fying and quantifying subclinical vascular disease and for evaluating CVD event.Measuring CIMT and identifying carotid plaque can be useful for refining CVD risk as-sessment in patients at intermediate CVD risk (i.e. patients with a 10–20% 10-yearrisk of myocardial infarction or coronary heart disease death who do not have estab-lished coronary heart disease or coronary disease risk equivalent conditions).Increased CIMT is associated with an increased risk of cardiovascular and cerebrovas-cular diseases.Aim: To analyse the correlation between increasing CIMT and cardiovascular eventsin patients with moderate cardiovascular risk factor.Methods: This study was an analytic observational study using longitudinal cohortretrospektif design which conducted at cardiovascular outpatient clinic Dr. SoetomoGeneral Hospital Surabaya from February 2016 until April 2016. This study populationinclude 86 participating in the 2010 enrolled 28 patients included inclusion and ex-clusion criteria. CIMT re-examined was measured by B-mode ultrasound with resultaverage mean CIMT and average max CIMT use semi-outomatic. Paired t-test correla-tion is used to examine increased between CIMT baseline with CIMT re-examined, re-gression logistic is used to examine correlation between increased CIMTwith CVD.Results: We examined increased CIMT over 71.661.13month among 28 subjects withmean FRS 16.2561.91%. The results showed increased CIMT mean 0.07960.104mm(<0.0001), CIMT max 0.13760.1150 (<0.0001). There is an association between increas-ing CIMTwith incident CVD event [CIMT mean, P¼ 0.016, 95% confidence interval, odds ra-tio (OR) 0.0001 (0.0001–0.044); CIMT max, P¼ 0.012, OR 0.0001 (0.0001–0.035)].Conclusion: There is increasing between CIMT baseline with CIMT re-examination in pa-tient with moderate cardiovascular risk factor. There is correlation between increasingCIMTand cardiovascular events in patient with moderate cardiovascular risk factor.Keywords: Increased CIMT • Moderate cardiovascular risk factor • Cardiovascularevents

Depression and sleep quality among congestive heart failure patients: results ofsurvey from Indamayu District Hospital (RSUD Indramayu), West Java, Indonesia

M.F. Adam1, N. Uyun2, Zulfan3, S. Zein3, and T. Sugihartini41Indramayu District Hospital, Indramayu, Indonesia, 2Internship of GeneralPractitioner, Indramayu District Hospital, Indramayu, Indonesia, 3Department ofInternal Medicine, Indramayu District Hospital, Indramayu, Indonesia, 4Departementof Psychiatry, Indramayu District Hospital, Indramayu, Indonesia

Background: Congestive Heart Failure (CHF) is a chronic disease that needs longtime treatments so that may be followed by several psychosocial problems such asdepression and sleep disturbance. This study aims to estimate the frequency of de-pression and to measure the sleep quality among patients suffering from CHF. It alsoassesses the association of both with several clinical parameters.Methods: We conducted a cross-sectional, descriptive, and co-relational study fromCHF patients age >18 years, admitted at RSUD Indramayu on January 2017. A stan-dardized questionnaire, also containing Patient Health Quistionairre-9 (PHQ-9) andPitssburgh Sleep Quality Index (PSQI) which are used for determining depression andsleep quality, was administered to patients when hospitalized. Statistical analysiswas done using SPSS.Results: Of the 41 patients recruited, 28 (68.3%) were males and 13 (31.7%) were fe-males. The mean age was 53.36 8.8 years. 11 (26.8%) were in NYHA Functional ClassI (FcI), 13 (31.7%) were in FcII, 12 (29.3%) were in FcIII, and 5 (12.2%) were in FcIV.The median of PHQ-9 score was 9 (3–26), divided into no depression (n¼ 4; 9.8%),mild (n¼ 16; 37.2%), moderate–moderately severe (n¼ 14; 32.6%), and severe de-pression (n¼ 7; 16.3%). PSQI score had median of 13 (5–28), also separated into nodisturbances (n¼ 1; 2.4%), mild (n¼ 14; 32.6%), moderate (n¼ 17; 39.5%), and se-vere sleep disturbances (n¼ 7; 16.3%). We found that the more severe NYHA, themore severe depression and sleep disturbance (P< 0.001). Mean rank of depressionand sleep disturbances between NYHA Fc1 and Fc4 was almost four times-fold and2.5 times-fold differences (8.86–30.80; 12.05–28.). The same association also re-vealed to sleep time duration (P< 0.001), drug compliance (P< 0.004; P< 0.04), hy-pertension (P< 0.001), and diabetes (P< 0.005; P< 0.001). No association was foundwith history of smoking, dyslipidaemia, and alcohol consumption.

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Conclusion: Depression and sleep disturbances are common among CHF patients andthey associated with many clinical parameters. Regular screening of such patients isthus essential for further comprehensive treatments.Keywords: CHF • Depression • Sleep quality • RSUD Indramayu • PSQI • PHQ-9

Relationship between cytochrome P450 2C19 polymorphism and cardiovascularevents in Indonesian patients with coronary artery disease

M. Mappiare, M. Amir, and P. KaboFaculty of Medicine, Department of Cardiology, University of Hasanuddin, Makassar,Indonesia

Background: The polymorphism of cytochrome P450 2C19 (CYP2C19) has been docu-mented as the determinant variability in the antiplatelet effect of clopidogrel. The relationbetween CYP2C19 polymorphism and the antiplatelet efficacy of clopidogrel in Indonesianpatients with coronary artery disease (CAD) is unknown. To address this issue, we examinedthe distribution of CYP2C19 genotypes and platelet aggregation, and assessed the impact ofCYP2C19 polymorphism on response to clopidogrel and cardiovascular events.Methods: This observational analytic study with retrospective cohort approach wasconducted in Wahidin Sudirohusodo and Hasanuddin University Hospital, Makassar.We measured the CYP2C19 genotype by polymerase chain reaction-restriction frag-ment linked polymorphism (PCR-RFLP) method and platelet aggregation by opticalplatelet aggregometry with 10lmol of adenosine diphosphate (ADP) in 69 patientswith stable CAD who were treated with clopidogrel. Platelet hyperaggregation wasdefined as maximal platelet aggregation> 94.3%. The patients were followed up ev-ery month at the outpatient department for 6months or at end point. The end pointwas acute myocardial infarction, ischaemic stroke, or cardiovascular death.Results: Distribution of CYP2C19 alleles were 89.8%, 40.6%, and 11.6%, in CYP2C19*1,CYP2C19*2, and CYP2C19*3, respectively. Distribution of CYP2C19 genotype was 50.7%,29.0%, 8.7%, 8.7%, and 2.9% in CYP2C19*1/*1, *1/*2, *1/*3, *2/*2, and *2/*3, respec-tively. Platelet hyperaggregation was more in patients with polymorphism than wildtype [P 0.034; odds ratio (OR) 3.707] and was associated with cardiovascular events (P0.030; OR 13.250). There was acute myocardial infarction in 2 patients, ischaemicstroke in 1 patient, and cardiovascular death in 1 patient. All of these patients werecarrying at least one variant allele of CYP2C19; details of genotype were in two pa-tients with CYP2C19*1/*2, one patient with *2/*2, and one with *2/*3 alleles.Conclusion: CYP2C19*2 and *3 were associated with cardiovascular events due toplatelet hyperaggregation.Keywords: Polymorphism • CYP2C19 • Clopidogrel • Coronary artery disease • Indonesia

Have we done enough to educate hypertensive patients?

S. OetamaRSUD Hadji Boejasin, Pelaihari, South Kalimantan, Indonesia

Background: Patient education is one of the most important aspects in hypertensionmanagement. Physicians are expected to provide specifically designated time in or-der to educate their patients in various topics regarding hypertension. This studyaims to determine the prevalence of education from a physician in hypertensive pa-tients and its association with office blood pressure (OBP), knowledge, and compli-ance in RSUD Hadji Boejasin.Methods: This analytic cross-sectional study was conducted at RSUD Hadji Boejasinfrom August to November 2016. A total of 210 hypertensive patients were included.Data were collected via direct interview. Knowledge was assessed using hypertensiveknowledge-level scale (HK-LS) and compliance was assessed using Hill-Bone compli-ance to high blood pressure scale. The data were analysed with SPSS 17.0.Results: Sample consisted of 110 (52.4%) males and 100 (47.6%) females. Mean agewas 58.586 11.52. Education from a physician was given to 130 (61.9%) samples andthe rest (80 samples; 38.1%) were never received any education from a physician.Self-educating behaviour only found on 66 (31.4%) samples. Only 77 (36.7%) sampleshad controlled OBP. Good knowledge regarding hypertension was noted on 131(62.4%) samples, but good compliance only noted on 98 (46.7%) samples. Analysisshowed a strong association between education from a physician with OBP(P¼ 0.001), knowledge (P¼ 0.001), and compliance (P¼ 0.001).Conclusion: This study reinforced the fact that patient education from a physician isan integral factor in hypertension management. However, the data suggested thatnot every physician did so. The majority of hypertensive patients are technology-illiterate senile population with low resource on hypertension education and distinc-tively low interest in self-educational behaviour, therefore it’s up to the physician astheir primary source of knowledge.Keywords: Hypertension • Education • Knowledge • Compliance

The effect of polysaccharide peptides Ganoderma lucidum to aortic foam cellcount and lipid profile in type-2 diabetic model Rattus norvegicus strain wistar

D. Sargowo1, T.A. Wihastuti2, C.T. Sukotjo3, P.M. Anjani3, O. Handayani4, andL.H. Adrian4

1Faculty of Medicine, Department of Cardiology and Vascular Medicine, BrawijayaUniversity, Malang, Indonesia, 2Faculty of Medicine, Department of BiomedicalScience Medicine, Brawijaya University, Malang, Indonesia, 3Brawijaya University,Malang, Indonesia, 4Faculty of Medicine, Department of Cardiology and VascularMedicine, University of Brawijaya, Malang, Indonesia

Background: Type 2 diabetes mellitus (DM) is one of the dominant factors of cardio-vascular death that induces endothelial dysfunction. Definite sign of endothelial dys-function is the formation of foam cells derived from oxidized LDL. This study wasconducted to determine effect of Ganoderma lucidum Polysaccharide Peptides (PsP)on foam cell counts and lipid profile in diabetic model rats with high-fat diet.Methods: The Rattus norvegicus strain Wistar rats were categorized into negative control,positive control, DM-50, DM-150, and DM-300. Streptozotocin was administered to makethe rats diabetic. PsP was administered with predetermined doses on each treatmentgroup (50, 150, and 300mg/kg). Foam cell count was measured using rat’s aortic sample;whereas the lipid profile was assessed by using blood sample from the rat’s heart. Datawas analysed by one way analysis of variance (ANOVA) and post hoc Tukey test.Results: From one way ANOVA test, the administration of Ganoderma lucidum PsP todiabetic rats showed a significant reduction of foam cell count (P¼ 0.017; 95% CI)and a significant difference between levels of each lipid components (total choles-terol, triglyceride, LDL-c, and HDL-c) in at least two treatment groups (P¼ 0.010;95% CI). Post hoc Tukey test showed that P-value for the relationship between theadministration of PsP and foam cell count is 0.002.Conclusion: Polysaccharide peptides (PsP) can be used as an adjuvant therapy in manage-ment of type 2 diabetic mellitus, as antioxidant and anti-inflammatory that inhibit athero-sclerosis and endothelial damage process. Further studies are necessary to evaluate thebenefits of PsP as an adjuvant therapy in management of diabetic dyslipidaemia.Keywords: PsP • Ganoderma lucidum; Foam cell; Lipid profile; DM

Comparison of safety and efficacy from ticagrelor as compared with clopidogrelin patients with acute coronary syndrome or stable coronary artery disease: ameta-analysis of randomized trials

M. Syane1 and Y.A. Wibowo21Faculty of Medicine, Atma Jaya Catholic University, Jakarta, Indonesia, 2Faculty ofMedicine, University of Muhammadiyah Jakarta, Jakarta, Indonesia

Background: Ticagrelor, as the new P2Y12 receptor inhibitors that is available inIndonesia, has a more rapid onset and more pronounced platelet inhibition than clopidog-rel, although raising several concerns on possible increase of bleeding. The aim of currentmeta-analysis was to evaluate the efficacy and safety of ticagrelor as compared with clo-pidogrel in patients with acute coronary syndrome or stable coronary artery disease.Methods: A comprehensive literature search was done to identify all relevant studiesfrom Pubmed, Cochrane, ScienceDirect, and MedLine database for randomized trials,comparing ticagrelor with clopidogrel in acute coronary syndromes or stable coronaryartery disease. Primary endpoint was all mortality. Secondary endpoints were reccur-ent ischaemia symptoms or non-fatal myocardial infarction, and major bleeding. Themeta-analysis was performed with RevMan 5.3, and SPSS with Wilson Macro to per-form statistical analysis and to provide pooled estimate data.Results: A total of 6 randomized trials comprising 20 737 patients were included inthe study. Ticagrelor significantly reduced mortality compared to clopidogrel [oddsratio (OR): 0.80, 95% confidence interval (CI): 0.70–0.91, P: <0.05, I2: 0%]. Therewere no significant differences found between ticagrelor and clopidogrel in majorbleeding incidence as a safety endpoint (OR: 1.06, 95% CI: 0.95–1.17, P: 0.32, I2:27%). However, there were no significant differences found between ticagrelor andclopidogrel in reccurent ischaemia symptoms or non-fatal myocardial infarction inci-dence as an efficacy endpoint (OR: 0.93, 95% CI: 0.83–1.05, P: 0.27, I2: 56%), withticagrelor group has slightly better outcome.Conclusion: This meta-analysis shows that ticagrelor is associated to significant reductionof mortality compared to clopidogrel, without a significant increase in bleeding complica-tions. However, the efficacy endpoint did not show any significant statistical analysis.Keywords: Clopidogrel • Ticagrelor • Acute coronary syndromes • Coronary arterydisease • Antiplatelet therapy • P2Y12

Roles of the red cell distribution width in predicting successful thrombolysis inacute STelevation myocardial infarction

A. Bestara1, M. Alfiansyah1, D.J.S.S. Dewi1, and T. Wasyanto21Resident of Cardiology and Vascular Medicine, University of Sebelas Maret,Surakarta, Indonesia, 2Cardiology and Vascular Medicine, Moewardi Hospital,University of Sebelas Maret, Surakarta, Indonesia

Background: Red cell distribution width (RDW) is a predictor of cardiovascular riskthat has been shown to correlate with impaired reperfusion in acute ST elevationmyocardial infarction (STEMI). In this percutaneous coronary intervention era, throm-bolysis still as main modality of treatment for acute STEMI especially in developingcountries. There was limited data regarding relationship between RDW and

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successful thrombolysis. The aim of this study is to investigate relationship betweenRDW and successful thrombolysis in acute STEMI.Methods: A total of 68 patients were included in retrospective observational studybetween January to December 2016 in Dr. Moewardi Hospital. Successful thromboly-sis considered if there is� 50% resolution of ST-segment elevation after 90min ofthrombolysis in single lead showing maximum ST elevation at presentation. The RDWwere compared between patients with successful or failed thrombolysis.Results: From analysis of 68 electrocardiogram (interobserver agreement with kappatest¼ 0.941), there were 47% achieved successful thrombolysis and 53% failed with 2different thrombolytic agent (streptokinase and alteplase, P> 005). Mean age was566 8.9 years vs. 59.86 9.6 years (P> 0.05), and median RDW was 11.65 (10.3–14.3)vs. 12 (11–14) (P< 0.05) in successful and failed group respectively. The RDW (OR0.28; P¼ 0.003; 95% CI 0.12–0.66) was independent predictor of successful fibrinolitictogether with inferior location of infarct (OR 7.046; P¼ 0.001; 95% CI 0.703–1.134)by multivariate analysis. The cut off RDW value for successful thrombolysiswas� 11.85% with a sensitivity of 77.8% dan a specificity of 62.5% (area under curve0.717; 95% CI 0.594–0.840; P¼ 0.002). The prevalence of successful thrombolysiswith significantly higher in patient with an RDW� 11.85 than in those with anRDW> 11.85 (71.4% and 30%, P¼ 0.002).Conclusion: The RDW may be used as adjunctive readily available index for assess-ment of thrombolysis outcome at admission.Keywords: ST elevation myocardial infarction • Red cell distribution width •Successful thrombolysis

Modified shock index: a simple and strong predictor of in-hospital mortalityamong patients with ST-segment elevation myocardial infarction

F. Atsari, A.A. Nasution, S. Zunaidi, Z. Mukhtar, and A.A. SiregarFaculty of Medicine, Department of Cadiology and Vascular Medicine, H. Adam MalikGeneral Hospital, Universitas Sumatera Utara, Medan, Indonesia

Background: Current risk scores of ST-segment elevation myocardial infarction(STEMI) need sophisticated algorithm and were limited for bedside use. Prompt iden-tification of higher risk patients presenting with STEMI will allow a more aggressivestrategy and approach. The aim of this study was to evaluate the modified shock in-dex as a predictor of in-hospital mortality and compare its predictive value withshock index in patients with STEMI.Methods: This retrospective study involved 108 consecutive patients with STEMI. Theblood pressure (BP) and heart rate (HR) measured at emergency department wereused to calculate Shock Index (SI) (HR/systolic BP) and Modified Shock Index (MSI)(HR/mean artery pressure). Patients were divided into groups with MSI<1.3and�1.3, SI< 0.7 and SI� 0.7, respectively, based on the receiver operating charac-teristic curve analysis from previous studies. MSI, SI, and clinical variables were com-pared between groups of patients with in-hospital mortality with a group of patientswho didn’t experience in-hospital mortality.Results: In patients with MSI value �1.3, have higher in-hospital mortality (0.52–4.69vs. 0.44–3.11, P¼ 0.032). And also patients with SI� 0.7 had an increased mortalityrate (0.40–1.56 vs. 0.32–1.53, P¼ 0.032). Logistic regression analysis showed that MSI(OR 7.16, P¼ 0.011) and SI (OR 5.45, P¼ 0.015) were independent factor for in-hospital mortality. However, the odds ratios of increased MSI for in-hospital mortalitywere higher than those of increased SI (7.16 vs. 5.45).Conclusion: MSI is a clinically significant predictor of mortality in STEMI patients.Both SI and MSI in emergency department could predict the in-hospital mortality inpatients with STEMI, but MSI is a stronger predictor than SI. The simplicity of thisproposed index makes its use accessible in large-scale clinical practices for risk strat-ification during first contact with patients.Keywords: Modified shock index • Shock index • Predictor • Mortality rate

Comparison of clinical outcomes between dual antiplatelet treatment andcilostazol-based triple antiplatelet treatment in patients undergoing percutaneouscoronary intervention: a meta-analysis of randomized controlled trial

Y.A. Wibowo1 and R.A. Nurafrilya21Faculty of Medicine, University of Muhammadiyah Jakarta, Jakarta, Indonesia,2Faculty of Medicine, Yarsi University, Jakarta, Indonesia

Background: Previous studies suggest that patients with complex lesions undergoingpercutaneous coronary intervention have more adverse cardiac event than those withsimpler cases. Intensive antiplatelet therapy such as adjunctive cilostazol reduces ad-verse cardiovascular outcomes after percutaneous coronary intervention. However, therole for triple antiplatelet therapy with cilostazol in addition to aspirin and clopidogrelafter PCI is not well defined. Therefore, the present study aimed to evaluate the safetyand efficacy of routine dual antiplatelet therapy plus cilostazol in patients with com-plex coronary lesions undergoing PCI in the era of drug-eluting stents (DES).Methods: We conducted a comprehensive literature search at PubMed, Cochrane,ScienceDirect, MedLine, and Embase, to identify all relevant randomized trial pub-lished from January 2010 until Dec 2016, Comparing DAPT with TAPT in patient un-dergoing PCI. Primary endpoints was mortality, with secondary endpoints was major

adverse cardiovascular events (MACE), major bleeding, and stent thrombosis. Themeta-analysis was performed with RevMan 5.3, and SPSS with Wilson Macro to per-form statistical analysis and to provide pooled estimate data.Results: Total of 12 Trials involving 20 176 patients were included in the study. Therewere no significant differences found between TAPT and DAPT Group, But a slightlybetter mortality outcomes was presented in DAPT group (OR: 1.32; 95% CI: 0.99–1.77, P: 0.06, I2: 14%), With MACE (OR: 0.83; 95% CI: 0.65–1.97, P: 0.66, I2: 0%),Major Bleeding (OR: 1.13; 95% CI: 0.65–1.97, P: 0.99, I2: 0%), and Stent Thrombosis(OR: 1.01; 95% CI: 0.59–1.70, P: 0.98, I2: 0%) as a secondary endpoints.Conclusion: In patient undergoing PCI, use of TAPT did not improve both clinical out-comes or mortality.Keywords: Triple antiplatelet therapy • Dual antiplatelet treatment • Cilostazol •Percutaneous coronary intervention

The association between acute myocardial infarction size based on modifiedSelvester QRS score and major adverse cardiac event 30-day after reperfusion

R.A. PuteraFaculty of Medicine, M.Djamil Hospital, Andalas University, Padang, Indonesia

Background: ST-segment elevation myocardial infarction (STEMI) is still the leadingcause of death in the world. Early reperfusion is a major therapeutic option forSTEMI to reduce mortality. Measurement of infarct size is a key in assessing the qual-ity of live in the future. Modified Selvester QRS score has been used to assess infarctextension and size. The purpose of this study was to assess the association betweeninfarct size and 30-day major adverse cardiac event after reperfusion.Method: This is descriptive analytic study with cross sectional design. Subjects were allpatient STEMI<12h onset. All patients underwent reperfusion and measure the infarctsize by using modified Selvester QRS Score. Statistical analysis is used to assess the as-sociation between infarct size and 30-day heart failure and death after reperfusion.Result: There are 64 subjects. 42.2% patients consist of modified Selvester QRS Score<4 and 57.8% patients �4. Heart failure was found more frequent than death (32.8%and 6.3%). There is significant association of modified Selvester QRS Sore and heartfailure (P< 0.001), but not with death (P¼ 0.132).Conclusion: There is association between modified Selvester QRS score with heartfailure, but not with deathKeywords: STEMI • Reperfusion • Modified selvester QRS score • MACE

Single-centre experience of transcatheter coil embolization of coronary arteryfistula with tornado coil in Indonesia

P. Almazini, A. Kristyagita, D. Firman, A. A. Alkatiri, N. Haryono, and S. SoerianataFaculty of Medicine, Universitas of Indonesia, Jakarta, Indonesia

Background: Coronary artery fistula is a congenital anomaly which is found rare.Intervention by transcatheter embolization was a choice of therapy in patients withcoronary artery fistula. In Indonesia, data about safety and success rate of this pro-cedure are still not available yet.Methods: This research conducted in National Cardiac Center Harapan Kita,Indonesia. We search data of patients who underwent coil embolization of coronaryartery fistula from June 2013 until June 2015. Data retrieved from medical recordand analyse with SPSS 17th version.Results: From June 2013 until June 2015, there were 10 patients who underwent coilembolization of coronary artery fistula. Based on source of coronary artery fistula, 1patient from RCA, 7 patients from LCA, and 2 patients were combinations. Based onsite of drainage, 8 patients drainage to pulmonary artery, 1 patient drainages to leftatrium, and 1 patient was combination. Of 8 patients, 4 patients using double coiland 4 patients using single coil. The success rate of transcatheter coil embolizationwas 80%. Procedure in 2 patients was failed because there was complication duringprocedure in 1 patient and difficulty to wiring due to sharp angulation of coronary ar-tery fistula in 1 patient. There were 2 patients who recoiling because failed in previ-ous procedure and 1 patient who underwent PCI to minimize residual flow in coro-nary artery fistula after previous intervention. There were complication cardiactamponade in 1 patient and protruding of coil to coronary artery in 1 patient. Therewas no in-hospital mortality after procedure.Conclusion: Transcatheter coil embolization of coronary artery fistula with Tornadocoil in National Cardiac Center Harapan Kita shows good result. The obstacle of thisprocedure was the sharp angulation of fistula. The complication of procedure wasminimal and in-hospital mortality after procedure was none.Keywords: Transcatheter • Coronary fistula • Tornado coil

The outcome of patients with STelevation myocard infarct at TulungagungEmergency Medical Service: the study of acute coronary syndrome networkingof Doctor Iskak General Hospital, Tulungagung

F.S. Laitupa1, I.P. Sari2, B. Prabowo3, E. Ruspiono2, T. Astiawati2, A. Wibisono2, andS. Widito4

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1Faculty of Medicine, Department of Cardiology and Vascular Medicine, BrawijayaUniversity, Dr. Saiful Anwar General Hospital, Malang, Indonesia, 2Department ofCardiology and Vascular Medicine, Dr Iskak General Hospital, Tulungagung, Indonesia,3Department of Emergency Medicine, Dr Iskak General Hospital, Tulungagung,Indonesia, 4Faculty of Medicine, Department of Cardiology and Vascular Medicine,Brawijaya University, Dr Saiful Anwar General Hospital, Malang, Indonesia

Background: Early management of ST elevation myocard infarct (STEMI) including ad-equate networking system before patient’s admission still becomes an important fac-tor to reduce morbidity and mortality. Tulungagung, a small town located nearMalang, Indonesia, has built networking system and Emergency Medical Service toundergo early management before admission that is called Tulungagung EmergencyMedical Service (TEMS).Methods: This is a retrospective study of 155 STEMI patients, that was conducted for6months (July–December 2016) in General Hospital of Doctor Iskak, Tulungagung. STEMIpatients (which underwent PCI/fibrinolytic or not) were divided into two groups: (A)STEMI patients managed by TEMS before admission through 24h callcenter consulta-tions via satellite and/or picked up by standby ambulances (n¼ 24), (B) STEMI patientsthat weren’t managed by TEMS before admission (n¼ 131). All groups were measuredfor five categories: first medical contact, door-to-balloon, door-to-needle, outhospitalrecovery patients, and success reperfusion. Statistical analysis was conducted usingpaired t-test for parametric data and Mann–Whitney test for non-parametric data.Results: We found that time from onset to first medical contact by TEMS only need258.336 340min (P¼ 0.043) compared with non-TEMS (875.946 4030.51min). Door-to-balloon by TEMS was 38.606 55.84min (P¼ 0.021) faster than non-TEMS(151.616 209.52min), and door-to-needle by TEMS was 36.866 40.75min (P¼ 0.035)compared with non-TEMS (875.946 4030.51min). The percentage of outhospital re-covery patients on TEMS was also higher (100%, P¼ 0.041) compared with non-TEMSpatients (71.6%). However, the success of reperfusion (TIMI Flow:3, success fibrino-lytic) wasn’t much more different between TEMS and non-TEMS (P¼ 0.052).Conclusion: TEMS as a networking system and Emergency Medical Service before ad-mission for STEMI patients can shorten time from onset to first medical contact, door-to-balloon, door-to-needle and increase percentage of outhospital recovery patients.Keywords: TEMS • STEMI • First medical contact • Door to balloon • Door to needle •Recovery patients

Lactate level as prognostic tool on hospital admission in patient with STelevationmyocardial infarction

N. Wilujeng1, M. Abusari1, H. Perdana1, M.D.H. Karimullah1, T.R. Makhmud1, andC.T. Tjahjono21Faculty of Medicine, University of Brawijaya, Malang, Indonesia, 2Saiful AnwarHospital, Malang, Indonesia

Background: The prognostic role of lactate level in patient with septic condition hasbeen established, however, its role in ST elevation myocardial infarction (STEMI) asprognostic tool is still unknown. This study was conducted to evaluate the role of lac-tate level as prognostic tool in STEMI patients whom were admitted to Saiful AnwarGeneral Hospital Malang.Methods: We measured arterial lactate of 22 patients with STEMI whom were admit-ted to emergency room at Saiful Anwar Hospital. The lactate level was able to repre-sent in-hospital mortality. The level of lactate was divided into 2 categories, 1.1–1.7mmol/L (n¼ 7) and >1.8mmol/l (n¼ 15). We compared both baseline character-istic and outcome measurement of the two lactate groups.Results: There was a significant association between lactate level and in-hospitalmortality (P¼ 0.024). Mortality also correlated to Killip class (P¼ 0.001), GRACEscore (P¼ 0.005), and systolic blood pressure (P¼ 0.001). There was, however, no as-sociation between lactate level with Killip class (P¼ 0.404), GRACE score (P¼ 0.509),systolic blood pressure (P¼ 0.162), smoking (P¼ 0.858), hypertension (P¼ 0.351), di-abetes Melitus (P¼ 0.609), hypercholesterolemia (P¼ 0.740), location of STEMI(P¼ 0.163), and onset of STEMI (P¼ 0.121).Conclusion: The lactate level is a promising prognostic tool in determining in-hospital mortality of patients with ST elevation myocardial infarction. Mortality itselfhas a strong association with Killip class, GRACE score, systolic blood pressure, dia-stolic blood pressure in STEMI patients.Keywords: Lactate level • STEMI • Mortality

Evaluation of ischaemic improvement after percutaneous coronary interventionthrough reduction in spatial QRS/Tangle in patient with stable coronary arterydisease

M. Aziz, T.M. Aprami, and ErwinantoDepartment of Cardiology and Vascular Medicine, Padjadjaran University, Dr. HasanSadikin Hospital, Bandung, Indonesia

Background: Widen spatial QRS/T angle has long been known associated with mortalityand predictor of arrhythmia development in coronary artery disease patients. Spatial

QRS/T angle is a contemporary vectorial projection of ventricular gradients which ableto detect the presence of ischaemia in patient with or without change in electrocardio-grams. Aim of this study is to evaluate spatial QRS/T angle devaluation in patients withstable coronary artery disease after stent implantation in order to reduce ischaemia.Methods: This is a prospective observational study with analytical pair comparison.The subjects were stable coronary artery disease patient who underwent percutane-ous coronary intervention procedure in Hasan Sadikin Hospital Bandung and Al IslamHospital Bandung from 10th–31st of December 2015. Electrocardiogram was per-formed before and after percutaneous coronary intervention procedure then changesin spatial QRS/T angle was calculated.Results: Total of 26 subjects with mean age 59 years and 76.9% male were enrolledin this study. Mean difference in spatial coronary calculation before and after proce-dure was 10.43. Spatial QRS/T angle was reduced by 10.43 (P¼ 0.031.) Sub-groupanalysis showed subject with complete revascularization and subject with no historyof acute myocardial infarction had significant reduction in spatial QRS/T angle).Conclusion: Spatial QRST angle significantly reduced after percutaneous coronary in-tervention procedure in patient with stable coronary artery diseaseKeywords: Coronary artery disease • Spatial QRS/T angle • Percutaneous coronaryintervension

Trans-radial primary percutaneous coronary intervention bleeding risk score inSTsegment elevation myocardial infarction

N. Iryuza1,2, S. Soerianata1,2, and D.A. Juzar1,21Faculty of Medicine, University of Indonesia, Jakarta, Indonesia, 2Faculty ofMedicine, Department of Cardiology and Vascular Medicine, National CardiovascularCenter Harapan Kita Hospital, University of Indonesia, Jakarta, Indonesia

Background: STEMI is a fatal manifestation of acute coronary syndrome. Reperfusiontherapy is indicated for acute STEMI patient within less than 12 h’ onset of chestpain. Major bleeding as a complication of primary PCI worsens the prognosis, prolonglength of hospital stay, and increase the cost of care. Nowadays, trans-radial accessduring primary PCI is a priority and the use of Gp2b3a inhibitor is no longer used rou-tinely. However, post-primary PCI bleeding event nonetheless tripled the risk ofdeath. Until now, there has been no system of assessments that measure the risk ofpost-primary PCI bleeding in specific trans-radial access population.Method: One thousand and thirty-five post trans-radial primary PCI STEMI patientsenrolled from a cohort retrospective study performed in National CardiovascularCenter Harapan Kita between January 2011 and August 2016. BARC bleeding defini-tion was utilized to standardize the identification of bleeding events. Chi square testand multivariate analysis using logistic regression were performed to identify the ad-justed association of each variable to bleeding event. Then scoring system was de-veloped using OR, coefficient B and its standard error. Internal validation was per-formed by ROC analysis and bootstrapping technique.Results: 4.7% from 1035 samples experienced bleeding event. Multivariate analysisfound that BMI< 18.5 kg/m2, KILLIP class> 2, age� 62, WBC� 12.000 103/lL,haemoglobin< 13 g/dL, and creatinine� 1.5mg/dL were independently associatedwith a higher risk of bleeding (P< 0.01). Scoring system to predict bleeding was de-veloped with good discriminant index and calibration, showed by AUC of 0.92 (95%CI, 0.89–9.96) and HL test (P¼ 0.405).Conclusion: This trans-radial primary PCI bleeding risk score has a good result of calibra-tion test, discrimination test, and internal validation. This scoring system can be consideredas one of the bleeding avoidance strategies in trans-radial primary PCI in STEMI patients.Keywords: Acute coronary syndrome • STEMI • Primary PCI • Bleeding • Risk score

Use of local intracoronary administration single bolus of combinationeptifibatide, streptokinase, and nitroglycerine in primary angioplasty

Z. MukhtarFaculty of Medicine, Department of Cardiology and Vascular Medicine, University ofSumatera Utara, H. Adam Malik General Hospital, Medan, Jakarta

Aims: Obtain the effects of local intracoronary single bolus administration of eptifi-batide, streptokinase, and nitroglycerine in order to get complete reperfusion of epi-cardial artery and microcirculation level in patients with TIMI 0/1 acute and sub-acute STEMI.Methods: This is a prospective non-randomised controlled study. In the case group af-ter recanalizing by thrombus aspiration catheter-TAC or balloon inflation. Use of TACadministered local intracoronary bolus 3.75mg eptifibatide followed by 100 KU strep-tokinase and after stent deployment given 300 mg nitroglycerine. Assessment of post-procedural TIMI and MBG is graded by two independent interpreter cardiologists whowere blind to all data apart from coronary angiogram. Echocardiographic assessmentpre and postprocedural.Result: We enrolled 111 patients (case) fulfilled inclusion criteria, between December2015 and January 2017 (13months). There were 99 males and 12 females, aged be-tween 35 and 78 years. Sixty five patients were anterior and 46 inferior wall infarct.Symptom to procedural time was 4.0–432h. Preprocedural 76 patients had TIMI andMBG 0, 35 patients had TIMI and MBG 1. Recanalization was done with balloon in 92

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and TAD 19 patients. Postprocedural 98 patients (88.3%) had TIMI and MBG 3, 13 pa-tients (11.7%) had TIMI and MBG 2. Echocardiogram showed elevation of LVEF 7.70–27.06%, Mean 15%. There were no significant hypotensive effect of intracoronary bolus300mcg NTG, allergic reaction, minor, and major bleeding, hospital mortality 3.6% and2 patients readmission within 30 days follow-up. We compared this result with a control65 colleagues’ patients, aged 35–80 years, treated with standard therapy. Forty pa-tients with anterior and 25 inferior infarct. Symptom to procedural time was 2.0–325h.Preprocedural 57 patients had TIMI and MBG 0, 8 patients had TIMI and MBG 1.Postprocedural 36 patients (55.4%) were TIMI and MBG 3, 26 patients (40.0%) were TIMIand MBG 2, 3 patients (4.6%) were TIMI and MBG 1. We found significant difference ofreperfusion P< 0.05, 95% confidence interval between two groups.Conclusions: The use of local intracoronary single bolus of eptifibatide, streptokinaseand nitroglycerine showed a successful dissolve of occlusive thrombus, reperfusionepicardial artery, and microcirculation level and improved LV function in patientswith acute and subacute STEMI.Keywords: Local intracoronary administration single bolus • Eptifibatide •Streptokinase • Nitroglycerine • Primary angioplasty

Relationship between vitamin D deficiencies with accelerated atherosclerosiscardiovascular diseases and diseases activities in systemic lupus erythematosuspatients: a systematic review and meta-analysis of observational studies

R.A. Nugraha1, F.F. Alkaff1, M. Jonatan1, A. Simon1, T.N. Octora2, and R. Yudiwati21Faculty of Medicine, Universitas Airlangga, Surabaya, 2Department of Biomedics,Faculty of Medicine, Universitas Airlangga, Surabaya

Background: Even though Indonesia as an equatorial country is rich in sunshine, sur-prisingly more than half of Indonesian people are prone to deficiency of vitamin D,especially women. It is believed that vitamin D plays a significant role in modulatingimmune system, renin-angiotensin-aldosterone (RAA) system, and endothelial func-tion, however no practical data available regarding the impact of hypovitaminosis Din systemic lupus erythematosus (SLE) patients in Indonesia.Aim: We aimed to evaluate the impact of vitamin D deficiency in the severity of SLE,especially in the appearance of ASCVD in SLE patients.Methods: This research was conducted using systematic review and meta-analysis ofobservational studies. The electronic databases (CENTRAL; Medline; Springerlink;Cochrane Database) were searched up to January 2017. Longitudinal study comparinglevel of serum 25-hydroxivitamin D in SLE patients with and without ASCVD eventswere included. Study selection, data extraction, and risk of bias assessment(Cochrane risk of bias tool) were performed by five reviewers.Results: A total of 16 trials (1723 participants) were included. Meta-analysis of 8 trials(781 participants) found that serum vitamin D (25-hydroxyvitamin D) levels in severeSLE patients with ASCVD manifestation were significantly lower compared to non-ASCVD SLE patients during remission (pooled RR 0.64; 95% CI¼ 0.34–0.77; P¼ 0.005).No statistically significant difference in serum vitamin D was observed in meta-analysisof other 8 trials (pooled RR 0.96; 95% CI¼ 0.54–1.7; P¼ 0.12). Moreover, there is a sig-nificant inverse correlation between serum vitamin D levels and Systemic LupusErythematosus Disease Activity Index 2000 (r¼�0.373, P¼ 0.016).Conclusion: Our data outline a strong relationship between vitamin D deficiency andASCVD events, thus it could be a novel risk in SLE patients. Recommendation for vita-min D supplementation which can improve immune system and stimulate endothelialrepair mechanisms in SLE patients still being studied.Keywords: ASCVD • Endothelial dysfunction • SLE • Vitamin D • 25-Hydoxivitamin D

Correlation between prolonged paced QTc interval with the incidence of atrialfibrillation in patients with ventricular base pacing

H. Balwel, Y. Yuniadi, and D.A. JuzarFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasIndonesia, Jakarta, Indonesia

Background: Implantation of permanent pacemaker (PPM) increasing in the last de-cades. Atrial fibrillation (AF) can also developed in patient using PPM. The possibleaetiology in these patients are because of the diastolic dysfunction in the right ven-tricle that impact the left ventricle and ventricular dissynchrony that can be seen asleft bundle branch block (LBBB). These abnormalities will impact to the left atrialand induced atrial fibrillation. There are many predictors for AF but we haven’tfound any study that correlate paced QT corrected (paced QTc) with the risk of AF inpatients PPM under ventricular based pacing.Aim: To determine the correlation between paced QTc with AF in patient implantedPPM.Methods: This is a case control study that was conducted in National CardiovascularCentre Harapan Kita Hospital Jakarta with subjects implanted PPM using doublechamber or single chamber with ventricular based pacing from January 2013 untilAugust 2014. The calculation of paced QTc using Framingham method.Result: There are total 75 subyeks in this study, 15 subjects developed AF (20%). Thepaced QTc using Framingham method was correlated well with AF. The cut-off valueof paced QTc was� 451.5ms and the risk to develop AF was 4.3 times.

