Introduction: Over the past 60 years there have been dramatic declines in the prevalence of rheum... more Introduction: Over the past 60 years there have been dramatic declines in the prevalence of rheumatic heart disease (RHD) throughout the industrialised world. These
International Journal of Integrated Health Sciences
Objectives: To present a rare case of Congenital Complete Heart Block (CCHB) in the setting of po... more Objectives: To present a rare case of Congenital Complete Heart Block (CCHB) in the setting of post-cesarean delivery of an asymptomatic young patient. Methods: A 30-year-old female patient complained of sudden weakness after C-section delivery with spinal anesthesia. She presented a slow heart rate and Complete Heart Block (CHB) on electrocardiogram (ECG). After one week of observation, the ECG still presented a CHB condition. A permanent pacemaker (PPM) with DDDR mode was then installed for this patient. Result: The etiology of CHB, especially at a young age, is unclear, hence challenging. A patient with a CCHB is difficult to diagnose, especially without any previously related symptoms. This abnormality is usually detected during routine screening not related to cardiovascular disease. The patient in this case study presented an ECG of persistent CHB from the time this patient was admitted until one week after observation. The echocardiography showed normal results. Other modalit...
BACKGROUND Glycemic control is very important in type 2 diabetic patients. Microangiopathy is the... more BACKGROUND Glycemic control is very important in type 2 diabetic patients. Microangiopathy is the first chronic complications in type 2 diabetic patients. Cardiac autonomic neuropathy can be used as a tool for early detection of complication in type 2 diabetic that relates well with cardiovascular morbidity and mortality. The aim of this study was to analyze the correlation between glycemic control and cardiac autonomic neuropathy in type 2 diabetic patients. METHODS It was an observational cross sectional with correlative analysis conducted on type 2 diabetic at Hasan Sadikin hospital within July until August 2019. Value of HbA1c, fasting plasma glucose, and post prandial plasma glucose within 2 years were obtained with NGSP standard of examination. Cardiac autonomic neuropathy was assessed by Cardiovascular Autonomic Reflex Testings (CARTs) with Bellevere scoring system. RESULT The research was conducted on 39 subjects with mean age 56±7,05 years (48,7% males and 51,3% women). Median value of the last HbA1c was 7,6% (5,2%-12,9%) and mean HbA1c in the last 2 years was 8,1±1,88%. Median CARTs score was 5 (1-8). Rank-Spearman correlation analysis showed significant moderately positive correlation between HbA1c and CARTs score (r=0,454, CI 95% 0,187-0,772, p=0,004) and also mean HbA1c within the last 2 years with CARTs score (r=0,564, IK 95% 0,289-0,839, p=0,000). Multivariate analysis, mean HbA1c remained correlated significantly with CARTs score even after adjustment toward age, gender, duration of diabetes, and diabetic therapy. CONCLUSION There is significant moderately positive correlation between glycemic control and cardiac autonomic neuropathy in type 2 diabetic patients.
Introduction : Manifest accesory pathway (AP) located in the Nodo Hisian (NH) region around the A... more Introduction : Manifest accesory pathway (AP) located in the Nodo Hisian (NH) region around the Atrioventricular Node (AVN) are rare and poses challenges for ablation strategy since ablation in this case is associated with risk of Atrioventricular (AV) block. Here we present a rare case of symptomatic Wolff-Parkinson-White (WPW) syndrome with NH AP and deterioration of left ventricular ejection fraction (LVEF) who underwent succesful AP ablation.
BACKGROUND Prolonged pacing of the right ventricle (RV) is associated with left ventricular (LV) ... more BACKGROUND Prolonged pacing of the right ventricle (RV) is associated with left ventricular (LV) systolic dysfunction. Several studies have shown that the RV pacing location, pacing burden (percentage), and paced QRS duration may affect LV systolic function. Subclinical LV dysfunction may occur early after implantation of a permanent pacemaker (PPM). Therefore, this study aims to detect early subclinical LV systolic dysfunction measured by global longitudinal strain (GLS) using speckle tracking echocardiography (STE) at one month after PPM implantation. METHODS A single-center, prospective cohort study was conducted, and all patients indicated for PPM implantation with preserved LV systolic function were included. Data of RV pacing location (RV apical vs right ventricular outflow tract (RVOT), pacing burden (percentage) (≤40% vs >40%), and paced QRS duration (≤150 ms and >150 ms) were obtained. The change of GLS was also measured before and one month after PPM implantation (de...
