ACI (Acta Cardiologia Indonesiana)

ASSOCIATION OF LEFT ATRIAL STRAIN WITH ATRIAL FIBRILLATION IN ACUTE ISCHEMIC STROKE PATIENTS

Wirawan Prabowo — 2024-06-28

Background: Acute ischemic stroke due to cardio-embolism associated with atrial fibrillation (AF) has been known to have the highest risk of recurrence and increased patient morbidity and mortality. However, the detection rate of AF rhythm in acute ischemic stroke patients using electrocardiograms and Holter monitoring was still quite low. Functional changes in the left atrium have been associated with an increased incidence of AF. Left atrial strain measurement using speckle tracking echocardiography 2D (STE-2D) can detect left atrial dysfunction associated with AF.

Aim: To determine the association between left atrial strain and atrial fibrillation in patients with acute ischemic stroke.

Research Methods: This analytical observation study was conducted with a cross-sectional design, using secondary data from medical records at RSUP Dr. Sardjito within January 2020–December 2022 on the population with acute ischemic stroke patients who underwent an electrocardiogram and transthoracic echocardiography examination.

Results: During the observation period 142 acute ischemic stroke patients underwent an electrocardiogram and transthoracic echocardiography examinations. A total of 72 patients diagnosed with acute ischemic stroke met the inclusion criteria as study subjects, there were 49 subjects (68%) with sinus rhythm and 23 subjects (32%) with AF rhythm. The left atrial strain value was found to be lower in the AF rhythm group (13,02 ± 8,49%) than in the sinus rhythm group (25,12 ± 8,36%) and was statistically significant (p <0,001). Determination of the optimal cut-off value using the Youden Index obtained a left atrial strain value < 16,25% with a sensitivity of 85,7%, specificity of 73,9%, and area under the curve (AUC) value of 84% (p < 0,001, 95% CI 0,74 – 0,95). The results of the multivariate analysis test showed that left atrial strain was an independent predictor related to the occurrence of AF rhythm (p = 0,001, OR 18,68; 95% CI 3,22 – 108,45).

Conclusion: Decreased left atrial strain is associated with atrial fibrillation rhythms in acute ischemic stroke patients. Acute ischemic stroke patients with a left atrial strain value < 16.25% have a higher prevalence of atrial fibrillation rhythm.

Keywords: left atrial strain; atrial fibrillation; ischemic stroke; speckle tracking echocardiography

Systemic Immune-Inflammation Index as A Predictor of Mortality and Rehospitalization in Heart Failure Patients

Daria Ilmasari — 2024-06-28

ABSTRACT

Systemic Immune-Inflammation Index as A Predictor of Mortality and Rehospitalization in Heart Failure Patients

Background

Heart failure (HF) is a disease closely associated with inflammation and the Systemic Immune inflammation Index (SII) is a novel inflammatory marker. SII is a combined inflammatory indicator that incorporates three significant immune cells namely neutrophils, lymphocytes and platelets. SII is considered an excellent indicator of local immune response and systemic inflammation. SII is an inexpensive and easily accessible laboratory test in peripheral health facilities.

Research Objective

This study aims to determine whether SII can be used as a predictor of clinical outcomes, which are mortality and rehospitalization in patients with chronic heart failure.

Research Methods

This study is a retrospective cohort study using data of chronic heart failure patients who underwent hospitalization from the HF (Heart Failure) registry of Dr. Sardjito Hospital for the period January 2022 - February 2023. SII was calculated as platelet count × absolute neutrophil count / absolute lymphocyte count.

Results

There were 188 patients who met the inclusion criteria as research subjects from 282 chronic heart failure patients who underwent hospitalization. Subjects had a mean age of 58.80 ± 11.48 years. A total of 67,6% (n=127) of the subjects were male. SII value for mortality based on receiver operating characteristic (ROC) cut-off was 1459,59 (area under curve (AUC) 0.600, sensitivity (Sn) 55,6%, specificity (Sp) 68,8%) and the ROC cut-off for rehospitalization was 0,474. Kaplan-Meier analysis of SII with mortality, subjects with high SII values (>1459.59) had a 50,5% survival rate with a mean survival of 8,5 months and low SII (<1459.59) had a 74% survival rate with a mean survival of 9,9 months. Multivariate regression analysis found SII as an independent predictor of mortality odds ratio (OR 3,08, 95% confidence interval (CI) 1,59 – 5,95, p=<0.001) but not significant for rehospitalization.