Conclusion: Paced QTc can be used as a predictor of AF in patient with double cham-ber or single chamber PPM with ventricular based pacing.Keywords: Paced QTc • Atrial fibrillation • Electrocardiogram

Immediate and long-term outcome of patients underwent percutaneous balloonmitral valvuloplasty with atrial fibrillation compared to sinus rhythm

R. Diansari, I.S. Atmosudigdo, B.E. Putra, and O. LilyasariFaculty of Medicine, Department of Cardiology & Vascular Medicine, NationalCardiovascular Centre Harapan Kita, University of Indonesia, Jakarta, Indonesia

Background: Atrial fibrillation (AF) is an important and common cardiac arrhytmia inpatients with mitral stenosis. It is associated with haemodynamic and clinical decom-pensation. Percutaneous balloon mitral valvuloplasty (PBMV) is considered a treatmentof choice of mitral stenosis. This study aims to examine the influence of AF in patientswith mitral stenosis who underwent PBMV compared to patients with sinus rhythm.Methods: Between 2011 and 2013, 121 patients underwent PBMV in NationalCardiovascular Center Harapan Kita. The clinical and haemodynamic data were com-pared between 72 patients with AF and 49 patients with normal sinus rhythm.Immediate results using post-procedural mitral valve area and long term outcome us-ing incidence of major adverse cardiac event (MACE) including cardiovascular death,surgical valve repair and repeat PBMV were compared between these two groups.Results: Patients with AF were mostly adults above 20-years old (98.6%, P¼ 0.039),mostly female (73.6% vs. 71%, P¼ 0.791) and presented more frequently with NYHAclass III-IV (50% vs. 14.2%, P< 0.0001). Patients with history of previous PBMV mostlyhas AF (75%, P¼ 0.471). In patients with AF, PBMV has inferior immediate and long-term outcome as resulted in significantly lower mitral valve area (less than 1.5 cm2)after procedure (83% vs. 67%, P¼ 0.041) and higher incidence of MACE although nosignificant difference (13.9% vs. 10.2%, P¼ 0.546), compared to patients with sinusrhythm.Conclusion: Patients with AF are mostly adult above 20-years old and presented withhigher NYHA class compared to patients with sinus rhythm. Patients with AF alsohave significantly worse immediate outcome reflected in lesser post PBMV mitralvalve area. There were no significant differences of MACE incidence as a long-termoutcome predictor between both groups.Keywords: Percutaneous balloon mitral valvuloplasty • Atrial fibrillation • Sinusrhythm • Comparison • Outcome

Mitral annular plane systolic excursion as a parameter of left ventricular systolicfunction

M.N. Ginting1, Z. Efendi1, J. Suganti1, N.Z. Akbar2, Z. Mukhtar2, and A.A. Siregar21Department of Cardiology and Vascular Medicine, Faculty of Medicine University ofSumatera Utara, 2Division of Cardiovascular Medicine, H. Adam Malik GeneralHospital, Medan, Indonesia

Background: Left ventricular (LV) systolic function is the most important informationthat should be obtained during clinical echocardiography. In most patients, LV sys-tolic function could be estimated visually by echocardiography, but in certain condi-tions, such as patients with obesity, lung disease, or tachycardia, we may require al-ternative methods to evaluate the LV systolic function. Mitral annular plane systolicexcursion (MAPSE) has been suggested as a simple, surrogate measurement for LV sys-tolic function.Aim: To analyse if MAPSE which is easy to acquire could be used as a parameter of LVsystolic function.Methods: A total of 56 patients with coronary artery disease admitted from October–December 2016 at Cardiology Department Haji Adam Malik General Hospital wereretrospectively analysed. MAPSE measured from septal and lateral walls using thefour-chamber views by M-mode echocardiography. The M-mode cursor aligned paral-lel to the LV walls. The systolic excursion of the mitral annulus measured from thelowest point at the end-diastole to aortic valve closure (the end of the Twave on theelectrocardiogram). Patients were divided into MAPSE <8mm and �8mm. Thesemeasurements were compared with the assessment of LV systolic function usingDoppler by measuring the EF Simpson. LV systolic dysfunction was defined as LV ejec-tion fraction (LVEF) <40%. Bivariate analysis was performed to study the associationbetween MAPSE and left ventricular function, P-value <0.05 was considered statisti-cally significant.Results: From these 56 patients, we found there were 13 patients with MAPSE<8mm, 43 patients with MAPSE �8mm, 23 patients with LVEF <40% and 33 patientswith LVEF �40% . The bivariate analysis showed that LV systolic dysfunction was sig-nificantly higher in patients with MAPSE <8mm than MAPSE �8mm (52% vs. 48%; P-value <0.001; OR 34.90 95% CI 4.058–300.272). Further analysis revealed that MAPSE<8mm has a sensitivity 52%, specificity 96%, positive predictive value 92%, negativepredictive value 74% for predicting LV systolic function.Conclusion: MAPSE can be used as a simple and useful parameter of left ventricularsystolic function.Keywords: Mitral annular plane systolic excursion (MAPSE) • Left ventricular (LV) sys-tolic function

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Diagnostic test squatting stress echocardiography and coronary angiography indiagnosing coronary heart disease

A. Rahman, M. Yanni, and M. SyafriFaculty of Medicine, Department of Cardiology and Vascular Medicine, AndalasUniversity, Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Assessment and diagnosis of coronary heart disease (CHD) is very impor-tant since the burden of mortality, morbidity, and in the economy is big enough. In pa-tients with significant CAD, increased preload and afterload during a squat can causewall motion abnormalities (WMA) which can be detected on echocardiography. Thisstudy was conducted to determine the diagnostic value of stress echocardiographysquatting as a non-invasive examination of a relatively simple, inexpensive, and safe inthe detection of coronary artery stenosis in stable CHD and unstable angina patients.Methods: This study was a diagnostic test research with cross sectional design. Thesubjects were all patients with stable CHD and unstable angina low to moderate riskwhom were treated and scheduled for coronary angiography examination in InstalasiPusat Jantung RS. Dr. M. Djamil Padang from May to July 2016. Subjects underwentsquatting stress echocardiography procedures followed by coronary angiography.Diagnostic test was used to determine the sensitivity, specificity, positive predictivevalue, negative predictive value, and accuracy of squatting stress echocardiography.Results: Of 58 patients with CHD, there were 49 patients met the inclusion and ex-clusion criteria. There was a difference in decreasing of pulse rate and increasing ofsystolic and diastolic blood pressure during squatting stress echocardiography proce-dure. The sensitivity, specificity, and accuracy of squatting echocardiography for di-agnosis of CAD were 90.3%, 88.9%, and 89.7%, respectively.Conclusion: Squatting stress echocardiography can be proposed as a non-invasive ex-amination of a relatively simple, inexpensive, and safe in the detection of coronaryartery stenosis in patients with stable CHD and CHD unstable.Keywords: Squatting • Wall motion abnormalities

Correlation of left ventricle systolic function with endothelial progenitor cellnumber in autologous bone marrowmononuclear cell from ischaemic heartdisease patient with stem cell therapy

C. Primasari, R. Sukmawan, and A.S. KoencoroFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia

Background: Myocardial infarct still carries significant morbidity in post infarctionpatients. This condition triggers many studies in stem cell therapy for myocardial re-generation after infarction. Endothelial progenitor cell as the component of bonemarrow mononuclear cell was one of determinant factor in migration capacity ofbone marrow mononuclear stem cell. Left ventricle systolic function has becomingone of determinant factor in selection of stem cell patient. No previous study hasevaluated the influence of decreased LV systolic function to the numbers of endothe-lial progenitor cell in bone marrow mononuclear cellAim: Evaluating correlation of LV systolic function and other risk factors of coronaryheart disease to the numbers of endothelial progenitor cell in bone marrow mononu-clear cell, from ischaemic heart disease patients with stem cell therapyMethods: This is a cross sectional study that was conducted in NationalCardiovascular Centre Harapan Kita on October 2016. Patients from two previousstem cell study in NCCHK enrolled to this studyResults: There were 21 patients in this study that undergo stem cell therapy fromOctober 2015 until September 2016. Factors that being analysed in this study were LVsystolic function and risk factors of coronary heart disease including hypertension, dia-betes mellitus, and history of cigarette smoke. Statistical analysis showed no significantcorrelation between LV systolic function and absolute numbers of endothelial progeni-tor cell in bone marrow mononuclear cell from patients with ischaemic heart disease(r:�0.350, P: 0.13). Significant result showed by correlation of bone marrow mononu-clear cell with LV systolic function, body mass index and hypertension (P> 0.05).Conclusion: LV systolic function has no significant correlation with absolute numbersof endothelial progenitor cell in bone marrow mononuclear cells from patients withischaemic heart disease.Keywords: Endothelial progenitor cell • Bone marrow mononuclear stem cell • Leftventricle systolic function

Effect of atorvastatin on interleukin-4 expression in mitral valve of rheumaticheart disease

A. Tonang1, I. Uddin1, S. Budijitno2, S. Fatah2, and Y. Herry11Faculty of Medicine, Department of Cardiology and Vascular Medicine, University ofDiponegoro, Semarang, Indonesia, 2Faculty of Medicine, Departement of Surgery, Dr.Kariadi Hospital Semarang, University of Diponegoro, Semarang, Indonesia

Background: Rheumatic heart disease is a chronic disease in heart valve resulting af-ter molecular mimicry of Streptococcus antigen. Progressivity occurs because of di-minished expression of anti-inflammatory cytokine interleukin (IL)-4. Various

therapeutic approaches attempt to delay the progressivity of the disease. Statin hasa pleiotropic effect as an anti-inflammatory; nevertheless researches in rheumaticheart disease remained scarce.Objective: To prove that there are differences in the expression of IL-4 in patientswith mitral valve rheumatic heart disease using atorvastatin.Method: A quasi-experimental clinical study was done in mitral valve rheumaticheart disease patients who underwent mitral valve replacement (MVR) surgery fromAugust to November 2015. Samples were randomized to receive standard medicaltherapy alone or standard medical therapy plus atorvastatin 40mg/day for at least2weeks before MVR. Native mitral valve was taken during MVR and quantitative im-munohistochemistry examination of IL-4 was performed.Result: During the study period there were 37 MVR, and 32 of them caused by rheu-matic heart disease thus were subsequently randomized into two groups each of 16samples. There were 1 sample dropped-out in the atorvastatin group, thus 31 sam-ples were analysed. All samples completed the study period without serious side ef-fects. There was significant increase in IL-4 expression in atorvastatin group vs. with-out atorvastatin (2.51%6 1.52 vs. 1.52%6 1.06; P¼ 0.044, subsequently).Conclusion: Atorvastatin increase the expression of cytokine IL-4 in patients with mi-tral valve rheumatic heart disease.Keywords: Interleukin-4 • Atorvastatin • Mitral valve rheumatic heart disease

High potassium level as a predictor of in-hospital mortality among hospitalizedacute heart failure patients

S. Ginting1, A.A. Siregar2, Z. Mukhtar2, and Z. Syahputra11Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department ofCardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia

Background: Serum potassium is routinely measured at admission for acute heartfailure (AHF) but information on association with clinical variables and prognosis islimited. In this study, we investigated the association between serum potassium levelon admission with mortality in hospital in acute heart failure (AHF) patients.Methods: Two hundred and fifty-five AHF patients were enrolled in the retrospectivecohort study. The data were collected from January 2015 to June 2016. Bivariate andmultivariate analyses were applied.Results: We calculated 134 (52.5%) patients survive and 121 (47.5%) patients dead inthis study. 30.6% with acute lung oedema, 30.6% with acute decompensated heartfailure and 26.7% patients with cardiogenic shock. According to bivariate analysis,age, haemoglobin (Hb), serum sodium level, serum potassium, creatinine, ejectionfraction, arrhythmia, and QRS duration were significant. In the multivariate logisticregression analysis, serum potassium� 5.5 mEq/l (P¼ 0.01 OR 4.42 95% CI: 1.38–14.932) as an independent predictor of in-hospital mortality, together with Hb(P¼ 0.00 OR 4.13 95% CI: 1.965–8.718), Arrhythmia (P¼ 0.00 OR 16.695 95% CI: 6.05–45.71) and QRS duration (P¼ 0.00 OR 11 95% CI: 5.146–26.64).Conclusion: High potassium level� 5.5 mEq/L was significant to predict in hospitalmortality among hospitalized AHF patients.Keywords: Serum potassium level • AHF • Hospital mortality

Electrocardiogram P-wave initial force to estimate pulmonary hypertension inadult patient with atrial septal defect

A. Pradhana1, D.W. Angrahini1, B.A. Hartopo1, and L. Krisdinarti21Faculty of Medicine, Departement of Cardiology and Vascular Medicine, GadjahMada University, Yogyakarta, 2Faculty of Medicine, Electrocardiography Division,Departement of Cardiology and Vascular Medicine, Gadjah Mada University,Yogyakarta, Indonesia

Background: Atrial septal defect (ASD) is most common congenital heart diseasewith incidence 56 per 100 000 births. Prevalence of pulmonary hypertension (PH) inadult patients with congenital heart disease is estimated between 1.6 and 12.5 mil-lion cases. PH in patients with congenital heart disease can increase mortality up totwofold and increase morbidity by threefold compared to congenital heart diseasepatients without PH. The main method used in diagnosing PH is right heart catheteri-zation, which is only available in tertiary healthcare centre. Electrocardiography isreadily available in primary healthcare centres and can be used to estimate PH byusing electrocardiogram P-wave Initial Force (PIF). The aim of this study is to see thespecificity and sensitivity of electrocardiogram PIF to predict PH in adult patientwith atrial septal defect.Methods: Design of this study cross-sectional with 104 subjects taken from registrydata of ASD in Cardiology and Vascular Medicine Department RSUP Dr. Sardjito,Yogyakarta. Data of heart catheter result are used to difference ASD patient with PHand without PH. Data of electrocardiogram result taken from medical record to seePIF. Whether PIF which exceeds 0.06mm on V2 and V1 lead indicate the possibility ofPH. Collected data are analysed using SPSS application with Chi-square analysis.Results: There is significant difference (P< 0.05) in PIF>0.06mm-s on V2 lead andPIF>0.06mm-s on V1 lead to estimate PH in adult patient with ASD, PIF also has sig-nificant difference where ASD patients with PH tend to have more right atrium en-largement compared to ASD patients without PH.

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Conclusion: From electrocardiogram PIF on V1 lead show 80.7% on specificity and53.8% of sensitivity to estimate PH in adult patient with ASD.Keywords: Electrocardiogram • P-wave initial force • Atrial septal defect •Pulmonary hypertension

Association of carotid intima-media thickness with critical limb ischaemiaincidence in diabetes mellitus patients

M.T. Ismail, A. Damarkusuma, D.H. Pradipta, and H. HariawanFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasGadjah Mada, Yogyakarta 55284, Indonesia

Background: As one of the non-communicable diseases, diabetes mellitus (DM) bringsa major global health problem with its complication or comorbid condition. Reducingthe DM burden is also one of the challenges by physicians in the world. One of thevascular complications is the peripheral artery disease (PAD) that could increase am-putation risk particularly in the critical limb ischaemia (CLI) state as the progressivityof the PAD worsened. Carotid Intimal-Media Thickness (CIMT) is one of the athero-sclerotic measurements that stated in some studies as predictors of vascular diseases(i.e. stroke, coronary artery disease). However, CIMT measurement to predict CLIevent in DM patients is not well studied. This study aims to observe the associationbetween CIMT and CLI in DM patients.Methods: A cross-sectional analytic study was done from vascular registry patients whoadmitted at Sardjito General Hospital since April to October 2016. All DM patients ad-mitted this registry underwent Doppler ultrasound assessment by the standard proto-col. Clinical characteristics and demographic data were collected from this registry.Results: From this registry, 51DM patients were included in this study which 14 (27.4%)of them were diagnosed CLI and the rest as a control. The mean of age was59.00610.02 and female sex (n: 30, 57.1%) are dominance in this study. Independentt-test was done to observe the CIMT mean difference between CLI group and controlgroups. The mean CIMTs were 0.896 0.04mm and 0.7360.03mm in CLI patients andcontrol group respectively. There was 0.16 difference with strong evidence (P: 0.006)Conclusion: In DM populations, the mean CIMT of CLI patients is shown higher thanthe control (without CLI) group with a strong evidence. However, further study withbigger sample is needed to justify this resultKeywords: Vascular disease • Critical limb ischaemia • Diabetes mellitus • Carotidintimal media thickness

Correlation between left atrial volume index and severity of mitral valvestenosis and pulmonary hypertension in mitral stenosis

G.M. Rahman and A. SubagjoFaculty of Medicine, Cardiology and Vascular Medicine Department, Dr SoetomoTeaching Hospital, Airlangga University, Surabaya, Indonesia

Background: Left atrial (LA) pressure and transmitral pressure gradient are chroni-cally increased in mitral stenosis (MS), that resulted in LA enlargement and pulmo-nary hypertension (PH). We aimed to investigate the correlation between left atrialvolume index (LAVI) and severity of mitral valve stenosis as well as PH in MS.Methods: The echocardiographic data of 59 subjects with MS (27 men and 32women), mean ages 41.36 9.51 years were evaluated in this study. All echocardio-graphic assessments were performed according to criteria of American Society ofEchocardiography (ASE). We examined the correlation between LAVI and parametersof mitral valve stenosis and PH (MVA Planimetry, MVA by Mean PHT, MVA VTI, TRVmax, TR maxPG, and Est PASP). We also determine the LAVI cut-off value as an indi-cator for severe MS.Results: Most of the subjects had severe MS (77%), mild PH (40%), and atrial fibrilla-tion (80%). LAVI markedly increased in this study (Mean: 83.796 38.32mL/m2). LAVIsignificantly correlated with MVA Planimetry, MVA by Mean PHT, MV Mean PG, and EstPASP (�0.40; �0.42; 0.27; 0.42 and 0.27 P< 0.05, respectively). LAVI cut-off valueas an indicator for severe MS was 59.72mL/m2, with the sensitivity and specificitywas 75.3% and 66%, respectively.Conclusion: LAVI significantly correlated with severity of mitral valve stenosis and PHin MS. LAVI also can be used as an indicator for severe MS.Keywords: Left atrial volume • Severity • Mitral stenosis • Pulmonary hypertension

Body mass index affects mesenchymal stem cells content in autologous bonemarrowmononuclear cells of patients with ischaemic heart disease whounderwent stem cell therapy

M. Silalahi, R. Sukmawan, C. Primasari, E. Listyaningsih, and D. TobingFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita Hospital, University of Indonesia, Jakarta, Indonesia

Background: Current medical treatment and intervention in heart failure due toischaemic heart may only improve clinical condition without repairment of damaged

heart muscle cell. Mesenchymal stem cells (MSC) taken from autologous bone mar-row stem cells have been used to regenerate cardiomyocyte in ischaemic or in-farcted heart. However, results from several studies have shown modest outcomes. Itmay be caused by several factors including inadequate number and function of trans-planted stem cells. Factor that affecting MSC levels in bone marrow mononuclearcell (BMMC) in patients with ischaemic heart disease remains unknown.Aim: To assess factors affecting MSC levels in BMMC in patients with ischaemic heartdisease who underwent stem cell therapy.Methods: Subjects were patients with coronary heart disease who have left ventricu-lar ejection fraction (EF) <35%. Subjects were selected consecutively among pa-tients who already scheduled for stem cell therapy. About 180 cc bone marrow aspi-rate was obtained from each patient for the therapy. After separation andpurification, samples of BMMC were analysed using Flowcytometer FACS-ARIA III toknow the number of MSC on each ml of BMMC. Correlation of clinical, demographic,and risk factors of the patients to the concentration of MSC were defined.Results: Total sample of BMMC was taken from 20 patients. The mean age of patientswas 546 9.62 years. Most of the subjects were male (95.2%). The mean of left ven-tricular ejection fraction was 27.196 7.16%. The mean percentage of MSC in BMMCwas 0.22% (0.03–1.07%). The absolute number of MSC within 1mL aspirate was 3.62(0.197–14.46)� 106 cells. We found significant positive correlation between bodymass index and the MSC number on each ml of BMMC (r¼ 0.602, P¼ 0.004).Conclusion: There is a relationship between BMI and MSC levels on BMMC in patientswith ischaemic heart disease with low EF underwent stem cell therapy. This suggeststhat BMI of each patient should be considered to obtain adequate number of MSC inBMMC for cell therapy.Keywords: Bone marrow mononuclear cell • Mesenchymal stem cell • Ischaemicheart disease

Autopsy findings in patients with sudden cardiac death

I.N.I. Mataram1, I.G.N.P. Gunadhi2, A.A.D.A. Yasmin2, and I.B.P. Alit21Department of Cardiology and Vascular Medicine, Udayana University, SanglahGeneral Hospital, Denpasar, Bali, 2Department of Forensic Medicine, UdayanaUniversity, Sanglah General Hospital, Denpasar, Bali

Background: Sudden cardiac death (SCD) among people was increasing worldwide.About 1–2 per 1000 people died in USA annually due to SCD. SCD was higher amongmen than women. Coronary artery disease as a leading cause of death. Died sug-gested within 1 h from the onset, with or without prodromal symptoms, was interest-ingly explored by an autopsy. This study is aimed to determine cause of death and alocation of coronary arteries lesion from an autopsy and pathological findings.Methods: We conducted a cross sectional descriptive study to whom suggested had asudden cardiac death and undergone an autopsy from January 2015–December 2016in Forensic Laboratory. Patient’s data include age, sex, cause of death, location anddegree of coronary occlusion, and abnormalities from other organs. This research didnot include risk factors of patient, due to retrospective data, cost and limited infor-mation from autopsy and pathology report. All subjects were described and tabu-lated. Data analysis using descriptive.Results: In 2 years from January 2015–December 2016, 16 patients whom suggested asudden cardiac death, had undergone an autopsy. Male 75% and women 25%, withage mean 59.196 2.602, the youngest is 40-years old and the oldest is 77-years old.The most common cause of death is coronary artery disease (68.8%) and most af-fected artery branch is left anterior descending artery. Highest percentages of occlu-sion are located at 3 cm from main branch of left anterior descending artery, mean32.56 35.4%. The most common organ beside of heart that showing an abnormalityfrom pathology is lungs (62.5%).Conclusion: Coronary artery disease as a leading cause of sudden cardiac death fromthis study. It is clearly seen from pathological changes which are showing narrowinglumen of coronary arteries and its branches.Keywords: Sudden cardiac death • Coronary artery disease • Coronary occlusion

Door to revascularization time of STelevation myocardial infarction in SaifulAnwar Hospital-Malang

M. Abusari, T. Andrianto, Hendrawati, F. Rahman, V. Kurniawati, M.T. Hapsito, andC.T. TjahjonoFaculty of Medicine, Department of Cardiology and Vascular Medicine, Saiful AnwarGeneral Hospital, Brawijaya University, Malang, Indonesia

Background: Time to revascularization is very important in ST elevation myocardialinfarction. According to ESC/ACC/AHA guideline of ST elevation myocardial infarctionthe door to needle time is 30min and the door to balloon is 90minAim: To determine the current door-to-revascularization time for the administrationof fibrinolytics and primary PCI for acute myocardial infarction (AMI) in RSSA Malang.Methods: A retrospective review of case notes from July 2016 to January 2017 of allpatients who had complete data and underwent revascularization either fibrinolyticor primary PCI for AMI in RSSA Malang. The total door-to-revascularization was calcu-lated and patient baseline characteristic was noted

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Results: A total of 27 patients with acute ST elevation myocardial infarction (STEMI)were identified and eligible for the study. Sixteen patients underwent fibrinolyticsand 11 patients underwent primary PCI. The mean door-to-needle time achieved was209min (range 80–360min). The mean door-to-balloon time achieved was 149min(range 90–240min). There were no patient received revascularization within 30minin fibrinolytics strategy and there was 1 patient underwent procedure within 90minof door to balloon in primary PCI strategy. The mean onset of symptoms patients was6 h. The predominant infarct location on ECG was inferoposterior (40%).Conclusion: A number of patients were not given fibrinolyticswithin 30min and mostprimary PCI were not performed within 90min. There were still delay time of revas-cularization time in RSSA Malang. Patient and Hospital system delayed the door-to-revascularization time in this study.Keywords: Revascularization time • STelevation myocardial infarction

Mitral annular plane systolic excursion as parameter of the left ventriclediastolic function

Z. Efendi, M.N. Ginting, N.Z. Akbar, and A.A. SiregarFaculty of Medicine, Department of Cardiology and Vascular Medicine, Haji AdamMalik General Hospital, Universitas Sumatera Utara, Medan, Indonesia

Background: Assessment of left ventricular diastolic function is an important part ofroutine echocardiographic examination and the clinical significance is important toidentify the underlying heart disease and determine the appropriate treatment.Mitral annular displacement toward the apex in systole plays important role in pumpfunction of the left ventricle. At the start of diastole, the atrioventricular (AV) planebegins to ascend rapidly toward the atrium away from the apex. Atrial systole alsocontributes to ventricular filling by further displacing the AV plane in the same direc-tion, and this notice as the last part of the diastolic phase of AV plane displacementand is associated with the P wave of electrocardiogram.Methods: Analysis was conducted on 56 subjects who underwent routine echocardi-ography. Mitral annular plane systolic excursion was measured from septal walls usingthe four-chamber views by M-mode echocardiography in mm. The M-mode cursoraligned parallel to the LV walls. The systolic excursion of the mitral annulus mea-sured from the lowest point at the end-diastole to aortic valve closure (the end ofthe T wave on the electrocardiogram).These measurements are compared with theassessment of left ventricular diastolic function using Doppler on mitral inflow (E’).Results: Mitral annular plane systolic excursion with cut-off value �9.75 for left ven-tricular diastolic dysfunction has sensitivity 50%, specificity 53%, positive predictivevalue 7%, and negative predictive value 93%.Conclusion: The results of this study indicate that measurement of mitral annularplane systolic excursion has a good correlation with LV diastolic function so it can beused as a parameter determining LV diastolic function.Keywords: Mitral annular plane systolic excursion • Mitral annular displacement •Diastolic function • Echocardiography

The prognostic value of elevated serum creatinine at admission in patients withcardiogenic shock without mechanical support

D. Yulianda, Z. Syahputra, H. Hasan, A. Sitepu, Z. Mukhtar, and A.A. SiregarFaculty of Medicine, Department of Cardiology and Vascular Medicine, Adam MalikGeneral Hospital, Universitas Sumatera Utara, Medan, Indonesia

Background: Cardiogenic shock is the leading cause of death in the world. The useof mechanical support in patients with cardiogenic shock is very important, unfortu-nately not all hospitals have this equipment. Elevated serum creatinine (SCr) has im-portant prognostic implications in critically ill patients, but the effects in the subsetof patients with cardiogenic shock without the use of intra-aortic balloon pumping(IABP) are not known. The aim of this study is to find out prognostic value of eleva-tion SCr at admission in patient with cardiogenic shock without mechanical support.Methods: This was a retrospective study of 65 patients with cardiogenic shock whoadmitted between January and December 2016 at Haji Adam Malik General Hospital.Elevation of SCr defined as a SCr level >1.5mg/dL based on the baseline levels ofSCr in the control cohort of the Framingham Study. This study calculated the risk ofin-hospital mortality associated with elevated SCr on admission and other comorbidfactors using bivariate and multivariate analysis.Result: s: There were 65 patients with cardiogenic shock and mostly with acute myo-cardial infarction as the cause. As many as 34 patients (52.3%) had elevated SCrwithin 24 h after the onset of shock. In-hospital mortality was 91.2% in patients withelevated SCr. Patients with SCr >1.5mg/dl have the higher rate of in-hospital mor-tality [odds ratio (OR) 5.68; 95% confidence interval (CI) 1.4–22.9; P¼ 0.009]. Othersignificant bivariate predictors of mortality included haemoglobin level <13mg/dL(OR 7.09; 95% CI 0.8–58.6; P¼ 0.04). Logistic regression analysis showed that ele-vated SCr was the only independent predictor for in-hospital mortality (OR 4.83; 95%CI 1.16–20.09, P¼ 0.03).Conclusion: Elevation of SCr at admission in patients with cardiogenic shock withoutmechanical support associated with in-hospital mortality. Elevation of SCr could be a

critical value to do more aggressive management and to monitor the patient morestringent.Keywords: Serum creatinine • Myocardial infarction • Mortality • Cardiogenicshock • Mechanical support

Neutrophil-lymphocyte ratio as predictor in-hospital major cardiovascularevents in acute coronary syndrome patients

H. Medishita1, I. Uddin2, S. Rifqi2, and Y. Herry21Faculty of Medicine, Department of Cardiology and Vascular Medicine, DiponegoroUniversity, Semarang, Indonesia, 2Faculty of Medicine, Department of Cardiology andVascular Medicine, Dr Kariadi Hospital, Diponegoro University, Semarang, Indonesia

Background: The neutrophil/lymphocyte ratio (NLR) has recently been proposed aspredictor of coronary stenosis severity in patients with acute coronary syndrome(ACS), but there is lack of data about the utility of NLR to predict major cardiovascu-lar events (MACE) among different subsets of ACS. The aim of this study is to investi-gate the utility of admission NLR in predicting in-hospital MACE in patients with dif-ferent ACS subsets, specifically STEMI and NSTEMI.Aim: To examine the ability of NLR as predictor of in-hospital MACE among ACSpatients.Methods: A clinical observational study was held in ACS patients who admitted inCardiac Emergency Unit, Kariadi Hospital during July–September 2016. We included70 consecutive patients and performed haematology examination. We analysed theNLR and performed follow up to observe MACE during hospitalization.Results: Seventy patients who meet the inclusion criteria were enrolled in the study. Areceiver operating characteristic (ROC) curve was drawn from the NLR data, we foundthat NLR >4.2 correlates with increased risk of in-hospital MACE [relative risk (RR)5.44; 95% confidence interval (CI) 2.36–12.56] in both group. Multivariable logistic re-gression analysis indicates that NLR is the strongest predictor for in-hospital MACEamong ACS patients (P� 0.001). We perform further analysis on each clinical subsetgroup STEMI and NSTEMI, and we found that on both groups the NLR remains statisti-cally significant in predicting in-hospital MACE (P� 0.001 and 0.004, respectively).Bivariate analyses showed that Troponin, Killip class and RNL play role in predicting in-hospital MACE, but multivariate regression analysis shows that Killip class is weakerthan NLR in determining MACE (P¼ 0.013). The final result concludes that NLR is thestrongest predictor of in-hospital MACE (P¼ 0.000), despite subsets of ACS.Conclusion: The NLR is the strongest predictor in occurrence of in-hospital MACEamong ACS patients despite clinical subsets.Keywords: Neutrophil/lymphocyte • Coronary syndrome • Cardiovascular events

Six-minute walk test as a predictor of maximum oxygen consumption aftercoronary artery bypass graft surgery

M.R. Amalia1, P. Wulandari2, M.A. Callista3, F. Tedjasukmana3, A. Nofandra3, andB. Radi31Department of Cardiology and Vascular, Diponegoro University, Semarang, Indonesia,2Department of Cardiology and Vascular, University of Sebelas Maret, Surakarta,Indonesia, 3Department of Cardiology and Vascular, University of Indonesia, Jakarta,Indonesia

Background: Maximum oxygen consumption (Vo2max) is defined as a maximal capacityof an individual to perform aerobic work, which is the product of cardiac output (CO)and arteriovenous oxygen (AV O2) difference at exhaustion. As the oxygen consumptionincreases after cardiac surgery, cardiopulmonary exercise becomes an important toolto measure and to assess functional capacity of the body. The purpose of this study isto investigate the relation between post-operative oxygen consumption and the func-tional exercise capacity by six-minute walk test in coronary artery bypass graft (CABG)surgery. The distance walked during six-minute walk test (6 MWD) in this study is usedas a predictor to measure Vo2max in patients undergone CABG surgery.Methods: Twenty-one patients that have completed Phase I and Phase II cardiac reha-bilitation with cardiopulmonary exercise (CPX) in National Cardiovascular CenterHarapan Kita Hospital between 2015 and 2016 were analysed. VO2max (mL/kg/min)based on age and gender is divided by excellent (�90), good (70–90), average (30–70), fair (10–30), and poor (�10). This is an observational study with cross-sectionalretrospective. Secondary data were taken from outpatient medical record, and werepresented as mean, median (minimum–maximum), bivariate analysis using paramet-rics method if the data are normally distributed (t-test) and non parametrics methodif they are not normal (Mann–Whitney test).Results: VO2max is higher in patients with 6 MWD in early Phase II> 500 m. As aver-age group correlates significantly to distance of 6 MWD> 500 m in men (P¼ 0.02) andwomen (P¼ 0.01). Bivariate analysis shows P-value of heart rate 0.001, VE/VCO2

0.03, BMI 0.12, smoking 0.25, diabetes mellitus 0.35, dyslipidaemia 0.40, family his-tory of CAD 0.55, and hypertension 0.043.Conclusion: Six MWD in the beginning of Phase II cardiac rehabilitation can predictthe maximum capacity of oxygen consumption measured by the cardiopulmonary ex-ercise test, done at the end of phase two.Keywords: Six-minute walk test • Vo2max; CABG

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Effect of the obstructive sleep apnoea risk level to the probability of theischaemic strokes occurrence based on Framingham study of residents inSekarbela District Mataram

S.K. Evelin1, H.S. Harahap2,3, and Y. Pintaningrum2,4

1Faculty of Medicine, Universitas Mataram, Mataram, Indonesia, 2Faculty ofMedicine, Division of Cardiology, Universitas Mataram, Mataram, Indonesia,3Department of Neurology, West Nusa Tenggara General Hospital, Mataram,Indonesia, 4Department of Cardiology, West Nusa Tenggara General Hospital,Mataram, Indonesia