BACKGROUND Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predis... more BACKGROUND Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predisposing factors could be measured by left atrial volume index (LAVI) and P-wave dispersion. AIM This study aimed to assess P-wave dispersion and LAVI as preoperative predictors of POAF among patients who underwent Coronary Artery Bypass Graft (CABG). METHODS An analytical retrospective cohort study was performed on patients who underwent CABG. The P-wave dispersion and POAF were evaluated based on documented ECG results. LAVI size was collected from echocardiographic reports. Hazard ratios of P-wave dispersion and LAVI for POAF were analyzed using Cox proportional hazard model. RESULT A total of 42 subjects (57±1 years) were included in this study. POAF occurred in 28.6% of patients at a median of 2 days after CABG. P-wave dispersion was significantly longer in patients in whom AF was developed (53.03±3.82ms vs. 44.01±1.98ms, p:0.028), while LAVI difference was not significant. The Cox proportional hazard model showed a significant association between P-wave dispersion and risk of POAF (HR 1.05, CI95%, 1.001-1.103;p=0.048). There was no association between LAVI and risk of POAF (HR1.003, CI 95%, 0.965-1.044;p=0.864). CONCLUSION P-wave dispersion is a predictor of POAF in patients who underwent CABG. Risk stratification using P-wave dispersion enables clinicians to identify high-risk patients before CABG surgery.
Objective: Spatial QRS-T angle (the angle between the QRS and T vectors) is a strong independent ... more Objective: Spatial QRS-T angle (the angle between the QRS and T vectors) is a strong independent predictor of cardiovascular death. Spatial QRS-T angle calculations can be obtained from the ECG 12 lead with Kors visual transform applications closest to Frank lead system. Half of patients with coronary artery disease (CAD) died from sudden cardiac death (SCD) with Left Ventricular Ejection Fraction (LVEF) as a predictor. The aim of this study was to correlate spatial QRS-T with LVEF in patients with old myocardial infarction (OMI). Methods: This is a cross-sectional study in patients with OMI that have not undergone revascularization and have achieved medical therapy. 12-lead electrocardiography (ECG) and echocardiography were done simultaneously. Spatial QRS-T angle was measured by Kors visual transform applications. Statistical analysis was performed using Pearson correlation and multivariate analysis with linear regression. Results: 46 patients meet the inclusion criteria. Baselin...
Background: Ischemic cardiomyopathy is the most frequent etiology of heart failure with reduced e... more Background: Ischemic cardiomyopathy is the most frequent etiology of heart failure with reduced ejection fraction (HFrEF) and a result of ventricular structural, functional and electrical remodeling. T peak to end (Tpe) interval is an electrocardiographic parameter that represents repolarization heterogeneity and had prognostic value for ventricular arrhythmia. Patients with ischemic cardiomyopathy face a significant burden of arrhythmias. Mechanical dispersion is a functional remodeling parameter that can be measured by time to peak longitudinal strain using speckle tracking echocardiography. This study aimed to assess the relationship between Tpe interval with time to peak longitudinal strain in ischemic cardiomyopathy patients. Methods: This study was conducted with an observational analytical cross-sectional design. Ischemic cardiomyopathy subjects were included at Dr. Hasan Sadikin General Hospital, Bandung, from August to October 2019. Tpe interval was measured manually with the tangential method. Time to peak longitudinal strain was measured using speckle tracking echocardiography. The correlation between Tpe interval and time to peak longitudinal strain was analyzed using Pearson correlation. Results: A total of 30 subjects were included in this study. The average age was 58 ± 8 years old, and the average left ventricular ejection fraction was 27±5.5%. The average of Tpe interval was 83.4 ± 7.62 ms, and the average time to peak longitudinal strain was 93.13 ± 34.51 ms. The Pearson correlation test showed a significant weak positive correlation (r = 0.386, 95% confidence interval: 0.029-0.743, P = 0.018) between Tpe interval and time to peak longitudinal strain in ischemic cardiomyopathy patients. Conlucions: There was a significant weak positive correlation between Tpe interval and time to peak longitudinal strain in ischemic cardiomyopathy patients.
