European Heart Journal Supplements (2019) 21 (Supplement F), F33–F114
The Heart of the Matter
doi:10.1093/eurheartj/suz182
Original Research Abstract
OR.1. Outcomes of percutaneous coronary intervention in diabetic patients with
significant coronary artery disease
M.M Oo1, K.S. Ng2, C.Z. Tan3, B.I. Dzafir1, Z.A. Imran1, W.A. Wan1
1 Conclusion: QT dispersion is a simple and reliable parameter with good diagnostic
Cardiology Unit, Medical Department, University Malaya Medical Center, Malaysia,
2 value to predict moderate-large ischemic burden as detected by SPECT MPI. This
Medical Department, University Malaya Medical Center, Malaysia, 3Medical
Department, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
Background: Cardiovascular diseases are the major leading cause of death globally
out of which 7.4 million were due to coronary artery diseases. In diabetes patients,
the prevalence of coronary artery disease is more common compare to general
population.
Objective: To identify the prevalence of diabetes in patients who underwent for per-
cutaneous coronary intervention. To determine immediate and long term outcome of
diabetes patients with significant coronary artery disease.
Method: Retrospective analysis of national cardiovascular disease data from 2007-
2013.
Result: Total 18155 patients had undergone percutaneous coronary intervention. 44%
(7990) patients were known to have diabetes with mean age of 58 years. Male
patients constitute 76.6% (6121). Hypertension was more commonly seen in diabetic
patients (6825 - 85.9%) compared to non-diabetic patients (6281- 62%). Even though
heart failure were more commonly associated in diabetic patients ( 5.1% vs 2.8%),
lesser percentage of diabetic patients were on optimal heart failure medications.
40.1% (3204) of diabetic patients were presented with acute coronary syndrome out
of which 53.5% (1714) were ST elevation myocardial infraction. Ostial lesions were
more commonly identified in diabetes patients (7.3% vs 6.6%). Immediate hospital
outcome such as death and also cardiac deaths were more common in diabetes (0.7%
and 0.4% respectively) compare to non-diabetes ones (0.4% and 0.2% respectively).
In survival analysis for long term clinical outcome, hazard ratio is found out to be 1.7
( 95% CI 1.1-2.6; p value < 0.05), indicating significant higher hazard of death in
established coronary artery disease who are having diabetes compare to non-diabe-
tes patients.
Conclusion: In conclusion, in coronary artery disease patients who are having diabe-
tes as preexisting co morbid carries more complex coronary angiogram findings as
well as poor immediate in hospital outcome compare to non-diabetic patients. 2
years follow up also identified lower survival rate in diabetes patients.
Keywords: Percutaneous coronary interventiondiabetes mellitus • significant coro-
nary artery disease
OR.2. Significance of QT dispersion as a valuable marker to predict the ischemic
burden on SPECT Myocardial Perfusion Imaging
Andrico Tobing1, Edison Bun2, Nizam Akbar1, Anggia Lubis1, Zulfikri Mukhtar1,
Harris Hasan1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Sumatera Utara, Haji Adam Malik General Hospital Medan, Indonesia, 2Department of
Nuclear Medicine, Haji Adam Malik General Hospital Medan, Indonesia
Background: Increased QT dispersion on the 12-lead electrocardiogram (ECG) has
been suggested to be a non-invasive marker of increased ventricular repolarization
heterogeneity and linked to increased of mortality of coronary artery disease
patients. Ischemic burden is a measurement of ischemic myocardium percentage and
can be used to determine the management strategy of Multivessel Coronary Artery
Disease (MvCAD). The superiority of revascularization compared with conservative
strategy was demonstrated in patients with moderate-large ischemic burden.
Objective: We aimed to investigate the value of QT dispersion to predict the ische-
mic burden as detected by SPECT Myocardial Perfusion Imaging (MPI).
Method: A cross-sectional study of patients with MvCAD who underwent SPECT MPI
were included. The QT dispersion, defined as the difference between the maximal
and minimal QT interval duration. QT interval was measured as corrected QT interval
(QTc) using Bazett Formula. Ischemic burden was measured by SPECT MPI using semi-
quantitative scores on 17-segment assessment according to standard nomenclature
and interpreted as small and moderate-large ischemic burden.
Result: Total of 62 patients (49 males, mean age 55.5 6 8.9 years). There was nega-
tive correlation with good strength between QT dispersion and ischemic burden (r ¼
-0.658, P < 0.001). Using ROC analysis, the optimal cut off value of QT dispersion was
80 ms that yielded the highest sensitivity and specificity to discriminate between two
Published on behalf of the European Society of Cardiology. All rights reserved. V
C The Author 2019. For permissions please email: journals.permissions@oup.com
groups. Sensitivity, specificity, positive and negative predictive value of QT disper-
sion  80 ms to predict moderate-large ischemic burden were 89%, 87%, 86%, and
90%, respectively.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
parameter could also be applied to determine the management strategy of
Multivessel Coronary Artery Disease (MvCAD) patients in daily practice.
Keywords: QT dispersion • SPECT
OR.3. Association Between miRNA-26a Platelets, Platelet Reactivity, and TIMI-
flow in Patients With Acute ST-segment Elevation Myocardial Infarction
Undergoing Primary Percutaneous Coronary Intervention
Geis Alazthta, Renan Sukmawan, Adelin Dhivi Kemalasari, Surya Dharma,
Erlin Listyaningsih, Nunung Nusyarofah, Soma Wijaya, Elok Ekawati, Anwar Santoso
Department of Cardiology and Vacular Medicine, and Harapan Kita National
Cardiovascular Center, Jakarta, Indonesia
Background: Micro-RNA has been known to play a role in the pathophysiology of vari-
ous diseases including cardiovascular disease. Clopidogrel resistance has been known
prevalent in Asian population, that may affect mortality and major cardiovascular
events. The relationship between the expression of platelet miR-26a and clopidogrel
resitance as well as TIMI flow post primary PCI in STEMI among Asian populations, has
never been reported.
Objective: The aim of this study is to define whether miR-26a platelet expression
has a relation with platelet reactivity and myocardial perfusion post Primary PCI.
Methods: STEMI patients who underwent primary PCI and has received 600 mg load-
ing dose of clopidogrel were recruited for the study. We measured platelet reactivity
by VerifyNow P2Y12, high platelet reactivity was defined as > 208 PRU. Realtime PCR
by taqman method were performed to asses the expression of miR-26a platelet.
Micro-RNA expression and platelet reactivity were correlated with TIMI flow post pri-
mary PCI in STEMI
Result: There were 100 patients recruited for this study. Among them, 59% of with
high expression of miR-26a platelet. Platelet reactivity showed 27% of the patients
clopidogrel non-responders. There was a relationship between high miR-26a expres-
sion and decreased function of platelet inhibition (OR 4.2, p ¼ 0.006). Platelet reac-
tivity index > 208 was associated with TIMI flow < 3 after primary PCI in STEMI (OR
3.3, p ¼ 0.015). There was no direct correlation between miR-26a expression and
TIMI flow < 3.
Conclusion: Patients with high miR-26a platelet expression had increased risk of
being clopidogrel non responders. There is no direct relationship between miR-26a
platelet expression and TIMI flow after priary PCI
Keywords: miR-26a platelet • VerifyNow • TIMI-flow • myocardial infarction
OR.4. A Nationwide Cohort Study of Long-term Outcomes of Valve Repair Versus
Replacement in Isolated and Concomitant Tricuspid Surgery
Wang-Kin Wong1, Shao-Wei Chen2
1
Department of Medicine, Chang Gung University, Taoyuan City, Taiwan, 2Division of
Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial
Hospital, Linkou Medical Center, Taoyuan City, Taiwan
Background: Surgery for tricuspid valve (TV) diseases is associated with poor progno-
sis, but there are few studies describing long-term outcomes by comparing TV repair
and replacement in either isolated or concomitant TV surgery.
Objectives: The aim of this study is to evaluate the trend of utilization of TV surgery
and compare early and late outcomes between TV repair and TV replacement.
Methods: Between 2000 and 2013, adult patients who underwent TV repair or
replacement were identified from Taiwan National Health Insurance Research
Database. Outcomes of interest were all-cause mortality, composite outcome (re-do
surgery, heart failure, pacemaker and major bleeding) and readmission due to any
cause. Concomitant and isolated TV surgeries were analyzed separately. Inverse
probability of treatment weight with stabilized weight was used to reduce
confounding.
F34
Results: Over a 14-year period, a total of 2644 patients underwent TV surgery with a
mean follow up of 4.9 years. Of them, 12.6% and 87.4% underwent isolated and con-
comitant TV surgeries respectively. In-hospital mortality of isolated and concomitant
TV surgery was 8.7% and 8.6% respectively. In-hospital mortality rate of TV repair in
isolated TV surgery was significantly lower than replacement (5.8% vs. 13.8%; odds
ratio 0.39; 95% confidence interval [CI] 0.18-0.85). Proportions of all-cause mortality
were 41.7% and 36.8% in the isolated and concomitant groups respectively. The TV
repair demonstrated lower risks of all-cause mortality, composite outcome and read-
mission in either isolated or concomitant TV surgeries compared to TV replacement.
However, a trend was observed that TV repair in isolated TV surgery was associated
with a lower risk of all-cause mortality, though not significant (hazard ratio 0.66; 95%
CI 0.42-1.04; P ¼ 0.072).
Conclusions: Compared with TV replacement, TV repair is associated with superior
short-term and long-term outcomes in either isolated or concomitant TV surgeries.
Keywords: Tricuspid valve disease • Tricuspid valve surgery • Tricuspid valve
repair • Tricuspid valve replacement
OR.5. Malang ACS score as Self Assessment Checklist For Detecting Myocardial
Infarction In General Population
Monika Sitio1,2, Muhamad Rizki Fadlan1,2, Diah Ivanasari1,2, Astrid Pramudya1,2,
Ardani Galih Prakosa1,2, M.Saifur Rohman1,2
1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya
University-dr.Saiful Anwar General Hospital, Malang East Java, Indonesia, 2Brawijaya
Cardiovascular Research Center, Brawijaya University
Background: Some studies show that about 25% of patients with ACS wait more than
6 h before seeking medical care.This is while treatment of ACS should begin within
1 h of symptom onset and every 30 min of delay in seeking medical care can increase
the relative risk of 1-year mortality as 7.5% in patients with acute myocardial
infarction.
Objective: The aims of this study to examined accuracy of Malang ACS score For
Detecting Myocardial Infarction In General Population
Methods: Consecutive patients (n ¼ 228 subject’s (20 Yo) with the symptoms con-
cerning for ACS admitted in our institution were included in this study. We randomly
divided these eligible patients into derivation (n ¼ 160) and validation (n ¼ 68), after
brief information by Resident of cardiology and vascular medicine, All participants
were individually interviewed with a structured questionnaire for collecting baseline
characteristic, clinical sign. Logistic regression identified statistical predictors for
myocardial infarction in a derivation cohort. Statistical coefficients were converted
to whole numbers to create a score. Each participant underwent 2 methods of
screening: Malang ACS score and 12-lead electrocardiogram with troponin level.
Result: In the derivation group, mean age of this subjects were 57,668,35 Yo. We
found 63,2% patient’s with myocardial infarciton and 68,3% subject’s were male. A
multivariate logistic regression analysis test showed that Known coronary artery dis-
ease or  3 risk factors, Pain radiates to arm and shoulder, Radiating Chest Pain to
the Back, Pain can be associated with pressure, fullness, or tightness in the chest,
Duration > 20 minutes, Pain occurred or worsened with inspiration, Epigastric chest
pain or reproduced by palpation were predictors for myorcardial infarction (OR 2,21,
p ¼ 0,016, OR :4,05, p ¼ 0,004, OR :2,5, p ¼ 0,043, OR :2,58, p ¼ 0,037, OR :7,49,
p ¼ 0,000, OR : 0,27 p ¼ 0.05, OR :0,78 p ¼ 0.015,respectively). MALANG ACS score
had an area under the receiver operating curve (AUC) of 0.881 (95% CI 0.84 to 0.92)
with a sensitivity of 0.85,4 (95% CI 0.82 to 0.92) and a specificity of 0.82 (95% CI 0.79
to 0.84) at a cut-off score of 10 on the scale. The predictive performance of the
score was maintained in the validation (AUC 0.84 [95% CI 0.80 to 0.95]).
Conclusion: In this study, we suggest that MALANG ACS score has a high sensitivity
but relatively low specificity for detecting myocardial infarction. It is therefore use-
ful for ruling out myocardial infarction. It may also be a useful for screening myocar-
dial infarction in general population.
Keywords: ACS score • Self Checklist • Myocardial infarction
OR.6. Predictors of Good Functional Capacity in Patients with Valvular Heart
Disease After Heart Valve Surgery who had Undergone Cardiac Rehabilitation
Rissa Ummy Setiani1,2, Ervan Zuhri1,2, Agil T Agassi1,2, Ade Median Ambari1,2,
Bambang Dwiputra1,2, Basuni Radi1,2, Dede Kusmana1,2, Budhi Setianto1,2,
Anwar Santoso1,2, Renan Sukmawan1,2
1
National Cardiovascular Center of Harapan Kita, Jakarta, Indonesia, 2Department of
Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia
Introduction: Patients with valvular heart disease, in contrast to coronary artery
bypass graft (CABG) patients, often experience cardiac abnormalities and decreased
functional capacity for years before surgery. Functional capacity after surgery is very
important because good functional capacity is strongly associated with good quality
of life, morbidity, and mortality in the years to come. Therefore, predicting
Abstracts
functional capacity after valve surgery is essential in determining the prognosis.
Currently, there is still few data about functional capacity on valvular heart disease
after heart valve surgery.
Objective: To determine the predictors of good functional capacity after heart valve
surgery based on pre-operative characteristics.
Methods: A retrospective study was performed with multivariate regression analysis
of medical record data of patients with heart valve disease undergoing heart valve
surgery and cardiac rehabilitation from September 2009 until June 2018 in Harapan
Kita National Cardiovascular Center. Factors that predict good functional capacity
(METs  6.00) were assessed based on patient’s pre-operative characteristics, such
as gender, age, body mass index (BMI), left ventricular ejection fraction (LVEF), dia-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
betes mellitus, hypertension, concomitant coronary artery disease, and electrocar-
diogram (ECG) result.
Result: The developmental dataset had 418 patients. From 418 patients, 78 (18.7%)
patients had aortic valve disease, 269 (64.4%) patients had mitral valve disease, and
71 (16.9%) patients had mitral and aortic valve diseases. The type of valve involved
did not significantly affect the functional capacity (p ¼ 0.073). The multivariate
regression analysis showed five variables that can significantly predict functional
capacity. Four variables, that were male (OR 0.15, 95%CI 0.08 to 0.27, p < 0.001),
hypertension (OR 0.47, 95%CI 0.23 to 0.96, p ¼ 0.038), BMI  25 kg/m2 (OR 0.40,
95%CI 0.20 to 0.78, p ¼ 0.007), and atrial fibrillation (OR 0.22, 95%CI 0.13 to 0.37,
p < 0.001), predicted poor outcome in functional capacity (METs < 6.00). One varia-
ble, preserved LVEF (OR 2.08, 95%CI 1.08 to 3.99, p ¼ 0.028), predicted good out-
come in functional capacity (METs  6.00).
Conclusion: Female gender, no hypertension, no obesity, preserved LVEF (50%), and
sinus rhythm predicted good functional capacity (METs  6.00) after heart valve
surgery.
Keywords: functional capacity • METs • heart valve surgery • cardiac rehabilitation
OR.7. Incremental benefit of bi-directional block as an end point of Pulmonary
Vein Isolation : One-year outcome of AF recurrence
Dian A. Munawar, Rajiv Mahajan, Thomas A. Agbaedeng, Kashif Khokar,
Mehrdad Emami, Anand Thiyagarajah, Kadhim Kadhim, Ricardo Mishima, Dominik Linz,
Dennis Lau, Kurt Roberts-Thompson, Prashanthan Sanders, Glenn Young
Center of Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital
Background: Complete electrical isolation of pulmonary veins (PV) remains the cor-
nerstone of ablation therapy for atrial fibrillation (AF). However, various approaches
to PV isolation have shown variable efficacy in the outcome of AF recurrence.
Objectives: This study sought to compare the efficacy of bi-directional block as com-
pared to entrance block only as an end point of PV isolation.
Methods: We performed a retrospective analysis of patients undergoing de novo PV
isolation between 2009 and 2014 for symptomatic paroxysmal and persistent AF with
at least one-year follow-up. Bi-directional block was confirmed by demonstration of:
(a) loss of all PV potentials (entrance block), and (b) failure to capture the left
atrium by pacing 10 bipolar pairs of the circumferential catheter placed at PV ostium
(exit block). Recurrence of AF was evaluated on clinical visit at 3,6, and 12 months
after procedure. AF recurrence within blanking period (3 months) was excluded from
the analysis.
OR.7. Figure 1 Kaplan Meier estimates of AF recurrence-free survival after PV
isolation
Abstracts
Results: There were 137 consecutive patients undergoing PVI included in this study
(mean age 58.2þ9.6 years, female 37.5%). At 12 month of follow-up, recurrence of
AF was present in 14 out of 77 patients (18.2%) in bi-directional block group as com-
pared to 23 out of 60 patients (38.3%) in entrance only group, respectively. The
Kaplan Meier survival analysis demonstrated a significant reduction in AF recurrence
in the bi-directional block group (p value 0.005, log rank test) (see figure). The cox
proportional hazards model also demonstrated significant reduction in AF recurrence
in the group of patients with bi-directional block after adjusting for age, gender, and
type of AF (HR 0.45; CI 0.22-0.91; p value 0.03).
Conclusion: The results of this study suggest that bi-directional block confirmation
after PVI procedure has a significant incremental benefit for prevention of 1-year AF
recurrence.
OR.8. Differences Between Treadmill Diastolic Stress Echocardiography and
Isometric Handgrip Diastolic Stress Echocardiography in Left Ventricular
Diastolic Function in Hypertensive Patients
Nani, Mefri Yanni, Yerizal Karani, Masrul Syafri
Department of Cardiology and Vascular Medicine, School of Medicine, Andalas
University, Padang, West Sumatera
Background: Hypertension is a major risk factor of heart failure with a normal left
ventricular ejection fraction (HFpEF). In everyday practice, it is often found com-
plaints of tightness during activity but the results of echocardiography show normal
diastolic function or diastolic dysfunction grade I without increasing of left ventricu-
lar filling. ASE and EACVI issued guideline for diastolic stress testing. So far the pro-
tocol used is supine cycle or treadmill. But there are several limitations of respira-
tory and movements artifacts. The isometric handgrip is expected to be a simple
protocol and reduce all of these limitations.
Objective: This research sought to determine the differences between treadmill dia-
stolic stress test and isometric handgrip on left ventricular diastolic function in
hypertensive patients.
Method: This research is an experimental study with a research design pre and post
test only group design. The subjects of the study were outpatient hypertension
patients at the cardiology department M. Djamil Padang in October-November 2018
with exertional dyspnea but normal ejection fraction. Bivariate analysis was per-
formed by the independent sample T test.
Result: Sixty patients underwent isometric handgrip diastolic stress echocardiogra-
phy and treadmill diastolic stress echocardiography. Thirty seven patients (61.7%)
were female with average age 58,3368,09 years. Resting diastolic function was at
most normal limits 46 patients (76.7%) and 14 patients (23.3%) were diastolic dys-
function grade I. After the isometric handgrip and treadmill diastolic stress echocar-
diography performed, the independent sample T test found significant differences in
heart rate (HR), but there were no significant differences for other hemodynamic
parameters or diastolic functions (DHR: p < 0,001; DSBP:p¼0,31; DDBP:p¼0,55;
DMAP: p ¼ 0,33; D lateral E/e’: p ¼ 0,81; D septal E/e’: p ¼ 0,30; average E/e’:
p ¼ 0,44; TR velocity: p ¼ 0,72).
Conclusion: There were no significant differences in the treadmill diastolic stress
echocardiography and isometric handgrip diastolic stress echocardiography on left
ventricular diastolic function in hypertensive patients.
Keywords: diastolic dysfunction • HFpEF • diastolic stress echocardiography • iso-
metric handgrip
OR.9. Daily Oral Nitroglycerin Improves Vascular Function in Peripheral Artery
Disease Patients: Pre-post Experimental Study
Arditya D. Kusuma, Hariadi Hariawan, Budi Y. Setianto, Nahar Taufiq
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Gadjah Mada, Sardjito General Hospital, Yogyakarta, Indonesia
Background: Globally, more than 200 millions people are suffering from peripheral
artery disease (PAD) in 2010 with 54.8 millions were in southeast Asia only. Nitric
oxide, a signaling molecule involved in endothelial function; is associated with symp-
tom worsening in PAD patients. However, little is known on the roles of nitrate
administration in improving the symptoms.
Objective: This study aims to observe the effect of nitrate administration on vascu-
lar functions which are determined by peak systolic velocity (PSV) ratio and pain-
free walking distance in 6-minute walk in PAD patients.
Method: Pre-post experimental analytic study was done in this study. Patients with
PAD registered in vascular registry at Dr.Sardjito general hospital were included in
the study. Oral nitroglycerin (2.5 mg daily) were given to the patients for 7-days. The
primary endpoints: PSV ratio and pain-free walking distance in 6-minute walk test,
were assessed before and 4-hours and 7-days after the treatment. Plasma nitrate
level at baseline, 4-hours and 7-days post-treatment were recorded. The effective-
ness and safety of nitroglycerin oral were assessed as secondary endpoints.
F35
Result: Thirty-three patients were enrolled in this study. The oral nitroglycerin treat-
ment increased nitrate plasma level by 11.42 lM (p:0.209) and by 2.99 lM (p:0.865)
from the baseline at 4-hours and 7-days post-treatment respectively. PSV ratios
improvement were observed after 4-hours (reduced by 0.239, p: 0.163) and 7-days of
treatment (reduced by 0.5, p: 0.002). The longer the treatment, the more PSV ratio
reduction was observed. Interestingly, free-pain walking distance was improved
by 9.96 meters (p:0.032) and 19.97 meters (p:0.001) after 4-hours and 7-days of
treatment respectively.
Conclusion: Nitroglycerin oral treatment improves vascular functions in PAD
patients. Further study with a larger sample size might be needed to validate the
potential benefits of nitrate exposures in ameliorating PAD symptoms.
Keywords: peripheral artery disease • endothelium • nitric oxide • nitro-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
glycerin • vascular function
OR.10. Reversine Increase Mesodermal Cardiac Expression In Differentiation
Process Of Cultured Adiposed-Derived Mesenchymal Stem Cells To
Cardiomyocyte
Rendra Mahardhika Putra1, Budi Susetyo Pikir1,2, Budi Baktijasa Dharmadjati1
1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga
University, Surabaya, Indonesia, 2Institute Tropical Disease (ITD), Airlangga
University, Surabaya, Indonesia
Background: The irreversible loss of functional cardiomyocytes is still a critical issue.
Successful used of Adipose-derived Mesenchymal Stem Cells (AMSCs) as tissue
renewal to healed scarring or infarct myocard depends on its ability to differentiate
to functional cardiomyocytes. Identification of small molecules which have the abil-
ity to dedifferentiate or reverse lineage-committed cells to multipotent progenitor
cells may overcome many of these obstacles.
Objective: To analyze the effect of reversine exposure to cardiomyocyte differentia-
tion mesodermal stage Flk-1 and terminal stage of cardiomyocyte cTnT of AMSCs
culture.
Method: This is an experimental post-test control group study. AMSCs isolated from
human adipose tissue, characterization using immunofluorescence cytochemistry
revealed expression of CD90þ, CD105þ, dan CD45-. Reversine were divided into
three dosages of 5nM, 10nM and 20nM for 48 hours then replace to cardiomyocyte dif-
ferentiation medium, then analyze the expression of Flk-1 and cTnT at 7th-day using
FITC labelled immunocytochemistry. The density of fluorescens than analyze using
ImageJ software and the data obtained analysed using one-way ANOVA and LSD for
significancy
Result: We found a significant increase of Flk-1 expression in early stage of differen-
tiation (7th day) at dose 10nM (p 0.005), otherwise cTnT expression have a significant
decrease in all of dosages (p 0.000)
Conclusion: Reversine has been shown to induce the process of dedifferentiation of
Adiposed Mesenchymal stem cells to become multipotent progenitors in forming car-
diomyocyte cells
Keywords: Stem cells • Adipose • Cardiomyocyte differentiation • Reversine •
Epigenetics
OR.11. Assessment of Microvascular Function of Adult Fontan Patients using
Tissue Oxygen Saturation Measurements – A Pilot Study
Raksheeth Agarwal1,2, Bill Chaudhry1, Katrijn Jansen3, John J. O’Sullivan1,3,
Mark Hudson4, John Allen5,6, Louise Coats1,3
1
Newcastle University Cardiovascular Research Centre, Institute of Genetic Medicine,
Newcastle upon Tyne, United Kingdom, 2Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia, 3Adult Congenital and Paediatric Heart Unit, Freeman Hospital,
Newcastle upon Tyne, United Kingdom, 4Liver Transplantation Unit, Freeman
Hospital, Newcastle upon Tyne, United Kingdom, 5Newcastle University
Cardiovascular Research Centre, Institute of Cellular Medicine, Newcastle upon Tyne,
United Kingdom, 6Microvascular Diagnostics, Northern Medical Physics and Clinical
Engineering, Freeman Hospital, Newcastle upon Tyne, United Kingdom
Background: The Fontan procedure greatly improves survival of univentricular con-
genital heart disease patients, but the resulting circulation causes multi-organ dys-
function in later life. Long-term outcomes of Fontan patients are variable and diffi-
cult to predict, hence non-invasive prognostic markers are needed.
Objective: The aim of this pilot study was to assess microvascular function in adult
Fontan patients by measuring tissue oxygen saturation (StO2) in superficial and deep
tissue.
Method: Four subject groups were recruited: Fontan patients (N ¼ 8), two disease
control groups consisting of repaired tetralogy of Fallot (TOF) patients (N ¼ 9) and
isolated liver disease patients (N ¼ 8), and a healthy control group (N ¼ 22).
Superficial and deep StO2 was measured on the forearm, thenar eminence, and index
and ring fingertips of both arms using the O2C device (LEA Medizintechnik GmbH).
F36
Result: An overall difference was observed in superficial StO2 across groups
(p ¼ 0.002). Fontan patients had lower superficial StO2 compared to healthy controls
(57.4% vs 67.4%, p ¼ 0.002) and TOF patients (57.4% vs 65.5%, p ¼ 0.016), but not
compared to isolated liver disease patients (57.4% vs 63.8%, p ¼ 0.313). There was no
difference in deep StO2 across groups (p ¼ 0.112). No clinically relevant differences
between right and left arms were observed. The pattern of variation of StO2 from
the forearm to the fingertips was similar across groups.
Conclusion: StO2 is a feasible and non-invasive measure of microvascular
function. This pilot study indicates the possibility of microvascular dysfunction in
the Fontan population. However, a prospective cohort study is needed to assess the
prognostic value of this measure in a larger Fontan group. We also provide important
normal range data in the healthy population which can be used to design future
studies.
Keywords: Fontan circulation • single ventricle • microvascular dysfunction • tis-
sue oxygen saturation
OR.13. Evaluating Left Ventricular Diastolic Dysfunction using the
Atrioventricular Plane Displacement
Denio A. Ridjab, Giovanni Jessica, Kevin Wibawa
Medical Education Unit School of Medicine and Health Sciences, Atma Jaya Catholic
University of Indonesia, Jakarta, Indonesia
Background: Diastolic function plays an important role in ventricular filling. Diastolic
assessment by echo needs a diastolic assessment using many 2-dimensional, conven-
tional and tissue Doppler variables. Unfortunately, in developing countries, not all
echocardiography labs are equipped with a high-end echo machine with tissue
Doppler properties. The atrioventricular (AV) valve plane displacement has shown its
simplicity and capability in assessing left ventricular function, especially systolic.
During early diastole, the AV plane ascends rapidly toward the atrium away from the
apex. Atrial systole also contributes to ventricular filling by further displacing
the AV plane in the same direction. This could be seen in the last part of the diastolic
phase of AV plane displacement and is associated with the P wave of the
electrocardiogram.
Objective: We examined diastolic function of our patients using a conventional and
tissue Doppler variables and added AV plane displacement using M-mode.
Method: In this prospective study we examined the diastolic function of 28 patients
in our outpatient clinic. Left ventricular end-diastolic (LVEDV) and end-systolic vol-
ume (LVESV), septal thickness, LV ejection fraction (LVEF), LV diastolic function were
measured. In addition, using M-mode, the AV plane displacement (AVPD), atrial dis-
placement (AVPDa) due to atrial systole and the ratio of AVPD:AVPDa were examined
and measured. Diastolic dysfunction is diagnosed according to EAE-ASE recommenda-
tions for diastolic function.
Result: 60.7% of the patients were male. Mean age 57,8610,6 years. Mean heart
rate 75,9613 bpm. Mean septal thickness of 11,161,1 mm. Mean LVEDV and LVESV
were 71,9613,6 ml and 23,965,7 ml, respectively. Mean LVEF 66,964,6%. Mean E/A-
ratio 0,8860,26. Mean E/E’-ratio 8,1561,72. Mean AVPD and AVPDa were 1,4960,19
and 0,5960,11 cm, respectively. Mean AVPD:AVPDa ratio was 0,3960,08 Of 28
patients, 14 have normal diastolic function and 14 have diastolic dysfunction. A
Spearman-Rho’s correlation was run to determine the relationship between diastolic
dysfunction and AVPD:APDa ratio. There was a strong, positive correlation between
diastolic dysfunction and AVPD:AVPDa ratio (r ¼ 0,625, N ¼ 28, p < .001).
Conclusion: There is a strong, positive correlation between diastolic dysfunction and
AVPD:AVPDa ratio, reflecting an active atrial emptying as a concomitant compensa-
tory augmentation in diastolic dysfunction. This study provides a simple echocardio-
graphic means of assessing left ventricular diastolic function, especially in condition
where tissue Doppler measurement is not available.
Keywords: diastolic function • tissue Doppler • M-mode • AV plane dis-
placement • atrial displacement.
OR.14. The Screening of Congenital Heart Disease by Cardiac Auscultation and
Electrocardiography Examination in First Grade Elementary School Children in
Province of Yogyakarta, Indonesia
Lucia K. Dinarti1, Indah K. Murni2, Dyan W. Anggrahini1, V. Dewanto1, A. Pritazahra1,
Muhammad R. Hadwiono1, Anggoro B. Hartopo1
1
Department of Cardiology and Vascular Medicine Faculty of Medicine, Public Health,
and Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Yogyakarta,
Indonesia, 2Department of Paediatrics Faculty of Medicine, Public Health, and
Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Yogyakarta,
Indonesia
Abstracts
Background: Congenital heart diseases cause declining of functional capacity, cyano-
sis, arrhythmia, stroke, and death in adulthood. The screening for congenital heart
disease (CHD) in children has not been established in Indonesia. This results in a rela-
tively high prevalence of uncorrected CHD in adulthood, who mostly have developed
pulmonary artery hypertension (PAH). The screening program by cardiac auscultation
and electrocardiography (ECG) in schoolchildren has been proven to be feasible in
developed countries, which may also be feasible in Indonesia.
Aim: This study was planned to test and assess congenital heart disease screening
method based on electrocardiography examination in school children.
Methods: We conducted a screening program in elementary school children in the
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Province of Yogyakarta, Indonesia. The schools were determined by purposive sam-
pling. The trained general practitioners in community health centers were partici-
pated in the screening. The physical examinations, which focused on cardiac auscul-
tation and ECG examination, were performed. Those who have abnormal findings
will undergo trans-thoracal echocardiography to confirm the CHD.
Results: A total of 2,788 first grade students from 45 elementary schools were
included in the study. Of 113 (4.05%) students who were suspected to have heart
abnormalities, 31 (27%) students were found to have heart murmurs without abnor-
mal ECG readings, 80 (71%) students with abnormal ECG readings only, and 2 (2%)
students with positive heart murmurs and abnormal ECG readings.
Conclusions: The heart screening program in elementary school children is feasible.
By cardiac auscultation and ECG examination, the heart abnormalities including CHD
can be detected for further follow-up examination. If this screening program is
implemented, we can prevent complications of the CHD in the adulthood.
Keywords: Congenital Heart Disease • Screening • Electrocardiography
OR.15. Correlation Of Left Atrial Volume Index With Plasma Level Soluble
Supression Of Tumorgenicity 2 For Stuctural Remodelling Prediction In Acute
Heart Failure With Reduced Ejection Fraction Patients
Irien E. Hermawati, M. Aminuddin, Budi S. Pikir
1
Department of Cardiology and Vascular Medicine, Airlangga University, Dr.Soetomo
General Hospital, Surabaya – Indonesia, 2Department of Clinical Pathology, Airlangga
University, Dr.Soetomo General Hospital, Surabaya-Indonesia
Background: Left Atrial Volume Index (LAVI) is one of the substantial echocardiogra-
phy parameters to perceive structural remodeling of the heart in acute heart failure
condition. Not all emergency departments have these facilities. Soluble Suppression
of Tumorgenicity 2 (sST2) was a plasma protein that is markedly induced in mechani-
cally overloaded cardiac myocytes due to injury that can succeed echocardiography
roles in diagnostic, prognostic and guiding appropriate management in Acute Heart
Failure with Reduced Ejection Fraction (HFrEF).
Objective: To prove the relationship between LAVI enhancement as cardiac remodel-
ing parameter and sST2 plasma levels in acute HFrEF patients.
Method: This is a correlational study. Subjects of this study were acute HFrEF
patients who admitted to the emergency room of Dr. Soetomo Hospital Surabaya.
Each study subject was acquired LAVI and plasma sST2 levels examination at the
time of admission. The correlation between LAVI and plasma sST2 levels were ana-
lyzed by Pearson Correlation Test.
Result: A total of 30 subjects were enrolled in this study. Minimum LAVI value
23.26 ml/m2, maximum LAVI value 68.57 ml/m2, LAVI means value 45.30 ml/
m2þ12.66. Mild LAVI enlargement was obtained in 4 subjects (13.3%), moderate
enlargement in 1 subject (3.3%) and severe enlargement in 21 subjects (70%).
Minimum sST2 value 16.01 pg/mL, maximum value 71.26 pg/mL and means value
51.61 pg/mLþ18.49. The increased sST2 level was found in 24 subjects (80%). There
was a significant moderate positive correlation between LAVI and plasma sST2 levels
with r ¼ 0.394 and p ¼ 0.031.
Conclusion: LAVI, the main echocardiographic parameter in acute HFrEF, prove it
functions as atrial and cardiac structural remodeling in line with sST2 release in myo-
cardial stretch conditions.
Keywords: soluble ST2 • acute heart failure with reduced ejection fraction • left
atrial volume index.
Abstracts
OR.16. The Role of a-Mangostin of Garcia Mangostana Pericarp Extract as anti
oxidant to Inhibit Atherosclerosis Process in High Risk Framingham score Patient
ZI Aris Munandar1, Djanggan Sargowo1, Mohammad Ryan Ramadhan1, Aditha
Satria Maulana1, Olivia Handayani1, Puspa Lestari1, Muhamad Rizki Fadlan1,
Dion Setiawan1, William Prayogo Susanto2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya
University/Saiful Anwar General Hospital, Malang, Indonesia, 2Master Program of
Biomedical Science, Faculty of Medicine, Brawijaya University, Malang, Indonesia
Background: Atherosclerosis is the main factor of cardiovascular disease (CVD),
which process included oxidative stress dan inflammation. Garcinia has been known
for anti-oxidant property for years.
Objective: This study was done to investigate the role of The Role of a-Mangostin of
Garcia Mangostana Pericarp Extract as anti oxidant in inhibiting atherosclerotic proc-
ess in patient with high-risk Framingham score.
Methods: A randomized, Singleblind, placebo-controlled clinical trial was conducted
in 90 adults with highrisk cardiovascular score which were determined based on
Framingham criteria, age 50–70 y. The patients were devided into two group. One
group given 2520 mg/day Garcinia mangostana Linn extracts (GMLE) in 3 divided dose
for 90 days and the other group given placebo. Parameters were Nitrit Oxide (NO),
SOD and MDA, measured at baseline and after 90 day’s of treatment. We use morisky
score to evaluate treatment’s adherence, and exclude patient with morisky < 6.
Independent T-test was performed for normally distributed data and Mann-Whitney
test was performed for abnormally distributed data with significance level of
p  0.05.
Results: A total of 77 subjects were included in the study, 70,5% of whom were
female.Mean of FRAMIGHAM score of Patients were 33.21 6 19,6. At 90 days, after
administration of GMLE,we found that there was significantly decreasing of
Framingham score in GMLE compare with placebo (-7,769,4 vs -1,269,1). We found
that there was a significance decreasing in Nitric Oxide (NO) compared with placebo
(7.91611,8 uM vs. -0,5 6 2,90 uM;respectively P ¼ 0.001,). We found that The
plasma,MDA, concentration was significantly decrease compared with placebo
(6,49612,45 vs 3.868,9 pg/ml, respectively;).Interestingly, SOD level slightly
increased in GMLE patients, but significant against placebo patients (0,1960,79 vs -
0,360,7, respectively p ¼ 0.007).
Conclusion: a-mangostin of Garcinia mangostana pericarp extract has an antioxidant
effect that significantly inhibit atherosclerosis process in high risk Framingham score
patients.
Keywords: a-mangostin • antioxidant • atherosclerosis • Framingham score •
Garcinia mangostana
OR.17. Procalcitonin as a Predictor of Major Adverse Cardiovascular Events in
Patients with Acute ST Elevation Myocardial Infarction Underwent Primary
Percutaneous Coronary Intervention
Rika Yandriani, Muhammad Syukri, Didik Hariyanto, Masrul Syafri
Department of Cardiology and Vascular Medicine Faculty of Medicine Andalas
University / General Hospital Dr. M. Djamil Padang
Background: Inflammation response plays an important role in acute myocardial
infarction, in the initiation of atherosclerotic plaque and progression plaque into vul-
nerable plaque. Inflammation process will released the cytokine and the inflamma-
tion marker which could be used as a predictor of major adverse cardiovascular
events (MACE). Procalcitonin as an inflammation marker could increase in a bacterial
and a non-bacterial condition including acute myocardial infarction.
Objective: The aim of this study was to reveal the association of procalcitonin level
with in-hospital and within 30 days MACE in patients with acute ST elevation myocar-
dial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI)
Method: This study is conducted using cohort desain (prospective) in STEMI patients
underwent primary PCI at The Heart Installation Center in RSUP Dr. M. Djamil
Padang from July to November 2018. The procalcitonin serum level on the patient
were checked, followed with in-hospital MACE and within 30 days observation.
Bivariate analysis on the procalcitonin level and MACE of STEMI patients was done
using the Independent Sample T-test, followed with diagnostic test to determined
the cut-off point on the procalcitonin level based on receiver operating curve anal-
ysis (ROC).
Result: There are 62 subjects of the study assessed for in-hospital and within
30 days MACE. The cut-off point of procalcitonin level in the patients who had in-
hospital MACE was 3,1945 ng/ml. This value had 76,9% sensitivity and 72,2% specif-
icity with Area Under Curve (AUC) 81,1%. The cut-off point of procalcitonin in
the patients who had 30 days MACE was 3,099 ng/ml with 76,4% sensitivity, 71,4%
specificity and AUC 77,2%. Level of procalcitonin  3,099 ng/ml was a predictor
for 30 days MACE with hazard ratio 1,23 (95% CI, p ¼ 0,000) and median follow up
13 days.
Conclusion: Procalcitonin can be a predictor for in-hospital and 30 days MACE in
STEMI patients underwent PPCI.
F37
Keywords: Procalcitonin • STEMI • primary percutaneous coronary intervention •
major adverse cardiovascular events
OR.18. Sternal wound infection after open heart surgery
Si Thu Thet Tun, Win Win Kyaw, Aung Thu
Department of Cardiovascular surgery, University of Medicine (2), Yangon, Myanmar
Background: Infections of the sternal wound are among the most serious complica-
tions after open heart surgery. It is associated with increased morbidity and mortality
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
and decreased long-term life expectancy. Despite the significant clinical and eco-
nomic consequences of sternal wound infections, there are currently no specific
guidelines for the prevention and treatment of sternal wound infections.
Objective: To study the occurrence of sternal wound infection after open heart sur-
gery and To find out the risk factors for sternal wound infection after open heart
surgery
Method: A total 138 patients over 18 years of age who underwent open heart surgery
were studied. Preoperative and intra operative risk factors were recorded. Numbers
of sternal wound infected patients were noted during hospital stay and follow-up
examination up to 30 days after surgery. And then, relationship between risk factors
and sternal wound infection was assessed. Sample size was calculated by using the
formula (Reference: Daniel, 2013).
Result: Among 138 patients, superficial sternal wound infection was found in 59
patients (43%), deep sternal wound infection in only 2 patients (1%) and no sternal
wound infections in 77 patients (56%). The sternal wound infection was associated
with preoperative risk factor such as hypertension (p < 0.008) and diabetes mellitus
(p < 0.02). There was a significant association between operation time and sternal
wound infection (p < 0.001). It demonstrated that there was a significant association
between type of surgical procedure and sternal wound infection (p < 0.001).
Conclusion: As preoperative risk factors such as hypertension and diabetes mellitus
are associated with occurrence of sternal wound infection, it is very important to
control blood pressure and blood glucose level for the best optimal outcome of oper-
ation. Since the operation time and type of surgical operation are significant associ-
ated factors influencing the sternal wound infection, perioperative optimization is
needed to decrease the incidence of sternal wound infection in the modern era of
cardiac surgery.
n  o
N ¼ ðZ1a=2 Þ2 p ð1  pÞ =d2
Keywords: Sternal wound infection • risk factors • guidelines • open heart surgery
OR.19. The Association between Angiotensin II type 1 Receptor A1166C Gene
Polymorphism and The Risk of Essential Hypertension: Meta-analysis
Melly Susanti1, Budi S. Pikir1, Jonny K. Fajar2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Airlangga, Surabaya, Indonesia., 2Medical Research Unit, School of Medicine,
Universitas Syiah Kuala, Banda Aceh, Indonesia.
Background: Since first reported having an association with essential hypertension,
angiotensin II type 1 receptor (AT1R) A1166C was investigated around the world.
However, controversy was found. Furthermore, previous meta-analyses were not
strong enough to clarify the correlation in this context.
Objective: To perform a meta-analysis concerning the association between AT1R
A1166C single nucleotide polymorphism (SNP) and the risk of essential hypertension.
Method: Some information related to sample size of hypertension and control
groups, and genotype frequencies of hypertension and control groups were extracted
from each study. Data were analyzed using fixed or random effect model to deter-
mine the overall correlation.
Result: A total of 41 papers consisting of 10473 cases and 9816 controls were
enrolled for the study. Our overall analysis showed that C allele of AT1R A1166C was
associated with 1.2-fold increasing the risk of essential hypertension, while the
decreasing risk of essential hypertension was observed in A allele and AA genotype.
In subgroup analysis, the association was found only in AA genotype of European
population.
Conclusion: Our meta-analysis reveals that AT1R A1166C remains a valuable SNP
associated with the risk of essential hypertension.
Keywords: angiotensin II type 1 receptor • A1166C • essential hypertension • single
nucleotide polymorphism
F38
OR.20. Associations between Carotid Plaque Score with Severity of Coronary
Atherosclerosis Lesions using Gensini score in Patients with Suspected Stable
Coronary Heart Disease
Dwi Krisnawati, Irsad A. Arso, Hariadi Hariawan
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health,
and Nursing, Universitas Gadjah Mada – Sardjito Hospital, Yogyakarta, Indonesia
Background: The prevalence of coronary heart disease (CHD) and mortality related
to it in Indonesia keeps increasing. The process of atherosclerosis is a systemic proc-
ess involving many blood vessels but with different degrees of progressiveness. The
presence of carotid plaque be related to 3 times increased risk of incident cardiovas-
cular disease. Examination of carotid plaque score (PS) by using the carotid ultraso-
nography (USG) to become a useful quantitative parameter of carotid plaque to
detect the presence of coronary artery disease.
Objective: To examine the prevalence ratio (PR) of carotid PS with severity of coro-
nary atherosclerosis lesions using Gensini score in patient with suspected stable CHD.
Method: Analytic observational study using cross sectional design was performed
between July 2017- October 2018. The subjects of this study was patient with sus-
pected stable CHD in Dr. Sardjito hospital. Examination of coronary angiography to
evaluate Gensini score and carotid USG to evaluate carotid PS performed on the
same day. Chi square test is used to analyze of PR of carotid PS and Gensini score.
Multivariate analysis with logistic regression test to find out the confounding factors
that influence the variables of this study. A p-value <0.05 was considered significant.
Result: Of the total 95 study subjects, there are 60 (63.2%) subjects with high caro-
tid PS ( 5 mm) and 35 (36.8%) subjects with low carotid PS (<5mm). Subjects who
have high Gensini score (54) in the group with high carotid PS compared to low car-
otid PS by as much as 47 (78.3 %) vs 10 (28.6%) (PR: 2.74; CI 95%: 1.59-4.7;
p ¼ 0.000). Multivariate analysis shows only the carotid PS remained independently
associated with the Gensini score (p ¼ 0.000).
Conclusion: In patients with suspected stable CHD who have high carotid PS has a PR
2.74 times for the occurrence of high Gensini score compared with low carotid PS.
Keywords: Carotid plaque score • Gensini score • stable coronary heart disease
OR.21. The Role of Echo Calcium Score Index as A Simple Parameter to Detect
Coronary Artery Disease Severity
Akhmad Hidayat1, Zainal Safri1, Andika Sitepu1, Nizam Zikri Akbar1, Harris Hasan1,
Andre P Ketaren1
1
Departement of Cardiology and Vascular Medicine, Medical Faculty of Sumatera
Utara University, Adam Malik Hospital, Medan, Indonesia
Background: Coronary angiography is considered as the gold standard to detect and
assess the severity of coronary artery disease (CAD), especially for the high risk
patients. Patients with medium risk is best assessed the coronary artery calcium
score (CACS) by CT angiography. However, both of the methods above are not widely
available and need highly skillful operator. Calcium score index (CSI) assessed by 2-
Dimensional (2D) transthorathoracic echocardiography (TTE) was a cheap and easy
method to detect CAD.
Objective: In this study, we evaluated CSI as a new simple parameter for assessment
of CAD severity (Gensini score 20 or Gensini score >20) by using 2-D TTE.
Methods: This study included 47 patients who would be chateterized from January
2018 to April 2018. Every subjects would be assessed their CSI around 24 hours before
coronary angiography. Patients with history ACS, valvular stenosis disease, previous
PCI or CABG, on routine hemodialysis treatment, and age >65 year old were
excluded. CSI consisted of four components, that were aortic valve sclerosis, mitral
annular calcification, aortic root calcification, and papillary muscle calcification. The
index then compared with the coronary angiography result determined by Gensini
score.
Results: Of the 47 study subjects, 28 patients with severe atherosclerosis (Gensini
score >20) and 19 patients with mild athersclerosis (Gensini score 20). From the
multivariate analysis, CSI was proven as a atherosclerosis severity predictor that sig-
nificant statistically (OR 12.587; CI 1.29-128.44; p ¼ 0.029). Aortic valve sclerosis (OR
9.056; CI 1.541-53.237; p ¼ 0.015) and mitral annular calcification (OR 7.219; CI
1.394-37.40; p ¼ 0.019) were the main predictor of atherosclerosis severity. There
was a strong correlation between CSI and Gensini score using Spearman correlation
(p < 0.001). Using ROC curve, CSI >2 can predict severe atherosclerosis with 89.3%
sensitivity, 94.7% specificity, 96.15% of positive predictive value (PPV), 85.71% of
negative predtive value (NPV), positive likehood ratio (LRþ) of 16.85, and negative
likehood ratio (LR-) of 0.11. Intraobserver and interobserver variabilities showed by
Kappa value had a high concordant measurement.
Conclusions: The CSI was an easy, cheap, free radiation, quick, and reliable meas-
urement to estimate the severity of atherosclerosis.
Keywords: CSI • TTE • CAD • atherosclerosis • Gensini score
Abstracts
OR.22. The Differences in Neutrophil to Lymphocyte Ratio (NLR) before and
after Administration of Simvastatin in Rheumatic Mitral Valve Disease
S. B. Utami1, J. Faustin2, S. N. Sofia1, S. A. Wicaksono2
1
Department of Cardiology and Vascular Medicine. Faculty of Medicine, Diponegoro
University, Semarang, Indonesia, 2Department of Anesthesiology and Intensive
Therapy. Faculty of Medicine, Diponegoro University, Semarang, Indonesia
Background: Rheumatic heart disease (RHD) is the impairment of the heart valves
caused by a sequelae of abnormal cellular immune response to the previous infection
of group A Streptococcus (GAS), that is commonly effecting the mitral valve.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Recognition of bacterial antigen and self antigen depends on antigen presentation by
antigen-presenting cells (APCs) that is mediating the molecular mimicry. There are
upregulation, infiltration and adhesion of CD4þ and CD8þ T lymphocyte cells in rheu-
matic mitral valve disease (RMVD). Neutrophil to lymphocyte ratio (NLR) is the ratio
between absolute neutrophils to the absolute lymphocytes count. NLR can reflect
ongoing inflammation. Due to lymphocytes count is high in RMVD, NLR may be low in
RMVD. Statins are hypothesized to have pleiotropic effects in anti-inflammatory. This
study was to investigate the differences between NLR before and after simvastatin
administration in RMVD patients.
Methods: This study was an experimental study with one group pretest and posttest
design. Subjects were selected using consecutive sampling from June to September
2018 for patients with RMVD by echocardiography. Twenty patients was given
Simvastatin 40 mg therapy for 3 months, and NLR was measured before simvastatin
administration and 3 months after simvastatin administration. Statistical analysis will
be calculated by computer program. Normality test was using the Saphiro-Wilk test.
The statistical test was using non-parametric Wilcoxon test with significance value
p < 0.05.
Results: There were no patients showing complications or adverse events due to sim-
vastatin. Male gender were 4 (20.0%) and female gender were 16 (80.0%). Patients
were in age range of 21-30 years old ¼ 4 (20%), 31-40 years old ¼ 4 (20%), 41-50
years old ¼ 4 (20%), and 51-60 years old ¼ 8 (40%). Nine (60%) patients was with
sinus rhythm and eleven (40%) was with atrial fibrillation. In baseline, leucocyte
count was 8.12061.670 /uL, hemoglobin was 13.4861.23 g/dL, thrombocyte count
was 263.860660.320 /uL, uric acid levels was 6.961.68 mg/dL, total cholesterol lev-
els was 151.93623.35 mg/dL, and triglycerides levels was 135.33640.79 mg/dL.
Patients with left atrial diameter of > 40 mm were 16 (80%) and with <40 mm were 4
(20%). There was no significant difference in NLR between before simvastatin admin-
istration and after simvastatin administration (2.3161.09 vs 2.5061.16, p¼0.379).
There was a decreased of leucocyte count after simvastatin administration, although
it was not significant (8.12061.670 vs 7.53061.570, p¼0.068). There were increased
of staff neutrophyl count (2.0660.59 vs 2.3360.61, p¼0.301) and segment neutro-
phyl count (59.0668.22 vs 61.066.62, p¼0.215) in after simvastatin administration
in comparation to before simvastatin administration, although they were not signifi-
cant. There was a decreased of lymphocyte count after simvastatin administration,
but it was not significant (27.468.70 vs 25.6768.58, p¼0.162). There was no differ-
ence in monocyte count in pre and post simvastatatin administration (7.8662.13 vs
8.062.33, p¼0.698).
Conclusion: Simvastatin slightly increased NLR after simvastatin administration in
rheumatic mitral valve disease, through increasing of neutrophyl count and decreas-
ing of lymphocyte count, although they were not significant.
Keywords: Rheumatic Mitral Valve Disease • neutrophil-to-lymphocyte ratio •
Simvastatin
OR.23. Diastolic Dysfunction in Regularly Transfused Patients with
Beta Thalassemia Major
Jefri, Philipus Andre, Aldi R. Ismail Regional Hospital Prof. Dr. H. Aloei Saboe Kota
Utara, Gorontalo, Indonesia
Background: Thalassemia is the most common genetic disease in worldwide. Patients
with thalassemia especially beta major (TM) must receive regular transfusion ther-
apy. Regular transfusion while improving patient quality of life, creates a state of
iron overload. The duration of transfusion since TM was diagnosed related to iron
deposition in heart. Iron overload leads to myocyte death and one of the complica-
tion is diastolic dysfunction.
Objective: This research want to find out the relationship between the duration of
transfusion since TM diagnosis and diastolic dysfunction in patient with TM
Method: The study was a cross sectional study done in RSCM, poli thalassemia,
Jakarta. Study participants were recruited from regular TM patient visit from March
to November 2017. Data was collected by using questionnaires. Echocardiography
was used to obtain ejection fraction and E/A ratio. Duration since TM diagnosis was
calculated by subtraction of current age and age of TM diagnosis. Diastolic dysfunc-
tion is defined by E/A ratio > 2.0.
Abstracts
Result: A total of 58 patient with TM was recruited. Majority of the study partici-
pants is female. Mean current age of study participants is 23.4 years with mean age
of TM diagnosis of 2.8 years. Mean duration since TM diagnosis is 20.64 years.
Diastolic function compared duration since TM diagnosis did not differ significantly
between duration >20 years and below or equal to  20 years (p > 0.05). While the
latter not significantly differ, study participants with normal diastolic function has
lower mean duration since TM diagnosis than participants with documented restric-
tive filling (25 years compared to 30 years).
Conclusion: Diastolic dysfunction is not statistically significant to duration of transfu-
sion since TM was diagnosed probably caused by the optimal therapy of iron chelat-
ing agent in all participants. More data is needed to assess such risk.
Keywords: Thalassemia • Iron Overload • Diastolic Dysfunction
OR.24. Early Evaluation of Left Ventricular Remodeling, Systolic Function and
Diastolic Parameters During Anthracylines-contained Chemotherapy in Breast
Cancer Patients
AstriAstuti, Aulia P. Ayu, Mohammad R. Akbar, Erwan Martanto
Departemen of Cardiology and Vascular Medicine Hasan Sadikin General Hospital,
Bandung, Indonesia
Background: Anthracyclines are the cornerstone in breast cancer chemotherapy regi-
men. Although they improve breast cancer survival, anthracyclines possess potential
cardiotoxic effect. This effect can be prevented by periodic measurement of cardiac
function.
Objective: The aim of this study was to identify the potential cardiotoxic effects in
breast cancer patients undergoing anthracycline-contained chemotherapy during
early period.
Method: This prospective cohort study was a part of Cardiotoxicity Cardiomyopathy
Registry in Hasan Sadikin General Hospital, Bandung, Indonesia, from July 2018 –
February 2019. Patients who received anthracycline-contained chemotherapy for
breast cancer were enrolled to this study. All patients underwent echocardiography
before, within 3 weeks, and 12 weeks following first cycle of chemotherapy.
Statistical analysis was performed using ANOVA repeated measure, Friedman test,
and post-hoc using Bonferroni test.
Result: A total of 68 female patients were enrolled to the study, 38 patients were
excluded due to poor echocardiography window, the remaining 30 patients were the
subject of the present analysis. The patients’ mean age was 47 years old. The left
ventricular remodeling parameters were significantly increased, as described by
LVESV and LVESd (25 6 9 and 31 6 12, p ¼ 0.005; 25.47 6 4.37 and 28.19 6 4.46,
p ¼ 0.006, respectively). There were also a trend of increasing value in LVEDV and
LVEDd (83 6 23 and 92 6 25, p ¼ 0.132 and 42.49 6 5.08 and 44.42 6 5.40,
p ¼ 0.146, respectively) although not significant. The left ventricular ejection frac-
tion (LVEF) did not reduce significantly, even though we found the LVEF was tend to
decrease at 12th week compared to baseline (66 6 7 and 69 6 5, p ¼ 0.271). There
were no significant differences in diastolic parameters. These changes were occured
in mean cumulative doxorubicin dose 240.38 mg/m2.
Conclusion: Anthracycline-contained Chemotherapy could precipitate significant LV
remodeling at 12 week after first exposure. There were no significant deterioration
on LVEF and differences in diastolic parameters in early 12th week period during
chemotherapy
Keywords: Anthracyclines • Breast Cancer • Chemotherapy • Echocardiography
OR.25. Cardiac Profile during 6 Month Follow-up of Breast Cancer Chemotherapy
in Dr. Sardjito Hospital: an Early Insight of Chemotherapy-induced Cardiotoxicity
from Cardio-Oncocare Registry
Hafizha Herman1, Anggoto B. Hartopo1, Vita Y. Anggraeni2, Dyah A. Kusumastuti1,
Hasanah Mumpuni1, Mardiah S. Hardianti2, Ibnu Purwanto3, Susanna H. Hutajulu3
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health
and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, 2Division of
Cardiology, Department of Internal Medicine, Faculty of Medicine, Public Health and
Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, 3Division of
Hematology and Medical Oncology, Department of Internal Medicine, Faculty of
Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital,
Yogyakarta
Background: Breast cancer is one of the most common diagnosed cancer with the
highest mortality rate amongst Indonesians female. Recent advances in breast cancer
treatment with adjuvant chemotherapy may improve overall and disease-free sur-
vival, leading to decrease in mortality rates. But certain chemotherapy can also lead
to adverse to cardiotoxic manifestation including heart failure, arrhythmia, and
thromboembolic disease.
F39
Objective: To elaborate on the cardiac profile of breast cancer patient during a
period of chemotherapy.
Methods: This is a cohort prospective study in patients with breast cancer received
adjuvant chemotherapy. We use a consecutive sampling from Cardio-Oncocare
Registry at Dr Sardjito Hospital from April 2018until 6 months of end chemotherapy.
Cardiac profile such as physical examination, standard 12-lead ECG, and echocardiog-
raphy were obtained before chemotherapy at baseline, continued with follow up at
the end of first chemotherapy, midterms chemotherapy, and the end of
chemotherapy.
Results: We studied 25 Indonesian women with breast cancer. The mean age was
5369.62 years old, mean body mass index was 2464.03. Five patients (20%) received
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
chemotherapy with Taxane, 18 patients (72%) with Anthracycline, and 1 patients
(4%) with Fluoropyrimidine regimen combined with and/or without Alkylating agents.
Fourteen patients have completed midterms chemotherapy, 4 patients have com-
pleted chemotherapy. Median TAPSE was 23 (min-max: 20-26) mm, there was 1
patient with decreased TAPSE, 2 patients (14.3%) showed diastolic dysfunction at
midterms of chemotherapy, and 4 patients (16%) died after first chemotherapy. Mean
left ventricle ejection fraction (LVEF) was 70.5865.4% at of baseline, there was no
changes of LVEF, wall kinetics, and ECG during follow-up to an end of chemotherapy.
Conclusion: Breast cancer population has a normal cardiac profile at the beginning
of chemotherapy. There was early decreased of TAPSE and diastolic dysfunction dur-
ing chemotherapy, but no changes of left ventricle function and ECG.
Keywords: Cardiac profile • cardiotoxicity • chemotherapy • breast cancer
OR.27. Elevated Pentraxin-3 Level is Associated With Impaired Post Procedural
Myocardial Perfusion Assessed by Quantitative Blush Evaluator in Patients With
Acute STEMI Undergoing Primary PCI
Andrew Parlautan, Renan Sukmawan, Surya Dharma
Departemen of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Long Pentraxin-3 (PTX3) has been known as an emerging cardiac bio-
marker and has potential diagnostic and prognostic value in coronary heart disease.
Whether plasma PTX3 level is associated with post procedural myocardial perfusion
assessed by quantitative blush evaluator (QuBE) in acute ST-segment elevation myo-
cardial infarction (STEMI) undergoing primary percutaneous coronary intervention
(PCI) is unknown.
Objective: This study sought to evaluate the association between plasma PTX3 level
and post procedural myocardial perfusion assessed by QuBE in patients with acute
STEMI undergoing primary PCI.
Method: We enrolled 217 patients with acute STEMI who underwent primary PCI
(men¼191, women¼26). Post procedural myocardial perfusion was evaluated using
QuBE. PTX3 level was measured at admission by an ELISA method. We used 0.33 ng/
mL for PTX3 level as a cut off point for future worse clinical outcome as shown by
previous study. Impairment of myocardial perfusion was defined as QuBE < 9 arbi-
trary unit as also shown by previous studies.
Result: Plasma PTX3 level had an inverse correlation with QuBE score (r¼ -0.64,
p < 0.001). Patients in elevated PTX3 group (0.33 ng/mL; N ¼ 80) had lower median
QuBE score compared with lower PTX3 group (<0.33ng/mL; N ¼ 137), with QuBE
score (8.6 arbitrary unit vs. 15.1 arbitrary unit, P < 0.001). Multivariate logistic anal-
ysis showed that plasma PTX3 level 0.33 ng/mL (OR ¼ 7.65, p < 0.001) along with
Diabetes Mellitus (OR ¼ 2.30, p ¼ 0.04), and Killip class II-IV (OR ¼ 2.57, p ¼ 0.04)
were independent predictors of impaired myocardial perfusion, as shown by QuBE
score < 9 arbitrary unit.
Conclusion: Patients with acute STEMI with high plasma PTX3 level were associated
with reduced myocardial perfusion after primary PCI shown by low QuBE score.
Elevated PTX3 level may be used as a marker for persistent impairment of myocar-
dial perfusion after primary PCI in STEMI
Keywords: PTX3 • QuBE • STEMI • PPCI • Myocardial Blush
OR.28. The Correlation between Shunt Fraction and Right heart Function Based
on Right Ventricular Myocardial Strain and Fractional Area Change in Atrial
Septal Defect: PPJT RSUD DR. SOETOMO Registry-based study
I Maghfirah1, A Subagjo1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga
University - Dr Soetomo Teaching Hospital, Surabaya, Indonesia
Background: Atrial septal defects (ASD) are the most common congenital heart dis-
ease encountered in adulthood. It creates volume-overload condition in right heart,
which eventually cause pulmonary hypertension and leads RV dysfunction that can be
F40
scored by Right Ventricular Myocardial Strain and Fractional Area Change (FAC). We
investigate the relationship between shunt fraction (Qp/Qs) and RV function.
Methods: This study was conducted in DR. Soetomo Hospital from January 2018.
Shunt fraction (Qp/Qs), FAC and RV strain were calculated based on ASE Guideline
using echocardiography. RV function parameters include RV strain and FAC. The rela-
tionship between RV function and Qp/Qs were analyzed using Pearson correlation
test in SPSS software.
Results: The total sample included in this study was 518 subjects with ASD (218 men
and 300 women) mean ages 36.3 6 9.62 y.o were included in this study. The subjects
were dominated by Secundum type ASD patients those were 490 people (94.70%).
The RV function value ranges from -29.06 up tp -4.40, and the mean was
-18.8567.70. Meanwhile FAC score range was 13.63%-70% (the mean was
40.19615.29). Furthermore, The Qp/Qs value range was 0.69 – 5.69, and the mean
was 2.63 61.86. The result from Pearson correlation test showed that the relation-
ship strength between RV myocardial strain has stronger correlation (p < 0.001; r:
-5.35) rather than FAC (p ¼ 0.005; r ¼ 0.324) toward fraction shunt (Qp/Qs) in ASD.
Conclusion: RV myocardial strain and FAC was correlated well with pulmonary hyper-
tension parameters in ASD.
Keywords: Atrial septal defect • Right ventricle function
OR.29. Global Longitudinal Strain Changes in Correlation to Breast Cancer
Patient Treated With Chemotherapy during Mid Term Protocol from Dr. Sardjito
Hospital Cardio-Oncocare Registry
1 1 2 1 1
A. Prawasti , A. B. Hartopo , V. Y. Anggraeni , D. A. Kusumastuti , H. Mumpuni , M.
S. Hardianti2, I. Purwanto3, S. H. Hutajulu3
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health
and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, 2Division of
Cardiology, Department of Internal Medicine, Faculty of Medicine, Public Health and
Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, 3Division of
Hematology and Medical Oncology, Department of Internal Medicine, Faculty of
Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital,
Yogyakarta
Background: The high cardiotoxicity morbidity and mortality rates associated with the
antineoplastic therapy for breast cancer could be reduced with the early use of cardio-
protective drugs. However, the low sensitivity of left ventricular ejection fraction lim-
its its use in that preventive strategy. New parameters, such as global longitudinal
strain (GLS), are being used in the early detection of contractile function changes.
Objective: To assess the incidence of cardiotoxicity in patients treated for breast
cancer.
Method: Cohort study enrolling 43 patients with breast cancer that performed chemo-
therapy. The inclusion criteria were age < 75 years old. The exclusion criteria were
chronic kidney disease, chronic heart failure, history of acute myocardial infarction,
valvular heart disease and prior CABG or PCI. Echocardiograpy and global longitudinal
strain was measured before chemotherapy and mid chemotherapy. For analytical pur-
pose, baseline GLS was compared with GLS during mid protocol chemotherapy. Wilcoxon
test was performed for analysis. A p value < 0.05 was deemed statistically significant.
Result: Using Wilcoxon test, the mean GLS pre chemotherapy was -9.1% and GLS post
Chemotherapy was -9.4%. GLS was decreased in 12 subjects, was increase in 15 sub-
jects. GLS has not changed in 16 subject p ¼ 0.962. GLS pre and mid term protocol
chemotherapy outcomes did not significantly differ.
Conclusion: Despite insignificancy changes that we see from GLS, the research still
on progress to see the GLS accuration as cardiotoxicity prediction.
Keywords: Cardiac profile • global longitudinal strain • cardiotoxicity • chemo-
therapy • breast cancer
OR.30. Outcome Comparison of Primary PCI in Sardjito General Hospital : Office
Hour Versus Out of Office Hour
NI Persada, HP Bagaswoto, N Taufiq
Department of Cardiology and Vascular Medicine, Gadjah Mada University-Sardjito
General Hospital, Yogyakarta, Indonesia
Background: Reperfusion therapy has a key role in the management of ST Elevation
Myocardial Infarction (STEMI). Primary PCI is gold standard for reperfusion in STEMI.
Generally, general hospitals in Indonesia cannot fulfill the golden period of door to
wire time due to limited facilities, the primary team has not been 24 hours for 7
days, and no agreement to prioritize the primary PCI procedure.
Objective: The purpose of this study was to evaluate the management of primary
PCI implementation in Sardjito General Hospital.
Method: We retrieved data from Sardjito’s iSTEMI registry, cross sectional registry
study of patient with STEMI admitted to our cardiology critical care unit. Patients
treated PPCI procedure were included from January 2018 until January 2019. We
Abstracts
recorded adverse event as long as patient are hospitalized. We divided adverse event
into primary outcome and secondary outcome. We defined primary outcome as a
death due any cause, and secondary outcome as heart failure, bleeding, and stroke
which diagnosed after PPCI procedure. The data were analysed using bivariate
analysis.
Result: We registered 158 patients, 74 patients treated by PPCI in office hour and 84
patients treated by PPCI in out of office hour . We found that the primary outcome in
STEMI patient group performed by PPCI in office hour and in out of office hour was
comparable (office hour 7.14%, out office hour 9.45%, p ¼ 0.597). The same result
was also obtained in secondary outcome (p ¼ 0.128). Beside it, in this study we
examined some variable affected primary outcome including Age (p ¼ 0.564),
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Diabetes Mellitus (p ¼ 0.022), KILLIP Class (p < 0.01) and ST Elevation of anterior seg-
ment (p ¼ 0.532). We also compared this variable to secondary outcome, Age
(p ¼ 0.105), Diabetes Mellitus (0.189), KILLIP Class (<0.01), ST Elevation of anterior
segment (p ¼ 0.368).
Conclusion: Our study suggests there are no significant different for primary out-
come and secondary outcome between STEMI patient group performed by PPCI in
office hour and in out of office hour.
Keywords: STEMI patient- PPCI in office hour - Clinical outcome
OR.31. Comparison of Fragmented QRS to Persistent ST Elevation in Predicting
Presence of Left Ventricular Aneurysm in Post Myocardial Infarction
Catherine Jillian Hardi1, Ingrid Maria Pardede1,2, Aurea Stella Soetjipto1,
Michael Susanto1, Dessytha Nathania Hudjaja1, Queen Sugih Ariyani3, Sunanto Ng1,2
1
Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia, 2Siloam
Hospitals, Tangerang, Indonesia, 3Faculty of Medicine, Gadjah Mada University,
Yogyakarta, Indonesia
Background: A Left Ventricular Aneurysm (LVA) occurs in 10-30% of cases after myo-
cardial infarction (MI) cases. LVA is defined as a discrete, thinned ventricular seg-
ment, with akinetic or dyskinetic wall motion of the left ventricle. LVA can be pre-
dicted by the presence of persistent ST segment elevation (STE) post MI. It is also
postulated that fragmented QRS (fQRS) complexes are a sign of myocardial scar, a
characteristic of LVA.
Objective: We hypothesized that fragmented QRS can be a useful electrocardio-
graphic sign to identify LVAs in comparison to persistent ST elevation.
Methods: We consecutively included 30 patients with history of MI (>2 weeks post
index event) and divided them to those with (n ¼ 15) and without LVAs (n ¼ 15). LVA
was identified by imaging of echocardiography or cardiac magnetic resonance.
Fragmented QRS was defined as RSR pattern or its variant RSr, rSR, or rSr, without
evidence of bundle branch block (QRS duration < 120 ms) in at least 2 contiguous
leads in a major coronary artery territory. Persistent ST elevation was defined as ST
elevation persisting more than 2 weeks post infarct and was measured at the J60
point.
Results: Presence of fQRS had a higher sensitivity (80.0%) than persistent STE (60.0%)
However, both ECG parameters had comparable specificities (60.0% for fQRS and
66.7% for persistent STE). Based on the range of prevalence of LVA in post-myocardial
infarction population (10-30%) and on observed sensitivity and specificity, both find-
ings also had a similar positive predictive value, with 18.6-46.2% for fQRS and 16.7-
43.6% for persistent STE. Fragmented QRS had a higher negative predictive value
(87.5-96.4%) than persistent STE (80.0-93.8%).
Conclusion: Persistent ST elevation and fragmented QRS are moderately useful signs
that may be used to detect the presence of LVA. Fragmented QRS has a higher sensi-
tivity and higher negative predictive value than persistent ST elevation.
Keywords: Left Ventricular Aneurysm • Persistent ST elevation • fragmented QRS
OR.32. Immediate and long term outcome of patients with cardiac
resynchronization therapy devices (pacemaker and defibrillator) from single
center experience
M. M. Oo1, K.S Ng2, C. Z. Tan3, Z.A. Imran1
1
Cardiology Unit, Department of Medicine, University Malaya Medical Center,
Malaysia., 2Department of Medicine, University Malaya Medical Center, Malaysia,
3
Queens Elizabeth hospital, Malaysia.
Background: In Asian population, prevalence of heart failure is ranging from 1.26 –
6.7% with in hospital mortality varies from 4 to 9% with 6 to 12 month mortality of
9-15%. Cardiac resynchronization therapy has been a proven treatment modality for
heart failure patients.
Objective: To identify the immediate and long term outcome of patients with CRT
device over 9 years.
Method: Retrospective data analysis of heart failure patient who received cardiac
resynchronization therapy (CRT-P or CRT-D) device at a single center from 2008 to 2017.
Abstracts F41