Background: Stroke is the highest cause of disability in Indonesia, with ischaemicstroke as the type of stroke with highest incidence rate. Ischaemic stroke can be pre-dicted using a risk factor assessment based on Framingham study. Besides risk factorsthat have been included in Framingham Study, ischaemic stroke has other independentrisk factor, which is obstructive sleep apnoea (OSA). The prevalence of OSA is deter-mined based on the screening tests using various instruments, STOP-BANG question-naire is the instrument with highest sensitivity to assess the level of the OSA risk. Theeffect of OSA to the ischaemic stroke is not fully understood because lack of researchin this field. This research aims to determine the effect of OSA to the ischaemic stroke.Methods: This research is a non-experimental study with cross-sectional approach.The sample was conducted in Sekarbela District Mataram. The research began withbrief interview based on inclusion and exclusion criteria, then the research subjectwas interviewed and examined for risk assessment of OSA based on STOP-BANG ques-tionnaire and was examined for the probability assessment of ischaemic stroke basedon Framingham study. Data were analysed by using Mann–Whitney test.Results: Of the 55 sample, 67.3% have a high risk to OSA with the mean of probabilityof ischaemic stroke is 7.96%, and 32.5% have a low risk to OSA with the mean ofprobability of ischaemic stroke is 2.08%. Based on comparison using Mann–Whitneytest, showed that the level of OSA risk significantly affect the occurrence probabilityof ischaemic stroke (P¼ 0.003).Conclusion: There is an influence of level of risk of OSA to the occurrence probability ofischaemic stroke based on Framingham Study on residents in Sekarbela District Mataram.Keywords: Obstructive sleep apnoea • ischaemic stroke • STOP-BANG question-naire • Framingham Study

Blood pressure improvement in hypertension patients in primary health care atGorontalo rural area 2015/2016

F. Sania1, V. Tryani1, and R. Kumala21Internship Doctor Program, Paguyaman Medical Center, Gorontalo, Indonesia,2Paguyaman Medical Center, Gorontalo, Indonesia

Background: Hypertension is the leader of global morbidity and mortality, 80% of thisglobal burden being borne by developing countries including Indonesia. Estimated about25.8% people in Indonesia have hypertension, even higher in Gorontalo, about 29.4%. Tohelp manage this, there is Chronic disease management program or PROLANIS as commu-nity treatment. The aim of PROLANIS is to increase quality of life in chronic disease pa-tient, including hypertension and its complication. So it is important to know whether thisprogram helps improve blood pressure control in hypertension in primary health care.Methods: Cross-sectional study was conducted to 157 hypertensive patients, who al-ready diagnosed with hypertension in clinic and registered to PROLANIS program. Thedata were examined to show how PROLANIS affect trends of blood pressure control.Analysis was conducted to show trends of blood pressure through period of visits.Results: Patient mean age is 57.25 (610.05) with 70.1% is women. Majority havecomorbidities such as diabetes (4.5%), dyslipidaemia (51%), or both (19.1%). Averagefollow-up are 16 (2–20months), and with 12 (2–20) visits. About 68.8% have good at-tendance. Baseline blood pressure is 160 (100–270) for systole and 90 (60–150) for di-astole. About 64.3% have uncontrolled hypertension in 1st visit become 42.2% in 3rdvisit (P< 0.005). We also found that there is significant reduction from 1st to 3rd visitwith mean systole 160.61 (28.1) and 147.46 (22.054) (P< 0.005). Mean for diastole is91.05 (15.8) for 1st visit, and 84.39 (11.9) for 3rd (P< 0.005).Conclusion: The trend of blood pressure has improved among hypertensive adults af-ter three visits. There is decrease of systolic and diastolic blood pressure amongPROLANIS member.Keywords: Hypertension • Primary health care • Prolanis • Community treatment

Mortality rate of intra-aortic balloon pump patients underwent heart valvesurgery in adult ICU National Cardiovascular Heart Center Hospital, Jakarta,Indonesia

D. Rachmaniah1, F.S. Laitupa1, and R. Zahara21Faculty of Medicine, Department of Cardiology and Vascular Medicine, University ofBrawijaya, Malang, Indonesia, 2Faculty of Medicine, National Cardiovascular HeartCenter Hospital, University of Indonesia, Jakarta, Indonesia

Background: Intra-aortic balloon pump (IABP) is a temporary mechanical circulatorysupport device for cardiac surgery patients suffered from low-cardiac output in the

peri-operative phase. The main indication of IABP used in cardiac surgical patients isperi-operatively in the treatment of a low-cardiac output state refractory to theusual inotropic support. Using of IABP in heart valve surgery remains controversial.The aim of this study was to describe IABP profile in heart valve surgery includingmortality and length of stay in ICU.Methods: This is a retrospective study of 775 consecutive adult patients underwentheart valve surgery, that was conducted for 2 years from January 2014 untilDecember 2015. All patients were divided into two groups: (i) heart valve surgery pa-tients with IABP support (n¼ 16) (ii) heart valve surgery patient without IABP support(n¼ 759). All groups were measured for mortality rate in ICU. We also describe someclinical characteristic including sex category and length of stay. Statistical analysiswas conducted using Fisher exact test, for non-parametric data.Results: IABP was used in 16 patients (2.06%) of all 775 heart valve surgery patients.The samples consist of 533 females and 242 males. Mean of length of stay was 5.06days in IABP patients. Mortality rate of IABP patients was higher (n¼ 7 (46.7%)) thannon-IABP patients [n¼ 31 (3.2%)], and overall it’s statistically significant (P¼ 0.000).Conclusion: Overall, mortality rate of IABP group was higher than non IABP. Mean oflength of stay IABP group in ICU was 5.06 days. Although the mortality was higher inIABP group but numbers reported are very small to derive conclusions. This remainsto be tested with appropriate trials.Keywords: IABP • Heart valve surgery • Mortality

Microorganism profile, sepsis, and mortality rate of infective endocarditis inchildren at National Cardiovascular Center Harapan Kita, Jakarta

N.C. Proklamartina, P.S. Roebiono, O. Lilyasari, R. Andriyati, Ruswandiani,A.U. Rahajoe, I. Sakidjan, R. Prakoso, Y. Kurniawati, and G.M. HarimurtiFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasIndonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

Background: Infective endocarditis (IE) is associated with considerable morbidityand mortality despite improvements in its management. Experimental data and clini-cal observations indicate that some bacteria are more commonly associated with IEthan others due to bacterial adherence. Sepsis state is one of the independent pre-dictors of in-hospital mortality in the setting of IE.Aim: The aim of this study is to describe the association between microorganism,sepsis, and mortality in paediatric IE patients in National Cardiovascular CenterHarapan Kita in 2015–2016.Methods: Retrospective single-centre study was carried out in 35 children with IEduring 2-year period. Variables include microorganism profile from three consecutiveblood culture, sepsis, and mortality. Data were obtained from medical records andanalysed with SPSS version 22.Results: A total of 35 IE patients with median age 11.7 (3–18)-years old, 17 (48.6%)showed positive blood culture with Streptococcus anhemolyticus as the most fre-quent microorganism (52.9%). Sepsis rate was higher in positive blood culture com-pare to negative result (P¼ 0.04), while mortality rate did not differ significantly(P¼ 1.00). Fourteen (82.4%) of 17 patients with positive blood cultures showed grampositive bacteria. Only 2 patients with gram negative bacteria and 1 patient withboth gram positive and negative bacteria. Sepsis was found in 10 (71.4%) of 14 pa-tients with gram positive bacteria, while all patients with gram negative bacteria ex-perienced sepsis. Two patients died during hospitalization, one with gram negativebacteria and the other was undocumented. These two patients were presented tothe hospital in sepsis condition, but no significant difference was found between chil-dren with sepsis and without sepsis in term of mortality rate (P¼ 0.50).Conclusion: Nearly half of children with IE showed positive blood culture with majoritywas gram positive bacteria. Positive blood culture was associated with a significantlyhigher sepsis rate, while mortality rate was similar between children with positive andnegative blood culture. Sepsis condition did not increase mortality rate in these patients.Keywords: Children • Infective endocarditis • Microorganism • Mortality • Sepsis

Jones criteria findings in children with rheumatic fever reactivation withestablished rheumatic heart disease at National Cardiovascular Center HarapanKita, Jakarta: 10-year experience

A.P. Dewita, O. Lilyasari, P.S. Roebiono, A.U. Rahajoe, I. Sakidjan, R. Prakoso,Y. Kurniawati, and G.M. HarimurtiFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia

Background: Recurrent attacks of rheumatic Fever (RF) in patients with establishedrheumatic heart disease (RHD) caused permanent damage to the valves. RevisedJones criteria are used as universal standard for the diagnosis of RF.Aim: This study aimed to review the findings of major and minor manifestations ofJones criteria of RF reactivation in children with established RHD.Methods: This retrospective study conducted at National Cardiovascular CenterHarapan Kita, Jakarta, as the tertiary cardiovascular centre in Indonesia fromJanuary 2006 to December 2015. Diagnosis of RF reactivation based on revised Jonescriteria and 2002–2003 WHO criteria.

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Results: There were 147 children with RF with the median age of 13 (2–17) years in-cluded in this study. Among them, 74 (50.3%) were male and 73 (49.7%) female. Majormanifestations of Jones criteria were carditis in 64 (43.5%) cases, polyarthritis in 31(21.1%) cases, subcutaneous nodules in 7 (4.8%) cases, erythema marginatum in 5 (3.4%)cases and chorea in 1 (0.7%) case. None of two major manifestations were found. Therewas no significant difference between female and male for carditis (33 vs. 31, P¼ 0.685)and polyarthritis (13 vs. 18, P¼ 0.33). The most common minor manifestations foundwere elevated acute phase reactants (ESR, WBC, and CRP) in 68 (46.3%) cases, fever in60 (40.8%) cases, arthralgia in 39 (26.5%) cases and prolonged PR interval in 6 (4.1%)cases. There was no significant difference found in minor criteria between gender(P¼ 0.799). All patients had rising antistreptolysin-O titer (ASTO). The most commonfindings in throat culture was streptococcus viridans (14 patients, 9.5%), there was nopositive throat culture for group A of beta-haemolytic streptococcus found.Conclusion: Carditis was the most common major manifestation of Jones criteria, withacute phase reactants as the most common minor manifestation. No evidence of posi-tive culture of group A beta-haemolitic streptococcus infections found in throat cultureKeywords: Jones criteria • RF reactivation

Outcome of late presenters of ST-segment elevation myocardial infarction inintensive cardiac care unit: based on RAICOM registry

M.G.F. Harmani, D.D. Aulia, R.A. Fanani1, N. Fannia2, B. Widyantoro, D.A. Juzar,D.P.L. Tobing, D. Zamroni, Irmalita, S. Dharma, S.S. Danny, and I. Firdaus31Faculty of Medicine, Department of Cardiology and Vascular Medicine, University ofIndonesia, Jakarta, Indonesia, 2ICVCU, National Cardiovascular Centre Harapan Kita,Jakarta, Indonesia, 3Faculty of Medicine, Department of Cardiology and VascularMedicine, National Cardiovascular Center Harapan Kita Hospital, University ofIndonesia, Jakarta, Indonesia

Background: Current guidelines advocate attempting reperfusion therapy for allSTEMI patients presenting within 12 h of symptom onset and a recent analysis fromthe GRACE (Global Registry of Acute Coronary Events) shows that primary PCI is rap-idly becoming the preferred approach. Despite the wide contemporary availability ofpharmacological and mechanical means of reperfusion, a very significant proportionof ST-segment elevation myocardial infarction (STEMI) patients are still not offeredany reperfusion therapy, and some of them are considered ‘ineligible for reperfusion’because of time delays (onset more than 12 h). Outcome in those late presenters per-haps poorer than non-late presenter.Aim: To compare outcome in late presenter STEMI with non-late presenter STEMI interms of mortality and in-hospital length of stayMethods: Data were collected from Registry of Acute and Intensive Cardiac Outcome(RAICOM) at Intensive Cardiovascular Care Unit (ICVCU) National CardiovascularCenter Harapan Kita between September 2014 and September 2015.Results: Of the 894 patients ST-elevation myocardial infarction, 389 patients werelate presenter. Samples from this study were 85.2% male and 14.8% female. Meanage was no different between late presenter and non-late presenter (56.916 10.22vs. 55.346 10.08-years old). Mortality was significantly higher in late presenter with9% vs. 4.2% (odds ratio 2.165; 95% confidence interval 1.28–3.65, P-value 0.003). In-hospital length of stay (LOS) was also significantly higher in late presenter group withmedian LOS 6 days vs. 5 days (P-value 0.00002)Conclusion: Late presenters STEMI have higher mortality rate and longer in-hospitalLOS compared to non-late presentersKeywords: STEMI • Late presenters • Mortality • In-hospital length of stay • RAICOM

High mean platelet volume to platelet count ratio as an independent predictor ofin-hospital major adverse cardiovascular events in acute myocardial infarctionpatients

K. Jayantika1, W. Wita1, and R. Widiana21Faculty of Medicine, Department of Cardiology and Vascular Medicine, SanglahGeneral Hospital, University of Udayana, Denpasar, Bali, Indonesia, 2Faculty ofMedicine, Department of Internal Medicine, Sanglah General Hospital, University ofUdayana, Denpasar, Bali, Indonesia

Introduction: Despite the availability of risk stratification for acute myocardial in-farction (AMI), major adverse cardiovascular events (MACE) as complication of AMIare still high. So that currently available risk stratification is not fully satisfied.Platelet activation plays significant contribution in patogenesis and so does, there-fore, complication of AMI. Mean platelet volume (MPV) is a biochemistry marker forplatelet activation. Little is known about the role of MPV in predicting MACE in AMI.One of the factors influencing MPV is platelet count (PLT), and so, counting MPV toPLT as a ratio (MPV/PLT) was done. The aim of this study is to know whether MPV/PLT ratio can act as predictor of MACE in AMI patients.Methods: This is an observational prospective cohort study at cardiac emergencyunit Sanglah Hospital Denpasar from July to September 2016. There were 72 AMI pa-tients enrolled by consecutive sampling. MPV and PLT were available in routine CBC

measurement when patient was admitted. The patients were followed during hospi-talization, and outcome observed was in-hospital MACE (composite of cardiovasculardeath, cardiogenic shock, acute heart failure, and malignant arrhythmias).Results: From ROC analysis, optimal cut-off point for high MPV/PLT ratio was 0.031.Area under curve (AUC) was 0,661. There were 27 patients having MACE, 15 of thosehad high MPV/PLT ratio. Kaplan–Meier survival curve and log rank test showed thatsurvival rate of patients with high MPV/PLT ratio was significantly lower (49.46 vs.96.16 h, P< 0.001) than patients with low MPV/PLT. Multivariate analysis using coxregression showed that high MPV/PLT ratio is independent predictor for in-hospitalMACE in AMI patient with hazard ratio 4.02 (95% CI 1.68–9.57, P¼ 0,002).Conclusion: MPV/PLT ratio is a simple independent predictor for in-hospital MACE inAMI patients.Keywords: Mean platelet volume • Acute myocardial infarction • Major adverse car-diovascular events

The effect of atorvastatin before percutaneous coronary intervention in stablecoronary artery disease in periprocedural myocardial infarction

P.C.D. Lely, M. Yogiarto, and I.G.R. SuryawanFaculty of Medicine, University of Airlangga, Surabaya, Indonesia

Background: It has been proposed that pre-treatment statins pre percutaneous coro-nary intervention (PCI) could limit the occurrence of peri-procedural myocardialinfarction.Objective: To compare pre-treatment 40mg atorvastatin administered 2 h beforePCI in stable coronary artery disease (SCAD) patient and without pre-treatment inreducing the rate of periprocedural myocardial infarction who underwent electivePCI.Methods: Forty eight SCAD statin-naive patients admitted to Soetomo’s Hospital whofulfilled the inclusion criteria, were randomly assigned into two study groups.Atorvastatin group (n¼ 24, 40mg atorvastatin 2 h pre-PCI) and no statin treatment(control group, n¼ 24). Creatine kinase-myocardial isoenzyme (CK-MB) [upper limitof normal (ULN) 6.3 ng/mL] were assessed before and 12–24 h after PCI.Periprocedural MI was defined as a CK-MB elevation> 3 ULN.Results: The incidence of periprocedural MI was 0% in the atorvastatin group and8.3% in the control group (P¼ 0.489). Maximum CK-MB peak after PCI was 6.4 ng/mLin the atorvastatin group and 25.49 ng/mL in the control group.Conclusion: Pre-treatment 40mg atorvastatin has shown trend of reducing the inci-dence of periprocedural MI in SCAD patient who underwent PCI.Keywords: Peri-procedural myocardial infarction • Creatine kinase-myocardial isoen-zyme • Stable coronary artery disease • Atorvastatin • Elective percutaneous coro-nary intervention

Neutrophil lymphocyte ratio as predictors of arrhythmias incidence in patientswith acute myocardial infarction

M.D. Jalma, A. Purnawarman, and F. SatriaFaculty of Medicine, Department of Cardiology and Vascular Medicine, Dr. ZainoelAbidin General Hospital, Syiah Kuala University, Aceh, Indonesia

Background: Cardiac arrhythmias is one of the most commonly complications foundin patients with AMI. This condition may increase the incidence of post-infarctionmortality in patients during hospitalization. One cause of arrhythmias in patientswith AMI is due to necrosis of myocardial cells caused by inflammatory cells, whichresult in the disruptions of heart’s electrical rhythm. Inflammatory marker which canpredict the occurrence of cardiac arrhythmias are the NLR examination. Examinationof NLR is obtained from routine blood tests, the results from comparison of neutro-phils to lymphocytes values. The examination is relatively inexpensive, easy to ob-tain and are available at various levels of health care to predict the occurrence ofarrhythmias in post-infarction patients. Several studies also proved the role of NLR inincreasing stratification of risk factors for cardiovascular disease. This study aimedto assess the relationship between NLR with the incidence of arrhythmias in patientswith acute myocardial infarction.Methods: The study was observational analytic with cross sectional study involving105 patients with AMI, period of 2016 treated in the Intensive Cardiac Care Unit(ICCU) General Hospital Dr. Zainoel Abidin Banda Aceh. Diagnosis and NLR value ob-tained from medical records. Data analysis using chi-square test.Results: The result showed that AMI most occurred in male patients (76.2%) with themost categories at age 40–60 years (70.5%). IMA patients who have arrhythmia com-plications is 26.7% and patients who come with NLR value >4.5 is 41.9%. Chi-squaretest results showed a significant relationship between the NLR value with the inci-dence of arrhythmias (P¼ 0.001; odds ratio¼ 4.391) in patients with AMI.Conclusion: There is a significant correlation between the NLR value with the inci-dence of arrhythmias in patients with acute myocardial infarction.Keywords: Acute myocardial infarction (AMI) • Neutrophil lymphocyte ratio (NLR) •Arrhythmias

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QRS duration on admission as an independent predictor of in-hospital mortalityin acute heart failure

A.S. Adhitya, A.A. Siregar, Z. Mukhtar, Z. Syahputra, and M.F. SarahaztiFaculty of Medicine, Department of Cardiology and Vascular Medicine, Haji AdamMalik General Hospital, University of Sumatera Utara, Medan, Indonesia

Background: Prolonged QRS duration on electrocardiogram (ECG) is a strong predic-tor of poor outcome in chronic heart failure, myocardial infarction, and myocarditis.But it is unclear whether QRS duration predicts in-hospital mortality in the setting ofacute heart failure. The aim of this study was to evaluate QRS duration in-hospitalitymortality in acute heart failure.Methods: In this retrospective study, we were collected clinical, laboratory, and ECGdata from patients whom diagnosed with acute heart failure who were admitted tointensive cardiac care unit haji Adam Malik Hospital from January 2015 untilDecember 2016. Patient acute heart failure with comorbid shock except cardiogenicshock, acute heart failure medical records were incomplete and acute heart failurewith malignancy was exclude from the study. QRS duration on admission evaluatedfor in-hospital mortality in 255 patients with acute heart failure.Results: In this study, in-hospital mortality occurs in 121 patient acute heart failure(47.5%). Bivariate analysis showed QRS duration �0.12 on admission [odds ratio (OR)¼ 4.91, 95% confidence interval (CI) 2.71–8.89, P< 0.001], Creatinine� 2.5(OR¼ 5.19, 95% CI 2.75–9.80, P< 0.001), systolic blood pressure� 100 (OR¼ 16.8,95% CI 8.98–31.36, P< 0.001) heart rate> 100 (OR¼ 2.94, 95% CI 1.71–5.07,P< 0.001) were associated with in-hospital mortality. In multivariate analysis, ORSduration �0.12 (OR¼ 7.68, 95% CI 3.06–19.28, P< 0.001) remained significantly asso-ciated and became an independent predictor for in-hospital mortality in acute heartfailure.Conclusion: This study showed that QRS duration �0.12 on admission in acute heartfailure was related to in-hospital mortality. QRS duration from ECG could be a simpleindependent predictor to use in clinical assessment and help the physician for furtherappropriate management planning.Keywords: QRS duration • Acute heart failure • Independent • Predictor • In-hos-pital mortality

Ticagrelor effect on coronary microvascular perfusion after primarypercutaneous coronary intervention in acute STelevation myocardial infarctionpatient undergoing revascularization compared with clopidogrel

M.B.R. Jati1, N. Haryono2, and D. Tobing21Faculty of Medicine, University of Indonesia, Jakarta, Indonesia, 2Faculty ofMedicine, Department of Cardiology and Vascular Medicine, National CardiovascularCenter Harapan Kita Hospital, University of Indonesia, Jakarta, Indonesia

Background: Microvascular dysfunction becomes one of lethal reperfusion injurymanifestation. Ticagrelor known having cardioprotective effect against reperfusioninjury in animal trial. It effects in human need further investigation and evidence.The aim of this study is to determine the effect of ticagrelor on coronary microvascu-lar perfusion in acute ST elevation myocardial infarction (STEMI) patients underwentprimary percutaneous coronary intervention (PPCI)Methods: This was a double-blind randomized clinical trial conducted in NationalCardiovascular Center Harapan Kita from August to November 2016. Acute ST eleva-tion myocardial infarction patients underwent PPCI were randomized into twogroups, ticagrelor or clopidogrel loading dose before PPCI. Quantitative myocardialblush score was assessed after PPCI using Quantitative Blush Evaluator (QuBE)program.Results: There were 40 subjects included in this trial, 20 subjects in ticagrelor groupand 20 subjects in clopidogrel group. There was no significant difference betweentwo groups regarding the QuBE score (18.8 (6.6–33.6) vs. 18.1 (12.4–32.3), P-value0.978).Conclusion: There is no difference on quantitative myocardial blush score in STEMIpatient given ticagrelor before PPCI compare to clopidogrel.Keywords: Ticagrelor • Microvascular dysfunction • STEMI • PPCI • Reperfusion in-jury • QuBE score

Wall motion score index as powerful and user-friendly method in determiningleft ventricle systolic function in patients with acute coronary syndrome

T. Daindes, P. Handayani, and M. YanniDepartment of Cardiology & Vascular Medicine, RSUP Dr M Djamil, AndalasUniversity, Padang, Indonesia

Background: Determining left ventricle systolic function was crucial in acute man-agement of myocardial infarction. Widely used and well-accepted method was bymeasuring left ventricle ejection fraction (LVEF), even with highly dependency to op-erator and method. In the other side, wall motion score index (WMSI) was known assimple and user-friendly LV function measurement. This study was made to investi-gate the accuracy of WMSI compared to LVEF.

Methods: Transthoracic echocardiogram was performed in 449 patients (fromJanuary 1 until December 31 2016) during acute phase of acute coronary syndrome.Measurement of LV-EF was made by Simpson method and WMSI was calculated by di-viding all segments motion index with the number of calculated segment. We com-pared WMSI in patients with normal or mildly impaired and moderate-severe im-paired LVEF. Cut-off value was made by determining area receiver operatingcharacteristic curve.Results: In this study, 67.5% patients were male and nearly half of them (46.3%) haddiagnosed with ST elevation myocardial infarction (STEMI). The WMSI has negativelinear correlation with LVEF, both in all group and sub-group analysis. In all groupanalysis, WMSI� 1.75 was correlated with moderate-severe impaired LVEF (94% sensi-tivity, 72% specificity). Sub-group analysis also revealed similar findings, with cut-offvalue was 1.6875 (90% sensitivity, 67% specificity), 1.4375 (84% sensitivity, 93% spe-cificity) and 1.3125 (86% sensitivity, 94% specificity) for STEMI, NSTEMI, and unstableangina patients, respectively.Conclusion: Wall motion score index was a powerful method in determining LV sys-tolic function in patients with acute coronary syndrome. Addition to its simplicity,the use of this method may recommended, especially in rural hospital withoutcardiac-dedicated echocardiography facility.Keywords: LV systolic function • Wall motion score index • Ejection fraction

Abnormal heart rate recovery as a predictor of diastolic dysfunction in patientswith stable angina pectoris

S.D. Putri, S.N.M. Silaban, A. Hidayat, M.F. Sarahazti, N.Z. Akbar, and A.H RaynaldoFaculty of Medicine, Department of Cardiology and Vascular Medicine, Haji AdamMalik General Hospital, Universitas Sumatera Utara, Medan, Indonesia

Background: Attenuated heart rate recovery (HRR) after exercise is considered to rep-resent impaired parasympathetic tone and related to worse cardiovascular outcomes.Diastolic dysfunction is common in ischaemic patients and responsible for significantmorbidities, although it does not contribute to heart failure mortality to the same de-gree as systolic dysfunction. However, the independent value of abnormal HRR in pre-dicting diastolic dysfunction in patients with stable angina pectoris is unknown.Methods: This observational cross-sectional study evaluated 51 patients with stableangina pectoris who underwent exercise stress testing from October to December2016 at Adam Malik Hospital. Heart rate recovery defined as the difference betweenheart rate at peak exercise and exactly 1min into the recovery period with cut-offpoint <18. Diastolic function was measured using echocardiography and classifiedinto groups. Univariate, bivariate analysis using chi square test, and multivariateanalysis was performed with P-value< 0.05 considered statistically significant.Results: There was significant association between HRR recovery and diastolic func-tion [odds ratio (OR): 4.91; P-value: 0.009; 95% confidence interval (CI) 1.4–16.9].HRR was delayed in diastolic dysfunction group compared to normal group(18.636 9,4 vs. 25.166 9). After multivariate analysis using logistic regression test,the OR was 4.19 (P-value 0.04; 95% CI 1.01–17.3).Conclusion: Abnormal HRR recovery can be used as an early predictor of diastolicdysfunction in stable angina pectoris patients.Keywords: Heart rate recovery • Diastolic dysfunction • Stable angina

Correlation of fragmented QRS complexes with the severity of coronary arterydisease (using syntax score) in patients with non-STelevation acute coronarysyndrome in RSUP Dr. M. Djamil Padang June–December 2016

T. Setiadi1, M. Fadil2, M. Syafri2, and M. Syukri21Faculty of Medicine, University of Andalas, Padang, Indonesia, 2Faculty of Medicine,Department of Cardiology and Vascular Medicine, Dr. M. Djamil Hospital, AndalasUniversity, Padang, Indonesia

Background: Fragmented QRS is a novel ECG marker with more sensitivity and lessspecificity than Q wave, which reflect myocardial conduction delays in patients withcoronary artery disease (CAD). The significance of f-QRS complexes in non-ST eleva-tion ACS patients for detection of the severity of CAD (correlation with Syntax score)was evaluated in this study.Methods: A total of 23 patients with non-ST elevation ACS who underwent invasivecoronary angiography in RSUP Dr. M. Djamil June–December 2016 for detection ofcoronary artery disease were recruited in this study, ECG was done to all patients,which showed f-QRS in 12 patients (f-QRS group) and inverted T wave or depressedST in 11 patients (non f-QRS group). The significance of f-QRS complexes on 12-leadECG for detection of the severity of the CAD (correlated with Syntax score) wasassessed.Results: Among the patient studied, elderly patient, sex, diabetics, smokers, anddyslipidaemia didn’t have a significantly result in f-QRS complexes although diabeticmellitus factor is higher in f-QRS complexes than non f-QRS complexes (58% vs. 27%).In this study, we can find that a higher frequency of fQRS complexes in patient withmultivessel stenosis with severe degree of stenosis, in those with high syntax score(with P-value 0.049, 0.04).

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Conclusion: The frequency of f-QRS complexes was found to be higher in diabetic pa-tient with NSTE-ACS. The higher frequency of f-QRS was correlated with the extentand severity of coronary lesion in patient with NSTE-ACS.Keywords: Fragmented QRS (f-QRS) • Non-STelevation acute coronary syndromes

The corrected QT interval abnormalities in type 2 diabetes mellitus: rapid andspecific method to screening cardiovascular autonomic neuropathy

I.G. Sumantra1, H. Pangestu2, M.R. Akbar1, N.N.M. Soetedjo2, A. Purnomowati1, andT.M. Aprami11Faculty of Medicine, Departement of Cardiology and Vascular Medicine, HasanSadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia, 2Faculty ofMedicine, Departement of Internal Medicine, Universitas Padjadjaran, Hasan SadikinGeneral Hospital, Bandung, Indonesia

Background: Cardiovascular autonomic neuropathy (CAN) is a well-known complicationof long-standing diabetes mellitus and a common diabetic autonomic neuropathy leadsto silent myocardial infarction and sudden death. Abnormalities of corrected QT inter-val (QTc) in the electrocardiogram (ECG) have been found to be a specific, rapid, andobjective method for detecting CAN in most studies. The aim of this study is to evalu-ate ECG to screening cardiovascular autonomic neuropathy from prolongation QTc andincreasing QTc dispersion in duration of diabetes mellitus and HbA1c level.Methods: Fifty nine subjects diagnosed type 2 diabetes mellitus (T2DM) according toPERKENI guideline included in this study. Patients were divided into subgroups ac-cording the duration of T2DM (�5years or> 5years) and HbA1C level (�6.5%or> 6.5%). We took measurements QTc interval according to Bazett’s formula:QTc¼QT/�Rl Rl. And then we determined QTc max, QTc min, and QTc dispersion ac-cording a 12-lead resting ECG recorded at a paper speed of 25mm/s, containing aminimum of four beats per lead. All data were expressed as mean6 standard devia-tion. Student’s t-test analyses were used where appropriate. A two-tailed P-val-ue< 0.05 was considered statistically significant.Results: Fifty nine subjects of this study constituted 30 (50.8%) males and 29Females (49.2%) and were in the age (mean6 SD: 576 9 years). The mean QTc maxon the duration of DM over 5 years is longer than less and equal to 5 years(4956 59ms vs. 4406 79ms, P¼ 0.003) as well as QTc min (4306 50ms vs.3886 80ms, P¼ 0.022). The mean QTc dispersion (696 26ms vs. 566 26ms,P¼ 0.070). The mean QTc max in HbA1c over 6.5% is longer than less and equal to6.5% (5026 61ms vs. 3996 33, P¼<0,001) as well as QTc min (4406 58ms vs.3516 43ms, P¼<0.001) and QTc dispersion (706 26ms vs. 496 23ms, P¼ 0.004).Conclusion: Patients with T2DM over 5 years and HbA1C level over 6.5% had QTc in-terval abnormalities (prolonged) with increased of QTc dispersion. It is inferred fromthis study that calculates prolongation QTc and QTc dispersion in diabetics with dura-tion of DM more than 5 years and in patient with uncontrolled DM can be used as ascreening test for assessment of cardiac autonomic neuropathy.Keywords: QTc interval • Diabetes mellitus • Cardiovascular autonomic neuropathy

Should we choose transcatheter device over surgical approach for atrial septaldefect closure? weighing the evidence

B.E. Putra1, R. Diansari2, and R. Prakoso31Rumah Sakit Umum Daerah Berkah Pandeglang, Banten, Indonesia, 2GeneralPractitioner of Klinik Kertamedika, Jakarta, Indonesia, 3Department of Pediatric,Cardiologist of National Heart Centre Harapan Kita, Jakarta, Indonesia

Background: Transcatheter device has risen up as the new approach for atrial septaldefect closure, replacing surgery as the conventional approach. However, it is stilllargely unknown which therapy gives the best outcome. So, it is needed to evaluatethe short- and long-term outcomes of transcatheter device approach in comparisonto surgical approach as a method of atrial septal defect closure.Methods: Studies were searched using PubMed, ScienceDirect, and SpringerLink data-bases. Studies were appraised by using the Centre for Evidence-Based Medicine fromUniversity Oxford 2010. Primary and secondary outcomes were obtained from the se-lected articles.Results: Seven articles met the criteria for selection process. Majority of cases re-ported low-mortality rate (short term), ranging 0–1% and long-term follow-up rangingfrom 0% to 6.3% with no significant difference between surgery and transcatheter de-vice approach. However, it was shown in the literatures the superiority of transcath-eter (3.7–7.9 days) over surgery (3.7–9.1 days) approach in length of stay (P< 0.001),rehospitalization (7% vs. 0%; P¼ 0.002), NYHA class decrease, and complications (to-tal and major in short term; major events in long term). Though, transcatheter ap-proach was prone to reintervention compared to surgical approach in short- andlong-terms follow-up. Costwise, it is still debatable between the two approachessince there is conflicting evidence between two studies.Conclusion: There are several advantages of the modern transcatheter approachcompared to the conventional surgical approach, especially in length of stay, hospi-talization, and the emergence of complications. Though, the reintervention/surgicalcorrection rate is fairly higher than surgical approach. Therefore, eventhough

transcatheter is mostly better than surgical approach; surgical approach still stays asbackup approach if reintervention is needed.Keywords: Transchateter device • Atrial septal defect closure • Surgical ap-proach • Evidence

Secondary insomnia in heart failure patients and its association withhypertension

S. OetamaRSUD Hadji Boejasin, Pelaihari, Indonesia

Background: Secondary insomnia frequently develops in heart failure (HF) patientsdue to nocturnal dyspnoea and orthopnoea. Lack of sleep combines with decreasingquality of life can psychologically alter the blood pressure negatively. Hypertensionworsens the HF symptoms and a vicious cycle will be formed. This study aims to mea-sure the prevalence of insomnia in HF patients and its association with hypertensionin RSUD Hadji Boejasin, Pelaihari.Methods: This analytic observational study was conducted at RSUD Hadji Boejasinfrom July to December 2016 with purposive sampling. A total of 57 established HFpatients were interviewed first-handedly using validated insomnia severity index(ISI). Insomnia was further classified into subthreshold insomnia, moderate insomnia,and severe insomnia. All participants signed informed consent regarding the willing-ness to involve in this study. The data were analysed with SPSS 17.0.Results: Sample mean age was 57.566 13.55 and consisted of 20 (35.1%) males and37 (64.9%) females. A total of 32 (56.1%) samples were diagnosed with various levelof insomnia and 22 (68.7%) of them had uncontrolled blood pressure (BP).Subthreshold insomnia was found on 14 (43.7%) samples, moderate insomnia on 15(46.9%) samples, and severe insomnia on 3 (9.4%) samples. Controlled BP was notedonly on 25 samples (43.8%) with 15 (60%) of them were free from insomnia (no clini-cally significant insomnia). Analysis showed an association between insomnia with hy-pertension (P¼ 0.03, odds ratio¼ 3.3) in HF patients.Conclusion: Secondary insomnia in heart failure patients is a common finding. If leftuntreated insomnia can lead to elusive BP control. Attention on sleep deprivationmust be given as part of comprehensive management in HF patients.Keywords: Insomnia • Heart failure • Hypertension

Prognostic factors for predicting quality of oral anticoagulation control inpatients with valvular atrial fibrillation on Warfarin therapy

H.Y. Laksono1, E. Maharani2, and H. Hariawan31Faculty of Medicine, University of Gadjah Mada, Yogyakarta, Indonesia, 2Faculty ofMedicine, Arrhythmia Division, Department of Cardiology and Vascular Medicine,University of Gadjah Mada, Yogyakarta, Indonesia, 3Faculty of Medicine, VascularDivision, Department of Cardiology and Vascular Medicine, University of GadjahMada, Yogyakarta, Indonesia