Background: Myocardial necrosis may occur due to anthracycline (doxorubicin/adriamycin) chemother... more Background: Myocardial necrosis may occur due to anthracycline (doxorubicin/adriamycin) chemotherapy usage. Furthermore, myocardial necrosis can affect the heterogeneity of heart conduction system and lead to repolarization abnormalities. The aim of this study was to investigate the effect of cardiotoxicity caused by anthracycline to repolarization abnormalities measured by T peak to T end (TpTe) interval. Methods: This was a single center prospective cohort study with linear regression from October 2018 to May 2019. The subjects of the study were breast cancer patients after completing administration of chemotherapy with fluorouracil, adriamycin and cyclophosphamide (FAC) regimen (containing anthracycline) for 6 months. Myocardial necrosis was assessed by high sensitive (hs)-troponin I, and the heterogeneity of repolarization was measured by TpTe interval. Results: This study involved 25 breast cancer patients after chemotherapy in the 6-month FAC regimen. The mean age is 46 ± 7 years, and the cumulative dose of anthracycline is 591 ± 52 mg/m 2. The mean level of hs-troponin I is 90.5 ± 44.7 ng/L and the TpTe interval is 108.2 ± 10 ms. The results of linear regression analysis showed a positive correlation between hs-troponin I and TpTe interval (r: 0.421, P: 0.036) after controlling for one confounding variable (cumulative dose of anthracycline). Conclusions: Cardiotoxicity caused by accumulative dose of anthracycline may lead to myocardial necrosis which was shown by elevated hs-troponin I levels. This process may lead to heterogeneity conduction system that affect the repolarization phase of cardiac cycle which was shown by increased TpTe interval.
Background: Many studies have shown that T-peak to Tend (TPTE) interval was associated with sudde... more Background: Many studies have shown that T-peak to Tend (TPTE) interval was associated with sudden cardiac events. Peripartum cardiomyopathy (PPCM) causes reversible left ventricle systolic dysfunction which may deteriorate into sudden cardiac death. This study aimed to evaluate beta-blocker as an antiarrhythmic agent to improve TPTE interval as a prognostic value of sudden cardiac death. Methods: A cohort experimental prospective study was performed. The PPCM was diagnosed from the emergency ward. A total of 54 cases were identified from 2014 to 2016. Thirty-four patients were followed up for further analysis. Electrocardiograms were conducted in all the patients, and TPTE interval was measured. After a followup of 6 months of beta-blocker treatment, the echocardiography and TPTE interval were measured again to obtain the repolarization heterogeneity. Results: The mean age of subjects was 32 ± 6.4 years. The mean left ventricular ejection fraction (LVEF) was 32.24±6.3%. The mean TPTE interval was 123.7 ± 28.2 ms. After 6 months of beta-blocker administration, the mean LVEF was 58.26±4.4% and the mean TPTE was 98.7 ± 39.5 ms. The paired t-test showed a significant difference between TPTE interval pre-and post-administration of beta-blocker (P value < 0.001). Conclusions: There is an improvement of TPTE in PPCM patients after 6 months of beta-blocker administration. Administration of betablocker in PPCM patients is expected to prevent sudden cardiac death in PPCM populations.