Conclusion

Systemic Immune-inflammation Index (SII) is an independent predictor of mortality, but not a predictor of rehospitalization in chronic heart failure patients undergoing hospitalization.

Keywords: Systemic Immune-inflammation Index (SII), heart failure (HF), mortality and rehospitalization

3D Echocardiographic Assesment of Left Ventricle Size and Function with Automated Adaptive Software in Patients with Right Heart Dominant

Real Kusumanjaya Marsam — 2024-06-28

Introduction : Echocardiography is a fundamental tool for assessing cardiac chamber size and function, with evolving technologies like real-time three-dimensional echocardiography (3DE) and automated quantification software offering new possibilities. This study aims to validate left ventricular (LV) measurements obtained through automated quantification software against manual 3DE and 2D measurements, explore the relationship between these measurement techniques, and compare their reproducibility and analysis time.

Methods : A total of 60 patients with uncorrected severe mitral stenosis (MS) and atrial septal defect (ASD) underwent echocardiography. Automated and manual 3DE measurements were compared, with subgroup analysis for software performance. Analysis times were also assessed.

Results : The automated quantification software did not work in 16 patients, with notable differences in tricuspid regurgitation parameters. Automated 3DE measurements yielded larger LV volumes than manual 3DE measurements, while LV ejection fraction (LVEF) measurements were smaller. Good correlations were observed, but agreement analysis revealed significant differences between the two methods. The use of automated software significantly reduced analysis time.

Conclusions : Automated quantification software can effectively measure LV parameters in patients with MS and ASD, significantly reducing analysis time. However, manual methods may still be necessary in cases with structural changes or unique anatomical conditions, emphasizing the importance of selecting the appropriate measurement technique for specific patient populations.

Keywords: 3D Echocardiography, Automated Adaptive Software, Cardiac Imaging

Myocarditis with Brugada Pattern : An Unusual Early Manifestation of Leptospirosis

Gagah Buana Putra — 2024-06-28

Leptospirosis is a zoonotic disease caused by Leptospira spirochaetes. Cardiac involvement in leptospirosis is frequent yet underdiagnosed. We describe a myocarditis case showing Brugada pattern Type 1, a rare leptospirosis cardiac complication. As myocarditis is an atypical cardiac manifestation of leptospirosis, it is important to investigate anything sign related to cardiac involvement in managing leptospirosis.

The CARDIAC MANIFESTATION IN DENGUE INFECTION

Achnes Pangaribuan — 2024-06-28

ABSTRACT

Introduction: Dengue infection rarely affects the heart, but clinical symptoms of cardiac involvement may range greatly from a silent illness to severe myocarditis resulting in death. With the increasing incidence of dengue fever, reports of atypical manifestations are on the rise, these may be underreported because of a lack of awareness and underdiagnosed

Cases: A 40-year-old man presents with acute fever for three days with positive non-structural protein 1 (NS1) and asymptomatic bradycardia. ECG revealed sinus rhythm (40 bpm) with an absence of ST-segment elevation. His laboratory examination showed a rise in NT-Pro BNP and CKMB levels. Echocardiography showed hyperechogenic myocardium suspicious for myocarditis, with a left ventricle ejection fraction (LVEF) of 73% and no systolic, diastolic, or valve abnormalities. The patient recovered without further complications and was discharged home.

Conclusion: Cardiac involvement is uncommon and encountered in centres which handle large numbers of patients with dengue infection. Clinical manifestations of cardiac involvement in dengue infection can vary widely, from an incidental finding to severe cardiac failure resulting in death.

Keywords: bradycardia; dengue infection; myocarditis; NS1