Background: Valvular atrial fibrillation (AF) is a subset of AF patients with highestrisk of stroke thromboembolism, in which warfarin as vitamin K antagonist in thissubset of patients is the only drug of choice for stroke prevention to date. Guidelinessuggest to calculate the person’s time in therapeutic range (TTR) of InternationalNormalized Ratio, from Prothrombin Time (INR PT) for assessing quality of anticoagu-lation control in patients with warfarin. Studies found demographic-clinical factorscan predict patients with poor anticoagulation control in non-valvular AF patients asSAMe-TT2R2 score stated in recent guideline. Prediction of patients with poor antico-agulation control in valvular AF patients on warfarin has not been studied.Aims: To identify the TTR value of valvular AF patients on warfarin in real-world clin-ical setting, and analyse demographic-clinical factors associated with low TTR.Methods: Retrospective cohort study was conducted on valvular AF patients on warfa-rin from medical records in RSUP Dr. Sardjito Yogyakarta on January 2014–November2016. Rosendaal method used to calculate TTR as proportion of days in INR range com-pared to total days on warfarin. Univariate analysis was done to assess demographic-clinical factors associated with low TTR, and multivariate analysis by logistic regressionto evaluate which factors independently associate with low TTRResults: Eighty-eight patients were included as subjects in this study, with means ofTTR 40.86 25.1%. There was 77 subjects with TTR< 70% and 11 subjects withTTR� 70%. Univariate analysis founds 7 demographic-clinical factors (smoker, hyper-tension, obesity, ischaemic stroke, liver disease, comorbid >2, and spironolactoneuse) associated with TTR< 70% (P< 0.25). Multivariate analysis was done but foundsnone independently associates with TTR< 70%.Conclusion: Demographic-clinical factors does not independently predict poor anti-coagulation control of TTR< 70% in valvular AF patients on warfarin.Keywords: Atrial fibrillation • Valvular AF • Warfarin • Anticoagulation control • TTR

Association between neutrophyl–lymphocyte ratio and functional capacity andhigh-sensitive C-reactive protein in ischaemic heart failure patients

T. Srimulyo, T. Wasyanto, and B. Murti

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Cardiology and Vascular Medicine, Moewardi Hospital, University of Sebelas Maret,Surakarta, Indonesia

Background: Heart failure is still being a main problem of the world. The main causeof heart failure is due to ischaemic problem (ischaemic heart failure). Observationalresearches have found the role of high-sensitive C-reactive protein (hsCRP) and totalleucocyte count in many chronic diseases. The neutrophyl has positive associationwith the severity of coronary heart disease dan heart failure, lymphocyte has not.Neutrophyl–lymphocyte ratio (NLR) is easily measurable in many hospital. The abilityto exercise is important parameter which can measure as a daily activity. Meanwhile,the ability to exercise is a predictor for morbidity and mortality in heart failurepatient.Objective: To analyse the association between NLR and functional capacity andhsCRP in ischaemic heart failure AHA Stage C patients.Methods: This is an analytic cross sectional study. As many as 35 patients of ischae-mic heart failure AHA stage C at outpatient clinics in Cardiovascular Department ofDr.Moewardi’s Hospital, Surakarta were selected consecutively. Peripheral venousblood samples to measure the NLR and hsCRP were drawn before treadmill test in allstudy population. METs and hsCRP compared using Mann–Whitney-test based on pre-liminary study so that will be 2 groups, NLR< 2.3 and NLR� 2.3. Correlation analysiswas performed using Spearman’s test. P< 0.05 was considered as statisticallysignificant.Result: There was significant different in functional capacity and hsCRP betweengroup NLR< 2.3 and NLR� 2.3 (P< 0.001 dan P¼ 0.001, respectively). Correlationanalysis using Spearman’s test showed that NLR had significant negative correlationwith functional capacity (r¼ –0.600; P< 0.001) and significant positive correlationwith hs-CRP (r¼ 0.509; P¼0.002). The cut-off value of NLR for prediction of poorfunctional capacity (<5 METs) was> 2.28 with a sensitivity of 73.3% and a specificityof 80% in the ROC curve analysis [area under the curve (AUC) 0.71; 95% CI 0.519–0.891; P¼0.040].Conclusion: NLR had significant negative correlation with functional capacity andsignificant positive correlation with hs-CRP. The cut-off value of NLR for prediction ofpoor functional capacity (<5 METs) was >2.28 with a sensitivity of 73.3% and a spe-cificity of 80% .Keywords: NLR • Functional capacity • hsCRP

Correlation between endothelin-1 plasma level with haemodynamic profile inpatient with systolic heart failure

D. Caroline1, D. Soemantri1,2, and A. Subagjo1,21Faculty of Medicine, Department of Cardiology and Vascular Medicine, AirlanggaUniversity, Surabaya, Indonesia, 2Faculty of Medicine, Department of Cardiology andVascular Medicine, Dr. Soetomo General Hospital, Surabaya, Airlangga University,Indonesia

Background: Until now biomarkers in heart failure has been used as an additional op-tion for the diagnostic evaluation of patients suspected heart failure. One of bio-marker of heart failure is Endothelin-1 (ET-1). Increased levels of ET-1 have been re-ported in patients with chronic heart failure, particularly in the presence of leftventricular dysfunction. Haemodynamic profile using non-invasive measurement(echocardiography) is important as the physician will be able to adjust the therapyand identify the progression of heart failure.The aim of the study was to explore is there any correlation between Endothelin-1(ET-1) plasma level with haemodynamic profile in patients with systolic heart failure(HFrEF).Methods: Using purposive sampling, 38 patients with chronic systolic heart failurewho met the criteria were included. We measured levels of ET-1 in peripheral venousblood using QuantikinineVR Human Endothelin-1 immunoassay. Transthoracic echocar-diogram was performed to measure haemodynamic profile such as LVEF by biplanemethod, PCWP, cardiac output, stroke volume and SVR. Bivariate correlation testwas used to determine the correlation between them.Results: ET-1 level is 1.06–7.68 pg/mL, with mean 2.56 1.33 pg/mL. This result ishigher than normal range (mean level 1.17 pg/mL). Result of haemodynamic profile:PCWP 20.456 8.62mmHg, EF by biplane 30.056 5.86, cardiac output 3.576 1.30 l/min, stroke volume 42.66 19.0, and SVR 2013.26 819.6. Using Spearman rank test,there is a significant positive correlation between PCWP with ET-1 (r¼ 0.606,P¼0.000). The others did not reach statistical significance.Conclusion: Increased levels of ET-1 followed by increased PCWP value in patientswith systolic heart failure (HFrEF). ET-1 levels are able to represent PCWP value inpatients with HFrEF.Keywords: Endothelin-1 • Haemodynamic profile • PCWP • Systolic heart failure

The correlation between serum gamma glutamyl transferase level and the meta-analysis global group on heart failure (MAGGIC) score in patient with chronicstable heart failure

A.Z. Amir and B.S. Pikir

Medical Faculty, Cardiology and Vascular Medicine Department, Soetomo GeneralHospital, Airlangga University Surabaya, Indonesia

Background: Increasing life expectancy of the cardiovascular patients because theadvance and better management is causing aging of the population and increasingthe heart failure prevalence in a few last decades. Risk stratification of the chronicheart failure patients utilizing the meta-analysis global group in chronic heart failure(MAGGIC) score is a novel system to predict the mortality of those patients. Gammaglutamyl transferase (GGT) is an enzyme used as a biomarker of an oxidative stressis less researched in accordance of its utilization to estimates mortality in patientswith chronic heart failure.Aim: To analyse the correlation between serum GGT Leveland MAGGIC score in pa-tient with chronic heart failure.Methods: This study was an analytic observational study using cross-sectional designwhich conducted at cardiovascular outpatient clinic Dr. Soetomo General HospitalSurabaya from March 2016 until June 2016. This study enrolled 35 patients that eligi-ble and measure the GGT level and calculate the MAGGIC score. Spearman non-parametric correlation test is used to analyse correlation between GGT level andMAGGIC score.Results: The results showed GGT level from 35 subjects with highest values 88U/L,lowest value 18U/L, with median 60 U/L. The MAGGIC score was measured with high-est score 33 and lowest score 14. There is significant correlation between GGT leveland MAGGIC score (r¼ 0.752 and P¼ 0.0001).Conclusion: There is positive, significant, and strong correlation between serum GGTlevel and MAGGIC score in patients with chronic heart failure.Keywords: Gamma glutamyl transferase • GGT • The meta-analysis global group inchronic heart failure, MAGGIC • Chronic heart failure • Oxidative stress

The effects of ferrous sulphate supplementation on left ventricular intrinsicfunction by global longitudinal strain in systolic heart failure patient with irondeficiency anaemia

R. Sagita, B.B. Siswanto, and L.D. LiastutiFaculty of Medicine, Department of Cardiology and Vascular Medicine, University ofIndonesia, Jakarta, Indonesia

Background: Iron deficiency is common in heart failure (HF) and associated with im-pairment of myocardial functional parameters and dimension of the left ventricle(LV). Speckle tracking echocardiography assesses myocardial deformation and LV sys-tolic function by measuring global longitudinal strain (GLS). But the improvement ofintrinsic LV function using GLS in systolic HF patient with iron deficiency anaemia(IDA) due to oral iron treatment is not yet known.Aim: To evaluate improvement in intrinsic LV function measured by GLS after oralferrous sulphate (FS) treatment.Methods: This is a single centre, randomized controlled trial that enrolled HF(LVEF< 50%), IDA (Ferritin< 100ng/mL or 100–300 ng/mL with Tsat< 20%) andHb< 13 g/dL) patients at outpatient clinic of Harapan Kita Hospital between Januaryand November 2016. Patients were randomized 1:1 to treatment with FS or placebofor 12weeks. Echocardiography was performed before and after treatment to mea-sure GLS.Results: We performed analysis of 37 patients that complete follow up period,Treatment group (n¼ 21) and Control group (n¼ 16). There was no significant im-provement in GLS in treatment group compared to control group (�9.176 3.71 vs.�8.836 4.07; P¼ 0.876).Conclusion: There was no significant improvement in GLS after oral FS treatment insystolic HF patient with IDA.Keywords: Systolic heart failure • Anaemia • Iron deficiency • Ferrous sulphate •Global longitudinal strain

Relationship between the ratio of epicardial fat thickness against fat mass andthe severity of coronary artery lesion based on Gensini score in stable anginapectoris patients

M.S. Chesario, B.B. Tiksnadi, M.R. Akbar, A. Purnomowati, and T.M. ApramiDepartment of Cardiology and Vascular Medicine, Padjadjaran University, HasanSadikin Hospital, Bandung, Indonesia

Background: Epicardial adipose tissue (EAT) is the real adipose tissue of the heart.The tissues are thought to be related with cardiovascular risk factors, coronary ar-tery plaque, and the progression of the calcified coronary plaque. Previous studyshowed that fat mass, which consists of visceral and subcutaneous fat, was not re-lated with cardiovascular diseases. This study aimed to analyse the relationship be-tween the ratio of EAT thickness against fat mass on Gensini score in stable anginapectoris patients.Methods: This cross-sectional study was conducted in Hasan Sadikin GeneralHospital. The population of this study is stable angina pectoris patients who under-gone elective coronary angiography during November–December 2016. The EAT

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thickness was measured using 2D echocardiography in the parasternal long axis view.Fat mass examination was measured using bioelectrical impedance analysis (BIA).The severity level of coronary artery lesion was quantified using Gensini score.Statistical analysis about the relationship between the ratio of EAT thickness againstfat mass using Gensini score was performed using bivariate test.Results: We enrolled 44 patients (88.6% male with mean age of 586 9 years). Themedian for EAT thickness was 4.88 (2.00–9.00) mm, median of fat mass was 18.21(7.21–35.78) kg, median of Gensini score was 66.48 (4.00–15.00) and the median forEAT against fat mass ratio was 0.25 (0.13–0.50) mm/L. Statistical analysis for ratio ofEAT thickness against fat mass with Gensini score was r¼ 0.314 and P¼ 0.038).Conclusion: Ratio between EAT thickness against fat mass has a weak positive corre-lation with the coronary complexity using Gensini score.Keywords: Stable angina pectoris • Epicardial adipose tissue (EAT) • Fat mass •Gensini score • Bioelectrical impedance analysis (BIA)

Statin treatment in coronary artery disease patients who underwent electivepercutaneous coronary intervention procedures in Dr. Kariadi General Hospital:Evaluation of Implementation of the 2013 ACC/AHA blood Cholesterol Guideline

F. Muttaqien, M. Limbong, L. Bramantyo, P.K. Dewi, U. Bahrudin, and Y. HerryFaculty of Medicine, Department of Cardiology and Vascular Medicine, DiponegoroUniversity, Dr. Kariadi General Hospital, Semarang, Indonesia

Background: The 2013ACC/AHA Blood Cholesterol Guideline has recommended highdose statin as primary and secondary prevention for coronary artery disease (CAD).However, the use of high dose of statin remains low in daily clinical practice due tosome reasons including the clinician preference, insurance, and side effects. Thisstudy aimed to evaluate the profile of statin intensity in patients who underwentelective percutaneous coronary intervention (PCI) in the Dr.Kariadi General Hospital.Methods: A total of 219 patients with CAD who underwent elective PCI from Januaryto March 2016 were included in this registry. The intensity of statin was classified ac-cording to the guideline. The Spearman rho test was used to analyse the correlationbetween statin intensity and other clinical variables related with the statin use.Results: Ninety six percent of patients were treated with statin prior PCI. Low-,moderate-, and high-intensity statin therapy were found in 4.5%, 90%, and 1.4% ofpatients, respectively. Ten mg, 20mg, and 40mg simvastatin were given in 4.6%,56.6%, and 8.2% of patients, while 20mg or 40mg atorvastatin were used in 25.1%and 1.4%, respectively. The intensity of statin used was correlated with clinicianpreference (r¼ 0.162, P< 0.05) and patient’s age (r¼�0.141, P< 0.05), but it wasnot correlated with severity of CAD, diabetes, creatinine level, obesity, nor healthinsurance ownership.Conclusion: The use of high dose statin in patients who underwent PCI in Dr.KariadiGeneral Hospital remains low. The intensity statin used was correlated with clinicianpreference and patient’s age.Keywords: Statin intensity • Percutaneous coronary intervention • Coronary arterydisease

The visit-to-visit blood pressure variability gender differences in more than 55and less than 55-years-old hypertensive population

A. Thengker1, A.A. Lukito1,2, M.W. Hadi1, H. Lim1,2, and A. Christiani11Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia, 2Faculty of Medicine,Pelita Harapan University, Tangerang, Banten, Indonesia

Background: Age is the single most important risk factor for stroke and coronaryheart disease (CHD) which are the most common cause of death in elderly.1 Thechance of having a stroke approximately doubles for each decade of life after age55.2 The appropriateness of standard deviation (SD) as an index of blood pressure(BP) variability has been questioned, and it has been proposed a new index, namedaverage real variability (ARV).3 higher ARV of 24-h systolic and diastolic BPs signifi-cantly predicted cardiovascular (CV) mortality, combined fatal and nonfatal events,and stroke.4,5 But, ASCOT-BPLA ABPM study showed that variability in BP on ABPMwas a weaker predictor of CV events than was visit-to-visit variability.6 Therefore,this study aims to find out visit-to-visit SD and ARV BP variability in more than or 55-years-old (older) compared to less than 55-years-old (younger) hypertensivepopulation.Methods: Visit-to-visit blood pressure data were collected from Siloam HospitalLippo Village hypertensive patients medical record with total of 131 in the year of2015. There were 51.9% (68) male subjects with mean age 60.43 (36–91) years. Theblood pressure was tracked back until the first visit.Results: Mean systolic ARV 15.7mmHg in older and 13.29mmHg in younger hyperten-sive subjects. Systolic SD showed mean 16.42mmHg in older subjects and13.86mmHg in younger hypertensive subjects. Data was analysed with comparativeindependent-samples, and showed significant differences of Systolic ARV (P¼ 0.03)and Systolic SD (P¼ 0.01) between older and younger hypertensive subjects.Conclusion: This study found that more than 55-year-old (older) hypertensive sub-jects had higher systolic blood pressure (SBP) average real variability and higher SBPstandard deviation as well than younger hypertensive subjects. SBP SD had higher

significancy than SBP ARV This result may imply that older hypertensive subjects hashigher risk of CV event, and SBP SD still can be used to predict CV events.Keywords: Index of blood pressure • Gender differences

Association between platelet to lymphocytes ratio and contrast-inducednephropathy in patients undergoing percutaneous coronary intervention foracute coronary syndrome

R. Musritha, H.E. Rasyid, and M. SyukriFaculty of Medicine, Department of Cardiology and Vascular Medicine, AndalasUniversity, Padang, Indonesia

Background: Contrast-induced nephropathy (CIN) is a serious complication in patientsundergoing percutaneous coronary intervention (PCI). The platelet-to-lymphocyte ratio(PLR) has been proposed as inflammatory marker and predictor for major adverse CVoutcomes in coronary artery disease (CAD). Because of the potential role of inflamma-tion in the development of CIN, we investigated the role of PLR in predicting CIN in pa-tients undergoing percutaneous coronary intervention for acute coronary syndromeMethods: This study was a descriptive analytic with cross-sectional design. Subjectswere all patients with acute coronary syndrome undergoing percutaneous coronaryintervention who met the inclusion and exclusion criteria. All subjects were mea-sured for platelet to lymphocyte ratio on admission. Serum creatinine values weremeasured before and after 48–120 h after PCI. Patients were divided into two groups:the CIN group and the non-CIN group. Statistical analysis was used to assess associa-tion of platelet to lymphocytes ratio and CIN using Fisher’s exact test.Results: CIN developed in 10 patients (18.2%) of the overall study population.Platelet to lymphocyte ratio was higher in patients who developed CIN compared tothose who did not (122.436 46.34 vs. 97.226 44.05, P¼ 0.111). Patients in the CINgroup had also higher creatinine level on admission, lower estimated glomerular fil-tration rate and lower left ventricular ejection fraction. Platelet to lymphocyte ra-tio� 148 had relative risk 2.52 (95% CI 0.817–7.761, P¼ 0.149) for predicting CIN.Conclusion: Increased platelet to lymphocyte ratio are associated with a greater riskof CIN in patients undergoing PCI for acute coronary syndrome, but not statisticallysignificant.Keywords: Platelet to lymphocyte ratio • contrast-induced nephropathy • acutecoronary syndrome

Risk factor and cardiovascular characteristics of peripartum cardiomyophathy atDr Kariadi hospital

Y.S. Pratama1, S.B. Utami1, Y. Herry1, and M.B.A. Pramono21Faculty of Medicine, Department of Cardiology and Vascular Medicine, Dr. KariadiCentral General Hospital, Diponegoro University, Semarang, Indonesia, 2Faculty ofMedicine, Department of Obstetrics and Gynecology, Diponegoro University, Dr.Kariadi Central General Hospital, Semarang, Indonesia

Background: Peripartum cardiomyopathy (PPCM) is relatively rare in pregnancy, buthas a high mortality and morbidity. Genetic and cultural variation potentially influ-ences the incidence of PPCM.Objective: To observe the risk factors and cardiovascular characteristics of PPCMMethod: A descriptive study by secondary data involving women with PPCM in outpa-tient or inpatient unit at Dr. Kariadi Central General Hospital Semarang fromNovember 2013 to December 2016.Result: A total of 29 patients, the average age was 29.16 7.77-years old, 23 patients(95.8%) with single pregnancy, 13 patients (54.2%) with primipara, 6 patients (24%)with gestasional hypertension and 14 patients (56%) with preeclampsia. For cardiovas-cular characteristics, the average baseline left ventricular ejection fraction (LVEF) was27.486 8.03% and left ventricular internal diameter end-diastole (LVIDd) was53.736 11mm. Seven patient (24.13%) had LVEF improvement and 2 patient (6.89%)had normal LVEF. We also found 22 patients (74.8%) with NYHA III-IV, 1 patient (3.57%)with cardiogenic shock, 1 patient (3.57%) with cardiac arrest due to VT/VF and 4 pa-tients (14.28%) with acute pulmonary oedema. For maternal and perinatal outcome,we found 14 patients (60%) underwent caesarean delivery, 28 patients (96.6%) withcongestive heart failure and prematurity occurred in 7 patients (33.3%).Conclusion: Peripartum cardiomyopathy could occur in women at any ages, primip-ara, single pregnancy, and preeclampsia. Severe LV dysfuction with mild LV dilatationwas the most common in PPCM at RSUP Dr Kariadi.Keywords: Peripartum cardiomyopathy • Pregnancy • Cardiovascular characteris-tics • Risk factors • Maternal outcomes • Perinatal outcomes

Association between higher Hba1c with low-exercise capacity and abnormalhaemodynamic in treadmill stress test of post myocardial infarction patientswith type 2 diabetes mellitus

M.S. Yudha1, I.G.N. P. Gunadhi1, and I.K. Suryana21Faculty of Medicine, Department of Cardiology and Vascular Medicine, SanglahHospital Denpasar, Udayana University, Bali, Indonesia, 2Faculty of Medicine,

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Department of Internal Medicine, Sanglah Hospital Denpasar, Udayana University,Bali, Indonesia

Background: Type 2 diabetes mellitus (T2DM) is one of important risk factor of coro-nary artery disease (CAD) particularly in post myocardial infarction (MI). Blood glu-cose control represented with HbA1c is a stable indicator and one of well-knownprognostic marker in T2DM. HbA1c >7% predisposed higher mortality and incidenceof microvascular complications than HbA1c �7%. Several methods to assess prognosisof post MI patients with treadmill stress test are exercise capacity and abnormal hae-modynamic response (hypotension, abnormal heart rate recovery, chronotropic in-competence, and ventricular ectopy).Aim: The objective of this study is to assess the association between higher HbA1clevel on exercise capacity and abnormal haemodynamics in treadmill stress test ofpost MI with T2DM.Methods: The design of this study is observational analytic enrolled in outpatientclinic, treadmill room and pathology clinic laboratory in Sanglah general hospitalDenpasar. The study duration is 10months. There are 74 samples selected with con-secutive sampling. HbA1c levels were measured with COBAS Integra 400 plus in labo-ratory and underwent treadmill test with Mortara Instrument.Results: The results of this study are post MI patients with T2DM and HbA1c >7% as-sociated with 5-times incidence of low-exercise capacity [odds ratio (OR)¼ 4.896,95% confidence interval (CI)¼ 1.219–19.663, P¼ 0.025) correlated with T2DM dura-tion (correlation coefficient¼�0.299, P¼ 0.010 and 20-times incidence of ventricu-lar ectopy (OR¼ 20.496, 95% CI¼ 1.939–216.696, P¼ 0.012) than HbA1c �7%.Instead, HbA1c is not associated with abnormal heart rate recovery (OR¼ 2.747, 95%CI¼ 0.765–9.871, P¼ 0.121) and chronotropic incompetence (OR¼ 3.670, 95%CI¼ 0.842–15.988, P¼ 0.083).Conclusion: This study concluded that higher HbA1c associated with low-exercise ca-pacity only if correlated with DM duration and ventricular ectopy. Higher HbA1c arenot associated with abnormal heart rate recovery and chronotropic incompetence inpost MI with T2DM.Keywords: HbA1c • Exercise capacity • Abnormal haemodynamics • Post MI • Type2DM

Ganoderma lucidum polysaccharide peptides as a potent antioxidant, anti-inflammation, anti-hypertension, and anti-lipid in high-risk patients ofatherosclerosis

O. Handayani1, N. Ubaidillah1, A. Widya1, Vittryaturida1, K. Siwi1, and D. Sargowo21Faculty of Medicine, Department of Cardiology and Vascular Medicine, Dr SaifulAnwar General Hospital, Brawijaya University, Malang, Indonesia, 2Faculty ofMedicine, Department of Cardiology and Vascular Medicine, Dr Saiful Anwar GeneralHospital, Brawijaya University, Malang, Indonesia

Background: Ganoderma lucidum is a type of mushroom that has been used for thou-sands years throughout Asia. It is known to demonstrate numerous health benefitingproperties including antioxidant, anti-inflammation, anticancer effects, hypoglyce-mic, and blood cholesterol reducing properties. This research was conducted to de-termine the efficacy of Ganoderma lucidum polysaccharide peptides (PSP) as anti-inflammation and antioxidant in cardiovascular disease.Methods: This is a prospective study with pre- and post-test design of 37 high-riskpatients of cardiovascular disease based on the Framingham Risk Score that was con-ducted for 3months. Patients were advised to consume PSP 3� 250mg as an adju-vant to their previous medications. The primary endpoint was the change in choles-terol levels, blood pressure, and antioxidant markers.Results: The administration of PSP 3� 250mg could reduce total cholesterol levelby 3.486 46.9mg/dL (P¼ 0.672). Both pre- and post-test of total cholesterol aresignificantly correlated (r¼ 0.618, P¼ 0.000). PSP administration, however, in-creased the level of HDL cholesterol by 7.846 10.79 (P¼ 0.000). The systolic bloodpressure decreased from 130.146 43.37mmHg to 118.246 55.68 (P¼ 0.109),and the diastolic blood pressure decreased from 806 25.74mmHg to73.246 33.85mmHg (P¼ 0.102). Despite a great reduction of blood pressure to nor-mal range, it was not statistically significant. The reduction of anti-inflammatorymarkers interleukin-6, from 279.756 120.76 to 29.326 26.44 (P¼ 0.000) and TNFalpha, from 13447.846 2199.46 to 544.856 292.06 (P¼ 0.000) were significant.Malondialdehyde level also decreased significantly with PSP treatment for 3months(P¼ 0.000).Conclusion: The administration of polysaccharide peptides Ganoderma lucidum for3months in high-risk patients can reduce the blood pressure within normal range, improvetotal cholesterol level and significantly play role as anti-inflammation and antioxidant incardiovascular disease. Thus, it can be used as an adjuvant therapy in atherosclerosis.Keywords: Ganoderma lucidum • Polysaccharide peptides • Atherosclerosis •Antioxidant • Anti-inflammation • Hypertension

The difference between galectin-3 levels in mild and severe coronary arterydisease patients

H.A. Afrianto, N. Wijayahadi, S. Herminingsih, and S. Rifqi

Faculty of Medicine, Department of Cardiology and Vascular Medicine, DiponegoroUniversity, Kariadi Central General Hospital, Semarang, Indonesia

Background: Severity of coronary artery disease (CAD) can be assessed by coronary an-giography using scoring systems which are not easy to be applied. Galectin-3 is a newbiomarker of inflammation in atherosclerosis. It has a role in cell adhesive interactions,foam cells transformation and atherosclerotic plaque calcification. Therefore,Galectin-3 is expected to be a biomarker in distinguishing the severity of CAD.Aim: To determine the difference between Galectin-3 levels in mild and severe CADpatients.Methods: A cross sectional study in patients underwent coronary angiography at Dr.Kariadi Central General Hospital from December 2015 until March 2016. The severityof CAD was assessed using modified Gensini score (score <20 was considered mild,while �20 was considered severe). The galectin-3 levels were taken through a pe-ripheral vein. Independent t-test was done to determine the difference between se-rum galectin-3 levels in mild and severe CAD.Results: There were 35 patients who met the inclusion criteria which consisted of 19mild CAD and 16 severe CAD. There was a significant difference between the meanof galectin-3 levels in mild CAD (17.666 4.050) and severe CAD patients(20.256 2.910) with P¼ 0.041.Conclusion: Severe CAD patients had higher galectin-3 levels than mild CADpatients.Keywords: Galectin-3 • Modified Gensini score • Coronary artery disease •Atherosclerosis

Pro- and anti-inflammatory levels are similar in radial and coronary arteryassociated with epicardial adipose tissue thickness in coronary artery diseasesubject

M. Mappiare1, W. Horas1, A.H. Alkatiri1, S. Bakri2, and P. Kabo11Faculty of Medicine, Department of Cardiology, University of Hasanuddin, Makassar,Indonesia, 2Faculty of Medicine, Department of Internal Medicine, University ofHasanuddin, Makassar, Indonesia

Aim: To investigate the correlation between serum tumour necrosis factor (TNF)-a,high sensitivity C-reactive protein (hs-CRP) and adiponectin level in coronary artery(CA) with those in the radial artery (RA) associated with epicardial adipose tissue(EAT) thickness in coronary artery disease (CAD) subject.Methods: A cross-sectional study of 110 Indonesian subjects with stable CAD whounderwent coronary angiography were studied. Blood samples from RA and CA werecollected before coronary angiography. Serum TNF-a, hs-CRP, and adiponectin level inRA and CA were determined. We measured EAT thickness by transthoracic echocardio-gram. The severity of CAD was evaluated by modified Gensini score then divided into 2groups: non-severe CAD (score �13; n¼ 78) and severe CAD (score >13; n¼ 53).Results: EAT thickness was significantly greater in patients with severe CAD than inthose with non-severe CAD (8.56 6.9mm vs. 6.16 2.6mm; P< 0.001). Analysis ofthe correlation between serum level of TNF-a in RA vs. CA showed linear correlationin non-severe CAD (r¼ 0.57; P< 001), severe CAD (r¼ 0.67; P< 001) and all subjects(r¼ 0.61; P< 0.001). Serum level of hs-CRP showed strong correlation for non-severeCAD (r¼ 0.99; P< 0.001), severe CAD (r¼ 0.98; P< 0.001) and all subjects (r¼ 0.99;P< 0.001). Furthermore, analysis serum level of adiponectin for non-severe CAD(r¼ 0.87; P< 001), severe CAD (r¼ 0.86; P< 0.001) and all subjects (r¼ 0.86;P< 0.001) also showed linear correlation in both sample sites.Conclusion: Our data suggest a linear correlation between TNF-a, hs-CRP, and adipo-nectin in RA and CA associated with EAT in CAD subjects.Keywords: TNF-a • hs-CRP • Adiponectin • Epicardial adipose tissue • Coronaryartery disease

The correlation between plasma lipoprotein (a) level and carotid intima-mediathickness in patient with high risk of cardiovascular disease according toFramingham General CVD risk score 2008

S. Atmojo and B.S. PikirMedical Faculty, Cardiology and Vascular Medicine Department, Soetomo GeneralHospital, Airlangga University, Surabaya, Indonesia

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause ofmorbidity and mortality in the worldwide. Elevated plasma levels of lipoprotein(a)(Lp(a)) are considered to be an atherosclerotic risk factor, although additional stud-ies are necessary to provide confirmation. The carotid intima-media thickness (CIMT)is known as a surrogate index of atherosclerosis.Aim: To prove a correlation between plasma Lp(a) level and CIMT in patient with highrisk of cardiovascular disease according to Framingham General CVD risk score 2008.Methods: This is a correlational study with purposive sampling technique. Thirty subjectsparticipate in this research and each subject underwent a CIMT examination and theirblood sample were collected for Lp(a) measurement. This study was analysed withSpearman correlation test. A value of P< 0.05 was considered statistically significant.

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Results: The mean of plasma Lp(a) level in this study was 24.6667mg/dL. There wasa positive, strong, and significant correlation between plasma Lp(a) level and CIMTmean in patient with high risk of cardiovascular disease according to FraminghamGeneral CVD risk score 2008 (r¼ 0,618 dan P< 0,0001). There was also a positive,strong, and significant correlation between plasma Lp(a) level and CIMT max in pa-tient with high risk of cardiovascular disease according to Framingham General CVDrisk score 2008 (r¼ 0,698 dan P< 0.0001).Conclusion: There was a positive, strong, and significant correlation between plasmaLp(a) level and CIMT in patient with high risk of cardiovascular disease according toFramingham General CVD risk score 2008.Keywords: Atherosclerosis • Lipoprotein(a) • Carotid intima-media thickness •Framingham General CVD risk score 2008

The role of gender and biomarker in adult atrial septal defect patient withpulmonary hypertension

M.G. Satwiko1,2, D.W. Anggrahini1,2, A.B. Hartopo1,2, and L.K. Dinarti1,21Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia, 2Faculty ofMedicine, Department of Cardiology and Vascular Medicine, Sardjito GeneralHospital, Gajahmada University, Yogyakarta, Indonesia

Background: Atrial septal defect (ASD) is the most common congenital heart disease(CHD) found in adult. Lung overflow in ASD will increase lungs pressure and causespulmonary hypertension (PH).NT-pro BNP is marker of right ventricular dysfunction and mortality. Endothelin-1(ET-1) contributes to PH and predicts mortality in ASD.PH shows different characteristics between male and female. REVEAL registry has3.9 higher PH incidence in female compared to male. However, the mechanism ofthis phenomenon is unclear. This study analyses gender correlation, PH progressivityand it’s biomarker in adult ASD patients.Methods: Data were taken from 2015 as cohort observational study in part of ASD PHregistry in Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia. Datawere analysed from echocardiography, right heart catheterization (RHC), ET-1, andNT Pro BNP level.Results: ASD PH patients were 40 female and 11 male. Most patients were in NYHA II(male 64%, female 75.5%), NYHA III (male 36%, female 20%). Some female patientswere in NYHA I (5%) and NYHA IV (2.5%). None of male patients were in NYHA I nor IV.Male mean pulmonary arterial pressure (mPAP) was 42.386 11.53mmHg and femalemPAP was 38.816 12.79mmHg. Male right ventricular systolic pressure (RVSP) was84.116 45.49mmHg, and female RVSP was 65.696 42.24mmHg. Both P-values werenot significant (P¼ 0.4777 and P¼ 0.2508).Male ET-1 level was 5.2666 2.157, female ET-1 level was 5.8436 2.452. NT-pro BNPlevel in male was 3.8286 10.449, and in female was 1.5236 2.774. Both resultswere not significant (P¼ 0.4827 and P¼ 0.2100). Male and female mortality were 18%and 5%.Conclusion: In ASD PH, higher mortality and severity were found in male. However,NT-pro BNP and ET-1 level were not affected by gender.Keywords: ASD • PH • ET-1 • NT pro BNP

Do myocardial blush grade post chronic total occlusion–percutaneous coronaryintervention recanalization influence the clinical outcome of Angina quality

I. Handirosiyanto1 and M. Saifurrohman21Faculty of Medicine, Brawijaya University, Malang, Indonesia, 2Faculty of Medicine,Department of Cardiology and Vascular Medicine, Saiful Anwar Hospital, BrawijayaUniversity, Malang, Indonesia

Background: Percutaneous treatment of chronic total occlusion (CTO) remains a ma-jor challenge. There is a controversy in percutaneous coronary intervention (PCI) re-sults, considering its short-term and long-term outcomes. The study was aimed tocompare the clinical outcome of successful CTO–PCI with good vs. poor myocardialblush grade (MBG).Methods: We retrospectively analysed patients whom undergone successful CTO–PCIin Saiful Anwar General Hospital, Malang, Indonesia from January 2014 to August2016. The measurement of myocardial blush grade was conducted by using quantita-tive blush evaluator (QuBE) program post successful CTO–PCI. Clinical outcome of an-gina quality was followed up once using a validated Seattle Angina Questioner (SAQ).Results: Among 40 patients who underwent successful of percutaneous CTO recanali-zation, 19 patients (48%) had good MBG, whereas 21 of them (52%) had poor MBG.There were no significantly different in cardiac risk factors and angiographic baselinecharacteristics. Statistical analysis showed that there was no significant different be-tween good and poor MBG in SAQ domain of physical activity limitation (P¼ 0.247),angina frequency (P¼ 0.105), and quality of life (P¼ 0.932).Conclusion: Poor myocardial blush grade post CTO-PCI does not have a significant ef-fect in angina quality in patients with coronary artery disease whom receive an opti-mal medical treatment (OMT) after successful CTO-PCI.Keywords: Chronic total occlusion • Percutaneous coronary intervention •Myocardial blush grade • Seattle Angina questioner

Admission serum potassium level cut-off point for in-hospital mortality andventricular arrhythmias in ST-elevation myocardial infarction patients inMoewardi General Hospital Surakarta

I. Perkasa1, D.A. Paramita1, F. Harmani1, and T. Wasyanto21Faculty of Medicine, University of Sebelas Maret, Surakarta, Indonesia,2Departement of Cardiology and Vascular Medicine, Sebelas Maret University, Dr.Moewardi General Hospital, Surakarta, Indonesia

Background: Guidelines for potassium replacement in clinical practice recommendsa serum potassium (sK) level of 4.0–5.0mmol/L in acute myocardial infarction pa-tients. Recent trials demonstrate an increased mortality rate with a sK levelof> 4.5mmol/L. The aim of this study was to describe the correlation between ad-mission sK level with in-hospital mortality and ventricular arrhythmias.Methods: Retrospective cross sectional design, 169 patients with a primary diagnosis ofST-elevation myocardial infarction (STEMI) from October 2015 to October 2016 inMoewardi General Hospital Surakarta were included in this analysis. All measured valueswere reported as mean6 standard deviation (continues variable) or as percentage. Forstatistical analysis, data were analysed using SPSS version 20.0 and Medcalc software.Results: From the 169 patients, 33 patients (21%) died during hospitalization. Fromreceiver operating characteristic (ROC) analysis, the risk of in-hospital mortality willincreased with sK levels of> 4.4mmol/L with sensitivity 25% and specificity 84.9%. Inaddition, the incident of ventricular arrhythmia will increased in sK levels�3,4mmol/L with the sensitivity 37.78% and specificity 83.06%Conclusion: Admission sK level of> 4.4mmol/L was associated with increased in-hospitalmortality in STEMI patients. A significant correlation was found between sK levelof� 3,4mmol/L and ventricular arrhythmias (LR 2.23, 95% confidence interval 1.3–3.8).Keywords: Serum potassium • STEMI • Ventricular arrhythmias • In-hospital mortality