The existence of the upper common pathways is not well-established yet. This case describes atrio... more The existence of the upper common pathways is not well-established yet. This case describes atrioventricular nodal reentry tachycardia with persistent ventriculoatrial dissociation that proof of upper common pathway existence.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
International Research Journal of Medicine and Medical Sciences, 2018
Bidirectional ventricular tachycardia (VT) is a rare rhythm disorder, usually described in digita... more Bidirectional ventricular tachycardia (VT) is a rare rhythm disorder, usually described in digitalis intoxication, fulminant myocarditis, familial catecholaminergic polymorphic VT, familial hypokalemic periodic paralysis, and aconitine poisoning. This case describes a young male with rheumatic fever reactivation (RFR) with manifestation of myocarditis and bidirectional ventricular tachycardia (BVT). A myocarditis with BVT in RFR had not been reported before.
A total of 2052 rural Bangladeshi women with mean age of 44.46years were studied using a cross-se... more A total of 2052 rural Bangladeshi women with mean age of 44.46years were studied using a cross-sectional survey. Multiple regressions were used to examinethe association between circulatory ET-1 level and hypertension. Results: The prevalence of hypertensionwas30.3%. ET-1 levels were significantly higher in hypertensive (mean 3.08 pg/ml, SE ± 0.19) than non-hypertensive subjects (mean 2.01 pg/ml, SE ± 0.30) (p = <0.001). In univariateanalysis after adjusting for age, ET-1 had significant positive associations with diastolic blood pressure (DBP) (p = 0.002), systolic blood pressure (SBP) (p = <0.001), fasting blood glucose (p = 0.002), mean arterial pressure (MAP) (p = 0.001)and a negative significant association with high-density lipoprotein cholesterol (HDL) (p = 0.030). Unlike blood pressures, other variables including, triglycerides, body mass index, and waist circumference were not associated with ET-1. In multiple linear regression analysis after adjusting for age, ET-1 had significant positive associations with fasting blood glucose (p = 0.012) and mean arterial pressure (MAP) (p = 0.05)only. When we performed multiple logistic regression analysis considering hypertension status as dependent variable, hypertensive had significant positive associations with age (p = 0.015), waist circumference (p = <0.001), fasting blood glucose (p = 0.009), triglyceride (p = 0.001) and endothelin-1 (0.026). In tertile analysis, subjects with hypertension significantly increase as levels of ET-1 increase (P for trend = 0.02). Conclusions: Thus the present study demonstrates that there is higher concentration of ET-1 among hypertensive subjects of apparently healthy population in Bangladeshi rural women who did not know they were hypertensive. The relation of ET-1 and hypertension needs further investigations to define the clinical utility and predictive value of serum ET-1 levels in hypertension for South Asian population.
IJN. Among the parameters reviewed were pacing thresholds and impedances, pacing stability as wel... more IJN. Among the parameters reviewed were pacing thresholds and impedances, pacing stability as well as development of pacing related complications. Electrical performances were tracked from the point of implant to successful completion of 1-year follow up. Results: Between March 2014 to January 2018, 192 patients were subjected to procedural attempt to implant a Miera TPS for various indications. Out of these 192 patients, the Miera was successfully implanted in 190 patients (99%). 113 (59.5%) have completed 1-year follow-up. The mean age of these patients is 73.3±10.5 years old. 60 (53.1%) patients were female and 53 (46.9%) patients were male. The most common indication for Miera implantation was for complete heart block (27.4%). Early complications were bleeding in 1 patient (0.9%) and elevated capture threshold post implant in 1 patient (0.9%). 1 patient (0.9%) develop pacemaker related infection at 1 month needing extraction of the Miera pacemaker. Electrical performance was good from the point of implant to over 1-year period with stable threshold (1.7 at implant vs 2.0 at 1-year, p value=0.298). There were no late complications such as perforation or pericardia! effusion at 1-year. Conclusion: The Miera TPS leadless pacing system showed a high degree of efficacy and efficiency at 1-year follow-up.