Result: 57 patients were treated with CRT devices out of which 20 patients with
CRT-P and 37 patients were with CRT-D over 9 years. Male patients constitute 80.7%
with mean age of (62.27þ/-12.72). Indication for CRT of almost all patients (93%)
were poor cardiac function with ejection fraction ranging from 10% to 45%. 17.5% of
patients were recorded as ischemic dilated cardiomyopathy. Only 2 (3.5%) patients expe-
rienced the cardiac arrhythmia event prior to implant. Most of the patients were NYHA
class II and III. Perioperative complication were seen in 4 patients (7%). Device related
complications up to 1 year noted in 2 patients (3.5%) including lead displacement and
infection. Median follow up period of 3 years for most of the patients. Among 44 patients
with follow up outcome data, 12 patients were re hospitalized for decompensated heart
failure. 6 months follow up with repeated echocardiogram showed improved EF ( mean
CAP and CAIx significantly decreased with increasing BMI, as well as CSP-BSP
(p < 0.005).
Conclusion: The Obesity Paradox, presently unexplained, is likely to affect arterial
stiffness and arterial-LV interaction. This possibility warrants further longitudinal
studies focussed on sex differences, hemodynamics parameters and cardiovascular
risk with obesity.
Keywords: Pulsatility • obesity • central pressure

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

reduction in LVESV >15%) seen in 9 patients with overall improvement in EF recorded in
25 patients over 1 year. On long term follow up- up to 3 years, 15 patients (26%) died
and cause of death found out to be cardiac event in 7 patients.
Conclusion: Majority of CRT patients diagnosed as non-ischemic cardiomyopathy.
Improvement in functional status are noted even though all-cause mortality was 26%
over 3 years follow up.
Keywords: Cardiac failure • cardiac resynchronization therapy • left ventricular
ejection fraction
OR.33. The Obesity Paradox: A Phenomenon of Pulse Wave Reflection and Sex
Difference?
Junli Zuo, Biwen Tang, Audrey Adji, Alberto P. Avolio, Michael F. O’Rourke
Department of Geriatrics, Ruijin Hospital North/ Jiaotong University School of
Medicine, Shanghai, China, St Vincent’s Clinic/ Faculty of Medicine University of New
South Wales/ Victor Chang Cardiac Research Institute, Sydney, Australia, Faculty of
Medicine and Health Sciences, Macquarie University, Sydney, Australia
Background: Obesity is generally considered undesirable on account of its associa-
tion with metabolic syndrome and other risk factors for cardiovascular disease.
Recent studies, however, showed that with increasing body mass index (BMI), obese
subjects with heart failure paradoxically have better outcomes than their lean coun-
terparts. Additionally, Left Ventricular (LV) contractility dysfunction was more appa-
rent in women than men.
Objective: We sought to explore the effect of obesity through measures of arterial
hemodynamics – and how it may affect the function of the large arteries.
Method: Data recorded from 414 normal adult individuals attending a health assess-
ment clinic for cardiovascular disease screening at Ruijin Hospital North, Shanghai,
China, between December 2017 and October 2018. Subjects were divided into 3
groups according to their BMI ( < ¼24 kg/m2 normal, 24-28 overweight, > ¼28 obese;
for Chinese population). Aortic pressure waves and indices of aortic wave reflection
were generated from radial tonometry and calibrated to brachial cuff pressures
(SphygmoCor, AtCor Medical, Sydney, Australia).
Result: Brachial (BSP) and central systolic pressure (CSP), central augmented pres-
sure (CAP) and carotid-femoral pulse wave velocity (CFPWV) were highest in over-
weight (p < 0.05), while brachial (BDP) and central diastolic pressure (CDP) were
highest in the obese (p < 0.001). Central augmentation index (CAIx), pressure
amplification calculated as difference between CSP and BSP and as Brachial (BPP)
 Central Pulse Pressure (CPP) were lowest in obese group (p < 0.02). When
males and females were studied separately, BSP, CSP, CAP and CFPWV remained
highest in the overweight group, but only in females (p < 0.05) (table). In males,
OR.34. Analysis Of Procedural/Angiographic Characteristics Of Indonesian Pci
Registry
A.A. Alkatiri1, D. Firman1, N. Haryono1, E. Yonas2, R. Pranata2, I. Fahri3,
I.M.J.R. Artha4, V. Pratama5, W.A. Widodo6, N. Taufiq7, A.H. Alkatiri8, S. Ng9,
H. Sulastomo10, S. Soerianata1
1
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, 2Research
Assistant, Indonesian Percutaneous Coronary Intervention Registry,Jakarta,
Indonesia, 3RSUD dr.M Yunus, Bengkulu, Indonesia, 4RSUP Sanglah, Bali, Indonesia,
5
Gatot Soebroto Central Army Hospital, Jakarta, Indonesia, 6Jakarta Heart Center,
Jakarta, Indonesia, 7RSUP dr Sardjito, Yogyakarta, Indonesia, 8RSUP dr Wahidin,
Makassar, Indonesia, 9Siloam Hospital Lippo Village, Tangerang, Indonesia, 10RSUP
Moewardi, Surakarta, Indonesia
Background: The Indonesia PCI registry is the first multicenter registry involving 9
centers across Indonesia. This study represents analysis done on procedural/angio-
graphic characteristics based on data from the Indonesian PCI registry.
Objective: Our aim is to analyze and compare procedural/angiographic characteris-
tics between patients in this registry.
Method: This is a retrospective study involving 5420 patients designed to evaluate
the procedural characteristics of patients undergoing PCI in Indonesia. Data collec-
tions were performed during cath lab visits and follow up visits. Data were pooled
from 9 centers acrossIndonesia. Statistical analysis was then performed using IBM
SPSS Software.
Result: On group assignment, 74.5% of patients received radial access while 25.4% of
patients received femoral access. Analysis of procedural/angiographic characteristics
revealed several statistically significant results. More left main stem, LCX and graft
lesion treated using femoral approach (8.5 vs 3.8% p < 0.001), (48.8 vs 44.5%
p0.006), (1.7 vs 0.4% p < 0.001) respectively. More CTO PCI was done using the radial
approach (57.1 vs 42.9% p < 0.001). More STEMI and NSTEACS patients were treated
using radial approach (26.7vs17.9% p < 0.001), (6.7vs5.9% p < 0.001) respectively,
while a larger proportion of stable angina / elective patients are treated using femo-
ral approach (76.2 vs 66.6% p < 0.001). More contrast dye was used in the femoral
patient group (142.9 þ 66.5 vs 121.1 þ 54ml p < 0.001).
Conclusion: Currently, more complex lesion PCI was done using the radial approach
in Indonesia. More STEMI patients are also treated using a radial approach. On the
basis of the lesion site, more lesion site are also treated with radial approach in
Indonesia. Femoral approach also implements more judicious use of contrast.
Keywords: PCI • Registry • Analysis • procedural • characteristics.

OR.33. Table of hemodynamic parameters according to BMI class (mean þ SD).

BMI <24 24 < ¼ BMI < ¼ 28 BMI >28 p-value (BMI)

M F M F M F M F

N 77 88 118 53 54 24
Age (years) 55 (14) 51 (13) 52 (11) 59 (13) 47 (12) 57 (13) 0.002 0.001
ED (msec) 318 (26) 324 (23) 313 (23) 319 (26) 308 (21) 317 (27) 0.044 NS
BSP (mmHg) 135 (18) 130 (22) 138 (18) 141 (21) 135 (15) 140 (21) NS 0.004
BDP (mmHg) 78 (12) 73 (12) 80 (12) 79 (13) 81 (11) 82 (11) NS 0.001
CSP (mmHg) 124 (19) 119 (21) 126 (19) 131 (20) 122 (14) 129 (22) NS 0.002
CDP (mmHg) 81 (12) 75 (12) 82 (12) 81 (13) 83 (11) 83 (11) NS 0.001
CAP (mmHg) 13 (9) 13 (8) 11 (7) 16 (8) 8 (6) 13 (8) 0.005 0.045
CAIx (%) 26 (11) 28 (10) 24 (10) 31 (11) 20 (11) 27 (10) 0.007 NS
CPP  BPP 76 (17) 77 (14) 75 (16) 79 (15) 71 (17) 78 (13) 0.004 NS
CPP - BPP 11 (5) 11 (5) 12 (5) 11 (5) 14 (6) 11 (4) 0.004 NS
CFPWV (m/s) 8.3 (2.2) 7.6 (1.9) 8.5 (2.0) 9.3 (2.3) 8.4 (1.9) 8.4 (2.0) NS 0.000