Global longitudinal strain as parameter of left ventricular systolic function andindependent predictor for major adverse cardiac event in 30-days after acuteST-elevation myocardial infarction

M.F. Sarahazti1, Z. Syahputra1, D. Ashrinda1, E. Hasibuan1, Komaria1, A.S. Adhitya1,N.Z. Akbar2, A. P. Ketaren2, and Z. Safri21Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Departmentof Cardiovascular, Haji Adam Malik General Hospital, Medan, Indonesia

Background: It has long been known that left ventricular ejection fraction (LVEF) isone of predictor for major adverse cardiac event (MACE) in acute ST-elevation myo-cardial infarction (STEMI). Recent studies show that wall motion abnormality in acuteSTEMI make it difficult to obtain true global systolic function. Global longitudinalstrain (GLS) is a sensitive measurement and has been studied as a parameter to as-sess global true LVEF in many cardiac disease, this study carried out to see if therewas any association between GLS and MACE in 30-days after acute STEMI patient.Methods: This is an analytic observational study using prospective cohort study, 32adult subjects of acute STEMI patient were performed echocardiography to measuredLV function parameters at 24h admission from June 2016 until December 2016, thenfollowed-up until 30 days since admission for MACE (mortality, heart failure, and reho-spitalization). Patients with other comorbidity such as valvular and congenital heartdisease, atrial fibrillation, history of previous coronary artery disease, and time to re-perfusion less than 4h were excluded. Cut-off points were taken from ROC curve, thenthe subject was divided into two groups. Chi-square, Fisher’s exact, or logistic regres-sion tests were used to examine the association between two variables and obtainedrelative risk (RR). A value of P< 0.05 was considered statistically significant.Result: In this study, the optimum cut-off value for GLS was>�12.1% with sensitivity andspecificity of 83.3% and 70.1%, respectively. Bivariate analysis showed among the LVEFSimpson’s method <40% (LVEF) (RR¼ 7.2, 95% CI 1.17–45.25, P¼ 0.038) and GLS>�11.8%(RR¼ 12, 95% CI 2.37–60.65, P¼ 0.001) were associated with MACE in 30 days after STEMI.In multivariate analysis, GLS>�11.8% (RR¼ 12, 95% CI 2.37–60.65, P¼ 0.001) remainedsignificantly associated and had 92.8% probability for MACE in 30-days after STEMI.Conclusion: Our data show that GLS>�12,1% appears to be an independent predic-tor for MACE in 30-days after acute STEMI. This sensitive 2D-echocardiographyspeckle tracking measurement can help the physician for further appropriate man-agement planning.Keywords: GLS • LVEF • STEMI • Mortality

Survival analysis of acute coronary syndrome patients with new atrial fibrillationin Moewardi General Hospital

T. Sulistyono1, D. Ayu1, and T. Wasyanto21Department of Cardiology and Vascular Medicine, Faculty Medicine, Sebelas MaretUniversity, Dr. Moewardi General Hospital, Surakarta, Indonesia, 2Department ofCardiology and Vascular Medicine, Sebelas Maret University, Dr. Moewardi GeneralHospital, Surakarta, Indonesia

Background: The prognostic implication of atrial fibrillation (AF) in the acute coro-nary syndrome (ACS) setting is unclear. Some studies have found an association

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between AF and increased morbidity and mortality, whereas other studies have failedto detect this association. The aim of this study was to assess the survival rate in ACSpatients with new AF.Methods: In retrospective cross sectional design, data were obtained from inpatientACS medical record in Moewardi General Hospital. We analysed 161 ACS patients dur-ing December 2015–2016. For statistical analysis, data were analysed by Kaplan–Meier method using SPSS version 20.0.Results: A total of 161 ACS patients were included in this analysis while 31 patientsdeveloped new AF (19.25%). Statistical analysis showed that the risk of in-hospitalmortality in ACS patients with new AF will increased compare with ACS patientswithout AF (hazard ratio¼ 5.171; 95% confidence interval¼ 7.866–28.134).Conclusion: ACS patients with new AF have higher risk for in-hospital mortality.Keywords: Atrial fibrillation • Acute coronary syndrome • Survival analysis •Mortality

Characteristic comparison between random hypertensive patients andhypertensive patients joined to community based - chronic disease managementprogram in flores primary healthcare setting

K.M.H.J. Tandayu1 and A. Purnama21Puskesmas Waipare, Maumere, Flores, NTT, Indonesia, 2SMF Penyakit Dalam, RSUDTC Hillers, Maumere, Flores, NTT, Indonesia

Background: Due to the aging population and the lifestyle trends, the prevalence of hy-pertension is keep increasing. The consequences are petrifying, since it is related to in-creased cardiovascular burden and death. Effective treatment methods are needed toovercome that. PROLANIS (Program Pelayanan Penyakit Kronis) provided by the nationalcoverage is a community based—chronic disease management program (CDMP) consistsof community activities, education and patient logbook. This study aimed to comparecharacteristics differences of patients joined to the program and those did not.Methods: This study is a cross-sectional study consisting of questionnaire filling andexaminations at the time of inclusion. Patient recruitment was done in PuskesmasWaipare, Maumere, Flores from October 2016 to January 2017 using non-probabilitypurposive sampling. Inclusion criteria were adult hypertensive patients without dia-betes mellitus or history of cardiovascular events. Exclusion criteria were patientswho did not give consent to be participate. Expert face validation is used to validatethe instrument. MMAS-8 scoring was used to determine compliance.Results: Forty five subjects were included in the study, consisted of 21 chronic dis-ease management program participants (46.7%) and 24 non participants (53.3%),with the mean age of 59.896 9.14-years old. Thirty four subjects are female, and71.1% of the subjects’s income are below regional minimum rate. Based on historytaking and questionnaire, the CDMP participation is associated (P< 0.05) with higherphysical activity rates, better compliance based on MMAS-8, higher scores on knowl-edge, and higher attitude score towards hypertension. From physical examinationand capillary blood screening, the CDMP participation is associated (P< 0.05) withhigher controlled hypertension rate and lower abdominal obesity rate. But it was notsignificantly associated (P� 0.05) to cigarette smoking history, body mass index,blood glucose, uric acid, cholesterol levels.Conclusion: The community based—chronic disease management program is associ-ated with higher physical activity rates, better compliance based on MMAS-8, higherknowledge and attitude score, controlled blood pressure levels, and normal waistlinemeasurements.Keywords: PROLANIS • Chronic disease management program • Hypertension •Compliance • Characteristic • Rural setting

The role of HbA1c level as predictor of in-hospital adverse outcomes in STelevation acute myocardial infarction

Y. Astuti, A.B. Hartopo, and B.Y. SetiantoFaculty of Medicine, Department of Cardiology and Vascular Medicine, Dr SardjitoHospital, Universitas Gadjah Mada, Yogyakarta, Indonesia

Background: Elevated admission glucose level is a strong predictor of in-hospital ad-verse outcome in patients with ST elevation acute myocardial infarction (STEMI).However, the prognostic value of long-term diabetic control [i.e. haemoglobin A1c(HbA1c) levels] in patient with STEMI is still undefined clearly.Aim: To investigate the role of HbA1c level in predicting in-hospital adverse outcomeamong patients with STEMI.Methods: We conducted a prospective study of 182 patients with STEMI. Patients werestratified into two groups based on HbA1C level, measured within admission. Optimalcontrol group is HbA1c level� 7% and suboptimal control group is HbA1c> 7%. All pa-tients were followed up prospectively for incidence of in-hospital adverse outcome. In-hospital adverse outcomes were death, acute heart failure, cardiogenic shock, reinfarc-tion, and ventricular arrhythmia with resuscitation. Its incidence was compared be-tween two study groups and statistical analysis was performed.Result: s: In our cohort study, in-hospital adverse outcomes occurred in 41 patients(22.5%). The mean HbA1C level was significantly higher in patients with in-hospitaladverse outcome as compared with no in-hospital adverse outcomes (7.7%6 2.99 vs.

6.9%62.2, P value 0.047 respectively). The amount of patients with HbA1c� 7% is129 and patients with HbA1c> 7% is 53 patients. The incidence of in-hospital adverseoutcome is tended to be higher in patients with HbA1c>7% as compared with pa-tients with HbA1c� 7% (28.3% vs. 20.2%, P-value 0.232). The odd ratio forHbA1c> 7% to develop in-hospital adverse outcomes was 1.56 (95% CI 0.75–3.27).Conclusion: The levels of HbA1c significantly higher in patients with in-hospital ad-verse outcomes. HbA1c> 7% have tendency of increased incidence of in-hospital ad-verse outcome.Keywords: HbA1c • STEMI • In-hospital adverse outcome

Infective endocarditis in children: association between sites of vegetation andthromboembolic complications

Ruswandiani, P.S Roebiono, O. Lilyasari, N.C. Proklamartina, R. Andriyati,A.U. Rahajoe, I. Sakidjan, R. Prakoso, Y. Kurniawati, and G.M. HarimurtiFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia

Background: Infective endocarditis (IE) is the infection of the endothelial surface ofthe heart. Systemic embolization as one of the complications of IE has been esti-mated to occur in 22–50% of cases with left-sided IE and may be clinically silent.Aim: This study aimed to review majority sites of vegetation and the association be-tween sites of vegetation with thromboembolic complications in children at NationalCardiovascular Center Harapan Kita from 2015 until 2016.Methods: A total of 35 children with definite IE included in this study. Modified Dukecriteria used for diagnosis of IE and CT scan were done to show thromboembolic events.The independent variable was site of vegetation, while thromboembolic complicationas the dependent variable. Data were collected from archives records of all patients.Results: Left-sided heart vegetation was found in 57.1% of patients, right-sided heartvegetation in 34.3%, while both sided heart vegetation in 8.6%. Thirty one percent ofthese patients had thromboembolic complications. Neurological complications oc-curred in 9 patients, 1 with brain abscess, 3 with mycotic aneurysm, 2 with cerebralhaemorrhage, and 3 with cerebral ischaemia. Pulmonary embolisms found in 2 pa-tients, both at distal left pulmonary artery. There was no significant association be-tween site of vegetation and thromboembolic events (P¼ 0.84).Conclusion: Left sided of vegetation was the most frequent found in our series. Thissite of vegetation is associated with neurological complications, however, statisti-cally there was no significant association.Keywords: Infective endocarditis • Thromboembolic • Vegetation • Neurological

Role of immature platelet fraction as prognostic biomarker post acute coronarysyndrome

H. Perdana, M. Abusari, M.Z. Arthamin1, and C.T. Tjahjono21Department of Clinical Pathology, Saiful Anwar General Hospital, Malang, Indonesia,2Department of Cardiology and Vascular Medicine, Saiful Anwar General Hospital,Malang, Indonesia

Background: Activated platelets that involve in pathophysiology of atherosclerotic car-diovascular disease plays a role in plaque formation and in thrombus development.Immature platelet fraction (IPF) is a juvenile platelet that is metabolically more activeand has greater thrombotic potential. Higher IPF level shows an increase in plateletturnover, which later causes a resistant to aspirin and other anti-thrombotics. This canhappen in healthy individual, diabetes mellitus (DM), and also acute coronary syndrome(ACS). High IPF level will eventually cause an increase in post-aspirin platelet aggrega-tion, after being stimulated by adenosine diphosphate or collagen; and also an increaseof thrombosis-related protein expression - such as P-selectin, glucoprotein IIb/IIIa andCOX. Evaluating the level of IPF as part of routine blood collection in patients with ACSis expected to be used in determining prognosis.Methods: Sixty eight patients of stable coronary artery disease (SCAD), non-ST eleva-tion acute coronary syndrome (NSTEACS) and ST elevation myocard infarct (STEMI),and 30 healthy individuals were included in this single center, cross sectional, obser-vational study that was conducted from May to December 2016 at Saiful AnwarGeneral Hospital Malang. Parameters measured were IPF within 24 h of hospitaliza-tion and Major Adverse Cardiac Events (MACE) in 30 days.Results: The mean age of patient group was 57.66 10.83-years old and that of con-trol group was 32.606 5.57-years old. Sex proportion of male at both groups wassimilar, 79.4% in patient group and 73.3% in control group (P¼ 0.5). The mean imma-ture platelet fraction (IPF) value for STEMI patient was 4.596 0.38, whereas inNSTEACS and SCAD was 4.276 0.68 and 2.266 1.53, respectively. After 30 days offollow up, MACE occurred in 17 patients with mean IPF value of 3.786 2.43, howeverit did not occur in 51 patients with mean IPF value of 4.626 2.74 (P¼ 0.62).Conclusion: IPF is unable to be used to determine short-term prognostic biomarkerin post ACS patients.Keywords: Immature platelet fraction • Coronary artery disease • Prognostic bio-marker • Acute coronary syndrome

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General population knowledge and awareness of hypertension and itsmanagement: an online questionnaire-based study

N. Kusuma1 and R. Pranata21RSUD Prof. Dr. H. Aloei Sabo – Puskesmas Kota Selatan, Gorontalo, Indonesia,2Tabanan General Hospital – Puskesmas Tabanan III, Tabanan, Bali, Indonesia

Background: Worldwide, raised blood pressure is estimated to cause 7.5 milliondeaths, about 12.8% of the total of all deaths. (i) In Indonesia, 63.2% of hypertension inpopulation is undiagnosed. (ii) Hypertension is a ‘silent killer’ and often has no warningsigns or symptoms, and many people are unaware. (iii) We aimed to evaluate generalpopulation knowledge and awareness about hypertension and it’s management.Methods: We enrolled sample from all over Indonesia and there were 200 respondents(93 males and 107 females), ranging from 10-years-old to 60-years-old with majority ofrespondents came from Jakarta (103 respondents) and evaluate respondents by onlinequestionnaire using Google form (https://goo.gl/forms/cFYStm0GS3zBzuKS2), distrib-uted through several social media applications including Line apps, Whatsapp,Blackberry messenger, and Facebook broadcast message to non-medical personnel.Results: More than half of respondents (87,5%) answered they know about‘Hypertension’, the rest respondents (12,5%) answered the opposite. The majority ofrespondents answered correctly about normal blood pressure (71.5%). More than halfof respondents agreed that hypertension is deadly (88.6%). When asked for the symp-toms of hypertension, they voted 80.7% for headache, 44.1% for blurry vision, 40.1%for asymptomatic, 25.7% for chest angina, 32.2% for palpitation, and 9.9% who donot know at all. Yet, there were 36.8% respondents agreed that it is mandatory forpatients with hypertension to get medical treatment, the other respondents votedthe opposite (36.8%) and indecisive (26.4%). The majority of respondents (56%, 112respondents) answered that they didn’t know the treatment for hypertension, only(31%, 62 respondents) answered they know about hypertension treatment, and therest (14%, 28 respondents) voted probable. When asked if medicine is the only treat-ment for hypertension, there were 144 respondents (71,3%) didn’t agree, 42 respon-dents (20,8%) agreed, and the rest 7.9% indecisive. Interestingly, only 71 (35.5%) re-spondents agreed that hypertension drugs must be taken for lifetime, and the other129 respondents (64.5%) agreed that the drugs can be stopped when the blood pres-sure comes to normal range. When asked the best exercise for patient with hyper-tension, there were 124 respondents (61.4%) answered correctly (30min’ durationfor moderate intensity exercise). 33.5% of respondents answered correctly for maxi-mum sodium dietary intake per day for hypertension patients which is 1 tsp/day.Conclusion: The knowledge about the factual information of hypertension is compul-sory for all people to raise awareness about this disease. The study showed that poorknowledge of medication strategy and poor information about non-pharmacologicmeasures. Continued spreading of information via mass media and from person toperson is encouraged and we hope it may help to control blood pressure in hyperten-sive and might help in general population to take preventive measures.Keywords: Hypertension • Knowledge • Management

Demographic profile of paediatric patients with infective endocarditis atNational Cardiovascular Center Harapan Kita, Jakarta

R. Andriyati, P.S. Roebiono, O. Lilyasari, N.C. Proklamartina, Ruswandiani,A.U. Rahajoe, I. Sakidjan, R. Prakoso, Y. Kurniawati, and G.M. HarimurtiFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia

Background: Infective endocarditis (IE) is a microbial infection of endocardial sur-face. It frequently affects native or prosthetic heart valves, or intra-cardiovascularforeign devices; while also can involve in congenital heart disease (CHD) and rheu-matic valvular heart disease (VHD).Aim: The aim of this study was to review the demographic profile of IE paediatric pa-tients at National Cardiovascular Center Harapan Kita, Jakarta from January 2015 un-til December 2016.Methods: A retrospective study was performed in 35 IE paediatric patients during 2-year period. Demographic and clinical data obtained from medical record and ana-lysed using SPSS version 22.Results: Of total 4271 hospitalized paediatric patients, the prevalence of IE was notsignificantly increased between year 2015 and 2016 (0.81 and 0.82% respectively,P¼ 0.47). The median age of these patients was 12 (3–18) years old with majority fe-male (60%). Most patients present with chief complaint of fever (73.5%). Positiveblood culture results were found in 17 patients (48.6%) and Streptococcus anhemoly-ticus was the most frequent bacteria finding (52.9%). The underlying cardiac lesionswere non-cyanotic CHD in 25 (71.4%) patients, where VSD 11 (31.4%) was the mostlesions. Rheumatic VHD was recognized in 11 (31.4%) patients, where mitral valvewas the most affected valve (81.8%). Total of 23 (65.7%) patients received antibioticsfollowed by cardiac surgical repair with vegetation evacuation, while the rest wasonly treated with antibiotics alone. Two patients died during hospitalization (5.7%)due to sepsis and non-haemorrhagic stroke.Conclusion: The mortality rate of IE was high enough (5.7%) eventhough the preva-lence during study period was not increasing significantly. The most underlying

cardiac lesion was non-cyanotic CHD and more than half received antibiotics and car-diac surgical repair with vegetation evacuation.Keywords: Children • Demographic • Infective endocarditis • Paediatric

Platelet-to-lymphocyte ratio as a mortality prognostic marker in acute coronarysyndrome: a mini systematic review

A. Prabata and L. MaharinaPermata Depok Hospital, Depok, West Java, Indonesia

Background: Platelet-to-lymphocyte ratio (PLR), which was introduced as a noveland potential inflammatory marker, has recently been investigated as a predictor ofmajor adverse outcomes, especially mortality, in various cardiovascular diseases.Since acute coronary syndromes (ACS) is one of the cardiovascular diseases that hashigh mortality rates and prediction of the mortality risk is becoming important, weaim to review the role of PLR as a mortality predictor in ACS patients.Methods: We screened and filtered some studies in structured research for severaldatabases including Pubmed, Sciencedirect, EBSCOHost, and Proquest on PLR role asmortality predictor in ACS. The selected prognosis studies then underwent criticalappraisal based on Oxford CEEBM prognosis study clinical appraisal.Results: Eight prospective cohort studies comprising of 10 171 participants met allinclusion criteria were critically appraised. Four studies discussed unstable anginapectoris (UAP), non ST-elevation myocardial infarct (NSTEMI), ST-elevation myocar-dial infarct (STEMI), three studies discussed STEMI, and one study discussed NSTEMI.All of studies showed that PLR can be an independent predictor, although only sevenstudies which showed it statistically significant. The odds ratio (OR) of mortalityranged from 0.604 to 1.18. PLR cut-off is ranged from 116 to 201.Conclusion: This review shown that PLR can be a simple, inexpensive, easy to find,and effective laboratory examination for ACS. It could become one of important mor-tality prognostic marker in the future with more research.Keywords: Platelet-to-lymphocyte ratio • Acute coronary syndrome • Mortality

Self-medicating hypertensive patient and its drawbacks

S. Oetama1, M.B.G. Sitepu2, A. Fachrurrozi3, and I.B.D. Prayudi41RSUD Hadji Boejasin, Pelaihari, Kalimantan Selatan, Indonesia, 2RSUD Sukamara,Sukamara, Kalimantan Tengah, Indonesia, 3RS Pupuk Kaltim, Bontang, KalimantanTimur, Indonesia, 4RSUD Tarakan, Tarakan, Kalimantan Utara, Indonesia

Background: Self-medicating hypertensive patient is a thriving phenomenon in lesserparts of Indonesia. Without proper dose titration and surveillance this often leads tosub-optimal medication or on-and-off compliance. This study aims to determine theprevalence of self-medicating patient and its negative effect in different regions ofKalimantan.Methods: This analytic-observational study was conducted at 4 different hospitalsrepresenting 4 provinces of Kalimantan from July to December 2016. Primary datawere collected via direct interview with predefined form, either on emergencydepartment or outpatient clinic. Self-medicating defined as any unprescribed anti-hypertension or alternative medicine consumption, or initially prescribed anti-hypertension but continued independently without follow up from a physician. Thedata were analysed using SPSS 17.0.Results: A total of 521 samples were included and dominated by male (329; 63.1%).Mean age was 55.456 12.55. Universal health coverage was utilized by most samples(279; 53.6%). Self-medicating behaviour was observed on 166 samples (31.9%) withno symptom regarding hypertension as the main reason (99; 59.6%). Good compliancewas found on 285 samples (54.7%) but only 199 samples (38.2%) had controlled bloodpressure. History of hospitalization due to cardiovascular disease was noticed on 201samples (38.6%). Analysis showed a correlation between self-medication with bloodpressure (P¼ 0.001) and compliance (P¼ 0.001) but no correlation with history ofhospitalization due to cardiovascular disease (P¼ 0.214).Conclusion: Self-medication has a strong tendency to precipitate uncontrolled bloodpressure and poor compliance in hypertensive patients. This study designates moreendeavours and tuition from physician in order to eliminate this unfavourablebehaviour.Keywords: Hypertension • Self-medicating • Compliance

Hypertension treatment and blood pressure control in adult at PuskesmasSinggani, Palu, Central Sulawesi in 2016

Y. Triatmanto and W. GautamiPuskesmas Singgani, Palu, Central Sulawesi, Indonesia

Background: Hypertension is one of the major health problems among non-communicable diseases in Indonesia. Based on national data, provinces in Sulawesihave higher prevalence of hypertension compared to national average. This studyaimed to describe the epidemiological profile of hypertension, and to assess blood

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pressure control of patients with hypertension at one of the Primary Health Care(Puskesmas) in Palu, Central Sulawesi.Methods: This is a descriptive study with a total population sampling using the entiremedical records of adult patients in Puskesmas Singgani from January 2016 toDecember 2016. Variables observed include gender, age, degree of hypertension,blood pressure control, other comorbidities, and types of anti-hypertensive agentused.Result: Among 3300 medical records collected, there are 502 patients with hyperten-sion (15.2%). Females are more prevalent. Most patients ranged from age 50 to 70years. There are 57.3% patients that were diagnosed as stage I hypertension, and theother 42,7% were stage II hypertension, with a total of 36.7% lacking in blood pres-sure control. There are also comorbidities, such as dyslipidaemia and type 2 diabetesmellitus, with proportion of 17.5% and 17.7% respectively. As for the anti-hypertensive agent used, 62.4% patients were treated using single drug therapy, 74%of which is calcium-channel blocker, followed by ACE-inhibitor (16%). On the otherhand, 37.6% patients were using multiple drugs, 40% of which is ACE-inhibitor andcalcium-channel blocker combined, followed by combination of angiotensin-receptorblocker and calcium-channel blocker (16%).Conclusion: Our study showed that there is less number of hypertensive patientstreated compared to the actual prevalence. Anti-hypertensive agent used the mostis calcium-channel blocker and ACE-inhibitor types of drug. Moreover, above a thirddo not have a controlled blood pressure despite having treatment.Keywords: Hypertension • Anti-hypertensive agent • Blood pressure control •Primary health care

Association between smoking behaviour and low-density lipoprotein cholesterol(Ldl-C) level among workers at CV. Julian Pratama Pontianak

S.N. Minarti1, I. Ketaren2, and D.P. Hadi31Faculty of Medicine, Medical School, Universitas Tanjungpura, Pontianak, WestKalimanta, Indonesia, 2Department of Cardiovascular, Dr.Soedarso General Hospital,Pontianak, West Kalimantan, Indonesia, 3Faculty of Medicine, Department ofPhysiology, Universitas Tanjungpura, Pontianak, West Kalimantan, Indonesia

Background: Increasing number of smoker is related to increasing number of nega-tive effect for health. Cigarette smoking is a major risk factor for the developmentand progression of cardiovascular disease. Smoking habit tends to influence lipid pro-file, including Low Density Lipoprotein (LDL) level.Aim: The aim of this study was to investigate the association among smoking status,duration of smoking habit, number of cigarette per day, and cigarette type based onfilter presence, to LDL level in workers at CV. Julian Pratama Pontianak.Methods: This research was analytical study with cross sectional design. There were40 subjects chosen as research samples with simple random sampling method, basedon inclusion and exclusion criteria. Data of sample smoking habit were obtained byusing questionnaire. LDL level was measured by precipitate method.Results: LDL level in smoker group was higher than non-smokers group, but in statis-tical analysis showed that there were no significant association between smoking sta-tus and LDL level (P¼ 0.076). There were significant associations between durationof smoking habit (P¼ 0,037), number of cigarette per day (P¼ 0.003), and cigarettetype (P¼ 0.044) to LDL level among workers in CV. Julian Pratama Pontianak.Conclusion: There is no significant association between smoking status and LDL levelamong workers in CV. Julian Pratama Pontianak. Duration of smoking habit, numberof cigarette per day, and cigarette type show significant association to LDL level.Keywords: Smoking habit • Low density lipoprotein (LDL)

Differences of endothelin-1 in acute myocardial infarction with and withoutacute heart failure

M.R. Hadwiono1, B.Y. Setianto2, A.B. Hartopo2, and A.D. Pradana31Faculty of Medicine, Bachelor of Medicine, Universitas Gadjah Mada, Yogyakarta,Indonesia, 2Faculty of Medicine, Department of Cardiology and Vascular Medicine,Dr. Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia, 3Faculty ofMedicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

Background: Incidence of acute myocardial infarction (AMI) in Yogyakarta is higherthan other provinces in Indonesia. Acute heart failure is one of AMI complications.Endothelin-1 is a potent vasoconstrictor peptide which contributes in the process ofacute myocardial infarction. This study investigates endothelin-1 level in acute myo-cardial patient with acute heart failure complication.Method: Cross-sectional study was chosen for this research. Consecutive samplingwas done in Intensive Cardiac Care Unit of Dr. Sardjito Hospital, Yogyakarta. Killipscore was used to assess heart failure status. Assessment and serum collection wasdone at the time of patient admission. Calculation of endothelin-1 serum level wasperformed using ELISA method. The difference of endothelin-1 level between pa-tients with and without acute heart failure was analysed using Mann–Whitneymethod. Statistical significance was considered if P< 0.05.

Results: There are 118 subjects consist of 11 AMI patients with acute heart failureand 107 AMI patients without acute heart failure. The mean endothelin-1 level statis-tically different between AMI with acute heart failure group and AMI without acuteheart failure group (4.7061.97 vs. 2.846 1.25; P¼ 0.004).Conclusion: Endothelin-1 serum level is higher in acute myocardial infarction pa-tients with acute heart failure complication than acute myocardial infarction pa-tients without acute heart failure.Keywords: Acute myocardial infarction • Acute heart failure • Endothelin-1

Association between hypertension with cardiovascular disease among diabeticpatients: an observational study in rural area population in Rapak MahangPrimary Health Center, Tenggarong District, East Kalimantan

D. Budiono and J. N. AdamRapak Mahang Primary Health Center, Kutai Kertanegara, Indonesia

Background: Cardiovascular disease (CVD) is the major cause of morbidity and mor-tality in patients with diabetes mellitus (DM). Both of CVD and DM are very closelyrelated with lifestyle management. This study aimed to analyse the association be-tween hypertension and cardiovascular disease among diabetic patients of rural areapopulation in Rapak Mahang Primary Health Center, Tenggarong District, EastKalimantan.Methods: The research is observational analytic study. Study subject consisted of 412patients who were admitted on January to December 2016 in diabetic polyclinic ofRapak Mahang Primary Health Center. Data were analysed by chi-square test.Results: Among the 412 patients, 41.3% (n¼ 170) were male and 58.7% (n¼ 242)were female. The mean age was 55.07, ranging from 32 to 85 years which predomi-nated by age group of 46–55-years old (39.82%). Hypertension was diagnosed in 185subjects (44.9%), congestive heart failure (CHF) in 38 subjects (9.2%), coronary ar-tery disease (CAD) in 16 subjects (3.9%), arrhythmia in 4 subjects (1%), peripheral ar-tery disease (PAD) in 57 patients (13.8%), and stroke in 8 patients (1.9%). The associ-ation of hypertension and cardiovascular disease were following, CHF: P¼ 0.001;CAD: P¼ 0.676; PAD: P¼ 0.302; arrhythmia: P¼ 0.224; and stroke: P¼ 0.084.Conclusion: There is significant relationship between hypertension and CHF events,meanwhile there is no significant relationship between hypertension and CAD, PAD,arrhythmia, or stroke events among the diabetic patients of rural area population inRapak Mahang Primary Health Center, Tenggarong District, East Kalimantan.Keywords: Diabetes • Hypertension • Cardiovascular disease • Rural area popula-tion • Tenggarong district

QRS duration on admission and left ventricular ejection fraction as predictor ofin-hospital major cardiovascular events in non-STelevation myocardialinfarction patients: a retrospective study

Y. Safitri, Z. Syahputra, Z. Muchtar, N.Z Akbar, and A.A. SiregarFaculty of Medicine, Department of Cardiology and Vascular Medicine, Adam MalikHospital, University of Sumatera Utara, Medan, Indonesia

Background: QRS duration has been an independent predictor for determining prog-nosis and mortality in patients with ST elevation myocardial infarction (STEMI). Asleft ventricular ejection fraction (LVEF) which is often used as a tool for assessingprognosis and therapeutic efficacy in patients with acute coronary syndrome, espe-cially STEMI. However, a few studies evaluated the usefulness of these two parame-ters to assess the possibility of major cardiovascular events (MACE) during in hospitaltreatment in patients with non-ST elevation myocardial infarction (NSTEMI).Methods: A total of 95 patients with NSTEMI participated in this study. Patients wereclassified into high or low QRSd at a cut-off value of 110ms Noted on the initial EKGafter excluding bundle-branch block. LVEF were assessed using echocardiography ma-chine GE Vivid S6 with Teichholz or Simpson methods when the patient is still in a pe-riod of treatment and divided into groups of normal EF and EF decreased.Assessment of the basic characteristics and the risk of major cardiovascular events inpatients during treatment. Bivariate analysis using chi-square and multivariate analy-sis using logistic regression to find the correlation of LVEF and QRS duration withMACE.Results: A total of 95 NSTEMI patients with a mean of 566 8 years were included.73.7% were male and majority with smoker (65.3%) as a risk factor for acute coronarysyndrome. From the bivariate analysis found a significant correlation in QRS duration(P 0.016, OR 4.5, 95% CI 1.228–16.486) and LVEF (P 0.024, OR 0.18, 95% CI 0.040–0.888) with the occurrence of MACE. From the multivariate analysis found that dif-ferences in gender (OR 4.10, 95% CI 0.723–23.355) and LVEF (OR 3.681, 95% CI 0.699–19.373) is the most significant independent predictors of MACE in NSTEMIConclusion: QRS duration on admission and LVEF are independent predictor showed apotential of in-hospital major cardiovascular events in NSTEMI patientsKeywords: QRS duration • Left ventricular ejection fraction • Non ST elevation mio-cardial infarct (NSTEMI)

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The correlation between serum osteoprotegerin level and arterial stiffness usingcardio-ankle vascular index in hypertensive patients

A. Amelia and J.N.E. PutrantoFaculty of Medicine, Department of Cardiology and Vascular Medicine, Dr. SoetomoHospital, Universitas Airlangga, Surabaya, Indonesia

Background: Arterial stiffness is recognized to be an independent risk factor for car-diovascular morbidity and mortality. It is increasingly recognized as an importantprognostic index and potential therapeutic target in patients with hypertension. Thecardio-ankle vascular index (CAVI) is a recently developed clinical metric for evaluat-ing arterial stiffness from the origin of the aorta to the ankle. Osteoprotegerin (OPG)has been suggested implicated in the process of vascular stiffness and may reflectendothelial dysfunctionAim: To prove a positive correlation between osteoprotegerin serum level and arte-rial stiffness using CAVI in hypertensive patients.Methods: This is a correlational study with purposive sampling technique. Thirty sub-jects participate in this reseach and each subject underwent a CAVI examination toassess arterial stiffness and their blood samples were collected for OPG measure-ment. This study is analysed with Pearson correlation test.Results: The mean of osteoprotegerin serum level in this study was 5.5261.5pmol/.There is a positive, strong and significant correlation between osteoprotegerin serum leveland arterial stiffness using CAVI in hypertensive patients (r¼ 0.730 dan P<0.0001).Conclusion: There was a positive, strong, and significant correlation between osteo-protegerin serum level and arterial stiffness using CAVI in hypertensive patients.Keywords: Osteoprotegerin • Arterial stiffness • Cardio-ankle vascular index •Hypertension

Two-year follow-up after percutaneous balloon mitral valvuloplasty in patientswith mitral stenosis

R. Diansari, I.S. Atmosudigdo, B.E. Putra, and O. LilyasariFaculty of Medicine, Department of Cardiology & Vascular Medicine, University ofIndonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia

Background: Rheumatic heart disease is the most prevalent cause of mitral valvestenosis (MS). Rheumatic heart disease (RHD) remains an accountable disease in apoverty and low socioeconomic area. It is prevalent in the developing world.Percutaneous balloon mitral valvuloplasty (PBMV) is considered the treatment ofchoice for rheumatic mitral valve stenosis. This study aims to report 2-year follow-upof post PBMV patients in National Cardiovascular Center Harapan Kita.Methods: Between 2011 and 2013, 121 patients underwent PBMV in NationalCardiovascular Center Harapan Kita. A retrospective cohort was done based on 121medical records of patients underwent PBMV during those years and followed up for2 years. The primary endpoint is 2-year-post-procedural major adverse cardiac event(MACE) including cardiovascular death, mitral surgery or repeat PBMV.Result: s: Two years follow-up was completed in 121 patients. The incidence of primaryend point was seen in 15 patients (12.4%). The rate of death, mitral surgery, and repeatPBMV was 0%, 73.3%, and 40%, respectively. With two patients had both mitral surgeryand repeat PBMV. In statistical analysis, there were no significant difference betweenMACE incidence and gender (P¼ 0.123), age above 50 (P¼ 0.692), atrial fibrillation(P¼ 0.460), mitral valve area (MVA)< 1.5 cm2 (P¼ 0.187), and NYHA class (P¼ 0.237).Conclusion: It was concluded that the major adverse cardiac event post PBMV had noassociation with gender, age, atrial fibrillation, MVA< 1.5 cm2, and NYHA class. After 2-year follow-up, more than 80% of patients still in a good condition confirming thatPBMV is still a reasonable therapeutic intervention for rheumatic mitral valve stenosis.Keywords: Percutaneous balloon mitral valvuloplasty • Balloon mitralvalvuloplasty • Mitral stenosis • Follow-up

Risk factors with socioeconomic status and clinical profiles of acute coronarysyndrome

S. Oetama1, S.P. Kurniawan2, and A.A. Kuncoro21RSUD Hadji Boejasin, Pelaihari, Indonesia, 2Internist at RSUD Hadji Boejasin,Pelaihari, Indonesia