Introduction: Over the past 60 years there have been dramatic declines in the prevalence of rheum... more Introduction: Over the past 60 years there have been dramatic declines in the prevalence of rheumatic heart disease (RHD) throughout the industrialised world. These
International Journal of Integrated Health Sciences
Objectives: To present a rare case of Congenital Complete Heart Block (CCHB) in the setting of po... more Objectives: To present a rare case of Congenital Complete Heart Block (CCHB) in the setting of post-cesarean delivery of an asymptomatic young patient. Methods: A 30-year-old female patient complained of sudden weakness after C-section delivery with spinal anesthesia. She presented a slow heart rate and Complete Heart Block (CHB) on electrocardiogram (ECG). After one week of observation, the ECG still presented a CHB condition. A permanent pacemaker (PPM) with DDDR mode was then installed for this patient. Result: The etiology of CHB, especially at a young age, is unclear, hence challenging. A patient with a CCHB is difficult to diagnose, especially without any previously related symptoms. This abnormality is usually detected during routine screening not related to cardiovascular disease. The patient in this case study presented an ECG of persistent CHB from the time this patient was admitted until one week after observation. The echocardiography showed normal results. Other modalit...
BACKGROUND Glycemic control is very important in type 2 diabetic patients. Microangiopathy is the... more BACKGROUND Glycemic control is very important in type 2 diabetic patients. Microangiopathy is the first chronic complications in type 2 diabetic patients. Cardiac autonomic neuropathy can be used as a tool for early detection of complication in type 2 diabetic that relates well with cardiovascular morbidity and mortality. The aim of this study was to analyze the correlation between glycemic control and cardiac autonomic neuropathy in type 2 diabetic patients. METHODS It was an observational cross sectional with correlative analysis conducted on type 2 diabetic at Hasan Sadikin hospital within July until August 2019. Value of HbA1c, fasting plasma glucose, and post prandial plasma glucose within 2 years were obtained with NGSP standard of examination. Cardiac autonomic neuropathy was assessed by Cardiovascular Autonomic Reflex Testings (CARTs) with Bellevere scoring system. RESULT The research was conducted on 39 subjects with mean age 56±7,05 years (48,7% males and 51,3% women). Median value of the last HbA1c was 7,6% (5,2%-12,9%) and mean HbA1c in the last 2 years was 8,1±1,88%. Median CARTs score was 5 (1-8). Rank-Spearman correlation analysis showed significant moderately positive correlation between HbA1c and CARTs score (r=0,454, CI 95% 0,187-0,772, p=0,004) and also mean HbA1c within the last 2 years with CARTs score (r=0,564, IK 95% 0,289-0,839, p=0,000). Multivariate analysis, mean HbA1c remained correlated significantly with CARTs score even after adjustment toward age, gender, duration of diabetes, and diabetic therapy. CONCLUSION There is significant moderately positive correlation between glycemic control and cardiac autonomic neuropathy in type 2 diabetic patients.
Introduction : Manifest accesory pathway (AP) located in the Nodo Hisian (NH) region around the A... more Introduction : Manifest accesory pathway (AP) located in the Nodo Hisian (NH) region around the Atrioventricular Node (AVN) are rare and poses challenges for ablation strategy since ablation in this case is associated with risk of Atrioventricular (AV) block. Here we present a rare case of symptomatic Wolff-Parkinson-White (WPW) syndrome with NH AP and deterioration of left ventricular ejection fraction (LVEF) who underwent succesful AP ablation.
BACKGROUND Prolonged pacing of the right ventricle (RV) is associated with left ventricular (LV) ... more BACKGROUND Prolonged pacing of the right ventricle (RV) is associated with left ventricular (LV) systolic dysfunction. Several studies have shown that the RV pacing location, pacing burden (percentage), and paced QRS duration may affect LV systolic function. Subclinical LV dysfunction may occur early after implantation of a permanent pacemaker (PPM). Therefore, this study aims to detect early subclinical LV systolic dysfunction measured by global longitudinal strain (GLS) using speckle tracking echocardiography (STE) at one month after PPM implantation. METHODS A single-center, prospective cohort study was conducted, and all patients indicated for PPM implantation with preserved LV systolic function were included. Data of RV pacing location (RV apical vs right ventricular outflow tract (RVOT), pacing burden (percentage) (≤40% vs >40%), and paced QRS duration (≤150 ms and >150 ms) were obtained. The change of GLS was also measured before and one month after PPM implantation (de...