M ¼ males, F ¼ females, NS ¼ not significant

F42
OR.35. Analysis Of Periprocedural Adverse Events Between Radial And Femoral
Access Site From The Indonesian Pci Registry
A.A. Alkatiri1, D. Firman1, N. Haryono1, E. Yonas2, R. Pranata2, I. Fahri3,
I.M.J.R. Artha4, V. Pratama5, W.A. Widodo6, N. Taufiq7, A.H. Alkatiri8, S. Ng9,
H. Sulastomo10, S. Soerianata1
1
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, 2Research
Assistant, Indonesian Percutaneous Coronary Intervention Registry,Jakarta,
Indonesia, 3RSUD dr.M Yunus, Bengkulu, Indonesia, 4RSUP Sanglah, Bali, Indonesia,
5
Gatot Soebroto Central Army Hospital, Jakarta, Indonesia, 6Jakarta Heart Center,
Jakarta, Indonesia, 7RSUP dr Sardjito, Yogyakarta, Indonesia, 8RSUP dr Wahidin,
Makassar, Indonesia, 9Siloam Hospital Lippo Village, Tangerang, Indonesia, 10RSUP
Moewardi, Surakarta, Indonesia
Background: The radial approach is the current favored access site for PCI in
Indonesia, its use is a breakthrough and beneficial from the perspective patients
ambulation, bleeding, and the decreased need for hospitalization. This abstract rep-
resents analysis done based on data from the Indonesian PCI registry.
Objective: Our aim is to analyze and compare periprocedural adverse events
between patients who underwent either radial or femoral based percutaneous coro-
nary intervention.
Method: This is a retrospective study involving 5420 patients designed to evaluate
the periprocedural adverse events of patients. Data collections were performed dur-
ing cath lab visits and follow up visits. Data were pooled using forms issued by the
registry which are available online and offline. Data were pooled from 9 centers
across Indonesia. Statistical analysis was then performed using IBM SPSS Software.
Result: From the total of 5420 patients, 74.5% of patients received radial access
while 25.4% of patients received femoral access. Descriptive analysis of periproce-
dural adverse events showed several statistically significant variables. In-hospital
mortality was higher on the femoral group (3.3 vs 1.7% p0.001), Cardiogenic shock
was higher on the femoral group (1.8 vs 0.8% p0.005), major arrhythmia were higher
on the femoral group (2.8 vs 1.6% p0.001), and lastly Tamponade were higher on the
femoral group( 0.3% vs 0% p0.016)
Conclusion: Based on the results from this analysis, fewer adverse events were seen
on the radial approach. However, this result might arise from the fact that more clin-
ically worse patients were assigned to the femoral approach due to the need for
larger catheter size that rarely used on radial approach.
Keywords: PCI • Registry • Analysis • periprocedural • adverse events.
Abstracts
OR.36. Clinical Characteristics and Quality of Life of Adult Uncorrected Atrial
Septal Defect in Sanglah General Hospital Denpasar: Single Center Registry
M.S. Yudha Dewangga1, V.K. Yantie2, E. Gunawijaya2, W. Aryadana1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Udayana
University/Sanglah General Hospital Denpasar, 2Division of Pediatric Cardiology,
Department of Child Health, Faculty of Medicine Udayana University/Sanglah
General Hospital Denpasar
Background: Atrial septal defect (ASD) is the most frequent acyanotic congenital
heart disease in children and adulthood. Most problems of ASD in adulthood are late
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
presentation and development of pulmonary hypertension (PH) that increase morbid-
ity, mortality and decrease quality of life (QoL). Most symptoms of adult ASD with PH
are similar with heart failure including dyspnea on effort, fatigue and leg swelling.
Objectives: The aim of the study were to characterize the clinical characteristics
and quality of life of adult uncorrected ASD patients.
Methods: The study design was cross sectional. The subjects were enrolled consecu-
tively from outpatient clinics and wards. The demography, clinical, laboratory and
imaging data were collected and recorded in case report form. Quality of life meas-
urement were obtained with Minnesota Living with Heart Failure Questionnaire
(MLHFQ). Descriptive statistics was applied to characterize the subjects.
Results: Forty three subjects were enrolled. The majority were women (69.8%) in
the productive and child-bearing ages (48%). The most common symptoms were dyspnea
on effort and fatigue. Most subjects had WHO functional class II in 21 patients (48.8%). The
mean peripheral oxygen saturation was 94.7%. Based on the echocardiography examina-
tion, 31 (72.1%) of subjects had suffered from PH. The mean longest diameter of defects
were 26.9 mm. The direction of blood flow was mostly left to right in 30 patients (69.8%).
Left and right ventricle function were within normal limit in all patients. Only 11 patients
(25.6%) had undergone right heart catheterization and showed mean pulmonary artery
pressure of 41.45 mmHg. The pulmonary artery resistance index mostly <8 Wood Unit/m
(58%) indicating the feasibility to close the defect, whereas 25% patient has irreversible
pulmonary vascular disease (PVD), 16% has reversible PVD and 1 patient were contraindi-
cated for closure due to massive PA thrombosis. MLHFQ showed that in most patients still
have good quality of life (62%).
Conclusions: most adult ASD patients in Sanglah general hospital had developed PH,
mostly young women in productive ages, admitted due to symptoms of PH, still have
left to right shunt, mostly had reduced functional capacity and good quality of life.
Keywords: Clinical characteristics • Quality of Life • Atrial Septal Defect.
OR.37. Fibrinolytic in North Kalimantan: a Descriptive Study of STEMI Patients
from Tarakan Registry for Acute Coronary Syndrome
M.A. Muttaqin, F. Ahmad, D.S. Syamsul, M.H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan
Background: North Kalimantan is the province with the highest prevalence of heart
disease in Indonesia based on Indonesia Basic Health Research 2018 (Riskesdas 2018).
ST elevation myocardial infarction (STEMI) is one of the heart diseases that has a role
in increasing its prevalence. Fibrinolytic is one of the strategies for reperfusion ther-
apy in patients with STEMI. The Province of North Kalimantan only has fibrinolytic as
reperfusion therapy in STEMI patients. Tarakan Regional Public Hospital is the only
hospital in North Kalimantan that has this therapeutic modality.
Objective: This study was aimed to determine the success rate of fibrinolytic therapy
in STEMI patients at Tarakan Hospital from January 2017 to December 2018.
Method: This was a descriptive observational study with a retrospective approach.
Data collected from Tarakan Registry of Acute Coronary Syndrome. Samples were
STEMI patients at Tarakan Hospital treated with fibrinolytic therapy at Tarakan
Hospital by using consecutive sampling method. Successful fibrinolytic were assessed
with complete resolution from chest pain, electrocardiography changes (>50% ST
segment resolution), and appearance of reperfusion arrhythmia.
Results: There were 42 patients in this study consisted of 92.9% of males and 7.1% of
females. The average age of patients was 49.6 years (46.8-52.3). The success rate in this
study was 83.3% with failure of 16.7%. Reperfusion arrhythmia occurs in 31% of patients.
Conclusion: The success rate of STEMI patients who treated by fibrinolytic in North
Kalimantan is quite high at 83.3%. This value can be higher if reperfusion therapy
was administered with optimum recommendations and timings.
Keywords: Fibrinolytic • STEMI • success rate
OR.38. Correlation of Transmural Dispersion of Repolarization Interval (Tpeak-
Tend) with Left Ventricular End Diastolic Pressure in Patients With ST-Elevation
Myocardial Infarction That Underwent Primary Percutaneous Coronary
Intervention
A Muthmaina, IW Nugraha, F Hidayati, AB Hartopo, N Taufiq
Departement Cardiology and Vascular Medicine Gadjah Mada University/ Sardjito
General Hospital, Yogyakarta, Indonesia
Background: Transmural dispersion of repolarization, that represent in ECG as inter-
val of T-peak to T-end (Tpeak-Tend) is associated with echocardiographic markers of
Abstracts
diastolic dysfunction and elevated Left Ventricular End Diastolic Pressure (LVEDP),
that can be measured by combining mitral inflow with mitral annular velocity (E/e’)
in echocardiography. E/e’ >15 correspond for elevated LVEDP. Left Ventricular End
Diastolic Pressure can be used as a predictor of heart failure and mortality in patient
with acute myocardial infarction.
Objective: The aim of this study is to see the correlation between Tpeak-Tend and
LVEDP in patient with (STEMI) that underwent Primary Percutaneous Coronary
Intervention (PCI).
Method: A cross sectional study design in STEMI patients who underwent primary PCI
and fulfilled the inclusion and exclusion criteria. We correlate the Tpeak-Tend in the
first electrocardiogram that was taken after primary PCI with E/e’ by echocardiogra-
phy that was taken within 6 to 24 hours after intervention using Pearson analysis with
P value < 0.05 regarded as a significant result.
Result: A total of 40 patients (34 males and 6 females) were included in this study
with mean age was 58611.039. From study population 18 patients were diagnosed
with anterior STEMI and the others were inferior STEMI, 17 patient had reduced Left
ventricular ejection fraction (LVEF), 14 patients had mid-range LVEF, and 9 patient
had preserved LVEF. There is a significant positive correlation between Tpeak-Tend
and E/e’>15 (p < 0.05)
Conclusion: There is a significant positive correlation between Tpeak-Tend and E/
e’>15, that may represent diastolic dysfunction and elevated LVEDP in patients with
STEMI that underwent primary PCI
Keywords: Transmural dispersion of repolarization • Tpeak-Tend • LVEDP •
STEMI • Primary PCI
OR.39. Correlation between B2MG and FGF23 to heart chamber function in post
myocardial infarct (MI) patients with chronic kidney disease (CKD)
M Akbar1, TE Firsty1, AS Khaerani1, E Ginanjar2
1
Faculty of Medicine, Universitas Indonesia, 2Division of Cardiovascular, Department
of Internal Medicine, Dr. Cipto Mangunkusumo National Central General Hospital,
Faculty of Medicine Universitas Indonesia
Background: Beta-2 microglobulin (B2MG) is an immunoregulator molecules and
infection marker in vertebrates secreted by the kidneys. Fibroblast growth factor 23
(FGF23) is produced in the bones and increased if the kidney’s failing. These numbers
will increase as kidney function decreases, which is known to put more burden into
heart function, even more so after an ischemic event.
Objective: To find the correlation between B2MG and FGF23 on MI patients on admis-
sion with CKD comorbidity.
Method: Data was collected from ACS patient undergoing angiography in RSUPN-CM,
and patients assessed with kidney failure are included in the analysis. Bivariate anal-
ysis and logistic regression were carried out.
Result: Bivariate analysis shows that FGF23 level is not significantly related with sys-
tolic function (p ¼ 0.611), left ventricle hypertrophy/LVH (p ¼ 0.932), type of LVH
(p ¼ 0.984), left ventricle dilatation (p ¼ 0.888), diastolic function (p ¼ 0.100), left
atrial dilatation (p ¼ 0.253), and right ventricle function (p ¼ 0.559). In addition,
B2MG level is significantly related with systolic function (p ¼ 0.025) and right ven-
tricle function (p ¼ 0.006). Meanwhile, B2MG level is not related with LVH
(p ¼ 1.000), type of LVH (p ¼ 0.918), LV dilatation (p ¼ 0.331), diastolic function
(p ¼ 0.226), and LA dilatation (p ¼ 0.277). On multivariate analysis with logistic
regression, it is found that level of FGF23 was associated with right ventricle func-
tion (OR 0.248; CI 95% 0.087-0.707; p ¼ 0.042) in post-myocardial infarct patients
with chronic kidney failure.
Conclusion: b2-M is significantly associated with Ejection Fraction (EF) and Tricuspid
annular plane systolic excursion (TAPSE) in MI patients with ckd, however the stage
of CKD is found to be confounding factor for TAPSE. This strong association with EF
and TAPSE suggests decreasing systolic function and right ventricular function in this
patient group. b2-M and FGF23 are found not to be associated with Left Ventricular
Hypertrophy (LVH), Left Ventricular End-Diastolic Dimension (LVDEd), E/A ratio, nor
left atrium dimension.
Keywords: B2MG • FGF23 • heart chamber function • myocardial infarct • chronic
kidney disease
OR.40. Correlation between Tricuspid Annular Plane Systolic Excursion with
Pulmonary Velocity Acceleration Time and Pulmonary Artery Resistance Index in
Grown Up Congenital Heart Disease Patients
H. Arif Setyo, P. Yanuar Surya, Reza M. Munandar, Firman N. Habibi, M. Arif Nugroho
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University - Dr. Kariadi Central General Hospital Semarang, Indonesia
Background: Patients with Grown Up Congenital Heart Disease (GUCHD) usually
had Pulmonary Hypertension (PH) characterized by high Pulmonary Resistance index
(PARi). Gold standard to measure PARi is by Right Heart Catheterization (RHC).
Pulmonary Velocity Acceleration Time (PVAT) has become one of non-invasive param-
eters to estimate PH. Right ventricular systolic function will also be aggravated
by PH.
F43
Objective: The aim of this study is to determine if right ventricular systolic function
by Tricuspid Annular Plane Systolic Excursion (TAPSE) has correlation with PVAT and
PARi in GUCHD patient.
Method: This was a cross sectional study involving patients with GUCHD in Dr. Kariadi
Central General Hospital Semarang undergoing surgery from February 2018 to
February 2019. PVAT and TAPSE was obtained by Transthoracic Echocardiography
(TTE), PARi was obtained by RHC. Data then analyzed with Spearman correlation
study.
Result: A total of 36 patients with mean age 36612 years old, consists of 26 (72.22%)
women and 10 (27.78%) man, with diagnosis of ASD 27 patients (75%), VSD 6 patients
(16.67%), and PDA 3 patients (8.33%). Mean value of TAPSE was 25.39 6 5.9, PVAT
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
110 6 33.9 and PARi 5.7 6 6.89. Spearman correlation study showed TAPSE has cor-
relation coefficient with PVAT 0.378 and significance 0.023, while TAPSE correlation
coefficient with PARi -0.375 and significance 0.024.
Conclusion: There is a correlation between PVAT with TAPSE and PARi, even though
the correlation is weak. From the study we can concluded that the smaller PVAT
value, the smaller TAPSE and the higher PARi value. Although RHC was the gold
standard to measure PH, measurement of PVAT by non-invasive TTE examination
could represent PARi, especially in non-catheterization laboratory hospital.
Keywords: PVAT • TAPSE • PARi
OR.41. Myocardial Diastolic Dysfunction Index As A Reproducible
Echocardiographic Parameter In Prediction New Onset Atrial Fibrillation After
Coronary Bypass Graft (CABG) Patients Without Reduced Ejection Fraction
Z. Syahputra, R. Amanda , Tengku W Ardini, Andre P Ketaren, N. Akbar, H. Hassan
Department of Cardiology and Vascular Medicine, Adam Malik Hospital, Medan,
Indonesia, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia
Introduction: Post Operative Atrial Fibrillation (POAF) is the most complication after
CABG surgery and associated with diastolic dysfunction. The presence of diastolic
dysfunction showed the left atrium subtrate of atrial fibrillation and progressive
atrial mechanical remodelling due to increased LA pressure and LV filling pressure.
Some conventional diastolic dysfunction parameters with echocardiography had pre-
dictive value of new onset atrial fibrillation,but in patients without reduced ejection
fraction remained unclear.
Objective: We introduce Myocardial Diastolic Dysfunction Index(MDI) with formula
(PA-TDI x LAVI)/S’ as a novel parameter to reflect diastolic dysfunction wheter could
be a predictor of new onset atrial fibrillation after CABG patients, especially without
reduced ejection fraction.
Method: We analyzed 77 CABG patients in synus rhytm without reduced ejection frac-
tion. Patients with history of AF, inadequate echocardiografic images, paced rhytm,
congenital heart disease were excluded. The echocardiographic measurements were
performed according to the recommendations of the American Society of
Echocardiography, working together with European Association of Echocardiography.
Results: During the follow-up period ( 30 days; 10 days in hospitals, 20 days after-
wards), 19 patients (24,7%) developed AF, the most in day 2 after CABG (7,8%) and 1
patients with recurrent AF was found. On Multivariate Cox Analysis showed
Myocardial Diastolic Dysfunction Index (MDI) (HR ¼ 5,354 95%CI 1,186-24,165,p¼
0,029) and PA-TDI (HR ¼ 4,325 95%CI 1,204-15,538, p ¼ 0,025) were independent pre-
dictor of new onset AF. The optimal MDI Cutt-off to predict new onset AF was  325(
85% sensitivity, 60%specificity). New onset AF was higher in patients with MDI 325
than in patients with MDI<325 (16(40%) versus 3(8%), p < 0,001) .MDI demonstrated a
highest degree of discriminative power than others diastolic dysfunction parameters
and POAF Score with index of discrimination was 0,767 (p < 0,001).
Conclusion: Myocardial Diastolic Dysfunction Index(MDI) with formula (PA-TDI x
LAVI)/S’ seems to be good parameter in prediction of new onset atrial fibrillation
after CABG patients, especially without reduced ejection fraction.
Keywords: Myocardial Diastolic Dysfunction Index • New onset POAF.
OR.42. Association Between Pre-Operative Flow Mediated Dilatation
Abnormality Degree and Arteriovenous Fistula Maturation in End Stage Renal
Disease Patients
Putri R. Dewi1,3, J. NugrohoE. Putranto1,3, Heroe Soebroto2,3
1
Departement of Cardiology and Vascular Medicine Dr. Soetomo Hospital, Surabaya,
Indonesia, 2Departement of Cardiothoracic Vascular Surgery Dr. Soetomo Hospital,
Surabaya, Indonesia, 3School of Medicine, Airlangga University, Surabaya, Indonesia
Background: Arteriovenous fistula (AVF) is the preferred method of vascular access
for hemodialysis in End Stage Renal Disease (ESRD) patients. However, 28 – 53% of de
novo AVF failed to mature to be used because of endothelial dysfunction. Doppler
ultrasound assessment of flow-mediated dilatation (FMD) can be used for endothelial
dysfunction screening preoperatively.
Objective: To know the association between preoperative FMD abnormality degree
and AVF maturation in ESRD patients.
Method: A prospective cohort study involved 27 patients undergoing autologous AVF
surgery. Characteristic of the vessel and FMD of the brachial artery were assessed
F44
pre-operatively then categorized into mild and severe abnormal FMD group. Six
weeks after surgery, fistula maturity were evaluated using Doppler ultrasound
evaluation.
Result: Ten of 27 patients had severe abnormal FMD pre-operatively. Immature AV
fistula was found in 14 patients. There was no significant difference in AVF maturity
between mild and severe abnormal FMD (p ¼ 1.00). We found higher of systolic blood
pressure (166.92þ25.62 mmHg vs 150.00þ23.86 mmHg, p ¼ 0.025), cephalic vein flow
(150.00þ23.86 ml/min vs 11.47þ7.21 ml/min, p ¼ 0.042), and vein remodelling
(220.59þ88.32% vs 108.75þ85.96%, p ¼ 0.003) in patients with mature fistula than in
the immature group.
Conclusion: FMD abnormality degree was not associated with AVF maturation. FMD
as a single parameter to assess macrovascular endothelial function may not be suffi-
cient to be a prognostic factor of fistula maturity.
Keywords: Arteriovenous fistula • hemodialysis • endothelial dysfunction • flow
mediated dilatation • Doppler ultrasound
OR.43. Correlation of Posterior to Anterior Mitral Valve Leaflets Ratio with Mitral
Valve Area in Rheumatic Mitral Stenosis
Citra Kiki Krevani, Mefri Yanni
Department of Cardiology and Vascular Disease, DR M Djamil Hospital, Faculty of
Medicine Andalas University
Background: Mitral valve area (MVA) measurement is the gold standard for echocar-
diography to determine the severity of rheumatic mitral stenosis. Measurement of
MVA performed by using planimetric method which is an anatomic parameter.
Planimetry itself has weaknesses in measurement, especially for poor ecogenicity
and existence of valves anatomic distortions, especially mitral valves that have
severe calcification. Posterior to anterior mitral valve leaflets ratio (PMVL / AMVL
ratio) is a simpler anatomic parameter in evaluating the degree of stenosis severity.
Methods: This is a descriptive analytic study with cross-sectional design. Subjects
were all patients with rheumatic mitral stenosis who underwent echocardiographic
examination to measure PMVL / AMVL ratio while the value of mitral valve area
(MVA) was measured by the planimetric method. The analysis test was used to assess
the correlation between PMVL / AMVL ratio and value of planimetric MVA using
Pearson correlation test.
Result: A total of 71 patients with rheumatic mitral stenosis were included. Woman
became the majority patients with atrial fibrillation. The average ejection fraction
from echocardiographic examination was 6 55% with LAVI and SPAP escalation based
on the severity of SMR (LAVI; 44 6 1.3 vs 55 6 1.5 vs 74 6 1.7 ml / m2 SPAP; 29 6
1.2 vs 46 6 9.0 vs 68 6 1.4 mmHg). The mean value of PMVL / AMVL ratio was 0.65
6 0.15 cm2 while the mean value of MVA planimetry was 1.14 6 0.45 cm2. There
was a strong correlation between the value of PMVL / AMVL ratio with MVA planime-
try, because the correlation was directly proportional (p < 0,0001; r ¼ 0,84).
Conclusion: The PMVL / AMVL ratio correlates strongly with planimetric MVA value
Keywords: PMVL/AMVL ratio • MVA planimetry • Rheumatic mitral stenosis
OR.44. Effects of N-Acetylcystein on hsCRP Level in Acute Myocardial Infarction
Patients Receiving Fibrinolytic Therapy
Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia
Background: Worldwide, coronary heart disease (CHD) is a leading cause of death.
Inflammation in CHD and acute myocardial infarction (AMI) is a trigger due to the for-
mation of atheroma plaques in the coronary arteries. N-Acetylcysteine (NAC) can
prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibro-
sis, and improve survival.
Objective: To determine the effect of NAC on hsCRP levels in patients with acute
myocardial infarction who received fibrinolytic therapy.
Methods: This study was an experimental study with pre and post, single blind and
randomization methods on the effect of NAC on hsCRP levels compared to controls
carried out in July - August 2018 on the incidence of ST Elevation Myocardial
Infarction (STEMI) came to Dr Moewardi Hospital and get fibrinolytic therapy.
Results: A total of 33 patients were included in this study, there were 15 patients
(mean age 58.80 6 8.54 years) of the control group and 18 patients (mean age 55.45
6 9.92 years) the treatment group receiving additional therapy of NAC evervescent
600 mg three times a day for three days . This study showed that hsCRP levels after
intervention in the control and treatment groups were significantly different with
p ¼ 0.001. The level of hsCRP in the control group after administration of NAC had a
median of 114.50 mg / L (18.60 - 300.00) while in the treatment group had a median
of 18.75 mg / L (5.50 - 102.90).
Conclusion: The addition of NAC 600 mg of therapy three times daily for 3 days can
reduce hsCRP levels in patients with STEMI receiving fibrinolytic therapy compared
to patients with acute myocardial infarction with ST segment elevation who did not
receive additional NAC therapy.
Keywords: hsCRP • N-Acetylcysteine • acute myocardial infarction
Abstracts
OR.45. Long-Term Effect of Intravenous Vasodilator Nitroglycerin among Acute
Heart Failure Patients: Insight from RAICOM Registry
G. Lilihata, A. Rezeki, I. Firdaus, DA. Juzar, DPL Tobing, D. Zamroni, Irmalita,
S. Dharma, SS. Danny
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Regardless of the cause, hospitalization for acute heart failure (AHF)
indicates acceleration of disease course and worsening of prognosis. However, no sin-
gle treatment has been proven superior in improving outcomes among patients hospi-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
talized for AHF. Vasodilators are routine medication given to provide symptomatic
relief of congestion. However, documented benefit on mortality, especially long
term, is lacking. This study aims to evaluate the long-term efficacy of intravenous
vasodilators, principally nitroglycerin, among severe AHF patients requiring care in
intensive cardiology care unit (ICCU).
Method: We reviewed consecutive AHF patients admitted to ICCU of National
Cardiovascular Center Harapan Kita (NCCHK), Jakarta, as documented on Registry of
Acute and Intensive Cardiovascular Care on Outcome (RAICOM) from 2014-2015.
Patients were either treated with intravenous nitroglycerin or not based on the deci-
sion of attending physician on top of standard care of treatment. Bivariate analysis
was performed for the effect of nitroglycerin on in-hospital and 6-month mortality
followed by multivariate analysis adjusting for other covariates related to outcome.
Result: Nitroglycerin group (n ¼ 234) compared to control (n ¼ 430) were significantly
younger, have higher systolic blood pressure, have more AHF related to acute coro-
nary syndrome, hypertensive AHF or acute pulmonary edema. However, baseline rate
of renal dysfunction, anemia, valve disease, use of intravenous diuretic and ino-
trope/vasopressor agents were not different among the two groups. Unadjusted
analysis showed lower mortality rate in nitroglycerin group for both in-hospital and
6-months [OR 0.595 (95% CI 0.374-0.945, p ¼ 0.027 and OR 0.598 (95% CI 0.385-
0.928, p ¼ 0.021) respectively]. After adjustment for other covariates, nitroglycerin
group showed no difference for in-hospital mortality rate [OR 0.765 (95% CI 0.420-
1.393, p ¼ 0.381] but strong trend toward lower all-cause mortality after 6 months
[OR 0.586 (95% CI 0.340-1.009, p ¼ 0.054)].
Conclusion: Intravenous vasodilators nitroglycerin showed trend toward beneficial
long-term effect on mortality, irrespective of other treatments received.
Keywords: acute heart failure • vasodilator • nitroglycerin • in-hospital mortal-
ity • 6-months mortality
OR.46. The Differences in Neutrophil to Lymphocyte Ratio (NLR) before and
after Administration of Simvastatin in Rheumatic Mitral Valve Disease
S. B. Utami1, J. Faustin2, S. N. Sofia1, S. A. Wicaksono2
1
Department of Cardiology and Vascular Medicine. Faculty of Medicine, Diponegoro
University, Semarang, Indonesia, 2Department of Anesthesiology and Intensive
Therapy. Faculty of Medicine, Diponegoro University, Semarang, Indonesia
Background: Rheumatic heart disease (RHD) is the impairment of the heart valves
caused by a sequelae of abnormal cellular immune response to the previous infection
of group A Streptococcus (GAS), that is commonly effecting the mitral valve.
Recognition of bacterial antigen and self antigen depends on antigen presentation by
antigen-presenting cells (APCs) that is mediating the molecular mimicry. There are
upregulation, infiltration and adhesion of CD4þ and CD8þ T lymphocyte cells in rheu-
matic mitral valve disease (RMVD). Neutrophil to lymphocyte ratio (NLR) is the ratio
between absolute neutrophils to the absolute lymphocytes count. NLR can reflect
ongoing inflammation. Due to lymphocytes count is high in RMVD, NLR may be low in
RMVD. Statins are hypothesized to have pleiotropic effects in anti-inflammatory. This
study was to investigate the differences between NLR before and after simvastatin
administration in RMVD patients.
Methods: This study was an experimental study with one group pretest and posttest
design. Subjects were selected using consecutive sampling from June to September
2018 for patients with RMVD by echocardiography. Twenty patients was given
Simvastatin 40 mg therapy for 3 months, and NLR was measured before simvastatin
administration and 3 months after simvastatin administration. Statistical analysis will
be calculated by computer program. Normality test was using the Saphiro-Wilk test.
The statistical test was using non-parametric Wilcoxon test with significance value
p < 0.05.
Results: There were no patients showing complications or adverse events due to sim-
vastatin. Male gender were 4 (20.0%) and female gender were 16 (80.0%). Patients
were in age range of 21-30 years old ¼ 4 (20%), 31-40 years old ¼ 4 (20%), 41-50
years old ¼ 4 (20%), and 51-60 years old ¼ 8 (40%). Nine (60%) patients was with
sinus rhythm and eleven (40%) was with atrial fibrillation. In baseline, leucocyte
count was 8.12061.670 /uL, hemoglobin was 13.4861.23 g/dL, thrombocyte count
was 263.860660.320 /uL, uric acid levels was 6.961.68 mg/dL, total cholesterol lev-
els was 151.93623.35 mg/dL, and triglycerides levels was 135.33640.79 mg/
dL.Patients with left atrial diameter of > 40 mm were 16 (80%) and with <40 mm
were 4 (20%). There was no significant difference in NLR between before simvastatin
administration and after simvastatin administration (2.3161.09 vs 2.5061.16,
p ¼ 0.379). There was a decreased of leucocyte count after simvastatin
Abstracts
administration, although it was not significant (8.12061.670 vs 7.53061.570,
p ¼ 0.068). There were increased of staff neutrophyl count (2.0660.59 vs
2.3360.61, p ¼ 0.301) and segment neutrophyl count (59.0668.22 vs 61.066.62,
p ¼ 0.215) in after simvastatin administration in comparation to before simvastatin
administration, although they were not significant. There was a decreased of lym-
phocyte count after simvastatin administration, but it was not significant (27.468.70
vs 25.6768.58, p ¼ 0.162). There was no difference in monocyte count in pre and
post simvastatatin administration(7.8662.13 vs 8.062.33, p ¼ 0.698).
Conclusion: Simvastatin slightly increased NLR after simvastatin administration in
rheumatic mitral valve disease, through increasing of neutrophyl count and decreas-
ing of lymphocyte count, although they were not significant.
Keywords: Rheumatic Mitral Valve Disease • neutrophil-to-lymphocyte ratio •
Simvastatin
OR.47. Smartphone Application Self Checklist For Detecting Atrial Fibrillation In
General Population
Muhamad Rizki Fadlan1,2, Ardian Rizal1,2, Monika Sitio1,2, Diah Ivanasari1,2,
Astrid Pramudya1,2, Ardani Galih Prakosa1,2, Dea Arie Kurniawan1,2
1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya
University-dr.Saiful Anwar General Hospital, Malang East Java, Indonesia, 2Brawijaya
Cardiovascular Research Center, Brawijaya University
Background: Atrial fibrillation (AF) is associated with high morbidity and mortality.
Accordingly, occult AF may cause stroke before it is clinically diagnosed. Early diag-
nosis is likely to improve therapy and prognosis. MENARI (Self Pulses Assesment) is
national program to detect atrial fibrillation, its has low sensitivity and specificity
for detecting atrial fibrillation. We developed clinical scoring for increasing their
sensitivity and specificity.
Objective: The aims of this study to examined accuracy of smartphone application
self checklist for detecting atrial fibrillation in general population.
Methods: A total of 226 subject’s (50 Yo) were collected from high risk patient’s in
Yayasan Jantung Indonesia Malang raya. We randomly divided these 216 eligible
patients into derivation (n ¼ 160) and validation (n ¼ 66), after brief information by
Resident of cardiology and vascular medicine, All participants were individually
interviewed with a structured questionnaire for collecting baseline characteristic,
clinical sign, Mini-Mental State Examination (MMSE) score to detect cognitive func-
tion and Profile of Mood States-Fatigue (POMS-F) to detect Fatigue. Each participant
underwent 2 methods of screening: a 60-second radial pulse-check; 12-lead electro-
cardiogram (AF diagnosed by cardiologist).
Result: In the derivation group, mean age of this subjects were 60,268,9 Yo. We
found 35,2% patient’s with AF and 62,4% subject’s were female. A multivariate logis-
tic regression analysis test showed that MENARI, Hypertension,Old more than 60 yo,
Palpitation, and Excersise intolerance (fatigue) were related to atrial fibrillation
((OR : 4,40, p ¼ 0,001, OR :2,38, p ¼ 0,038, OR :2,4, p ¼ 0,049, OR :2,48, p ¼ 0,048,
OR :2,43, p ¼ 0,048, respectively).MENARI PLUS had an area under the receiver oper-
ating curve (AUC) of 0.83 (95% CI 0.84 to 0.92) with a sensitivity of 0.84 (95% CI 0.82
to 0.94) and a specificity of 0.80 (95% CI 0.79 to 0.84) at a cut-off score of 7 on the
scale. The predictive performance of the score was maintained in the validation
(AUC 0.87 [95% CI 0.80 to 0.95]).
Conclusion: In this study, we suggest that MENARI PLUS has a high sensitivity but rel-
atively low specificity for atrial fibrillation. It is therefore useful for ruling out atrial
fibrillation. It may also be a useful screen to apply opportunistically for previously
undetected atrial fibrillation.
Keywords: atrial fibrillation • MENARI • pulse palpation
OR.48. High Lipoprotein(a) Level as a Predictor In-Hospital Major Adverse
Cardiovascular Events in Acute Myocardial Infarction
I Dewa G. D. Sumajaya1, A. A. Wiradewi Lestari2, K. Badjra Nadha1
1
Department of Cardiology and Vascular Medicine, Sanglah Hospital, Bali, Indonesia,
2
Department of Clinical Pathology, Sanglah Hospital, Bali, Indonesia
Background: The similarity of lipoprotein(a)/Lp(a) structure with plasminogen
(Kringle-IV structure) makes this lipoprotein a unique protein in pathogenesis of
acute myocardial infarction (AMI). Intrinsic thrombolysis activity is disrupted, which
worsens the thrombosis process that occurs in AMI. The Lp(a) component consisting
of apoB100 and apoA causes Lp(a) to have a prothrombotic and proinflammatory
effects. Both have a strong impact on predictors of acute AMI processes.
Objective: To evaluate the role of lipoprotein(a) as predictor of major adverse cardi-
ovascular events (MACE) in patients with AMI.
Methods: During the period June 2018 to August 2018, prospective cohort observatio-
nal studies were conducted at Sanglah Hospital, Denpasar. The sample of this study
are 66 AMI patients (STEMI & NSTEMI) who were taken by consecutive sampling.
Samples that met the inclusion and exclusion criteria were examined Lp(a) levels at
the time of hospital admission and observed the occurrence of MACE during hospital-
ization. Level of Lp(a) was measured with enzyme linked immunosorbent assay
(ELISA) technique.
F45
Result: During observation time, MACE occurred in 25 (38%) patients, including: car-
diogenic shock in 7 (10.6%) patients, heart failure in 20 (30.3%) patients, cardiovas-
cular death in 5 (7.6%) patient, malignant arrhythmias in 5 (7.6%) patients and post
infarction angina in 5 (7.6%) patients. Patients are divided into 2 groups with cut-off
value high Lp(a) is > 10.25 mg/dL based on receiver operating characteristic (ROC
curve) analysis. After the log rank test, there was a significant difference in survival
(p ¼ 0.001) between groups of high Lp(a) (survival rate of 60.6 hours; 95% CI 43.3 -
77.9) and low Lp(a) (average survival of 104.3 hours, 95% CI 91.4 - 117.2). In the
bivariate analysis, it was found that the hazard ratio of Lp(a) was high against MACE
at 4.63 (p value ¼ 0.002) and become 4.69 in multivariate analysis with cox propor-
tional hazards regression test (p ¼ 0.003). It is showed that high Lp(a) levels in AMI
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
patients independently increase risk of MACE 4.69 times higher than low Lp(a)
levels.
Conclusion: Patients with high Lp(a) levels have poor survival compared to patients
with low Lp(a) levels during hospitalization. The high level of Lp(a) is a risk factor
for the occurrence of MACE during hospitalization in patients with AMI.
Keywords: acute myocardial infarction • lipoprotein(a) • major adverse cardiovas-
cular events
OR.49. Early Effects of Chemotherapy on Myocardial Function in Breast Cancer
Patients : a Speckle Tracking Echocardiography Study.
Evan Kurniawan, Astri Astuti, Aang Setiawan, Muhammad R. Akbar, Erwan Martanto
Departemen of Cardiology and Vascular Medicine School of Medicine, Padjadjaran
University, Bandung, West Java
Background: Measurement of myocardial function is crucial in screening for chemo-
therapy induced cardiotoxicity. Speckle tracking echocardiography offers more
detailed assessment of myocardial contractility than conventional method.
Objective: The aim of this study is to examine the early effects of chemotheraphy
on myocardial function in asymptomatic breast cancer patients using two-dimen-
sional speckle tracking echocardiography.
Method: This is a prospective cohort study, part of Cardiotoxicity Cardiomyopathy
Registry in Hasan Sadikin General Hospital. The inclusion criteria was all breast can-
cer patients who were indicated for fluorouracyl-anthracycline-cyclophosphamide
(FAC) regimen of chemotherapy from July 2018- February 2019. All study populations
have never had previous chemotherapy or radiotherapy before and no symptoms or
cardiovascular disease prior to chemotheraphy regimen. Left ventricular ejection
fraction (LVEF) by Simpson’s method and global longitudinal strain (GLS) were deter-
mined using standard 2D echocardiography and speckle tracking software. Statistical
analysis was performed using ANOVA repeated measure, Friedman test, and post-hoc
using Bonferroni test.
Result: A total of 68 patients were enrolled to this study. At final analysis, there
were 38 patients who were eligible. The average age was 47 6 6 years old. The LVEF
by Simpson’s method were normal and showed no significant reduction after one and
four cycles of the regimen (69 6 5 vs 67 6 6 vs 66 6 7, p ¼ 0.17). The GLS showed
no significant difference after one cycle of the regimen, but significant difference
after four cycles (-19.43 6 1.97 vs -19.37 6 2.08 vs -18.43 6 1.84, p ¼ 0.037, a
reduction of 1 6 0.96). The cumulative dose of anthracycline after four cycles was
240.37 mg/m2.
Conclusion: Myocardial function deterioration were common and began to occur as
early as after four cycles of FAC chemotherapy regimen among breast cancer
patients.
Keywords: speckle tracking • breast cancer • anthracycline • myocardial
function • cardiotoxicity.
OR.50. Relationship of Soluble Interleukin 6 Receptor with Premature Coronary
Heart Disease: A Case Control Study in Indonesia
Jajang Sinardja1, Eryati Darwin2, Eva Decroli3, Djong Hon Tjong4
1
Eka Hospital Pekanbaru, 2Department of Histology, Faculty of Medicine, Andalas
University, Padang, Indonesia, 3Department of Internal Medicine, Faculty of
Medicine, Andalas University, Padang, Indonesia, 4Department of Biology, Faculty of
Mathematics and Natural Sciences, Andalas University, Padang, Indonesia
Background: Inflammation plays an important role in CHD, and even greater role in
premature CHD. Although it has been recognized as the most important inflammatory
agent for CHD, CRP does not have a causal relationship with the pathogenesis of
CHD. This encourages studies of interleukin 6 (IL-6), which is the upstream of CRP,
and has led to the understanding that it is the trans-signal pathway of IL-6 which
plays the important role in chronic inflammation including CHD. Soluble interleukin 6
receptor (sIL-6R) and soluble glycoprotein 130 (sgp130) are two important compo-
nents of IL-6 trans-signal pathway, in which sIL-6R has pro-inflammatory effect by
binding to IL-6 and exerting the signal cascade of IL-6 activation; on the other hand
sgp130 has anti-inflammatory effect due to its ability to bind to the IL-6/sIL-6R com-
plex and inhibit further reaction of the trans-signal pathway.
F46
Objective: To assess whether there is a relationship between the level of sIL-6R and
sgp130 with premature CHD population in Indonesia, to give better understanding of
the role of IL-6 trans-signal pathway in the pathogenesis of premature CHD.
Method: This is an analytic case control study including 30 CHD subjects and 30 non-
CHD subjects as control group (male < 45 y.o, female < 55 y.o, age and sex matched
between two groups) at Eka Hospital Pekanbaru, Indonesia, from July to November
2018. CHD was confirmed by coronary angiography as stenoses of > 70% of at least
one coronary artery, while non-CHD patients were subjects with normal ECG, without
history of chest pain and family history of CHD. All participants were checked for sIL-
6R and sgp130 serum levels using ELISA assays tests. According to the median level of
sIL-6R and sgp130, participants were then grouped into 2 groups, below or beyond
the 50th percentile level. The results are statistically evaluated using Chi Square.
Result: The mean age of CHD group was 45.27 6 5.62 y.o, and 43.97 6 4.22 y.o
(p > 0.05). The characteristics of both groups were not significantly different, except
for hypertension which showed 53.3% in the CHD group vs 6.7% in the control group
(p < 0.05) and diabetes mellitus which showed 30.0% in the CHD group vs 6.7% in the
control group (p < 0.05). The incidence of CHD in sIL-6R > 50th percentile group was
70% as compared to 30% in sIL-6R < 50th percentile group ( p < 0.05). The incidence
of CHD in sgp130 < 50th percentile group was 53.3% as compared to 46.7% in sgp130
> 50th percentile group (p > 0.05).
Conclusion: This study showed that sIL-6R has relationship with CHD in which the
higher the level of sIL-6R, the higher the incidence of premature CHD. As for sgp130,
this study didn’t show relationship between sgp130 with premature CHD. The rela-
tionship between sIL-6R with premature CHD in this study might be an indication of
the role of IL-6 trans-signal pathway in the pathogenesis of CHD in young age, and
need further study.
Keywords: premature coronary heart disease • soluble interleukin 6 receptor • solu-
ble glycoprotein 130 • trans-signal interleukin 6 pathway
OR.51. Association between Salt sensitive-related Gene Polymorphism and
Hypertension in Rural Indonesian Sundanese Population
Nitia Almaida Asbarinsyah, Rony Mario Candrasatria,
Bambang Widyantoro, Suko Adiarto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Salt sensitivity is a trait in which blood pressure “changes parallel to
changes in salt intake.” It is counted as a risk factor for cardiovascular mortality and
morbidity, independent of and as powerful as blood pressure. Previous studies have
reported the involvement of G Protein-Coupled Receptor Kinase 4 (GRK4) A486V gene
polymorphism with hypertension and salt sensitivity based on ethnic and geographic
region. Risk stratification and therapeutic potential associated to salt sensitivity are
common background for studies on this gene. As our knowledge, this is the first
report of GRK4 A486V gene polymorphism on hypertension in Indonesian population.
Objective: To investigate the association of GRK4 A486V gene polymorphism and
hypertension in rural population of Indonesia.
Method: A total of 412 Sundanese adults from Gunung Sari Village in Bogor
Indonesia, consist of 211 hypertensive subjects and 201 non-hypertensive subjects as
a control group were enrolled in this population based case-control study. The geno-
types of the GRK4 A486V were determined by a TaqMan assay. Odds ratio with 95 %
confidence interval was used to assess the risk of association.
Result: Frequency of GRK4 A486V gene polymorphism were 68.2% and 59.2% in
hypertensive and non-hypertensive subjects respectively. After adjustment of age,
body mass index, waist circumference, and diabetes mellitus, we observed associa-
tion between GRK4 A486V gene polymorphism with hypertension (OR 1,7; 95% CI 1,1-
2,7)
Conclusion: There is an association between GRK4 A486V gene polymorphism and
hypertension in rural population of Indonesia.
Keywords: hypertension • polymorphism • salt sensitive • genetic study
OR.52. The Roles of Pentraxin-3 in Predicting Major Adverse Cardiac Event in
Acute Myocardial Infarction Patients
Adi Bestara, Imelda Christina, Trisulo Wasyanto
Departement of Cardiology and Vascular Medicine, Faculty of Medicine Sebelas Maret
University/Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia
Background: Pentraxin-3 (PTX3) may be a useful marker for localized vascular
inflammation and damage to the cardiovascular system. Recent studies have shown
that plasma PTX3 is elevated in patients with myocardial infarction; however, its
prognostic value still remains unclear.
Objective: The aim of this study is to investigate the relationship between PTX3 and
in-hospital major adverse cardiac event (MACE) in acute ST elevation and non-ST ele-
vation myocardial infarction (STEMI and NSTEMI) patients.
Methods: A total of 61 patients were included in the observational study between
September 1st, 2018 to February 28th, 2019 in Dr. Moewardi Hospital. In-hospital
MACE considered if there is one of acute heart failure, arrhythmia, cardiogenic
Abstracts
shock, cardiopulmonary resuscitation, or death. The admission PTX3 and other
parameter were compared between the patient with and without MACE.
Result: Among patient, 52.2% was anterior STEMI, 34.4% was inferior STEMI, and 3.1%
was NSTEMI. The MACE occurred in 60,7% patients, while acute heart failure, arrhyth-
mia, cardiogenic shock, cardiopulmonary resuscitation, and death event was 44,3%,
32,8%, 14,8%, 11,5%, 9,8% of patients. There are different of MACE between the patient
with low (<8.225 ng/mL) and high (8.225 ng/mL) PTX3 level (p ¼ 0.036). Patient with
MACE had higher TIMI and GRACE score, higher Killip status II, lower estimated glo-
merular filtration rate (eGFR), and also lower left ventricular ejection fraction (LVEF).
Bivariate analysis shown that PTX3 8.225 (OR 3.077; p ¼ 0.003) as predictor of in-hos-
pital MACE, along with TIMI score (OR 0.671; p ¼ 0.010), GRACE score (OR 0.965;
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
p ¼ 0.003), eGFR (OR 1,02; p ¼ 0.036), and LVEF (OR 1.143; p ¼ 0.001). The cut off
PTX3 level 8.225 ng/mL for predicting MACE had a sensitivity of 64.9% and a specific-
ity of 66.7% (area under the curve (AUC) 62.9%; 95% CI 0.480-0.779) and had a better
diagnostic profile with added to LVEF (AUC 84.4%; 95% CI 0.737-0.950).
Conclusion: The PTX3 can be used as a biomarker for predicting in-hospital MACE.
Keywords: myocardial infarction • pentraxin-3 • major adverse cardiac event
OR.53. High Plasma Malondialdehyde Associated with Diabetes Mellitus not
Diastolic Dysfunction in Patients with Heart Failure with Preserved Ejection
Fraction
M.A. Sobirin1,2, Y. Herry1, N. Maharani2, U. Bahrudin1, P. Ardhianto1, M.A. Nugroho1,
S. Herminingsih1, S. Rifqi1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University - Dr. Kariadi Central General Hospital Semarang, Indonesia, 2Department
of Pharmacology and Therapeutics, Faculty of Medicine Diponegoro University -
Semarang, Indonesia
Background: Heart failure with preserved ejection fraction (HFpEF) is characterized
by diastolic LV dysfunction leads to HF symptoms. Diabetes mellitus is a common
comorbid in HFpEF and plays an important role in the development of HFpEF with
worse prognosis. Oxidative stress may contribute to diastolic dysfunction by increas-
ing relaxation stiffness in cardiomyocytes.
Objective: The aim of this study is to determine the association of diabetes mellitus
and oxidative stress in patients with HFpEF
Method: This study was a prospective cohort study enrolling subjects with HFpEF in
outpatient clinic at Dr. Kariadi General Hospital, Semarang. Plasma malondialdehyde
(MDA), a marker of oxidative stress, and glycated haemoglobin (HbA1c) was measured
in fasting blood during outpatient visit. Based on MDA level, subjects were allocated
to low MDA (1.375) and high MDA (>1.375). Echocardiographic study for LV diastolic
function was evaluated by two dimensional and Doppler echocardiography as follows;
average E/e0 , septal and lateral e0 velocity, and left atrium volume index (LAVI).
Result: A total of 30 patients were available for the study. The mean patient age,
MDA level, and HbA1c level were 62.1 years, 1.44 mmol/L, and 7.8 % (61.7 mmol/
mol), respectively. A statistically significant association was observed between high
MDA level with diabetes mellitus (p < 0.05) and more severe HbA1c (p < 0.05) in
patients with HFpEF. High MDA level was not associated with age, BMI, blood pres-
sure, hypertension, coronary artery disease (CAD), creatinine level dan blood choles-
terol. There were no differences in LV diastolic dysfunction between HFpEF patients
with low and high MDA levels in all parameters.
Conclusion: High plasma malondialdehyde associated with more severe diabetes
mellitus but may not contribute to diastolic dysfunction in patients with heart failure
with preserved ejection fraction
Keywords: HFpEF • diabetes mellitus • malondialdehyde • LV diastolic dysfunction
OR.54. Potential Use of CADILLAC Score to Predict Early Discharge following ST
Elevation Myocardial Infarction in Sardjito Hospital
A. Ramadhani, H. Purnasidha, F. Saputra
Department of Cardiology and Vascular Medicine, Medical Faculty, Gadjah Mada
University, Yogyakarta
Background: Patients with STEMI are typically hospitalized to monitor for serious
complications such as arrhythmias, heart failure, and reinfarction. Optimal length of
stay is unclear. Whether low risk patients can be safely discharged before 72 hours of
hospitalization is unclear.
Objective: To identify number of patients which has low CADILLAC Score and their
feasibility for early discharge from hospitalization.
Methods: This is a cohort retrospective study with 165 subjects taken from STEMI
registry data in Cardiology and Vascular Department RSUP Sardjito, Yogyakarta.
Patients with STEMI who underwent successful PCI were retrospectively stratified
using CADILLAC risk score to low risk (n ¼ 62) and intermediate to high risk (n ¼ 107).
The primary outcome was composite of adverse clinical events during hospitaliza-
tion. Secondary outcome was death during hospitalization.
Results: Low risk patients had lower major adverse clinical events compared to
intermediate to high risk, but statistically insignificant (25 vs 32%, p ¼ 0.192).
Despite of insignificancy in major adverse clinical events rate, STEMI patient with
Abstracts
low CADILLAC risk score less likely to die during hospitalization compared to STEMI
patient with intermediate to high risk score (0 vs 11%, p ¼ 0.005).
Conclusion: Low risk patients identified using CADILLAC risk score with STEMI treated
successfully with primary PCI have a lower but statistically insignificant adverse
event rate on the hospitalization suggesting that an earlier discharge is remain
unclear. Despite of that, CADILLAC risk score is still useful to predict mortality.
Keywords: acute myocardial infarction • ST elevation myocardial infarction • eco-
nomic • cost-effectivenes • percutaneous coronary intervention
OR.55. The Correlation between Wire Crossing Time and Tpeak-Tend Interval in
ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary
Intervention
F Siddiq, IW Nugraha, F Hidayati, AB Hartopo, N Taufiq
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health
and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
Background: According to recent researches, the Tpeak-Tend (TpTe) interval in sur-
face ECG was known as an index of transmural dispersion of repolarization (TDR).
Prolongation of TpTe is associated with abnormal relaxation and diastolic dysfunc-
tion. Diastolic phase is the first function which impaired following an acute myocar-
dial infarction as a results of disturbance of active relaxation and passive filling.
Objective: This study is aimed to analyze the correlation between the wire crossing
time and TDR index in patients with ST-elevation myocardial infarction (STEMI)
treated with primary percutaneus coronary intervention (PCI).
Method: This cross sectional study was designed in STEMI patients who were per-
formed primary PCI and fulfilled the inclusion and exclusion criteria. We correlate
the wire crossing time and TpTe interval in ECG that was taken 0-3 hours after pri-
mary PCI using pearson analysis with P value < 0.05 represented significant result.
Result: A total of 40 patients (34 males and 6 females) were included in this study
with mean age was 58611.04. From study population 18 patients were diagnosed
with anterior STEMI and the others were inferior STEMI. There is a significant positive
correlation between wire crossing time and TpTe (p < 0.05; R ¼ 0.68).
Conclusion: There is a significant positive correlation between wire crossing time
and transmural dispersion of repolarization index (TpTe) that may represent abnor-
mal relaxation and diastolic dysfunction in patients with STEMI that underwent pri-
mary percutaneous coronary intervention.
Keywords: Wire crossing time – Transmural dispersion of repolarization – TpTe – STEMI
– Percutaneous coronary intervention
OR.56. Outcomes in Patients with Non ST-Elevation Acute Coronary Syndrome
(NSTE-ACS) Treated with Invasive versus Conservative Strategy in Sardjito
General Hospital Yogyakarta
GK Ahimsa1, HP Bagaswoto2, N Taufiq2, BY Setianto2
Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada - Sardjito
General Hospital, Yogyakarta, Indonesia, Department of Cardiology and Vascular
Medicine, Universitas Gadjah Mada - Sardjito General Hospital, Yogyakarta, Indonesia
Background: There is debate about routine early invasive treatment compared with
conservative treatment in patients with non-ST-segment elevation acute coronary
syndromes (NSTE-ACS). Current guidelines recommend an early invasive approach in
high-risk patients with acute coronary syndromes without ST-segment elevation. We
sought to perform a study to determine whether early invasive strategy improves
clinical outcomes in patients with NSTE-ACS in Sardjito General Hospital.
Methods: This cross sectional study included all NSTE-ACS patients who were hospi-
talized in Sardjito General Hospital from the registry of SCIENCE (Sardjito
Cardiovascular Intensive Care) and ISTEMI from January 2018 to February 2019. We
compare the effect of conservative versus invasive strategies on the clinical outcome
using chi-square analysis with P value< 0.05 represented significant result. The
major outcome was an in-hospital mortality from any cause. Additional outcomes
were the incidence of acute stroke, cardiac arrest, bleeding, and Acute heart
failure.
Result: A total of 141 patients with NSTE-ACS were included in this study, 86 patients
treated with invasive strategies, while 55 received conservative therapy. In hospital
mortality was higher in patients who treated with invasive strategy (RR 3.12; 95% CI
0.59-16.5; p ¼ 0.15). Invasive strategy can lower the risk of stroke incidence (RR
0.78; 95% CI 0.07-8.41; p ¼ 0.07), bleeding incidence (RR 0.52; 95%CI 0.05-4.88;
p ¼ 0.83), and heart failure (RR 0.78; 95% CI 0.07-8.41; p ¼ 0.54), except cardiac
arrest incidence during care was higher in invasive strategy group (RR 3.9; 95%CI
0.78-19.45; p ¼ 0.83)
Conclusion: In patients with NSTE-ACS in Sardjito General Hospital, selection of
strategies between invasive or conservative have no correlation with the clinical out-
come of death, stroke, bleeding, acute heart failure, and cardiac arrest. But,
F47
Invasive strategy can reduce the risk of stroke incidence, bleeding and acute heart
failure compare to conservative strategy, though not statistically significant.
Keywords: NSTE-ACS – invasive strategy – conservative strategy – clinical outcomes
OR.57. Relationship between Carotid Intima Media Thickness and Left
Ventricular Hypertrophy
Yusrina Saragih, Harris Hasan, Zulfikri Mukhtar
Department of Cardiology and Vascular Medicine, University of Sumatera Utara, Haji
Adam Malik Hospital, Medan, North Sumatera
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: Hypertension is a 50% cause of cardiovascular disease and stroke, 40%
of cause of death in Diabetics, and is a major risk of kidney failure, pregnancy and
dementia. Left ventricular hypertrophy (LVH) is a preclinical manifestation of cardio-
vascular disease and a strong predictor of cardiovascular morbidity and mortality.
Examination of Carotid Intima-Media Thickness (CIMT) is one method that can be
used to Evaluate the occurrence of coronary heart disease and in Several studies
reported that carotid intima-media thickness is also associated with left ventricular
function and hypertrophy
Methods: This cross-sectional study conducted on Hypertensive Patients in the outpa-
tient unit in Cardiac Center Haji Adam Malik Hospital since March 2018-August 2018.
Examination of Carotid B-Mode ultrasound was conducted to Obtain CIMT values. LVH
is assessed by LVMI as measured by M-mode method using the Cube formulas from
echocardiography. Then the analysis is done using the Spearman correlation test to
see the relationship between CIMT and LVH
Results: CIMT> 0.5 mm have a positive correlation with LVM (r ¼ 0.594, p < 0.001),
LVMI (r ¼ 0.618, p < 0.001), RWT (r ¼ 0.364, p < 0.001), and LVH (r ¼ 0484, p < 0.001).
CIMT> 0.5 mm has a sensitivity of 83.6%, specificity 90.4%, PPV NPV 76% and 93.8%.
The CIMT value of 0.55 mm is Considered to be the optimal value in diagnosing LVH in
Hypertensive Patients in the RSUP HAM based on the ROC curve with a sensitivity of
83.6% and specificity of 90.5%, AUC 0.9.
Conclusion: There is a positive correlation between Carotid Intima-Media Thickness
and Left Ventricular Hypertrophy in Hypertensive Patients
Keywords: CIMT • LVH • LVMI • Hypertension
OR.58. A Prevalence of Increased Left Ventricular Mass Index, Left Ventricular
Hypertrophy, Diastolic Dysfunction and Increased Left Atrial Volume Index in
Diabetic Individuals with no Signs and Symptoms of Heart Failure and those not
Known to have Coronary Artery Disease
M.M. Oo1, K.L. Tan1, R. Jeyakantha2, Sharmila2, A. Tan2, K.H. Chee1
1
Cardiology unit, University Malaya Medical Center, Malaysia, 2Endocrinology Unit,
University Malaya Medical Center, Malaysia
Background: Diabetes is a well-known concomitant risk factor (40%) of
cardiac failure. Echocardiography parameters such as left ventricular mass index.
left ventricular hypertrophy, left atrial volume index and diastolic function are
useful tools to identify cardiac remodeling in totally asymptomatic diabetic
patients.
Objective: To identify the prevalence of cardiac remodeling in type 2 diabetes
patients with no signs and symptoms of heart failure.
Method: Type 2 diabetes mellitus patients with no history of coronary artery disease,
valvular heart disease, congestive cardiac failure and atrial fibrillation are electively
recruited.
Result: Three hundred and thirteen patients with mean age of 62.12 (þ/- 10.15)
years were involved. Female predominance (64.9% vs 35.1%) with mean BMI of
27.84 (þ/- 4.79) are noted. Active smoker in 3.2%, hypertension in 241 patients
(77%), dyslipidemia in 281 patients (89.8%), peripheral vascular disease in 6
patients (1.9%) and cerebrovascular accident in 17 patients (5.4%). 72.6% were
known to have diabetes for more than 10 years. Mean left ventricular ejection
fraction was noted as 68.21 þ/- 4.45 percent. Diastolic dysfunction noted in 211
patients (67.4%) - Grade I (impaired relaxation) -in 191 patients ( 61%), Grade II
(pseudo normal) in 18 patients (5.8%) and Grade III (reversible restricted) in 2
patients (0.6%). Increased left ventricular mass index identified in 51.3% of
patients. Concentric hypertrophy (relative wall thickness >0.42) identified in
49.4% of all while eccentric hypertrophy (relative wall thickness 0.42) in 50.6% of
patients. Left atrial volume index was within normal range on 66.3% and the rest
being abnormal.
Conclusion: This single center study proving the significant prevalence of diastolic
dysfunction and cardiac remodeling in totally asymptomatic diabetic patients. Wide
range association with insulin resistance, variability of HBA1C, other preexisting risk
factors are identified in this study.
Keywords: Diabetes • left ventricular mass index • left ventricular hypertrophy •
diastolic dysfunction • increased left atrial volume index
F48
OR.59. Correlation between Serum Level Galectin-3 and Early Remodeling
Indicator of Left Ventricle in Patient with Acute Myocardial Infarction during Pre-
Percutaneous Coronary Intervention
I. N. I. Mataram, W. Aryadana, A.A.W. Lestari
Department of Cardiology and Vascular Medicine, Sanglah General Hospital, School of
Medicine Udayana University, Denpasar, Bali, Department of Clinical Pathology,
Sanglah General Hospital, School of Medicine, Udayana University, Denpasar, Bali
Background: Left ventricle remodeling is one of the complication in myocardial
infarction. Early remodeling process (0-72 hours) post-infarction can be assessed by
circulating biomarker (Galectin-3), echocardiography, coronary angiography, and
clinically.
Objective: Aim of study is to know the correlation between Galectin-3 and early
remodeling indicator among patients during pre-PCI. The parameters are LVEDV,
LVEF, diastolic function, TIMI flow, MBG, and acute heart failure (AHF).
Method: Cross sectional study was conducted in Sanglah General Hospital during
March-May 2018 with 62 samples were selected consecutively.
Result: Spearman correlation shows Galectin-3 correlated with LVEDV (r ¼ 0.808;
p ¼ 0.000), E/e’ average (r ¼ 0.297; p ¼ 0.019), E/A ratio (r ¼ 0.261; p ¼ 0.041), and
MBG (QuBE) (r ¼ 0.647; p ¼ 0.000). No correlation was found between Galectin-3 and
LVEF Teich (r ¼ -0.213; p ¼ 0.097), LVEF Biplane (r ¼ -0.226; p ¼ 0.077), and LAVI
(r ¼ 0.301; p ¼ 0.170). Chi square shows no association between Galectin-3 and dia-
stolic dysfunction (OR ¼ 1.032, p ¼ 0.966, 95%CI¼ 0.239-4.462), TIMI flow
(OR ¼ 1.032, p ¼ 0.966, 95%CI¼ 0.239-4.462), MBG score (OR ¼ 0.264, p ¼ 0.197,
95%CI¼ 0.031-2.259), and acute heart failure (OR ¼ 0.577, p ¼ 0.476, 95%CI¼ 0.127-
2.617). Multiple linear regression shows an increase in Galectin-3 has been proven
associated independently with LVEDV, LAVI, E/e’ average, and E/A ratio. Multiple
logistic regression shows Galectin-3 has not been proven independently with diastolic
dysfunction, TIMI flow, MBG score, and AHF. LVEDV is the best outcome since its value
influenced by constant, BMI, and Galectin-3 (R2 ¼ 0.509).
Conclusion: Galectin-3 correlated with LVEDV, average E/e’, E/A ratio, and MBG
(QuBE). An independent association was found between Galectin-3 and LVEDV, LAVI,
average E/e, and E/A ratio. Anti-remodeling during early phase is strongly recom-
mended to prevent worse outcome in short and long term.
Keywords: Galectin-3 • early remodeling • myocardial infarction • pre-percutane-
ous coronary intervention
OR.60. Garcinia mangostana L. Extract as A Potent Protective Vascular
Endothelium in Patients with Type 2 Diabetes and High-risk Framingham Score: A
Prospective Randomized Control Trial
Olivia Handayani, Muhammad Ryan Ramadhan, Aditha Satria Maulana, Aris Munandar,
Muhammad Rizki Fadlan, Puspa Lestari, Ardian Rizal, Djanggan Sargowo
Cardiology and Vascular Medicine, Faculty of Medicine Universitas Brawijaya
Background: Endothelial dysfunction is the hallmark of vascular complications in car-
diovascular disease with type 2 diabetes as the comorbid. Garcinia mangostana L., or
mangosteen, has been known as the queen of fruits from Southeast Asia that owns
anti-inflammatory and anti-oxidant properties for years.
Objective: This study was aimed to evaluate the role of G. mangostana extract as a
potent protective vascular endothelium in patients with type 2 diabetes and high-
risk Framingham score.
Method: This is a prospective, randomized, single blind, placebo-controlled trial in
subjects with type 2 DM and high-risk Framingham score. Subjects were randomly
divided into two groups: one group of G. mangostana extract, administered
2,175 mg/day in divided dosage for 90 days, and control group receiving placebo.
The primary endpoint was the changes in endothelial progenitor cells (EPCs) and cir-
culating endothelial cells (CECs) levels; whereas nitric oxide (NO), IL-1, IL-6, TNF-a,
fasting blood glucose and HbA1c were also evaluated. Study had been approved by
local ethics committee. Statistical analysis was done and p < 0.05 considered
significant.
Results: From 90 subjects with high-risk Framingham score, there were 49 (54.4%)
subjects with type 2 diabetes, which randomly divided into two groups. The treat-
ment group (n ¼ 23) received G. mangostana extract and control group (n ¼ 26)
received placebo. Statistical analysis showed that increase of EPC and decrease of
CEC levels were significant in treatment group, compared to control (p ¼ 0.000 and
p ¼ 0.002, respectively). The levels of NO increased significantly (p ¼ 0.027) and lev-
els of IL-1, IL-6, TNF-a decreased significantly in comparison to placebo (p ¼ 0.003,
p ¼ 0.002, p ¼ 0.000, respectively). Analysis also showed that HbA1c decreased signif-
icantly (p ¼ 0.002) compared to placebo; however, it was insignificant for fasting
blood glucose reduction (p ¼ 0.336)
Conclusion: Garcinia mangostana L. extract, as an adjuvant therapy, plays a role in
improving endothelial dysfunction by significant increase in EPCs and decrease in
CECs, in patients with type 2 diabetes and high-risk Framingham score.
Keywords: Garcinia mangostana • type 2 diabetes • endothelial dysfunction • anti-
inflammation • endothelial progenitor cells
Abstracts
OR.61. The Role of b-1,3/1,6-D-Glucan (Polysaccharide Peptide) of Miselia
Ganoderma lucidum Extracts To Improve Endothelial and Myocardial Function in
Post-Myocardial Infarction Patients : A Double-Blind Randomized Controlled Trial
Liemena Harold Adrian, Muhammad Rizki Fadlan, Djanggan Sargowo
Department of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya
University, Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia
Background: Bioactive polysaccharide component of Miselia Ganoderma lucidum (b-
1,3/1,6-D-Glucan) has shown benefit in coronary artery disease (CAD) prevention.
Inflammation and oxidative stress contribute to endothelial dysfunction and athero-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
sclerosis, leading to reduced myocardial function. CECs and EPCs represented endo-
thelial dysfunction in CAD. IL-1, IL-6, hsCRP, SOD, MDA, and NO were markers of
inflammation and oxidation which may found in post myocardial infarction (MI)
patients. The effect of b-1,3/1,6-D-Glucan might be associated with amelioration of
endothelial and myocardial function.
Method: This is a single-center, prospective, randomized double blind clinical trial in
post MI (STEMI and non-STEMI) patients who had undergone reperfusion or conserva-
tive therapy or surviving acute phase. 45 of total 50 patients were selected and div-
ided into treated and control groups. The treated group was given daily dose of
540 mg b-1,3/1,6-D-Glucan polysaccharide peptide (PsP) of Ganoderma lucidum
extracts in 3 divided dose for 90 days, and the latter was receiving placebo. A
Morisky score was used to evaluate patients’ adherence to treatment, in which score
<6 contribute to exclusion. Laboratory and biomolecular examination were assessed.
Echocardiography was measured as a standard manner by two standardized physi-
cian. All statistical analysis were 2-sided (using SPSS version 24.0). P < 0.05 was
regarded as statistically significant.
Result: At 90 days, b-1,3/1,6-D-Glucan PsP of Ganoderma lucidum extracts signifi-
cantly increased EPCs levels (P ¼ 0.000), but not significantly reduced CECs
(P ¼ 0.069) compared to placebo. Significant reduction has seen in IL-1 and IL-6 lev-
els (P ¼ 0.042 and P ¼ 0.005; respectively), but not in hsCRP (P ¼ 0.064). It also
exhibited significant elevation of NO (P ¼ 0.02) and SOD (P ¼ 0.023), and reduction of
MDA levels (P ¼ 0.001). Echocardiography showed significant improvement in regional
wall motion abnormality in PsP group compared to placebo (P ¼ 0.019).
Conclusion: The role of b-1,3/1,6-D-Glucan PsP of Ganoderma lucidum extracts
exhibit elevation of EPCs, NO, SOD levels, but reduction of IL-1, IL-6 and MDA levels,
ameliorating endothelial and myocardial function in post MI patients through antioxi-
dant and anti-inflammatory mechanisms.
Keywords: Ganoderma lucidum • b-1,3/1,6-D-Glucan • anti-inflammatory •
echocardiography • myocardial infarction
OR.62. The Developmental Role of b-1,3/1,6-D-Glucan (Polysaccharide Peptide)
of Miselia Ganoderma lucidum Extracts To TNF-a Levels And Left Ventricular Mass
And Geometry In Post-Myocardial Infarction Patients : A Double-Blind
Randomized Controlled Trial
Faris Wahyu Nugroho, Liemena Harold Adrian, Djanggan Sargowo
Department of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya
University, Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia
Background: Bioactive polysaccharide component of Miselia Ganoderma lucidum (b-
1,3/1,6-D-Glucan) has been proven beneficial in the prevention of coronary artery
disease. Inflammation plays an essential role in atherosclerosis, contributing to ven-
tricular remodeling process leading to heart failure. Tumor necrosing factor-a (TNF—
a), a proinflammatory cytokine, has contributed to myocardial remodeling.
Myocardial remodeling might be represented by echocardiographic parameters i.e
left ventricular mass index (LVMI), relative wall thickness (RWT), and LV geometry.
The role of b-1,3/1,6-D-Glucan might be associated with improvement of LVMI, RWT
and LV geometry through anti-inflammatory mechanisms.
Method: This is a single-center, prospective, randomized double blind clinical trial in
post myocardial infarction (STEMI and non-STEMI) patients who had undergone reper-
fusion or conservative therapy or surviving acute phase. 50 patients were assessed
for eligibility, whom 45 were selected and divided into treated and control groups.
The treated group was given daily dose of 540 mg b-1,3/1,6-D-Glucan polysaccharide
peptide (PsP) of Ganoderma lucidum extracts in 3 divided dose for 90 days, and the
latter was given placebo. A Morisky score was used to evaluate patients’ adherence
to treatment, in which score <6 contribute to exclusion. Echocardiography and
TNF—a levels were assessed. Echocardiography was measured as a standard manner
by two standardized physician. All statistical analysis were 2-sided (using SPSS ver-
sion 24.0). P < 0.05 was regarded as statistically significant.
Result: At 90 days, b-1,3/1,6-D-Glucan PsP of Ganoderma lucidum extracts signifi-
cantly lowered TNF—a levels (P ¼ 0.006) and showed reduction in RWT (P ¼ 0.005),
LVMI (P ¼ 0.04), and left ventricular internal diameter in diastole (LVIDd) (P ¼ 0.000)
compared to placebo. Pearson correlation showed that decrease of TNF—a levels cor-
relate with reduction of LVMI (r ¼ 0.69, P ¼ 0.046).
Conclusion: The role of b-1,3/1,6-D-Glucan PsP of Ganoderma lucidum extracts
significantly reduce TNF—a levels and improve LWMI, RWT and LV geometry in post
myocardial infarction patients.
Abstracts
Keywords: Ganoderma lucidum • b-1,3/1,6-D-Glucan • TNF—a • echocardiography •
myocardial infarction
OR.63. Pulsatile Studies of Arterial and Cardiac Function: Beyond the Brachial
Cuff
Audrey Adji, Michael F. O’Rourke
St Vincent’s Clinic/ Faculty of Medicine University of New South Wales/ Victor Chang
Cardiac Research Institute, Sydney, Australia
Background: Impedance is a comprehensive description of Left Ventricular (LV) load,
as it includes steady and pulsatile components of load which are related to physio-
logical properties of the aorta and large systemic arteries.
Objective: Current practice in assessment and management of cardiovascular dis-
ease can be improved with non-invasive estimation of vascular impedance.
Method: Data in normal population were collected from two research centres; n ¼ 50
from Paris (E Mousseaux) and n ¼ 37 from Sydney (S Grieve). In Paris, subjects (21-70
years, 28 males) underwent velocity-encoded Cardiac Magnetic Resonance (CMR) using
a 1.5T system (Signa, USA), followed by carotid tonometric artery waveforms (as surro-
gate of central aortic pressure), and calibrated using brachial pressures measured dur-
ing CMR examination. In Sydney, subjects (23-79 years, 24 males) had their CMR data
acquired using a 3T system (GE, USA), with simultaneous continuous recording of radial
tonometry. Radial waves were converted offline to aortic pressure and calibrated using
brachial pressures. Impedance was determined by relating in modulus and phase,
corresponding frequency components of aortic flow velocity with aortic pressure.
Result: Results in humans with non-invasive techniques are comparable with those
achieved in experimental animals and humans using invasive methods. Results to
date confirm the effects of aortic stiffening with age. Aging causes increase in sys-
temic vascular resistance (steady component) and aortic characteristic impedance
(as an index of arterial stiffening). As arteries stiffens with age, the interaction
between LV and vascular tree is altered, from rise in aortic systolic pressure, slight
fall in aortic diastolic pressure, and impaired LV contractility.
Conclusion: Aortic impedance as a measure of LV afterload can be measured accu-
rately and non-invasively in humans. The pulsatile cardiac function and the pattern
of travelling pulse wave can be utilised as a target for management and treatment
of hypertension and heart failure.
Keywords: Aortic pressure • Aortic flow velocity • Impedance
OR.64. Garcinia mangostana L Extract Its Constituents to Lower Lipid Content
and Inflammatory Process on Intermediate and High Risk Cardiovascular Patients
: Comparison with Statin
M. R. Ramadhan1, Djanggan Sargowo1,3, A. Rizal1, A. S. Maulana1, O. Handayani1,
A. Munandar1, M. R. Fadlan1,2, P. Lestari1, D. Setiawan1, W. P. Susanto1
1 1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya
University, Dr.Saiful Anwar General Hospital, Malang East Java, Indonesia, 2Brawijaya
Cardiovascular Research Center, Brawijaya University, 3Center Study of Degenerative
Disease
Objective: This study aims to prove the effect of Garcinea Mangostana L extract
(GMLE) as potent anti-inflammatory and anticholesterol in intermediate and highrisk
cardiovascular patients.
Method: A randomized, singleblind, placebo-controlled clinical trial was conducted
in 90 adults with highrisk cardiovascular score which were determined based on
F49
Framingham criteria, age 50–70 y. The patients were devided into two group. One
group given 2520 mg/day GMLE in 3 divided dose for 90 days and the other group
given placebo. Parameters were IL-1,IL-6, TNF-a,HsCRP, HDL, LDL, Trigliserida, Total
Cholesterol measured at baseline and after 90 day’s of treatment. In sub group analy-
ses,patients were divided into 6 group (A,B,C,D,E,and F). Group A has received
2520 mg/day GMLE with Moderate intensity Statin, Group B has received 2520 mg/
day GMLE with high intensity statin, Group C has received high intensity statin with
placebo, Group D has received moderated intensity statin with placebo, Group E has
received GMLE and Group F has received placebo. We use morisky score to evaluate
treatment’s adherence, and exclude patient with morisky < 6.
Result: We found that The plasma IL-6, IL-1, TNF-a, and HsCRP concentration was
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
significantly lower in GMLE group compared with placebo (3,36 1,8 pg/ml vs. -
1,161,4 pg/ml; P ¼ 0.000; 2,6 61,6 pg/ml vs. 0.8461.19 pg/ml,; P ¼ 0.000;
2,661,75 pg/ml vs. -0,961,09 pg/ml; P ¼ 0.000, (1,626 0,9 pg/ml vs. -
0,460,7 pg/ml; P ¼ 0.000, respectively). LDL level significantly lowered in GMLE
compared with placebo (19,3629 mg/dl vs -1,3618,11 mg/dl; P ¼ 0.002, respec-
tively). There was no difference in HDL, TG, and total cholesterol. In sub-group anal-
ysis, we found that Group B significantly lowered anti-inflammatory marker com-
pared with other groups.
Conclusion: GMLE has anti-inflammatory effect due to reduce plasma level of IL-
1,IL-6, TNF-a and HsCRP. Administration of GMLE was able to reduce LDL significantly
in moderated and highrisk cardiovascular patient.
Keywords: Garcinia Mangostana • Anti-Inflammatory • High Risk Cardiovascular •
Statin
OR.65. Do Breastfeeding Have an Impact in Left Ventricular Function
Improvement? An Insight from Single Center Peripartum Cardiomyopathy
Registry
Nataya R. Sutrisno, E. Chandra, M. Hasan, Triwedya I. Dewi, Hawani S. Prameswari
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, Indonesia
Background: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening
heart disease emerging towards the end of pregnancy or in the first postpartum
months in previously healthy women. Benefit and risk of breastfeeding towards left
ventricular (LV) systolic function in PPCM patients are still controversial and there is
no consensus stating the recommendation of breastfeeding in PPCM.
Objective: To evaluate whether breastfeeding affect the recovery of LV systolic func-
tion in PPCM patients.
Method: This is a retrospective cohort study from Hasan Sadikin General Hospital
PPCM Registry. The recruitment was from 2014 until 2018. The patients were fol-
lowed up in the 3rd, 6th and 12th month. The data were divided into two groups based
on LV systolic function recovery in the follow up periods. Association between breast-
feeding and recovery of LV systolic function was analyzed bivariate followed by chi-
square test. Multivariate analysis was performed by binary logistic regression test to
adjust confounding factors.
Result: Total patients included were 71. The mean age was 30.35 þ 5.78 years old.
The most frequently found risk factors were multiparity (74.6%), preeclampsia
(59.2%), and age 30 years old (57.7%). The mean initials LVEF, LVEDD, and LVESD
were 32.89 þ 6.48 %, 55.96 þ 5.24 mm, 41.55 þ 9.36 mm consecutively. There were
49 (69.0%) breastfeeding patients, 34 (69.4%) recovered, whereas 22 (31.0%) who did
not breastfeed, 16 (72.7%) recovered. This wasn’t statistically different (p ¼ 0.76).
Patients with recovered LV systolic function had current LVEF 58.08 þ 4.26 %.
Multivariate analysis showed breastfeeding did not have correlation with LV systolic
function recovery (p ¼ 0.892, CI 95% 0.2 – 3.5). All patients received guideline-
directed medical therapy for heart failure.
Conclusion: This study showed breastfeeding didn’t affect the recovery of LV systolic
function in PPCM patients. We encourage PPCM patients to continue breastfeeding.
Keywords: Breastfeeding • PPCM • LV systolic function recovery
OR.66. High Coronary Collateral Circulation Increases Left Ventricular Reverse
Remodeling Event in Patients with Chronic Ischemic Heart Disease Underwent
Coronary Artery Bypass Surgery
I.F. Yuwono1, U. Bahrudin1, M.H. Cahyadi1, I. Uddin1, Y. Herry1, S. Rifqi1, S. Fatah2,
H. Hardian3, M.A. Nugroho1, S. Herminingsih1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Diponegoro
University - Dr. Kariadi General Hospital, Semarang, Indonesia., 2Department of
Cardiothoracic Surgery, Faculty of Medicine, Diponegoro University - Dr. Kariadi
General Hospital, Semarang, Indonesia., 3Department of Physiology, Faculty of
Medicine, Diponegoro University, Semarang, Indonesia.
Background: Coronary collateral circulation (CCC) is linked to myocardial remodeling
severity in patients with chronic ischaemic heart disease (IHD). However its effect on
left ventricular reverse remodeling (LVRR) in patients with chronic IHD underwent
coronary artery bypass surgery (CABG) has never been reported.
F50
Objective: Purpose of this study was to investigate the effect of CCC grade on the
LVRR event in patients with chronic IHD underwent CABG.
Method: This prospective cohort study was performed in patients with chronic heart
failure (CHF) caused by IHD underwent CABG. The CCC was classified using Rentrop col-
lateral score, i.e low CCC grade (Rentrop score 0 and 1) and high CCC grade (Rentrop
score 2 and 3). LVRR event was defined as a reduction of left ventricular end systolic
volume (LVESV) 10% or more, measured by a 3D full volume echocardiography at 1.5
months post CABG compared to the baseline before CABG.
Result: A total of 22 patients (81.8% male) with mean of age 58.6 years old were
enrolled. LVRR occurred in 50% patients. LVRR event was significantly higher in the
patients with high CCC grade than the low CCC grade patients (p¼0.009). The high
CCC grade increased LVRR event independently (odds ratio¼26.67; relative
risk¼6.93).
Conclusion: High coronary collateral circulation may increase left ventricular reverse
remodeling event in patients with chronic ischemic heart disease underwent coro-
nary artery bypass surgery.
Keywords: coronary collateral circulation • left ventricular reverse remodeling •
chronic ischaemic heart disease • coronary artery bypass surgery • 3D
echocardiography.
OR.67. Impact of Fibronectin Addition for Adipose Derived Mesenchymal Stem
Cells (AMSCs) Attachment Onto Polytetrafluoroethylene (PTFE) Cardiac Patch
AK Ratri1, IGR Suryawan1, Andrianto1, FA Rantam2, K Sudiana3
1
Cardiology and Vascular Medicine Department, Airlangga University, Soetomo
General Hospital, Surabaya, Indonesia, 2Stem Cells Laboratory, Tropical Disease
Center, Airlangga University, Surabaya, Indonesia, 3Electron Microscope Laboratory,
Pathology Department, Airlangga University, Surabaya, Indonesia
Background: Tissue engineering has become an innovative approach for intended
surgical replacement of congenital defects. By transplanting multi potential human
AMSCs onto widely used PTFE patch, a new solution for its prosthetic limitations is
proposed. The impact of Fibronectin addition on seeded stem cells attachment onto
PTFE patch has not been known.
Objective: To prove the impact of Fibronectin addition for AMSCs attachment onto
PTFE cardiac patch and the efficacy of number of days observed (whether it is 5, 7
or 10 days).