Background: Cardiovascular disease is still the leading cause of death with acutecoronary syndrome (ACS) as one of its most insidious forms. Several risk factors havebeen well defined and it is thought that chronic stress associated with lower socio-economic status (SES) plays a role in ACS. This study aims to determine the risk fac-tors, SES, and clinical profile of ACS patients in RSUD Hadji Boejasin.Methods: This cross-sectional study was conducted at RSUD Hadji Boejasin emer-gency department from June to December 2016. Sample consisted of 108 ACS pa-tients. Data were collected via direct interview with predefined form. All patientssigned informed consent regarding their permission to be included in this study.Results: A total of 62 males (57.4%) and 46 females (42.6%) were sampled. Mean age was58.52612.26. Most samples utilized universal health coverage (53; 49.1%). ST-elevationmyocardial infarction was found on 70 samples (64.8%), non ST-elevation myocardial

infarction on 24 samples (22.2%), and unstable angina on 14 samples (12.9%). Anteriorwall (with or without other region as well) was the predominant site for myocardial infarc-tion (63; 58.3%). Less-educated (graduated from junior high school or less) dominated thesamples (76; 70.4%) and majority of them were unemployed (60; 55.6%) with monthly in-come less than a million (49; 45.4%). Low social gradient (unemployed or retired) also ob-served on most samples (55; 50.9%). Hypertension (92; 85.2%) and smoking (64; 59.2%)were the most common risk factors with chest pain (86; 79.6%), breathlessness (81; 75%),and palpitation (76; 70.4%) were the leading clinical manifestations. Complication wasmainly due to heart failure (28; 25.9%) and arrhythmia (14; 12.9%).Conclusion: ACS is once again proven to be more prevalent in male population. LowSES is indeed found on most samples, putting more augmentation on chronic stresstheory. Hypertension and smoking are the most common risk factors in this studywhich are modifiable, urging for more effort in risk factor elimination.Keywords: Acute coronary syndrome • Socioeconomic status • Risk factors

Arrhythmias and in-hospital mortality of ST-elevation myocardial infarctionpatients in Moewardi General Hospital Surakarta

I. Perkasa1, D.A. Paramita1, T. Sulistyono1, and T. Wasyanto21Faculty of Medicine, University of Sebelas Maret, Surakarta, Indonesia,2Departement of Cardiology and Vascular Medicine, Sebelas Maret University, Dr.Moewardi Hospital General, Surakarta, Indonesia

Background: Cardiac arrhythmias and conduction abnormalities in ST-elevation myo-cardial infarction (STEMI) have been associated with adverse prognosis in numerousstudies. Several studies show different arrhythmias in different location of myocar-dial infarction. The aim of this study was to evaluate the arrhythmias and the impactof in-hospital mortality of STEMI patients in Moewardi General Hospital Surakarta.Methods: In retrospective cross sectional design, data from inpatient STEMI inMoewardi General Hospital from October 2015 to October 2016 were analysed. Thecollected data including age, sex, laboratory, and echocardiography findings, loca-tion of the infarct, and associated arrhythmias and conduction abnormalities. Allmeasured values were reported as mean6 standard deviation (continues variable) oras percentage. In-hospital mortality was used as end point for analysis.Result: A total of 169 STEMI patients were included in this analysis. 36 patients(21.3%) died during hospitalization with 17 patients (47.2%) with anterior STEMI and19 patients (52.7%) with inferior STEMI. The result showed patients with anterior andinferior STEMI were likely to develop VT/VF with insignificant differences (HR 2.07,P> 0.05), on the other hand, total AV block were likely to develop in inferior STEMI(P< 0.01). Among STEMI patient with arrhythmias, VT/VF associated with in-hospitalmortality with HR¼ 6.10 and P value was 0.002.Conclusion: This study demonstrated that patients with anterior or inferior STEMIcould develop VT/VF, but total AV block more likely to develop in patient with infe-rior STEMI. In addition, VT/VF is a significant predictor of in-hospital mortality.Keywords: STEMI • VT/VF • Arrhythmia • Total AV block • Mortality

A scoring system for detecting left ventricular diastolic dysfunction inhyperstensive patients

S.S. Donny1, H. Nani1, D.L. Lies1, K. Aria2, S. Rarsari1, and B.S. Bambang11Faculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasIndonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, 2Facultyof Medicine, Department of Community Medicine, Universitas Indonesia, Jakarta,Indonesia

Background: Hypertension is the most common condition seen in primary care and asa risk factor for diastolic dysfunction. Diastolic dysfunction occurred before heartfailure in hypertensive patients with preserved ejection fraction, therefore early di-agnosis of diastolic dysfunction is very important. Several factors have been knownto be associated with left ventricular diastolic dysfunction and a new scoring systemcould be generated from those factors.Aim: To identify factors related to left ventricular diastolic dysfunction in hyperten-sive patients, and to generate a scoring system from those related factors.Methods: A cross sectional study was conducted in Tarakan General District HospitalNorth Borneo with hypertensive subjects on October 2016. Patients characteristics,all factors related to left ventricular diastolic dysfunction, and echocardiographicdata were collected and analysed.Results: There were 132 total samples in this study, and left ventricular diastolic dys-function was found in 40.2% samples. From logistic regression analysis, age �55 years(P¼ 0.006), poor blood pressure control (P< 0.001), left ventricular hypertrophy(P¼ 0.003), and abnormal fasting plasma glucose (P¼ 0.001) were found to have asignificant relation with left ventricular diastolic dysfunction and became a finalmodel variables of scoring system. Left ventricular diastolic dysfunction scoring sys-tem could be generated from those variables final models. Calibration and internalvalidation tests for this scoring system showed good results.Conclusion: A scoring system can be generated to detect left ventricular diastolicdysfunction in hypertensive patients.Keywords: Hypertension • Scoring system • Left ventricular diastolic dysfunction

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Correlation between creatinine serum at admission and length of stay in acutedecompensated heart failure

I.H. Suryana1, A.D. Vatvani1, Z.L. Rimba1, M. Aziz2, and V.A. Damay21Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia, 2Departmentof Cardiology, Siloam Hospital Lippo Village, Tangerang, Indonesia

Background: Creatinine serum is one of practical parameter to determine renalfunction. Poor renal function is predictor of poor prognosis in heart failure patients.However, longer length of stay (LoS) leads to more complication during hospitaliza-tion beside apparently higher patients dissatisfaction and financial burden. We aimto determine the relationship between creatinine serum and LoS in patients withacute decompensated heart failure (ADHF).Methods: This is a cross sectional study in our Teaching Hospital. Data was takenfrom the medical records from August–December 2016. We excluded congenital heartdisease and cancer patients. Bivariate analysis was done using Spearman correlation.Results: A total of 59 subjects were included in this study, out of which 37 (62.7%)were male. The mean of patient’s age was 54.9 (612.4) years. Mean left ventricleejection fraction of the patients was 36.4 (619.6)%. Mean serum creatinine, ureum,and estimated glomerular filtration rate (eGFR) levels were 1.49 (61.27) mg/dL,53.9 (637.1) mg/dL, and 58.2 (631.4) respectively. Mean LoS was 6.5 (64.2) days.The most common aetiology was ischaemic cardiomyopathy (67.8%). Hypertensionand diabetes mellitus was present in 15 (25.4%) and 20 (33.9%) subjects. Serumureum had significant correlation with LoS (r: 0.366, P: 0.005). Serum creatinine hadsignificant correlation with LoS (r: 0.289, P: 0.028). eGFR had significant correlationwith LoS (r: �0.261, P: 0.046).Conclusion: There are significant correlations between level of serum ureum, creati-nine, and eGFR on hospital admission with LoS in subjects with ADHF in which serumcreatinine has weaker correlation than ureum with LoS, but stronger correlationthan eGFR with LoS.Keywords: ADHF • Length of stay • Creatinine

Factors associated with multiple vessel disease in patients undergoing coronaryangiography

Z.L. Rimba1, V.A. Damay2, J. Wiryanto1, A.D. Vatvani1, and A.A. Lukito21Faculty of Medicine, Universitas Pelita Harapan, Jakarta, Indonesia, 2Department ofCardiovascular Medicine, Universitas Pelita Harapan, Jakarta, Indonesia

Background: Multiple vessel disease is associated with high-mortality rate. Unlike itscounterpart, multiple vessel disease needs to be managed with coronary angiographybypass graft, which exposed the patients to increased risk of stroke. Thus worseningthe outcome of the patients. Various factors contribute to the occurrence of coro-nary artery disease, however factors that are associated with multiple vessel diseaseis less well characterized. This study aims to find factors that are associated withmultiple vessel disease in patients undergoing coronary angiography.Methods: This is a cross-sectional study. The study is conducted in Siloam GeneralTeaching Hospital from September 2016 to January 2017. Patients’ baseline charac-teristic and risk factors are taken from the medical records. The analysis is done us-ing Chi-Square test or Fisher test.Results: A total of 105 patients were included in our study. 81 (77.1%) of the patientswere male. The mean age of the patients was 57.1 (69.33) years. There were 83(79%) patients older than 50 years. Hypertension, diabetes mellitus (DM), and dyslipi-daemia was present in 39 (37.1%), 22 (21.0%), and 39 (37.1%) patients respectively.Sixty (57.1%) patients had a positive smoking history. Eighty (76.2%) patients hadmultiple vessel disease. Multiple vessel disease was significantly higher in patientsthat were male (OR: 3.143, P: 0.019), and aged more than 50 years (OR: 6.45,P< 0.001). Other factors such as hypertension, DM, dyslipidaemia, and smoking his-tory did not have any significant association with multiple vessel disease.Conclusion: Male gender and age older than 50 years are the factors associated withgreater risk for multiple vessel disease in patients undergoing coronary angiography.Keywords: Coronary angiography • Multiple vessel disease • Risk factors

Simplified clinical electrocardiogram score as a mortality predictor among acutemyocard infarct patient in intensive cardiac care unit Dr. Soedarso hospital

M. Sitorus1 and I. Ketaren21Faculty of Medicine, Dr. Soedarso State Province Hospital, Tanjungpura University,Pontianak, Indonesia, 2Department of Cardiology, Tanjungpura University, Dr.Soedarso State Province Hospital, Pontianak, Indonesia

Background: World Health Organization in 2008 said that three million people diedbecause myocard infarct around the world. In 2013, according to basic health re-search results acute myocard infarct is the most frequent disease that diagnosed byphysician and the major cause of mortality in Intensive cardiac care unit (ICCU) Dr.Soedarso hospital. One of the most causes of high mortality among acute myocard in-farct patient is lack of sensitivity among the physician to predict and prevent acutemyocard infarct complication. The aim of this study was to assess the relation

between Simplified Clinical Electrocardiogram score as a predictor of mortalityamong acute myocard infarct patient in ICCU Dr. Soedarso hospital.Methods: This research was an analytic study with case control design. The datawere obtained from ICCU Dr. Soedarso hospital. There are 96 samples who dividedinto 2 groups. Fifty-one samples are control group(score� 4) and 45 samples are casegroup (score� 5). This research calculates the electrocardiogram abnormality ofacute myocard infarct inpatient using Simplified Clinical Electrocardiogram scorecriteria.Results: Mortality among case group are 35 people and control group are 6 people.Chi-square test showed a relation between Simplified Clinical Electrocardiogramscore with mortality among acute myocard infarct patient in ICCU Dr. Soedarso hospi-tal (P¼ 0.00), odds ratio 26.25 95% confidence interval 25.15–27.35.Conclusion: There was significant relation between Simplified ClinicalElectrocardiogram score with mortality among acute myocard infarct patient in ICCUDr. Soedarso hospital.Keywords: Simplified clinical electrocardiogram score • Predictor • Mortality

Left ventricle diastolic wall strain as a simple parameter of in-hospital mortalityin patients with heart failure with reduced ejection fraction

A.L. Tobing, N.Z. Akbar, A.P. Ketaren, and A.A. SiregarFaculty of Medicine, Department of Cardiology and Vascular Medicine, Haji AdamMalik General Hospital, University of Sumatera Utara, Medan, Indonesia

Background: Impaired left ventricle (LV) relaxation and increased LV stiffness are themajor components of LV diastolic dysfunction which play an important role in chronicheart failure. Left ventricle diastolic wall strain (DWS) is a non-invasive, load-inde-pendent, and reproducible estimator of LV stiffness using 2D echocardiography basedon linear elastic theory. Several studies have shown the value of LV stiffness in heartfailure with preserved ejection fraction (HFPEF), but its role and prognostic value inHFrEF patients remains unclear.Methods: Forty patients with signs and symptoms of heart failure (EF< 50%) be-tween September–December 2016 were enrolled. Patients were excluded if theyhad the history of cardiac surgery, moderate to severe valvular heart disease,atrioventricular block, constrictive pericarditis, atrial fibrillation, and old myocar-dial infarction in posterior wall. DWS was calculated using the formula: DWS¼ [(LVposterior wall thickness at end systole� LV posterior wall thickness at end-diastole)/LV posterior wall thickness at end-systole]. HFrEF patients divided intotwo groups (with and without in-hospital mortality) and DWS was compared be-tween those groups.Results: A total of 40 patients, 9 females (22%), mean age 59.66 9.38 years.Hypertension in 18 patients (45%), type 2 Diabetes 22 patients (55%), Dyslipidaemia27 patients (67%). Fourteen patients (35%) suffered death during hospitalization.Bivariate analysis showed E/A ratio, E/E’, and DWS were significantly associated within-hospital mortality. Between two groups, DWS was significantly lower in patientswith in-hospital mortality by 0.146 0.09 vs. 0.226 0.08 (P¼ 0.008). The optimalcut-off value of DWS was 0.18 by ROC analysis. After multivariate analysis, lowerDWS is an independent predictor of in-hospital mortality (odds ratio 9.6; 95% confi-dence interval 1.76–52.16; P< 0.05)Conclusion: Diastolic wall strain is associated with worse outcome in HFrEF patients.DWS, as a simple and non-invasive parameter of LV stiffness, can be useful to predictpoor prognosis of HFrEF patients. Thus DWS might be taken into consideration toevaluate the HFrEF patients.Keywords: Diastolic dysfunction • DWS

QRS complex amplitude in electrocardiogram to estimate pulmonaryhypertension in adult patient with atrial septal defect

A.E. Prasetia1, D.W. Angrahini1, B.A. Hartopo1, and L. Krisdinarti21Faculty of Medicine, Department of Cardiology and Vascular Medicine, Gadjah MadaUniversity, Yogyakarta, Indonesia, 2Faculty of Medicine, Electrocardiography Division,Department of Cardiology and Vascular Medicine, Gadjah Mada University,Yogyakarta, Indonesia

Background: Atrial septal defect is most common congenital heart disease with inci-dence 56 per 100 000 births. One of complication is increased pulmonary blood pres-sure to lungs that is called pulmonary hypertension. Prevalence of pulmonary arteryhypertension in adult patients with congenital heart disease is estimated between1.6 and 12.5 million cases. Pulmonary artery hypertension in patients with congenitalheart disease can increase mortality up to two-fold and increase morbidity by three-fold compared to congenital heart disease patients without pulmonary artery hyper-tension. Main method used in diagnosing pulmonary hypertension is right heart cath-eterization, which is only available in tertiary healthcare centresElectrocardiography is readily available in primary healthcare centres which can beused to estimate pulmonary hypertension by using electrocardiogram QRS complexamplitudo. The aim of this study is to see the sensitivity and specificity electrocar-diogram QRS complex amplitude to predict pulmonary hypertension in adult patientwith atrial septal defect.

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Methods: Design of this study cross-sectional with 104 subjects taken from registrydata of Atrial Septal Defect in Cardiology and Vascular Medicine Department RSUP Dr.Sardjito, Yogyakarta. Data of heart catheter result are used to difference atrial septaldefect patient with pulmonary hypertension and without pulmonary hypertension. Dataof electrocardiogram result taken from medical record to see whether CHD is presentby measuring the amplitude of QRS complex in millimetres on V1 Lead. QRS complex inV1 Lead with amplitude< 6mm indicates the presence of pulmonary hypertension.Collected data are analysed using SPSS application with Chi-square analysis.Results: There is significant difference (P< 0,05) in kriteria QRS amplitude< 6mm inV1 lead to estimate pulmonary hypertension in adult patient with atrial septal defect.By using QRS amplitude <6mm on V1 criteria in finding difference between right atriumenlargement in patients with pulmonary hypertension and without pulmonary hyperten-sion, we use chi-square analysis and we found significant difference (P¼ 0.033)Conclusion: From Electrocardiogram QRS complex amplitude at V1 lead we havemeasured specificity 13.5% dan sensitifitas 64.3% to estimate pulmonary hypertensionin adult patient with atrial septal defect.Keywords: Electrocardiogram • QRS complex • Amplitude • Atrial septal defect •Pulmonary hypertension

Factors influencing medical adherence in patients with coronary artery diseasein Siloam Hospital Lippo Village: the care taker effect

A. Christopher1, E. Hindoro1, R.W. Putra1, S.H. Teja1, D.I. Putri1, and A.A. Lukito21Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia, 2Departmentof Cardiology and Vascular Medicine, Siloam Hospital Lippo Village, Tangerang,Indonesia

Background: Indonesia, as part of South Asian region has the highest rate of non-adherence to cardiovascular medication use. Unquestionably, medical therapy is pro-ven to be effective as primary and secondary prevention of myocardial infarction. Onthe other hand, non-adherence is associated with unneeded dose intensification,hence greater expenses. Therefore, identifying factors that may contribute to thedownfall of medical adherence is crucial for the well beings of Indonesia.Methods: This is a cohort retrospective study that was taken from a Coronary ArteryDisease registry in Siloam Hospital Lippo Village between the year 2013–2016.Sociodemographic data, diabetes, hypertension, dyslipidaemia, hyperuricemia,hyperaggregation, stroke, and CKD were the risk factors and co-morbidities thatwere taken from the medical records. Patients were interviewed by using the modi-fied ‘8-Item Morisky Medical Adherence Scale’ through phone. Data were input andanalysed by using IBM SPSS 22.0 to assess the correlation between risk factors,number-of-pills, age, gender, care taker and medical adherence.Results: Out of 94 phone calls that went through, 81 of them managed to fulfil thequestionnaire successfully. Most of them were adherent to their medications (72.8%vs. 27.2%). The mean age and adherence score were 57.76 10.7 years old and6.16 1.8, respectively. Age and care taker have positive correlations with adherenceand adherence-score, respectively (R¼ 0.20, 0.23; P¼ 0.04, 0.02), however risk fac-tors, number-of-pills, and gender do not (R¼ 0.03, 0.05, 0.14; P¼ 0.38, 0.32, 0.10).The correlation between having a care taker with increasing age were also positive(R¼ 0.50, P¼ 0.00), which explains the good compliance of older patients.Conclusion: Older patients are more apt to have care taker. Albeit correcting non-adherence needs a multimodal intervention, having a care taker might give slight ad-vantage to them, hence they managed to have better compliance than the youngones.Keywords: Medical-adherence • Coronary artery disease • Multi-drug • Indonesia

False positive treadmill exercise test: could false diagnosis indicate trueprognosis?

L.T. Ratana, M. Jonathan, Hizkia, D.C. Santoso, A. Ridha, A.S. Setyasari,P. Pujowaskito, and P.E. WidodoDustira Army Hospital, Cimahi, West Java, Indonesia

Background: Treadmill exercise test (TMET)’s sensitivity and specificity were widelyjeopardized in several literatures and research, yet, it is used as a prerequisite fordiagnostic coronary angiography (DCA) for patients without elevated cardiac markerin JKN era. This research aimed at knowing the ability of TMET in predicting signifi-cant stenosis in DCA and the quality of life in patients with false positive TMETresult.Methods: This is a prospective analytical study in 214 angina pectoris patients under-going DCA by indication of positive TMET result. ECG recording during TMET was as-sessed by two cardiologists. Patients were stratified according to DCA result intonon-significant CAD, slow flow syndrome, CAD 1, 2, and 3 VD. Culprit vessel(s), ex-tent of occlusion, and quality of angina upon first outpatient follow-up were notedand their associations were analysed.Results: Among 214 patients, 41.1% patients had non-significant CAD, 6.3% had slowflow syndrome, 22.2% patients had CAD 1VD, 14.0% had CAD 2VD, 16.4% CAD 3VD,and 2.4% had left main disease. Among 85 patients with non-significant CAD, 35 hadnormal coronary anatomy and 50 had<50% stenosis (58% in LAD, 20% in LCX, 22% in

RCA). Several comorbidities were found in false positive patients, 2 patients hadpericardial effusion and 2 patients has mitral valve prolapse. 72 patients with falsepositive TMET continued to experience angina in first outpatient follow-up: 40 pa-tients experienced angina CCS 1, 22 patients experienced CCS 2, and 2 patients ex-perienced CCS 3. Angina quality in patients with false positive TMET was not signifi-cantly different from that of patients with significant CAD without PCI (P¼ 0.083).Conclusion: Positive TMET in Dustira Army Hospital accurately predicts 58.9% pa-tients with significant stenosis. However, positive TMET could predict ongoing anginain non-significant CAD patient.Keywords: Angina • Coronary artery disease • Diagnostic coronary angiography •Treadmill exercise test • Quality of life

Medical adherence of hypertension management in primary health care settings

S.A. Yuwono1, J. Christina1, V. Sungono1, and S. Ng1,21Faculty of Medicine, University of Pelita Harapan, Banten, Indonesia, 2Division ofCardiology, Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia

Background: Hypertension remains a public health challenge worldwide with increas-ing number of morbidity and mortality. Compliance to treatment plays an importantrole for a better outcome. The objective of this study was to evaluate medicationadherence characteristic of hypertensive patients and its associated factors in pri-mary healthcare settings.Methods: A cross-sectional study was conducted at a primary health care center inTangerang. Eighty-nine patients diagnosed with hypertension were included. Patient’ssocio-demographic status, clinical/medication status, family support, health care sup-port and self-motivation were assessed by interview and questionnaire. Adherence tomedication was assessed using the Morisky Medication Adherence Scale (MMAS-8).Logistic regression was used to identify predictors of non-adherence.Results: The mean age of participants was 53.8610.1 years. Forty-eight (71%) were fe-male and 65 participants (73%) had low antihypertensive medication adherence. The roleof health care provider in educating patients about hypertension was significantly givenmostly to patients who had low medical adherence and less to patients with high medicaladherence (69% vs. 46%, respectively) P 0.04. Gender, age, education background, in-come, availability of health insurance, transportation cost, duration of hypertension, fam-ily support, and self-motivation showed no significant correlation, though most of the pa-tients (98%) have a high self-motivation. Interestingly, among those, the antihypertensivemedication of 21.3% participants was known to be discontinued by health care providers.Conclusion: Medical adherence of hypertension remains very low in primary healthcare settings. Also there are still health care providers who provide a poor healthcare services that is less supportive to hypertension medication including limited ed-ucation related to hypertension and education related with its long term and contin-uous therapy. Patients education is needed as patients self-motivation alone is notenough to achieve medical adherence in hypertension.Keywords: Hypertension • Medication adherence • MMAS-8 • Primary healthcare • Risk factors

Evaluation of haemodynamic and vasoreactivity test using oxygen in adult withatrial septal defect: pulmonary hypertension

A. Rakhmawati1, D.W. Anggrahini2, and L. Krisdinarti21Faculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasGadjah Mada, Yogyakarta, Indonesia, 2Faculty of Medicine, EchocardiographyDivision, Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada,Yogyakarta, Indonesia

Background: Right heart catheterisation (RHC) use to identify ASD-PH. In order to en-sure the correct evaluation of haemodynamic parameters from RHC, standard proce-dures should be drawn such as the agents for vasoreactivity test. Most centres use ni-tric oxide (NO) or oxygen (O2) inhalation, iloprost nebulization, or combination thereof.Acute responders were defined as patients who showed a decrease in mean pulmonaryartery pressure of at least 10mmHg to an absolute level< 40mmHg with preserved orincreased cardiac output (CO). A positive test predicts better survival and response tocalcium channel blocker (CCB) therapy. In the diagnostic workup for PH, it is recom-mended that the RHC should include a comprehensive haemodynamic assessment com-prising the measurement of CO, cardiac index (CI), and stroke volume (SV).Aim: This study described the haemodynamic parameters of ASD-PH patients under-went O2 vasoreactivity testMethods: This study was conducted on 46 adults with ASD-PH in Sardjito HospitalYogyakarta in 2015–2016. Vasoreactivity test using O2 10 litres per minute for 10minfor patients who had PVR> 8 WU. Haemodynamic responses were continuously mea-sured using RHC. CO was measured using Fick’s method. CI related CO from left ven-tricle (LV) in a minute to body surface area (BSA). SV described the volume of bloodpumped from LV per beat.Results: The study was done in 46 patients. The mean CO pre- and post-O2 testswere 2.776 0.77 L/min and 3.736 0.12 L/min. The mean CI pre- and post-O2 testswere 2.286 0.08 L/min/m2 and 1.436 0.98 L/min/m2. The mean SV pre and post O2test were 0.256 0.07 L and 0.376 0.09 L.

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Conclusion: Haemodynamic parameters were measured by RHC. The vasoreactivitytesting with oxygen might be safe and useful for identifying CCB responders in ASD-PH patients.Keywords: Pulmonary hypertension • Vasoreactivity test • Oxygen • Haemodynamic

The 6-minute walking test after mitral valve surgery profile and cardiovascularevents (post discharge) in National Cardiovascular Center Harapan Kita

S.A. Elfa1,2, A. Sariningrum1,2, A.M. Ambari1,2, B. Radi1,2, and B. Setianto1,21Faculty of Medicine, Diponegoro University, Semarang, Indonesia, 2Faculty ofMedicine, Department of Cardiology and Vascular Medicine, National CardiovascularCenter Harapan Kita, University of Indonesia, Jakarta, Indonesia

Background: The 6-minute walk test is a simple, inexpensive, and reproduciblemethod for the assessment of exercise capacity. The 6MWT is a common test usedto assess cardiovascular events outcome of heart failure, myocardial infarction,or death. The feasibility of 6MWT as a measure of cardiac rehabilitation pro-gramme in patients undergoing cardiac rehabilitation mitral valve surgery and ad-mitted to in-hospital rehabilitation unit has been described before. The aim ofthis study is to describe profile, baseline characteristics and hospitalization (postdischarge) in patients undergoing cardiac rehabilitation programme after mitralvalve surgery.Methods: This was a descriptive analysis, take in National Cardiovascular CenterHarapan Kita during January 2013–January 2016. Subjects had cardiac rehabilitationprogramme after underwent mitral valve surgery (repair or replacement). The 6MWTwas taken in the first visitation during phase 2 cardiac rehabilitation. Data about hos-pitalization due to cardiovascular events were taken from the record.Results: The study enrolled 99 patients who undergoing cardiac rehabilitationprogramme after Mitral Valve Surgery during January 2013–January 2016. Thereare 57 patients (57.6%) men, and 42 patients (42.4%) women with 39 patients(39.4%) with 6 MWT <300 m and 60 patients (60.6%) with 6 MWT >300 meters.From the record (medical record and phone calls) we find 20 case of hospitaliza-tion after the patients discharge, between the patients, there were 6 patients(30%) with 6 MWT <300 m and 14 patients (70%) 6 MWT >300 m, 8 patients (40%)having cardiac events (heart failure or arrhythmia) and 12 patients (60%) withhospitalization due to another cause. There were 3 patients died due to non-cardiovascular events.Conclusion: There is no significant difference between profile and characteristic and car-diovascular events in post discharge patients having 6 MWTafter mitral valve surgeryKeywords: 6-minute walking test • Cardiac rehabilitation programme •Cardiovascular events • Mitral valve surgery

The role of mangosteen pericarp extract (Garcinia mangostana L.) on theexpression of VCAM-1, H2O2, iNOS, and eNOS of the Wistar strain rat’s aortictissue induced by high fat diet

O. Handayani1, S.A. Wibowo2, N.A. Sari2, T.A. Wihastuti2, and D. Sargowo31Faculty of Medicine, Department of Cardiology and Vascular Medicine, BrawijayaUniversity, Dr. Saiful Anwar General Hospital, Malang, Indonesia, 2Faculty ofMedicine, Malang Cardiovascular Research Center, Brawijaya University, MalangIndonesia, 3Faculty of Medicine, Department of Cardiology and Vascular Medicine,Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia

Background: Atherosclerosis is one major cause of cardiovascular morbidity and mor-tality, which is characterized by the presence of endothelial dysfunction.Mangosteen (Garcinia mangostana L.) pericarp has been widely known of its variouspharmacological properties, such as anti-inflamation and antioxidant, and used to in-terfere the atherogenesis cycle through the suppression of H2O2, VCAM-1, and iNOSexpressions and the increase of eNOS expression. This research was aimed to demon-strate the effects of mangosteen pericarp extract (MPE) administration on the aortictissue of Wistar strain rats induced by high-fat diet.Methods: This is a 3-month experimental study using 20 Wistar rats Rattus norvegicusthat were divided into 5 groups (n¼ 4): negative control group with normal diet, pos-itive control group with high fat diet (HFD), HFD groups with various doses of MPE(200mg/kg, 400mg/kg and 800mg/kg). The evaluation of H2O2 was done byColorimetric Hydrogen Peroxide Kit and ELISA; whilst the analysis of VCAM-1, iNOS,and eNOS was done by immunofluorescence.Results: The administration of MPE showed a significant difference of iNOS and eNOSexpressions among treatment groups (P¼ 0.000). Mangosteen pericarp extract dose of200mg/kg could reduce iNOS level, however increased eNOS level, compared to thepositive control (P¼ 0.000). The administration of MPE 800mg/kg revealed the greatestreduction of iNOS expression (P¼ 0.000), however increased the eNOS value close tothe negative control (P¼ 0.459). The various doses of MPE also reduced the expressionof VCAM-1 and H2O2 level (P¼ 0.032 and 0.000, respectively) on the treatment groupscompared with both control groups. The Pearson correlation of H2O2 and VCAM-1 ex-pression with MPE doses was �0.716 (P¼ 0.000) and �0.347 (P¼ 0.314), respectively.

Conclusion: The administration of mangosteen pericarp extract with an optimal doseof 200mg/kg can significantly reduce the expression of VCAM-1, iNOS, and H2O2 leveland enhance the expression of eNOS in the atherogenesis.Keywords: Mangosteen pericarp • H2O2 • VCAM-1 • iNOS • eNOS • High fatdiet • Atherosclerosis

Global longitudinal strain as predictor of left ventricular remodelling in latepresenter ST-segment elevation myocardial infarction

S. Sungkar, S. Noventi, A. Nugroho, and S. RifqiFaculty of Medicine, Department of Cardiology and Vascular Medicine, Dr.KariadiHospital, Diponegoro University, Semarang, Indonesia

Background: Left ventricular remodelling (LVr) has profound effects on the ventricu-lar function and thus the patients prognosis, especially in late presenter ST-segmentelevation myocardial infarction (STEMI) patients. LV ejection fraction (LVEF) has beenused for the prediction of LVr, but it accuracy is low. Global longitudinal strain (GLS)provides incremental value to predict LVr after STEMI.Aim: To investigate that global longitudinal strain can be used as predictor of LVr af-ter STEMIMethods: This is prospective cohort study. First STEMI patients who present latewere enrolled consecutively. Global longitudinal strain by speckle tracking was as-sessed as part of echocardiographic measurement during hospitalization and re-peated 1–3months after MI. LVr was defined as> 20% increase in LV end diastolic vol-ume (LVEDV) and or> 15% end systolic volume (ESV) at follow-up.Results: Forty two patients (mean: 56.73 years old) were divided into 2 groups: 24patients (57.2%) without LVr and 18 patients (42.8%) with LVr. We used logistic regres-sion to identify factors associated with LVr. In bivariate analysis, hypertension, in-complete revascularization, LVEF, and GLS had significant correlation with LVr. Aftermultivariate analysis, only GLS [odds ratio 22.10 (95% confidence interval: 3.63–134.31), P¼ 0.001] independently predict LVr after STEMI. A receiver operating char-acteristic curve showed that the GLS predicted LVr with an optimal cut-off valueof� 11.2% (AUC: 83%, sensitivity: 73.3%, specificity: 81%).Conclusion: Global longitudinal strain measured by speckle tracking echocardiogra-phy is an independent predictor of LV remodelling in late presenter STEMI patientsKeywords: Global longitudinal strain • LVr • STEMI

Predictor of atrial fibrillation in acute coronary syndrome patients at MoewardiGeneral Hospital

T. Sulistyono1, F.M.S. Harmani1, I. Budi1, D. Ayu1, and T. Wasyanto21Faculty Medicine, SebelasMaret University, Dr. Moewardi General Hospital,Surakarta, Indonesia, 2Department of Cardiology and Vascular Medicine, Dr.Moewardi General Hospital, Sebelas Maret University, Surakarta, Indonesia

Background: Atrial fibrillation (AF) is often associated with acute coronary syndrome(ACS) and acute myocardial infarction (MI). Overall, AF complicates approximately10% of acute infarcts and the incidence rate is comparable between the thrombolyticand percutaneous coronary intervention (PCI) eras. It is common in AF to triggeredby ACS. The aim of this study is to determine the predictor of AF in ACS patients atMoewardi General Hospital.Methods: We analyse 161 in-hospital data of ACS patients at Moewardi Hospital dur-ing December 2015–2016 with retrospective cross sectional design. The collecteddata including age, Killip, GRACE, heart rate, blood pressure, random blood glucose,creatinine, creatinine clearance test (CCT), uric acid, HbA1c, lipid profile, potas-sium, sodium, body mass index (BMI), cardiac marker enzyme, ejection fraction (EF)and length of hospitalization. All measured values were reported as mean6 standarddeviation (continues variable) or as percentage. Multivariate analysis was done afterthe selected variables have P< 0.25.Results: From this study, there were 130 patients (80.75%) did not develop new AF,while 31 patients developed new AF (19.25%). Bivariate analysis showed GRACE(151.976 7.99, P< 0.01), uric acid (8.516 0.57, P< 0.004), creatinine clearancetest (41.596 3.09, P< 0.01), Killip (P< 0.05), TIMI (P< 0.03), and EF (P< 0.003)were significantly correlate to the incidence of new AF in ACS patients. From multi-variate analysis, we conclude that EF was the independent predictor for new AF inACS patients (hazard ratio¼ 1.14, 95% confidence interval¼ 0.89–1.45).Conclusion: This study showed that GRACE, uric acid, CCT, Killip, TIMI, and EF corre-lated with new AF in ACS patients but EF is predictor of AF in ACS.Keywords: Atrial fibrillation • Acute coronary syndrome • Ejection fraction

Correlations between body mass index, waist circumference, and hipcircumference in primary health care patients in Tangerang

A.N.M. Wibowo1, D.H. Wongso1, and S. Ng2

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1Faculty of Medicine, University of Pelita Harapan, Tangerang, Indonesia,2Department of Cardiology, Faculty of Medicine, University of Pelita Harapan, SiloamHospital Lippo Village, Tangerang, Indonesia

Background: Body mass index (BMI) is the most frequently used measurement of obe-sity. However, BMI does not take into account the proportion of weight related to in-creased muscle or the distribution of excess fat within the body. Hence, waist cir-cumference and hip circumference was used to measure the level of abdominalvisceral adipose tissue. The aim of this study is to see the correlation of BMI, waistcircumference and hip circumference in Tangerang population.Methods: Data were collected consecutively from primary health care in Tangerangin January 2017. We collected gender, age, BMI, waist circumference hip circumfer-ence, blood pressure and history of diabetes mellitus, hypertension, and dyslipidae-mia of the patients.Results: We collected 177 patients—female 120/177 (67.8%), mean of age46.186 13.49, history of diabetes mellitus 24/177 (13.6%), history of hypertension75/177 (42.4%), history of dyslipidaemia 34/177 (19.2%). Mean of systolic blood118.596 21.79, and diastolic blood pressure 76.846 13.74. Mean of BMI was24.586 5.20, mean of waist circumference was 85.696 12.12 with r¼ 0.824 and P-value< 0.001, and mean of hip circumference was 94.386 12.79 with r¼ 0.717 andP-value< 0.001. For male, the mean of BMI was 22.796 4.19, waist circumference84.196 11.72, and hip circumference 91.126 9.85, and those of female was25.446 5.42, 86.416 12.29, and 95.936 13.75 respectively. Pearson’s correlation forBMI and waist circumference were r¼ 0.834 and P-value< 0.001 for both male andfemale, while BMI and hip circumference were r¼ 0.860, P-value< 0.001 for maleand r¼ 0.666, P-value< 0.001 for female.Conclusion: In female, the correlation of waist circumference and BMI are more cor-related than hip circumference and BMI. While in male, they are both equallycorrelated.Keywords: Body mass index • Waist circumference • Hip circumference

Profile of modifiable cardiovascular risk factors in chronic kidney diseasepatients undergoing chronic haemodialysis at the Renal Unit in Gatot SoebrotoHospital

A. Kristyagita1, D.E. Wahono2, B.S. Purwowiyoto1, P. Almazini1, and H. Munirwan11Faculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasIndonesia, Jakarta, Indonesia, 2Department of Internal Medicine, National CentralArmy Hospital Gatot Soebroto, Jakarta, Indonesia