BACKGROUND Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predis... more BACKGROUND Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predisposing factors could be measured by left atrial volume index (LAVI) and P-wave dispersion. AIM This study aimed to assess P-wave dispersion and LAVI as preoperative predictors of POAF among patients who underwent Coronary Artery Bypass Graft (CABG). METHODS An analytical retrospective cohort study was performed on patients who underwent CABG. The P-wave dispersion and POAF were evaluated based on documented ECG results. LAVI size was collected from echocardiographic reports. Hazard ratios of P-wave dispersion and LAVI for POAF were analyzed using Cox proportional hazard model. RESULT A total of 42 subjects (57±1 years) were included in this study. POAF occurred in 28.6% of patients at a median of 2 days after CABG. P-wave dispersion was significantly longer in patients in whom AF was developed (53.03±3.82ms vs. 44.01±1.98ms, p:0.028), while LAVI difference was not significant. The Cox proportional hazard model showed a significant association between P-wave dispersion and risk of POAF (HR 1.05, CI95%, 1.001-1.103;p=0.048). There was no association between LAVI and risk of POAF (HR1.003, CI 95%, 0.965-1.044;p=0.864). CONCLUSION P-wave dispersion is a predictor of POAF in patients who underwent CABG. Risk stratification using P-wave dispersion enables clinicians to identify high-risk patients before CABG surgery.
Objective: Spatial QRS-T angle (the angle between the QRS and T vectors) is a strong independent ... more Objective: Spatial QRS-T angle (the angle between the QRS and T vectors) is a strong independent predictor of cardiovascular death. Spatial QRS-T angle calculations can be obtained from the ECG 12 lead with Kors visual transform applications closest to Frank lead system. Half of patients with coronary artery disease (CAD) died from sudden cardiac death (SCD) with Left Ventricular Ejection Fraction (LVEF) as a predictor. The aim of this study was to correlate spatial QRS-T with LVEF in patients with old myocardial infarction (OMI). Methods: This is a cross-sectional study in patients with OMI that have not undergone revascularization and have achieved medical therapy. 12-lead electrocardiography (ECG) and echocardiography were done simultaneously. Spatial QRS-T angle was measured by Kors visual transform applications. Statistical analysis was performed using Pearson correlation and multivariate analysis with linear regression. Results: 46 patients meet the inclusion criteria. Baselin...
Background: Ischemic cardiomyopathy is the most frequent etiology of heart failure with reduced e... more Background: Ischemic cardiomyopathy is the most frequent etiology of heart failure with reduced ejection fraction (HFrEF) and a result of ventricular structural, functional and electrical remodeling. T peak to end (Tpe) interval is an electrocardiographic parameter that represents repolarization heterogeneity and had prognostic value for ventricular arrhythmia. Patients with ischemic cardiomyopathy face a significant burden of arrhythmias. Mechanical dispersion is a functional remodeling parameter that can be measured by time to peak longitudinal strain using speckle tracking echocardiography. This study aimed to assess the relationship between Tpe interval with time to peak longitudinal strain in ischemic cardiomyopathy patients. Methods: This study was conducted with an observational analytical cross-sectional design. Ischemic cardiomyopathy subjects were included at Dr. Hasan Sadikin General Hospital, Bandung, from August to October 2019. Tpe interval was measured manually with the tangential method. Time to peak longitudinal strain was measured using speckle tracking echocardiography. The correlation between Tpe interval and time to peak longitudinal strain was analyzed using Pearson correlation. Results: A total of 30 subjects were included in this study. The average age was 58 ± 8 years old, and the average left ventricular ejection fraction was 27±5.5%. The average of Tpe interval was 83.4 ± 7.62 ms, and the average time to peak longitudinal strain was 93.13 ± 34.51 ms. The Pearson correlation test showed a significant weak positive correlation (r = 0.386, 95% confidence interval: 0.029-0.743, P = 0.018) between Tpe interval and time to peak longitudinal strain in ischemic cardiomyopathy patients. Conlucions: There was a significant weak positive correlation between Tpe interval and time to peak longitudinal strain in ischemic cardiomyopathy patients.