Method: In vitro study using thawed cryopreserved stem cells culture (hAMSCs) derived
from adipose tissue. Identified AMSCs with CD90þ, CD105þ, and CD45- with immuno-
fluorescence. Minced PTFE patches divided into groups of treatment with Fibronectin
addition to soak. Stem cells were seeded onto each patch. The cell-seeded scaffolds
were placed in 96 medium wells under dynamic cell culture conditions, divided into for
5, 7 or 10 days observation groups along with control on each arm. Qualitative and mean
number of cell per field of scanning electron microscope (SEM) view were calculated.
Result: Fibronectin has a positive impact on hAMSCs attachment seeded onto PTFE
patch; mean number of cell per field of view was 31.25613.28 versus control 1.1461.13
(p 0.000, p < 0.05). However, observation at 5 days was 17.67620.21, at 7 days was
12.11610.94, at 10 days was 18.83623.25; longer duration of cell culture did not show
significant difference on cell-to-patch surface attachment (p 0.802, p < 0.05).
Conclusio;: Fibronectin has a positive impact on hAMSCs attachment seeded onto
PTFE patch. However, longer duration of cell culture after Fibronectin addition did
not provide improvement on cell-to-patch surface attachment.
Keywords: human-Adipose Mesenchymal Stem cells (hAMSCs) • Fibronectin • PTFE
patch • stem cells seeding • tissue engineering
OR.68. Correlation Between Level of Soluble Suppression of Tumorigenicity-2
And Left Ventricle End-Diastolic Pressure In Acute Myocardial Infarction
Dyah A. Kusumastuti1, Nahar Taufiq2, Hasanah Mumpuni3, Anggoro B. Hartopo4
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Gadjah Mada, 2Division of Invasive and Non-Surgical Intervention, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada,
3
Division of Echocardiography, Department of Cardiology and Vascular Medicine,
Faculty of Medicine, Universitas Gadjah Mada, 4Division of Prevention and
Rehabilitation, Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Gadjah Mada
Background: The acute remodelling process after acute myocardial infarction
involves a mechanical mechanism in which there is a change in left ventricular geom-
etry as an adaptive response to the incidence of infarction and then results in
increased left ventricular wall stress. Mechanical overload in the myocardium is
known to increase sST2 levels while left ventricular wall stress is directly propor-
tional to left ventricular pressure. The relationship between levels of sST2 and left
ventricle end-diastolic pressure (LVEDP) in patients with acute myocardial infarction
has never been studied before. The aim of this study is to examine the correlation
between levels of sST2 and LVEDP in acute myocardial infarction.
Method: This study is an analytic observational study with a cross-sectional design
conducted from July to September 2018 at Dr. Sardjito Hospital. Patients diagnosed
Abstracts
with acute myocardial infarction and fulfilling the inclusion and exclusion criteria
were included in the study. We measured sST2 levels using ELISA test. Left ventricle
end-diastolic pressure is determined by measuring E/e’ using doppler echocardiogra-
phy. Blood sample and echocardiography data was obtained on the first day of admis-
sion. Correlation test analysis was conducted to determine the correlation between
sST2 levels and LVEDP.
Results: There were 61 subjects, 49 males and 12 females, with mean age 56 years
old. Mean level of sST2 in this study was 4,243 6 198 pg / mL, and mean E/E’ 11.62.
Correlation test using Spearman showed that there was no correlation between
increased sST2 levels and E/e’ values in acute myocardial infarction (r ¼ 0.168;
p ¼ 0.196).
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Conclusion: Increased sST2 levels were not associated with increased LVEDP in acute
myocardial infarction.
Keywords: soluble suppression of tumorigenicity 2 • sST2 • left ventricle end-dia-
stolic pressure • acute myocardial infarct
OR.69. Association between Polymorphism gain of Function E670G Proprotein
Convertase Subtilisin Kexin Type-9 Level And Major Cardiocerebrovascular
Outcome In Acute ST-segment Elevation Myocardial Infarction Undergoing
Primary Percutaneous Coronary Intervention
Yulianto1,2, Anwar Santoso1,2, Suko Adiarto1,2, Renan Sukawan1,2
1
Departemen of Cardiology and Vascular Medicine Faculty of Medicine, University of
Indonesia, Jakarta – Indonesia, 2National Cardiac Centre, Harapan Kita Hospital,
Jakarta – Indonesia
Background: PCSK9 is a molecule that regulates blood LDL cholesterol level.
Recent evidences suggest that PCSK9 may also have other mechanisms, such as
inflammation, increased Lp(a), triglyceride-rich lipoprotein metabolism, activation
of prothrombotic pathways and platelets, and modification of atherosclerotic pla-
que, which all may play a role in the pathogenesis of atherosclerotic diseases,
including STEMI. Previous advances in the management of STEMI had succeed in
increasing survival. However, some STEMI patients still experienced adverse out-
comes eventhough they already received optimal management in accordance with
the guidelines. Polimorphysm gain of function PCSK9 may have a role in the resid-
ual risk that those patients have. However, our knowledge regarding this associa-
tion between polymorphism gain of function E670G PCSK9 and MACCE in STEMI is
still unknown.
Objective: The aim of this study is to evaluate the association between polymor-
phism Gain of Function E670G PCSK9 with MACCE in STEMI patients who underwent
primary PCI.
Methods: In total, 423 patients with STEMI who were treated with primary PCI had
their plasma sample drawn during admission and evaluated for Polymorphism PCSK9.
PCSK9 Polymophism was measured with PCR RT. MACCE and other supportive data
were taken from the medical records and telephone follow-up.
Results: The prevalence of Poymorphisme E670G PCSK9 in STEMI patient who under-
went PPCI is 2,1 %. There were 65 (15,4%) study participants who experienced
MACCE in 180 days. Survival analysis shows a significant association between
Polymorphsm Gain of Function E670G PCSK9 and MACCE in 180 days. (HR 7,486;
IK95% 3.57-15.697; P ¼ 0,0000).
Conclusion: There was significant association between Polymorphsm gain of function
E670G PCSK9 and 180 days MACCE in STEMI patients treated with primary PCI.
Keywords: Polymorphism E670G • PCSK9 • STEMI • PPCI • MACCE
OR.70. Sweet Purple Potato (Ipomoea batatas L.) Extract and Vitamin C Increase
Endothelial Progenitor Cell Migration in Peripheral Blood of Stable Coronary
Disease Patient
Febryanti Hartono, Yudi H. Oktaviono
Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya,
Indonesia
Backgroun: Migration function of Endothelial Progenitor Cells (EPC) are reduced in
coronary artery disease (CAD) patient. EPC as progenitor of mature endothelial cell
has important role for angiogenesis. Dysfunctional EPC partly because of oxidative
stress. Decreasing oxidative stress with antioxidant such as sweet purple potato and
vitamin C which is easily found in Indonesia, may improve EPC migration to ischemic
organ in CAD patient.
Purpose: To analyze effect of sweet purple potato extract and vitamin C on
Endhotelial Progenitor Cell in stable CAD patient.
Method: This is experimental post-test control group study. Mononuclear cells (MNC)
are isolated from peripheral blood of sample, and cultivated in medium for 3 days,
immunofluorescence assay with CD34 as a marker for EPC. EPCs divided into sweet
purple potato extract group (1 and 25 mcg/mL), vitamin C group (10 and 250 mcg/
mL) and control, incubated for 2 days. 5x105 cell taken from each group and place in
upper chamber of Transwell system. EPC migration was assessed in lower chamber of
Transwell system after 24 hours using automated cell counters. Statistic testing using
ANOVA.
Abstracts
Results: EPC migration was increased significantly in sweet purple potato extract
and vitamin C compared with control (3.03 6 0.01, 2.15 6 0.03 vs control 1.21 6
0.04, p < 0.01). Increased dose of sweet purple potato extract and vitamin C shows
significantly increased of EPC migration (1.81 6 0.02 vs 3.03 6 0.01 and 1.47 6 0.04
vs 2.15 6 0.03, p < 0.01). There is significantly differentiation between sweet potato
purple extract and vitamin C (3.03 6 0.01 vs 2.15 6 0.03, p < 0.01).
Conclusion: Sweet purple potato extract and vitamin C increased EPC migration
dose-dependently. Sweet purple potato extract induces EPC migration better than
vitamin C.
Keywords: EPC migration • Stable CAD • sweet purple potato extract • vitamin
C • antioxidant
OR.71. Effect of Pericardial Carbon Dioxide Insufflation on Neurocognitive
Outcome After Open Heart Surgery
S. Po, K. M. Lwin, A. Z. Myo
Department of Cardiovascular Surgery, University of Medicine (1), Yangon, Myanmar
Background: Neurocognitive dysfunction after open heart surgery continues to
threaten postoperative quality of life, raise mortality, and increase length of hospital
stay. Many centers in the world are using carbon dioxide insufflation method to
reduce air embolism following open heart surgery. This prospective comparative
study was performed to determine the effect of pericardial carbon dioxide insuffla-
tion on neurocognitive outcome after open heart surgery.
Objective: To describe the various symptoms and signs of neurocognitive dysfunction
in open heart surgery patients with or without CO2 insufflation by the field flooding
technique and to compare the neurocognitive outcomes of open heart surgery
patients undergoing cardiopulmonary bypass with or without CO2 insufflation by the
field flooding technique
Methods: In this study, randomly selected patients are differentiated two groups
(Group A and Group B). Group A (n ¼ 88) was given carbon dioxide and Group B
(n ¼ 88) was not given carbon dioxide. Mini Mental State Examination was performed
one week preoperatively, one week and one month postoperatively.
Results: In this study, the means and standard deviations of scores of neurocognitive
tests of group A at preoperative, one week and one month after operations were
29.1 (6 1.15), 28.6 (6 1.77) and 29.2 (6 1.35), and those of group B were 28.7 (6
1.50), 28.4 (6 2.03) and 29.0 (6 1.76) respectively. The incidence of the neurocogni-
tive dysfunction of the patients in group A (CO2 used) and group B (non-CO2 used)
were 0.05, (95% CI: 0.01, 0.11) and 0.06 (95% CI: 0.01, 0.11) respectively. The rela-
tive risk between the groups is 0.8 (95% CI: 0.25, 2.55). There was no statistically
significant difference between groups (P ¼ 0.14).
Conclusion: In this study, the use of pericardial carbon dioxide insufflation is ineffec-
tive on neurocognitive outcome after open heart surgery.
Keywords: open heart surgery • carbon dioxide insufflation • neurocognitive test •
neurocognitive dysfunction
OR.72. Left Ventricle End Systolic Volume as an Independent Predictor for Major
Acute Cardiovascular Events on Stable Coronary Artery Disease Patients
Hilfan AP. Lubis, Manoefris Kasim, Elen Sahara, Celly A. Atmadikoesoemah
Nuclear and Imaging Division on Department of Cardiology and Vascular Medicine,
School of Medicine, National Heart Center Harapan Kita, Universitas Indonesia
Background: Left ventricle end systolic volume (LVESV) were known as parameter for
assessing left ventricular function besides ejection fraction. Studies considering the
correlation of LVESV with major acute cardiovascular events (MACE) for post infarc-
tion patients have been done but yet for the stable angina patients.
Objective: To find the prognostic value and the median LVESV for predicting MACE on
stable coronary artery disease (SCAD) patient.
Method: A cohort retrospective study were done on 103 SCAD patients without pre-
vious history of myocardial infarction or revascularization who undergone SPECT Tc99
tetrophosmin in National Heart Centre Harapan Kita from January 2017 to June 2018
and were follow for 6 months except the MACE existed.
Result: From total 103 subjects, 29 subjects (28,2%) were found to have MACE. This
MACE group were found having a larger LVESV (190.31þ11.56 mL vs
105.76þ80.44 mL) compared to non MACE patients (p 0.001). Bivariate analysis of
LVESV were correlated significant for MACE. Cox regression analysis were shown that
LVESV >113 mL was a significant predictor for MACE (HR 3.753, CI 1.595-8.855, p
value 0.001)
Conclusion: LVESV were found to be one of a significant independent predictor for
MACE. LVESV > 113 mL were having a prognostic value for MACE.
Keywords: Left ventricle end systolic volume (LVESV) • major acute cardiovascular
events (MACE) • stable coronary artery disease (SCAD) • SPECT • nuclear
F51
OR.73. Survivors vs Non Survivors of Post Myocardial Infarction Ventricular
Septal Rupture 5 Years Review of Clinical Characteristic and 30-Days Mortality
Oryza Sativa, Ivana P. Dewi, Hendra Gunawan, David C. Hermawan, Yan E. Sembiring,
Budi B. Dharmadjati
Department of Cardiology and Vascular Medicine, Department of Thoracic, Cardiac,
and Vascular Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Background: Mortality related with post myocardial infarction (MI) ventricular septal
rupture (VSR) remain high despite advances in cardiac intervention and surgical
field.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Objective: The objectives of this study is to analyzed clinical characteristics and out-
comes in attempt to identify risk factors related to 30-days mortality.
Method: A retrospective study was performed on 42 post-MI VSR patients, hospital-
ized in Dr. Soetomo General Hospital from February 2014 to February 2019. Patients
were divided into survivor group (n¼14) and non-survivor group (n¼28). The perio-
perative conditions, morbidity, and mortality were analyzed. SPSS 20.0 was used for
statistical analysis.
Result: Post-MI VSR was more frequent in male (61.9%), with mean age 61.2668.31
years. More than half of the patients (57.1%) have no history of previous MI and pre-
sented with systolic blood pressure (SBP) 100 mmHg during initial presentation
(64.3%), where as 28.6% patient have ejection fraction below 40%. Almost half of the
patient (47.6%) died before undergoing catheterization. Double vessel disease are
the most frequent (21.4%0, with apical VSR (64.30%) as the common type. Bivariate
analysis showed that diabetes mellitus (p ¼ 0.042), increased creatinine serum
(p ¼ 0.025), first MI (p ¼ 0.047), SBP 100 mmHg (p ¼ 0.04), VSR pressure gradient
(PG) (p ¼ <0.001), TR PG (p ¼ 0.01), ventilator usage (p ¼ 0.02), inotropes usage
(p ¼ 0.004), dynamic changes of VSR size (p ¼ <0.001), EF  40% (p ¼ 0.036), and
EUROSCORE (p ¼ 0.04) were associated with increased 30-days mortality risk.
Meanwhile from regression analysis only VSR PG, ventilator usage and DM (p ¼ 0.005;
p ¼ 0.03; p ¼ 0.042) found as an independent risk factors.
Conclusion: The 30-days mortality of post-MI VSR remain high in this study. The pres-
ence of DM, dynamic changes of VSR PG, mechanical assisted ventilation, and
decreased EF associated with a higher risk of mortality.
Keywords: myocardial infarction • ventricular septal rupture • risk mortality • risk
factors
OR.74. The Effect Of Darapladib Administration To Inflammation Marker In Early
Development Of Atherosclerosis: In Vivo Study For Dyslipidemia Model
Titin Andri Wihastuti1, Putu Nina Belinda Saka2, Djanggan Sargowo3, Teuku Heriansyah4
1
Department of Biomedicine, Faculty of Medicine, Brawijaya University, Malang,
Indonesia, 2Faculty of Medicine, Brawijaya University, Malang, Indonesia,
3
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya
University, Malang, Indonesia, 4Department of Cardiology and Vascular Medicine,
Faculty of Medicine, University of Syiah Kuala, Banda Aceh, Indonesia
Background: Dyslipidemia is a condition of chronic inflammation which related to
Lp-PLA2. Lp-PLA2 has anti-inflammatory role as it hydrolyze atherogenesis mediators
such as oxLDL to produces lysoPC and oxFA that have pro-inflammatory, proliferative
and pro-atherogenic effect. Atherosclerotic lession is characterized by high expres-
sion of Lp-PLA2. Darapladib has been shown to reduce Lp-PLA2 activity in human car-
otid plaque. Darapladib becomes a potent inhibitor of atherosclerosis.
Methods: This study aimed to discover the expression of inflammation marker of
dyslipidemia in vivo model with darapladib treatment. True experimental labora-
tory and only post test with control group design using 30 Spraque Dawley rats
which is divided into 3 main groups: normal, dyslipidemia, and dyslipidemia with
darapladib administration 20 mg/kg body weight per oral/day. The dyslipidemic
rats were prepared by feeding them with a high-cholesterol diet. Each group con-
sisted of 2 serials treatment time: 8-weeks and 16-weeks. Measurement of lipid
profile is using colometric method by using EnzyChromTMkit produced by BioAssay
System. ELISA method with Platelet Activating Factor (PAF) ELISA kit (Cat. No.
MBS722041) is used for measuring plasma PAF. The expression of Lp-PLA2 is calcu-
lated with immunofluorescence method and rhodamin rat as labelling for secondary
antibody (Biosource).
Result: The serum levels of total cholesterol (TC), Non-HDL-C, PAF significantly
increased in dyslipidemia model groups in 8 and 16 week, whereas high-density lipo-
protein cholesterol (HDL-C) in decreased (p<0.05). The expression of Lp-PLA2 is
increased in 8 and 16 weeks (p<0.05). Levels of TC, Non-HDL-C, were respectively
reduced in darapladib groups in 8 and 16 week (p<0.05), as did PAF in 16 week,
whereas HDL-C significantly increased in 8 week (p<0.05). Expression of Lp-PLA2
were respectively reduced in darapladib groups in 8 and 16 week (p<0.05).
Conclusions: This study conclude that darapladib proved to have role to decrease
PAF and Lp-PLA2 in vivo model of dyslipidemia.
Keywords: Dyslipidemia • inflammation marker • darapladib
F52
OR.75. High Level of Serum Growth Differentiation Factor-15 as Independent
Predictor of Major Adverse Cardiovascular Event in Acute Myocardial Infarction
Patients During Hospitalization Period
M. Sanjiwani1, W. Aryadana1, R. Widiana2
1 Keywords: GDF-15 • major adverse cardiovascular event.
Department of Cardiology and Vascular Medicine, Udayana University, Sanglah
Hospital, Denpasar, Indonesia, 2Internal Medicine Department, Udayana University,
Sanglah Hospital, Denpasar, Indonesia.
Background: Inflammatory condition and stress following Acute Myocardial Infarction
(AMI) can be used to predict avoidable morbidity and mortality. Inflammation and
stress may cause acute increase of Growth Differentiation Factor (GDF)-15 secretion
from cardiomyocytes which plays a role in the pathogenesis of post-AMI major
adverse cardiovascular event (MACE).
Objective: GDF-15 is a strong predictor of MACE during the acute phase of IMA
patient hospitalization.
Methods: This study is an observational analysis with prospective cohort design. Inclusion
criteria includes all IMA patients in emergency unit and all care unit in Sanglah Hospital
Denpasar who has given consent to participate. Sample was taken consecutively until a
target of 60 patients was collected from April 2018 to June 2018. Blood GDF-15 level was
measured and analyzed in the Clinical Pathology laboratory of Sanglah Hospital. This
study produced a Hazard Ratio (HR) and survival curve from prognostic factors of MACE.
Results: Analysis of ROC curve found a cut-off value for GDF-15 of 936.97 pg/mL with
81.8% sensitivity and 74.1% specificity. Controlled variables in this study includes
age, sex, smoking, hypertension, diabetes mellitus, dyslipidemia, obesity, atrial
fibrillation, chronic kidney disease, reperfusion therapy and diagnostic category.
Abstracts
Multivariate analysis with Cox regression shows high serum level of GDF-15 is an inde-
pendent factor of MACE with HR of 7.4.
Conclusion: High level of serum GDF-15 is proven as an independent predictor of
MACE in AMI patients during the hospitalization.
OR.76. 3D Printed Model of Coronary Arteries: Survey Among Patients and Their
Families at Sardjito General Hospital
P.P.R. Gharini1, N. Arfian2, Herianto3, N.C.M. Susilo4
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
and Nursing, Universitas Gadjah Mada-Dr.Sardjito General Hospital, Universitas
Gadjah Mada Academic Hospital, Yogyakarta, Indonesia, 2Department of Anatomy
and Embryology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah
Mada, 3Department of Electrical and Information Technology Engineering, Faculty of
Engineering, Universitas Gadjah Mada, Yogyakarta, Indonesia, 4Research Assistance,
PKU Muhammadiyah Yogyakarta Hospital
Introduction: Explaining the anatomical structure of the coronary heart to patients or
their families prior to a certain coronary procedure is challenging. The right media is
needed so that the patient correctly understands, so patients can make better decisions.
Objective: To evaluate the use and feasibility of 3d printed model of coronary
arteries for education model for the patients and their families
Design: A coronary artery model was reconstructed from cardiac CT dataset using
fused deposition method. Subjects are the patients and their families at RSUP DR.
Sardjito Yogyakarta, who are non expert in medical sciences. They were presented
about their coronary arteries problem from the coronary angiography results.
Subjects were randomly assigned to two groups who underwent the presentations
with or without coronary artery models. Participants were then subjected to a 10
post- test question of medical questionnaire.
Results: Fifty two participants were completed trial; 27 were not using 3d coronary
model, 25 were using coronary model. Post-test were significantly higher in 3D model
groups (71.6 vs 58.14, p ¼ 0.001)
Conclusion: The finding of this study suggests that use of 3D printing model may con-
fer certain benefits to anatomy learning and structure to patients and their families.
The 3D model may used as supplements to conventional media from patients coro-
nary angiography results.
Keywords: coronary artery model – 3D printing – patient education
OR.77. Atrial Septal Defect (ASD) Area Measured by Simple Ellipse Formula Has
Better Correlation with Pulmonary Hypertension, Compared with ASD Diameter
in Adult Secundum ASD
Suryo Ardi Hutomo1,2, Rosi Amrilla Fagi1,2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Airlangga, 2Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Pulmonary hypertension in secundum ASD, are developed in response to
a chronic volume overload of the pulmonary circulation, caused by a left-to-right
shunt. Size of ASD, usually measured as ASD diameter, is one of echocardiographic
finding that correlates with pulmonary hypertension.
Objective: We aimed to investigate whether another sizing method of ASD, ASD
area, measured by simple ellipse formula has better correlation compared with usual
ASD diameter.
Method: The echocardiographic data of 30 subjects with secundum ASD (10 men and
20 women), mean ages 35 6 14.1 y.o, were evaluated in this study. All echocardio-
graphic assessments were performed according to the criteria of American Society of
Echocardiography (ASE). We examined the size of ASD using ASD area (with simple
ellipse formula: p x a x b) and ASD diameter. We also investigate the correlation of
them with various PH parameters (sPAP, mPAP, LV eccentricity index), right heart
dimensions (RA Area, RV basal diameter) and right ventricle function (TAPSE)
Result: Most of subject had secundum ASD with left to right shunt (66.6%) and mild
PH (50%). ASD Area (measured by simple ellipse formula) significantly correlated
with sPAP (r: 0.44, p < 0.05). This correlation is higher than ASD diameter-sPAP corre-
lation (r: 0.38, p < 0.05). ASD Area also significantly correlated with Right Atrial Area
(r: 0.65, p < 0.01). In another parameters, ASD Area is also have better correlation
with mPAP (r: 0.26 vs 0.18), LV eccentricity index (r: 0.33 vs 0.32), RV basal diameter
(r: 0.304 vs 0.272) and TAPSE (r: -0.256 vs -0.150), compared with ASD diameter.
Conclusion: ASD Area (measured by Simple Ellipse Formula) has better correlation
with severity of pulmonary hypertension, compared with usual ASD diameter. This
measurement should be considered in routine examination and prognostication of
adult secundum ASD.
Keywords: Secundum ASD • ASD Area • Pulmonary Hypertension • Ellipse Formula
Abstracts
OR.78. Correlation between Tricuspid Annular Plane Systolic Excursion and
Systolic Pulmonary Artery Pressure in Patients Undergoing Valve Surgery
Hari H. Satoto, R. Adrianto, Sulistiyati B. Utami, Mochamad A. Nugroho
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Diponegoro
University – Dr. Kariadi General Hospital, Semarang, Indonesia
Background: Right ventricular dysfunction is the complication of pulmonary hyper-
tension. TAPSE is the simplest method for measuring right ventricular systolic func-
tion, however there is no data that support TAPSE correlates with increasing pulmo-
nary artery pressure. The aim of this study was to investigate the correlation
between tricuspid annular plane systolic excursion (TAPSE) and the systolic pulmo-
nary artery pressure (SPAP) in patients undergoing valve surgery.
Objective: The objective of this study was to find correlation between TAPSE and
SPAP measured using echocardiography in patients undergoing valve surgery.
Method: Patients with mitral and aortic valve disease undergoing valve surgery in
Kariadi General Hospital during April – December 2018 were enrolled in this study.
TAPSE was assessed by using the echocardiographic by placing an M-mode cursor
through the tricuspid annulus and measuring the amount of longitudinal motion of
the annulus at peak systole. In the absence of a gradient of across the pulmonic
valve or right ventricular outflow tract (RVOT), SPAP is considered equal to right ven-
tricular systolic pressure (RVSP). RVSP was measured by peak tricuspid regurgitation
(TR) jet velocity, using the simplified Bernoulli equation and combining this value
with an estimate of the RA pressure (RAP).
Result: There were 49 patients (age 43611 years old, 63% female). The median
TAPSE was 18 mm (range, 9-34 mm) and the median SPAP was 56 mmHg (range, 13-
163 mmHg). TAPSE had a significant negative moderate correlation with SPAP (r¼-
0.57, p < 0.001) in patients undergoing valve surgery. Receiver operating characteris-
tic analysis showed that area under curve for TAPSE was 0.79 for the estimated SPAP.
Patients with TAPSE < 17 mm were likely had SPAP > 50 mmHg or pulmonary hyper-
tension (OR ¼ 9.84, p ¼ 0.002).
Conclusion: In patients undergoing valve surgery, tricuspid annular plane systolic
excursion was correlated with systolic pulmonary artery pressure.
Keywords: TAPSE • SPAP • valve surgery
OR.79. Calcification of Mitral Leaflet is Correlated with Significant Mitral
Regurgitaion after Percutaneus Baloon Mitral Valvulotomy
F Esa, Novaro A. Tafriend, L Morlim, A Carina, Dina A. Permatasari, B. Sulistiyati
Department of Cardiology and Vascular Medicine, School of Medicine, Diponegoro
University, Kariadi Hospital, Semarang, Indonesia
Background: Significant mitral regurgitation (MR) is one of the complications after
percutaneous balloon mitral valvulotomy (PBMV) procedure in patients with rheu-
matic mitral stenosis (MS). However, there were conflicting data about the correla-
tion between Wilkins score and event of significant MR after PBMV procedure.
Objective: The aim of this study was to investigate the correlation between Wilkins
score and the significant MR event after PBMV procedure.
Method: Rheumatic MS patients who had Wilkins score 8 and submitted to PBMV
procedure from January 2015 to December 2018 were enrolled into this retrospective
study. Two-dimensional and Doppler echocardiography to determine Wilkins score
were performed in all patients on the day before and one day after PBMV. MR
severity was assessed by jet area and vena contracta. Statistical analysis was per-
formed using Spearman test.
Result: A total of 29 patients (age 44.6169.4 years old, 68.9% female) were
enrolled. A significant MR following PBMV was found in 8 (27.5%) patients. Mitral
valve area (MVA) before and post PBMV were 0.7860.28 cm2 and 1.4260.5 cm2,
respectively. Mean Wilkins score was 6.37þ0.37, valvular thickening was 1.87þ0.1,
valvular mobility was 1.12þ0.11, valvular calcification was 2.25þ0.095 and subvalvu-
lar thickening was 1.12þ0.08 . There were no correlation between Wilkins score
(r ¼ 0.1; p ¼ 0.57), valvular thickening (r ¼ 0.026; p ¼ 0.89), valvular mobility (r¼ -
0.32; p ¼ 0.087), and subvalvular thickening (r¼ -0.07; p ¼ 0.69) with significant MR
event after PBMV procedure. However valvular calcification of mitral leaflet was cor-
related significantly with the event (r ¼ 0.38; p ¼ 0.042).
Conclusion: Calcification of mitral leaflet, but not Wilkins score, is correlated with
significant mitral regurgitation after percutaneus baloon mitral valvulotomy
Keywords: Percutaneous mitral balloon valvulotomy • Wilkins score • mitral regur-
gitation • mitral stenosis
F53
OR.80. Combination of Three Electrocardiogram Criteria From Kaplan To
Diagnose Right Atrial Enlargement In Adults With Uncorrected Secundum Atrial
Septal Defect
Purwati Pole Rio, Hariadi Hariawan, Dyah Wulan Anggrahini, Anggoro Budi Hartopo,
Lucia Kris Dinarti
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health
and Nursing Universitas Gadjah Mada and Dr. Sardjito Hospital, Yogyakarta, Indonesia
Background: Enlargement of right atrium (RA) in patients with uncorrected ASD is a
consequence of chronic volume overload. The most famous but insensitive ECG crite-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
rion for RA enlargement is P pulmonale. However, several studies have shown that P
pulmonale is limited only to obstructive pulmonary disease (emphysema, asthma)
and is not found in pulmonary hypertension, interstitial lung disease or RA volume
overload (such as in patients with ASD).
Objective: To compare three electrocardiogram criterias from Kaplan et al. with P
pulmonale to detect RA enlargement in adults with uncorrected secundum ASD.
Methods: A cross sectional study with 120 adults with uncorrected secundum ASD. RA
enlargement was determined by planimetric measurement of RA volume index by
transthoracic echocardiography using Simpson method. Electrocardiograms were
evaluated for three ECG criteria from Kaplan et al. and were compared with P pul-
monale criterion to diagnose RA enlargement. The statistics analysis was performed
to compare sensitivity, specificity, accuracy, positive predictive value (PPV) and neg-
ative predictive value (NPV).
Results: From 120 subjects, increased RAVI was detected in 64.2% subjects. The
three ECG criterias from Kaplan et al. were: QRS axis >90o, P wave amplitude
>1.5 mm in V2, and R/S ratio amplitude >1 in V1. They had 77%, 56%, and 71% accu-
racy to predict RA enlargement, respectively. The combination of these three crite-
rias had 53% accuracy, 35% sensitivity, 86% specificity to predict RA enlargement. The
combination of only two criterias: QRS axis >90o and R/S ratio amplitude >1 in V1
had 73% accuracy, 82% sensitivity, and 56% specificity. On the other hand, P pulmo-
nale criteria had 48% accuracy, 19% sensitivity, and 100% specificity to detect RA
enlargement.
Conclusion: Combination of three ECG criteria from Kaplan et al. was more accurate
and had higher PPV than P pulmonale criterion to detect RA enlargement in adults
with uncorrected secundum ASD. The most sensitive, most accurate and highest pre-
dictive criterias are QRS axis >90o, R to S ratio >1 in V1, and combination of these
two criterias.
Keywords: ASD • RA enlargement • RAVI • ECG • P pulmonale
OR.81. Comparison between 12-lead ECG and Transthoracic Echocardiography in
Detecting Pulmonary Hypertension in Secundum Atrial Septal Defect
Jimmy O. Santoso, Radityo Prakoso, Ronaldo Simamora, Hary S. Muliawan, Bambang
B. Siswanto
Faculty of Medicine, Universitas Indonesia,National Cardiovascular Center Harapan
Kita, Departemen of Cardiology and Vascular Medicine Universitas Indonesia
Background: Pulmonary hypertension in congenital heart disease is widely under-
diagnosed and untreated while the gold standard (right heart catheterization) is only
available in big city in Indonesia. However, a simple method like echocardiogram and
ECG is available in remote areas. Since TTE is operator-dependent and not widely
available as ECG, this study aim was to compare the ability of ECG and TTE in pre-
dicting PH in ASD.
Objective: To compare the ability of ECG and TTE in predicting PH in ASD
Methods: We performed a cross sectional study on 62 patients (devided into 2 groups
: PH and non PH) with secundum ASD and compare the ability of ECG and transthora-
cic echocardiogram (TTE) in the detection of PH in secundum ASD. Both methods
compared to gold standard (right heart catheterization).
Results: We found that ECG was not much inferior compared to TTE in the detection
of PH in secundum ASD. The area under the curve of RV strain, RVH voltage criteria,
and a score derived from this study (RRR score – RAD, RVH voltage criteria, and RV
strain - for the prediction of PH in ASD) is 85,6%, 80,8%, and 87,2% while in echocar-
diography, the AUC was 89,8%.
Conclusion: ECG is comparable to TTE in detecting PH in secundum ASD so that the
early detection of PH in secundum ASD can be achieved by using ECG.
Keywords: Pulmonary hypertension • Secundum ASD • ECG • TTE
F54
OR.81. Table 1 Comparison of ECG and Echocardiography in the Detection of PH in
Secundum ASD
OR.82. Regression of Pulmonary Hypertension after Mitral Valve Replacement
for Mitral Stenosis in Early and Late Phase
G. Gerry Tampi, Reza M. Munandar, Firman N. Habibie, M. Fauziar Ahnaf, M. Arif
Nugroho
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University – Dr. Kariadi General Hospital Semarang, Indonesia
Backgrounds: Pulmonary hypertension (PH) in mitral stenosis (MS) can be ascribed to
pulmonary vasoconstriction in respose to increased left atrial pressure. It has been
one determinant of poor outcome in mitral valve replacement (MVR). The reversibil-
ity of PH after MVR has been a topic of many investigations. Following cardiac sur-
gery such as MVR, transient myocardial dysfunction (stunning) and cellular damage
may develop in relation with cardiopulmonary bypass and cardioplegia.
Objective: The purpose of this study is to evaluate regression of PH after MVR for MS
patients in early and late phase by echocardiographic assessment.
Methods: The study population included MS patients with PH undergoing MVR with or
without other cardiac surgery between October 2016 and February 2019 in
Department of Cardiology and Vascular Medicine, Dr. Kariadi General Hospital. A
total 23 patient was divided to two group according to duration of echocardiographic
assessment after MVR. Early phase for postoperative assessment before 1 month,
late phase for assessment after 1 month. Regression of PH was evaluated by estimat-
ing pre and postoperative right ventricular systolic pressure (RVSP).
Result: Twenty-three patients with MS and RVSP greater than 40 mmHg were eval-
uated. Early phase assessment was done in 11 patients and late phase assessment in
12 patients. All patients showed a decrease in RVSP after MVR. In the group which
evaluated in early phase, the average RVSP decreased from 57 to 42 mm Hg (23,9%).
While in patients which evaluated in late phase, the average RVSP decreased from
72 to 35 mm Hg (47,4%).
Conclusion: Patients with mitral stenosis may benefit from surgical treatment
regardless of the degree of pulmonary hypertension. Regression of pulmonary hyper-
tension can be seen since early phase after mitral valve replacement and greater
improvement is seen over time.
Keywords: pulmonary hypertension • mitral stenosis • mitral valve replacement
OR.83. Developement, Internal Validation and Calibration of Medan Arrhytmias
Prevention (MAP) Score to predict Malignant Ventricular arrhytmias in Patients
with Myocardial Infarction Presenting Late After Symptoms Onset
Z. Syahputra, T. Delfian, Y Fitrina , A. Sitepu, Anggia C Lubis, Ali N Nasution, H. Hassan
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sumatera
Utara University, Medan, Indonesia
Introduction: Patients with delayed presentation of Acute Myocardial Infarction with
STEMI have frequently a poor prognosis and high risk for occurence of life –
Abstracts
threatening arrhythmias, such as sustained ventricular tachycardia or fibrillation.
The risk stratification models for prediction of this complication is crucial.
Objective: To develope and validate a risk score for the prediction of malignant ven-
tricular arrhythmias in patients with late presentation of STEMI.
Methods: 480 late stemi presenters were enrolled in this study. Patients were divided
into developement (n ¼ 380) and validation (n ¼ 100) cohorts.Multivariate analysis
was applied to determine independent risk factor and developed the MAP Score using
logistic regression models.
Results: In the developement cohort, 11,8% developed malignant ventricular arrhymias
and independent predictors of ventricular arrhythmias analyzed with backward selec-
tion logistic regression were KILLIP Class > 2 (OR 2,67, p ¼ 0.009 95%CI 1,26-5,37), QRS
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
duration > 0,12seconds (OR 3,60, p ¼ 0,004 95%CI 1,52-8,52), 0nset 13-24 hours (OR
3,36, p ¼ 0,002 95%CI 1,56-7,21), Inotropic agents used (OR 3,17,p¼0.002 95%CI 1,55-
6,51) and low ejection fraction (OR 3,60 p ¼ 0,023 95%CI 1,18-10,91). A scoring system
was generated from this final model with good calibration by hosner-lemeshow test
(p ¼ 0,858) .C-indies of ROC for Malignant ventricular arrhytmias were 0,804 and 0,806
in the developement and validation groups respectively. Cutt-off points 2, predicting
17,5% risk of malignant ventricular arrhythmias (sensitivity 75%, specificity 75%).
Conclusion: Medan Arrhytmias Prevention (MAP) Score had been developed and vali-
dated to predict malignant ventricular arrhytmias in patients with late presentation
of STEMI.Patients who achieve high scores using this predicting system should
undergo early invasive strategy to avoid this complication.
Keywords: Malignant ventricular arrhytmias • Late STEMI presenters • scoring
system.
OR.84. Ejection Dynamic Parameter Assessment in Aortic Stenosis Severity
Rian Apriza, Bertha G. Napitupulu, Nizam Z. Akbar, Harris Hasan
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Assessment of severity of aortic stenosis (AS) is essential for clinical
decision making based on echocardiographic. Inconsistencies between gradients,
velocity and valve area are frequent in evaluation of aortic stenosis from echocardio-
graphic. Ejection dynamics parameter are useful in assessing prosthetic valve
obstruction, but very limited data are available in the setting of native aortic
stenosis.
Objective: The aim of this study to evaluate whether Acceleration Time (AT),
Ejection Time (ET) and ratio of AT to ET, could be diagnostic parameter in assessing
severity of native aortic stenosis.
Method: This cross sectional study involved 28 patients with AS that underwent
transthoracic echocardiography examination on January 2018 in Adam Malik
Hospital. Ejection Dynamics parameters (AT,ET,AT/ET) and standard severity AS
parameters( AVA, velocity, gradient) were analyzed. Ejection dynamic parameter
were analyzed based on stages of AS . A receiver operating characteristic curve was
plotted to determine the best cutoff value to identify severe AS.
Result: Twenty eight patients with mean age 52.79 þ 15.09 (60.1 % was male) were
enrolled in this study of whom 13 ( 46.4%) had severe AS, 8 (28.6 %) had moderate
AS, 7 (25%) had mild AS. AT was higher in patients with severe AS than non severe AS
(131 þ 26 vs 90 þ 19 msec,P < .001). As well as AT/ET ratios ( 0.38 þ 0.05 vs 0.27 þ
0.04. P < .001). Using a cutoff of 114 msec, AT had sensitivity of 92% and specificity
of 93%, Using cutoff of 0.32 the AT/ET ratio had sensitivity of 92% and specificity of
93%.
Conclusion: Ejection dynamics parameter particularly AT and AT/ET ratio can help to
evaluate AS severity.
Keywords: aortic stenosis • ejection parameter • doppler echocardiography
OR.86. Postoperative Fever After Open Heart Surgery
Phyo-Naung Win, Win-Win Kyaw, Aung Thu
Department of Cardiovascular Surgery, University of Medicine 2, Yangon, Myanmar
Background: Postoperative fever after open heart surgery is common. Inflammatory
response and infection are often the major considerations.
Objectives: To describe the demographic data and to find out causes of cardiac post-
operative fever in Yankin Children Hospital (YKCH) and North Okkalapa General and
Teaching Hospital (NOGTH).
Methods: This is a prospective study including adult patients (18 years and above)
undergoing open heart surgery in YKCH and NOGTH between January 2018 and
December 2018 (n ¼ 86). Fever was defined as temperature above 100.4˚F.
Results: Of 86 patients, the mean age (SD) was 54 (10) years, consisting of 51 male
patients (60%). The postoperative fever on days 1, 3 and 7 was 35.2%, 24.4% and
4.3% respectively. The main intraoperative factor is Cardiopulmonary Bypass time
(>120mins) that was associated with more postoperative fever patients (18.2% versus
8.8%; p ¼ 0.04). There was one positive culture for blood. However, there were no
Abstracts
differences in wound infection, urinary tract and other infection, in patients experi-
encing postoperative fever.
Conclusion: Postoperative fever after open heart surgery is common and resolves
spontaneously by day 7. Postoperative fever after open heart surgery is not associ-
ated with infection. Therefore, early postoperative fever after open heart surgery
alone is not sufficient to diagnose postoperative infection.
Keywords: Postoperative fever • open heart surgery
OR.87. Survival Analysis of Post-Surgical Ventricular Septal Rupture 5 Years
Review of In-hospital and Long Term Outcome in Dr. Soetomo General Hospital
Oryza Sativa, Ivana P. Dewi, Hendra Gunawan, David H. Christian, Yan E. Sembiring,
Budi B. Dharmadjati
Department of Cardiology and Vascular Medicine; Department of Thoracic, Cardiac,
and Vascular Surgery; Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Background: Ventricular septal rupture (VSR) is a rare but well-recognized mechani-
cal complication of acute myocardial infarction (MI). The mortality rate remains high
even in the era of reperfusion therapy. Surgery is well known to provide a maximum
survival benefit.
Objective: The objectives of this study are to investigate the risk factors of in-hospi-
tal mortality and to do survival analysis in the past five years at our hospital.
Method: Data from 15 consecutive patients post-surgical VSR repair hospitalized in
Dr. Soetomo General Hospital from March 2014 to March 2019 were retrospectively
analyzed for demographics, comorbidities, operative and post-operative outcomes.
The primary outcome was in-hospital mortality.
Result: The mean age of the patient was 58.4767.64 years with 10 males (66.7%)
patients. The VSR were mostly apical in 10 (66.7%) patients. Triple vessel disease
were recorded in 5 (33.3%) patients. More than half of patients (53.3%) were in car-
diogenic shock during initial presentation. Mean cardio-pulmonary bypass time was
153,47667.21 minutes and mean aortic cross clamp time was 130.2644.19 minutes.
Bivariate analysis showed that VSR site (p ¼ 0.019) and low cardiac output syndrome
(LCOS) (p ¼ 0.02) were associated with increased in-hospital mortality risk.
Meanwhile from logistic regression analysis both of VSR site and LCOS (p ¼ 0.13;
p ¼ 0.06) also found to be independent risk factors. The mean survival at two years
was 10.86 months, with survival rate 46.7%. Almost half of the patients (44%) devel-
oped CHF and VA (33.3%) during 2 years follow up periods.
Conclusion: Our study demonstrated that post-MI VSR surgical repair had relatively
high in-hospital mortality rate. VSR site and LCOS were independent predictors of in-
hospital mortality risk.
Keywords: myocardial infarction • ventricular septal rupture • risk mortality •
ventricular septal repair
OR.88. Functional Area Capacity (FAC) and Right Ventricular Myocardial Strain as
Indicators of Pulmonary Hypertension in Secundum Type Atrial Septal Defect :
PPJT RSUD Dr. Soetomo Registry
I Maghfirah, A Lefi
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga
University - Dr Soetomo Teaching Hospital, Surabaya, Indonesia
Background: Atrial septal defects creates intracardiac shunt from left to right
atrium. It is the most common congenital heart disease encountered in adulthood. It
creates volume-overload condition in right heart, which eventually cause pulmonary
hypertension and leads Right Ventricular (RV) dysfunction that can be scored by RV
Myocardial Strain and Fractional Area Change (FAC). We investigate the relationship
between pulmonary hypertension and RV function.
Methods: This study was conducted in PPJT DR. Soetomo General Hospital from
January 2018 up to March 2019. RV function parameters include RV strain and FAC.
Pulmonary Hypertension is scored by Pulmonary Valve Acceleration Time (PV AccT).
FAC, RV strain, PV AccT and Est PASP were calculated based on ASE Guideline using
echocardiography. The relationship between RV function and PH parameters were
analyzed using Pearson correlation test in SPSS software.
Results: The total sample included in this study was 518 subjects with ASD (218 men
and 300 women) mean ages 36.3 6 9.62 y.o were included in this study. The subjects
were dominated by secundum type ASD patients those were 490 people (94.70%).
The RV function value ranges from -29.06 up tp -4.40, and the mean was -
18.8567.70. Meanwhile FAC score range was 13.63%-70% (the mean was
40.19615.29). Furthermore, The PV AccT value range was 38 ms – 125 ms, and the
mean was 88.58626.58. Result from Pearson correlation test showed PV AccT corre-
late well with RV myocardial strain (p < 0.001; r: -0.777) as well as FAC (p < 0.001;
r ¼ 0.662 ) in ASD patients.
Conclusion: RV myocardial strain and FAC was correlated well with pulmonary hyper-
tension parameters in ASD.
Keywords: Atrial septal defect • Right ventricle function
F55
OR.89. The Usefulness of Short-term Heart Rate Variability as Predictors of
Diabetic Cardiomyopathy in Type 2 Diabetic Patients
Johan Senihardja, Liem A. Natalino, Evan J. Gunawan, Darwin C. Indra, Vika Fransiska,
Harry Pribadi, Alvin Budiono, Janry A. Pangemanan, Prof. Reggy L. Lefrandt, Frederick
G. Langi, Agnes L. Panda
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sam Ratulangi
University, Manado, Indonesia
Background: The non-ischemic diabetic cardiomyopathy has been considered to be
caused by imbalance of cardiac autonomic nervous system (ANS). It developed earlier
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
than diabetic cardiomyopathy. Recently, it was able to be measured by short-term
heart rate variability (HRV).
Objective: We hypothesized that short-term HRV examination would predict the car-
diomyopathy event in newly diagnosed type 2 DM patients.
Method: This observational case-control study was analyzed using logistic regression,
conducted between December 2017 to April 2018. Totally, there were 69 subjects
involved, divided into type 2 DM group and control. The blood sampling, ECG exami-
nation, echocardiography, and short-term HRV examination were performed in all
subject. The data was analyzed using SPSS.
Result: There was significant difference in most short term HRV parameters, time
domain and frequency domain (p value < 0,05), between two groups. The incidence
of diastolic dysfunction between two groups showed significant difference, 45% vs 8%
(p ¼ 0,003). Area under the curve (AUC) analysis for short term HRV parameters
showed good indicator, between 0,75-0,85. Overall, they tended to be rightly skewed
with lower values dominated the data. As such, the quantities were presented as
median and IQR. From univariate analysis, all short-term HRV variables demon-
strated a significant relationship with the outcome (p value <0.05). For most, a
lower level of short-term HRV appeared to increase the odds of diastolic dysfunc-
tion. The multivariate analysis controlling for serum HbA1c in addition to age, gen-
der, and triglyceride level revealed a substantial change of OR level in many short-
term HRV variables, but direction of the association was unaltered with p value
<0.05. From multivariate analysis, a one percent higher of serum HbA1c on average
increased the odds of diastolic dysfunction among the patients significantly by a
factor from 1.47 to 1.60.
Conclusion: There was significant difference of short term HRV value between DM
type II and control group. Lower level of short term HRV parameters increased odds
ratio for diastolic dysfunction independently. Increasing level of HbA1c independ-
ently increased the odds for diastolic dysfunction.
Keywords: Diabetic cardiomyopathy • heart rate variability
OR.90. Modified QRS Selvester Scores and End Systolic Volume as a Predictor of
Myocardial Non-Viability in Ischemic Cardiomyopathy
Mirhansyah Perdana, Cindy Ayuningtias, Edison Bun, Harris Hasan, Ali Nafiah
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara / Haji Adam Malik Hospital, Medan, Indonesia
Background: Assessment of viability in ischemic cardiomyopathy is very important to
identify patients who would benefit from revascularization.
Objective: This study aims to assess whether modified QRS Selvester scores and rou-
tine echocardiography can predict non-viability in ischemic cardiomyopathy.
Method: This study consecutively enrolled 60 patients with documented coronary
artery disease, NYHA functional class I-III heart failure symptoms and EF of  0.35
who referred for viability study. Patients with bundle brach block were excluded.
All patients underwent rest technetium-99m sestamibi SPECT. The segment viability
was evaluated semiquantitatively by using Cedars Quantitative Perfusion SPECT
(QPS) software packages. The LV is divided into 17 segments and each segment is
given a value of 0 - 4. Value of 3 and 4 indicates the radiotracer activity is less than
60% and is considered non-viable. The viability defined as those with 11 or more
viable segments. QRS scores were calculated from 12 lead ECGs based on the modi-
fied selvester score which consists of 37 criteria and 29 points. Echocardiography
was carried out based on the American Society of Echocardiography (ASE)
Guidelines.
Result: Patients studied were 54 þ 7 years old and median EF 0.30 (0.25 - 0.34).
Most patients (95%) are male with three vessel disease (89%). Viability of myocardium
was found in 76% of patients. Modified selvester QRS scores, End Systolic Volume
(ESV), and End Diastolic Volume (EDV) were associated with non-viable myocardium.
Logistic regression analysis showed that QRS score  10 (OR: 10.8, 95% CI: 2.2 to
52.1) and ESV  157 ml (OR: 9.3, 95% CI: 1.9 to 45) were associated significantly with
non-viable myocardium.
Conclusion: Modified QRS Selvester score and ESV can predict non-viability in ische-
mic cardiomyopathy. Further prospective study to validate is needed.
Keywords: Ischemic Cardiomyopathy • Viability • QRS scores • ESV.
F56
OR.91. Accuracy of Malang ACS score as Self Assessment Checklist For Detecting
Myocardial Infarction In Diabetes Patients
Diah Ivanasari1,2, Muhamad Rizki Fadlan1,2, Monika Sitio1,2, Astrid Pramudya1,2, Ardani
Galih Prakosa1,2, M.Saifur Rohman1,2
1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya
University-dr.Saiful Anwar General Hospital, Malang East Java, Indonesia, 2Brawijaya
Cardiovascular Research Center, Brawijaya University
Background: Acute coronary syndrome, some times present in Diabetes patients with
atypical symptoms may range from silent myocardial ischemia to a wide spectrum of
non-chest pain symptoms.
Objective: The aims of this study to examined accuracy of Malang ACS score For
Detecting Myocardial Infarction In Diabetes Patients
Methods: Consecutive patients (n ¼ 118 subject’s (20 Yo) with the symptoms con-
cerning for ACS with diabetes admitted in our institution were included in this study.
after brief information by Resident of cardiology and vascular medicine, All partici-
pants were individually interviewed with a structured questionnaire for collecting
baseline characteristic and clinical sign to measure Malang ACS score Each partici-
pant underwent 2 methods of screening: Malang ACS score and 12-lead electrocardio-
gram with troponin level.We used X2 for determaining Sensitivity and specificity. The
predictive performance of the score was maintained in ROC curve.
Result: We found 68,6% patient’s with myocardial infarciton and 69,2% subject’s
were male, mean age of this subjects were 57,7968,35 Yo. Mean of random blood
glucose was not difference between ACS with diabetes and Diabetes with Non ACS
(188,6625.6 vs 182,46628.8 mg/dl, respectively, p ¼ 0,48). A multivariate logistic
regression analysis test showed that Known coronary artery disease or  3 risk fac-
tors, Pain radiates to arm and shoulder, Radiating Chest Pain to the Back, Pain can
be associated with pressure, fullness, or tightness in the chest, Duration >
20 minutes, Pain occurred or worsened with inspiration, Epigastric chest pain or
reproduced by palpation were predictors for myorcardial infarciton. MALANG ACS
score had an area under the receiver operating curve (AUC) of 0.783 (95% CI 0.84 to
0.92) with a sensitivity of 0.755 (95% CI 0.73 to 0.82) and a specificity of 0.748 (95%
CI 0.72 to 0.81) at a cut-off score of 10 on the scale.
Conclusion: In this study, we suggest that MALANG ACS score has a high sensitivity
but relatively low specificity for detecting ACS in diabetes patients. It is therefore
useful for ruling out myocardial infarction. It may also be a useful for screening myo-
cardial infarction in diabetes patients.
Keywords: ACS score • Self Checklist • Myocardial infarction
OR.92. Correlation between Wire Crossing Time with Left Ventricular End-
Diastolic Pressure in Patients with ST Segment Elevation Myocardial Infarction
Undergoing Primary Percutaneous Coronary Intervention
Indra W. Nugraha, Nahar Taufiq, Anggoro B. Hartopo
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas
Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
Background: Mortality and morbidity in acute myocardial infarction depend on the
extent of the infarct area. Rapid recovery of coronary artery blood flow with primary
percutaneous coronary intervention (primary PCI) can limit the extent of infarction
and improve left ventricular function. Acute myocardial infarction will reduce sys-
tolic and diastolic function. In the early stages of diastolic dysfunction, there is an
increase in left ventricular end-diastolic pressure (LVEDP). The E/e’ ratio is an accu-
rate non-invasive predictor of increasing LVEDP and has a strong positive correlation.
Objective: To determine the Correlation between Wire Crossing Time with LVEDP in
Patients with ST Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary
PCI
Method: This was a cross-sectional study enrolling 40 consecutive patients with
STEMI who underwent primary PCI at Sardjito Hospital from December 1st, 2018 –
January 15th, 2019. The wire crossing time is calculated from the onset of typical
anginal chest pain until the guide wire crossing the infarct-related artery during the
primary PCI procedure. Echocardiography examination is performed within 48 hours
after the primary PCI. Correlation between the wire crossing time and the E/e’ ratio
was assessed by the Pearson test. The value of p < 0.05 was considered statistically
significant.
Result: A total of 40 patients were included in this study. The average wire crossing
time was 12.73 6 5.22 hours. The median value of the E/e’ ratio was 8.36 (minimum
– maximum range: 4.71 - 22.00). From the correlation analysis, there was a signifi-
cant relationship between the wire crossing time and the E/e’ ratio (r ¼ 0.572;
p < 0.001). Patients with E/e’ ratio >15 had longer wire crossing time than in patient
with E/e’ ratio 15 respectively (20.21 6 2.5 hours vs. 11.41 6 4.39 hours;
p < 0.001).
Conclusion: There is a significant correlation between the wire crossing time and
LVEDP in STEMI patients who underwent primary PCI. Subject groups with an E/e’
ratio >15 have a longer wire crossing time.
Keywords: STEMI • Primary PCI • wire crossing time • LVEDP • E/e’ ratio
Abstracts
OR.93. SHOuld We CArry Out an InvaSivE Strategy in Patients with Acute
Myocardial Infarction Without ST-Segment Elevation in Accordance with The
American and European Guidelines? [SHOWCASE-AMI Study]
Hendry P. Bagaswoto1, Stephanie Salim2, Dian Zamroni2, Bambang Widyantoro2, Siska
S. Danny2, Isman Firdaus2, Irmalita2, Daniel P.L. Tobing2, Dafsah A. Juzar2
1
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Gadjah Mada – Sardjito Hospital, Yogyakarta, Indonesia, 2Department of Cardiology
and Vascular Medicine, School of Medicine, Universitas of Indonesia – National
Cardiovascular Heart Center Hospital, Harapan Kita, Jakarta, Indonesia
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: The issue of comparing results between invasive and conservative strat-
egies in patients with non ST-segment elevation acute coronary syndrome (NSTE-ACS)
has been widely discussed. The European and American guidelines recommends inva-
sive strategies in patients with moderate to high risk because this provides favorable
clinical outcomes. This has never been studied in Harapan Kita National Heart Center
(HK-NHC).
Objective: To find out how the invasive strategy influences the clinical outcome of
NSTE-ACS patients.
Method: This study was conducted from June 2018 to January 2019. All NSTE-ACS
patients with high or very high risk who were hospitalized fulfilled the inclusion cri-
teria. The primary outcome was a death due to any cause. Secondary outcomes were
the incidence of stroke, rehospitalization and repeated revascularization. All out-
comes was defined as composite end-point. Bivariate analysis was performed to ana-
lyze the effect of conservative versus invasive strategies on the clinical outcome of
the patients and and p < 0.05 showed significant results in this study.
Result: Of the 637 NSTE-ACS patients, 338 patients were finally included in this study
because they met the inclusion criteria. Furthermore, 243 patients underwent con-
servative therapy, while the remaining 95 patients underwent invasive strategies. In
our study, invasive strategies are associated with insignificant reduction in risk to pri-
mary outcomes (OR 0.90), but on the contrary have the potential to increase the
incidence of hospitalization (OR 1.56), repeated revascularization (OR 2.57), stroke
(OR 2,59) and composite end-point (OR 1.35) at 1-month of follow-up. The same
results were obtained when the analysis was conducted in a group of patients with
GRACE score >140.
Conclusion: Invasive strategies reduce the risk of death compared to the conserva-
tive approach, although not statistically significant. This was also found in patients
with GRACE score >140.
Keywords: NSTE-ACS patients • invasive strategy • clinical outcomes
OR.94. Clinical Features of Aortic Dissection Patients in National Cardiovascular
Center Harapan Kita, Jakarta, Indonesia
Rissa U. Setiani1, Mohamed Amshar2, J.H.T. Kevin Moses2, Edwin A.D. Batubara2,
Suko Adiarto2, Taofan2, Suci Indriani2
1
Cardiology and Vascular Department, Faculty of Medicine, Universitas Indonesia,
National Cardiovascular Center, Harapan Kita Hospital, Jakarta, Indonesia, 2Vascular
Division, Cardiology and Vascular Department, Faculty of Medicine, Universitas
Indonesia, National Cardiovascular Center, Harapan Kita Hospital, Jakarta, Indonesia
Background: Aortic dissection is an uncommon disease that exhibits a variety of clin-
ical manifestations, from asymptomatic to a life-threatening condition that requires
urgent treatment. Our aim is to describe the clinical features of aortic dissection
patients in National Cardiovascular Center Harapan Kita (NCVCHK), Jakarta,
Indonesia.
Method: This study was a cross-sectional study. Data were collected from medical
records. Subjects were patients diagnosed with aortic dissection from 2017-2019.
Results: 134 subjects were involved in this study. 50.7% subjects had DeBakey Type
III aortic dissection (Stanford B), while 40.3% and 9.0% had DeBakey Type I and Type
II aortic dissection (Stanford A) respectively. 61.2% subjects presented with acute
onset. 78.4% subjects were male, and 60.9% subjects were below 60 years old. 59.7%
subjects had thoracic aortic aneurysm. 88.8% subjects had hypertension. 75.4% sub-
jects experienced abrupt pain (52.2% sharp quality, 17.2% tearing/ripping quality,
6.0% other qualities), in which 34.3% subjects had chest pain, 26.9% back pain, and
14.2% abdominal pain. D-dimer level was elevated in 93.1% subjects (median value
3210 ng/mL) and fibrinogen level was elevated in 35.7% subjects (median value
399 mg/dL). Complications that occurred include acute renal failure (20.1% sub-
jects), pleural effusion (11.9%), stroke (11.2%), heart failure (6.7%), aortic rupture
(5.2%), cardiac tamponade (4.5%), limb ischemia (4.5%), mesenteric ischemia (3.7%),
acute pulmonary edema (1.5%) and acute coronary syndrome (0.7%). 44.6% subjects
were hospitalized > 10 days (median length of stay 9 days), and intrahospital mortal-
ity rate was 13.4%. Endovascular intervention was conducted in 38.8% subjects, sur-
gery in 26.9% subjects, hybrid in 6.7% subjects, and conservative treatment in 27.6%
subjects.
Conclusion: There is a diverse clinical manifestation of aortic dissection patients in
NCVCHK. Clinicians need to be aware regarding this matter in order to establish a
proper diagnosis and treatment for the patient.
Keywords: Aortic dissection • Aorta • National Cardiovascular Center Harapan Kita
Abstracts
OR.95. Assessment of Myocardial Reperfusion using TIMI Flow Grade after
Intravenous Thrombolytic versus Primary Percutaneous Coronary Intervention
(PCI) with Intracoronary Bolus of Thrombolytic in ST-segment Elevation
Myocardial Infarction within 12 Hours of Symptom Onset
Fildzah Y. Rizal, Harris Hasan, Zulfikri Mukhtar, Ali N. Nasution, Dika Ashrinda
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: The presence of intracoronary thrombus and impaired Thrombolysis in
Myocardial Infarction (TIMI) flow are risk factors associated with adverse cardiovascu-
lar events. Reperfusion therapy using thrombolytic agents has been used to mini-
mized this thrombus burden.
Objective: We investigated myocardial reperfusion in acute ST-segment Elevation
Myocardial Infarction (STEMI) patients undergoing reperfusion therapy then com-
pared the result between different administration of thrombolytic therapy; intrave-
nous and intracoronary during Primary PCI.
Methods: This study included 66 patients with acute STEMI within 12 hours of symp-
tom onset who underwent reperfusion therapy. First group received 100mg intrave-
nous administration of alteplase and the other got low dose (3.5-5mg) intracoronary
bolus of alteplase during Primary PCI. Both groups were compared in terms of epicar-
dial coronary flow after each reperfusion therapy measured by TIMI flow grade.
Results: There was no difference in cardiovascular risk profile or cardiac history
between two groups. But there was a significant difference of onset to reperfusion
between groups. The intravenous thrombolytic group tend to received reperfusion
therapy earlier than the primary PCI group (p < 0.01). All patients from both groups
obtained successful reperfusion, with TIMI flow grade II and III. The primary PCI group
had 28 patients (84.8%) with TIMI Flow III while the thrombolytic group had 19 patients
(57.6%). It shows that the primary PCI with intracoronary administration of alteplase
restored epicardial coronary flow better. (OR ¼ 4.13; 95% CI 1.23 – 13.37; p < 0.05)
Conclusion: Local intracoronary bolus of thrombolytic therapy during primary PCI
restore myocardial perfusion better than systemic intravenous administration.
However, conventional intravenous thrombolytic therapy in early onset before trans-
ferring patients to the PCI centre, remains a good option for reperfusion due to lot
of limitation of mechanical intervention therapy.
Keywords: TIMI flow • thrombolytic • intracoronary • primary PCI • STEMI
OR.96. A Simplified Risk Scoring System Provides Good Prediction for in-Hospital
Mortality among Patients with Acute Heart Failure: A Cohort Study from the
Malang Heart Failure Registry
Putri Annisa Kamila, Mohammad Saifur Rohman
Departemen of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya, Saiful Anwar General Hospital Malang, Malang, Indonesia
Background: Acute heart failure is a leading cause of hospitalization and death.
Early identification of risk factors that contribute to in-hospital mortality may
improve prognosis and aid in decision making.
Objective: The objective of this study was to develop a risk score for in-hospital
mortality in patients hospitalized with acute heart failure.
Method: This was a cohort study, analyzed 555 patients that were admitted to the
Intensive Cardiovascular Critical Care for acute heart failure. Patients were divided
into two groups, derivation and validation set, with amounts of 155 and 400 patients
respectively. Independent risk factors for in-hospital mortality were obtained by mul-
tiple logistic regression using stepwise variable selection method, and used to estab-
lished the risk score. Model performance was assessed using an area under the
receiver operating characteristic curve (AUC) and C-statistic Test.
Result: Data from 555 patients with acute heart failure were included in the analy-
sis. The final model included 7 independent variables (age, New York Heart
Association functional class, heart rate, systolic blood pressure, potassium level,
sodium level and glomerular filtration rate). The risk scoring system showed good dis-
crimination, provides AUC for derivation and validation set, 0.813 (95% CI 0.699-
0.868) and 0,811 (95% CI 0.702-0.920) respectively. The specificity and sensitivity of
the score was 0.807 (95% CI 0.77-0.816) and 0.802 (95% CI 0.785-0.822), respectively.
Conclusion: The risk scoring system provide good prediction for in-hospital mortality
in patient with acute heart failure.
Keywords: acute heart failure • risk score • mortality
OR.97. Ascosiation Between Time to Wire Crossing with Echocardiography
Finding E/e’ ratio in Acute ST-Elevation Myocardial Infarction (STEMI) in Patients
Underwent Primary Percutaneus Coronary Intervention (PPCI)
F. Jaya, I. W. Nugraha, H.P. Bagaswoto, N. Taufiq, A.B. Hartopo
Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas
Gajah Mada- dr Sardjito Hospital Yogyakarta, Indonesia
Background: The aim to this study is to identify the correlation between time to
wire crossing with echocardiography finding E/e’ ratio in STEMI patients underwent
primary PCI in Sardjito General Hospital
F57
Objective: Acute myocardial infarction (AMI) is a leading factor associated with heart
failure. The ratio of early transmitral flow velocity (E) to early diastolic septal or lateral
mitral annulus velocity (E/e’) has been shown to be the most accurate noninvasive pre-
dictor of elevated LV filling pressure. An elevated E/e’ ratio, especially more than 15
can predict poorer prognosis following MI. We hypothesized that delayed time to reper-
fusion will be associated with worsening E/e’ ratio in patients underwent PPCI
Methods: This study enrolled 40 STEMI patients who underwent PPCI in December
2018 until January 2019 who received echocardiographyc examinations within
48 hours of hospitalization.
Results: Median time to wire crossing, defined as the time from symptom onset to guide
wire crossing infark related artery, was 12.73 6 5.22 hours. Median time echocardiogra-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
phy examination was 18.04 6 9.48 hours. From echocardiographyc finding, median LVIDd
was 45.05 6 6.48 mm, median ejection fraction (Simpsons) was 42.5 6 9.26%, median
TAPSE ¼ 17.80 6 5.21 mm, median E/A ratio was 0.82 and median E/e’ ratio was 8.36.
Patien with E/e’ratio  15 was 34 (85%) patiens and E/e’ ratio > 15 was 6 (15%)
patients. There were a positive correlation between time to wire crossing and E/e’ ratio,
which patients with E/e’ ratio >15 had longer time to wire crossing with p < 0.001.
Conclusion: prolonged time to wire crossing correlated with elevated E/e’ ratio
Keywords: time to crossing wire • E/e’ ratio • primary PCI
OR.98. Renal insufficiency is associated with admission diagnosis and length of
stay in patients with hypertensive heart disease and atrial fibrillation
Faris Jaisyi Umam1, Fadhian Akbar1, Arieska Ann Soenarta2, Bambang Widyantoro2
1
Faculty of Medicine, Universitas Indonesia, 2Department of Cardiology and Vascular
Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center
Harapan Kita Hospital
Background: Hypertension Heart Disease (HHD) is most common form of hyperten-
sion mediated organ damage (HMOD) among hypertensive patients. The condition
which characterized by left ventricular hypertrophy (LVH) and increased of LV mass
index often leads to structural changes resulting in the presence of Atrial Fibrillation
(AF). Patients who suffered from HHD and AF concomitantly have been reported to
show worse outcome and higher mortality.
Objective: This study aimed to investigate factors associated with in hospital out-
come and length of stay in patients admitted with HHD and AF.
Method: Data of patient with HHD and AF were collected retrospectively from elec-
tronic medical record in National Cardiovascular Centre Harapan Kita. Then, we ana-
lyzed contributing factors related to length of stay and diagnosis at admission.
Result: There were 160 patients hospitalized with HHD and AF during 2018. They were
diagnosed with acute decompensated heart failure (ADHF; 65,2%), AF rapid ventricular
response (18,6%) and acute coronary syndrome (3,7%) at admission. The most common
co-morbidity was Diabetes Mellitus (36%). Median eGFR was 56 ml/min/1,73 m2 (IQR
42-76). From multivariate analysis, we observed correlation of renal insufficiency
(eGFR < 60) with ADHF and AF RVR in admission (OR 2,525; 95%CI: 1,193 – 5,342 and
OR 2,674; 95%CI: 1,261 – 5,673; respectively). There was significant difference of
length of stay among different stages of renal insufficiency based on eGFR (p < 0,05).
Conclusion: Among the patients with HHD and AF, renal insufficiency is associated
with ADHF and AF RVR in admission diagnosis. Stages of renal insufficiency is also
associated with difference in length of stay.
Keywords: hypertensive heart disease • atrial fibrillation • renal insufficiency •
admission diagnosis • length of stay
OR.99. Characteristic of Subjects with High Expression of Galectin-3 Level on
Myocardial Infarction: a Perspective Adverse Cardiac Remodelling
I.N.I Mataram1, W. Aryadana2, A.A.W. Lestari3
1,2
Department of Cardiology and Vascular Medicine, Sanglah General Hospital,
Faculty of Medicine, Udayana University, Bali, Indonesia, 3Department of Clinical
Pathology, Sanglah General Hospital, Faculty of Medicine, Udayana University, Bali,
Indonesia
Background: Galectin-3 (Gal-3), a biomarker associated with fibrosis and inflamma-
tion has been implicated in heart failure (HF). HF frequently develops after myocar-
dial infarction (MI). Several factors has been found to be related with high circulat-
ing Gal-3. This study aimed to know characteristic of MI subjects with high
expression of Gal-3.
Methods: Descriptive, cross-sectional study was conducted. Serum Gal-3 was meas-
ured on the admission time simultaneously with assessing patient’s clinical profile
and angiographic parameters.
Results: High level Gal-3 was determined by receiver operating characteristic (ROC)
curve and yields value of 7.67 ng/ml according to study. Subjects with high expres-
sion of Gal-3 (> 7.67 ng/ml) in their serum has mean age 57 6 2 years, dominantly
male on 45 (73%) subjects, normal body mass index (BMI) on 34 (55%) subjects, domi-
nantly without existing chronic HF on 45 (73%) subjects, without DM on 37 (60%) sub-
jects, without hypertension on 28 (45%) subjects, smoking on 33 (53%) subjects.
Subjects have mean symptom onset 8 6 1 hours, with further classified as onset of pre-
sentation within 12 hours on 45 (85%) subjects, presenting with acute heart failure or
F58
advanced killip class (III-IV) on 28 (45%) subjects, and assessment with STEMI on 48
(77%) subjects. Subjects dominantly classified into 3VD on 18 (29%) subjects according
coronary lesion complexity from angiographic view, IRA in LAD on 41 (66%) subjects,
infarcted region dominantly affecting anterior wall on 40 (65%) subjects, MBG pre-pro-
cedure 1 on 38 (61%) subjects, and TIMI flow pre-procedure 0 on 21 (34%) subjects.
Conclusion: High Gal-3 level in serum was dominantly found on male, normal BMI,
and smoking habit. Subjects present within 12 hours of onset, affected anterior
infarction region, CAD/3VD, IRA on LAD, low MBG, and low TIMI flow pre-procedure.
Keywords: galectin-3 • myocardial Infarction • adverse cardiac remodelling •
anterior infarction • MBG • TIMI flow
OR.100. Blood Culture-Negative Endocarditis: Risk Factors of In-Hospital
Mortality
Lira Firiana1, Radityo Prakoso1, Bambang B. Siswanto1
Departemen of Cardiology and Vascular Medicine, Faculty of Medicine Universitas
Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Infective endocarditis (IE) is a life-threatening disease with high mortality
rates despite recent advances in diagnostics, pharmacotherapy, and surgical interven-
tion. Risk stratification in IE patient is very important because this information can help
in deciding better treatment. However, until now, very limited study regarding factors
associated with mortality in blood culture-negative infective endocarditis (BCNIE),
despite difference in patient’s characteristics compared to general IE population.
Objective: The aim of this study is to identify risk factors associated with in-hospital
mortality in BCNIE patients.
Method: A retrospective cohort study was conducted at National Cardiovascular Center
Harapan Kita, Jakarta in BCNIE patients from 2013-2018. Patient characteristics, clinical
parameters, echocardiographic parameters and clinical complications are categories of
variables collected through medical records and hospital information systems. The data
were then processed by multivariate analysis using logistic regression method.
Result: There were 146 patients with BCNIE, with in-hospital mortality rate 13.5%,
higher than patient with positive blood culture (10.6%). Factors related to mortality
are heart failure functional class III and IV (p ¼ 0.011), worsening kidney function
(p < 0.001) and stroke event (p ¼ 0.001).
Conclusion: Presence of heart failure with NYHA functional class III and IV, worsening
kidney function and stroke during hospitalization are risk factors that associated
with in-hospital mortality in BCNIE patients.
Keywords: risk factors • infective endocarditis • blood culture negative • pre-
dictors • mortality.
OR.101. Role of Lp-PLA2 Selective Inhibitor (Darapladib) in Lowering Lipid
Profile, Blood Glucose and Aortic Tissue Inflammation at Type 2 Diabetes Mellitus
Rat Model
D.Z.P. Andiyani1, D.P. Widiaputro2, T.A. Wihastuti1, T. Heriansyah3
1
Faculty of Medicine, Brawijaya University, Malang, Indonesia, 2Faculty of Medicine,
Mataram University, Mataram, Indonesia, 3Faculty of Medicine, Syiah Kuala
University, Banda Aceh, Indonesia
Background: Type 2 diabetes mellitus (T2DM) is one of the most non communicable
disease involving multiple genes and environmental factors that characterized by
impaired insulin secretion through a dysfunction of pancreatic b-cells and insulin
resistance. It is associated with an increased risk of atherosclerotic cardiovascular
disease. Prolonged exposure of hyperglycemia altered vascular homeostasis and asso-
ciated with vascular inflammation that has been hypothesized underlying atheroscle-
rosis process in T2DM condition. Both free fatty acid and advanced glycation end
product directly activate nuclear factor-jB (NF-jB) that required for the transcrip-
tion of most proinflammatory molecules, adhesion molecules, and cytokine in the
pathology of atherosclerosis and diabetic complication. Lipoprotein-associated phos-
pholipase A2 (Lp-PLA2) is an enzyme circulated in blood and found in atherosclerotic
lesion. This enzyme has a dualism since it has anti inflammatory properties to hydrol-
ize pro-inflammatory glycerophospholipid PAF; and has pro inflammatory properties
since its substrate generates lysophosphatidylcholine and oxidized fatty acid. Lp-
PLA2’s pathways that related to inflammation has been hypothesized to have a role
in atherosclerotic process. Darapladib is reversible Lp-PLA2 inhibitor that inhibits Lp-
PLA2’s mass and activity both in mRNA and protein level. However, studies show con-
troversial results about Lp-PLA2’s role in cardiovascular disease.
Objective: This study aimed to measure lipid profile, blood glucose level and aortic
tissue inflammation such as NF-jB activation with Lp-PLA2 selective inhibitor treat-
ment in T2DM sprague dawley rat model.
Method: This research used experimental laboratory and serial posttest with control
group design. Thirty Sprague-Dawley rats were divided into 3 main groups: normal
group, T2DM group, and T2DM with darapladib treatment (DMDP) group. Each group
was divided into 2 serial time treatments, 8 weeks and 16 weeks. Control group was
given normal rats food while T2DM induction was done by giving high fat diet (HFD)
and low dose streptozotocin (STZ) 30 mg/kgbw. Darapladib was given orally 20 mg/
kgbw once daily according to the serial time group given. Lipid profiles measured
Abstracts
total cholesterol, high density lipoprotein (HDL) cholesterol and low-density lipopro-
tein (LDL) cholesterol in rat blood serum. T2DM was diagnosed by measuring blood
glucose level taken from rat’s tail and insulin level in rat’s blood plasma. Activation
of NF-jB expression was measured by immunofluorescence staining and quantita-
tively analyzed using Olympus FluoViewSoftware v.1.7A. Software statistical product
and service solution (SPSS) v.22 with significance level 0.05 (p ¼ 0.05) and confident
interval 95% (a ¼ 0.05) is used for data analysis.
Result: Darapladib exhibited significant reduction of LDL-cholesterol and reduction
of fasting blood glucose as mentioned in table 1 (p < 0.05). Immunofluorescence
analysis shows darapladib significantly reduced NF-kB activation in T2DM group near
to normal level as shown in figure 1.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Conclusion: Darapladib as Lp-PLA2 selective inhibitor can restore evidence of dyslipide-
mia and hyperglycemia at in T2DM Sprague dawley rat model. It also reduced aortic tis-
sue inflammation though inhibition of NF-kB activation. This study suggested that Lp-
PLA2 played a role in pro inflammation process occurring in the metabolic disorder.
Keywords: Lp-PLA2 • Darapladib • NF-kB • Atherosclerosis • Type 2 Diabetes
Mellitus
OR.101. Table 1 LDL cholesterol and fasting blood glucose in each group
Variable Group 8 weeks 16 weeks treatment
treatment
LDL cholesterol (mg/dL) N 49,83 þ 5,06 19,54 þ 3,57
DM 95,53 þ 8,66 88,24 þ 6,23
DMDP 85,92 þ 6,84 61,52 þ 6,03
Fasting blood Glucose (mmol/L) N 5,24 þ 0,23 4,7 þ 0,56
DM 8,46 þ 0,91 7,89 þ 0,28
DMDP 5,46 þ 0,63 5,44 þ 0,60
OR.101. Figure 1a mean expression of NF-kB activation and b) immunofluorescence
staining of NF-kB in each group
OR.102. Prediction Score of Chronic Total Occlusion Percutaneous Coronary
Intervention Success In DR. Kariadi Central General Hospital Semarang
Anggit Pudjiastuti, Sodiqur Rifqi, Sefri N. Sofia, Suhartono
Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro University,
Dr. Kariadi Central General Hospital Semarang
Background: Percutaneous coronary intervention (PCI) for chronic total occlusion
(CTO) is a difficult procedure associated with increased risks of failure and periproce-
dural complications. Characteristics of CTO lesion are independent predictors of PCI
success. A prediction score consist of lesion characteristics can help a pre-procedural
assessment to improve the procedural success. Various prediction score had been
established but none had been validated or established in Indonesian population.
Objective: To establish prediction score of CTO PCI succes based on local Indonesian
population
Methods: We analyzed 200 patients underwent CTO PCI in Dr.Kariadi Hospital during
2018. A CTO was defined by angiography as a coronary occlusion without antegrade
filling of the distal vessel other than via collateral with estimated duration had to be
more than 3 moths. Success of CTO PCI was defined as successfull stent implantation
with <20% residual stenosis and TIMI flow III. Bivariate and multivariate analysis
were used to identify independent predictors and to establish a scoring model.
Results: All of the procedure included in this study used an antegrade CTO PCI
approach. Success rate was 75.5%. Five independent predictors were found and used
for establishing a prediction score as follows: bending (1 point), calcification (2
points), blunt stump (3 points), long lession (1 points), and poor retrograde collateral
filling (2 points). Score value  3 was categorized as difficult lesion with probability
of success < 55.3% and had OR 15.4 compared to score value <3. The scoring model
Abstracts F59