Background: Chronic kidney disease can bring significant morbidity and mortality ifuncontrolled. The optimal treatment will prevent the uremic complications. Sometraditional modifiable cardiovascular (CV) risk factors that can lead to CKD and itsprogressivity are smoking, obesity, hypertension, dyslipidaemia, and diabetes melli-tus (DM). Haemodialysis (HD) can remove toxins, prevent fluid overload, and main-tain the blood’s chemical balance.Methods: A descriptive study was conducted at the Renal Unit of Gatot SoebrotoHospital, Jakarta. Primary data were collected from medical record, anamnesis, andphysical examinations of chronic HD patients. Subjects were determined using con-secutive sampling method. The inclusion criterion was the CKD patients undergoingroutine HD at weekdays. The exclusion criteria were patients undergoing acute HD orsuffering from acute diseases (infection, obstructive uropathy, etc). Epidemiologicaland clinical data, including: age, gender, body weight, and body height, were col-lected. We used the SPSS 19.0 program for statistical analysis. Numerical and cate-gorical data were expressed as mean and standard deviation and percentage,respectively.Results: A total of 61 patients (37 men, 24 women) were studied. The mean age,body weight, and body height were 556 14 years, 61.46 13.5 kg, and 1626 7.2 cm,respectively. The percentage of CV risk factors was: BMI� 25 kg/m2 (overweight andobese) 70.5%, hypertension 60.7%, DM 47.5%, dyslipidaemia 34.4%, and smoking32.8%.Conclusion: The number of modifiable CV risk factors in chronic HD patients is high.The BMI� 25 kg/m2, hypertension, and DM are the three most common risk factors inthis study. The result is not significantly different if compared with Pernefri(Perhimpunan Nefrologi Indonesia) data showing that hypertension is the most preva-lent (34%) cause of CKD and international data showing that DM is the most prevalentcause of CKD.Keywords: Chronic kidney disease • Cardiovascular risk factors • Overweight •Obese • Hypertension • Diabetes mellitus

Descriptive study of competency-based curriculum about cardiovascular block inUnivesity of Pelita Harapan

A. Fatah1,2, W. Wiharja1,3, R. Pranata1,4, Bertha1,3, H. Deka5,6, and S. Ng71University of Pelita Harapan, Karawaci, Banten, Indonesia, 2Klungkung GeneralHospital, Puskesmas Banjarangkan II, Semarapura, Bali, Indonesia, 3Krakatau MedikaHospital, Puskesmas Cibeber, Cilegon, Banten, Indonesia, 4Tabanan General Hospital,Puskesmas Tabanan III, Tabanan, Bali, Indonesia, 5Gadjah Mada University,

Jogjakarta, Indonesia, 6Sanjiwani Gianyar Hospital, Puskesmas Payangan, Gianyar,Bali, Indonesia, 7Department of Cardiovascular, Siloam Hospital Lippo Village,Karawaci, Tangerang, Indonesia

Background: Competency-based curriculum is currently used in most of medicalschools in Indonesia. This curriculum focuses on human body system approach. Withthis approach, medical students learn about anatomy, physiology, pathophysiology,and pharmacology about one specific human body system at a time. In this study, weaim to describe lowest, highest, and mean score before and after cardiovascularblock.Methods: This study was done in medical school in University of Pelita Harapan in-volving 198 students. Inclusion criteria were medical student whom never take car-diovascular block. The study was done for 8weeks. Before the cardiovascular blockstarted, each student was given questionnaire about cardiovascular basic science,electrocardiograph (ECG) interpretation, and Acute Cardiac Life Support (ACLS).Students then took classes with small group discussion and lecture by cardiologist.On 8th week, the students were asked to take the same questionnaire. Descriptivestudy was done measuring lowest, highest, and mean score.Results: Overall score was measured as pre- and post-test. Result showed lowestscore 40.5, highest score 60, and mean 55 as pre-test. Post-test showed lowest score65, highest score 85, and mean 74. We classified the questionnaire into basic sciencegroup, ECG interpretation group, and ACLS group. Basic science pre-test showed low-est score 50, highest score 70, and mean score 61. Basic science post-test showed60, highest score 90, and mean 75. ECG interpretation and ACLS pre-test showedlowest score 20, highest score 50, and mean 36. ECG interpretation and ACLS post-test showed lowest score 65, highest score 90, and mean 78. Based on result, overalland grouping score was increased on all lowest, highest, and mean score.Conclusion: We concluded that cardiovascular block, as a competency-based curricu-lum is favourable for medical students to learn specific human body systems.Keywords: Competency-based curriculum • Cardiovascular block • Pre-test and post-test

Left atrial enlargement progression in hypertensive heart disease

H.W. Parlindungan, S.D. Putri, D. Yulianda, M.K.S. Nasution, N.Z. Akbar, A.P. Ketaren,A.A. Siregar, and Z. MukhtarDepartment of Cardiology and Vascular Medicine, Adam Malik Hospital, University ofSumatera Utara, Medan, Indonesia

Background: How to identify the early signs of hypertensive heart disease is the keyto block or reverse the process of heart failure. From hypertension to hypertensiveheart disease is a slow and progressive process, and persistent high pressure loadmay lead to compensatory left ventricular (LV) hypertrophy. Previous studies haveshown that echocardiographic left atrial (LA) enlargement occurring before LV hyper-trophy is an early sign of hypertensive heart disease.Methods: This is a retrospective study of 50 consecutive patients with HypertensiveHeart Disease who were admitted to the cardiac care unit at Adam Malik hospitalduring 2016. Two-dimensional guided M-mode measurement of LA posteroanterior di-mension was measured from the parasternal long-axis view according to theAmerican Society of Echocardiography standards. Patients were divided by group ofwith or without signs of congestive heart failure, clinical outcome was compared be-tween those groups.Results: Of total 50 patients, a total of 15 patients (30%) were diagnosed as havingHFnEF in the study population. Patients with HfnEF had larger diameter of LA andsignificantly higher prevalence of LA enlargement than those without HFnEF (86.6%vs. 48.5%, P< 0.0001).Conclusion: Our findings reveal that LA enlargement is a common but easily ignoredcondition in Hypertensive Heart Disease. We found close relationship between LA en-largement and HFnEF. Patients at heightened risk for developing heart failure war-rant not only more aggressive antihypertensive therapy, but also reverse remodellingtreatment and intensive risk factor modification. The simple measurement of LA di-ameter by echocardiography may be an effective method for identifying those high-risk individualsKeywords: Hypertensive • LA dimensions • HFnEF

Neutrophil leukocytosis and elevation of blood serummatrixmetalloproteinase-8and NADPH oxidase-1 in acute coronary syndrome patients

Suryono1, I.D.A. Susilawati2, and Hairrudin31Faculty of Medicine, Cardiology Department, University of Jember, Jember,Indonesia, 2Faculty of Dentistry, Biomedical Department, University of Jember,Jember, Indonesia, 3Faculty of Medicine, Biomedical Department, University ofJember, Indonesia

Background: Inflammation and oxidative stress play important role in pathogenesisof acute coronary syndrome (ACS).

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Aim: This study purposed to analyse level of inflammatory markers neutrophil colla-genase matrix metalloproteinase 8 (MMP-8) and oxidative enzyme NADPH Oxidase-1(NOX-1) in ACS.Methods: A total of 84 subjects were studied, consisted of 52 ACS patients [including21 unstable angina and 15 non–ST-segment elevation myocardial infarction (NSTEMI)and 16 STEMI], 16 subjects with stable angina pectoris and 16 healthy control. Levelof MMP-8 and NOX-1 was analysed in blood serum by means of enzyme linked immu-nosorben assay (Elisa). In addition white blood cell (WBC) count was analysed aswell.Results: Level serum MMP-8 and NOX-1 were significantly (P< 0.05) elevated in ACS,the highest level was in STEMI patients. Neutrophil leukocytosis was most frequentlyfound in STEMI patients.Conclusion: Acute coronary syndrome patients demonstrated sign of inflammationand oxidative stress. Elevation of neutrophil activities might provide as marker forpredicting as well as a guide for preventing and developing therapy for ACS.Keywords: Acute coronary syndrome • Neutrophil • MMP-8 • NOX-1 • STEMI

A brief cognitive therapy improves heart failure outcome among inpatient withheart failure

S.R. Wibawa1, Y. Chandra2, R. Riadi1, and I.Y. Puspowardojo11RSI Kendal, Kendal, Indonesia, 2RS Panti Wilasa Dr. Cipto, Semarang, Indonesia

Background: Depression and inadequate self-care are common comorbidities in heartfailure and their relationship creates worse outcome for patients during hospitalization,ranging from requiring more pain medication, lengthening duration of hospitalization,and ultimately adding risks of cardiovascular disease (CVD) recurrence. Cognitive ther-apy (CT) for heart failure patients with depression episodes carries the potential to be-come one of the deciding factors, as it can significantly improves emotional health andeventually their overall quality of life. However, its potency for inpatient usage is stillwidely unknown, as it is not commonly used during inpatient hospitalization which em-phasizes only in pharmacological management. This study aims to incorporate nonpharmacological approach as in CT with standard pharmacological management to im-prove the outcome of patients with heart failure during their hospitalization.Methods: This study uses prospective, single centre, cluster-randomized control trialdesign. Control group receives standard care from experienced healthcare profes-sional. Case group received standard care and once daily-CT sessions during theirstay in hospital. All participants are subjected to daily pain assessment using VisualAnalogue Scale (VAS) scoring, and monitored for their pain medication usage andlength of hospitalization.Results: Forty patients were recruited to this study (14 cases, 26 control). At dis-charge, the case group had better average VAS score (2.607–3.165; P¼ 0.001), fewerneeds for pain medication (0.571–1.461; P¼ 0.004) during their hospitalization, andfewer days spent in hospital (3.35–3.80; P¼ 0.104).Conclusion: Brief CT sessions improve clinical outcomes of heart failure patients, sig-nificantly reducing average VAS score and numbers for pain medication usage. It is acost effective and easily implemented method for consideration of hospital manage-ment guidelines of heart failure.Keywords: CT • Heart failure • Quality of life • VAS score • CVD

Clinical profiles and outcomes of acute coronary syndrome patients presentingto emergency room of a rural type C hospital with no reperfusion facilities

L.T. Ratana and Y.M. AdrianLeuwiliang General Hospital, Bogor, West Java, Indonesia

Background: In West Java Province, there remain a number of rural type C and Dhospitals with no reperfusion facilities. Clinical profiles and outcomes of the patientsin these hospitals have never been put under scrutiny.Methods: This was a cross-sectional study of 75 ACS patients during the period ofJanuary 1 to December 30, 2015. Age, sex, chief complains, clinical diagnosis, KillipClass, heart rate, blood pressure, ECG abnormalities, cardiac enzyme examination,risk factors, glucose level, drug therapies, and mortality were noted.Results: From 75 patients with ACS, age range was 24–85 year, mean age was57.586 14.74 year. There was 30.6% male. Most prevalent chief complains were typi-cal chest pain (33.3%), followed by epigastric pain (26.6%), burning chest pain (20%),and stabbing chest pain (20%). Non ST-elevation ECG changes were more prevalent.49.24% patients were classified in Killip class 1, 35.3% patients in Killip class II, 16.9%patients in Killip class III, and 10.7% patients in Killip class IV. Mean heart rate was90.136 13.73 bpm. Mean systolic blood pressure was 1256 30.98mmHg. Troponin Twas only available for 2 patients, 0.09ng/mL and 0.1ng/mL each. Most prevalent riskfactor was smoking, Admission hyperglycaemia occurred in 15 patients (23.07%), and6 of whom had been previously diagnosed with diabetes. All patients were givenASA, sublingual ISDN, captopril, and laxatives. Twenty percent patients received fon-daparinux, 17.3% patients received enoxaparin, 20% patients received CCB, 6.7% pa-tients received nitroglycerin iv, no patient received P2Y12 and beta blocker due to

unavailability of drug. Ten patients were referred to higher facilities for reperfusion.Mortality occurred in 11 patients, mostly in hyperglycemic patients.Conclusion: Characteristic of ACS patients in Leuwiliang Hospital differs from previ-ous researches. Hospitals without reperfusion facilities bear higher mortality rate ofACS patients.Keywords: Acute coronary syndromes • Clinical profiles • Mortality • Reperfusion •West Java

Assessment of cardiovascular intensive care unit patient profile: analyses thedata from Sardjito Cardiovascular Intensive Care registry (the SCIENCE registry)

M. Suryantoro1, A. Damarkusuma1, H.P. Bagaswoto2, N. Taufiq2, and B.Y. Setianto21Faculty of Medicine, Department of Cardiology and Vascular Medicine, GadjahmadaUniversity, Yogyakarta, Indonesia, 2Faculty of Medicine, Department of Cardiologyand Vascular Medicine, Gadjahmada University, Yogyakarta, Indonesia

Background: Cardiovascular diseases (CVDs) are a major cause of premature deathworldwide and an important cause of loss of disability-adjusted life years. Acute car-diac care involves the treatment of cardiac patients in need of intensive care primar-ily related to acute cardiovascular disease. Apart from acute coronary syndrome(ACS), cardiac diseases with haemodynamic instability and conduction disorders arealso treated in these units. The purpose of this study was to provide a comprehensiveevaluation of the patient profile, treatment, and outcomes of patients admitted tothe cardiovascular intensive care unit (CICU) by retrospective data from our registry.Methods: This retrospective study was performed as a substudy on the SardjitoCardiovascular Intensive Care (SCIENCE) registry population. The data of 467 patientsadmitted to our CICU between March 2016 and October 2016 were collected. The pa-tients were assessed with respect to demographics, admission diagnosis, treatment,and outcomes.Results: During the study period, 467 patients were admitted with mean of age was59.56 13.5 years [232 (49.7%) was geriatric patients] and predominantly male (314patients; 67.2%). Acute coronary syndrome is the most common cause in patients ad-mitted in CICU (331 patients, 70.9%), while the rest ranging from arrhythmias, wors-ening of heart failure condition, post cardiac surgery or limb ischaemia. Acute myo-cardial infarction with elevation of ST-segment was found in 197 (42.2%) patients,followed by non-ST segment elevation acute myocardial infarction 65 (13.9%) and un-stable angina pectoris 69 (14.8%) patients. From the ACS patients, 164 (49.5%), 35(10.6%), and 132 (39.9%) underwent percutaneous coronary intervention, successfullythrombolysis, and conservative treatment respectively.Conclusion: Acute coronary syndrome is the leading cause of patients admitted toour CICU with predominantly ST elevation myocardial infarction.Keywords: Cardiovascular intensive care unit • Sardjito hospital

Left ventricular diastolic function and length of stay in the intensive cardiac careunit

I. Christine1 and R. A. Fagi21Faculty of Medicine, University of Airlangga, Surabaya, Indonesia, 2Dr. SoetomoGeneral Hospital, Surabaya, Indonesia

Background: Patients hospitalized in the intensive cardiac care unit (ICCU) oftenshowed significant ventricular dysfunction. Left ventricular diastolic dysfunction isassociated with conditions that yield to prolonged relaxation and increased left-ventricular stiffness. Acute cardiac injury patients are at high risk of developingacute lung oedema which results in prolonged hospital stay.Aim: To investigate the relationship between left ventricular diastolic function as-sessed by transthoracic echocardiography and length of stay of patients in the ICCU.Methods: Secondary data of patients hospitalized in the ICCU of Dr.Sutomo GeneralHospital consisted of vital signs, echocardiography, comorbid, and length of staywere collected. Data were analysed using Spearman correlation test and multiple lin-ear regression test.Results: Thirty-nine patients hospitalized during June–July 2016 were included,mostly male 34 (87.2%) with mean of age 556 10.8 years. There were 25 (64.1%) di-agnosed as STEMI, 5 (12.8%) as NSTEMI, 3 (7.7%) as unstable angina, and 6 (15.4%) asnon-acute coronary syndrome. Left ventricular diastolic function parameters takenwere the septal E’ (6.056 1.356 cm/s) and E/E’ septal (11.126 5.033). Seventeenpatients had impaired relaxation, and only two with normal diastolic function.Median length of stay of all subjects was 3 days (2–9 days). There was no significantcorrelation found between left ventricular diastolic parameter and length of stay(P> 0.05),. However, septal E’ was shown as the most significant factor for length ofstay (P¼ 0.037) after adjusting for other variables.Conclusion: There is no significant correlation between ventricular diastolic functionand length of stay due to limited number of subjects, therapy, and laboratory infor-mation. Septal E’ was found to be the most influencing factor for length of stay ofpatients in the ICCU.

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Keywords: Left ventricular diastolic function • Length of stay • Intensive cardiaccare unit • Echocardiography

Characteristics and outcomes of patient with acute myocardial infarction inSanglah General Hospital

D. Idarto, V. Tedjamulia, A. Yasmin, and I.G.N.P. GunadhiDepartment of Cardiology and Vascular Medicine, Udayana University, SanglahGeneral Hospital, Bali, Indonesia

Aim: The aim of this study was to describe the characteristics and in-hospital out-comes of patients with acute myocardial infarction who were treated in SanglahGeneral Hospital.Methods: This study was a prospective cohort observational study that enrolled allpatients who were admitted with acute myocardial infarction during December 2016–January 2017Results: There were 66 patients included in this study consist of 43 patients (65.2%)with ST-elevation myocardial infarction (STEMI) and 23 patients (34.8%) with non ST-elevation myocardial infarction (NSTEMI). Hypertension was the most encounteredrisk factors with prevalence 65.2%, followed by dyslipidaemia (43.9%) and smoking(37.9%). Among all STEMI patients, 34 patients (79.1%) have done reperfusion therapyeither with fibrinolytic or primary Percutaneus Coronary Intervention (PCI). The inci-dence of major adverse cardiac events (MACE) among all subjects was 42.4%, whichwere predominantly by heart failure (22.7%), followed by malignant arrhythmia(19.7%), cardiogenic shock (7.6%), post-infarction angina (6.1%) and cardiovasculardeath (3.0%).Conclusion: Hypertension was the most prevalent risk factors encountered in thisstudy, regardless of the type of myocardial infarction. Almost half of the subjectswere developed with MACE. Further study with more samples is needed to evaluatethe factors that contribute to the development of MACE among patients with acutemyocardial infarction.Keywords: Acute myocardial Infarction • Risk factors • Major adverse cardiacevents

Atrial fibrillation in Belitung Timur General Hospital year 2014–2016

M. Dharmawan1, R. Mikhael1, F.P. Marthadinata1, L. Lustoyo1, and C. Kawengian21Belitung Timur General Hospital, Manggar, Indonesia, 2Department of InternalMedicine, Belitung Timur General Hospital, Manggar, Indonesia

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered inclinical practice. However, there is lack of epidemiological data regarding of AF pro-file in rural hospital in Indonesia.Aim: This study aimed to provide the epidemiological data of atrial fibrillation pa-tient profile in Belitung Timur general hospital from 2014–2016.Methods: We reviewed medical records from hospitalized patients in Belitung Timurgeneral hospital from 2014–2016. Relevant variables such as sociodemographic char-acteristic, comorbids, electrocardiogram, antiarrhythmic therapy, and mortality ratewere documented.Results: Sixty nine cases of atrial fibrillation from 2014–2016 were analysed. Therewere 35 (50.7%) male dan 34 (49.3%) female patients. Most of them (36.2%) were 60–75 years old. The most common symptoms were dyspnoea (59.4%), loss of conscious-ness (13.9%), and palpitation (8.7%). Most of the patients (55.1%) had AF with rapidventricular response. Besides suffering AF, they had comorbid such as hypertension(76.8%), heart failure (73.9%), acute infections (42%), cerebrovascular disease(11.6%), chronic kidney disease (10.1%), anaemia (8.7%), type 2 diabetes mellitus(7.2%), and hyperthyroid (2.9). The most common (39.1%) antiarrhythmic drug usedwas the combination of bisoprolol and digoxine. Mortality rate was 15.9%.Conclusion: The prevalence of AF in Belitung Timur was higher in men and elderlygroup. The most common symptoms were dyspnoea. Hypertension and heart failurewere the most common comorbids found. Most of the patients had AF with rapid ven-tricular response. The combination of bisoprolol and digoxine was used as the highestproportion of antiarrhythmic therapy. Mortality rate was 15.9%.Keywords: Atrial fibrillation • Comorbid • Antiarrhythmic • Mortality

The association between high blood glucose level at admission with length ofstay in non-STelevation myocardial infarction patients at Haji Adam MalikGeneral Hospital Medan

O.M. Siregar1, A.A. Siregar2, Z. Mukhtar2, Z. Syahputra1, J. Suganti1, and B. Napitupulu11Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, 2Department ofCardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan,Indonesia

Background: Although high blood glucose level was associated with short-term and long-term mortality in acute coronary syndrome patients, there was a limited data whether a

high blood glucose level at admission affect the length of stay in non-STelevation myocar-dial infarction (NSTEMI) patients. The aim of this study is to analyse the association be-tween blood glucose levels at admission with length of stay in patients with NSTEMI.Methods: In this retrospective study, 63 patients admitted to Haji Adam Malik GeneralHospital Medan from January 2016–December 2016 diagnosed with NSTEMI patientswith or without history of known diabetes mellitus. Patients then divided into 2 groupsbased on the blood glucose level (<140mg/dL and �140mg/dL) at admission. Bloodglucose level �140mg/dL considered as hyperglycaemia. Prolonged length of stay de-fined as hospitalization more than 7 days. Exclusion criteria are patients diagnosedwith cardiogenic shock at admission and death during hospitalization. Bivariate analysiswas performed, P-value< 0.05 was considered statistically significant.Results: From 63 patients, age 58 (69.65) years, 25 patients with blood glucose lev-el< 140mg/dL have a mean length of stay of 6 days (6.726 3.16) while 38 patientswith blood glucose level �140mg/dL have a mean length of stay of 7 days(7.136 2.09). We found 24 patients (38.09%) with diabetes mellitus. Bivariate analy-sis showed that there was no significant association between high blood glucose atadmission with length of stay in Haji Adam Malik General Hospital Medan (P¼ 0.152).Conclusion: This study showed that there is no significant association between highblood glucose levels at admission with length of stay in NSTEMI patients at Haji AdamMalik General Hospital Medan.Keywords: Blood glucose level • NSTEMI • Length of stay • Hyperglycaemia •Diabetes mellitus

Association between lipoprotein (a) level with traditional risk factor in acutemyocardial infarction patient

Y.R. Ilhami1,2 and R. Hamdani21Medical Faculty, Department of Physiology, Andalas University, Padang, Indonesia,2Medical Faculty, Department of Cardiology and Vascular Medicine, AndalasUniversity, Padang, Indonesia

Introduction: Lipoprotein (a) has a role in atherosclerosis process through prothrom-botic effect, anti-fibrinolytic and accelerated atherogenesis. Traditional risk factorplays an important role as independent risk factor of cardiovascular disease.Association between Lp(a) level with traditional risk factor and lipid profiles still notgiving consistent result yet, so it is needed to do research about association betweentraditional risk factor with Lp(a) levels.Method: Patient with acute myocardial infarction that was hospitalized in InstalasiPelayanan Jantung Terpadu M. Djamil Hospital was included in research. Clinicalcharacteristic and laboratorium was collected and then statistical analysis was doneto see the association and correlation with Lp(a) level with cardiovascular riskfactor.Result: There were 32 patients with acute myocardial infarction included in re-search. Most of the patients were male, had risk factors of hypertension, smoker anddyslipidaemia, had Lp(a) level within normal limit. There was differences betweenLp(a) level in patients with and without hypertension, while for another cardiovascu-lar risk factors there was no significant differences. Correlation between Lp(a) leveland lipid profiles, there was no significant correlation.Conclusion: There was difference between Lp(a) level in patient with and withouthypertension, while there was no significant correlation between Lp(a) with lipidprofilesKeywords: Lipoprotein(a) • Traditional risk factor • Acute myocardial infarction •Lipid profile

Effect of percutaneus coronary intervention on quality of life in stable coronaryartery disease patients with intermediate and high SYNTAX score

W. Karolina and M.S. RohmanFaculty of Medicine, Department of Cardiology and Vascular Medicine, University ofBrawijaya, Dr Saiful Anwar General Hospital, Malang, Indonesia

Background: In stable coronary artery disease (CAD) patients with intermediate andhigh SYNTAX score, coronary artery bypass grafting (CABG) is more recommendedthan percutaneus coronary intervention (PCI) as revascularization strategy. For thesepatients, which choose PCI as initial revascularization strategy, the benefit in qualityof life over that provided by osteopathic manipulative treatment (OMT) has not beenclearly established.Methods: We assigned 48 stable coronary artery disease patients with intermediateand high SYNTAX Score which 26 patients undergo PCI with optimal medical therapy(PCI group) and 22 patients receive optimal medical therapy (Medical Therapygroup). We assessed angina health specific status with the use of Seattle AnginaQuestionnaire for quality of life for outcome.Results: There were 80.8% patients with good quality of life in the PCI group and 10%in the medical therapy group. There were significant differences for quality of life(P¼ 0.025) for PCI group compared with medical therapy group.Conclusion: This study demonstrated that there were significant differences for qual-ity of life between patients on PCI group compared with medical therapy group instable CAD patients with intermediate and high SYNTAX score.

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Keywords: Quality of life • Intermediate and high SYNTAX score • PCI

Utility of GRACE score to predict coronary revascularization among patients withnon-STelevation myocardial infarct: a retrospective study

R.A. Tarigan, Z. Syahputra, Z. Muchtar, I.N. Kaoy, and A.A. SiregarFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasSumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia

Background: GRACE scores are risk stratification tools to predict the short-term andlong-term mortality in patients with non-ST elevation myocardial infarct (NSTEMI).The value of GRACE scores in predicting coronary revascularization is insufficientfrom the literature. This study was performed to assess the utility of GRACE score topredict the requirement for coronary revascularization.Methods: A total of 95 patients with NSTEMI participated in the study. Baseline char-acteristics of all the patients were recorded. GRACE scores were calculated for thepatients using web-based calculator. Based on angiographic data, the need for coro-nary revascularization was assessed. The ability of GRACE score to predict coronaryrevascularization was estimated by plotting ROC curves.Results: Fourty one (43%) patients need for percutaneous coronary intervention (PCI)and fifty seven (57%) patients need for coronary artery bypass graft (CABG) surgery.An average value of GRACE score which need for CABG (103.986 22.90). The cut-offfor GRACE score, to predict the need for CABG was 96 (AUC of 0.67; P¼ 0,005, 95%CI 0.557–0.781) with sensitivity 65% and specificity of 63%.Conclusion: The GRACE score showed a marginal potential of predicting the need forcoronary revascularization in NSTEMI patients and may be a useful, preliminaryscreening tool in the cardiac catheterization laboratory.Keywords: Global registry of acute coronary syndrome (GRACE) • Coronary revascu-larization • Non-STelevation miocardial infarct (NSTEMI)

In-hospital stay of patient with STelevation myocardial infarction with orwithout diabetes mellitus

D.D.A. Sakti, Novi Ariyanti, I. Firdaus, D.A. Juzar, D.P.L. Tobing, Irmalita,S. Dharma, S.S. Danny, D. Zamroni, and B. WidyantoroFaculty of Medicine, Department of Cardiology and Vascular Medicine, NationalCardiovascular Center Harapan Kita Hospital, University of Indonesia, Jakarta,Indonesia

Background: The risk of coronary artery disease is increase in patients with type 2 dia-betes by a factor of two to four. This increased risk is the main factor underlying theexcess mortality and reduced life expectancy of people with type 2 diabetes. The prog-nosis is poorer in patients with diabetes mellitus type 2 that suffers myocardial infarc-tion compared with people without diabetes and can prolong in-hospital stay.Aim: To compare the length-of stay STEMI patients with type 2 diabetes mellitus andwithout type 2 diabetes mellitus in intensive cardiac care unit in NationalCardiovascular Center Harapan Kita.Methods: Data were collected from Registry of Acute and Intensive Cardiac Outcome(RAICOM) at Intensive Cardiovascular Care Unit (ICVCU) National CardiovascularCenter Harapan Kita between September 2014 and September 2015.Results: Of the 910 patients with STEMI, 33.2% patients have type 2 diabetes. In hos-pital stay of STEMI patients with type 2 diabetes was significantly longer (45.7% pa-tients was hospitalized not longer than 5 days, 54.3% patients was hospitalized morethan 5 days), as compared to STEMI patients without type 2 diabetes (61.5% patientswas hospitalized not longer than 5 days, 38.5% patients was hospitalized longer than5 days), P-value 0.0001. The prevalence of in hospital mortality in type 2 diabetesgroup and without type 2 diabetes was not significantly different (P-value 0.67).Conclusion: Diabetic patients with ST elevation myocardial infarction had a longerin-hospital stay period, resulting in an increased management costs, in comparisonwith non-diabetic patients.Keywords: Type 2 diabetes mellitus • STEMI • In-hospital stay • In-hospital mortality

Clinical profile of patient undergoing percutaneous coronary intervention inDustira Army Hospital: a cardiac catheterization report

M. Jonathan1, L.T. Ratana1, Hizkia1, D.C. Santoso1, A. Ridha2, A. Setyasari3,P. Pujowaskito3, and P.E. Widodo31Dustira Hospital, Indonesia, 2Dustira Hospital, Indonesia, 3Dustira Hospital,Indonesia

Background: Percutaneous coronary intervention (PCI) is regarded as preferable re-perfusion therapy for ACS patient with proper indication. Dustira Hospital Cathlabwas established on January 2016 and has harboured 194 procedures. Characteristicof these patients has not previously been studied and may diver from PCI patients inother geographical locations. This purpose of this study was defined clinical profileand outcome of PCI patients during the year of 2016.

Methods: This was a cross-sectional study of 194 patients undergoing PCI in DustiraCathlab during January–December 2016. Age, sex, history of smoking, hypertension,creatinine, dyslipidaemia, diabetes mellitus, puncture location, stent types, pres-ence of aritmia, clinical diagnose, DCA, and culprit vessel were noted.Results: From 194 patients undergoing PCI, age range was 30–77 years, mean agewas 55.726 8.981. There was 26.8% female and 73.2% male. Most prevalent riskfactor were smoking (72.7%). Elevated creatinine level occurs in 22.8% patient.Thirty two point five percent patient was diagnosed with STEMI, 25.8% patientwith NSTEMI, and 41.8% with CAD. Pre-PCI aritmia was found in 2.58% patients, 3patients with AF and 2 patients with SVT. From DCA result, CAD 1 VD was found in54.1% patient, CAD 2 VD in 44.3% patient, CAD 3 VD in 1.5% patient. Site of stenosiswere RCA 28.4%, LAD 60.3%, LCx 10.8%, LM 0.5%. Due to its ease of use, femoralapproach was more preverable than radial approach (87.6% vs. 12.4%). Baremetalstent was inserted to 117 patients (60.3%) and drug eluting stents to 77 patients(39.7%). One patient died 1week after PCI procedure due to acute stentthrombosis.Conclusion: Majority of PCI patients in Dustira Hospital was smoking male and postPCI mortality in Dustira is extremely low.Keywords: Clinical profile • Risk factors • Coronary artery disease • Diagnostic cor-onary angiography • Percutaneous coronary intervention

Effect of phase II cardiac rehabilitation on improvement of functional capacity inpost revascularization patients with metabolic syndrome

M.R. Harun, B.B. Tiksnadi, N.N.D. Wahjoepramono, S. Sastradimaja, M.R. Akbar,A. Purnomowati, and T.M. ApramiFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasPadjadjaran, Bandung, Indonesia

Background: Improvements in functional capacity are an important parameter incardiovascular patients. This study aims to determine the changes in functional ca-pacity in patients with metabolic syndrome (MetS) undergoing phase II cardiac reha-bilitation program in comparison with patients without MetS to determine the viabil-ity of the program.Methods: This study is a subanalysis of a previous prospective registry of patientsthat have undergone complete revascularization (PCI or CABG) and entered phaseII cardiac rehabilitation program between September 2014 and May 2015 in HasanSadikin Hospital, Bandung. Patients with MetS are defined in accordance with theATP-NCEP-III criteria. The phase-II cardiac rehabilitation program is conductedusing treadmill- or ergocycle-based exercise completed within 6–8 weeks.Improvements in functional capacity are evaluated using the metabolic equiva-lents METs score.Results: Out of 46 patients undergoing phase-II cardiac rehabilitation, 13 patientswere determined to have MetS, 8 without, and 25 patients were excluded due toinsufficient data. The mean baseline functional capacity in patients with MetSand patients without MetS is 6.14 METs [95% confidence interval (CI):5.06–7.22],and 7.14 METs (95% CI: 5.52–8.76), respectively. There are no statistically signifi-cant differences between the baseline of the two groups (r: 1.19, P> 0.05).After the rehabilitation program, the mean functional capacity in patients withMetS is 7.80 METs (95% CI: 6.84–8.76), and 8.88 METs (95% CI: 7.27–10.49) in pa-tients without MetS. There is a statistically significant improvement in METs scorepre- and post-rehabilitation program (P< 0.05) for both groups. There are no sta-tistical differences between the improvements of METs score in both groups(P> 0.05).Conclusion: CAD patients with MetS who had undergone revascularization still expe-rience improvements in functional capacity after phase-II rehabilitation. Even thoughthe scale of improvement is no different than those of patients without MetS, phaseII cardiac rehabilitation still has the same contribution on functional capacity on pa-tients with MetS and therefore is still necessary. The lack of differences might bedue to limitations in program duration and quality of patient nutrition education,which are essential for patients with MetS.Keywords: Metabolic syndrome • Cardiac rehabilitation program • Metabolic equiv-alents (METs)

The 6-minute walking test early after coronary artery bypass surgery: referencevalues in different staging of left ventricular ejection fraction in NationalCardiovascular Center Harapan Kita in 2016

A. Sariningrum1, S.A. Elfa1, A.M. Ambari2, B. Radi2, and B. Setianto21Faculty of Medicine, Diponegoro University, Semarang, Indonesia, 2Faculty ofMedicine, Department of Cardiology and Vascular Medicine, National CardiovascularCenter Harapan Kita, University of Indonesia, Jakarta, Indonesia

Background: The 6-minute walk test (6MWT) is a simple, inexpensive, and repro-ducible method for the assessment of exercise capacity. The feasibility of 6MWT asa measure of cardiac rehabilitation programme in patients undergoing cardiac re-habilitation after cardiac surgery and admitted to an in-hospital rehabilitation unithas been described before. The aim of this study is to describe the 6MWT in

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different staging of LVEF in patients undergoing cardiac rehabilitation programmeafter CABG.Methods: This was a descriptive analysis and linear regression study, taken inNational Cardiovascular Center Harapan Kita during January–December 2016.Subjects had cardiac rehabilitation programme after underwent CABG. The 6MWTwas record in the first visitation and last session of rehabilitation programme.Results: The study enrolled 347 patients who undergoing cardiac rehabilitation pro-gramme after CABG in 2016. There are 76 patients (21.9%) with LVEF<40%, 43 pa-tients (12.4%) with LVEF 41–49%, and 228 patients (65.7%) with LVEF� 50%. The meandistance walked at first day is 3116 77 m in EF< 40% is, 3026 72 m in EF 40–49%,and 3136 70 m in with EF� 50%. After the programme, the mean distance is3686 81 m in EF< 40%, 3646 72 m in EF 40–50%, and 3796 67 m in EF> 50%. Thechange of mean distance is 576 66 m in EF< 40%, 616 53 m in EF 40–49%, and666 58 m in EF� 50%. The increasing of distance in EF 40–49% is 5.5 m higher thanEF< 40% but not statistically significant (P¼ 0.617). The increasing of distance inEF� 50% is 9.7 m higher than EF< 40% but not statistically significant also(P¼ 0.217).Conclusion: The distance after cardiac rehabilitation programme is increase in eachgroup. The higher increasing is found in patients with LVEF� 50%.Keywords: 6-minute walking test • Cardiac rehabilitation programme • Left ventric-ular ejection fraction • Coronary artery bypass surgery

Characteristic and risk factors in coronary artery disease patients undergoingcoronary artery bypass graft surgery in Tarakan Hospital Jakarta

C.R.J. Putra1, P.I. Suryajaya1, S. Manurung1, Z. Khan1, T.H. Pratikto1, B. Gunawan2,D.A. Hanafy2, E. Ratnaningsih1, T. Sinaga3, and R.K. Priharto31Cardiology and Vascular Department, Tarakan Hospital, Jakarta, Indonesia, 2Cardio-Thoracic Surgery Department, Tarakan Hospital, Jakarta, Indonesia, 3TarakanHospital, Jakarta, Indonesia