Background: Myocardial necrosis may occur due to anthracycline (doxorubicin/adriamycin) chemother... more Background: Myocardial necrosis may occur due to anthracycline (doxorubicin/adriamycin) chemotherapy usage. Furthermore, myocardial necrosis can affect the heterogeneity of heart conduction system and lead to repolarization abnormalities. The aim of this study was to investigate the effect of cardiotoxicity caused by anthracycline to repolarization abnormalities measured by T peak to T end (TpTe) interval. Methods: This was a single center prospective cohort study with linear regression from October 2018 to May 2019. The subjects of the study were breast cancer patients after completing administration of chemotherapy with fluorouracil, adriamycin and cyclophosphamide (FAC) regimen (containing anthracycline) for 6 months. Myocardial necrosis was assessed by high sensitive (hs)-troponin I, and the heterogeneity of repolarization was measured by TpTe interval. Results: This study involved 25 breast cancer patients after chemotherapy in the 6-month FAC regimen. The mean age is 46 ± 7 years, and the cumulative dose of anthracycline is 591 ± 52 mg/m 2. The mean level of hs-troponin I is 90.5 ± 44.7 ng/L and the TpTe interval is 108.2 ± 10 ms. The results of linear regression analysis showed a positive correlation between hs-troponin I and TpTe interval (r: 0.421, P: 0.036) after controlling for one confounding variable (cumulative dose of anthracycline). Conclusions: Cardiotoxicity caused by accumulative dose of anthracycline may lead to myocardial necrosis which was shown by elevated hs-troponin I levels. This process may lead to heterogeneity conduction system that affect the repolarization phase of cardiac cycle which was shown by increased TpTe interval.
Background: Many studies have shown that T-peak to Tend (TPTE) interval was associated with sudde... more Background: Many studies have shown that T-peak to Tend (TPTE) interval was associated with sudden cardiac events. Peripartum cardiomyopathy (PPCM) causes reversible left ventricle systolic dysfunction which may deteriorate into sudden cardiac death. This study aimed to evaluate beta-blocker as an antiarrhythmic agent to improve TPTE interval as a prognostic value of sudden cardiac death. Methods: A cohort experimental prospective study was performed. The PPCM was diagnosed from the emergency ward. A total of 54 cases were identified from 2014 to 2016. Thirty-four patients were followed up for further analysis. Electrocardiograms were conducted in all the patients, and TPTE interval was measured. After a followup of 6 months of beta-blocker treatment, the echocardiography and TPTE interval were measured again to obtain the repolarization heterogeneity. Results: The mean age of subjects was 32 ± 6.4 years. The mean left ventricular ejection fraction (LVEF) was 32.24±6.3%. The mean TPTE interval was 123.7 ± 28.2 ms. After 6 months of beta-blocker administration, the mean LVEF was 58.26±4.4% and the mean TPTE was 98.7 ± 39.5 ms. The paired t-test showed a significant difference between TPTE interval pre-and post-administration of beta-blocker (P value < 0.001). Conclusions: There is an improvement of TPTE in PPCM patients after 6 months of beta-blocker administration. Administration of betablocker in PPCM patients is expected to prevent sudden cardiac death in PPCM populations.
The existence of the upper common pathways is not well-established yet. This case describes atrio... more The existence of the upper common pathways is not well-established yet. This case describes atrioventricular nodal reentry tachycardia with persistent ventriculoatrial dissociation that proof of upper common pathway existence.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, ther... more group; 23.6/hr vs. 14.8/hr, 49.7/hr vs. 26.3/hr and 88 bpm vs. 79 bpm respectively. However, there was a trend towards lower sleep efficiency and oxygen desaturation index in the Nocturnal ACS group compared to Nonnocturnal ACS group; 80% vs. 84% and 27/hr vs 18/hr respectively. There was no difference in average desaturation drops and lowest oxygen desaturation between the groups; 4.5% vs 4.4% and 81% vs 80% respectively. Conclusion: Differences in sleep parameters between Nocturnal and Non-nocturnal ACS among OSA individuals may explain the pathogenesis of the cardiac event onset. However, a larger sample size is required to determine the significance of these observed trends.