had good callibration and discrimination capacity to predict procedural success OR.103. The Correlation between Wire Crossing Time and P Dispersion in ST-
(Hosmer-lemeshow p ¼ 1.000 and ROC¼0.883). Elevation Myocardial Infarction Patient Performed Primary Percutaneous
Conclusion: Five independent predictors of CTO PCI-success were identified and Coronary Intervention
included in the prediction score as follows: bending, calcification, blunt stump, long
A Sakrie, IW Nugraha, F Hidayati, AB Hartopo, N Taufiq
lession, and poor retrograde collateral. Score value 3 classified as difficult CTO
Cardiology and Vascular Medicine Gadjah Mada University/ Sardjito General Hospital
lesion and had higher probability of failure compared to score value <3 (OR 15,4).
Keywords: CTO • PCI • success • prediction score
Background: Clinical evidence shows P-wave dispersion (Pwd) as a simple parameter
OR.102. Table 1 Bivariate analysis to predict atrial fibrillation (AF). The prevalence of AF in acute myocardial infarction
(AMI) patients was reported as 10-20%. Recent studies indicate a significant reduction
of AF in revascularized AMI patient.
Variable All subjects Success CTO Failure CTO p

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

Objective: This study objective is to determine the association between Pwd and
(n ¼ 200) PCI (n ¼ 151) PCI (n ¼ 49)
wire crossing time in ST-elevation myocardial infarction (STEMI) managed with pri-
mary percutaneous coronary intervention (PCI).
Target Vessel of CTO PCI
Method: We enrolled STEMI patient who has been admitted to Sardjito Hospital since
LAD 97 (48,5%) 69(45,7%) 28(57,1%) 0,164
December 2018 – January 2019 and fulfilled as a subject criteria. The Pwd were measured
LCX 23 (11,5%) 20(13,2%) 3 (6,1%) 0,174
using ImageJ program. Clinical examination and echocardiography result were recorded.
RCA 80 (40,0%) 62(41,1%) 18(36,7%) 0,591
Result: Thirty seven patients (31 males and 6 females) were included in this study with
Ostial lesion 2 (1,0%) 1 (0,6 %) 1(2,0%) 0,431
mean age was 57.31611.07. Patients had hypertension and diabetes melitus were 26
Side branch 66 (33,0%) 43 (28,5%) 23 (46,9%) 0,017
patients (65%) and 14 patients (14%) respectively. There were 18 patients with diagnose
Bending >450 9 (4,5%) 2 (1,3%) 7(14,3%) 0,001
anterior STEMI and the others were inferior STEMI. Mean wire crossing time was 150.026
Calcification 30 (15,0%) 14 (9,3%) 16 (32,7%) 0,000
44.91 (minutes), mean EF was 43.0869.37. We found that there is a non-significant
Blunt stump 55 (27,5%) 21(13,9%) 34(69,4%) 0,000
positive correlation between wire crossing time and P dispersion (P > 0.05; R ¼ 0.053).
Long lesion 30 (15,0%) 12 (7,9%) 18 (36,7%) 0,000
Conclusion: These findings suggest that there is non-significant positive correlation
Bridging collateral 160 (80,0%) 126(83,4%) 34(69,4%) 0,033
between Pwd and wire crossing time in patients with STEMI underwent primary per-
Collateral retrograde <2 14 (7,0%) 1(0,6%) 13(26,5%) 0,000
cutaneous coronary intervention.
Keywords: P-wave dispersion - Wire crossing time – STEMI – Percutaneous coronary
intervention
OR.102. Table 2 Multivariate Analysis

Variable OR 95%CI (min-max) P OR.104. Transcatheter or Surgical Pulmonary Valve Replacement in Congenital
Heart Disease Patients with Ventricular Outflow Tract Pathology: A Meta-Analysis
Collateral retrograde <2 44,313 4,368-449,650 0,001 and Systematic Review
Blunt stump 11,530 4,620-28,774 0,000
Bending 7,002 0,818-59,907 0,076 Indra Utami, Andi Wiliam, Radityo Prakoso
Calcification 6,274 2,144-18,361 0,001 Departemen of Cardiology and Vascular Medicine Faculty of Medicine, Universitas
Long lesion 3,612 1,123-11,611 0,031 Indonesia, National Cardiac Centre Harapan Kita, Indonesia

Background: Transcatheter pulmonary valve replacement (TPVR) has been one of

OR.102. Table 3 Scoring calculation the greatest advances in interventional catheterization over the past decade. It is
increasingly utilized to address right ventricular outflow tract pathology in congenital
Variable B SE B/SE Score Final score heart disease patients as it allows for intervention before the development of ven-
tricular dysfunction while decreasing the number of sternotomies required over a
Collateral retrograde <2 3,791 1,182 3,207 1.805 2 lifetime. While this approach might seem attractive to both patients and physicians,
Blunt stump 2,445 0,467 5,236 2,946 3 available literature is still limited due to small patient population, and it does not
Bending 1,946 1,095 1,777 1 1 reflect massive procedural practice pattern change over the last decade.
Calcification 1,836 0,548 3,350 1,885 2 Objective: To describe the comparative benefits and pitfalls of TPVR over SPVR for
Long lesion 1,284 0,596 2,154 1.212 1 congenital heart disease patients with right ventricular outflow tract pathology
Total Score value 9 Method: A systematic search was conducted using MEDLINE, CENTRAL, and EBSCO
databases, identifying all relevant studies with comparative data on TPVR versus
SPVR published until April 2019. The primary outcomes were 30-day mortality and
echocardiographic indicators. We also included secondary outcomes such as peripro-
cedural complications, reintervention rate, length of stay, and hospital cost.
Qualities of studies were assessed according to The GRADE tool. Analysis of the
results were performed with random effect model (Mantel-Hanszel method) using
RevMan to calculate the mean difference or pooled risk ratio (RR).
Result: In 7 retrospective cohorts, 648 patients underwent TPVR and 1494 patients
underwent SPVR. We found no difference in mortality (pooled RR 0.78, CI 0.19 – 3.16
), or pulmonary valve (PV) reintervention rate (pooled RR 0.57 CI 0.17 – 1.89)
between 2 groups. Peak pulmonary valve gradient as indicators of PV function was
3.7 mmHg higher (mean difference 0.38 – 7.13 mmHg) in TPVR cohorts. In terms of
periprocedural outcomes, TPVR group has significantly lower incidence of major hae-
morrhage (pooled RR 0.24, CI 0.06 – 0.98)
Conclusion: Our study provides favourable updated estimates of clinical outcomes with
marginally higher mean hospital cost after transcatheter pulmonary valve replacement
Keywords: Congenital Heart Disease • Transcatheter Pulmonary Valve

OR.105. Effect of Angiotensin Converting Enzyme Inhibitors or Angiotensin

Receptor Blockers Consumption and new Onset Lung Cancer: A Systematic
Review and Meta-Analysis
Aditya A. Adam1,2, Eliana Susilowati1, Fania D. Aslamy1, Maltadilla R. Hajjrin1, Galuh
I. Nirwana1, Nadia Ovianti1,3, Hanani Octaviani1, Cholid T. Tjahjono1,4
1
Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia, 2Prof. Dr.
W.Z. Johannes General Hospital, Kupang, East Nusa Tenggara, Indonesia, 3Baptist
Hospital, Batu, East Java, Indonesia, 4Departement of Cardiovascular, Saiful Anwar
General Hospital, Malang, East Java, Indonesia

Background: Controversies of angiotensin converting enzyme (ACE) inhibitors and

OR.102. Figure 1 Discriminatory capacity of prediction score (AUC) angiotensin receptor blockers (ARBs) with cancer was raising in recent years. Some
F60
meta-analysis showed those drugs could increase cancer risk, but some showed the
contrary.
Objective: Current study intended to determine the association between ACE inhibi-
tors or ARBs consumption and new onset of lung cancer.
Method: A systematic literature search of Pubmed/Medline, Science Direct, and
Cochrane Library from January 2000 to March 2019 was conducted. All authors
reviewed and selected articles based on predetermined criteria.
Result: From 1252 literatures, one randomized clinical trial (RCT) and 9 observatio-
nal cohort study were selected for analysis. Current study involved 4,148,928 partici-
pants. We found a significant no association between the use of ACE inhibitors or
ARBs and risk of new onset lung cancer (Relative risk [RR] 0.985 95% confidence
interval [CI] 0.898-1.080). Two studies showed positive effect of ACE inhibitors and
ARBs toward lung cancer incidents. The rest of studies that included in this meta-
analysis showed RR of no greater than 1, but also did not have sufficient protective
effect against lung cancer. Only 1 study correlated ACE inhibitors or ARBs inversely
toward lung cancer incidents. Thus, neither protective effects nor harmful effects of
angiotensin inhibitor toward lung cancer were proved in this study. No publication
bias was detected.
Conclusion: Overall, there was no association between the use of ACE inhibitors or
ARBs and risk of new onset lung cancer. But further studies are still needed to con-
firm this finding.
Keywords: Angiotensin converting enzyme inhibitors • angiotensin receptor block-
ers • lung cancer • meta-analysis
OR.106. Association Between the Severity of CAD and TP-e Interval, Tp-e/QT
Ratio Parameters Including Fragmented QRS in Patients Undergoing First
Coronary Angiography
Akhmad Hidayat1, Zunaidi Syahputra1, Zulfikri Mukhtar1, Harris Hasan1
1
Department of Cardiology and Vascular Medicine, Medical Faculty of Sumatera Utara
University, Adam Malik Hospital Medan, Indonesia
Background: Coronary angiography as the gold standard to detect and assess the
severity of CAD especially for the high risk patients and stable symptomatically can-
not be used widely in the peripheral area. Tp-e interval, Tp-e/QT ratio, Tp-e/QTc
ratio, including fragmented QRS (fQRS) can be used to stratify the CAD severity.
Objectives: To assess the correlation between ECG parameters on admission with the
CAD severity calculated by SYNTAX score in patients undergoing first coronary angiog-
raphy and without known vascular diseases and myocardial fibrosis.
Methods: This study included 41 angina pectoris patients who will be chateterized
from January 2018 to March 2018. The ECG parameters would be evaluated before
coronary angiography procedure. The coronary angiography results then would be
measured its SYNTAX score. Patients with history of ACS, previous PCI or CABG,
chronic kidney disease, valvular heart disease, age >65 years old, evidence of LVH
from ECG, incomplete and complete bundle branch block, and reduced EF were
excluded. The measurements were in the lead V2 and any lead for the fQRS.
Results: Of the 41 study subjects, 21 patients had fQRS, 15 among them were with
high SYNTAX score (22). Patients with fQRS significantly had higher SYNTAX score
and more severe stenotic lesions. Tp-e interval was significantly higher in high
SYNTAX score compared to low SYNTAX score (p < 0.001). TP-e/QT ratio was also sig-
nificantly higher in high SYNTAX score compared to low SYNTAX score (p < 0.027). In
addition, TP-e/QTc ratio was higher in high SYNTAX score compared to low SYNTAX
score (p < 0.004)
Conclusions: The higher frequency of fQRS, TP-e interval, Tp-e/QT ratio, TP-e/QTc
ratio were significantly associated with the higher SYNTAX score and extent and
severity of coronary lesions.
Keywords: fQRS • TP-e interval • TP-e/QT ratio • TP-e/QTc ratio • SYNTAX score
OR.107. The Significance of HEfGRASP as A Simple Scoring System Which
Comparable to EuroSCORE II for Improving Mortality Prediction After Cardiac
Surgery on Adam Malik Hospital, an Indonesian Subpopulation, North Sumatra
B. Napitupulu1, A. Nasution1, D. Prabisma2, H. Hasan1
1
Faculty of Medicine, Universitas Sumatera Utara, Department of Cardiology and
Vascular Medicine of Haji Adam Malik General Hospital, Medan, Indonesia.,
2
Department of Surgery, Sub Department of Thoracic and Vascular Surgery of Haji
Adam Malik General Hospital, Medan Indonesia
Background: Due to over or underestimation of its prediction over population
defined by such regional studies, the recommendation of EuroSCORE II has already
Abstracts
downgraded even by its previous performance on improving mortality prediction
among the high risk population in Europe. The need for a new scoring system is
increasing for EuroSCORE II has not been validated either over generally Asian popu-
lation or Indonesian subpopulation as well.
Methods: This is a crossectional study of preprocedural registry data on cardiac sur-
gery from January 2017-October 2018 in Cardiac Centre of H. Adam Malik Hospital
Medan. EuroSCORE II were tested for its accuracy and discriminating power to pre-
dict mortality by ROC analysis. Clinical and echocardiography parameters that are
found significantly corelated with mortality from bivariate analysis are proceed to
logistic regression then finalized to a simple scoring system.
Results: There are 164 patients with 17.6% mortality rate with EuroSCORE II
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
2.0560.27 are underestimating mortality rate within inhospital mortality
patients. From some parameters that are found significant until logistic regres-
sion, seven factors are statistically arranged into a scoring system abbreviated
into HEfGRASP. Calibration is adequate for both scores (p > 0.05). HEfGRASP
has a better AUC than EuroSCORE II (0.948 vs 0.656). For score 1 on EF < 50%,
age>60 years, RVFrac<40%, PASP >30mmHg and a valve type surgery, then 2
on HbA1C>6% and GFR<70 mL/min, HEfGRASP equal or more than 4 has a 5.97%
mortality rate with 100% sensitivity and 65.7% specificity with mean value
3.562.17.
Conclusion: Our local scoring system, HEfGRASP is an helpful tools for predicting
mortality after cardiac surgery for its better compatibility and suitability over our
population in North Sumatra. HEfGRASP are challenged to be applied on cardiac
centres around ASEAN that have similar population and hospital resources.
Keywords: EuroSCORE II • HEfGRASP • cardiac surgery • ASEAN • scoring
OR.108. Analysis of Baseline Patient Characteristics on the Indonesian PCI
Registry
A.A. Alkatiri1, D. Firman1, N. Haryono1, E. Yonas2, R. Pranata2, I. Fahri3,
I.M.J.R. Artha4, V. Pratama5, W.A. Widodo6, N. Taufiq7, A.H. Alkatiri8, S. Ng9,
H. Sulastomo10, S. Soerianata1
1
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, 2Research
Assistant, Indonesian Percutaneous Coronary Intervention Registry,Jakarta,
Indonesia, 3RSUD dr.M Yunus, Bengkulu, Indonesia, 4RSUP Sanglah, Bali, Indonesia,
5
Gatot Soebroto Central Army Hospital, Jakarta, Indonesia, 6Jakarta Heart Center,
Jakarta, Indonesia, 7RSUP dr Sardjito, Yogyakarta, Indonesia, 8RSUP dr Wahidin,
Makassar, Indonesia, 9Siloam Hospital Lippo Village, Tangerang, Indonesia, 10RSUP
Moewardi, Surakarta, Indonesia
Background: The Indonesia PCI registry is the first multicenter registry involving 9
centers across Indonesia. This study represents analysis done on baseline patient
characteristics based on data from the Indonesian PCI registry.
Objective: Our aim is to analyze and compare patient baseline characteristics
between patients who got assigned between radial and femoral access site for PCI.
Method: This is a retrospective study involving 5420 patients designed to evaluate
the clinical profile and outcome of patients. Data collections were performed
during cath lab visits and follow up visits. Data were pooled using forms issued by
the registry which are available online and offline. Data were pooled from 9 cen-
ters across Indonesia. Statistical analysis was then performed using IBM SPSS
Software.
Result: From the total of 5420 patients, 74.5% of patients received radial access
while 25.4% of patients received femoral access. Analysis of baseline patient
characteristics revealed several statistically significant results, Age were lower at
radial group ( 57.10 þ 9.916 vs 58.36 þ 9.689 p < 0.001), higher rates of male
patients received radial access ( 84.1% vs 81.4% p0.023), higher HF patients were
assigned to femoral group (25.3% vs 20.3% p < 0.001), higher CKD patients
received femoral access (11.9% vs 9.3% p0.007). Higher patients with 2nd&3rd
degree AV block received femoral access (2.5% vs 0.8% p < 0.001), higher patients
with documented significant CAD received femoral access (61.2% vs 46.6%
p < 0.001), higher proportion of patients with previous PCI and CABG received
femoral access (25.8% vs 37.5% p < 0.001) (4.6%vs 1.1% p < 0.001), and higher
patients with new onset angina received radial approach (21.4% vs 14.9%
p < 0.001).
Conclusion: Currently, more radial approach PCI was done in Indonesia. Patients with
worse clinical state such as heart failure, chronic kidney disease, AV block, signifi-
cant CAD, and previous revascularization tends to be assigned for femoral approach
PCI.
Keywords: PCI • Registry • Analysis • Baseline • patient characteristics.
Abstracts F61

OR.110. Outcomes of After-hours Versus Regular Working Hours Primary

Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction in
Adam Malik General Hospital
H.D. Putra, H. Hasan, M. Zulfikri, Ali N. Nasution
Department of Cardiology and Vascular Medicine, School of Medicine, North
Sumatera University, Medan, North Sumatera

Background: The new guideline from European Society of Cardiology stated that pri-
mary PCI is recommended if wire crossing for reperfusion with PCI is feasible
in  120 minutes with the performance quality indicator set < 90 minutes. An impor-

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

tant factor affecting outcome in primary PCI is delays to treatment, a particular con-
cern after regular working hours, when facilities must be activated and staff brought
in from home.
Objective: The aim of the study is to compare the outcome after-hours and regular
working hours primary PCI for ST-elevation Myocardial Infarction in Adam Malik
General Hospital.
Method: Using a registry from cardiac catheterization laboratory of Adam Malik
General Hospital, STEMI patients undergoing primary PCI from October 2018 to
February 2019 were screened for. Patients were divided into after-hours and work-
ing-hours admission. TIMI flow and Myocardial Blush Grade (MBG) as outcomes were
evaluated using Mann-Whitney test.
Result: A total of 10 patients (37%) were admitted during regular working-hours and
17 patients (67%) during after-working hours for primary PCI (table 1). Median door
to wire time was 138 minutes, much longer than guideline recommendation. An inde-
pendent sample T-test (figure 1) revealed that door to wire time in after-working
hours group was significantly longer than regular-working hours group (155.76 vs
112.80; p < 0.05). Final analysis for outcomes concluded that no statistically differ-
ence in TIMI flow post primary PCI and MBG between regular and after-working hours
group (p ¼ 0.464 & 0.580, table 2).
Conclusion: Door to wire time of primary PCI was statistically different between reg-
ular-working hours and after-working hours admission. Still, no difference for TIMI
flow post primary PCI and MBG in both groups as the outcomes.
Keywords: primary PCI • after working hours • door to wire

OR.109. Impact of Coronary Artery Disease to Outcomes in Intracerebral

Hemorrhage Patients
Niyata H. Karunawan1, Rizaldy T. Pinzon1
1
Faculty of Medicine, Duta Wacana Christian Univesity, Yogyakarta, Indonesia