Background: Degenerative and metabolic disorders have risen above infectious dis-ease in the last few decades. This phenomenon is attributed to the sedentary life-style, which also commonly leads to coronary artery disease as one of the highestmortality rate in the world. Coronary artery bypass graft (CABG) is the most effec-tive modalities for the treatment of coronary artery disease (CAD), especially forthose who are not suitable for PCI. This study aims to describe the base characteris-tic and the risk factors of CAD that may contribute to CABG and their success rate.Methods: We observed all the patients undergoing CABG in the period of August2012–March 2016 on this retrospective observational study. All the subject data ac-counted to the CABG was analysed and also the outcome in the first 30 days periodafter the surgery.Results: We found 131 patients undergoing CABG in this study. The dominant sex ismale (n¼ 98, 74.8%), and aged> 45 years (n¼ 116, 88.5%). The highest risk factor forCAD requiring CABG is hypertension (n¼ 113, 86.3%), followed by diabetes mellitus(n¼ 79, 60.3%), Dyslipidaemia (n¼ 77, 58.8%), and cigarette smoking (n¼ 72, 55.0%).The success rate of CABG in this study is 93.1% with a very low mortality rates.Conclusion: An active screening and management of modifiable risk factors (e.g.smoking, hypertension, diabetes mellitus, weight, and dyslipidaemia) is of an impor-tance in patients with non-modifiable risk factors (e.g. advanced age, male), to re-duce the risks of CAD requiring CABG surgery.Keywords: Coronary artery disease (CAD) • Coronary artery bypass graft (CABG) •CAD risk factors • Major adverse cardiac events

Role of the neutrophil/lymphocyte ratio in predicting successfulness offibrinolytic in STEMI patients

S. Widodo1, H.P. Bagaswoto2, N. Taufiq2, and B.Y. Setianto21Faculty of Medicine, Department of Cardiology and Vascular Medicine, GadjahmadaUniversity, Yogyakarta, Indonesia, 2Faculty of Medicine, Department Cardiology andVascular, Dr. Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia

Background: Coronary plaque disruption, with consequent platelet aggregation andthrombosis, is the most important mechanism by which atherosclerosis leads to theacute myocardial infarction. There is substantial evidence implicating an inflamma-tory process in the pathogenesis of acute coronary syndromes (ACS). Neutrophils/lymphocyte ratio (NLR) provides a simple and inexpensive method for assessment ofinflammatory status in patients with ACS. Fibrinolytic therapy was a major advancein the treatment of acute STEMI and several factors influence the success of fibrino-lytic. Do NLR can be a predictor of the success of fibrinolytic not widely known.Aims: To investigate the relationship between successfulness of fibrinolytic and NLRin patients presenting with ST - elevation myocardial infarction (STEMI).Methods: Cross sectional study enrolling 73 patients with ST-elevation acute myocar-dial infarction that performed fibrinolysis. The inclusion criteria were ages 40–75years, onset< 24 h and no contraindication to performed fibrinolysis. The exclusioncriteria were chronic kidney disease, chronic heart failure, acute infection, andacute stroke. Neutrophils/lymphocyte ratio was measured from peripheral bloodtaken on admission STEMI patients, before performed fibrinolytic. Follow-up

successfulness of fibrinolytic (no pain, more than 50% reduction of ST elevation byECG) at 30min after fibrinolytic. For analytical purpose, subject divided into twogroups with low and high NLR. The successfulness or failed fibrinolytic was comparedbetween these group.Results: Using table 2� 2, the mean NLR level was 7.365. High NLR group (n¼ 28)and low NLR group (n¼ 44). Succesful fibrinolytic in higher NLR group are 67.8% vs.54.5%. The higher NLR group, the higher the risk the patients more likely succesfulfibrnolytic RR¼ 1.42 (95% CI, 0.752–2.695; P 0.262). Successful and failed fibrinolyticdid not significantly differ between groups.Conclusion: High level NLR not associated with fibrinolytic but increases the chanceto have succesful fibrinolyticKeywords: Neutrophils/lymphocyte ratio (NLR) • ST-elevation myocardial infarc-tion • Fibrinolytic

Pulmonary vasoreactivity testing with pure O2 in adult with atrial septaldefect-pulmonary hypertension in RS Sardjito Yogyakarta

I. Paranita1, D.W. Anggrahini1, and L. Krisdinarti21Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada,Yogyakarta, Indonesia, 2Faculty of Medicine, Echocardiography Division, Departmentof Cardiology and Vascular Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

Background: Pulmonary vasodilator testing is currently used to guide management ofpatients with pulmonary hypertension (PH) to identify patients who are likely tohave a beneficial response to calcium-channel blockers (CCBs). Patients with PH asso-ciated with congenital heart disease who have a cardiovascular shunt need to un-dergo a completely catheterization. As an important method of haemodynamic as-sessment in PH, cardiac catheterization combined with pulmonary vasoreactivitytesting remains with limited experience, and the acute pulmonary vasodilator agentsas well as response criteria for vasoreactivity testing remain controversial. In manyinstitutions around the world, breathing 100% oxygen is used for pulmonary vasoreac-tivity testing. This study aims to evaluate the acute haemodynamic effect of pure O2

used to measure pulmonary vasoreactivity in atrial septal defect with PH.Methods: Between January 2014 and December 2016, a total of 82 patients underfollow-up with a diagnosis of pulmonary hypertension secondary to atrial septal de-fect who underwent vasoreactivity test with pure O2 were retrospectively evaluated.Cardiac pressure and oxygen saturation values were obtained before and after pureO2 inhalation, while flow ratio, pulmonary and systemic vascular resistance were cal-culated. Based on Sitbon criteria, a reduction of the mean pulmonary artery pressure(mPAP)� 10mmHg to reach an absolute value of mPAP� 40mmHg with an increasedor unchanged cardiac output were considered as positive responses to the vasoreac-tivity test.Results: Eighty two cases of atrial septal defect with suspected pulmonary hyperten-sion underwent cardiac catheterization. Patients received standard cardiac catheter-ization and pulmonary vasoreactivity testing. Seventeen (20.73%) of the patients hadpositive vasoreactivity test results. Baseline mPAP was (596 14) mmHg, mean flowratio was 1.136 1.52 and pulmonary vascular resistance index (PVRI) (196 14) WoodU/m2. After inhalation of pure oxygen, mPAP fell to (566 16) mmHg, mean flow ratioincrease to 4.676 10.25 and PVRI decrease to (12614) Wood U/m2.Conclusion: Inhalation of pure oxygen for pulmonary vasoreactivity testing in adultpatient was not effective to measure pulmonary vasoreactivity in adult patient withatrial septal defect and pulmonary hypertension.Keywords: Vasoreactivity testing • Pure O2; Pulmonary hypertension; Atrial septaldefect

The gender visit-to-visit blood pressure variability differences at the 5th decadeof life

A.A. Lukito1,2, A. Thengker1, M.W. Hadi1, H. Lim1,2, A. Christiani1, and V.A. Damay1,21Division of Cardiology, Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia,2Unversitas Pelita Harapan, Tangerang, Banten, Indonesia

Background: Increased of visit-to-visit variability (VVV) has proven to be an indepen-dent predictor of major cardiovascular events and death. NHANES III data showed forboth men and women, average diastolic blood pressure (DBP) increased from earlyadulthood until the 5th decade of life (around 55-years-old). Anyway, the rate of in-crease was more gradual than for systolic blood pressure (SBP). Mean DBP was lowerafter 55-years-old, and pulse pressure became increasingly greater with advancingage. However, little is known about the effects of gender on blood pressure variabil-ity (BPV), especially the VVV before and after 55-years-old.Methods: Visit-to-visit BP data were collected from our institution’s medical recorddepartment, which documented hypertensive patients in January–December 2015who regularly attended follow-up visits. The BP data were tracking back until thefirst visit. The BPVs of these patients were calculated using standard deviation (SD)and average reading variability (AVR) in each follow up visit. AVR is defined as an av-erage of absolute differences consecutive readings.Results: There were 131 subjects who met the inclusion criteria, There were 51.9%(68) male and 48.1% (63) female subjects with mean age of 58.61 (33–91 years), 56%

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were 55 years or older. Bivariate analysis of gender–age group using unpaired t-testbetween gender in the age groups with cut-off 55 year-old showed in women< 55year-old, the DBP-SD of 10.04mmHg and DBP-ARV of 9.31mmHg were significantlyhigher than women� 55 year-old with DBP-SD 7.53mmHg and DBP-ARV 6.58mmHg(P¼ 0.007 for DBP-SD and P¼ 0.002 for DBP-ARV). While men� 55 year-old showedhigher SBP-VVV than< 55 year-old with SBP-SD 16.42mmHg, SBP-ARV 15.70mmHg inolder group and SBP-SD 13.86mmHg, SBP-ARV 13.29mmHg in younger group (P¼ 0.01for SBP-SD and P¼ 0.03 for SBP-ARV). In the age group< 55 years, showed signifi-cantly higher DBP-VVV in women (DBP-SD 10.04mmHg and DBP-ARV 9.31mmHg) thanin men (DBV-SD 7.97mmHg, DBP-ARV 7.21mmHg) with P¼ 0.031 for DBP-SD andP¼ 0.035 for DBP-ARV. Whereas in the�55 years age group showed SBP-VVV signifi-cantly higher in men than women, with SBP-SD 16.42mmHg, SBP-ARV 15.70mmHg inmen and SBP-SD 14.41mmHg, SBP-ARV 13.46mmHg in women (P¼ 0.028 for SBP-SDand P¼ 0.046 for SBP-ARV).Conclusion: This study found that there was diastolic visit-to-visit BP difference inwomen before and after 55 year old, in contrary, systolic visit-to-visit BP was differ-ent in men before and after 55 year old. Furthermore, before the 5th decade of life(around 55 year-old), there was gender difference in diastolic visit-to-visit BP, how-ever, after the fifth decade of life, the gender difference was found in systolic visit-to-visit BP. These findings imply there may be an intrinsic difference in BP regulationin women compared to men, and may help to understand the disparity in cardiovas-cular disease morbidity and mortality between genders.Keywords: Visit-to-visit variability • Before and after 55-years-old

Correlation between diabetes mellitus and non-valvular atrial fibrillation inMataram

M.I. Setiawan1 and Y. Pintaningrum2

1Faculty of Medicine, Al Azhar University, Mataram, Indonesia, 2Faculty of Medicine,Mataram University, Mataram, Indonesia

Background: Atrial fibrillation (AF) is the most common form of arrhythmia in theworld. The development of AF is likely to be multifactorial and the mechanism is elu-sive, while there is emerging evidence on the correlation between AF and diabetesmellitus (DM). DM is one of the most common concomitant diseases in patients withAF. The causal relation between DM and AF is still debatable and will be discussed. Inthe analysis of 41 436 residents in Japan, the prevalence of DM in AF patients ishigher than in controls (20% vs. 12%). The multivariate analysis showed that DM is in-dependently associated with AF (odds ratio, 1.46).5 In the cross sectional survey inmainland China, the prevalence of AF in participants with self-reported DM is higherthan those without known DM (1.29% vs. 0.88%) after adjustment for age and sex.Analysis of the Framingham study subjects showed that LV mass increased with theworsening of glucose tolerance and the trend was more striking in women than inman. Studies have indicated there were increased CRP and IL-6 and marked inflam-matory infiltrates in AF. Here, we reported correlation between diabetes mellitusnon valvular atrial fibrillation at cardiology clinic in Mataram (Sun Y, 2010).Objective: The purpose of this study was to analyse the correlation between diabe-tes mellitus and non-valvular atrial fibrillation from March 2015 until March 2016.Methods: This research is based on analytic method use cross sectional study. Sampleof this research was 40. It was taken using systematically total sampling. Data werecollected from medical records and analysed by univariate and bivariate method us-ing coefficient contingency test.Results: Among 40 non valvular AF patients, 12.5% patients were diagnosed AF withDM and 37.5% patients were diagnosed AF without DM. We compared with non AFand DM patients were 7.5% and non AF and non DM patients were 42.5%. Prevalenceratio was 1.3, it showed risk factor DM patients to develop AF. Using contingency co-efficient, P-value was 0.3 and correlation (r) þ0.108, means there is no correlationbetween diabetes mellitus and non-valvular atrial fibrillation in many hospitals inMataram from March 2015 until March 2016. The weakness of this research was lackof samples and we didn’t exclude risk factor of atherosclerotic such as hypertension,dyslipidaemia, smoking, etc.Conclusion: This research showed that there is no significant correlation between di-abetes mellitus and non-valvular atrial fibrillation at cardiology clinics in Mataram.Keywords: Diabetes mellitus • Atrial fibrillation • Non-valvular atrial fibrillation

Comparison of plasma endothelin-1 levels between acute myocardial infarctionpatients with and without hyperglycaemia

A.D. Pradana1, B.Y. Setianto2, A.B. Hartopo2, and M.R. Hadwiono31Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, 2Faculty ofMedicine, Department of Cardiology and Vascular Medicine, Dr. Sardjito Hospital,Universitas Gadjah Mada, Yogyakarta, Indonesia, 3Faculty of Medicine, UniversitasGadjah Mada, Yogyakarta, Indonesia

Background: High blood glucose levels are proportional to the increasing level ofendothelin-1. Endothelin-1 is a peptide which plays a role in atherogenesis throughvasoconstriction mechanism and vascular smooth muscle cell growth. In patientswith AMI found elevated levels of endothelin-1. This study aimed to evaluate if there

was any difference between the plasma endothelin-1 levels of AMI patients with andwithout hyperglycaemia.Methods: This research design was cross sectional. Sample was recruited in consecu-tive patients admitted to ICCU of Dr. Sardjito Hospital, Yogyakarta. The measure-ment of endothelin-1 and plasma glucose level from venous blood sample was donebefore thrombolysis. The plasma level of endothelin-1 was measured with ELISAmethod. Student t-test or Mann–Whitney test was used to compare endothelin-1 val-ues between AMI patients with and without hyperglycaemia. A statistical significancewas considered when P< 0.05.Results: There are 113 subjects consist of 61 AMI patients with hyperglycaemia and 52AMI patients without hyperglycaemia. Glucose plasma level was a mean of239.96101.98mg/dL and 117.656 13.15mg/dL in AMI patients with hyperglycaemiaand without hyperglycaemia respectively. The difference between groups was signifi-cant (P< 0.001). The difference of endothelin-1 plasma level was not significant be-tween AMI patients with hyperglycaemia and without hyperglycaemia (3.016 1.59pg/mL vs. 2.9061.09pg/mL, P¼ 0.72). However, there is a significant difference betweenplasma endothelin-1 levels of AMI patients with and without prior history of type 2 dia-betes mellitus (3.6461.92pg/mL vs. 2.676 0.96pg/mL, P¼ 0.009)Conclusion: No significant differences in plasma endothelin-1 levels between twogroups of study participants could be detected in this study, but higher level of circu-lating ET-1 may be more closely associated with T2DM.Keywords: Hyperglycaemia • Acute myocardial infarction • Endothelin1 • Type-2diabetes mellitus

Correlation of routine clinical and laboratory examinations with left ventricularejection fraction among hospitalized non-ST-elevation myocardial infarctionpatients

M. Perdana, A. Handayani, K. Kaban, M. Nasri, R. Hasan, and A.A. SiregarFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasSumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia

Background: Left ventricular ejection fraction (LVEF) is an independent predictor ofin-hospital major adverse cardiac events (MACEs). Unfortunately, LVEF examinationcannot be measured in many rural areas in Indonesia. The aim of the study is to seethe association of routine clinical and laboratory examination with LVEF among hospi-talized non-ST elevation myocardial infarct (NSTEMI) Patients at Haji Adam MalikGeneral Hospital Medan.Methods: This was a retrospective study involved 140 NSTEMI patients that were hos-pitalized in Haji Adam Malik General Hospital Medan between January 2014 and July2015. We performed Pearson correlation analysis of each routine clinical and labora-tory examination with LVEF.Results: Among 13 routine clinical and laboratory examination, there were 9 exami-nations that have significant correlation with LVEF. Those are systolic blood pressure(r¼ 0.237; P¼ 0.005), heart rate (r¼�0.365; P< 0.01), KILLIP class (r¼�0.387;P< 0.001), TIMI score (r¼�0.184; P¼ 0.029), GRACE Score (r¼�0.472; P< 0,001),leucocyte count (r¼�0.170; P¼ 0.044), blood glucose level (r¼�0.208; P¼ 0.14),ureum level, troponin level (r¼�0.191; P¼ 0.024), (r¼�0.173; P¼ 0.041).Conclusion: There were nine clinical and laboratory examinations that have signifi-cant correlation with LVEF. Although there were no strong correlations among thosenine variables. GRACE score has the strongest correlation with LVEF.Keywords: NSTEMI • LVEF • GRACE • Routine examinations

Prevalence of acute coronary syndrome in H. Adam Malik General HospitalMedan

I.K. Darmawan, H.W. Parlindungan, A.A. Siregar, and Z. MukhtarFaculty of Medicine, Department of Cardiology and Vascular Medicine, UniversitasSumatera Utara, H. Adam Malik General Hospital, Medan, Indonesia

Background: Acute coronary syndrome (ACS) is a state of emergency in cardiovasculardisease which increasing in number of incidence by years and globally becoming thecause of death, especially in patient with many risk factors, including smoking habits,hypertension, diabetes, and dyslipidaemia. This study was made to determine descrip-tion of patients with acute coronary syndrome in Adam Malik General Hospital, Medan.Methods: Secondary data from all ACS cases which admitted in EmergencyDepartment H. Adam Malik General Hospital, Medan were collected and evaluated.Descriptive research has been conducted with a cross-sectional study and a retro-spective approach using medical record. All risk factors and history of medicationswere analysed using Statistic program. Categorical data were summarized as fre-quencies and percentages.Results: From 1 January 2015 to 31 December 2016, 412 patients who admitted inEmergency Department RSUP H. Adam Malik were enrolled. Fifty-five percent hadST-elevation myocardial infarction (STEMI), 27.7% had non-ST elevation myocardialinfarction (NSTEMI), and 16.7% had unstable angina pectoris (UAP). The STEMI groupwas predominantly in male patients (77.3%). The risk factor risk factors vary inSTEMI, non-STEMI and UAP such as smoking (55%; 64%; 62.3%), hypertension (53.3%;67.5%; 63.8%), Diabetes (41%; 44.7%; 56.5%) and dyslipidaemia (48,9%; 44,7%;

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43,5%). The risk factor group was predominantly in male patient (73.3–71%), but lesspercentages of smoking, hypertension, and diabetes (41%) in STEMI group thanNSTEMI and UAP group but dyslipidaemia had more higher percentages. than NSTEMIand UAP group. Most of patients had a aspirin (98.7%), ADP inhibitor (96.5%), andStatin (96.5%). Enoxaparin and unfractionated heparin (UFH) were frequently used inSTEMI (57.2% and 9.6%, with Fondaparinux in UAP (55.1%). From univariate analysis,hypertension and diabetes had a significant correlation to acute coronary syndrome.(P< 0.05, 95% confidence interval).Conclusion: STEMI is more prevalent ACS cases in RSUP H. Adam Malik Medan.Stratification of risk factors and education to healthy people may play role in ACSprevention. Optimal therapy during hospitalization may lead to a better outcome.Keywords: Acute coronary syndrome • ST-elevation myocardial infarction • Risk factors

Characteristics and incidence of deep vein thrombosis in patients undergoingvascular Doppler in DR M Djamil Hospital Padang in 2016

D.P. Pradita, F. Ulzim, F.E. Eka, and S. MasrulDepartment of Cardiology & Vascular Medicine, Andalas University, RSUP Dr M DjamilPadang, Padang, Indonesia

Background: Deep vein thrombosis is a subset of venous thromboembolism (VTE)that affect the extremities. It occurs most commonly in the veins of the calvesbut may also develop initially in the more proximal veins such as popliteal, femo-ral and iliac vessel. We aim to sought the characteristics and incidence of pa-tients diagnosed with deep vein thrombosis (DVT) underwent vascular Dopplerimaging examinations at DR M Djamil Hospital Padang from 1 January to 31December 2016.Methods: This is a descriptive study. The characteristics of the patients were takenfrom medical records of hospitalized patients diagnosed with DVT underwent Dopplervascular at DR M Djamil Hospital Padang during the period 1 January 2016–31December 2016.Results: Vascular Doppler was performed in 47 patients (62% aged< 60 years and 38%aged� 60 years), 29 were women (53%). The most associated conditions were malig-nancy (32%). Thirty three had normal random blood glucose (70%) and 26 had creati-nine levels<1.1(55%). Thirty nine had Wells score� 2 (83%). Thirty patients had DVTin femoralis vein (64%).Conclusion: From 1 January to 31 December 2016 we found 47 patients diagnosedwith DVT. Common associated disease was malignancy, and most common location ofDVTwas femoralis vein.Keywords: Deep vein thrombosis

The neglected role of blood pressure as important prognostic factor in acuteheart failure

M. Kemuning1, Z. Syahputra1, H. Hasan2, Z. Mukhtar2, and A. A. Siregar21Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Departmentof Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan,Indonesia

Background: Acute heart failure can present with low and high blood pressure, andeach of these groups has different patophysiology and respond to treatment.Nowadays, in new evidence of biomarkers and comorbidities, the role of blood pres-sure has been neglected. The aim of this study is to investigate the blood pressure asthe critical role in the prognosis of acute heart failure.Methods: A retrospective data of 255 patients admitted with acute heart failure wasanalysed. The blood pressure and another factor were enrolled in bivariate and mul-tivariate analysis.Results: Mortality rate was 47.5%. The independent predictors of in-hospital mortal-ity analysed with backward selection logistic regression were: age� 70 years[P¼ 0.014 odds ratio (OR) 4.314 95% confidence interval (CI) 1.346–13.832], diastolicblood pressure (P¼ 0.001 OR 6.213 95% CI 2.120–18.205), Systolic blood pressure(P¼ 0.002 OR 5.043 95% CI 1.854–13.717), heart rate (P¼ 0.002 OR 3.93 95% CI1.658–9.332, haemoglobin (P¼ 0.044 OR 2.530 95% CI 1.026–6.242), creatinine(P¼ 0.002 OR 4.38 95% CI 1.731–11.104, arrhythmia (P¼ 0.001 OR 7.6 2.217–26.45).Conclusion: Blood pressure plays a critical role in the prognosis of acute heart failureand should be a control consideration in management decision.Keywords: Diastolic blood pressure • Systolic blood pressure • AHF • Hospital mortality

SYNTAX score as a predictor of short-term outcome in patients undergoingprimary percutaneous coronary intervention

M.R. Amalia, S.N. Nugroho, and Y. HerryDepartement of Cardiology and Vascular, Diponegoro University, Semarang, Indonesia

Aim: SYNTAX (synergy between percutaneous coronary intervention with TAXUS andcardiac surgery) has been used as an angiographic tool to quantify coronary artery

disease lesions based on their location and complexity. The use of SYNTAX score hasbeen known to predict long-term outcomes in patients undergoing primary percutane-ous coronary intervention (PCI). This study aimed at the usefulness of SYNTAX score asa predictor of short-term outcome in primary percutaneous coronary intervention(PCI).Method: s: SYNTAX scores were calculated for 36 patients of acute myocardial infarc-tion undergoing primary PCI at Dr. Kariadi General Hospital Semarang in 2016.Patients were divided into 3 SYNTAX score groups: low� 15 (n¼ 9), mid 16–22(n¼ 8), high� 23 (n¼ 19). The primary endpoint was cardiac death at 48 hours.Secondary endpoints were arrhythmias and cerebrovascular events at 48 hours afterthe procedure begin.Results: Cardiac death at 48 h after primary PCI begin was higher in SYNTAX highgroup compared to mid group and low group (27.5% vs. 5.2% P¼ 0.02). Arrhythmias(46.2%, P¼ 0.01) were higher in high group compared to mid and low. The locationof infarct related artery (66.5%, P¼ 0.03) and heart rate (0.26) significantly correlatewith 48-h mortality after primary PCI.Conclusion: SYNTAX score can predict the 48-h mortality in patients with acute myo-cardial infarction undergoing primary PCI, also the risk of arrhythmias which occur48 h later. These populations should be treated with a certain strategy intervention,considering the complexity of the coronary tree.Keywords: SYNTAX score • Short-term outcome • PCI

Visit-to-visit diastolic blood pressure variability in menopausal womenpopulation

H. Lim1,2, A.A. Lukito1,2, A. Thengker1, M.W. Hadi1, and A. Christiani11Siloam Hospital Lippo Village, Tangerang, Indonesia, 2Faculty of Medicine, PelitaHarapan University, Tangerang, Indonesia

Background: Cardiovascular disease has been emerged as leading cause of death inwomen worldwide. It is known that 2 of every 3 women have at least one of the riskfactor for CVD such as: age> 55 years, hypertension, dyslipidaemia, obesity, diabetesmellitus, and smoking, with hypertension is the most important modifiable risk fac-tors.1,2 In which, the incidence of hypertension is likely to increase in women espe-cially in post-menopausal period. Recently, visit-to-visit blood pressure variabilityshowed association with development of cardiovascular events. However, the rela-tionship of blood pressure variability (BPV) in menopausal-age women (>55 years)has not been established.Method: Visit-to-visit blood pressure data were collected from documented hyper-tensive patients who regularly visit our institution from January – December 2015and tracked back to the first time visit. From total 131 subjects who met the inclu-sion of criteria, there were 48.1% (63) female subjects included in this study.Result: From total 63 subjects included, with mean age of 56.65 (33–87 years), 58.7%were below 55 years and 41.3% were 55 years or older. BPV data were analysed usingstandard deviation (SD) and comparative independent samples. The BPV data showedsignificant differences in mean diastolic blood pressure (DBP)-SD of 10.0mmHg inthe< 55 year-old group, and mean DBP-SD of 7.5mmHg in the� 55 year-old(P¼ 0.005). While the DBP average real variability was 9.3mmHg in the youngergroup and 6.6mmHg in the older group (P¼ 0.001).Conclusion: This study found that women with menopausal-age group has lower dia-stolic BPV than the younger group. While the other studies showed significant associ-ation between lower DBP with increase of CV mortality. With these findings, aggres-sive lowering BP treatment in menopausal-age women needs more attention andrequires further study.Keywords: Blood pressure variability • Average real variability • Menopausal-age

Correlation of body mass index and high sensitivity C-reactive protein levelsamong young people

D. Budiono and J. H. SurentuFaculty of Medicine, University of Sam Ratulangi, Manado, Indonesia

Background: Obesity is defined as having excess body fat. Because of it’s difficult todirectly measure body fat, the body mass index (BMI) is used to estimate it. Themost frequent forms of cardiovascular disease (CVD, coronary heart disease is almostalways due to the presence of atherosclerotic plaque. Necropsy studies have demon-strated that the development of atherosclerosis plaque begins early in life. Inducedby dyslipidaemia, inflammation plays a crucial role in the pathogenesis of the differ-ent stages of atherosclerosis. High sensitivity C-reactive protein (hs-CRP) is a bio-marker of low grade inflammatory state, which characterizes an atherosclerotic pro-cess. This study aimed to know the correlation of body mass index and hs-CRP levelsamong young people.Methods: A cross sectional study involved 32 young people aged 17–20 years. Theydidn’t have infectious, malignancy, or another chronic disease. They didn’t smoke,take lipid-lowering drug, and drink alcohol regularly. The correlation of body mass in-dex and hs-CRP was analysed using Spearman’s correlation test.Results: The mean of body mass index is 25.816kg/m2. The mean of hs-CRP level is1.334. The correlation of body mass index and hs-CRP level is r¼ 0.358 and P¼ 0.044.

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Conclusion: Body mass index has weak correlation with hs-CRP level. Low-grade chronicinflammation which characterizes an atherogenesis is happening since young age.Keywords: Atherosclerosis • Body mass index • High sensitivity C-reactive pro-tein • Young people

Gender effect on blood pressure variability in less than 55-years-oldhypertensive population

M.W. Hadi1, A.A. Lukito1,2, A. Thengker1, H. Lim1, and A. Christiani11Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia, 2Faculty of Medicine,Universitas Pelita Harapan, Tangerang, Banten, Jakarta

Background: The prevalence of hypertension in less than 55-years-old population isincreasing and so are the cardiovascular diseases. Unfortunately, they are less likelyto have awareness and to be treated for hypertension than older population. Lately,some studies showed that blood pressure variability (BPV) also correlated with car-diovascular disease, but there were only a few studies about gender differences ofBPV. This study aims to know the gender differences of BPV in< 55-years-old hyper-tensive population.Methods: In this cross-sectional study, all medical records of hypertensive patientsaged <55 years in our institution from 2010 until 2015 who routinely took follow-upvisits were collected, then the BPV using standard deviation (SD) and average readingvariability (AVR) of these patients in each follow up visit were calculated. AVR is de-fined as an average of absolute differences consecutive readings. The BPV data werecompared between men and women.Results: There were 59 subjects who met the inclusion criteria, 62.7% were men.The subjects were 33–54 years old (mean 47.66 5.47). The mean of BPV data basedon gender was: systolic SD (men 15.836 5.52, women 13.646 3.66), diastolic SD(men 9.906 4.37, women 8.036 4.22), systolic AVR (men 14.666 4.86, women12.846 4.24), and diastolic AVR (men 9.186 4.33, women 7.246 3.51). Bivariateanalysis using unpaired t-test showed statistically significant differences betweenmen and women’s diastolic SD (P< 0.05) and diastolic AVR (P< 0.05), but no signifi-cant differences of systolic SD and AVR.Conclusion: This study found that <55-years-old men with hypertension prone tohave higher diastolic BPV than women. In contrary, there were no differences be-tween men and women’s systolic BPV.Keywords: Hypertension • Blood pressure variability • Men • Women

Gender and visit-to-visit diastolic blood pressure variability in elderly population

A. Christiani1, A.A. Lukito1,2, A. Thengker1, H. Lim1,2, and M.W. Hadi11Siloam Hospital Lippo Village, Tangerang, Indonesia, 2Faculty of Medicine,Universitas Pelita Harapan, Tangerang, Banten, Jakarta

Background: Blood pressure variability (BPV) is considered nowadays a novel riskfactor for cardiovascular disease. Increased BPV has been associated with greatersheer stress and great end organ damage. Sollers JJ et al, reported that both sys-tolic and diastolic BPV was greater in older than younger adults. Jaquet F et al, re-ported that BPV was higher in the elderly, in women in particular. Poortvliet et al,reported that variability in diastolic BP associated with increased risk of coronaryevents, heart failure hospitalization, vascular and total mortality. This study aimsto find the gender differences of diastolic variability in elderly (more than 65-years-old) subjects.Methods: Visit to visit BP data were collected from Siloam Hospital Lippo Village’smedical records of hypertensive patients with total of 40 subjects over 65 years oldin 2015. There were 50% (20) male and 50% (20) female subjects. The data weretracking back until the first follow-up visit. The BPV were calculated using standarddeviation (SD) in each visit.Results: Diastolic SD showed mean 6.49mmHg with range of 4.28–9.35mmHg in maleand 8.07mmHg with range of 4.26–11.13mmHg in female subjects. Data were ana-lysed with comparative independent samples, and showed significant differences ofdiastolic SD (P¼ 0.049) between male and female subjects.Conclusion: This study found that in elderly hypertensive female had higher diastolicBPV than male. This result may imply that elderly hypertensive female had higherrisk of exposure to vascular and total mortality as a result of broader diastolic BPV,thus need tighter attention.Keywords: Diastolic variability • Gender • Elderly

The relationship between isotonic exercise and incidence of coronary heartdisease in outpatient heart clinic of Gatot Soebroto Central Army Hospital onMarch–April 2014 period

A.Y. Wirawan1, C.A. Aprilia1, and A. Harsoyo1,21Faculty of Medicine, University of Pembangunan Nasional "Veteran", Jakarta,Indonesia, 2Cardiology Department, Gatot Soebroto Army Hospital, Jakarta,Indonesia

Background: Coronary heart disease (CHD) is the number one cause of death in theworld as well as in Indonesia. One risk of CHD incidence is the lack of physical exer-cise. However, according to the American Heart Association (AHA), acute and brieflyphysical exercise can increase the risk of sudden cardiac death. This research aimsto find out the relationship between isotonic exercise and incidence of CHD in outpa-tient heart clinic of Gatot Soebroto Central Army Hospital on March-April 2014period.Methods: This research was an analytical method, used cross sectional design andconsecutive sampling method. Data obtained using medical record to find out thefinal diagnosis of patients from cardiologist and Global Physical ActivityQuestionnaire (GPAQ) to find out the degree of isotonic exercise has done. A ques-tionnaire given to 75 people subject who fulfilled criteria. Data were analysed bychi-square test.Results: The results obtained, 58 patients (77.33%) had CHD. From 58 patients, 49patients (84.42%) had severe isotonic exercise and 9 patients (15.58%) had moderateisotonic exercise. There was a significant relationship between isotonic exercise andincidence of CHD (P¼ 0.000) (P< 0.05). This happens due to during exercise, coro-nary blood flow increases as much as five-fold above the resting value. Subjects withCHD often cannot maintain adequate coronary blood flow to the affected region andsupply the metabolic demands of the myocardium during exercise; consequently,myocardial ischaemia occurs.Keywords: Coronary heart disease • Isotonic exercise • Sudden cardiac death

Correlation of waist to height ratio with Duke coronary artery disease prognosticindex in stable angina pectoris

V.A. Damay1,2, P. Tedjokusumo1,2, C. Achmad1,2, and T.M. Aprami1,21Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Bandung,Indonesia, 2Faculty of Medicine, Department of Cardiology and Vascular Medicine,Universitas Padjajaran, Bandung, Indonesia

Background: Adiposity is known as pivotal factor in coronary artery disease (CAD).Waist to height ratio (WHtR) is one of adiposity parameter in European Society ofCardiology guideline and suggested to be more appropriate for Asian population al-though not commonly recognized yet. Duke CAD prognostic index is a quantificationof the extent of CAD with prognostic weight value. Previous studies concluded a rela-tionship between anthropometry adiposity parameter and severity of coronary arterystenosis, despite serendipity of obesity paradox. However, according to our bestknowledge, there was no previous study analyse relationship between WHtR andDuke CAD prognostic index.Methods: This cross sectional study included 30 subjects with stable angina pectorisand proved to have significant CAD by coronary angiography. We used Spearman rankcorrelation for analysis.Results: Subjects were predominantly male (93%), with mean age 566 10.73 yearsold (male 55.93611.09). Eighty five subjects have abnormal WHtR (�0.5). MedianWHtR is 0.54 with 0.471–0.706 in range, and Duke CAD prognostic index with median37 (range 19–82). Spearman’s rank correlation analysis showed a significant moderatepositive correlation (r¼ 0.425; P¼ 0.019) between WHtR and Duke CAD prognosticindex.Conclusion: There is a positive correlation between WHtR and Duke CAD prognosticindex in CAD subjects with stable angina pectoris.Keywords: Waist to height ratio • Duke CAD prognostic index • Stable anginapectoris

Estimating the benefit of low-dose aspirin in preventing atherosclerosiscardiovascular disease in systemic lupus erythematosus patients: a systematicreview

R.A. Nugraha1, M. Jonatan1, F.F. Alkaff1, A. Simon1, Awalia2, and R. Yudiwati31Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, 2RheumatologyDivision, Internal Medicine Department, Dr. Soetomo General, Hospital, Indonesia,3Faculty of Medicine, Department of Biomedics, Universitas Airlangga, Surabaya,Indonesia

Background: Atherosclerosis cardiovascular disease (ASCVD) contributes to highermorbidity and mortality in SLE patients. Aspirin is known to be associated with a de-crease in the incidence of thromboembolic events in general population, but its po-tential benefit in SLE patients has not yet been investigated. Thus, aim of this studyis to discover whether aspirin has a significant protective effect on the risk of ASCVDin SLE patients.Methods: Twelve RCT studies identified from the Medline, Embase, and Cochranedatabases were selected with available individual patient-level data, reporting theuse of low-dose aspirin in SLE patients. The primary outcome was the incidence ofASCVD in SLE patients treated with low-dose aspirin compared to those not treatedwith low-dose aspirin. The secondary outcome was frequency and duration of SLE ex-acerbation during a mean 7-years follow-up.Results: Pooled effect estimates were obtained using a random effects model.Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using

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Bayesian hierarchical models. We pooled data from 2.135 subjects with 364 ASCVDevents during a mean 7-years follow-up. Subgroup analysis showed a protective ef-fect of low-dose aspirin against ASCVD, including CHD, TIA, stroke, and PAD[HR: 0.43 (95% CI: 0.20–0.93)] but not for SLE exacerbation [HR: 0.49 (95%CI: 0.22–1.11)].

Conclusion: This meta-analysis shows that the risk of ASCVD event is significantly de-creased by low dose aspirin among SLE patients. Low-dose Aspirin are considered safe andmay be beneficial for thromboprophylaxis. Moreover, bigger studies are needed to providea better recommendation for clinicians in using low-dose Aspirin in SLE patients.Keywords: ASCVD • Low-dose aspirin • SLE • Thromboprophylaxis

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