International Research Journal of Medicine and Medical Sciences, 2018
Bidirectional ventricular tachycardia (VT) is a rare rhythm disorder, usually described in digita... more Bidirectional ventricular tachycardia (VT) is a rare rhythm disorder, usually described in digitalis intoxication, fulminant myocarditis, familial catecholaminergic polymorphic VT, familial hypokalemic periodic paralysis, and aconitine poisoning. This case describes a young male with rheumatic fever reactivation (RFR) with manifestation of myocarditis and bidirectional ventricular tachycardia (BVT). A myocarditis with BVT in RFR had not been reported before.
A total of 2052 rural Bangladeshi women with mean age of 44.46years were studied using a cross-se... more A total of 2052 rural Bangladeshi women with mean age of 44.46years were studied using a cross-sectional survey. Multiple regressions were used to examinethe association between circulatory ET-1 level and hypertension. Results: The prevalence of hypertensionwas30.3%. ET-1 levels were significantly higher in hypertensive (mean 3.08 pg/ml, SE ± 0.19) than non-hypertensive subjects (mean 2.01 pg/ml, SE ± 0.30) (p = <0.001). In univariateanalysis after adjusting for age, ET-1 had significant positive associations with diastolic blood pressure (DBP) (p = 0.002), systolic blood pressure (SBP) (p = <0.001), fasting blood glucose (p = 0.002), mean arterial pressure (MAP) (p = 0.001)and a negative significant association with high-density lipoprotein cholesterol (HDL) (p = 0.030). Unlike blood pressures, other variables including, triglycerides, body mass index, and waist circumference were not associated with ET-1. In multiple linear regression analysis after adjusting for age, ET-1 had significant positive associations with fasting blood glucose (p = 0.012) and mean arterial pressure (MAP) (p = 0.05)only. When we performed multiple logistic regression analysis considering hypertension status as dependent variable, hypertensive had significant positive associations with age (p = 0.015), waist circumference (p = <0.001), fasting blood glucose (p = 0.009), triglyceride (p = 0.001) and endothelin-1 (0.026). In tertile analysis, subjects with hypertension significantly increase as levels of ET-1 increase (P for trend = 0.02). Conclusions: Thus the present study demonstrates that there is higher concentration of ET-1 among hypertensive subjects of apparently healthy population in Bangladeshi rural women who did not know they were hypertensive. The relation of ET-1 and hypertension needs further investigations to define the clinical utility and predictive value of serum ET-1 levels in hypertension for South Asian population.
IJN. Among the parameters reviewed were pacing thresholds and impedances, pacing stability as wel... more IJN. Among the parameters reviewed were pacing thresholds and impedances, pacing stability as well as development of pacing related complications. Electrical performances were tracked from the point of implant to successful completion of 1-year follow up. Results: Between March 2014 to January 2018, 192 patients were subjected to procedural attempt to implant a Miera TPS for various indications. Out of these 192 patients, the Miera was successfully implanted in 190 patients (99%). 113 (59.5%) have completed 1-year follow-up. The mean age of these patients is 73.3±10.5 years old. 60 (53.1%) patients were female and 53 (46.9%) patients were male. The most common indication for Miera implantation was for complete heart block (27.4%). Early complications were bleeding in 1 patient (0.9%) and elevated capture threshold post implant in 1 patient (0.9%). 1 patient (0.9%) develop pacemaker related infection at 1 month needing extraction of the Miera pacemaker. Electrical performance was good from the point of implant to over 1-year period with stable threshold (1.7 at implant vs 2.0 at 1-year, p value=0.298). There were no late complications such as perforation or pericardia! effusion at 1-year. Conclusion: The Miera TPS leadless pacing system showed a high degree of efficacy and efficiency at 1-year follow-up.
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