Background: The Impact of Coronary Artery Disease (CAD) to outcomes in

Intracerebral Hemorrhage (ICH) is unclear. This is the first study to correlate CAD in
ICH patients with mortality, length of stay and disability by using the modified
Rankin Scale (mRS).
Objective: This study aimed to investigate the impact of CAD in the outcome of ICH
patients.
Method: This retrospective cohort study of 100 patients were first incidence of acute
ICH stroke recorded in the Bethesda Hospital Yogyakarta Stroke Registry(2012-2018).
These patients were divided into ICH patients with a history of CAD and ICH patients
without a history of CAD. CAD included stable angina pectoris, which was confirmed
by the cardiac stress test, unstable angina pectoris, ST-elevation myocardial infarc-
tion (STEMI), and non-STEMI confirmed by electrocardiography (ECG). The outcomes
of the study were in-hospital mortality, disability measured by the modified Rankin
Scale(mRS), and length of stay. The data were analyzed univariate and bivariate fol-
lowed by the Chi-square test and Mann-Whitney.
Result: Data of 100 patients with 50 ICH patients with CAD consist of thirty male
(60.0%), and thirty-three (66.0%) were more than 50 years old. The mortality of ICH
patients with CAD group is seven patients (14.0%), thirty-four patients (68%) have
the poor functional outcome (mRS>2) and have the length of stay 11.64 6 7.97
days. Bivariate analysis showed ICH patients with CAD group is significantly associ-
ated with worse disability (RR:2.7, 95%CI:1.1–6.1, p < 0.016) and prolonged hospital
stay (11.6467.97 vs 6.9064.30, p < 0.001) than in ICH patients without CAD group
but the mortality of ICH patients with CAD is not significantly associated with the
mortality of ICH patients without CAD (RR:1.1, 95% CI:0.3–3.8, p < 0.766).
Conclusion: ICH patients with CAD is statistically significantly associated with worse
disability and prolonged hospitalization than in ICH patients without CAD but no sig-
nificant difference in the mortality of ICH patients with CAD and without CAD.
Keywords: coronary artery disease • intracerebral hemorrhage • outcomes
F62
OR.110. Figure 1 Independent sample T-test analysis for door to wire time between
regular-working hours and after-working hours admission
OR.111. Outcomes of Various Drainage Procedures for Pericardial Effusion
K. H. Wai, K. M. Lwin, A. Z. Myo
Department of cardiovascular Surgery, Yangon General Hospital
Background: Pericardial effusion is a common findings in clinical practice. The diag-
nosis and treatment of massive pericardial effusion have evolved over the years. The
aim of this study was to study the outcomes of various drainage procedures for peri-
cardial effusion.
Methods: A total of 136 patients underwent various drainage procedure (147 proce-
dures) in Department of cardiovascular Surgery, Yangon General Hospital, Myanmar
from January 1, 2018 to December 31, 2018. To determine the etiology, clinical fea-
tures, echocardiographic features and intraoperative findings of pericardial effusion.
To describe various drainage procedure and outcomes of pericardial effusion. All
patients will be reminded to come back to cardiovascular surgical department follow
up at 1 week, 1 month and 3 months after discharge to assess the outcomes of the
patients.
Results: 136 patients ( 52.9% male, 47.01% female) were included. Malignancy and
infection are common aetiological factors for pericardial effusion. Bedside needle
aspiration 48 (32.65%), percutaneous pig tail catheter insertion 62 (42.17%), opened
pericardial drainage tube insertion 37 (25.17%) were done. Recurrence rate was
8.08%. 30-days mortality rate was 3.4%.
Conclusion: Surgical drainage is a rapid and effective treatment for pericardial effu-
sion. It is also life saving procedure for cardiac tamponade
Keywords: Pericardial effusion • drainage procedures • Recurrence rate • mortal-
ity rate
OR.112. Factors Affecting Time to Major Adverse Cardiac Events (MACE) in Acute
Coronary Syndrome (ACS) Patients With Concomitant Chronic Kidney Disease
(CKD)
Tamara E. Firsty1, Ayu S. Khaerani1, Muhammad Akbar1, Eka Ginanjar2
1
Faculty of Medicine, Universitas Indonesia, 2Division of Cardiovascular, Department
of Internal Medicine, Dr. Cipto Mangunkusumo National Central General Hospital,
Faculty of Medicine Universitas Indonesia
Background: Major adverse cardiac events (MACE) is a composite end points com-
monly used in cardiovascular researches to describe complications and mortalities
following particular cases, one such case being acute coronary syndrome (ACS).
Combined with chronic kidney disease (CKD), this patient group suffers from higher
risk of atherosclerosis and eventual complications. Increased level of kidney regu-
lated protein such as B2MG and FGF23 can act as biomarkers in CKD, which in turn
can be a risk marker for ACS.
Objective: To find factors affecting duration to MACE in aforementioned patients.
Method: ACS patient undergoing angiography in RSUPN-CM was checked for kidney
function and those with GFR <89 ml/min/1,73m2 are included in the data. Bivariate
analysis and logistic regression were then performed.
Result: From 117 patients in the study, 81 (69%) are males, 70 (40%) are less than 60
years old, and 56 (48%) are of Javanese descent. From bivariate analysis we find sig-
nificant association between hemoglobin (p ¼ 0.041), FGF23 (p ¼ 0.040), and B2MG
(p ¼ 0.032) level on admission and time to MACE. Yet we find no significant associa-
tion between comorbidities specifically diabetes mellitus (p ¼ 0.419), dyslipidemia
(p ¼ 0.254), hypertension (p ¼ 0.216), and stage of CKD (p ¼ 0.069) and time to
MACE. Further multivariate analysis with logistic regression shows significant associa-
tion between level of FGF23 (OR 0.454; CI 95% 0.212-0.912; p ¼ 0.026) and time to
MACE in ACS patients with CKD.
Abstracts
Conclusion: There is significant association between time to MACE and the hemoglo-
bin, B2MG, and FGF23 level on admission, with the latter almost cutting the time in
half, in ACS patient with CKD. Markers of kidney disease may be a better predictor
of MACE in ACS patient with concomitant CKD than the disease stage itself.
Keywords: factors • time to MACE • major adverse cardiac events • acute coronary
syndrome • chronic kidney disease
OR.113. Modified Shock Index (MSI) as a Bedside Clinical Risk Assessment for
Acute Coronary Syndrome Patients Presenting with Acute Heart Failure
Taufik Delfian, Harris Hasan, Ali Nafiah, Zunaidi Syahputra
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Department of Cardiology and Vascular Medicine, School of Medicine, University of
North Sumatera, Medan, Indonesia
Background: Identification of acute coronary syndrome (ACS) patients at high risk in-
hospital MACE is crucial, especially those presenting with complication such as acute
heart failure. It is needed for determining treatment strategy.
Objective: The aim of this study is to evaluate the modified shock index as a simple
bedside clinical risk assessment for acute coronary syndrome in patients presenting
with acute heart failure.
Methods: We collected data of acute coronary syndrome patients with acute heart
failure admitted to Adam Malik General Hospital from June 2017 to December 2018.
Modified Shock Index (MSI) was calculated as the ratio of heart rate over mean arte-
rial pressure. Patients presenting with cardiogenic shock were excluded.
Results: 153 patients ACS presenting with acute heart failure were enrolled in this study
(60.1% NSTEMI, 32% STEMI, 7.9% UAP). In hospital MACE were found in 55 patients. In
multivariate logistic regression analysis, hospital MACE was a dependent variable, while
age (OR 3.512; 95%CI 1.136-10.862; p0.029), creatinin level (OR 3.512; 95%CI 1.148-
8.190; p0.025), and Modified Shock Index (OR 9.372;95%CI 4.221-20.808; p < 0,001) were
independent variables. Optimal cut-off MSI for predicting MACE was 1.29 (sensitivity
71%, specificity 88%). MSI 1.29 was effective with AUC of ROC was 0.808 p < 0,001
Conclusion: MSI is a simple bedside clinical index for predicting MACE in ACS patients
with acute heart failure. The patients with MSI 1.29 need intensive and aggressive
management.
Keywords: ACS • heart failure • MSI
OR.114. Lp-PLA2, ox-LDL and Lipid Profile in Cardiovascular Risk Population
Asri Prameswari
Department of Internal Medicine, Medical Faculty, Brawijaya University, Malang,
Indonesia
Background: Lp-PLA2 (Lipoprotein-associated phospholipase A2) is an phospholipase
A2 enzyme which breaks down oxidized phosphatidylcholine of LDL in the blood ves-
sels’s wall so that it can increase the incidence of atherogenesis through induction of
monocytes and leukocytes with a forming of ox-LDL. Lp-PLA2 is important for inflam-
matory biomarkers in blood vessels and is thought to be an early marker of athero-
sclerotic risk populations.
Objective: This study aimed to analyze the levels of Lp-PLA2, ox-LDL and another
metabolic characteristic in the cardiovascular risk population after Framingham Risk
Score conducted.
Method: Research was done on 158 adults, elderly, obesity, and hypertension, on the
Framingham Risk Score divided into a group of low risk, moderate risk, and high risk.
Then the Lp-PLA2 levels and ox-LDL were measured by the ELISA method and other
lipids profile by spectrophotometry from the subject’s venous blood.
Result: Characteristic of respondent based on body mass index shows that obese 1
place the highest position in low risk group. Furthermore, low risk group has a sys-
tolic pressure around 140-179mmHg and also the highest percentage of total choles-
terol and HDL. Surprisingly, mean level of Lp-PLA2 in low risk group is 0.102 ng/mL
and became the highest mean compared with moderate and high risk groups. Male
sex has a higher mass and activity of Lp-PLA2 compared with female, especially in
low risk group. Spearman analysis shows correlation between Lp-PLA2 and ox-LDL
(q ¼ 0.465, p ¼ 0.000), with a regression equation Y ¼ -3,492 þ 36,263 X.
Conclusion: Lp-PLA2 correlates with ox-LDL in cardiovascular risk population.
Keywords: Lp-PLA2 • ox-LDL • Lipid Profile • Framingham Risk Score •
Cardiovascular Risk
OR.115. Risk Stratification of Women with Stable Angina Pectoris Using Perfusion
and Functional Parameters assessed by 99m Tc-Sestamibi Single Photon Emission
Computed Tomography (SPECT) Imaging : Can Reveal the Mystery ?
Z. Syahputra, T. Delfian, Hilfan A Lubis, Edison, Ali N. Nasution, H. Hassan
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sumatera
Utara University, Medan, Indonesia
Background: Given the lower prevalence of obstuctive ischemic heart disease,
greater variety of (atypical) symptoms, and commonly lower functional capacity,
detection of heart disesase can be challenging and mystery in women. SPECT is
Abstracts
appropriate non invasive testing for risk stratification in women with stable angina
pectoris.
Objective: The aims of this study to assess the prognostic value of perfusion and fuc-
tional parameters in women with stable angina pectoris by using 99m Tc-Sestamibi
Single photon emission computed Tomography.
Methods: We followed 84 consecutive women patients.Averange follow up was 15
months. The endpoints were cardiac death, acute myocardial infarction,heart fail-
ure, and late revascularization. Event –free survival curved were obtained. Optimal
cutt-off values of perfusion and functional data to predict outcomes were deter-
mined by ROC curve analysis. We also analysed the optimal cutt-off were obtained if
added to highrisk patients in Framingham risk score and Intermediate Clinical Pre-
test probabilities (PTP) of 15-85%.
Results: : 72 patients with PTP of 15-85%. 17,9% total patients experienced cardiac
events; cardiac death (3patients), myocardial infarction (10 patients) and Heart fail-
ure (2 patients). Summed stress score (SSS) (HR 3,482 ;95%CI 1,186-10,220;
p ¼ 0,023) and LVEF (HR 4,955; 95%CI 1,641-14,958; p ¼ 0,005) showed independent
incremental prognostic value to predict cardiac events.The survival curved were
maximally separated when using cutt-off values for SSS 14 and LVEF <56%. In High
risk patients with framingham risk score gave incremental prognostic value if adding
SSS14 or LVEF <56% than only framingharm risk score ( HR 15,744;95%CI 5,448-
45,559;p<0,001 by adding SSS14; HR 8,606; 95% CI 3,003-24,665; p < 0,001 by add-
ing LVEF<56%, and OnlyFramingham risk score HR 1,904;95%CI 1,032-6,750;
p < 0,001). In intermediate PTP,pateints with PTP 15-65% (intermediate low) and
SSS 14 had incremental prognostic value to predict cardiac events (HR 5,832; 95%CI
1,570-21,663; p ¼ 0,008); patients with PTP 66-85% (intermediate high) and SSS14
could also predict these events ( HR 6,691 95% CI 2,114-21,183;p¼0,001). By adding
LVEF<56% in intermediate PTP patients didn’t show the prognostic value.
Conclusion: The perfusion and functional parameter derived fom SPECT can
adequately be used for cardiac risk assessment. In women with stable angina pectoris
at increased risk of cardiac events, those with an LVEF<56% and or SSS 14, may
benefit from more agrresive invasive therapy, especially with high risk by framingham
score and intermediate PTP.
Keywords: 99m Tc-Sestamibi SPECT • SSS,LVEF • Women with Stable Angina.
OR.116. Correlation Between Reperfusion Criterias for Successful Fibrinolytic
and TIMI flow from Coronary Angiography in STEMI Patients
Indri M. Benazir, Harris Hasan, Zulfikri Mukhtar, Ali Nafiah
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: STEMI can cause major cardiovascular events, so revascularization
needs to be performed as soon as possible to restore coronary blood flow which can
be done by fibrinolytic or primary percutaneous coronary intervention. Several crite-
rias have been used to determine successful fibrinolytic.
Objective: The aim of this study is to assess the correlation between reperfusion cri-
terias for successful fibrinolytic and TIMI flow from coronary angiography in STEMI
patients.
Method: This study involved STEMI patients who were treated at Adam Malik hospi-
tal. All subjects diagnosed with STEMI based on ECG with onset <12 hours and
undergo fibrinolytic if there was no contraindications. After the fibrinolytic was
done, we assessed the succesfullness with criterias: decrease of chest pain, resolu-
tion of ST segments >50% and reperfusion arrhythmia. All subjects performed coro-
nary angiography when hospitalized. Bad TIMI flow was in 0-1 score and good TIMI
flow was in 2-3 score.
Result: Of a total of 62 patients, 26 patients experienced successful fibrinolytic. The
fibrinolytic was success if there were 2 from 3 criterias. ST segment resolution >50%
had a positive correlation with good TIMI flow (r ¼ 1.00; p ¼ <0.001). There was also
a significant positive correlation between reperfusion arrhythmia and good TIMI flow
(r ¼ 0.392; p ¼ 0.003). Unfortunately, all subjects had a reduction in chest pain so
they cannot be analyzed.
Conclusion: The findings suggest that ST segment resolution >50% and reperfusion
arrhythmia criterias have correlation with good TIMI flow from coronary angiography
in STEMI patients.
Keywords: fibrinolytic • reperfusion • STEMI • TIMI flow
OR.117. Corrected QT (QTc) Interval as Electrocardiography Parameter for
Assessment Right Ventricular Function
Safni Marlina, Harris Hasan, Ali N. Nasution
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Right ventricular function is an important predictor of quality and mor-
tality life in patients with left ventricular heart disease, congenital heart disease
and pulmonary hypertension (PH). QTc in electrocardiogram used to assess electrical
properties of ventricle depolarization and repolarization. In recent study, QTc
F63
prolongation occurs in pulmonary hypertension and decreased RV function. In rat
models of PH and right ventricular hypertrophy (RVH), QTc interval also showed
prolongation.
Objective: The aim of this study is to evaluate QTc interval to assess right ventricular
function.
Method: This cross sectional study is conducted in Adam Malik Hospital from January
to February 2019. All patients underwent transthoracic echocardiography and elec-
trocardiography examination. We used bazett’s formula for calculate the QTc inter-
val. RV Fractional Area Change (RV FAC) and other standard echocardiography param-
eters were measured. The duration of QTc on ECG was correlated with RV FAC, TAPSE
and chamber of right heart.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Results: A total of 67 patients, 35 patients (mean age 51 þ 11 years, 78% men) has
impaired RV function and 32 patients (mean age 54 þ 12 years, 84% men) in control
group. QTc has negative correlation with RV FAC (r ¼ -0.62, p < 0.001) and TAPSE
(r ¼ -0.53, p < 0.001) and positive correlation with RV basal diameter (r ¼ 0.34,
p ¼ 0.005), RA mayor diameter (r ¼ 0.38, p ¼ 0.008). QTc interval >466.5 ms was
82.5% sensitive and 78.8% specific to identify patients with impaired right ventricular
function.
Conclusion: QTc prolongation can be used as a parameter electrocardiography for
assessment impaired right ventricular function.
Keywords: QTc interval • Right Ventricular Function • RV Fractional Area Change •
Echocardiography
OR.118. Correlation Between Average E/e’ Ratio and Plasma NT-proBNP Level in
Acute Heart Failure Patients
F. H. Margolang, H. Hasan, A. Nafiah
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia
Background: Acute heart failure (AHF) is a complex clinical syndrome with high inci-
dent of mortality and morbidity worldwide include Indonesia. Heart failure can result
from any structural or functional cardiac disorder that impairs the ability of the ven-
tricle to fill with or eject blood. Systolic and diastolic heart failure are the two clini-
cal subsets of the syndrome of heart failure (HF). The severity of HF and its prognosis
are closely related to the degree of diastolic filling abnormalities.
Objective: Echocardiography parameters such as ratio of early transmitral inflow (E)
and early diastolic mitral anulus velocity (e’) and the amino-terminal pro-B-type
natriuretic peptides (NT-proBNP) provide powerful incremental assessment of left
ventricle diastolic and systolic function.
Method: This is a cross sectional study which conducted 50 acute heart failure
patients in Adam Malik General Hospital. Conventional echocardiography and Tissue
doppler imaging (TDI) and Plasma NT-proBNP level was measured at admission. The
variables were analyzed with spearmen correlation.
Result: From a total 50 acute heart failure patient, men patient (n ¼ 41; 46,1%) with
mean age 57 (SD 6 8) and mean EF 38,7 (SD 6 11,9), median NT proBNP level 6088,5
and median E/e’ 18. We found a significant correlation between average early trans-
mitral inflow to early diastolic mitral anulus velocity ratio (E/e’) and plasma NT-
proBNP level in acute heart failure patients (r ¼ 0,556; p < 0,001)
Conclusion: Average early transmitral inflow to early diastolic mitral anulus velocity
ratio (E/e’) correlate with NT-proBNP level in acute heart failure patients.
Keywords: Acute heart failure • Conventional echocardiography • TDI
echocardiography • NT-proBNP
OR.119. Cardiac High-Energy Phosphate Metabolism is not Associated with
Measures of Whole Body Metabolism in Healthy Female Adults
Prisca G. Wibowo, Sarah J. Charman, Nduka C. Okwose, Lazar Velicki, Dejana Popovic,
Kieren G. Hollingsworth, Guy A. MacGowan, Djordje G. Jakovljevic
Faculty of Medicine, University of Indonesia, Jakarta; Newcastle Cardiovascular
Research Centre, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne
Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Cardiovascular
Surgery, Institute of Cardiovascular Diseases Vojvodina, Novi Sad; Cardiology
Department, Clinical Centre Serbia, Belgrade, MRC Centre for Ageing and Vitality,
Newcastle University, Newcastle upon Tyne
Background: Decline in cardiac high-energy phosphate metabolism [phosphocrea-
tine-to-ATP (PCr/ATP) ratio] and whole body metabolism increase the risk of heart
failure and metabolic diseases.
Objective: The aim of the present study was to assess the relationship between PCr/
ATP ratio and measures of body metabolic function.
Method: A total of 35 healthy women (56 6 14.0 years of age) underwent cardiac 31P
magnetic resonance spectroscopy to assess PCr/ATP ratio  an index of cardiac high-
energy phosphate metabolism. Fasting and 2-hour glucose levels were assessed using
oral glucose tolerance test. Indirect calorimetry was performed to determine oxygen
consumption and resting metabolic rate.
Results: There were no significant relationships between PCr/ATP ratio and resting
metabolic rate (r¼-0.09, p ¼ 0.62), oxygen consumption (r¼-0.11, p ¼ 0.54), fasting
F64
glucose levels (r¼-0.31, p ¼ 0.07), and 2-hour plasma glucose (r¼-0.10, p ¼ 0.58).
Adjusted analysis for covariates including age, body mass index, fat mass, and physi-
cal activity, had no significant influence on the relationship between PCr/ATP ratio
and body metabolism.
Conclusion: Lack of relationship between cardiac PCr/ATP ratio, glucose control
and metabolic rate may suggest that overall metabolic function does not influence
cardiac high-energy phosphate metabolism.
Keywords: cardiac metabolism • body metabolism • women
OR.120. Minnesota Living With Heart Failure Questionnaire (MLHFQ) Is
Correlated With Left Ventricular Ejection Fraction (LVEF) And New York Heart
Association (NYHA) Classification In Chronic Heart Failure Patients
K A Shonafi1,2, R R Juwita1, M J Al-Farabi, D N Ghassani1, Andrianto1, R Herdyanto2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga
University, Jl. Mayjend. Prof. Dr. Moestopo No.6-8, Surabaya, Indonesia, 2Department
of Cardiology and Vascular Medicine, Sosodoro Djatikoeseomo General Hospital,
Bojonegoro, Indonesia
Background: Chronic heart failure may have a significant impact on a patient’s qual-
ity of life. However, contradicting result was shown on the association between heart
failure and the quality of life in patients with chronic heart failure.
Objective: This study identifies the predictive value of LVEF score and NYHA classifi-
cation for the low quality of life patients with chronic heart failure.
Methods: This study was conducted on 34 consecutive CHF patients in
Cardiovascular Departement, Sosodoro Djatikoesoemo General Hospital. LVEF was
obtained from echocardiography, NYHA scores were derived from existing patient
data, and quality of life was assessed using MLHFQ. Low quality of life defined as
MLHFQ score  45.
Results: This research showed that the score of LVEF is inversely correlated with
MLHFQ Total (r¼-0,727), and NYHA classification is positively correlated with MLHFQ
Total (r ¼ 0,773). Logistic regression analysis showed that LVEF predicts the risk of
the low quality of life (OR: 0.858, 95% CI 0.761-0.967, p ¼ 0.012) and NYHA classifica-
tion (OR: 5.280, 95% CI 1.496-18.631, p ¼ 0.010). Cutoff point analysis from ROC
curves shows LVEF  31.5% can predict the low quality of life with the specificity of
79.2% and sensitivity of 80%. While NYHA classification of  3.5 can predict the low
quality of life with the specificity of 70% and sensitivity of 79.2%.
Conclusion: LVEF and NYHA classification are able to predict the low quality of life in
chronic heart failure patients.
Keywords: Ejection Fraction • Psychological • Quality of Life • ROC Curve
OR.121. Correlation between Visit to Visit Blood Pressure Variability and
Changes of Exercise Capacity in Hypertensive Patients Undergoing Phase 2
Cardiac Rehabilitation in Hasan Sadikin General Hospital Bandung
Vonna Istananda1, Mega Febrianora1, Badai Bhatara Tiksnadi1, Sunaryo
B. Sastradimadja2
1 Intensive Cardiovascular on Outcome) conducted at ICVCU Harapan Kita Hospital
Cardiology and Vascular Medicine Department Hasan Sadikin General Hospital –
Universitas Padjadjaran, Bandung, Indonesia, 2Physical Medicine and Rehabilitation
Department Hasan Sadikin General Hospital – Universitas Padjadjaran, Bandung,
Indonesia
Background: Visit to Visit BP Variability (VVV) is considered as a novel risk factor for
Cardiovascular disease. There was no data proving that lower level of VVV will affect
exercise capacity in hypertensive patients.
Objective: To find correlation between VVV and changes of exercise capacity in
hypertensive patients undergoing cardiac rehabilitation (CR)
Method: A retrospective study of CR Registry data was presented. The sample was
all hypertensive patients undergoing complete CR program from May until
November 2018. A total of 39 patients was recruited. Fourteen patients were
excluded due to incomplete data. CR consist 12 times of supervised exercise, twice
a week. BP was measured every session of CR program before starting exercise.
VVV was defined by the oscillation of BP from visit to visit. VVV of SBP and DBP
were calculated as coefficient variation (CV). Maximal stress test was performed
using treadmill or ergocycle. Exercise capacity was measured by using indirect for-
mula from duration of maximal stress test as METs . Changes of exercise capacity
was measured by counting difference between the beginning and the end of
program
Result: From 25 patients, the mean age was 59.36 6 7.36 years old, 23 (92%) male.
CV of SBP was 8.08 6 2.37 mmHg and 8.46 6 3.15 mmHg of DBP. The median of exer-
cise capacity parameter changes was 0.59 (-3.36 - 2.52) METs. There was significant
correlation between CVSBP with changes of exercise capacity (SBP p value 0.036, R:
- 0.366; but not with DBP p value 0.163).
Conclusion: There is moderate negative correlation between SBP variability. The
Lower SBP Variability, the higher improvement of exercise capacity of hypertensive
patients underwent CR
Keywords: Visit to Visit Blood Pressure Variability • Cardiac Rehabilitation •
Hypertension • cofficient variation • METs
Abstracts
OR.122. Comparison of Left Atrial Remodeling in Heart Failure Reduce Ejection
Fraction with and without Atrial Fibrilation, A Single Center Study
B.S.I Hutagaol1, Y.P. Santosa2, I. Cahyadi3, J. Henrina3
1
Atma Jaya Teaching and Research Center Hospital, Jakarta, Indonesia, 2Department
of Internal Medicine-Atma Jaya Teaching and Research Center Hospital,
Jakarta,Indonesia, 3Faculty of Medicine, Indonesia Catholic University Atma Jaya,
Jakarta, Indonesia
Background: Atrial fibrillation (AF) is an emerging medical epidemic.1 It is found in
approximately 10% of general population and it’s the most common arrhythmia seen
by doctors today.2 Remodelling of the left atrial (LA) is the final pathway of a high
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
number of cardiac disease. Any condition generating volume or pressure overload of
the LA could be considered a causal factor for AF development.3
Objective: To understand the impact of left atrial remodeling in heart failure reduce
ejection fraction as a risk factor for atrial fibrillation.
Methods: This observational cohort study included subject with heart failure reduce
ejection fraction (HFrEF) with AF and HFrEF without AF as the control group.
Echocardiography was used to quantify LA diameter (dilated >38mm), and ECG was
used to diagnosed AF condition and Chi Square was used to analyzed bivariate data.
Results: Total subjects of this study were 207 subjects, HFrEF without AF 110 sub-
jects (53%), HFrEF with AF 97 subjects (47%). In this study, the mean age was 59.05
þ 0.75 years with the youngest age 32 years and the oldest 83 years. The mean for
left ventricular ejection fraction (LVEF) is 27.64 þ 0.55 % with the lowest value of 8%
and the highest of 41%. There is no significant correlation between age, sex, and left
ventricular ejection fraction (LVEF) in HFrEF group with p value 0.499; 0.389; and
0.529 (p > 0.05). There was significant correlation with good strength between dila-
tation of LA diameter in HFrEF with AF and the p value 0.034 (p < 0.05).
Conclusion: LA remodeling which represented by LA dilatation is a risk factor for
atrial fibrillation in heart failure reduce ejection fraction condition.
Keywords: atrial remodeling • heart failure • atrial fibrillation
OR.123. Admission Plasma Blood Glucose Predicts in Hospital Mortality of ST-
Elevation Myocardial Infarction Patients in Intensive Cardiovascular Care Unit
Stephanie Salim, Bambang Widyantoro, Gloria Kartika, Joni Indah Sari, Isman Firdaus,
Dafsah Arifa Juzar
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia- National Cardiovascular Center Harapan Kita
Background: Acute hyperglycemia is a common feature during the early phase after
acute myocardial infarction (AMI). However, hyperglycemic state often associated
with poor prognosis on the morbidity and mortality of patients presenting with ST-
elevation Myocardial Infarction (STEMI).
Objectives: This study aimed to describe the correlation between admission plasma
blood glucose and in hospital mortality of STEMI patients in Intensive Cardiovascular
Care Unit (ICVCU).
Methods: We used retrospective data from RAICOM study (Registry of Acute and
from 2014 to 2015. Admission plasma BG defined as BG taken before admission to
ICVCU. There were 918 patients diagnosed with STEMI. Eighty-one patients were
excluded due to insufficient data.
Results: A total 837 patients were included in this study. STEMI patients were pre-
dominantly male (85,19%), mean age 56,16610,14 years, predominantly smoking or
ex-smoker (65,35%) and had hypertension (55,07%). Median admission plasma BG in
all patients were 146 (0-767) mg/dL. ROC curve plotting analysis show significant
correlation between plasma BG and in-hospital mortality (AUC¼ 0.600; p ¼ 0.013).
BG cut-off obtained was 157.5mg/dL (sensitivity 50% specificity 56,7%). Bivariate
analysis show significant association of BG  157.5mg/dL to mortality (OR ¼ 1.930
(1.105-3.371); p ¼ 0,019). ICVCU length of stay also prolonged as well in
BG  157.5mg/dL compared to BG < 157.5mg/dL (2 days (0-46) vs 2 days (0-16);
p ¼ 0,023), and in-hospital length of stay (5 days (2-68) vs 5 days (0-48); p < 0,001)
respectively. After adjustment to age, sex, previous history of hypertension, DM, dys-
lipidemia, smoker, and family history, multivariate logistic regression analysis show
that admission BG still a significant predictor of in-hospital mortality (OR ¼ 1.003
(1.000-1.005); p ¼ 0,025).
Conclusion: Admission plasma blood glucose is an outcome predictor of in hospital
mortality of STEMI patients in Intensive Cardiovascular Care Unit.
Keywords: STEMI • blood glucose • mortality
OR.124. Effect Of MDR1 Gene Variants In The Incidence Of In Stent Restenosis In
Coronary Heart Disease Patients Who Treated With Clopidogrel
Arini N. Famila1, Heru Sulastomo2, Muhammad T. Nugraha2
1
Faculty of Medicine, Sebelas Maret University, Surakarta, 2Department of Cardiology
and Vascular Medicine, Dr. Moewardi General Hospital, Surakarta
Background: Coronary heart disease is a major cause of death and disability in devel-
oped country. The combination of aspirin and P2Y12 inhibitors are recommended for
Abstracts
acute coronary syndrome patients undergoing PCI (6-12 months). Immediate reperfu-
sion therapy, with percutaneous coronary intervention (PCI) is indicated if there is
clinical or electrocardiographic (ECG) evidence of ongoing ischemia. Variants in the
Multi-Drug Resistance Gene-1 (MDR1) associated with oral clopidogrel bioavailability
and determine the prognosis of these patients.
Objective: To determine the effect of MDR1 gene variant in the incidence of In Stent
Restenosis (ISR) in coronary heart disease patients who treated with clopidogrel and
the influence of other risk factor.
Method: This is a case control study with 44 samples (22 samples from the non-ISR
group and 22 samples from the ISR group) who underwent PCI and treated with clopi-
dogrel at RSUD dr. Moewardi Surakarta, Central Java. Patients who met inclusion cri-
teria were carried out DNA isolation, electrophoresis and DNA sequencing. Bivariate
tests were performed to find the differences in the proportion of MDR1 gene variants
of non ISR and ISR groups. Multivariate analysis to assess the effect of MDR1 gene
variants on ISR. The value of p < 0.05 considered statistically significant.
Result: The non-ISR group were patients with MDR 1 C3435 wild type variant, namely
CC as much as 77.3% while in the ISR sample there were more MDR 1 C3435 genes,
variants of TT than CC variants, which were 54.5% with chi square values, v2 ¼
4.697 with a probability of 0.030 (p < 0.05). Based on multivariate analysis, MDR1
gene variants obtained regression coefficient results of b ¼ -1.624 with probability of
p ¼ 0.024 and Odd ratio of 0.197. Diabetes mellitus and dyslipidemia variables did
not affect the occurrence of ISR (p > 0.05).
Conclusion: MDR1 3435 gene TT variant affects the incidence of ISR in coronary heart
disease patients undergoing PCI treated with clopidogrel
Keywords: MDR1 gene variant • In stent restenosis
OR.125. Correlation between Tricuspid Annular Plane Systolic Excursion and
Right Atrial Pressure in Mitral Stenosis Patients
Hari H. Satoto, Robert A. Raharjo, Sulistiyati B. Utami, Mochamad A. Nugroho
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Diponegoro
University – Dr. Kariadi General Hospital, Semarang, Indonesia
Background: High right atrial pressure (RAP) provides poor prognostic in patients
with left heart disease such as mitral stenosis. Raising RAP can be caused by right
ventricular dysfunction. Tricuspid Annular Plane Systolic Excursion (TAPSE) is the sim-
plest method for measuring right ventricular systolic function, however there is no
data that support TAPSE correlates with increasing RAP. The aim of this study was to
investigate the correlation between TAPSE and RAP in mitral stenosis patients.
Objective: The objective of this study was to find correlation between TAPSE and
RAP measured using echocardiography in mitral stenosis patients.
Method: Patients with mitral stenosis in Kariadi General Hospital during April – June
2016 were enrolled in this study. TAPSE was assessed by using the echocardiographic
by placing an M-mode cursor through the tricuspid annulus and measuring the
amount of longitudinal motion of the annulus at peak systole. RAP was assessed by
inferior vena cava diameter and collapsibility during sniffing. If there is minimal IVC
collapse with a sniff (<35%) and secondary signs that indices of elevated RAP are
present, RAP may be upgraded to 15 mmHg.
Result: There were 33 patients (age 4269 years old, 61.8% female). The median
TAPSE was 17 mm (range, 9-26 mm) and the median RAP was 10 mmHg (range, 5-
20 mmHg). TAPSE had a significant negative weak correlation with RAP (r¼-0.34,
p ¼ 0.046) in mitral stenosis patients.
Conclusion: Tricuspid annular plane systolic excursion has a weak correlation with
right atrial pressure in mitral stenosis patients.
Keywords: TAPSE • RAP • mitral stenosis
OR.126. Relation of QT Interval to Echocardiographic Left Ventricular
Hypertrophy and Geometric Pattern in Hypertensive Patients
Afif Anshari, Mohammad A. Wijayanto, Haikal, Amiliana M. Soesanto,
I N. Sukamiartadana
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Department of
Cardiology, Gatot Soebroto Army Center Hospital, Jakarta, Indonesia, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia,
Jakarta, Indonesia, Division of Cardiology, Surya Husadha Nusa Dua General Hospital,
Bali, Indonesia
Background: In hypertensive patients, left ventricular hypertrophy (LVH) may gener-
ate conditions for QT interval prolongation, which is a risk marker for malignant ven-
tricular arrhythmias.
Objective: We aim to investigate the relation between QT interval and echocardio-
graphic LV geometric pattern in hypertensive patients.
Method: Corrected QT (QTc) interval (Bazett’s and Framingham’s formula) and LV
geometry (LV Mass Index (LVMI) and Relative Wall Thickness (RWT)) were retrospec-
tively assessed in patients underwent echocardiography during year 2016–2017 at
Surya Husadha Nusa Dua General Hospital. From 356 data collected, individuals aged
18–80 years old with diagnosis of hypertension were included. Patients with irregular
heart rhythm, low ejection fraction (<55%), moderate-to-severe valvular heart
F65
disease, history of valve repair or replacement, congenital heart disease, ischemic
heart disease, and thyroid disorder were excluded.
Result: Among 58 patients (60.3% male, mean age¼57612 years old), ECG findings
showed that 74.1% subjects were in sinus rhythm with mean QRS rate of 77.7619
bpm. Average QTc was 443.9640.1 ms and 426.3639 ms (Bazett’s and Framingham’s
formula, respectively). Average value for RWT was 0.6460.23, LV mass was
233.6678.6 g, LVMI was 135.8641.3 g/m2 (60.3% had moderately abnormal LVMI). In
categorical analysis between QTc interval prolongation and LV geometric pattern,
QTc interval was particularly prolonged in eccentric hypertrophy type, although not
significant (p ¼ 0.057, Bazett; p ¼ 0.076, Framingham). Numerical analysis between
QTc interval duration and LV geometry also showed no significant association
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
(p ¼ 0.511, Bazett; p ¼ 0.092, Framingham). However, post-hoc analysis between LV
geometry types showed significant difference between concentric remodeling and
eccentric hypertrophy subgroup (p ¼ 0.326, Bazett; p ¼ 0.015, Framingham).
Conclusion: In general, there was no significant association between QT interval and
echocardiographic LV geometry. This was most likely due to the markedly low number
of subjects in normal geometry and eccentric hypertrophy subgroup. However, QTc
interval duration showed increasing trend towards more severe LV geometric
pattern.
Keywords: QT interval • left ventricular hypertrophy • left ventricular geometry •
hypertension
OR.127. Comparison of Echocardiographic Parameters in Chronic Kidney Disease
Patients with and without Pulmonary Hypertension at Sardjito General Hospital,
Yogyakarta, Indonesia
A. P. Rahman, H. P. Bagaswoto
Cardiology and Vascular Medicine at Gadjah Mada University / Sardjito General
Hospital, Yogyakarta, Indonesia.
Background: Pulmonary hypertension (PH) is common in patients with Chronic
Kidney Disease (CKD) and associated with increased mortality. CKD, especially end-
stage renal disease, has been proposed to cause pulmonary vascular remodeling and
PH. Possible mechanisms that have been suggested include endothelial dysfunction
due to increased oxidative stress from uremic toxins, chronic inflammation resulting
from exposure of the blood to dialysis membrane, vascular calcification, and
increased flow from arteriovenous fistula. The purpose of this study was to compare
structural and functional abnormalities of the heart between CKD patients with PH
and without PH.
Methods: This was a retrospective analytical study of all CKD patients who were on
routine hemodialysis at Sardjito General Hospital. PH in the CKD patients were
defined by echocardiography. The echocardiographic parameter in this study were:
left atrial diameter, left ventricular diameter, right atrial diameter, right ventricular
diameter, left ventricular function, right ventricular function, and diastolic dysfunc-
tion. Each echocardiography parameter was compared using the chi-square test or
it’s alternative test (SPSS ver.23) and a p value of less than 0.05 was considered stat-
istically significant.
Results: There were 70 samples included in the study, 43 patients with PH and 27
others with no PH. The only echocardiography parameter with significant p value was
diastolic dysfunction.
Conclusion: Diastolic dysfunction was the only significant echocardiographic parame-
ter between CKD patients with PH and without PH. This study suggests that aware-
ness of PH should be higher in patients with diastolic dysfunction during echocardiog-
raphy examination.
Keywords: Pulmonary Hypertension • Echocardiography • Chronic Kidney Disease
OR.128. Mitral Valve Replacement for Rheumatic Mitral Stenosis: When and Why?
: A Study in Kariadi General Hospital
Tampi, P.A.D. Kuntadi, F.N. Habibie, M.F. Ahnaf, M.A. Nugroho
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University – Dr. Kariadi General Hospital Semarang, Indonesia
Backgrounds: Mitral stenosis (MS) is identically associated with rheumatic heart dis-
ease (RHD). In RHD patients, MS often followed by problem such as high tromboem-
bolic burden, multivalves involvement, and unfavourable anatomical criteria for
Percutaneous Mitral Commissurotomy (PMC), therefore need mitral valve replace-
ment (MVR). This study evaluated factors that caused rheumatic MS patients not suit-
able for PMC in Kariadi General Hospital by echocardiographic assessment.
Methods: The study population included rheumatic MS patients undergoing MVR with
or without other cardiac surgery between October 2016 and February 2019 in
Department of Cardiology and Vascular Medicine, Dr. Kariadi General Hospital.
Preoperative echocardiographic data collected include Wilkins Score, left atrial
thrombus, and other valves disease requiring surgery.
Result: A total of 80 patients age 19-67 year dominated by woman (72.5%) consist of
68 severe MS (85%), 8 moderate MS (10%), and 4 mild MS (5%). More than mild mitral
regurgitation was present in 32 (40%). There were also 7 patients (8.8%) which have
prior PMC. Patient with high Wilkins score for PMC >8 were only found in 29 patients
F66
(36.3%) with mean score 7.961.7. Fiveteen patients (18.8%) have left atrial throm-
bus from echocardiographic finding. A number of 54 patients (67.5%) underwent mul-
tiple associated valve surgery included aortic valve replacement (27.5%), tricuspid
valve repair (13.6%), and combination of them (12,5%).
Conclusion: There were many factors contribute in decision to perform mitral valve
replacement for rheumatic mitral stenosis. The needs of other associated cardiac
surgery was the most according to multivalvular involvement in RHD.
Keywords: mitral stenosis • rheumatic • mitral valve replacement • percutaneous
mitral commissurotomy
OR.129. Improvement in Diagnostic Accuracy of Treadmill Stress Test with ST/HR
Hysteresis in Detection of Significant Coronary Artery Disease
Sakta Suryaguna, Nyoman Wiryawan, Wayan Wita
Cardiology and Vascular Medicine of Udayana University, Bali, Indonesia
Background: Cardiovascular disease which is the leading cause of death in the world
costs a lot. In the era of global health insurance and precision medicine, it is neces-
sary to improve the quality of examinations carried out at an efficient cost. The
cost-effective treadmills stress test (TST) are more prevalent in hospitals than
sophisticated imaging tests for the detection of coronary heart disease, but unfortu-
nately it has low sensitivity and specificity. Meanwhile ST/HR hysteresis could be
used in detection of coronary artery disease (CAD) in patients undergoing standard
exercise testing. Its diagnostic value has never been widely accepted even though it
has the possibility of greater accuracy.
Objective: The objective of our study was to determine the capability of ST/HR hys-
teresis to detect significant CAD.
Method: Retrospective analysis of data was performed on patients referred for evalu-
ation of significant CAD. 134 patients underwent a standard TST and coronary angiog-
raphy were included. ST/HR hysteresis value was taken from stored TST data. Using
angiographic evidence of significant CAD as a reference, the area under the curve
(AUC) of receiver operator characteristic (ROC) of the ST/HR hysteresis and standard
ST-Depression were calculated and compared. Diagnostic performance of variables
was assessed.
Result: Area under ROC curve for ST/HR hysteresis was 84.8% (95% CI 77.7%-91.2%,
p < 0.001). Sensitivities of standard ST-Depression and ST/HR hysteresis were 64.4%
and 79.7% respectively, specificities were 49.3% and 85.3% respectively. The cut
points for ST/HR hysteresis was 0.026 mV. It has positive likelihood ratio of 5.43, pos-
itive predictive value of 81%, accuracy index of 83%, and net reclassification
improvement of 0.27.
Conclusion: In this population, the ST/HR hysteresis could be very useful for diagnos-
ing CAD and provide improvement in diagnostic capability of standard diagnostic cri-
teria during TST without additional cost.
Keywords: ST/HR hysteresis • Diagnostic • CAD • Improvement
OR.130. The Prevalence of Chemotherapy-induced Arrhytmia in Breast Cancer
Patients Receiving Chemotherapy Regimen
Jagaddhito Probokusumo1, Anggoro Budi Hartopo1, Vita Yanti Anggraeni2, Dyah
Adhi Kusumastuti1, Hasanah Mumpuni1, Mardiah Suci Hardianti3, Ibnu Purwanto3,
Susanna Hilda Hutajulu3
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health
and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, 2Division of
Cardiology, Department of Internal Medicine, Faculty of Medicine, Public Health and
Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, 3Division of
Hematology and Medical Oncology, Department of Internal Medicine, Faculty of
Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital,
Yogyakarta
Background: Breast cancer patients receiving chemotherapy regimen have potential
risk to develop arrhythmia. The prevalence of chemotherapy–induced arrhythmia
(CTIA) has not been well described in Indonesian population.
Objective: To investigate the prevalence of arrhythmias in breast cancer patients
receiving chemotherapy regimen.
Method: This is a cohort prospective study in patients with breast cancer receiving
chemotherapy regimen. We use a consecutive subjects from Cardio-Oncology
Registry at Dr. Sardjito Hospital from August 2018 to March 2019. The baseline profile
such as physical examination, standard 12-lead ECG, and echocardiography were
obtained before chemotherapy at baseline and continued with 2-month follow up.
We defined CTIA as any new arrhythmia diagnosis found on ECG within 2 months after
chemotherapy initiation.
Result: All of the subjects are females (n ¼ 95) with 37.9% patients are ages < 50
years old, 44.2 % at the range of 50-60 years old and 17.9% are > 60 years old. The
most chemotherapy regimen used is a combination of doxorubicin and
Abstracts
cyclophosphamide (25.3%). Others are epirubicin and cyclophosphamide and taxane-
based chemotherapy regimens. The 12-lead ECG result at a baseline is 41.5 % with
normal sinus rhythm and 14.6% with ischemic finding. As many as 4.8% of subjects
developed arrhythmias after receiving chemotherapeutic agents. After 2-month fol-
low-up, there is 4.9% of subjects developed arrhythmia.
Conclusion: The prevalence of CTIA was 4.9% in breast cancer patients. There is no
increased of CTIA prevalence before and 2-month after receiving chemotherapeutic
regimen.
Keywords: chemotherapy-induced arrhytmia • cchemotherapy • breast cancer
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.131. Increase of Serum ApoB As Major Adverse Cardiovascular Events
Predictor in Acute Myocardial Infarction During Hospitalization
Sidharta Kunardi, Wayan Aryadana
Department of Cardiology and Vascular Medicine, School of Medicine, Udayana
University, Denpasar, Bali
Background: -Acute myocardial infarction (AMI) is a major component of cardiovas-
cular disease burden, with severe effects which include high mortality and complica-
tions as main problem in AMI management. It is recommended that risk stratification
using clinical signs and biomarkers combination for therapy selection and patient
evaluation in short-term or long term. ApoB is the lipoprotein content of LDL which
is the main core in thrombus formation in AMI.
Methods: -This is a prospective cohort study with inclusion criteria of all AMI patients
treated in emergency department, with exclusion criteria include chronic heart fail-
ure, end stage renal disease, sepsis, malignancy and valvular heart disease. Total
sampel of 68 participants were determined with consecutive sampling from March
2018 to June 2018. Serum apoB were measured using ELISA method and analysis of
the result were done with Hazard Ratio (HR) and estimation of survival curve as
major adverse cardiovascular event (MACE).
Results: -During observation, cardiovascular mortality occurred in 2 patients and
MACE experienced by 29 patients which comprised of acute heart failure (15
patients, 45.4%), cardiogenic shock (8 patients, 24.3%), arrhythmia (6 patients,
18.2%). ROC curve analysis determined apoB level for MACE at cutoff value of
92.5 mg/dL (sensitivity 71%, specificity 34%). Log rank test showed significant differ-
ence on MACE (p ¼ 0.003) between high apoB level (average survival rate at 67 hours,
95% CI 50.26-85.14) compared to low apoB level (average survival rate at 104 hours,
95% CI 93.7-115.52). Bivariate analysis calculated high apoB level HR 3.8 (p ¼ 0.026)
for MACE with HR of high apoB level of 3.3 (p ¼ 0.026) for MACE after multivariate
analysis using Cox proportional hazards regression.
Conclusion: -Higher apoB level is a predictor of MACE in AMI patients during
hospitalization.
Keywords: acute myocardial infarction • apoB • mortality • major adverse cardio-
vascular events
OR.132. Association of Modifiable Risk Factors with the Total Length of Coronary
Stent used in patients underwent PCI for Complete Revascularization
Vito A. Damay1,2, Raymond Pranata1, Wendy Wiharja1, Cindy1, Antonia Anna Lukito1,2
1
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia, 2Department
of Cardiovascular Medicine, Siloam Hospital Lippo Village, Tangerang, Indonesia
Background: Despite all advancement in cardiology, prevention is still our best and
arguably cheapest effort to reduce the burden of cardiovascular disease. Modifiable
risk factors (MRF) are responsible to development of coronary lesions, which prob-
ably will need longer stent in PCI. In the other hand, Total length of coronary stent
(TLCS) was independently associated with major adverse cardiac events and financial
burden. This study aim is to determine the association between MRF and TLCS
needed for complete revascularization.
Method: This is a cross-sectional study involving 308 patients underwent PCI at
Siloam Hospitals Lippo Village in the year 2017. Out of 308 patients, 46 patients
were excluded because absence of coronary intervention leaving 262 patients who
underwent coronary intervention. 190 patients who underwent complete revasculari-
zation were included.
Result and Discussion: In bivariate analysis, longer TLCS was needed in those with
DM (40 mm vs 36.5 mm, p ¼ 0.008), family history (43 mm vs 38 mm, p ¼ 0.019), and
hypertension (40 mm vs 36 mm, p ¼ 0.043). Gender, Smoking, and dyslipidemia were
not associated with increased TLCS. In multivariate analysis DM (beta-coefficient
12.519, p ¼ 0.002) and family history (beta-coefficient 12.846, p ¼ 0.025).
Hypertension lost its significance after adjustment. TLCS at LAD was longer in male
(28 mm vs 18 mm, p ¼ 0.017) and smokers (30 mm vs 23.5 mm, p ¼ 0.025).
Conclusion: Diabetes and hypertension was associated with total length of coronary
stent in patients underwent PCI for complete revascularization. Diabetes was the
most significant modifiable risk factor contributing to longer total stent length
Abstracts
needed, while smoker is associated to longer total stent length needed in LAD PCI.
Early and proper prevention perhaps could reduce cardiovascular and also financial
burden.
Keywords: Stent • PCI • Modifiable • Risk Factors • Coronary
OR.133. Does Intracoronary Alteplase Affect Myocardial Perfusion in Patient with
ST-segmen Elevation Myocardial Infarction underwent Primary Percutaneous
Coronary Intervention ?
Ayub B.N. Raharja, Zulfikir Mukhtar, Harris Hasan
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Myocardial blush grade (MBG) is a valuable tool for assessing coronary
microvasculature and myocardial perfusion in patients undergoing coronary angiogra-
phy and angioplasty.
Objective: We investigated the effects of intracoronary alteplase in primary PCI with
myocardial perfusion using MBG in patient with ST-segmen Elevation Myocardial
Infarction (STEMI) who underwent primary PCI.
Methods: This is an observational study of 66 STEMI patients retrospectively who
underwent primary PCI, divided into two groups, 31 patients underwent primary PCI
using intracoronary alteplase and 35 patients underwent primary PCI without intra-
coronary alteplase. We then assesed the MBG of each patient. MBG is a qualitative
visual assessment of the amount of contrastmedium filling territory supplied by an
epicardial coronary artery. It is graded as MBG 0 to 3. The data was collected from
January 2018 to March 2019. Bivariate analysis was applied.
Results: From 31 patients (90.3% man, mean of age of 54.84 6 10.59 years old)
underwent primary PCI using intracoronary alteplase, 29 patients (93.5%) had MBG 3,
and 2 patients (6.5%) had MBG 2. From 35 patients (91.4% man, mean age 58.836
7.85 years old) who underwent primary PCI without intracoronary alteplase, 26
patients (74.3%) had MBG 3 and 9 patients (25.7%) had MBG 2. From the bivariate
analysis, intracoronay alteplase was found to be significant variables for myocardial
blush grade. (OR 4.3 with p value < 0.05)
Conclusion: Intracoronary use of alteplase during primary PCI showed better MBG
score than PCI only.
Keywords: alteplase • myocardial blush grade • primary PCI
OR.135. Diagnostic Value of First Minute Heart Rate Recovery on Predicting
Coronary Lession Significancy at Stable Angina Pectoris Patient
Uvitha Y. Suchyar, Muhammad Syukri, Rita Hamdani, Masrul Syafri
Department of Cardiology and Vascular Medicine, Faculty of Medicine Andalas
University / General Hospital Dr. M. Djamil Padang
Background: Treadmill exercise test is an important examination method which is
often being used to evaluate patient with chest pain and becomes the tool for con-
sidering more invasive but expensive therapy. An abnormal first minute heart rate
recovery (HRR1) after treadmill test has proven role as mortality predictor and coro-
nary lession predictor at stable angina pectoris patient. However, on daily clinical
practice, HRR after treadmill exercise test does not include yet as one of risk score
or prognostic factor which is considered on decision making for managing stabile
angina pectoris patient.
Methods: This study used analytical observational approach by using case control
study. Data were taken retrospectively at Heart Center Installation at RSUP Dr. M.
Djamil Padang from August – October 2018 e.g stable angina pectoris patients with
positive treadmill test results whom undergo coronary angiography. Bivariate analysis
were done at first minute heart rate recovery variables towards coronary lession sig-
nificancy with chi-square method, then diagnostic test were done based on receiver
operating curve analysis (ROC).
Results: There were 109 subjects of the study which were divided into two groups.
The value of cut off point of first minute heart rate recovery was 14 times, so that
first minute heart rate recovery was abnormal if the result was < 14 times and first
minute heart rate recovery was normal if the result was  14 times. This value had
sensitivity 87,7% and specificity 91,7% with AUC ¼ 94,9%. The subjects with signifi-
cant lession commonly had abnormal first minute heart rate recovery (p ¼ 0.000)
Conclusion: first minute heart rate recovery can be a predictor for significant coro-
nary lession.
Keywords: Heart Rate Recovery • Treadmill Exercise Test • Coronary Lession
Significancy
OR.136. Mortality rate for cardiac surgical patients using STS score
Aung Zayar Oo, Win Win Kyaw, Aung Thu
Department of Cardiovascular surgery, University of Medicine, Yangon, Myanmar
Background: The Society of Thoracic Surgeons Score (STS score) has been developed
for open heart surgery and coronary artery bypass grafting surgery (CABG). The aim
F67
of our study was to evaluate the performance of STS score in cardiac surgical
patients in University of Medicine (2), Yangon, Myanmar.
Objective: To evaluate the performance of STS Score in cardiac surgical patients in
Myanmar and to study the predictive mortality rate for cardiac surgical patients
using STS Score
Method: A total of 119 patients underwent single valve surgery and coronary artery
bypass grafting surgery from January 2018 to December 2018 was studied.
Preoperative and intra operative risk factors were recorded. And then, predictive
mortality rate was calculated by using STS score. 30 days mortality rate was
recorded. And the performance of STS score in cardiac surgical patients was eval-
uated. Sample size was calculated by using the following formula (Reference: Daniel,
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
2013).
Result: Data from 119 patients were analyzed. Predictive mortality rate for single
valve surgery was 3.9% and observed mortality rate was 1.47%. Predictive mortality
rate for CABG was 2.3% and observed mortality rate was 1.96%.
Conclusion: The Society of Thoracic Surgeons Score performed well when predicting
the mortality for cardiac surgical patients in Myanmar undergoing single valve sur-
gery and coronary artery bypass grafting surgery. This scoring system is suitable for
predicting mortality rate for open heart surgery in Myanmar.
n  o
N ¼ ðZ1a=2 Þ2 p ð1  pÞ =d2
Keywords: The Society of Thoracic Surgeons Score (STS score) • single valve sur-
gery • coronary artery bypass grafting surgery • mortality rate
OR.137. Effect of Statins on Mortality in Heart Failure With Preserved Ejection
Fraction Without Coronary Artery Disease On behalf of Heart Failure Registry –
dr. Saiful Anwar General Hospital Malang
Liemena Harold Adrian, Mohammad Saifur Rohman
Department of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya
University, Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia
Background: Previous RCTs with ACE inhibitors or ARBs, aldosterone antagonists, and
b-blockers showed no benefit regarding to mortality in heart failure with preserved
ejection fraction (HFpEF). Statin with its pleiotropic effects might be associated
with improved survival and reduced mortality in HFpEF patients. The effect of statins
in HFpEF without coronary artery disease (CAD), however, remains unclear.
Method: An observational, single-center, prospective cohort with 674 patients aged
 20 years requiring hospitalization for heart failure was performed. 108 patients
with LVEF  50% without CAD were selected for outcome analysis. Based on prescrip-
tion of statins at admission, we divided patients into the statin group (n ¼ 54) or no
statin group (n ¼ 54). Follow-up was performed within 24 months after discharge and
association between statin use and all-cause mortality was assessed.
Result: Male was more predominant in no statin group (11.7% vs. 24.5%, P ¼ 0.039).
There were no significant difference in diabetes mellitus, atrial fibrillation, smoking
habit, COPD, CKD, eGFR, lipid profile, and HbA1c in both groups. Interestingly, the
statin group showed less incidence of hospitalization for HF and less frequent use of
ACE inhibitors or ARBs compared to the latter (29.4% vs. 52.9%, P ¼ 0.027; 59% vs.
88%, P ¼ 0.002, respectively). In this cohort, 2-years mortality was lower in statin
group (HR 0.11; 95%CI: 0.03–0.46; P ¼ 0.003). The statin group had a significantly
lower incidence of all-cause mortality (log-rank P-value ¼ 0.002). The beneficial
effect of statins on mortality did not have any significant interaction with cholesterol
level, HF severity or prior baseline medications. Diuretic, however, showed signifi-
cant correlation with reduced mortality (HR 0.03; 95%CI: 0.01–0.22; P ¼ 0.001).
Conclusion: Statin might has a beneficial effect on mortality in HFpEF without CAD.
These present findings should be tested in an adequately powered randomized clini-
cal trial.
Keywords: heart failure with preserved ejection fraction • all-cause mortality •
statin • coronary artery disease • non-ischemic heart failure
OR.138. Lower Tolerated Beta-Blocker Dosage in Indonesian Population: a Pilot
Study in Heart Failure and Coronary Artery Disease Patients
Hans Nuari, Vito A. Damay, Michael Tanaka, Melisa Aziz, Indah Sukmawati
Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village,
Tangerang, Indonesia
Background: It is still being discussed regarding up-titration of beta-blocker as an impor-
tant therapy of heart failure with reduced ejection fraction (HFrEF) and coronary artery
disease (CAD). Do we need to achieve reduced heart rate or maximum dose to obtain
desired effect? According to high profile studies, bisoprolol was suggested to be up-
titrated to maximum of 10 mg daily. However, Asia-Pacific populations tend to use much
lower dose to achieve heart rate reduction target (50-60 b.p.m.). There are only few
studies in Asia-Pacific and no specific study regarding this in Indonesia.
Objective: This preliminary study aims to reveal a real-world heart rate response of
bisoprolol dosage in Tangerang, Indonesia, also discover association between patient
characteristics and bisoprolol dosage.
F68
Method: Samples were Siloam hospital outpatient subjects. Inclusion criteria were
HFrEF and CAD patients treated at least 2 months with a tolerated bisoprolol dose,
20-70 year old. Exclusions were fever/systemic infection, respiratory insufficiency,
on digoxin/ivabradine therapy, thyroid disease, and pregnancy.
Result: This study enrolled 150 patients. From 94 patients (56 male; 38 female) with
heart rate of 50-60 b.p.m. (mean: 56.79 6 2.90 b.p.m.), 77 patients (81.91%) were
treated with less than 5 mg bisoprolol. This result was much lower compared to
European studies. There is a significant difference between age and bisoprolol dose
by T-test (p:0.019). Mean age 60.51 6 9.90 year on bisoprolol <5mg, compared to
54.12 6 10.32 year on bisoprolol 5 mg.
Conclusion: Most patients (81.91%) need lower than daily 5 mg bisoprolol to achieve
heart rate reduction target of 50-60 b.p.m. Older age is significantly associated with
lower bisoprolol dosage to achieve heart rate reduction target. Thus should be part
of consideration in real world practices, with respect to dose related benefit of
beta-blocker.
Keywords: heart failure • coronary artery disease • heart rate • beta blocker •
bisoprolol
OR.139. The Significance of HEfGRASP as A Simple Scoring System Which
Comparable to EuroSCORE II for Improving Mortality Prediction After Cardiac
Surgery on Adam Malik Hospital, an Indonesian Subpopulation, North Sumatra
Bertha G. Napitupulu, Ali N. Nasution, Harris Hasan, Doddy Prabisma
Department of Cardiology and Vascular Medicine, School of Medicine, Adam Malik
Hospital, Universitas Sumatera Utara, Medan Indonesia
Background: Due to over or underestimation of its prediction over population
defined by such regional studies, the recommendation of EuroSCORE II has already
downgraded even by its previous performance on improving mortality prediction
among the high risk population in Europe.
Objective: The need for a new scoring system is increasing for EuroSCORE II has not
been validated either over generally Asian population or Indonesian subpopulation as
well.
Method: This is a crossectional study of preprocedural registry data on cardiac sur-
gery from January 2017-October 2018 in Cardiac Centre of H. Adam Malik Hospital
Medan. EuroSCORE II were tested for its accuracy and discriminating power to pre-
dict mortality by ROC analysis. Clinical and echocardiography parameters that are
found significantly corelated with mortality from bivariate analysis are proceed to
logistic regression then finalized to a simple scoring system.
Result: There are 164 patients with 17.6% mortality rate with EuroSCORE II
2.0560.27 are underestimating mortality rate within inhospital mortality patients.
From some parameters that are found significant until logistic regression, seven fac-
tors are statistically arranged into a scoring system abbreviated into HEfGRASP.
Calibration is adequate for both scores (p > 0.05). HEfGRASP has a better AUC than
EuroSCORE II (0.948 vs 0.656). For score 1 on EF < 50%, age>60 years, RVFrac<40%,
PASP >30mmHg and a valve type surgery, then 2 on HbA1C>6% and GFR<70 mL/min,
HEfGRASP equal or more than 4 has a 5.97% mortality rate with 100% sensitivity and
65.7% specificity with mean value 3.562.17.
Conclusion: Our local scoring system, HEfGRASP is an helpful tools for predicting
mortality after cardiac surgery for its better compatibility and suitability over our
population in North Sumatra. HEfGRASP are challenged to be applied on cardiac
centres around ASEAN that have similar population and hospital resources.
Keywords: EuroSCORE II • HEfGRASP • cardiac surgery • ASEAN • scoring
OR.140. Propotion of Ablation Candidate Based on Left Atrial Diameter and
mEHRA Score in Patients with Atrial Fibrillation in Sanglah General Hospital
I D G Surya Mahardika Badung, Putra Swi Antara, Kevin Cherlie
Department of Cardiology and Vascular Medicine, Faculty of Medicine Udayana
University, Sanglah General Hospital, Denpasar, Bali
Background: One established predictor for failure of surgical ablation for atrial fibril-
lation is increased left atrial size. Surgeon perception is that surgical ablation in
these patients is ineffective and should not be performed but the procedure still
have benefits for some patients. In some circles this issue is still being discussed. On
the other side, there are many patients who should get the benefits and potential
for ablation but are not properly identified.
Objective: The purpose of this study was to determine the candidate patients who
would have a left atrial ablation catheter based on left atrial diameter and mEHRA
score in patients with atrial fibrillation.
Method: A cross-sectional study was done on 99 patients with AF (valvular and non-
valvular heart disease) in outpatient clinic Sanglah General Hospital. The echocar-
diography parameter was LA diameter. Categorized into large group (>5 cm) and nor-
mal group (5 cm) left atrial size groups were compared with mEHRA score. This
Abstracts
study took secondary data and all patients had echocardiography within last 1 year
start from January until desember 2018.
Result: Patients in the normal left atrium group were older (77.5%; N ¼ 55), the type
of AF based on duration in normal left atrium group were dominant non-paroksismal
AF (76.4%;N¼55) and had higher score the modified of European Rhythm Association
symptom classification in AF (51.4%;N¼37). The large and normal left atrium group
were similar to had high risk of TE using CHA2DS2VASc score (84.6; N ¼ 22 vs 90.1%;
N ¼ 64) rhythm at 1 year (86% vs 93%, P 1=4 .04), event of embolic stroke was similar
(19.2%;N¼5 vs 12.7%;N¼9) despite the majority of patients not taking anticoagula-
tion at 1 year.
Conclusion: The prevalence of normal LA diameter was higher in older age, non-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
paroksismal AF and had higher score of mEHRA and valvular disease were the most
common comorbid diseases found in this study. Thromboembolism risk in this study
was relative high. Suggestion the importance of LA catheter ablation should be con-
sidering to be candidates. Beside considering the BMV procedure in a number of the
patient. Even though the use of anticoagulant has been optimized.
Keywords: Ablation • Atrial Fibrillation • Left Atrial Diameter • mERHA
OR.141. Circadian Variation of ST-elevation Myocardial Infarction Patients in Dr.
Iskak General Hospital Patients
N. A. Suyani, F. S. Laitupa, E. Ruspiono, A. Wibisono2, T. Astiawati, A. W. Nugraha,
F. Caesario, S. Hayon
Dr. Iskak General hospital, Tulungagung, East Java, Indonesia
Background: The circadian rhythm is known to influence a number of physiological
and pathological cardiovascular processes, yet little is known about the characteris-
tics of circadian rhythm on ST-segment elevation myocardial infarction (STEMI) onset
and its impact on clinical outcomes
Methods: We examined circadian rhythm of STEMI in 450 patients over a 1-year
period. Patients were categorized by time of symptom onset obtained from patient
self-reports in the medical record into three 8-hour intervals: 6AM-2PM, 2PM-10PM,
and 10PM-6AM. Patient’s demographic, risk factors, and clinical characteristics of
each subgroup were analyzed.
Results: A circadian variation in the timing of symptom between 6AM- 2PM (40.9%);
2PM-10PM (35.1%) and 10PM-6AM (24%) was observed. It peaked at approximately 12
AM. There were no age, sex, pre-hospital delay differences between the 3 subgroups.
There was also no difference in the prevalence of cardiovascular risk factors and
clinical characteristics between the 3 groups except for Killip class. Patients in the
time interval of 10 PM-6 AM have the highest proportion (74.1%) for presenting Killip
1 followed by those (67.9%) in the time interval of 6 AM-2 PM (p ¼ 0.03).
Conclusion: We observed a circadian peak in STEMI onset was at noon. Notably, var-
iation in circadian rhythm impact the clinical presentation of Killip class.
Keywords: Circadian rhythm • ST-segment Elevation Myocardial Infarction
OR.142. Correlation Between BUN/Creatinine Ratio With Left Ventricle
Dysfunction Degree in Acute Decompensated Heart Failure Patients
Drastis Mahardiana
Mardi Waluyo General Hospital, Blitar, Indonesia, Medicine Faculty of Malang Islam
University, Malang, Indonesia
Background: Acute decompensated heart failure is a condition of failing heart to
fullfill systemic circulation demand which is represend systolic and diastolic dysfunc-
tion of left ventricle followed by heart structural damage. Some evidence exists
about the possible relationship between BUN and creatinine serum in peripheral
blood vessel as a sign of acute renal injury (azotemia) with this disease severity.
Objective: This study intended to prove the relationship between BUN/creatinine ratio
with left ventricle dysfunction degree in acute decompensated heart failure patients.
Method: An explorative study with correlation design was done. 40 patients with
acute decompensated heart failure those meet inclusion criteria were consecutively
choosen. Patients’ peripheral vein blood were took and analized with analyzer
machine to get BUN and creatinine data. Degree of left ventricle dysfunctions were
measured using echocardiogram machine. The correlation among variables was
tested with pearson correlation test.
Result: There are significant correlations between BUN/creatinine ratio with left
ventricle systolic dysfunction degree (EF by Teich r ¼ -0.992; p ¼ 0.000 and EF by
Biplane r ¼ -0.992; p ¼ 0.000) and left ventricle diastolic dysfunction degree (E/A r
¼ -0.994; p ¼ 0.000, Deceleration Time r ¼ 0.986; p ¼ 0.000, and E’ r ¼ -0.958;
p ¼ 0.000). Both analyzed with 95% confidence interval of the difference.
Conclusion: The increasing BUN/creatinine ratio as marker of renal injury level have
significant correlation with decreasing of systolic dan diastolic function of left ven-
tricle in patients with acute decompensated heart failure.
Keywords: BUN/creatinine ratio • renal injury • left ventricle dysfunction • acute
decompensated heart failure
Abstracts F69

OR.143. Blood Urea Nitrogen-to-creatinine Ratio at admission as a Predictor of
Rehospitalization in Patients with Acute Decompensated Heart Failure
Vitri Alya, Harris Hasan, Ali N. Nasution
Departemen of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatra Utara, Medan, Indonesia
Background: Elevated blood urea nitrogen-to-creatinine ratio (BCR) describe high
neurohormonal activity in patient with acute decompensated heart failure (ADHF),
therefore it’s value has been thought to be a parameter of rehospitalization and
mortality in this patient. Although elevated of this marker at hospital admission has
OR.145. Clinical Profiles and Electrocardiographic Features of
Radiofrequency Catheter Ablation Outcome in Ventricular Arrhythmias
Originating from The Left Ventricular Summit in National Cardiovascular Center
of Harapan Kita
Dwi Yuda Herdanto, Sunu Budhi Raharjo, Dony Yugo Hermanto, Dicky Armein Hanafy,
Yoga Yuniadi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas
Indonesia-National Cardiovascular Center Harapan Kita
Background: Radiofrequency ablation of ventricular arrhythmias (VAs) originating

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

been reported to be associated with poor inhospital outcome, its association to reho- from left ventricular (LV) summit is a challenge. This region is the highest portion of
spitalization in patients with ADHF remains to be elucidated. the LV epicardium, near the bifurcation of the left main coronary artery (LMCA), and
Method: Patients were collected from July 2018 until December 2018. A cohort pro- accounts for up to 14.5% of LV VAs. LV summit VAs have various anatomical limitation,
spective study of 110 consecutive ADHF patients admitted to the emergency depart- making it difficult and often need multiple mapping and ablation.
ment was studied. Variables such as previous comorbidities, medication history, ejec- Objectives: The objectives of this study were to determine clinical profiles and elec-
tion fractions (EF), and laboratory findings were evaluated. The BCR were calculated trocardiographic features of LV summit VAs, also to determine features for successful
from the ratio between blood urea nitrogen (BUN) and creatinine on admission. They ablation prediction.
were then further followed up. The patient whom readmitted to any hospital due to Methods: We recruited all LV summit VAs cases underwent radiofrequency catheter
ADHF within 1 months after discharged was then considered positive. ablation (N ¼ 12 patients; male 50%; mean age 53 þ 13 years) between January 2015
Result: From total 110 patients, there were 38 patients (34.5%) rehospitalization. and July 2018.
The utilization of ß-blockers, nitrates, and aspirin as well as BUN, BCR, and random Results: LV summit VAs ablation success rate in National Cardiovascular Center of
blood glucose give statistical difference (p < 0.25) between both groups as univariate Harapan Kita was 58.3% (Figure). Patients more frequently in preserved LV and RV
analysis. We performed a ROC analysis for BCR to receive a cut-off point of 16.05 function, with hypertension as traditional risk factor. Only 25% patients underwent
(AUC 62.7 %) for 71.1% sensitivity and 56.9% specificity in predicting rehospitalization recurrent ablation and 66.7% with 3D-mapping ablation. Only one patient with atrial
(p ¼ 0.029). We then performed logistic regression between them with the results of fibrillation as electrocardiographic (EKG) basic rhythm. All patients with LV summit
statistically significant of random blood glucose (OR ¼ 0.99, 95% CI: 0.986 – 1.000; VAs, show LBBB type morphology with inferior axis and negative in aVL lead. About
p ¼ 0.041) and BCR (OR ¼ 3.38, 95% CI: 1.418 – 8.076; p ¼ 0.006). 66.7% patient have earlier VAs precordial lead transition with higher R/S ratio in V2
Conclusion: BCR is a independent predictor of rehospitalization in ADHF patients. and V3, than their basic rhythm. All patients have Maximum Deflection Index (MDI)
Further prospective study in validating its predicting value was needed. >0.55. However, patient with successful ablation of LV summit VAs were older (56 þ
Keywords: Admission • Blood Urea Nitrogen-to-creatinine Ratio • 15 vs 47 þ 10), hypertensive and using 3D mapping ablation with equivalent proce-
Rehospitalization • ADHF dure duration. Earliest ventricular activation in successful ablation was earlier (60 þ
15 vs 45 þ 13). Patients with earlier VAs precordial lead transition than basic rhythm
showed higher success rate during ablation. VAs and basic rhythm R/S ratio in V2 and
OR.144. Association Between Common Carotid Artery Intima-Media Thickness V3 were lower and Betensky score was higher in successful ablation. However, due to
And Microalbuminuria In Type 2 Diabetes Mellitus Patient small population of LV summit VAs underwent radiofrequency ablation, no statisti-
Gede Aditya, Wayan Aryadana, Wira Gotera cally significant factors found in the study.
Department of Cardiology and Vascular Medicine, School of Medicine, Udayana Conclusion: The LV summit VAs radiofrequency catheter ablation is challenging, with
University, Bali, Indonesia lower success rate rather than ablation of others idiopathic VAs. Patient with suc-
cessful ablation of LV summit VAs were older, hypertensive, using 3D mapping, earlier
ventricular activation, earlier VAs precordial lead transition with lower R/S ratio in
Background: Microalbuminuria is associated with cardiovascular mortality in patient V2-3 and higher Betensky score.
with type 2 diabetes mellitus. It is not known whether microalbuminuria is related to Keywords: Left Ventricular Summit Ventricular Arrhythmias • Radiofrequency
an early stage of atherosclerosis. Catheter Ablation • ECG features
Objective: The aim of this study was to evaluate the association between microalbu-
minuria and Carotid Artery Intima Media Thickness (CIMT) in type 2 Diabetes mellitus
patient.
Method: This study was an observational study with a cross-sectional design at
Sanglah Hospital, Bali, Indonesia during January to March 2019. A 60 sample was
determined consecutively. The CIMT was measured for all of the patients by one
researcher. The Albumin Urine Creatinine Ratio (AUCR) was measure for all of the
patient. The patients were divided into normoalbuminuria and microalbuminuria
group according to urinary albumin excretion rate. All patients underwent routine
investigations including BMI, blood sugar, lipid profile, ECG, urinary albumin excre-
tion rate and glycosylated hemoglobin. CIMT was investigated by B-mode real-time
high-frequency.
Result: A total of 60 patients with type 2 diabetic patient were enrolled with a mean
diabetes duration of 4.8 years (26 women and 34 men). Compare to subject with nor-
moalbuminuria (n 28), microalbuminuria (n 32) patient dominantly older age (56.7
68.03 year) vs (51.568.21 year). Bivariate analytic shows significant correlation
between AUCR and CIMT (r 0.69, r2 0.48, p < 0.001). After adjusted for potential
confounders, microalbuminuria was associated with CIMT also significantly correlate
with AUCR (p 0.001, 95% CI 0.001-0.002), hypertension (p 0.014, 95% CI 0.016-
0.134), and HBA1C (p 0.033, 95% CI 0.002-0.035), r2 0.61, adjusted r2 0.55.
Dyslipidemia, duration of diabetes, age don’t correlate significantly with CIMT.
Conclusion: This study showed a significant association between CIMT as a marker of
macrovascular complication of diabetes mellitus and microalbuminuria as an impor-
tant index of microvascular complication
Keywords: Carotid intimal medial thickness • Microalbuminuria • Type 2 diabetes
mellitus
OR.145. Figure 1 LV Summit Ablation Success Rate
F70 Abstracts

Objective: To investigate association between CHA2DS2-VASc score with the pres-

OR.145. Table 1 Baseline characteristic of LV summit PVC
ence of multiple vessels coronary artery disease (MVCAD ) in ST elevation acute coro-
nary syndrome (STE-ACS).
Total Success Failed P – value Method: This was cross-sectional study of of 30 consecutive patients with STE-ACS
(N ¼ 12) (N ¼ 7) (N ¼ 5) within 12 hours after the onset of chest pain underwent Primary Percutaneus
Coronary Intervention ( PPCI ) between Januari and February 2019 were enrolled.
Age (years) 53 þ 13 56 þ 15 47 þ 10 0,286 The patients were divided into two group CHAD2DS2-Vasc < 2 and CHAD2DS2-Vasc
Male 6 (50%) 4 (57.1%) 2 (40%) 0,558  2. MVCAD was assessed at the time PPCI and divided into two groups, single vessel
Reduced EF (<40%) 4 (33.3%) 3 (42.9%) 1 (20%) 0.576 and multiple vessle. Statistical analysis was performed using chi-square test.
Reduced TAPSE (<1.7cm) 1 (8.3%) 1 (14.3%) 0 (0%) 0.377 Result: STE-ACS patients underwent PPCI showed baseline characteristic : age 56.93
Hypertension 7 (58.3%) 5 (71.4%) 2 (40%) 0.558 6 11.66 years, 26 male (86%), systolic blood pressure 118.36 6 17.7 mmHg, diastolik
Dyslipidemia 3 (25%) 3 (42.9%) 0 (0%) 0.205

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

blood pressure 73.9 6 9.7 mmHg, 40 % LAD related infarct, 60 % non-LAD related
DM 3 (25%) 2 (28.6%) 1 (20%) 0.735 infarct, patients with CHAD2DS2-Vasc < 2 ¼ 13 (43,3%),  2 ¼ 17 (56,7%), patients
Weight (kg) 64 þ 15 64 þ 14 64 þ 18 0,947 with one vessel ¼ 12 (40%), multiple vessels 18 (60%). There were higher number of
NYHA >I 4 (33.3%) 3 (42.9%) 1 (20%) 0.598 patients with MVCAD in groups with CHA2DS2-VASc score  2 (p ¼ 0.003)
History of PVC ablation 3 (25%) 1 (14.3%) 2 (40%) 0.523 Conclusion: CHA2DS2-VASc score was associated with the presence of MVCAD in STE-
3D Ablation 8 (66.7%) 6 (85.7%) 2 (40%) 0.222 ACS
Total Mapping Area 3 (2-4) 4 (2-4) 3 (2-4) 0,681 Keywords: CHADS2-VASc score • MVCAD • STE-ACS
Mapping Coronary Sinus 10 (83.3%) 7 (100%) 3 (60%) 0.152
Mapping Coronary Cusp 9 (75%) 5 (71.4%) 4 (80%) 0.735
Mapping Below LCC 9 (75%) 5 (71.4%) 4 (80%) 0.735
Mapping RVOT 12 (100%) 7 (100%) 5 (100%) - OR.147. The Relationship between First Minute Heart Rate Recovery and
Earliest Activation (ms) 54 þ 16 60 þ 15 45 þ 13 0,088 Severity of Coronary Artery Disease Using the Gensini Score in Patient with
Duration of Procedure (minutes) 230 þ 77 233 þ 58 227 105 0,907 Stable Angina Pectoris at Heart Center RSUP Dr. M. Djamil Padang
Putri Handayani, Uvitha Y. Suchyar, Citra K. Krevani
Department of Cardiology and Vascular Medicine University Andalas Padang; General
Hospital Dr. M. Djamil Padang
OR.145. Table 2 Baseline electrocardiographic feature of LV summit PVC

Total Success Failed P – value Introduction: Abnormal heart rate recovery (HRR) occurs due to insufficient vagal
(N ¼ 12) (N ¼ 7) (N ¼ 5) activity after exercise and has proven role as mortality predictor. The association
between first minute HRR and coronary artery disease (CAD) angiographic severity
has been investigated, but the confounding data about diagnostic ability still exist.
Basic ECG of Sinus Rhythm 11 (91.7%) 6 (85.7%) 5 (100%) 0.377
Objectives: The aim of this study is to investigate whether first minute HRR can
Basic ECG Axis (..o) 22 þ 37 15 þ 33 33 þ 42 0.433
include as one of prognostic factor for coronary artery disease severity detection.
PVC with LBBB type 12 (100%) 7 (100%) 5 (100%) -
Methods: This was an observational retrospective study at Heart Center RSUP Dr. M.
Inferior lead PVC with positive axis 12 (100%) 7 (100%) 5 (100%) -
Djamil Padang from August – October 2018 included 109 stabile angina pectoris
Lead I PVC with negative axis 7 (58.3%) 5 (71.4%) 2 (40%) 0.558
patients with positive treadmill test results whom undergo coronary angiography.
Lead aVL PVC with negative axis 12 (100%) 7 (100%) 5 (100%) -
Abnormal first minute HRR (HRR1) if the result was <14 times at the first minute
PVC or Basic rhythm
after the recovery phase. The Gensini severity score, a measurement of the severity
first precordial transition?
of coronary stenosis, was also calculated.
 Basic rhythm transition first 2 (16.7%) 1 (14.3%) 1 (20%) 0.152
Results: Significant CAD was detected in 60 (55%) patients, mostly male (n ¼ 51; 85%)
 PVC transition first 8 (66.7%) 6 (85.7%) 2 (40%)
with mean age 53.066.39 years old. Risk factor for smoking and dyslipidemia statisti-
 Same transition 2 (16.7%) 0 (0%) 2 (40%)
cally significant in CAD group (p < 0.001and p < 0.038, respectively). There were 54
PVC R amplitude V1 (mm) 1.4 þ 1.3 1.5 þ 1.3 1.2 þ 1.3 0.747
(90 %) patients with an abnormal HRR1 in significant CAD group (p < 0.000). Gensini
PVC S amplitude V1 (mm) 8 þ 1.6 7.8 þ 1.5 8.3 þ 1.9 0.616
scores were significantly higher in the CAD group than in the control group
PVC R amplitude V2 (mm) 4.4 þ 4.3 4.7 þ 4.2 4 þ 5.1 0.795
[20.8617.08 vs. 1.461.95, p < 0.000]. There was relationship of Gensini scores and
PVC S amplitude V2 (mm) 12.4 þ 7 12.1 þ 5.1 12.9 þ 9.7 0.850
abnormal HRR1 (OR ¼ 1.9, 95% CI: 1.4 - 2.7, p < 0.000).
PVC R amplitude V3 (mm) 9.6 þ 6 8.6 þ 4.4 11 þ 8.2 0.530
Conclusion: There is a significant relationship between abnormal HRR at one minute
PVC S amplitude V3 (mm) 6.2 þ 3.7 5.9 þ 3.3 6.8 þ 4.6 0.688
and the severity of coronary artery disease
Basic Rhythm R 1.9 þ 3.8 2.6 þ 5 1 þ 0.9 0.502
Keywords: Heart Rate Recovery • Coronary Artery Disease • Gensini Score
amplitude V1 (mm)
Basic Rhythm S amplitude V1 (mm) 7.9 þ 3 9 þ 3.2 6.5 þ 2.4 0.185
Basic Rhythm R amplitude V2 (mm) 5.4 þ 4.1 4.8 þ 4.9 6.2 þ 3.1 0.583
Basic Rhythm S amplitude V2 (mm) 10.2 þ 3.9 10 þ 4.1 10.4 þ 4.2 0.871 OR.148. Novel Combination of Digoxin and Ivabradine as Acute Rate Control
Basic Rhythm R amplitude V3 (mm) 6.6 þ 5.5 5 þ 5.6 8.8 þ 5.2 0.259 Treatment for Rapid-Ventricular-Response Atrial Fibrillation : A Pilot Study
Basic Rhythm S amplitude V3 (mm) 6.9 þ 2.6 6.1 þ 1.6 8 þ 3.6 0.250
Laksmi Senja Agusta1, Rizal Rahmanda Akbar1, Muhamad Rizki Fadlan2, Ardian Rizal1,2
PVC R/S Ratio V1 0.18 þ 0.2 0.2 þ 0.2 0.16 þ 0.21 0.749 1
Wava Husada Hospital, Malang, Indonesia, 2Departement of Cardiology and Vascular
PVC R/S Ratio V2 0.83 þ 1.44 0.57 þ 0.74 1.2 þ 2.2 0.486
Medicine, Faculty of Medicine, Brawijaya University-dr.Saiful Anwar General
PVC R/S Ratio V3 2.3 þ 2 2.1 þ 1.5 2.7 þ 2.8 0.636
Hospital, Malang East Java, Indonesia
Basic Rhythm R/S Ratio V1 0.4 þ 0.98 0.56 þ 1.3 0.18 þ 0.15 0.525
Basic Rhythm R/S Ratio V2 0.7 þ 0.8 0.67 þ 1 0.77 þ 0.58 0.838
Basic Rhythm R/S Ratio V3 1.4 þ 2 1 þ 1.4 2 þ 2.7 0.414 Background: Recent studies have stimulated interest in ivabradine, a newly emerg-
PVC TMD (ms) 89 þ 11 88 þ 13 90 þ 10 0.843 ing If channels inhibitor, to have potential benefit for ventricular rate control in AF.
PVC QRS duration (ms) 147 þ 13 145 þ 14 149 þ 11 0.675 Objective: The aim of this study to compare efficacy between combined therapy
Betensky Score 1.09 þ 0.9 1.34 þ 0.9 0.73 þ 0.7 0.250 digoxin- ivabradine versus digoxin alone in controlling heart rate of rapid AF as well
MDI 0.6 þ 0.04 0.6 þ 0.05 0.6 þ 0.04 0.930 as investigating the safety issues due to administration.
Methods: Single centered, retrospective, observational study was conducted to com-
pare patientstreatedby combined therapy of digoxin and Ivabradine and digoxin only
who were admitted from emergency department with rapid ventricular response AF.
Acute rate control, length of stay, and notable safety issues comprise hypotension,
OR.146. CHA2DS2-VASc Score was Associated with The Presence Of Multiple severe bradycardia, and use of inotropic agents, were obtained from medical record.
Vessels Coronary Artery Disease in ST Elevasion Acute Coronary Syndrome Statistical analysis using T-test and chi-square test was employed to assess compari-
son between both treatment.
F Esa, Novaro A. Tafriend, L Morlim, A Carina, Dina A. Permatasari, B. Sulistiyati
Results: We analyzed data from 23 patients who were treated by both digoxin- ivab-
Department of Cardiology and Vascular Medicine, School of Medicine, Diponegoro
radine comparing with 14 patients receiving digoxin. Heart rate was reduced signifi-
University, Kariadi Hospital, Semarang, Indonesia
cantly within four hours after administration in group treated by both drugs com-
pared to controls (35,23 % vs 18,46%, p ¼ 0.007). In terms of length of stay, mean
Background: CHA2DS2-VASc scores are widely used in clinical practice and include duration was lower in patients with combined therapy than digoxin only, which were
similar risk factors for the development of coronary artery disease (CAD). It is known 3.26 days and 5.93 days, respectively (p ¼ 0.052). In other hand, bradycardia or
that the factors comprising CHA2DS2-VASc score promote atherosclerosis and associ- hypotension occurred in 26.1% of patients treated with ivabradine, whilst the other
ated with CAD. group demonstrated nearly twice higher incidence of 50%.
Abstracts
Conclusion: This study has demonstrated the efficacy and safety of treatment using
ivabradine in concurrent with digoxin for rapid AF. Combination treatment benefited
to significantly reduce heart rate as well as shorten admission duration, without
remarkable incidence in safety issues. However, further investigation using larger
sample size should be conducted.
Keywords: Ivabradine • digoxin • rate control
OR.149. Trends in Age and Gender and Difference in Mortality of Patients with
Acute Coronary Syndrome in Indonesia
Hardya G Hikmahrachim1, Rezza Mahandhika1, Saur M E J Siregar1, Surya Dharma2
1
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 2Departmen of
Cardiology and Vasculara Medicine, Faculty of Medicine, Universitas Indonesia,
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: acute coronary syndrome (ACS) is still a global leading cause of death.
As time goes, demographic characteristic in Indonesia was changing since life expect-
ancy was higher and healthcare facilities has improved.
Objective: to investigate the trends in both age and gender among Indonesian with
acute coronary syndrome admitted to hospital and its mortality differences.
Method: An analysis was done from Jakarta Acute Coronary Syndrome (JAC) Registry
data in two different period, 2008-2010 (n ¼ 2762) and 2015-2017 (n ¼ 5406). This
registry data is from patients admitted to tertiary academic cardiovascular centers
in Jakarta. The comparison was present in descriptive analysis.
Result: Compared to 2008-2010 period, female patients admitted for ACS has
reduced from 22.7% to 20.8% (p < 0.05), in contrary to male (77.3% to 79.2%,
p < 0,05). Among male patients, the incidence of STEMI was increasing (34.7% to
50.5%, p < 0.001), while NSTEMI and UAP was decreasing (28.3% to 22.9%, p < 0.001
and 36.9% to 26.5%, p < 0.001, respectively). In female patients, both STEMI and
NSTEMI was increasing (19.5% to 33.5%, p < 0.001, and 26.4% to 28.2%, p < 0.001,
respectively) while UAP incidence was decreasing (54.2% to 38.2%, p < 0.001).
Otherwise, we found a relatively stable trend in age-based analysis between that
two period. A risk factors analysis showed that dyslipidemia and family history of
ACS was significantly reduced in both genders, while hypertension was reduced only
in male patients. On the other hand, female smoker has significantly increasing (6.1%
to 11.2%, p ¼ 0.001). A significant increase in mortality was found in 51-65 years old
and 66-75 years old group (46.7% to 51.7%, p < 0.05, and 16.7% to 22.8%, p < 0.05,
respectively). There were no difference in mortality among gender and the other
age groups.
Conclusion: There were a shifting trends in age and gender of patients with acute
coronary syndrome admitted to tertiary academic hospital in Indonesia. This would
lead clinician to assign different approach for ACS prevention in male and female. It
also poses a challenge to reduce mortality in specific age groups.
Keywords: acute coronary syndrome • age • gender • mortality • trend
OR.150. Polymorphism of CYP2C19 is Associated with Poor Platelet Reactivity
and Indirectly Affect TIMI-flow among Asian Patients with STEMI Underwent
Primary PCI
Adelin Dhivi Kemalasari, Renan Sukmawan, Suko Adiarto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: The platelet response to clopidogrel and prognosis in patients with
myocardial infarction have recently been demonstrated to be significantly worse in
population carrying genetic variant of cytochrome P450 (CYP450) which alters bio-
transformation of clopidogrel. It is unknown whether platelet reactivity measured by
P2Y12 reaction unit (PRU) is affected by CYP2C19 polymorphism or predictive of TIMI
flow in Asian populations.
Purpose: We sought to define whether polymorphisms on CYP2C19 genes and platelet
reactivity may affect the TIMI flow in Asian patients with STEMI heving undergone
primary percutaneous coronary intervention (PCI).
Method: This study recruited 90 patients with ST-elevation myocardial infarction
(STEMI) receiving 600 mg loading dose of clopidogrel prior to primary percutaneous
coronary intervention (PCI). High-on-treatment platelet reactivity was evaluated
using the VerifyNow Assay in a subset of patients. Patients presenting with values
exceeding 208 P2Y12 reactivity unit (PRU) are categorized as non-responders to clo-
pidogrel. CYP2C19 genotyping was performed by real-time polymerase chain reaction
(PCR). Post-PCI TIMI flow was categorized into TIMI flow 3 and TIMI flow <3.
Results: Among all 90 patients (median age ¼ 54.5 (24 – 76) years old; 93.3% male),
23.3% of patients with *2 allele, 11.2% of *3 allele carriers, and 1.1% carried both
allele. 23.4% of patients were clopidogrel non-responders. Overall, there was no cor-
relation between CYP2C19 polymorphism and TIMI flow <3, but there was a relation-
ship between CYP2C19 polymorphism and decreased function of platelet inhibition
(OR 4.7, p ¼ 0.030). VerifyNow >208 PRU increased the risk of suboptimal reperfu-
sion (OR 3.3, p ¼ 0.046)
Conclusions: In Asian STEMI patients receiving clopidogrel prior to primary PCI, pres-
ence of even one-reduced function CYP2C19 allele was associated with a significant
F71
increase in PRU level and the gene indirectly affected post procedural myocardial
perfusion. However, populations of clopidogrel non-responder significantly had
increased risk of getting post-procedural TIMI flow <3.
Keywords: CYP2C19 polymorphism • VerifyNow • TIMI flow • myocardial infarction
OR.151. CHA2DS2-VASc-HSF Score: A Novel and Simple Independent Predictor
for Severe Coronary Artery Disease
M. J. Al-Farabi1,2,*, I. G. P. G. Semita1,3, K.A Shonafi1, B. Jovie3, Andrianto1
1
Department of Cardiology and Vascular Medicine, Soetomo General Hospital, Faculty
of Medicine, University of Airlangga, Surabaya, Indonesia, 2Postgraduate School,
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
University College London, London, United Kingdom, 3Department of Cardiology and
Vascular Medicine, Indonesian Navy Hospital of Dr. Ramelan, Surabaya, Indonesia
*Correspondence: m.farabi.17@ucl.ac.uk
Background: A plethora of scores is available to assess the severity of CAD (Coronary
Artery Disease). However, the majority of them requires advanced technologies.
CHA2DS2-VASc-HSF is a novel and simple risk scoring which is easily used for primary
care settings in Indonesia.
Objective: We hypothesize CHA2DS2-VASc-HSF is predictive to severe CAD as assessed
by GS (Gensini Score) and we compare its predictive value with CHA2DS2 and
CHA2DS2-VASc score.
Method: A total of 210 consecutive patients who underwent coronary angiography
were enrolled in our study. Anthropometric, laboratory, clinical findings, and patient
history was obtained from medical records and used to calculate CHA2DS2, CHA2DS2-
VASc, and CHA2DS2-VASc-HSF score. Severe CAD defined by GS  20. Statistical analy-
ses were done using SPSS 25.0.
Result: CHA2DS2, CHA2DS2-VASc and CHA2DS2-VASc-HSF is correlated with GS (r ¼ 0.315,
p ¼ 0.000; r ¼ 0.395, p ¼ 0.000; and r ¼ 0.612, p ¼ 0.000). Multiple stepwise linear
regression analysis showed that CHA2DS2, CHA2DS2-VASc and CHA2DS2-VASc-HSF score
was significantly associated with the GS (b ¼ 0.351, p ¼ 0.000; b ¼ 0.298, p ¼ 0.001; and
b ¼ 0.609, p ¼ 0.000) and independent from other variables (BMI, Blood Pressure,
Complete Blood Count, Renal Function and Blood Haemostasis Parameter). Receiver
operating characteristic (ROC) curve analysis showed the CHA2DS2 score (AUC [Area
Under the Curve], 0.630; 95% CI, 0.555–0.706; p ¼ 0.001), CHA2DS2-VASc score (AUC,
0.680; 95% CI, 0.608–0.753; p ¼ 0.000), and CHA2DS2-VASc-HSF score (AUC, 0.785; 95%
CI, 0.723–0.846; p ¼ 0.000) were predictive of severe CAD. Cut-off point analysis
showed that the CHA2DS2-VASc-HSF score  2.5 (sensitivity ¼ 81.4% and specificity ¼
68.1%) provided the highest predictive value for severe CAD.
Conclusion: The CHA2DS2-VASc-HSF score provides the highest predictive value for
severe CAD compared to the CHA2DS2 and CHA2DS2-VASc score, suggesting that
CHA2DS2-VASc-HSF score  2.5 may provide a better prediction of severe CAD in pri-
mary care and suggesting referral for coronary angiography.
Keywords: Atherosclerosis • Coronary angiography • Gensini Score • ROC curve.
OR.152. Diagnostic Value Of QTc Dispersion And QT Dispersion Ratio Changes In
Treadmill Training Test For Detecting Coronary Lesion In Stable Angina Pectoris
Patients
Putri Yeantesa, Uvitha Suchyar, Hauda El Rasyid, Masrul Syafri
Department of Cardiology & Vascular Medicine of Andalas University / Dr M Djamil
General Hospital Padang
Background: Treadmill test (TMT) is often used in the initial evaluation of patients
with chest pain and can be a filter for more expensive invasive diagnostic. Increased
QT dispersion (QTD) occurs because of the heterogeneity of ventricular repolariza-
tion because transient ischaemia during TMT can be a marker of coronary artery dis-
ease (CAD) and can improve the accuracy of exercise tests to diagnose CAD.
Objective: Addition of DQTcD and DQTdR parameters in TMT can provide better sen-
sitivity for detecting ischemic responses in patients with stable angina pectoris (SAP)
than only using conventional criteria that have been determined.
Method: This is an analytic observational approach with a cross sectional study. Data
was taken retrospectively at the Heart Center of RSUP Dr. M. Djamil Padang, from
March to April 2019, SAP patient with positive TMT who underwent coronary angiography
as the subject. Bivariate analysis was performed on changes in QTcD (DQTcD) and QTdR
(DQTdR) variables on the significance of coronary lesions by the chi-square method,
after which a diagnostic test was based on receiver operating curve (ROC) analysis.
Result: There were 113 subjects, older age, male and smoking were more common
in groups with significant coronary lesions. Cut off point for DQTcD is  13 ms with a
sensitivity of 96.7% and specificity 98.0% and AUC 97.8%, while DQTdR 5.5% with
sensitivity 95.1% and specificity 96.2% and AUC 96.6% are related to CAD. Obtained
subjects with CAD generally had a value of DQTcD  13 ms (p < 0.001) and DQTdR 
5.5% (p < 0.001).
Conclusion: The use of QTD parameters as ECG variables, which are easily obtained in
evaluating stress tests, can improve the diagnostic accuracy of exercise tests. In addi-
tion, evaluation of QTD variables can provide information about the incidence of CAD.
Keywords: DQTcD • DQTdR • Treadmill Exercise Test • Coronary Lession
Significancy
F72
OR.153. Impact Duration of Haemodialysis on Left Ventricular Ejection Fraction
and Tricuspid Annulus Plane Systolic Excursion
D.Y. Pertiwi, D. Rostiati
Bandung Regional Public Hospital
Backround: Chronic Kidney Disease (CKD) have associated with cardiovascular dis-
eases. Early diagnostic of CVD (Cardio Vascular Diseases) as risk factor in CKD espe-
cially of haemodialysis patients. Echocardiograph shown some information about
heart function and structure to know association between theirs. Decrease Left
Ventricular Ejection Fraction (LVEF) over time in haemodialysis patients may be due
to negative effect of CKD. Tricuspid Annulus Plane Systolic Excursion (TAPSE) is one
method to measure systolic function of right ventricle.
Method: Thirty haemodialysis stable patients in September-November 2018 at
Bandung Regional Public Hospital were subjected to evaluated by transthoracic echo-
cardiographic. We were analyzed association between LVEF and TAPSE and duration
of haemodialysis. Value of these are 50% for LVEF, 16mm for TAPSE and 1 year for
duration of haemodialysis.
Result: In Normal LVEF, there are 18 (60.00%) patients doing haemodialysis over 1
year and 6 patients (20.00%) doing less of it. In decreasing LVEF, there are 6 patients
(20.00%) doing haemodialysis over 1 year and no one doing haemodialysis less 1 year.
In Normal TAPSE, there are 23 (76.67.00%) patients doing haemodialysis over 1 year
and 2 patients (6.67%) doing less of it. In abnormal TAPSE, there are 2 patients (6.67%)
doing haemodialysis over 1 year and no one doing haemodialysis less 1 year and 3
patients (10.00%) haemodialysis less 1 year. We were analyzed association between LVEF
and duration of haemodialysis with chi-square test p 0.171. Beside that, association
between TAPSE and duration of haemodialysis with chi-square test p 0.049. In this anali-
sis, TAPSE have associated with duration of haemodialysis, but LVEF does not have it.
Conclusion: In our analyzed, there is has association between TAPSE and duration of
haemodialysis. For different result from other analyses, we must compare and know
weakness of the research.
Keywords: Haemodialysis • LVEF • TAPSE • Echocardiographic
OR.154. Correlation Between Total Lean Body Mass Percentage, and Total Body
Fat Percentage to VO2 Max in The Viewpoint of Medicine and Nursing
Anang Basuki Maharjito1, Bunga Listia Paramita1, Endah Silfiyanti2
Rumah Sakit Olahraga Nasional, Jakarta, Indonesia
Background: Maximal oxygen consumption (VO2 max) is the maximum capacity to
transport and utilize oxygen and is often used as a measure of an individual’s aerobic
capacity.4 Previous pertinent studies indicated body mass, fat free mass, % body fat,
and body surface area, are the best predictor of VO2 max.2
Objective: The purpose of this paper was to examine the correlation between total
lean body mass percentage, and or total body fat percentage to VO2 Max, and how sig-
nificant it is. Moreover, we would like to know significancy between total body mass to
VO2 Max compared with specific dominant body mass region (i.e. foot) to VO2 Max.
Method: Quantitative analysis of 63 person (n ¼ 63) aged 18-54 years old (18 female, 45
male), was grouped into 2 groups. First group was measured their VO2 Max using
Cardiopulmonary Exercise Testing (CPET) Cosmed treadmill (n1 ¼ 46) and or using CPET
Cosmed static ergocycle (n2¼17, n ¼ 63), then the correlation between total lean body
mass percentage, total body fat percentage, to VO2 Max is tested. Second group was
measured their VO2 Max using CPET Cosmed static ergocycle (n2¼17), then the correla-
tion between leg mass percentage to VO2 Max is tested. Total lean body mass percent-
age, total body fat percentage was measured using DXA (dual X-Ray Absorbtiometry) GE
Lunar Prodigy. The data of the two groups were then processed using SPSS version 16.
Result: Based on linearity test there was significancy result between total lean body
mass percentage to VO2 Max (sig. ¼ 0,212 (>0,05)), and significancy result between
Abstracts
total body fat percentage to VO2 Max (sig. ¼ 0,734 (>0,05)), therefore there was lin-
ear correlation significancy result, and so does between total leg mass to VO2 Max
(sig. ¼ 0,947 (> 0,05)). In the multiple regression analysis, it was found that total
body fat percentage and total lean body mass percentage to VO2 Max was 63% (r
square coefficient 0,63). Based on the Pearson bivariate correlation test, we found a
significant negative correlation (inversely) between total body fat percentage to VO2
Max (r coefficient ¼ - 0,794 (>r table ¼ 0,33)) and siginificant positive correlation
between lean body mass percentage to VO2 Max (r coefficient ¼ 0,792 (> r table ¼
0,33)). We found no significant correlation between leg mass percentage to VO2 Max
(r coefficient ¼ 0,225 (< r table ¼ 0,468)).
Conclusion: Total lean body mass percentage and total body fat percentage has sig-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
nificancy correlation 63% towards VO2 Max. Total lean body mass percentage has pos-
itive correlation to VO2 Max while total body fat percentage has negative correlation
to VO2 Max. there was no significant correlation between leg mass percentage to
VO2 Max.
Keywords: Leg Mass Percentage • Total Lean Body Mass Percentage • Total Body Fat
Percentage • VO2 Max
OR.155. Correlation between Type of Acute Coronary Syndrome and Traditional
Risk Factor of Coronary Artery Disease in Papua
Perdana R Kusuma Hermawan1, Ervan Zuhri2,3, Iman Setiadi4
1
Freeport Hospital, Papua, Indonesia, 2National Cardiovascular Center of Harapan
Kita, Jakarta, Indonesia, 3Department of Cardiology and Vascular Medicine, Faculty
of Medicine, University of Indonesia, 4Pasar Rebo General Hospital, Jakarta,
Indonesia
Background: Acute coronary syndrome (ACS) can manifest as ST-segment elevation
acute coronary syndrome (STEACS) or non-ST-segment elevation acute coronary syn-
drome (NSTEACS). But, factors that correlate with the type of ACS are unclear.
Objective: To assess whether traditional risk factors of coronary artery disease
(CAD), such as diabetes mellitus, hypertension, dyslipidaemia, smoking, and family
history of CAD correlate with the type of ACS.
Method: We conducted cohort retrospective study from January 2015 to June 2018 in
Freeport Hospital, Papua, Indonesia. We collected patients with ACS (STEACS and
NSTEACS) from medical record and searched their traditional risk factor of CAD. We
analysed whether traditional risks factor of CAD had correlation with type of ACS.
Result: There are 119 patients (100% men) included in this study, 72 patients with
STEACS and 47 patients with NSTEACS. The mean age is 48 (67.6) years old in
STEACS and 47.3 (68.1) years old in NSTEACS. STEACS group had higher prevalence
of all traditional risk factor of CAD than NSTEACS group. But, the statistical analysis
showed that there is no significant correlation between type of ACS (STEACS or
NSTEACS) with diabetes mellitus (13.9% vs 10.6%, p ¼ 0.811), hypertension (33.3% vs
26.4%, p ¼ 0.554), dyslipidaemia (97.2% vs 95.7%, p ¼ 0.517), smoking (54.2% vs
51.1%, p ¼ 0.886), and family history of CAD (12.5% vs 10.6%, p ¼ 0.986).
Conclusion: Traditional risk factor of CAD did not correlate with type of ACS.
Keywords: Acute coronary syndrome • non-ST-segment elevation acute coronary syn-
drome • ST-segment elevation acute coronary syndrome • traditional risk factor
OR.156. Better Health Service Quality Improves Blood Pressure Control Visits in
Primary Health Care
Rio Alexsandro1, Rianty Febriandani1, Prily Prianty1, Novendy1, Andrew Parlautan,
Maria P. Inggriani2, Sem D. Timothy2, Mustika Mahbubi3
1
Departemen of Public Health, School of Medicine, Tarumanagara University,
Jakarta, 2School of Medicine, Gadjah Mada University, Yogyakarta, 3Departemen of
Cardiology and Vascular Medicine, Soewondo Hospital, Pati
Background: Hypertension control is still a major issue. A recent survey of Ministry
of Health of Indonesia reported an increase in the prevalence of hypertension over
the last 5 years. Prior study showed that communication skills of health care provider
affects hypertensive outcomes.
Objective: The present study aims to improving patient visits through better health
service quality.
Method: A quasi-experimental method was conducted in a primary health care in
Jakarta. Patients with history of hypertension were followed-up for 2 months in
2017. Interventional training was performed on health providers to improve educa-
tional counseling. Patients were subjected to educational intervention from health
providers at the first visit and scheduled for subsequent post-intervention visits.
Number of patients to blood pressure (BP) control visits were compared using v2
test.
Result: A total of 6 health providers and 130 hypertensive patients were included.
The training doubled the educational skills of health care providers, with mean6SD
of pre-test score of 4661.78 and mean of post-test score of 89610.01. Patient mean
(6SD) age was 51.25 (67.98) years, 82.1% women, 67.9% grade I hypertension and
32.1% grade II hypertension. Intervention boosted number of BP control visits. The
percentage of hypertensive patients presented for BP control increased up to 8 times
on the fifth visit compared to the first visit, with 14 (11%) patients on first visit; 104
Abstracts
(80%) on second visit; 108 (83%) on third visit; 109 (84%) on fourth visit; and 112
(86%) on fifth visit. There was a statistically significant increase in number of patient
visits directly after the intervention, which was observable on the second visit
(p ¼ 0.001), and remained high up to the fifth visit (p ¼ 0.001).
Conclusion: Educational counseling from health providers improves patients’ visits in
hypertension control. Better health service quality may encourage BP control in pri-
mary health care.
Keywords: hypertension • blood pressure control • patient visits • primary health care
OR.157. Advanced Heart Failure: Demographic Characteristics of Patients with
Recurrent Heart Failure Admissions
Niken Anthea S1,2, Nani Hersunarti1,2, Rarsari Soerarso1,2, Renan Sukmawan1,2,
Ratna SD Gill1,2, Muhammad Isra Tuasikal1,2, Maruli Wisnu WB1,2, Christian Rendy C1,2,
Athikah Khairunnisa1,2, Rienna Diansari1,2, Tommy Alexander1,2
1 Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine,
Department of Cardiology and Vascular Medicine Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia, 2National Cardiovascular Heart Center Hospital,
Jakarta, Indonesia
Background: Experts have estimated the prevalence of advanced heart failure (HF) to
range from 6% to 25% of the heart failure population. Patients identified with the most
advanced disease and worst prognosis can be identified using iterative, integrated clini-
cal assessment of symptoms, effort intolerance, and cardiac dysfunction. Recognizing
the transition to advanced HF is necessary for its management. However, data regarding
characteristics of patients with advanced HF is limited. This study was conducted to
describe demographic characteristics of patients with advanced HF.
Methods: We analyzed data from inpatient’s registry in National Cardiovascular
Center Harapan Kita from January 2017 until December 2018. Patients included in
this study were patients with clinical diagnosis of heart failure with LVEF 30% who
at least rehospitalized >1 in a year. The data were presented in mean (6SD) for nor-
mal distribution data and in median (min-max) for abnormal distribution data.
Results: There were 87 patients with advanced heart failure hospitalized from
January 2017-December 2018. It counted for 25% of total heart failure cases. Median
age of the patients was 56 (20-92) years old. Mean rehospitalisation in a year was
361.5 times (50.6% were hospitalized twice, 20.2% 3 times, 15.7% 4 times, and
13.5% 5 or more times). Prevalence was higher for male than female (73.0% vs.
27.0%). Mean ejection fraction of subjects was 20.464.2%. The most common etiol-
ogy founded was coronary artery disease, followed by hypertensive heart disease and
cardiomyopathies (71.9%, 12.4%, 12.4% respectively). Among those with CAD, the
traditional risk factors were hypertension (64%), diabetes mellitus (62.9%), smoking
history (38.2%), dyslipidemia (12.4%), and family history (3.4%). Patients receiving
RAAS blocker were 95.5%, beta blocker 95.5%, MRA 65.2%, and diuretics with optimal
dose were 96.6%.
Conclusions: In this study, patients with advanced HF count for 25%. The most com-
mon etiology was CAD followed by HHD and cardiomyopathies. Patients received
optimal GDMT (guideline directed medical therapy) were 61.8%. Each subsequent HF
hospitalization is associated with incremental increase in risk of death. Thus, more
than one HF hospitalizations in a previously stable chronic HF patient may herald the
onset of advanced HF and should alert the care provider to a potential change in the
course of the patient’s HF.
Keywords: advanced heart failure • coronary artery disease • demographic charac-
teristics • hypertensive heart disease
OR.158. Determination of Chronotropic Incompetence Using 24-hours Holter
Monitoring : a Lower Cut-off is Needed
Sakta Suryaguna, Putra Antara, Nyoman Wiryawan
Cardiology and Vascular Medicine of Udayana University, Bali, Indonesia
Background: Chronotropic incompetence (CI) is an important thing that is often
overlooked. CI is associated with an increased risk of developing atrial fibrillation
and mortality, a poor prognosis in heart failure, and is one indication of the implan-
tation of a pacemaker. However, there are obstacles in conducting CI studies because
the lack of consistent methodology for determining CI. CI is usually determined by
treadmill strest test (TST), but in some conditions or patient preference, it cannot
be done and holter is an alternative. 24-hours Holter monitoring report often include
chronotropic responses but the statement are subjective, even though the holter
itself can provide more objective information.
Objective: To analyze the usefulness of 24-hours holter monitoring in detecting chro-
notropic incompetence
Method: Retrospective analysis of data was performed with twenty two patients
underwent a standard TST and 24-hours holter were included. Maximal HR, Age-pre-
dicted Maximal Heart Rate (APMHR), and %APMHR achieved were calculated from
both examination with additional parameter (circadian index) from holter monitor-
ing. The threshold of %APMHR achieved using holter monitoring are evaluated at
60%, 65% and 70%. Goodness of fit test of variables was assessed.
Result: As CI is defined by inability to achieve 70% of APMHR with TST, the agreement
analysis result with kappa-test evaluation with cut-off of 70%, 65% and 60%APMHR
while using holter have agreement value of 0.13 (63.6% concordant), 0.19 (72.7%
F73
concordant), 1.0 (100% concordant) respectively. Meanwhile using circadian index
with cut-off 1.24 and 1.10 have agreement value of 0.06 (45.4% concordant), 0.64
(95.4% concordant) respectively.
Conclusion: Determination of CI using holter monitoring need a lower cut-off (60%
APMHR) for better agreement value. Although it only involves a small number of sam-
ples so that its application in clinical settings is limited, this study can be the basis
for conducting larger studies so that the determination and management of CI is
improved.
Keywords: Chronotropic • Incompetence • Holter
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.159. Tolvaptan: Short Term Efficacy of Vasopressin-2-Receptor Antagonist as
Acute Heart Failure Symptoms Reliever
Rizky E. P. Yuriza, Indah E. F. Wainsaf, Ahmad Z. Alhamid
University of Papua, Sorong, Indonesia
Background: Congestion and volume overload symptoms are immediate goals treat-
ment in acute heart failure (AHF). Tolvaptan as a vasopressin-2-receptor antagonist
has potential benefit to improve the symptoms and support diuretics to prevent
undesired condition in the acute phase.
Objective: This review aimed to critically appraise tolvaptan roles in short term
effect. Ameliorated dyspnea, edema, body weight reduction, increased fluid loss are
several expected findings at least in the first few days.
Method: Relevant RCT and review articles were thoroughly searched from PubMed,
EBSCO, ProQuest, and Cochrane Database of Systematic Reviews. Findings were nar-
rowed down by using selection criteria. Three selected articles got critically
appraised by using the Center of Evidenced-based Medicine, University of Oxford
guideline.
Result: The analysis was carried out in 2 RCTs and 1 meta-analysis. Two RCTs com-
pared Tolvaptan with placebo. On the first RCT, Tolvaptan results in more body
weight reduction in the first 24 hours [-2.36 6 2.08 kg, p < 0.001] even though ame-
liorated dyspnea is not significantly different. Another RCT with greater sample
shows significant difference between Tolvaptan and placebo to ameliorated dyspnea
in first few days [OR 1.2 (day 1) & 1.22 (day 2), p < 0.05], edema [OR 1.23 (day 1) &
1.2 (day 2), p < 0.05], and orthopnea [OR 1.18, 1.28, 1.23, p < 0.05, (the first 3 days
respectively)]. This result supported by meta-analysis study based on dyspnea [RR
0.82; 95% CI 0.71 to 0.95], body weight reduction [WMD 1.35; 95% CI 0.75 to 1.96]
and fluid loss [WMD 0.66; 95% CI 0.35 to 0.98]. There were no significant difference
and serious adverse events between Tolvaptan and control.
Conclusion: Tolvaptan showed promising efficacy as symptoms reliever in the early
treatment of acute heart failure. Further studies are needed to explore Tolvaptan as
single or combination therapy in AHF.
Keywords: tolvaptan • acute heart failure • efficacy • short term
OR.160. A Meta-analysis of Efficacy and Safety of Extended Thromboprophylaxis
with Direct Oral Anticoagulant in Medically Ill Hospitalized Patients
Eka P. B. Mulia1, J. Nugroho E. Putranto1,2, Irma Maghfirah1, Ardianto Nandiwardhana1
1
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, 2Department of
Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: The risk of venous thromboembolism (VTE) is increased significantly in
the hospitalized patient for medical illness, and the risk persists after discharge. The
role of extended-duration pharmacological thromboprophylaxis is effective for the
prevention of symptomatic VTE in high-risk surgical patients, but in hospitalized
medical patients is still a subject of controversy.
Objective: This review aimed to evaluate the efficacy and safety of direct oral
anticoagulants (DOACs) for extended-duration thromboprophylaxis (ET) in this
population.
Method: We conducted a systematic literature search from PubMed, Medline and
EMBASE until April 2019. We used the Jadad scale to measure the quality of the stud-
ies. A meta-analysis was performed to assess the efficacy and safety of ET of DOACs.
Efficacy outcomes were defined by the prevention of symptomatic VTE, total VTE,
and VTE-related death. Safety outcomes were defined by the occurrence of major
bleeding (MB) and clinically relevant non-major bleeding (CRNMB).
Result: Four randomized controlled trials (RCT) with a total of 34.166 patients were
included for analysis. The quality of all studies was good. Among medically ill hospi-
talized patients, extended DOACs recipients (30-45 days) had a significantly lower
risk of symptomatic VTE (p¼0.0005, RR:0.59 (95%CI: 0.44-0.79), I2¼0%, absolute risk
reduction (ARR)¼0.003, number needed to treat (NNT)¼303) and total VTE
(p¼0.0008, RR:0.80 (95%CI:0.70-0.91), I2¼0%, ARR¼0.015, NNT¼68), but no signifi-
cant reduction in VTE-related death (p¼0.17, RR:0.81 (95%CI: 0.60-1.10), I2¼0%).
Safety outcome showed significantly higher risk of MB (p<0.0001, RR:1.96 (95%CI:
1.40-2.75), I2¼37%, absolute risk increase (ARI)¼0.003, number needed to harm
(NNH)¼315) and CRNMB (p<0.00001, RR:1.82 (95%CI: 1.54-2.16), I2¼74%, ARI¼0.009,
NNH¼114).
F74 Abstracts

Conclusion: ET with DOACs in medically ill hospitalized patients was associated with OR.162. Postoperative Atrial Fibrillation Following Cardiac Surgery
a significantly lower risk of symptomatic VTE and total VTE but was associated with
Aye Nandar Kyaw, Win Win Kyaw, Aung Thu
significantly increased risk of MB as well as CRNMB.
Department of Cardiovascular, Yankin Children Hospital, University of Medicine 2,
Keywords: extended thromboprophylaxis • direct oral anticoagulant • medically ill
Yangon, Myanmar.
hospitalized patients

Background: New-onset postoperative atrial fibrillation is the most common form of

OR.161. Frequency of Left Atrial Thrombus in Patients of Mitral Stenosis with rhythm disturbance following cardiac surgery. In this study we are trying to examine
Atrial Fibrillation at Sardjito General Hospital the potential risk factors for post-operative atrial fibrillation in our patients evaluat-
Muhammad A Mukti, ErikaMaharani, Hendry P. Bagaswoto ing short- and long-term outcome.
Department of Cardiology and Vascular Medicine, School of Medicine, Gadjah Mada Objective:

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

University, Yogyakarta, Indonesia (1) To determine the Demographic data and clinical characteristics of the study
population
Background: Left Atrium (LA) thrombus is a common source of thromboemboli and it (2) To detect the occurrence of AF within postoperative 7 days after cardiac
is usually seen in Atrial Fibrillation (AF). In patients with Mitral Stenosis (MS) and AF, surgery
the risk of thrombus formation in the LA is very high. In 90% cases of AF, blood cloths (3) To determine the intraoperative and postoperative data of AF within postopera-
form in the Left Atrial Appendage. tive 7 days after cardiac surgery
Objective: To determine the frequency of left atrial thrombus in patients with mitral (4) To determine the complications of POAF within 30 days after cardiac surgery
stenosis having atrial fibrillation
Methods: A hospital-based cross sectional descriptive study of 120 patients without
Method: This Cross Sectional study was conducted at Sardjito General Hospital. Both
prior history of AF who underwent cardiac surgery in cardiovascular department of
male and female patient between 25 to 65 years with mild to severe mitral stenosis
Yankin Children Hospital and North Okkalapa General Hospital between January,
and atrial fibrillation were included while patients with mitral stenosis and normal
2018 to December, 2018. Perioperative data including gender, age and postoperative
sinus rhythm were excluded. The severity of mitral stenosis was calculated by Mitral
morbidity and mortality were extracted from medical records.
Valve Area (MVA), which the value less than 1 cm2 classified as severe, 1-1.5 cm2 as
Results: The rate of POAF was 42% and was higher following CABG (34%) than after
moderate, and more than 1.5 cm2 as mild. Incidence of left atrial thrombus was seen
DVR (24%) or MVR (22%). In general, patients with POAF were more often male, were
by Trans Esophageal Echocardiography.
marginally siginificant older, had diabetes and smoking. Patients who developed
Result: In this study a total of 152 patients were included with 27% patients were
POAF had lower ejection fraction, large left atrial volume, prolonged CPB time and
males, about 18% patients were hypertensive, only 5% were diabetic, and 5% had BMI
ACX time, valve surgeries.
> 30. Patients who had mild, moderate, and severe mitral stenosis were 5%, 11%,
Conclusion: In our study, male gender, enlarged LA volume, lower ejection fraction,
and 84% respectively. Left Atrial thrombus found in 28% patients. There are no corre-
CABG surgeries were found to be the risk of atrial fibrillation after cardiac surgery.
lation between left atrial thrombus with age, sex, diabetes, and severity of Mitral
Keywords: Postoperative atrial fibrillation • Coronary artery bypass surgery •
stenosis with p-value 0.472; 0.275; 0.419; and 0.064 respectively.
Double valve replacement • Mitral valve replacement
Conclusion: There are more incident of left atrial thrombus in the severe mitral
stenosis group. Therefore proper screening for thrombus is needed in patient with
AF, especially in severe mitral stenosis. But there is still much more predictor that
can relate to the incident of left atrial thrombus, so we conclude that there is still OR.163. Patency Assessment of Coronary Artery bypass Grafts by Using Transit
room for improvement in this study. Time Flow Meter
Keywords: Atrial Fibrillation • Mitral Stenosis • Left Atrial Thrombus
M.P. Khine, K.M. Lwin, A.Z. Myo
Department of Cardiovascular Surgery, Yangon General Hospital
OR.162. Table 1
Background: A widely accepted technique of graft assessment in coronary artery
Variable Frequency (n) Percentage (%) bypass surgery is transit time flow measurement. This technique is very effective and
quick method for intraoperative graft flow assessment in coronary artery bypass
Age grafting. The aim of this study was to assess the patency of the grafts by using
• 25-35 years • 26 • 17,1 % Transit Time Flow Meter (TTFM ) during CABG
• 36-45 years • 51 • 33.6 % Method: This study was hospital based prospective descriptive study who underwent
• 46-55 years • 49 • 32,2 % coronary artery bypass surgery only from January 2018 to December 2018.
• 56-65 years • 26 • 17,1 % Result: In this study, total number of patients was 66. 68.2% of patients had EF > 35%
Sex and mean flow >30ml/min, 30.5% had EF > 35% and mean flow <30ml/min, 1.5% had
• Male • 41 • 27 % EF < 35% and mean flow >30ml/min. Among the patients who did not have wall
• Female • 111 • 73 % motion abnormality, 65.2% had mean flow >30ml/min, 22.7% had mean flow <30ml/
Hypertension min. 4.5% of patients who had mean flow >30ml/min and 7.6% who had mean flow
• Hypertensive • 27 • 17,8 % <30ml/min had wall motion abnormality .1.5% was EF > 35% and Pulsaltility Index
• Non hypertensive • 125 • 82,2 % (PI)>5, 97% was EF > 35% and PI < 5. 1.5% was EF < 35% and PI < 5. 1.5% of the
DIabetes patients who did not have wall motion abnormality had PI > 5and 86.4% had PI < 5
• Diabetic • 7 • 4,6 % and 12.1% had wall motion abnormality and PI < 5.
• Non DIabetic • 145 • 95,4 % Conclusion: Measurement of coronary blood flow can assess early graft function and
BMI predict early clinical outcomes. This study intends to assess graft patency intra-oper-
•  30 • 145 • 95,4 % atively and to measure the flow of the grafts after anastomosis of the patients who
• > 30 • 7 • 4,6 % undergoing CABG.
Mitral Stenosis Keywords: Transit Time Flow Meter • Pulsaltility Index • Coronary Artery Bypass
• Mild • 7 • 4,6 % Grafts,Ejection Fraction
• Moderate • 17 • 11,2 %
• Severe • 128 • 84,2 %
Left Atrial Thrombus
• Thrombus • 42 • 27,6 %
• 72,4 %
• No thrombus • 110

OR.162. Table 2

Age p-value

25-35 years 36-45 years 46-55 years 56-65 years Total

Left Atrial Thrombus Thrombus 8 10 16 8 42 0,472

No Thrombus 18 41 33 18 110
Total 26 51 49 26 152
Abstracts F75

OR.162. Table 3

Sex p-value

Male Female Total

Left Atrial Thrombus Thrombus 14 28 42 0,275

No Thrombus 27 83 110
Total 41 111 152
Hypertension p-value
Hypertensive Non-Hypertensive Total

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

Left Atrial Thrombus Thrombus 5 37 42 0,243
No Thrombus 22 88 110
Total 27 126 152
Diabetes p-value
Diabetic Non-Diabetic Total
Left Atrial Thrombus Thrombus 1 41 42 0,419
No Thrombus 6 104 110
Total 7 145 152
BMI p-value
 30 > 30 Total
Left Atrial Thrombus Thrombus 41 1 42 0,419
No Thrombus 104 6 110
Total 145 7 152

OR.162. Table 4

Mitral Stenosis p-value

Mild Moderate Severe Total

Left Atrial Thrombus Thrombus 1 1 40 42 0.064

No Thrombus 6 16 88 110
Total 7 17 128 152

OR.164. Invasivepharmacology Strategy Intralesion Single Bolus Administration Conclusion: Intralesion administration of eptifibatide and alteplase showed a suc-
of Eptifibatide and Alteplase into Infarct Related Artery during Primary cessful dissolved of occlusive thrombus, improved reperfusion microvascular level
Percutaneus Coronary Intervention in Acute STEMI Patients Within 12 hours and Left Ventricle function in acute STEMI patients.
Symptom Onset Keywords: STEMI • pPCI • TIMI • MBG • cTFC.

Zulfikri Mukhtar1, Nizam Z Akbar2, Henry Panjaitan3, Nora C Hutajulu3,

Sutomo Kasiman2, Harris Hasan4
1
Faculty of Medicine, Universitas Prima Indonesia / Adam Malik General Hospital / OR.165. Correlation Between P Terminal Force in lead V1 and E/e’ ratio in
Murni Teguh Memorial Hospital, Medan, Indonesia., 2Adam Malik General Hospital / Chronic Kidney Disease Patients on Routine Hemodialysis
Murni Teguh Memorial Hospital., 3Murni Teguh Memorial Hospital / RS St Elisabet, Kartika Apshanti, Hasanah Mumpuni
Medan, Indonesia., 4Cardiology Department Faculty of Medicine, Universitas Department of Cardiology and Vascular Medicine, Gadjah Mada University, Jogjakarta
Sumatera Utara / Adam Malik General Hospital

Background: Chronic kidney disease (CKD) patients represent a subset of population

Background: Acute STEMI patients have complete occlusion of a major epicardial
coronary artery caused by fresh thrombus and accompanied by vasoconstriction at
microvascular level.
Objective: Intralesion (IL) single bolus administration of eptifibatide and alteplase
dissolve intracoronary occlusive or residual thrombus and distal microembolization
after manual thrombectomy during primary PCI in acute STEMI patients (TIMI 0 /1)
within 12 hours symptom onset.
Method: Prospective nonrandomized controlled study. During the primary PCI (pPCI)
procedure, after wiring and recanalizing by manual thrombectomy or balloon infla-
tion, we administered local IL bolus of eptifibatide 3.75 mg, followed by Alteplase 3.
5 mg and administered local intracoronary nitroglycerine (NTG) 200 mg after stent
deployment. Echocardiographic assessment Pre and Postprocedure. The control
group is colleagues’ patients with standard pPCI. TIMI, MBG flow and corrected TIMI
Frame Count (cTFC) were graded by two independent interpreters.
Result: There were 165 patients from October 2016 to January 2019, age 26 - 81 y,
symptom onset was 1.0-12 hours, 145 males and 20 females, 87 anterior and 78 infe-
rior wall infarction. Preprocedural TIMI and MBG 0 were 134 patients, TIMI and MBG 1
were 31 patients. Postprocedural TIMI and MBG 3 were 143 patients, TIMI and MBG 2
were 22 patients, door to wire crossing time (DWCT) was 26-250 minutes, median-
cTFC was 17.6, LVEF increased 7.44-31.5%. 2 patients with gum bleeding, 2 patients
haematuria, hospital mortality was 1.8%. There were 3 patients hospitalized and no
mortality during 30 days follow-up. A control of 165 colleagues’ patients, age 35 - 87
y. Symptom onset was 1.0-12 hours, 130 males and 35 females, 89 anterior and 76
inferior wall infarction. Preprocedural TIMI and MBG 0 were 145 patients, TIMI and
MBG 1 were 20 patients. Postprocedural TIMI and MBG 3 were 94 patients, TIMI and
MBG 2 were 67 patients, TIMI and MBG 1 were 4 patients. DWCT was 25-309 minutes,
m-cTFC was 22.0. Statistically, there was significant difference in postprocedural
TIMI, MBG flow, cTFC between the 2 groups (p < 0.05).
with special clinical and haemodynamic features that differ from common person.
Chronic volume and pressure overload, chronic inflammation, oxidative stress, athe-
roslerotic acceleration and non physiological fluid shift in hemodialysis have all put
myocardium to face enormous burden and damage leading to inevitable cardiac
remodelling that finally can cause cardiac dysfunction with increased cardiac filling
pressures. In previous studies, P terminal force in lead V1 (PTFV1) has been linked
with not only left atrial size but also left ventricular filling pressure.
Objective: Whether PTFV1 correlates with left ventricular filling pressure measured
by E/e’ ratio in CKD patients is our study interest.
Method: This cross sectional study was done in CKD patients on hemodialysis in Dr.
Sardjito Hospital Jogjakarta. Electrocardiogram and echocardiography were done after
hemodialysis procedure. PTFV1 was measured by multiplying amplitude and duration of
terminal negative portion of the P wave in lead V1, with value of more than
40 mm.msec is considered to be abnormal. E velocity measurement was obtained from
pulsed-wave Doppler in apical 4 chamber view, sample volume was placed between the
mitral leaflet tips. Annular pulsed wave Doppler tissue imaging was also derived from
apical 4 chamber view, with e’ is the average of septum and lateral e’ value.
Result: This study was done in 71 patients with mean age 50 years old. Forty three
subjects (61%) were men. Sixty four subjects (90%) had hypertension. Sixty two
patients (87%) had normal left ventricular ejection fraction. Forty four subjects
(62%) had abnormal PTFV1. Median PTFV1 value was 44 mm.msec. By correlation
analysis, it is found that there is significant correlation between PTFV1 value and E/
e’ ratio (r ¼ 0.265, p ¼ 0.027). PTFV1 value also shows significant correlation with LA
size (r ¼ 0.4, p ¼ 0.001) and LAVI (r ¼ 0.255, p ¼ 0.032).
Conclusion: The present study shows significant correlation between P terminal
force in lead V1 and left ventricular filling pressure measured by E/e’ ratio in CKD
patients on routine hemodialysis.
Keywords: P Terminal Force V1 • E/e’ ratio • chronic kidney disease • hemodialysis
F76
OR.166. KARIADI Risk Score: An Attempt to Stratify Intensive Care Needs After
Primary Percutaneous Coronary Intervention
An A. Asrial, Yan Herry, Novi Anggriyani, Suhartono, Bahrudin
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University, Semarang/ Dr. Kariadi General Hospital, Semarang-Indonesia
Background: Reduction of major cardiovascular events (MACE) in ST-Segmen Elevation
Myocardial Infarction (STEMI) patients has been achieved by primary percutaneous coro-
nary intervention (PCI) strategy and intensive care management. However, the inten-
sive care unit (ICU) bed avaibility and cost remain a problem for those patients, and
thus risk stratification using an objective risk score instrument is required.
Objective: To develop a risk score of in-hospital MACE for patients with STEMI under-
went primary PCI.
Methods: A cohort study of 208 patients with STEMI undergoing primary PCI at the
Dr. Kariadi General Hospital Semarang. Predictor analysis was carried out using
bivariate Chi-Square test and multivariate logistic regression. The quality of the risk
score was tested by the Hosmer and Lemeshow calibration test and AUC ROC analysis
for discrimination test.
Results: Seven independent predictors, i.e. Killip class (OR 20.04, p ¼ 0.0001), age
(OR 3.02, p ¼ 0.04), renal insufficiency (OR 9.48, p ¼ 0.007), infark related artery
final TIMI flow (OR 11.57, p ¼ 0.001), admission systolic blood pressure (OR 3.04,
p ¼ 0.025), duration of total ischaemic time (OR 3.14, p ¼ 0.032) and increase of
blood glucose levels (OR 3.04, p ¼ 0.029) were fulfilled the criteria for risk scores of
in-hospital MACE. The risk scores had a good quality with the Hosmer and Lemeshow
calibration test> 0.05 and AUC ROC 0.886 (95% CI, 0.827-0.944, p < 0.005).
Conclusions: A risk scoring model consisting of 7 independent predictor variables i.e.
Killip class, Age, Renal insufficiency, Infark related artery final TIMI flow, Admission
systolic blood pressure, Duration of total ischaemic time and Increase of blood glu-
cose levels (KARIADI) has a good calibration and discrimination in predicting the risk
of in-hospital MACE in patients with STEMI underwent primary PCI.
Keywords: ST-segment elevation myocardial infarction • primary PCI • risk score.
OR.167. Blood Lactate to Predict Mortality in Patient with Acute Myocardial
Infraction
Katherine G. Sugiarto, Winardi E. Setiawan, Fandi Ahmad, Donny S. Syamsul,
Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: Acute myocardial infraction (AMI) is a pathological processes cause by
thrombosis after rupture of atherosclerotic plaque that lead to ischemic condition.
During ischemia, glycolysis process accelerates then produces lactate and hydrogen.
The blood lactate can be significantly increase in condition such as sepsis, acute cor-
onary syndrome, and correlated to shock cardiogenic.
Objective: This study aimed to predict the mortality risk in patient with AMI using
blood lactate.
Method: Total sample was 49 patients with AMI at Tarakan Hospital form 2017 to
2018. Data was collected form Tarakan registry using consecutive sampling. Lactate
data were taken at the admission and the risk of mortality was assessed using GRACE
score. Data were analysed using Pearson correlation and ROC curve.
Result: There was a strong correlation between log lactate levels and GRACE score
(r ¼ 0,47, p < 0,01). Using cut-off point of blood lactate 2.5 mmol/L, there was a sig-
nificant mean difference of GRACE score (blood lactate 2.5 mmol/L vs < 2.5 mmol/
L ¼ 149.30 vs 113.17, p < 0.01). The analysis was continued to determine blood lac-
tate cut-off of each type of AMI to predict high risk mortality based on GRACE score.
Lactate level 2,12 mmol/ L in STEMI patients increase the risk of in-hospital mortal-
ity rate > 5% (sensitivity 85%, specificity 62%, p ¼ 0,01) whereas lactate level in
NSTEMI patients was 3.15 mmol/L (sensitivity 80%, specificity 90%, p ¼ 0,05)
increase the risk of in-hospital mortality rate >3%.
Conclusion: This study shows blood lactate level can be use predict mortality patient
with AMI.
Keywords: Blood lactate • in-hospital mortality • GRACE
OR.168. The Correlation of Albuminuria with Silent Myocardial Ischemia and
Delayed Heart Rate Recovery in Type 2 Diabetes Mellitus
Natalia Ch. I. Polii1, Ira Posangi1, Agnes L. Panda1, Edmond L. Jim1, Janry
A. Pangemanan1, F. L. Fredrik, G. Langi2
1 cardial infarction, biomarker”. The search was limited to clinical trials published
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sam
Ratulangi University, Manado, Indonesia, 2Faculty of Public Health, Sam Ratulangi
University, Manado, Indonesia
Background: Albuminuria indicates endothelial dysfunction of the renal blood vessel
which may lead to other diabetes vascular complications, especially cardiac auto-
nomic neuropathy and silent myocardial ischemia.
Objective: This study aims to prove whether or not albuminuria increases the likeli-
hood of SMI and delayed HRR in asymptomatic type 2 diabetic patients.
Method: The design of this study was observational with cross sectional approach. It
was conducted on January - March 2018. All subjects who met the inclusion criteria
Abstracts
went through anamnesis, physical examination, laboratory test, electrocardiography
and echocardiography examination. Subjects with normal ECG and LV function under-
went treadmill stress test subsequently. Statistical analysis with logistic regression was
used to determine the correlation between albuminuria with SMI and delayed HRR.
Result: From a total of 57 subjects, there were 37 (65%) male and 20 female (35%)
with a mean age of 53 years. Logistic regression analysis showed that asymptomatic
type 2 diabetes patients with albuminuria had increased probability of SMI (OR 4,53
95% CI 1,36 - 15,07; p ¼ 0,014), which increased even higher in those with older age,
male gender and smoking history (OR 5,56 95% CI 1,42 - 21,77; p ¼ 0,014). There was
no statistical difference on delayed HRR between both groups. In ROC curve, the
AUC for albuminuria in predicting SMI was 0,67 (sensitivity 88%, specificity 50%, posi-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
tive predictive value 58% and negative predictive value 84%). This proved that albu-
minuria alone was not good enough to predict SMI.
Conclusion: Albuminuria increases the probability of SMI four times higher in asymp-
tomatic type 2 diabetes mellitus patients. Albuminuria in the presence of older age,
male gender, and smoking history increases the probability of SMI and the accuracy
on predicting its occurrence.
Keywords: albuminuria • silent myocardial ischemia • diabetes
OR.169. High Atherogenic Coeficient Value Correlated with Coronary Artery
Stenosis Severity in Stable Coronary Artery Disease
G.A.P. Astara1, I.G.N.P. Gunadhi2, W. Gotera3
1,2
Cardiology Department, Faculty of Medicine, Udayana University/ Sanglah General
Hospital, Bali, Indonesia, 3Internal Medicine Department, Faculty of Medicine,
Udayana University / Sanglah General Hospital,Bali, Indonesia
Background: Dyslipidemia is one of well known classical risk factor of atherosclerosis
and coronary artery disease (CAD). Atherogenic coefficient (AC) is a lipid ratio which
reflects the state and amount of atherogenic and non-atherogenic cholesterols. This
study investigated the correlation of AC and coronary artery stenosis severity in sta-
ble CAD patients.
Method: The study used cross sectional design, which enrolled 66 subjects in Sanglah
General Hospital Bali whom already undergone coronary artery catheterization, from
December 2018 until February 2019. Fasting lipid profile result taken to measure AC
using the formula of : (total cholesterol – HDL cholesterol ) / HDL cholesterol.
Result: We divided the study subjects into high AC groups and low AC groups based
on the AC cut off value of 3.83. Degree of coronary artery stenosis was measured
using SYNTAX score. 32 subjects were in group with low SYNTAX score (<22), and 28
subjects (42%) had SYNTAX score >22. Bivariate analysis showed significant correla-
tion of high AC score with higher SYNTAX score (PR 8.24, p ¼ 0.001, 95% CI 2.6-26.1).
Multivariate analysis showed significant correlation of high AC score with severe cor-
onary artery stenosis with regression coefficient 1.80 (OR 6.0, p ¼ 0.019, 95% CI 1.3-
27.5), along with other classical risk factors such as smoking (OR 18.4, p ¼ 0.006, 95%
CI 2.3-146.4), diabetes (OR 18.9, p ¼ 0.001, 95% CI 3.3-108.4), and hypertension (OR
31.8, p ¼ 0.001, 95% CI 4.4 – 225.6).
Conclusion: This study showed significant correlation of high AC score with severe
coronary artery stenosis in stable CAD.
Keywords: atherosclerosis • coronary artery stenosis severity • SYNTAX score • sta-
ble coronary artery disease • atherogenic coefficient
OR.170. Tryptase as a New Horizon Biomarker in Acute Coronary Syndrome: A
Meta-Analysis
Ivana P. Dewi1, Louisa F. K. Wardhani1, Oryza Sativa1, Budi B. Dharmadjati2
1
Faculty of Medicine, Airlangga University, Surabaya, Indonesia, 2Departement of
Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Acute coronary syndrome (ACS) was initiated by the rupture or erosion
of atherosclerotic plaque. Tryptase has recently been reported to be involved in
atherosclerotic plaque destabilization. Release of inflammatory mediators derived
from tryptase mast cell degranulation plays a role in process of atherosclerosis that
causing ACS.
Objective: The aim of this meta-analysis was to assess the tryptase level in ACS
patients as a potential biomarker in diagnosis and prognosis of ACS.
Method: Major medical databases (PubMed, MEDLINE, Clinical Key, Cochrane Library,
EMBASE) were systematically searched using terms “tryptase, mast cell, acute myo-
within the last ten years, human subjects, written in English, full-text availability.
We used the 22-item STROBE checklist to measure the quality of evidence.
Result: Six clinical studies one cohort study and five case-control studies met our
inclusion criteria with a total of 736 patients for analysis. The scientific quality of all
six studies were good. Five of the study showed a significant increase of tryptase
level in ACS group compare to control (MD 1.85; 95%CI 1.54-2.15; p ¼ 0.0004;
I2¼80%). Two studies assessed the relation between tryptase levels with major
adverse cardiovascular events (MACE). There is significant correlation between tryp-
tase levels measured during admission with development of MACE up to 2 years
(p < 0.0001). Several limitations are non-random trial assignment, various popula-
tion, and small sample size.
Abstracts
Conclusion: Higher tryptase level among patients with ACS may indicate an impor-
tant role in the pathophysiology of ACS. There is also possible benefit of tryptase as
a biomarker in long-term prognostic of ACS.
Keywords: tryptase • mast cell • acute coronary syndrome • prognosis
OR.171. Heart Rate Recovery: a Simple Marker of Autonomic Modulation
Improvement After Cardiac Rehabilitation
S. Cancerita, H. Hasan, A. Nafiah, A.H. Raynaldo
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Exercise-based cardiac rehabilitation has been shown to be beneficial
and reduce mortality among cardiac patients. A hypothesis invokes the effect of
exercise on autonomic tone by modifying the sympathovagal control of heart rate
toward an increase in parasympathetic tone. Heart rate recovery (HRR) is a simple
noninvasive assessment of cardiac autonomic activity. This study aimed to evaluate
the effect and correlation between phase II cardiac rehabilitation programs on HRR
in patients after Coronary Artery Bypass Graft (CABG).
Methods: A retrospective study was conducted from October to December 2018.
Patients who completed phase 2 cardiac rehabilitation and had entry and exit exer-
cise stress tests (n ¼ 30) were included in the study. Then HRR, functional capacity
and six minute walking test at baseline and on follow-up were compared. The study
observed changes in various parameters and analyzed the relationship between car-
diac rehabilitation programs and HRR.
Results: Following the completion of phase 2 cardiac rehabilitation, the HRR improved
significantly from 11.962.8 bpm to 1863.3 bpm (p < 0 .001). Statistically significant
improvement in body mass index (26.0864.2 kg/m2 to 25.3863.9 kg/m2), six minute
walking distance (192.97674.1 m to 3646128.99 m), and functional capacity
(2.6460.42 METs to 6.661.30 METs) were observed with p < 0.001. Furthermore, a
strong positive correlation was found between HRR and functional capacity before (r
0.811; p < 0.001) and after cardiac rehabilitation (r 0.755; p < 0.001).
Conclusion: Exercise training in a cardiac rehabilitation program improves HRR, six
minute walking distance, and functional capacity. HRR may be used in a cardiac
rehabilitation facility as a simple parameter for assessing autonomic tone, to identify
patients with higher risk profiles, and can be useful for evaluating patient outcomes.
Keywords: heart rate recovery • cardiac rehabilitation
OR.172. The Gensini Score as an Independent Predictor for the Reduced Left
Ventricular Ejection Fraction
I Gede P. G. Semita1,2, Makhyan J. Al-Farabi1,3, Radityo B. Wicaksono1, Ruth I. Gunadi1,
B. Jovie2, I Gde R. Suryawan1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Airlangga, Surabaya, Indonesia, 2Department of Cardiology and Vascular Medicine
Indonesian Navy Hospital of Dr. Ramelan, Surabaya, Indonesia, 3Postgraduate
Student, University College London, United Kingdom
Background: Coronary artery disease (CAD) is the most common cause of HF (heart
failure) and has been reported to account for 23–73% of reduced left ventricular
ejection fraction (LVEF). The direct association among both remains unconcluded.
Objective: We analyze the relationship between the Gensini score as CAD severity
assessment with the LVEF.
Methods: Gensini score, anthropometric and laboratory findings of the 168 patients
who underwent coronary angiography were consecutively collected. LVEF level was
examined using Vivid S60 Ultrasound instrument (General Electric) and categorized
into normal LVEF (LVEF>55%) and reduced LVEF (LVEF55%)
Results: Patient with normal LVEF had significantly lower Gensini score than those with
reduced LVEF (26.20 634.86 vs 45.24646.51; p ¼ 0.007). Multiple stepwise linear
regression analysis showed that the Gensini score was significantly and independently
associated with the LVEF level (b¼-0.223, p ¼ 0.004). Multivariate logistic regression
analysis also revealed that the Gensini score >36.5 increased risk of having reduced
LVEF (OR ¼ 2.612, CI ¼ 95%, p ¼ 0.004). Receiver operating characteristic (ROC) curve
analysis showed that the Gensini score [area under the curve (AUC), 0.619; 95% confi-
dence interval (CI), 0.527–0.710; p ¼ 0.011], were predictive of normal LVEF. Cut-off
point analysis showed that the Gensini score >36.5 (sensitivity ¼ 70.9% and specificity
¼ 51.7%) provided the highest predictive value for reduced LVEF.
Conclusion: The Gensini score as the coronary atherosclerosis severity assessment
can be a significant predictor for reduced LVEF while being independent of other
major risk factors including blood pressure, age, and BMI.
Keywords: gensini score • atherosclerosis severity • coronary artery disease • left
ventricular ejection fraction.
OR.173. Association of CYP2C19 Polymorphism and Myocardial Reperfusion in
Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary
Intervention
Maya R Amalia, Aldila N Sulma, Robert A Raharjo, Rahageng W Kusuma, Ilham Uddin,
Susi Herminingsih
Department of Cardiology and Vascular Medicine, Diponegoro University, Semarang
F77
Background: Dual antiplatelet (DAPT) is a mandatory in the setting of acute myocar-
dial infarction (AMI). Clopidogrel is one of drug of choice of DAPT, given to patients
based on different underlying conditions such as high risk of bleeding state. Current
guidelines suggest that loading with clopidogrel, along with aspirin, is necessary to
AMI patients undergoing percutaneous coronary intervention (PCI), as soon as the
first medical contact, to prevent further thrombosis. Administrating clopidogrel prior
to PCI with stent implantation improves myocardial reperfusion according to several
studies. Nevertheless, clopidogrel bioavalability could be affected by the reduced
hepatic metabolism activity of CYP2C19 genes, furthermore of *2 and *3 alelles.
Objective: This study aims to analyze the association of CYP2C19 polimorphism and
myocardial reperfusion in AMI patients undergoing PCI with stent implantation.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Method: 23 consecutive patients from February to March 2019 with AMI undergoing
PCI with stent implantation were included in this study. Loading with clopidogrel is
given to all patients prior to PCI. Myocardial perfusion is evaluated and valued as
final TIMI flow and myocardial blush grade (MBG) after stent implantation. CYP2C19
genotipe examination was performed after PCI and analyzed by polymerase chain
reaction (PCR) method. This is a cross sectional study using t test and fischer exact
test for univariate analysis, and multiple regression for final multivariate analysis.
Result: We found mean age 5967 yo, BMI 21,860,7 (normoweight), STEMI 73,9%,
NSTEMI 21,7%, UAP 4,3%. Polimorphism of CYP2C19 fenotipes were found as inter-
mediate 26,1% and normal 73,9%. Patient characteristics that correlated with MBG
score were TIMI flow (p ¼ 0,001) and trombosit level (p ¼ 0,032), also polimorphism
(p ¼ 0,03). From multivariate analysis TIMI flow was the only variable which affected
MBG (P ¼ 0,001, OR 0,63 95% CI 0,34-1,20).
Conclusion: CYP2C19 polimorphism is significantly correlated to MBG, but only TIMI
flow was found significant to affect MBG.
Keywords: clopidogrel • dual antiplatelet • CYP2C19 polimorphism • myocardial
reperfusion • acute myocardial infarction
OR.174. Clinical Characteristic Of Patients With Chronic Total Occlusion In Dr.
Kariadi General Hospital Semarang
M. Perdana1, A. Pudjiastuti1, A. Sidiek1, LV Bramantyo1, SN Sofia1, S. Rifqi1
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University, Dr. Kariadi General Hospital, Semarang, Indonesia
Background: Chronic total occlusions (CTO) was found in 7-20 % of patients with cor-
onary artery disease (CAD) undergoing coronary angiography. CTO patients had vari-
ous clinical presentation from silent ischaemia to overt heart failure. Lack of litera-
ture describe the characteristics of CTO patients in Indonesia. This study tried to
investigate the clinical characteristics of patients with CTO in Dr.Kariadi General
Hospital Semarang.
Methods: We retrospectively reviewed the CTO patients between January 2018 to
December 2018, in Dr. Kariadi General Hospital Semarang. CTO were confirmed from the
coronary angiographic showed no flow (TIMI flow 0) from antegrade other than from col-
lateral with estimated occlusion time more than 3 months. Estimation CTO duration
were analyzed from prior angiography data, clinical data, and collateral development.
Results: We had 168 patients included in this study and 92,9% patients were male.
Mean age were 57,2þ8,37 years, mean BMI were 24,7þ3,38 kg/m2. The 42,3%
patients diagnosed as heart failure and 45,8% patients as stable angina, while 11,9%
CTO lessions found as non-culprit lession in acute coronary syndrome. We found
52,4% patients had dyslipidemic, 56,5% had hypertensive; 40,5% had Diabetic, 57,7%
were all male smoker, and 21,4% had positive family history of CAD. The CTO lesions
were in LAD (53%), followed by RCA(38,1%), and LCX (8,9%). The presence of Q
waves, ST Depression, and T wave inversions in respective CTO teritority were
observed in 47%, 14,3%, and 38,7% patients. The presence of Q wave in anterior lead
from LAD CTO were 31% while the Q wave in inferior from RCA CTO were 42%.
Conclusion: The incidence of CTO lesion was more common in male than in female.
Most clinical presentation was stable angina. The presence of CTO were not always
followed by the presence of Q wave in electrocardiography of CTO territory.
Keywords: Chronic total occlusions • Clinical • Electrocardiography •
Characteristics
OR.175. Factors Associated with Successful Pharmacological Revascularization
Therapy among Patients with ST Elevation Myocardial Infarction at Cibinong
Hospital from January 2016 – February 2019
Sonya Aprelladiva, Dian Y. Hasanah, Fahmi I. Shahab, Radityo Prakoso
Faculty of Medicine, University of Indonesia, Cibinong Hospital, West Java,
Indonesia, Division of Pediatric Cardiology and Congenital Heart Disease, Department
of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Indonesia, National Cardiovascular Heart Center Harapan Kita Hospital, Jakarta,
Indonesia
Background: ST elevation myocardial infarction (STEMI) is a type of acute coronary
syndrome that is recognized as the leading cause of death worldwide. Definitive
management of STEMI, particularly those with the onset of < 12 hours, includes
revascularization therapy, either through pharmacological revascularization
F78
(fibrinolysis) or through mechanical intervention (primary percutaneous coronary
intervention); however, majority of healthcare centres in Indonesia do not have any
PCI facilities.
Objective: This study aimed to identify factors associated with successful fibrinolysis
among STEMI patients at Cibinong Hospital from January 2016 – February 2019.
Method: A cross-sectional study was conducted in a retrospective manner. The data
were collected consecutively. The study samples include STEMI patients whose onset
was <12 hours who received pharmacological revascularization therapy (fibrinolysis)
at Cibinong Hospital from January 2016 – February 2019. Bivariate analyses using Chi-
Square test, Fisher exact, Kolmogorov-Smirnov, and independent student T test were
performed appropriately for assessing the significance of each factor.
Result: Of 44 STEMI patients who underwent fibrinolysis at Cibinong Hospital from
January 2016 – February 2019, the treatment was successful in 27 (61%) patients.
From the analysis, the onset of chest pain (p ¼ 0.037), TIMI score (p ¼ 0.018), Killip
class (p ¼ 0.018), and smoking (p ¼ 0.022) were found to significantly associated with
successful fibrinolysis. Regarding the electrocardiographic (ECG) features, the pres-
ence of pathological Q wave (p ¼ 0.007) was a significant factor associated with suc-
cessful fibrinolysis. Conversely, the ST segment amplitude on the lead with the high-
est elevation (p ¼ 0.216) and QRS duration (p ¼ 0.289) were not proven to be
significant.
Conclusion: In this cohort, the onset of chest pain, TIMI score, Killip class, smoking
habit, and the presence of pathological Q wave are associated with successful phar-
macological revascularization therapy among STEMI patients at Cibinong Hospital
from January 2016 – February 2019.
Keywords: fibrinolysis • STEMI • early onset
OR.176. Comparison Electrocardiographic Criteria for Left Ventricular
Hypertrophy According to Genre in Hypertension Heart Disease Patient
Muhamad Fakhri, Giky Karwiky
Hermina Hospital, Sukabumi, Indonesia
Background: Electrocardiogram (ECG) is the most common diagnostic tools for evalu-
ating left ventricular hypertrophy in cardiac disease. Several factors are known to
interfere with ECG sensitivity, with the genre being one of the most important ones.
Objective: The aim of this study was to compare sensitivity between ECG criteria for
left ventricular hypertrophy (LVH) according to the genre.
Method: A retrospective cross-sectional study was carried out in 71 patients
(37 females and 34 males) with history and clinical profile of essential hypertension
that leads to LVH, as evidenced by echocardiography and/or electrocardiography.
Data research was collected in Hermina Hospital, Sukabumi. We compare sensitivity
and specificity between Sokolow Lyon, Cornell, Romhilt-Estes, and Paguero criteria
between genre. Sensitivities and specificities were estimated using receiver-operating
characteristic (ROC) curve in relation to Left Ventricle Hypertrophy using echocardiog-
raphy as standard (LVM/BSA>95 g/m2 in female and LVM/BSA>115 g/m2 in males).
Results: Sokolow Lyon criteria was able to diagnose LVH in 25 patients with 91.7%
specificity and 42.4% sensitivity, whereas Cornell criteria was able to diagnose LVH in
14 patients with 100% specificity and 23.7% sensitivity. Paguero Lo Presti criteria was
able to diagnose LVH in 26 patients with 91.7% specificity and 44.1% sensitivity.
Romhilt-Estes criteria was able to diagnose LVH in 32 patients with 75% specificity
and 54.2% sensitivity. Romhilt-Estes criteria showed better performance than other
criteria in the area under ROC curve analysis (AUC:0.75, p < 0.05). According to the
genre, man is more sensitive than woman for ECG criteria. Romhilt-Estes criteria
show better sensitivity in both man (57.1%) and woman (51.6%).
Conclusions: The ECG criteria is more sensitive in man. Romhilt-Estes criteria had
better sensitivity in both woman and man than other criteria for diagnosing LVH.
Keywords: Romhilt-Estes • Paguero Lo Presti • Sokolow Lyon • ECG criteria • Left
Vertricular Hypertrophy
OR.177. Incidence and One-year Risk of Adverse Outcomes in Patients with
Severe Rheumatic Mitral Stenosis
Mefri Yanni
Departemen of Cardiology and Vascular Medicine, Faculty of Medicine, University of
Andalas / DR.M. Djamil Hospital, Padang, Indonesia
Background: Rheumatic heart disease remains important health problems in devel-
oping countries. Mitral stenosis (MS) is the most common form of rheumatic heart
disease. Despite widespread use of echocardiography and continued health concern
regarding rheumatic mitral stenosis, data regarding incidence and predictors of long-
term adverse outcomes are still lacking.
Objective: The aim of this study was to investigate incidence and one-year risk of
adverse outcomes in patients with severe rheumatic mitral stenosis.
Method: We retrospectively reviewed medical records of patients diagnosed with
severe isolated rheumatic MS (RMS) at DR.M.Djamil Hospital between 2016 and 2018.
Demographic data, echocardiographic data, and one-year risk of adverse outcomes,
included all-cause mortality, hospitalization due to heart failure, and/or embolic
stroke during follow-up were collected and analyzed statistically.
Result: Eighty one patients with severe RMS (aged 44.8612.1 years, 75.3% female)
were included during follow-up period. Average mitral valve Wilkins score was
Abstracts
8.561. Only 18 patients (22.2%) underwent mitral valve intervention by percutane-
ous balloon mitral valvulotomy (13.6%) or surgery (8.6%) during follow up. Incidence
of one-year adverse outcome was 50.6% of all patients and included mortality in one
patient (1.2%), hospitalization due to heart failure in 38 patients (46.9%) and embolic
stroke in 4 patients (4.9%). Clinical parameter associated with one-year adverse out-
comes was atrial fibrillation (HR 1.3, 95%CI 1.0-6.6, p < 0.002) while echocardio-
graphic parameters associated with one-year adverse outcomes was the appearance
of left atrial thrombus (HR 1.2, 95% CI 1.1-6.1, p value ¼ 0.01).
Conclusion: One-year adverse outcomes are common in patients with severe rheu-
matic MS. One-year adverse outcomes were found to correlate with atrial fibrillation,
the appearance of spontaneous echo contrast and left atrial thrombus in this study.
Keywords: mitral stenosis • rheumatic heart disease • one-year adverse outcome
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.178. Association of Hypomagnesemia and Vascular Calcification among
Patients with Chronic Kidney Disease
Eic John Marayag1, Francis Marie Purino2, Stephanie Andres3, Jenina Jorge4,
Mario Milo5, Benjamin Joseph Ong6
1
Primary Investigator and Presenter, Section of Cardiology, University of Santo Tomas
Hospital, 2Section of Cardiology, University of Santo Tomas Hospital, 3,4Section of
Nephrology, University of Santo Tomas Hospital, 5,6Department of Radiology,
University of Santo Tomas Hospital
Background: Despite aggressive treatment, atherosclerosis is the leading cause of
cardiovascular morbidity and mortality among patients with Chronic Kidney Disease.
Coronary artery atherosclerosis correlates with the calcifications in the abdominal
aorta as studied by Kaupilla where lateral lumbar radiographs and the calculation of
the abdominal aortic calcification (AAC) score were done. Since Magnesium is fre-
quently deranged in CKD patients and hypomagnesemia is recognized for its athero-
sclerotic effect, the AAC score can be a tool for screening for coronary atherosclero-
sis in the setting of hypomagnesemia.
Objective General Objective: To determine if hypomagnesemia is associated with an
increased Vascular Calcification in patients with Chronic Kidney Disease
Specific Objectives: To Determine the baseline characteristics of patients with CKD
IV and V To determine the Abdominal Aorta Calcification Score of Patients Chronic
Kidney Disease in relation to Magnesium levels.
Method: CKD subjects were recruited, and lateral lumbar radiographs were obtained
using standard radiographic equipment and procedures as recommended by Kaupilla
et al. Two blinded radiographers interpreted the radiographs utilizing the AAC score
and interobserver variability was tested. Baseline characteristics and laboratories
were then reviewed.
Result: A total of 31 subjects were recruited in the study. Patients on hemodialysis
were also included. Most of the patients were males and have Diabetes Mellitus.
Vascular Calcification (VC) was 63.96% less for every unit of increase in Magnesium Odd
ratio (OR) 0.3604 (0.12 to 0.99 with P value 0.048 95% CI). Patients with diabetes were
six times more likely to have VC OR 6 (1.05 to 34.21 P value 0.044 95% CI) and for
every year increase in age, the odds of having Vascular calcification also increased by
16.53% OR 1.1653 (1.05 to 1.30 P value 0.005 95% CI). A higher creatinine was also cor-
related with higher VC OR 1.7715 (1.60 to 1.99 with P value 0.043 95% CI)
Conclusion: Higher Mg level decreases the risk of VC which transcribes to a lower
atherosclerotic burden among CKD patients. Strong predictors of higher VC were
Diabetes, older age, and a higher creatinine. This method therefore may be utilized
for screening patients with identified predictors such as hypomagnesemia for a
higher atherosclerotic burden which may warrant more aggressive cardiovascular
work-up and subsequent treatment among CKD patients.
Keywords: atherosclerosis • abdominal aorta calcification • hypomagnesemia
OR.179. A Randomized, Double-Blind, Placebo-Controlled Trial on Efficacy and
Safety of Blumea balsamifera (Sambong) on Prognostic Parameters and Quality-
of-Life of Chronic Heart Failure Patients
Jerome Reymatias, Agnes Custodio, Jan Mikhail Santos, Camilo Oliver Aquino
Department of Internal Medicine and ICU, Ospital ng Maynila Medical Center, Manila,
Philippines
Background: In the Philippines, Blumea balsamifera (Sambong) is one of the herbal
medicines endorsed as an alternative medicine in treating edema and urinary tract
stone dissolution. It has diuretic and anti-inflammatory properties but its efficacy in
heart failure remains unclear. This study aimed to evaluate the efficacy and safety of
Sambong as an adjunct to the standard therapy of heart failure patients with
reduced ejection fraction.
Method: A total of 39 patients aged 20-75 years with NYHA functional class II or III
and ejection fraction <40% seen at a tertiary hospital were enrolled and randomized
to placebo (control, n ¼ 20) or Sambong capsules (treatment, n ¼ 19) in addition to
their standard heart failure regimen for a duration of 2 months. The primary effec-
tiveness endpoint includes serum brain natriuretic peptide (BNP) level, six-minute
walk test, and two-dimensional echocardiographic parameters. The secondary effec-
tiveness endpoint is quality-of-life using Minnesota Living with Heart Failure
Questionnaire. Safety was assessed by measurement of serum transaminases, creati-
nine and electrolytes.
Abstracts
Result: There was a significant decrease in mean BNP of 501.14 in patients who
received Sambong while there was an increase of 118.76 in those who received pla-
cebo (Mean difference, 619.90; 95% CI 163.96 – 1075.83; p ¼ 0.01). The mean dis-
tance walked in six minutes and quality-of-life improved in both groups (p ¼ 0.28 and
p ¼ 0.45, respectively). The differences between the two groups were not statisti-
cally significant for all two-dimensional echocardiographic parameters. There was no
noted significant increase in the serum creatinine (p ¼ 0.11), alanine aminotransfer-
ase (p ¼ 0.89) and aspartate amino transferase (p ¼ 0.96), nor derangements in the
serum sodium(p ¼ 0.24) and potasssium (p ¼ 0.5).
Conclusion: The use of sambong capsules is safe, and causes a decline in serum BNP,
which may suggest its potential utility as an adjunct to the standard therapy of heart
failure patients with reduced ejection fraction.
Keywords: heart failure • sambong • randomized trial
OR.180. The Association Between Preoperative Pulmonary Function And Length
Of Stay In Patients Undergoing Coronary Artery Bypass Grafting Surgery - A
Retrospective Study
Leo D. Pradipta, Maria I.D. Siregar, Indah Sukmawati
Department of Cardiology and Vascular Medicine, Siloam Hospital Lippo Village,
Tangerang, Banten, Indonesia
Background: Heart surgeries still have high morbidity and mortality despite recent
advances in surgical techniques in perioperative cares. Several prognostic scores
have been developed to help clinicians decide whether cardiac surgery is appropri-
ate, for example The European System for Cardiac Operative Risk Evaluation (Euro-
SCORE) with Forced Expiratory Volume in one second (FEV1) as one of the parameter,
that can be measured by spirometry. Some studies showed that smoking has direct
effect to respiratory system which can reduce the FEV1.
Objectives: This study is aim to describe the association between spirometry result
and length of stay in patients undergoing coronary artery bypass graft (CABG).
Methods: This is retrospective study with medical record review, assessed preopera-
tive spirometry test result and length of stay in 33 coronary artery bypass grafting
(CABG) patients from October 2018 to December 2018. The Society of Thoracic
Surgeons (STS) definition used for determining the respiratory function of the
patient: normal (FEV1 > 75% predicted), mild (FEV1 60 – 75% predicted), moderate
(FEV1 50 – 59% predicted), and severe (FEV1 <50% predicted). All data was analyzed
using Spearman correlation test.
Results: Spirometry was performed in 33 patients (28 male patients, age mean 61.5
6 6.73 years and EF 54.54% 6 15.34%, ten patients were smoking. Mean hospital and
ICCU stay in normal FEV1 patient was 6.22 days and 2.11 days; mild restriction was
7.15 days and 2.84 days; moderate restriction was 6.85 days and 2.28 days; and
severe restriction was 5.33 days and 2.00 days (respectively). There is no association
between spirometry result and length of stay (hospital and ICCU stay) in patients
undergoing coronary artery bypass grafting (CABG) surgery with p ¼ 0.835 and
p ¼ 0.862, respectively, though there is correlation between smoking and low respira-
tory function (p ¼ 0.002).
Conclusion: There is no association between preoperative pulmonary function and
length of stay in patients undergoing CABG surgery.
Keywords: spirometry • coronary artery bypass grafting surgery • length of stay
OR.181. The Correlation Between Preoperative Ejection Fraction And Length Of
Stay In Patients Undergoing Coronary Artery Bypass Grafting Surgery
Maria I.D. Siregar, Leo D. Pradipta, Indah Sukmawati
Departemen of Cardiology and Vascular Medicine, Siloam Hospital Lippo Village,
Tangerang, Banten, Indonesia
Backgrounds: Poor preoperative ejection fraction is commonly found in patient with
coronary heart disease and associated with both clinical and cost outcomes in patient
undergoing coronary artery bypass graft surgery (CABG). There are fewer study show
the influence of preoperative ejection fraction on postoperative hospital length of stay.
Objectives: The primary objective of this study is to describe the correlation
between preoperative ejection fraction and length of stay in patients undergoing
coronary artery bypass.
Methods: Cross sectional study was conducted in 33 patients underwent CABG sur-
gery between October to December 2018 in our Heart center. We divided sample in
two groups (EF < 40% and EF  40%). Data were collected from medical record and
analysed with pearson test. Length of stay counted from day one post CABG and the
length of ICCU stay. Some studies suggested that EF of 40 % is a critical cut off point
with EF less than 40% as a significant risk factor for postoperative length of stay.
Results: Baseline characteristics of the patient are 28 male patients with mean 61.5 6
6.73 years and mean EF 54.54% 6 15.34%. Hypertension found in 23 patients, 4
patients have dyslipidemia, 6 patients have diabetic mellitus, and 10 patients were
smoking. Twenty three patient with EF greater than 40%. There is no significant differ-
ences between the length of stay (including ICCU stay) in patient with EF of 40% with
mean 6,66 days or less and EF greater than 40% with mean 6,65 days and p ¼ 0.87.
Conclusion: There is no correlation between preoperative ejection fraction and
length of stay in patient undergoing CABG surgery.
F79
Keywords: ejection fraction • coronary artery bypass grafting surgery • length of
stay
OR.182. Successful Rate of PCI Procedure in District Area with Limited
Resources: What a Challenge!
Yos A. Irmansyah1, Y. Pintaningrum2, R. Ermawan3
1
Medical Faculty of Mataram University, 2Cardiology Departement of West Nusa
Tenggara Hospital – Medical Faculty of Mataram University
Background: Cardiovascular disease (CVD) still being number one killer in the world
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
as non-communicable disease (NCD). In 2012 (WHO) 17.5 million people died because
of CVD and more than 3=4 happens in developing country including Indonesia that
reaches 12.9% case and still increase. In Indonesia, especially in Mataram, West Nusa
Tenggara, percutaneous coronary intervention (PCI) is the one of strategy to
decrease mortality and morbidity. The challenge is, how to manage CAD patients in
district area, especially Mataram, West Nusa Tenggara Province, which has limited
resources and almost 95% CAD patients are waived by government universal health
insurance.
Objective: This study would present the characteristic and the outcome of patient
who has performing cardiac catheterization in West Nusa Tenggara General Hospital
in 2017.
Method: This is an analytic description study based on secondary data that was taken
from medical record from January to December 2017. All data was collected to
describe the characteristic of patients which performing cardiac catheterization in
Cath Lab of West Nusa Tenggara General Hospital. All data was measured and ana-
lyzed statistically by SPSS and was presented into tables and graphics.
Result: From 511 patients in 2017 that has been performing cardiac catheteriza-
tion, most of them are male with 352 (68.9%) with mean of ages 58.61 6 9.625
following by female in 159 (31.1 %) with mean ages 57.81 6 9.967 years old. After
performing cardiac catheterization, most of them are triple vessel disease (29.5%).
Chronic Total Occlusion occurred in 32.2% patients. 14.5% are critical stenosis, and
9.4% of them are in-stent restenosis. Most of them has double risk factor such as
hypertension and smoking (17.0%), following by Hypertension and diabetes mellitus
type 2 (13.7%). In our data, from 551 patients, 248 (48.5%) PCI was performed,
with 66.3% success through CTO, and overall PCI successful rate procedure was
83.4%.
Conclusion: This data was the very first data that was collected since cardiac cathe-
terization was running in Mataram, West Nusa Tenggara. This study also showed even
in district area with limited resources, equipment, and 95% are covered by govern-
ment insurance, but still can have a high chance for succeed.
Keywords: Cath lab • PCI • district area • cardiovascular disease • successful rate.
OR.183. Determinant of Invasive Strategy in Patients with Non ST-Elevation
Acute Coronary Syndrome (NSTE-ACS) in Sardjito General Hospital Yogyakarta
GK Ahimsa, HP Bagaswoto, N Taufiq
Department of Cardiology and Vascular Medicine, Gadjah Mada University - Sardjito
General Hospital, Yogyakarta, Indonesia
Background: Patients with Non ST-Elevation Acute Coronary Syndrome (NSTE-ACS)
are a diverse patient group with clinical variability from low risk to very high risk
stratification. Clinically, every patients can fall on any risk stratification during care.
Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS
patients. In fact, NSTE-ACS patients can experience risk alteration during the care
abrubtly. Thus, it is not easy to decide the management of NSTE-ACS, whether inva-
sive or conservative.
Objective: The aim of this study is to determine factors that lead cardiologist to
decide an invasive strategy in NSTE-ACS patients in Sardjito General Hospital.
Methods: This retrospective cohort study included all NSTE-ACS patients who were
hospitalized in Sardjito General Hospital from the registry of SCIENCE (Sardjito
Cardiovascular Intensive Care) from June 2018 to March 2019. Patients were com-
pared between invasive or conservative management in order to determine predic-
tors to undergo invasive management. Multivariate logistic regression models were
performed to identify independent determinants of invasive management with
p < 0.05 represented significant result.
Result: A total of 189 patients with NSTE-ACS were included in this study. 80 patients
(42.32%) treated with invasive strategies, while 109 patients (57.68%) received con-
servative management. The logistic regression analysis identified Age <75 years old
(OR ¼ 0.09; 95%CI 0.01-0.53), JKN health payment (OR ¼ 0.22; 95%CI 0.05-0.92),
higher Grace score (OR ¼ 1.02; 95%CI 1.00-1.04), lower crusade score (OR ¼ 0.95;
95%CI 0.92-0.99), and increasing hs-Troponin T level (OR ¼ 0.34; 95%CI 0.14-0.83) as
independent determinants to undergo invasive management in NSTE-ACS patients
(p < 0.05).
Conclusion: In Sardjito General Hospital, The choice to perform invasive manage-
ment in NSTE-ACS patients associated more to health payment, younger age, grace
score, crusade score and hs-Troponin T level.
Keywords: NSTE-ACS –Determinant- invasive strategy – conservative strategy
F80 Abstracts

OR.184. Cardiovascular Risk Factor In Indonesian Rural Area: An Insight From OR.185. Characteristics and Contributing Factors of Acute Myocardial Infarction
Belu Regency with ST-segment Elevation in Young Adults: Data from Indonesian National
Cardiovascular Centre
Eka A. Pradipta1, Arvin Pramudita1
1
Marianum Catholic Hospital, Halilulik, East Nusa Tenggara, Indonesia Cahyo Baskoro1, Christian Rendy Chandra1, Ronaldo Simamora1, Jessica Putri Natalia1,
Nani Hersunarti2, Rarsari Soerarso2
1
Department of Cardiology and Vascular Medicine Faculty of Medicine University of
Background: Cardiovascular disease remains one of the most prominent non-commu-
Indonesia, National Cardiovascular Center Harapan Kita, 2Division of Clinical
nicable disease and is a growing concern in developing countries. Highly associated
Cardiology, Department of Cardiology and Vascular Medicine Faculty of Medicine
with urban population and lifestyle, data of cardiovascular risk profile were rarely
University of Indonesia, National Cardiovascular Center Harapan Kita
studied in rural area and data are scarce.
Objective: To provide an insight on cardiovascular risk profile in Indonesian rural

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

area. Introduction: Acute Myocardial Infarction with ST Segment Elevation (STEMI) is well
Method: This retrospective descriptive study involves all patient who had laboratory known for causing mortality and morbidity among adult patients and has been
examination screening for cardiometabolic risk factor between January 2017- reported in many studies. However, to our knowledge, there has not been such infor-
December 2018. All baseline data were then obtained consequently on the day of mation especially in Indonesia regarding STEMI in young adults.
laboratory examination. All subjects with incomplete data were excluded. ASCVD 10- Aims: To describe characteristic and factors related with STEMI of young adults in
year risk score were performed using available instrument provided online. Indonesia.
Result: A total of 337 patients out of 498 subjects fulfilled the inclusion criteria in Methods: We retrospectively analysed all STEMI patients’ data in National
this retrospective descriptive study. Most patients were women (57%), mean age Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia between January
57.6460.67 and had hypertension (39.2%). Some of the patient had history of CAD 2014 and December 2018. Data included was young adults under 30 years old hospi-
(5.9%), CVD (6.8%), CKD (1.5%) and CHF hospitalization (5.3%). ASCVD 10-year risk talized with STEMI who undergone Primary Percutaneous Coronary Intervention
score of some study subjects could not be calculated due to extremely old age >79 (PPCI). Analysis included cardiovascular risk factors such as smoking, dyslipidaemia,
years, low HDL (<20 mg/dl) and LDL cholesterol (<70 mg/dl). hypertension, familial history, diabetes mellitus (DM) ,acute heart failure, TIMI,
Conclusion: Hypertension and old age remain the main cardiovascular risk factor in KILIP, ejection fraction (EF), and length of stay (LOS)
rural area. Distinctive lipid profile and extremely old age in this population mitigate Results: There were 25 young male patients who had STEMI in the current study.
the usefulness of ASCVD 10-year risk score. Further cohort studies are necessary to Mean age was 27 years with age ranged from 19 to 30 years old. Smoking (92%) was
better understand the impact of cardiovascular risk factor in rural area. the most influencing risk factor. Furthermore. majority of the patients had anterior
Keywords: cardiovascular risk factor • Indonesia • rural area • ASCVD risk score STEMI ( 68% ) and most of them (80%) had TIMI low risk. The median of first contact
with medical team was 9 (2-72) hours. Single vessel disease (44%) was more preva-
lent disease in coronary artery findings. Complications include acute heart failure
(20%) and minority of patients (28%) had EF < 40%. Median of length of stays were 4
OR.184. Table 1 Baseline characteristic of the study population (1-10) days. It was also found that 80% of patients who had first contact with medical
team  12 hours had lower TIMI risk ( p < 0.05).
Variabel n ¼ 337 Conclusions: STEMI in young adults occurred predominantly in males with smoking as
the major risk factors. In this study, young adults patients mostly had anterior STEMI
Age 57.6460.67 and single vessel disease. In addition, Patients with early medical contact had a bet-
Male 145(43.0%) ter outcome.
Education Keywords: STEMI • risk factor • TIMI risk • percutaneous coronary Intervention
College 98(29.1%)
Senior High School 90(26.7%)
Junior High School 46(13.6%)
Elementary School 78(23.1%)
None 25(7.4%)
Occupation OR.187. Predicting the Risk of Left Ventricular Systolic Dysfunction using Global
Government officer 63(18.7%) Registry of Acute Coronary Events score at Early Onset of Acute Myocardial
Private sector 16(4.7%) Infarction
Priest/Nun 93(27.6%)
Farmer 48(14.2%) Winardi E. Setiawan, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Medical officer 11(3.3%)
Unemployed/housewife 106(31.5%)
Health insurance Background: Heart failure is one of the sequels in acute myocardial infarction (AMI)
Kartu Indonesia Sehat 209(62.0%) patients characterized by a decrease in left ventricular ejection fraction (LVEF). The
Asuransi Kesehatan 74(22.0%) occurrence of heart failure in AMI patients may cause mortality in the future.
None 54(16.0%) Identification the risk factor of left ventricular systolic dysfunction at the onset of
Fasting blood glucose 111.2363.27 AMI can optimize patient management.
Random blood glucose 139.4367.75 Objective: This study aimed to evaluate the Global Registry of Acute Coronary
Systolic blood pressure 140.1861.95 Events (GRACE) score to assess LVEF in patients with AMI.
Diastolic blood pressure 84.3460.96 Method: This study was a cohort-retrospective study using consecutive sampling
Total cholesterol 109.0261.77 technique. Data were obtained from medical records of patients diagnosed with AMI
LDL cholesterol 95.3463.62 in 2017-2018 based on the Tarakan Registry of Acute Coronary Syndrome (TRACS).
HDL cholesterol 30.9160.8 The GRACE score was classified as low, moderate and high-risk based on the 6 month
Triglyceride 117.0363.18 post-discharge mortality risk. Analisis were done using one-way ANOVA followed by
Diabetes mellitus 43(12.8%) post-hoc test to compare the mean of LVEF of each group. Relative risk were then
Insulin 4(1.2%) determined.
Oral hypoglcemic agent 40(11.9%) Result: The study included 72 sample in the analysis. Overall LVEF mean was
Active Smoker 60(17.8%) 48.06615.90. The mean ejection fraction in low-risk group was 63.00611.80%, mod-
Alcohol consumption 42(12.5%) erate-risk was 49.24616.20%, and high-risk was 45.09615.14%. The LVEF mean dif-
Hypertension 133(39.2%) ference between low-risk and moderate-risk group was 13.7666.47% (p¼0.04), while
Coronary artery disease 20(5.9%) low-risk and high-risk group was 17.9165.77% (p<0.01). Relative risk for low-risk
Chronic heart failure 18(5.3%) group to had LVEF 50% was 2.31 (95%CI 1.54 – 3.46)
Cerebrovascular disease 23(6.8%) Conclusion: Left ventricular systolic dysfunction can be predicted at early onset of
Chronic kidney disease 5(1.5%) myocardial infarction using GRACE score. Low-risk GRACE score was a protective fac-
Atrial fibrillation 8(2.4%) tor for left ventricular systolic dysfunction in patient with AMI, therefore monitoring
Prior ACE 85(25.2%) of ejection fraction in moderate and high-risk group should be done more frequently.
Prior ARB 26(7.7%) Keywords: GRACE • LVEF • AMI • ACS • outcome
Prior BB 19(5.6%)
Prior CCB 78(23.1%)
Prior Diuretic 18(5.3%)
Prior Spironolakton 5(1.5%)
Abstracts F81

OR.188. Red Blood Cell Distribution Width as a Novel Biomarker Predictor for
Clinical Outcomes and Mortality Risk Among Patients with Coronary Artery
Diseases: A Systematic Review and Meta-Analysis
Michael Jonatan, Kevin Luke, Ricardo A. Nugraha, Firas F. Alkaff, Rendra M. Putra
Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya,
Indonesia
Background: Red blood cell distribution width (RDW) is a simple and cheap examina-
tion that usually overlooked. Recent studies have shown that RDW might reflect
pathophysiological changes in human health.
Objective: This study aimed to evaluate the association between RDW and clinical
Hypertonic saline solution (HSS) mobilizes extravascular fluid into the intravascular
space that can enhance renal perfusion and maintain a therapeutic furosemide con-
centration. However, this method of increasing diuresis has not been largely studied
nor recommended by international guidelines.
Objective: To evaluate the safety and efficacy of the addition of HSS to furosemide
in acute decompensated heart failure (ADHF) treatment.
Method: Literature searching was done for randomized controlled trials regarding
the administration of HSS as an adjunct to furosemide in ADHF patients and was con-
ducted in 4 databases: PubMed, Cochrane, ProQuest, and ScienceDirect.
Result: HSS decreased the overall mortality in patients treated with HSS with an
RR of 0.36 (0.26-0.51). Patients who were treated with HSS also showed a reduced

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

hospital length of stay (p < 0.0001) and an increased diuresis (p < 0.0001). HSS
outcomes among patients with coronary artery diseases (CAD)
improved diuresis as seen from an increase in glomerular filtration rate (59.1 6
Method: We reviewed PubMed, Embase, and ScienceDirect literature from 1946 to
31.9 vs 4261; p < 0.0001). Creatinine clearance was significantly higher in the
2018 under Keywords: “RDW”, “Mortality”, and “Clinical Outcomes”, with limitations
treatment group (54.2 6 4.5 vs 44.6 6 5.1; p < 0.01). Furthermore, HSS
on English published article only. The eligibility criteria were cohort observational
group showed a significant reduction in hospitalization time when compared to
studies which reported quantitative clinical outcomes in association with RDW.
the furosemide-only group (p ¼ 0.046). In addition, furosemide decreased the
Statistical analysis was conducted in accordance to PRISMA-MOOSE guideline and
release of cardiac troponin when associated with HSS. B-type natriuretic peptide
quality checklist and was computed using RevMan 5.3.
(BNP) levels were significantly lower in the HSS group (542 6 285 vs 682 6 296;
Result: Twenty-one studies (12 prospective and 9 retrospectives) consists of 26,226
p < 0.0001).
patients were reviewed. Comparison of low vs high RDW value was conducted with
Conclusion: Hypertonic saline solution can be a safe therapeutic method in ADHF
cut-off varied from 13 to 16.3%. Low RDW represents a smaller number of impaired
patients, improves clinical symptoms, and does not have detrimental effects on the
LVEF (EF < 40%) with risk ratio (RR) 0.8 (95% CI, 0.66-0.98; p ¼ 0.03). Low RDW exhib-
myocardial cells. Future large, multi-centred, randomized controlled trials are
its smaller events of heart failure, re-infarction and major cardiac adverse events
needed to confirm the findings in this report prior to endorsement of HSS in ADHF
(MACE) with pooled RR 0.55 (95% CI, 0.47-0.64; p < 0.0001); RR 0.65 (95% CI, 0.56-
guidelines. HSS holds a promising solution as an advanced therapy for treating ADHF
0.74; p < 0.0001); and RR 0.49 (95% CI, 0.43-0.57; p < 0.0001), respectively. In terms
patients.
of mortality, low RDW also indicates a smaller mortality rate than the high RDW
Keywords: furosemide • heart failure • hypertonic saline
group. The results for low RDW vs high RDW in in-hospital mortality, short term, and
long term mortality were: pooled RR 0.46 (95% CI, 0.35-0.6; p < 0.0001); RR 0.27
(95% CI, 0.2-0.37; p < 0.0001); and RR 0.4 (95% CI, 0.36-0.45; p < 0.0001),
respectively.
Conclusion: This study indicates that low RDW value is associated with better prog- OR.191. Diagnostic Value of Lung Ultrasound in Differentiating Acute Heart
nostic and better clinical outcomes among patients with CAD. A stratified risk assess- Failure and Chronic Obstructive Pulmonary Disease in Emergency Room
ment and future studies focusing on levels of recommended RDW in conjunctions
with GRACE and TIMI score might provide breakthroughs in the cardiology field. Cindy A. Sitompul, Harris Hasan, Ali Nafiah
Keywords: Red Blood Cell • Coronary Artery Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia

OR.189. TIMI Flow in Primary Angioplasty With and Without Intracoronary
Alteplase in Adam Malik General Hospital
Esra J. Bangun, Harris Hasan, Zulfikri Mukhtar, Ali N. Nasution
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Percutaneous coronary intervention (PCI) performed within 12 hours
from symptom onset enables complete blood flow restoration in infarct-related
artery in 90% of patients. A new strategy of low dose intracoronary (IC) fibrinolytic
therapy has shown encouraging results in a number of small studies.
Objective: The aim of study is to compare the TIMI flow between primary angioplasty
with and without IC fibrinolytic (alteplase) in Adam Malik General Hospital and TIMI
flow as the outcome.
Methods: Using a registry from cardiac catheterization laboratory of Haji Adam Malik
General Hospital, STEMI patients undergoing primary PCI within 12 hours from
January 2018 to February 2019 were screened for. Patients were divided into primary
angioplasty with and without IC fibrinolytic (alteplase). TIMI flow as outcome was
evaluated using Chi-Square from SPSS.
Results: A total of 66 patients were found which 31 patients (47%) primary angio-
plasty with IC fibrinolytic and 35 patients (53%) without IC alteplase group. Overall,
we found 11 patients (16.7%) with TIMI flow II and 55 patients (83.3%) with TIMI flow
III post primary angioplasty (table 1). After analysis, we concluded there was statisti-
cally different in TIMI flow between IC fibrinolytic group and without IC fibrinolytic
group (p value <0.05) (table 2).
Conclusion: TIMI flow in primary angioplasty was statistically different between IC
fibrinolytic (alteplase) group and without fibrinolytic which dominated by TIMI flow 3
in IC fibrinolytic group (alteplase).
Keywords: TIMI flow • primary angioplasty • alteplase
Background: Acute dyspnea is the common chief complain in acute heart failure
(AHF) and chronic obstructive pulmonary disease (COPD) patient admitted to emer-
gency room. The clinical symptoms and signs frequently overlap, so it is challenging
to differentiate. Lung ultrasound (LUS) is a reliable, simple and direct diagnostic tool
to assess pulmonary extravascular fluid semi-quantitatively through B-line images.
Rapid diagnostics are needed to recognize patients with pulmonary edema in acute
heart failure.
Objective: The aim of this study is to investigate whether the LUS could differenti-
ate AHF and COPD.
Method: This cross-sectional study was conducted in Adam Malik General Hospital,
Medan. All patients with acute dyspnea who enter the emergency room were exam-
ined for LUS and NT-proBNP. Patients diagnosed with AHF were based on the 2016
ESC guideline criteria and NT-proBNP results >1000 qg/mL. COPD patients were
patients with NT- proBNP <1000 qg/mL and subsequent FEV1 spirometry value <80%.
LUS is performed in 4 zones in each hemithorax. B-Line is a discrete, hyperechoic
vertical artifact, shaped like a comet’s tail originating from the pleural line. The
number of lines is calculated semi-quantitatively.
Result: Two hundred six patients with acute dyspnea entered the emergency room of Haji
Adam Malik General Hospital. Fifty patients diagnosed with AHF, and 50 patients diagnosed
with COPD. B-line ROC curve for diagnosis differentiation is 0.96 (95% CI 0.82-1.00).
B- line >11 is the best cut-off for assessing pulmonary edema with 90% sensitivity, 98%
specificity, PPV 97% and NPV 90%. LUS has a very strong correlation with NT-proBNP
(r ¼ 0.84; p < 0.001). LUS correlates strongly with E/e’ with a value of r ¼ 0.77 with
p < 0.001.
Conclusion: LUS evaluation is a very good diagnostic tool in differentiating AHF and
COPD.
Keywords: lung ultrasound • chronic obstructive pulmonary disease • acute heart
failure

OR.192. High Sensitivity C Reactive Protein as a Predictor of Major Adverse

OR.190. Hypertonic Saline Solution Supplementation During Furosemide
Administration in Acute Decompensated Heart Failure: a Systematic Review and
Meta-analysis
Rinaldo Indra Rachman1, Nobian Andre1, Dela Ulfiarakhma1, Bambang Budi Siswanto2
1
Faculty of Medicine, Universitas Indonesia, 2Clinical Cardiology Division, Department
of Cardiology and Vascular Medicine, Universitas Indonesia
Background: Loop diuretics have long been accepted as the first-line treatment for
heart failure patients. However, a lack of response to them—due to a reduction in
renal blood flow in heart failure—is frequently found, resulting in acute events.
Cardiac Events in ST-Elevation Myocardial Infarction
Thomas Rikl1, Anggoro B. Hartopo2, Royhan Rozqie2
1
Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, 2Department
of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada-
Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Background: ST-elevation myocardial infarction (STEMI) is a serious worldwide car-
diac problem. Major adverse cardiac events (MACE) can still occur although standard
management for STEMI has been given. Studies suggest that the increase of high sen-
sitivity C Reactive Protein (hs-CRP) in plasma to be linked with an increased risk of
MACE in STEMI patients.
F82
OR.191. Figure 1 LV Summit Ablation Success Rate
Objective: This study aimed to investigate the increase of hs-CRP as a predictor of
MACE in STEMI during intensive care.
Method: This is a retrospective cohort study analyzing hs-CRP levels measured by the
immunoturbidimetric method from blood samples collected during admission in the
Emergency Room of Dr. Sardjito Hospital. MACE was observed during intensive care
in the Intensive Cardiac Care Unit (ICCU) Dr. Sardjito Hospital. The patients were div-
ided into two groups based on the occurrence of MACE. The proportion of those
groups were analyzed using the v2 test.
Result: A total of 163 STEMI patients were included in this study. The Kolmogorov-
Smirnov normality test showed a non-parametric distribution of hs-CRP levels. The
Mann-Whitney test showed that there is a significant difference between the hs-CRP
levels in MACE and non-MACE groups (0.475 mg/L versus 0.280 mg/L, p ¼ 0.024). The
median (0.33 mg/L) was used as the cut-off point of the hs-CRP level. The v 2 test
result showed that there is a significant correlation between the increase of hs-CRP
level in plasma and the increased risk of MACE (p ¼ 0.023). STEMI patients who have
the hs-CRP level in plasma >0.33 mg/L tend to have 1.95 times higher risk of having
MACE during the intensive care.
Conclusion: The increase of hs-CRP level in STEMI patients increases the risk of MACE
during intensive care.
Keywords: high sensitivity C Reactive Protein (hs-CRP) • major adverse cardiac
events (MACE) • ST-elevation myocardial infarction (STEMI)
Abstracts
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.193. Corrected TIMI Frame Count (cTFC) After Primary PCI in Acute STEMI
Patients within 12 hours of Symptom Onset
Furqan Arief, Harris Hasan, Zulfikri Mukhtar, Ali Nafiah
Department of Cardiology and Vascular Medicine School of Medicine, University of
Sumatera Utara/ Adam Malik General Hospital, Medan, Indonesia
Background: ST-segment elevation myocardial infarction (STEMI) is a life threatening
manifestation of coronary artery disease requiring timely reperfusion. The current
ESC recommendations is primary percutaneous coronary intervention (PCI) procedure
in the management of acute STEMI within 12 hours of symptom onset. Higher post
procedural TIMI flow grade and lower cTFC as successful reperfusion of infarct
related artery (IRA).
Objective: Corrected TIMI Frame Count after Primary PCI in Acute STEMI Patients
within 12 hours of symptom onset.
Methods: This is a prospective and observational study. All acute STEMI patient in
Emergency room received oral Clopidogrel 600mg or Ticagrelol 180mg, chewable
aspirin 160 or 200mg, atorvastatin 40mg, then patients transferred to
Catheterization Laboratory (PCI Center) for performing angioplasty procedure.
Patients with coronary angiography showed TIMI flow 0/1 and TIMI thrombus grade
4/5 in the IRA vessel, after guide wire crossing, manual thrombus aspiration
Abstracts
catheter-TAC device was to be advanced and suction started (thrombectomy) before
it crossed the occlusive thrombus lesion, if the TAC device unable to across the
lesion, predilatation with a small diameter balloon was to be performed (recanalized
procedure). Pre and post procedural TIMI flow grade, and cTFC were graded by 2
independent interpreters (senior residence and cardiologist intervention).
Results: We enrolled 27 patients (case) fulfilled inclusions criteria between October
2018 to February 2019 in Adam Malik General Hospital, aged 34-88 y, symptom to
procedural time was 1.0 to 12 h, mean 6.7 hours, 22 males and 5 females, 16 inferior
and 11 anterior wall infarction. Twenty-one patients obtained post procedural TIMI
flow grade 3 and mean cTFC was 15. Six patients obtained post procedural TIMI flow
grade 2 and mean cTFC was 24. There was significance difference in mean cTFC
between 2 groups (p < 0.05, SD 8.9 6 3.5).
Conclusion: Primary PCI procedure obtained successful reperfusion of IRA in acute
STEMI patients within 12 hours of symptom onset.
Keywords: STEMI. IRA. Reperfusion. TIMI. cTFC
OR.194. Clinical Characteristics, Length of Stay, and Major Adverse Cardiac
Events of ST Elevation Myocardial Infarction Patients at Cardiac Center Adam
Malik General Hospital: Early vs Late Presenters
Muhammad D. Pane, Harris Hasan, Zulfikri Mukhtar, H. Ade P. Lubis, Ali N. Nasution
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: ST-Elevation Myocardial Infarction (STEMI) is a critically time-depend-
ent process prevention of delays in treatment is critical as it influences morbidity
and mortality. Based on the latest guideline, early presenters (within 12 hours of
symptom onset) should be revascularized immediately.
Objective: The aim of this study is to compare the clinical characteristics, length of
stay, and MACE of STEMI patients based on onset of symptoms.
Methods: Total of 58 patients presenting with STEMI in Adam Malik General Hospital
Medan between November 2018 and January 2019 were enrolled and compared in 2
equal groups : early and late presenters (12 hours and >12 hours). Clinical charac-
teristics, length of stay, and MACE were analyzed using bivariate analysis (independ-
ent T-test and Chi-square).
Results: Each group consist of 26 STEMI patients with mean of onset 23.42 hours
(14.97-31.88). Demographic and risk factors generally were not different
significantly between two arms, except dyslipidemia was more common in late
presenter (25% vs 71.4%; p < 0.05). Although not statistically significant, late pre-
senters had more atypical chest pain, higher Killip class, TIMI risk, and GRACE.
MACE and mortality were more common in late presenter group but not signifi-
cant, contrast with cardiogenic shock which evidence signification (p < 0.05).
Length of stay were significantly longer in late presenter group (4.61 vs 9.27 days;
p < 0.05). Multivessel disease or left main involvement was found more common in
late presenter group (21.4% vs 47.8%; p < 0.05) and treated more conservatively
(p < 0.05).
Conclusion: Late presentation STEMI had higher risk score, atypical clinical finding,
and multivessel disease. STEMI presenting > 12 hours had higher cardiogenic shock
event, longer duration of hospitalization, and treated more conservatively which
contributed to higher morbidity and mortality.
Keywords: STEMI • onset • clinical characteristics • MACE • length of stay
OR.195. The Severity of Diastolic Dysfunction and The Incidence of Acute Heart
Failure in Severe Preeclampsia
Dhira A. Wardana, Rille P. Harjoko, Aruman Y. Mochtar
Department of Cardiology and Vascular Medicine, Diponegoro University Faculty of
Medicine - Dr. Kariadi General Hospital, Semarang, Indonesia
Background: Preeclampsia and heart failure are common causes of maternal morbid-
ity and mortality. Preeclampsia may lead to acute heart failure in pregnancy.
Diastolic dysfunction may be the cause of acute heart failure in these patients.
Objective: The aim of this study is to find out the correlation between the severity of
diastolic dysfunction with the incidence of acute heart failure in severe preeclampsia.
Method: A cross-sectional analytic study using secondary data involving severe pree-
clampsia at dr. Kariadi General Hospital Semarang from January 2014 until December
2016.
Result: A total of 20 patients with severe preeclampsia were observed. The mean age
was 31.2 6 1.53 years old. Diastolic dysfunction was seen in 14 (70%) cases. Among
these, 7 (50%) patients had grade I diastolic dysfunction and 7 (50%) patients had grade
II diastolic dysfunction. Acute heart failure was seen in 13 (65%) cases, 5 (25%) had
grade I and 8 (40%) had grade II diastolic dysfunction. There was a strong positive cor-
relation and statistically significant between the severity of diastolic dysfunction and
the incidence of acute heart failure in severe preeclampsia (r ¼ 0.807, p ¼ 0.000).
F83
Conclusion: The severity of diastolic dysfunction is correlated with the incidence of
acute heart failure in severe preeclampsia.
Keywords: Severe preeclampsia • diastolic dysfunction • acute heart failure
OR.196. Factors Affecting Hospital Length-of-Stay of STEMI Patients undergoing
PPCI in dr. Iskak General Hospital Tulungagung
F. Caesario, A. Wibisono, E. Ruspiono, T. Astiawati, F.S. Laitupa, A.W. Nugraha,
S. Hayon, N.A. Suyani
Dr. Iskak General hospital, Tulungagung, East Java, Indonesia
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: To determine the factors affecting hospital length-of-stay (LOS) of
patients with acute ST segment elevation myocardial infarction after Primary
Percutenous Coronary Intervention
Method: Data were from a retrospective, single center, hospital-based registry of
128 STEMI patients undergoing PPCI. The patients were divided into 2 groups, with
the cut off 4 days length-of-stay. Demographics, Electrocardiographic findings,
Angiographic findings and clinical characteristics which influencing Hospital Length-
of-Stay collected and analyzed with univariate analysis. Multivariate analysis by step-
wise logistic regression models tested variables that were significant at p<0.25 in
the univariate analysis.
Result: Longer Hospital Length-of-Stay (>4 days) were more likely among age > 60
years (OR: 3.194, p¼0.014), female patients (OR: 2.124, p¼0.246), Anterior MI (OR:
0.564, p¼0.175), Posterior MI (OR: 0.577, p¼0.248), and LMCA lesions (OR: 0.295,
p¼0.074). A multivariate logistic regression analysis revealed age > 60 years (OR
2.798; p ¼ 0.036) was an independent factor that influencing longer hospital length-
of-stay.
Conclusion: Age > 60 years, Female patients, Anterior MI, Posterior MI and LMCA
lesions were univariately associated with longer hospital length-of-stay in STEMI
patients undergoing PPCI. However based on logistics stepwise method, only age >
60 years had showed statistically significant and sizeable odds ratio in influencing
hospital length-of-stay.
Keywords: Hospital Length-of-Stay • STEMI • PPCI
OR.197. TIMI Risk Index as Triage Assessment for In-Hospital Mortality Predictor
in Non- Reperfused Stemi Patients
Alberta C. Undarsa1, Emir Yonas2, Irlandi M. Suseno1
1
Department of Cardiovascular Medicine, Regional General Hospital District Subang,
West Java, Indonesia, 2Research assistant Cardiology department. Gatot Soebroto
Central Army Hospital, Jakarta, Indonesia
Background: TIMI Risk index (TRI) is a scoring-based predictors of mortality risk after
presentation with STEMI. This scoring system provides a very simple tool and acts as
a single risk index in predicting mortality. TRI is derived from InTIME II substudy as
triage tool for STEMI patients with calculation: (heart rate  [age/10]2/systolic blood
pressure). This risk assessment can be done by any medical practitioner using data
routinely obtained during first contact with patient.
Objective: Our objective is to know the significance of increased TRI score in STEMI
subjects in relation to Mortality and Major Cardiovascular and Cerebrovascular
Adverse events (MACCE) treated conservatively without reperfusion therapy.
Method: This was retrospective cohort study. The subjects were 85 consecutive
patients who were admitted to our hospital whom rejected referral for reperfusion
therapy on March-December 2019. Out of 85 subjects 28 were excluded due to pres-
ence of severe clinical deteriorations that might act as confounding factors to in-hos-
pital mortality in our study. Analysis were done using T-Test. Normality of data was
defined using Skewness to Standard Error ratio, all analysis was done using SPSS v
25.0 (IBM Corp).
Result: Increased mean of TRI was associated with in-hospital mortality in patients
with STEMI (34.78þ15.81 on expired patients vs 23.02þ11.21 on survived group
p ¼ 0.017). There was no significant association on MACCE and its relation to TRI
(p ¼ 0.078). There was also no significant association between TRI and gender
(p ¼ 0.599), late presentation >12 hours (p ¼ 0.295), diabetes (p ¼ 0.504), hyperten-
sion (p ¼ 0.37), history of angina (p ¼ 0.87), and smoking (p ¼ 0.228). Several limita-
tions in our study include the unequal population between groups, absence propen-
sity matching between study groups and the abnormal distribution of data defined by
Skewness/SE ratio exceeding 2.0.
Conclusion: Increased TIMI Risk Index is associated with in-hospital mortality in
patients with STEMI
Keywords: TIMI • Risk Index • STEMI • MACCE • In-hospital mortality
F84
OR.198. Association between Pulse Pressure Index and Left Ventricular
Filling Pressure in Patients with Non ST-Segment Elevation Myocardial
Infarction
R. AninditaP. Matondang, Imy Ginting, Bertha G. Napitupulu, Harris Hasan, Nizam
Z. Akbar, H. Ade P.Lubis
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Patients with myocardial infarction often have poor left ventricular dia-
stolic dysfunction (LVDD) and poor vascular compliance. The pulse pressure index
(PPI) defined as (systolic blood pressure-diastolic blood pressure)/systolic blood pres-
sure) determined by both cardiac and vascular factors. Cardiac function and vascular
compliance is reportedly associated with left ventricular diastolic function, which
can reflects LV filling pressure.
Objective: This study aim to investigate whether PPI correlates with estimated left
ventricular filling pressure in NSTEMI patients.
Method: This study enrolled 69 NSTEMI patients who had been referred for echocar-
diographic examination. Blood pressure was manually measured with a sphygmoman-
ometer device. The high left ventricular filling pressure (LVFP) was estimated in
grade II or III diastolic dysfunction. Grade II diastolic dysfunction is defined when E/A
value is 0.8-<2 and two or three diastolic function parameter are met, which are TR
velocity > 2.8 m/s, LAVI > 34 ml/m2, and average E/e’ >14. Grade III diastolic dys-
function is defined when E/A value is  2.
Result: Among total 69 NSTEMI patients, high LV filling pressure was found in 36
patients (52%). Mean PPI in this study was 0.36. PPI was proven to be significantly
associated and negatively correlated with high LV filling pressure (p 0.010, pearson
correlation -0.3).
Conclusion: This study showed that PPI was significantly associated with LV filling
pressure, even with weak correlation.
Keywords: PPI • LVFP • NSTEMI
OR.199. The Effects of Senolytics on Murine Cardiac Function and Morphology
Post-Ischemia Reperfusion Injury
O, E Yausep1, E Dookun2, A Walaszczyk2, R Redgrave2, S Tual-Chalot2, A Owens2,
H Arthur2, J, Passos3, G Richardson2
1
Faculty of Medicine, University of Indonesia, Rumah Sakit Cipto Mangunkusumo,
Jakarta, Indonesia, Cardiovascular Research Centre, Institute for Genetic
Medicine, Newcastle University, Newcastle upon Tyne, UK, 3Ageing Research
Laboratories, Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
Background: Coronary heart disease (CHD) is responsible for over one-third of mor-
talities in people >35 years of age globally, amounting to over 7.6 million lives
annually. Myocardial infarction (MI) is the most prominent manifestation of CHD
and is defined as myocardial cell damage or death due to extended periods of
ischemia. Management of CHD involves restoring coronary perfusion by thrombo-
lytics or percutaneous coronary intervention. However, this can render the myocar-
dium susceptible to further irreversible injury, cardiomyocyte death and longer
term progressive adverse remodelling; which is known as ischemia reperfusion
injury (IRI). Our previous data with mice demonstrate that cardiomyocyte senes-
cence occurs following MI with reperfusion and may contribute to myocardial
remodeling. We therefore hypothesize that clearance of senescent cells via seno-
lytic compounds, a class of drugs that induces apoptosis in senescent cells, will
improve outcome to IRI.
Objective: To determine whether clearance of senescent cells via senolytic com-
pounds, a class of drugs that induces apoptosis in senescent cells, will improve out-
come to IRI in terms of cardiac function, scar tissue size, and cardiomyocyte prolifer-
ative capacity.
Method: This study used mice as a study population to evaluate the effects of IRI and
subsequent senolytic treatment on the heart. Mice were subjected to a surgical
model of induced IRI and 4 days later either provided the senolytic, Navitoclax or
lipid vehicle. Magnetic resonance imaging, histological analyses and EdU staining
were performed to evaluate heart cardiac function, morphology and proliferative
capacity as outcome measures.
Result: Our results demonstrate that mice treated with the Navitoclax have a
reduced number of senescent cardiomyocytes, improved cardiac function (as demon-
strated by maintained ejection fraction), significantly smaller scar size, and no
change in proliferative capacity. These findings parallel those of similar studies done
on other animal populations.
Conclusion: Hence we suggest that clearance of senescent cells with senolytics may
be a valid therapeutic strategy for IRI.
Keywords: Coronary Heart Disease • Ischemia Reperfusion Injury • Senolytics •
Mice
Abstracts
OR.200. The Role of Garcinia mangostana L Extract as Anti-inflammatory,
Anti-diabetic, and Anti-cholesterol in High-risk Cardiovascular Patient
Olivia Handayani1, Djanggan Sargowo1,3, Ardian Rizal1, M. Ryan Ramadhan1, Aditha
Satria Maulana1, Aris Munandar1, Muhamad Rizki Fadlan1,2, Puspa Lestari1,
Dion Setiawan1, William Prayogo Susanto1
1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya, dr. Saiful Anwar General Hospital, Malang East Java, Indonesia,
2
Brawijaya Cardiovascular Research Center, Universitas Brawijaya, 3Center Study of
Degenerative Disease
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: Oxidative stress and inflammatory process are the major pathology in
atherosclerosis, which underlies most cardiovascular diseases. Garcinia mangostana
Linn has been known for years for its health benefits.
Objective: This study was aimed to prove the effect of G. Mangostana as a potent
anti-inflammatory, anti-diabetic, anti-cholesterol in high-risk cardiovascular patients
with type 2 diabetes.
Method: A randomized, Single-blind, placebo-controlled clinical trial was conducted
in 90 adults with high-risk cardiovascular score which were determined based on
Framingham criteria, age 50–70 y. The patients were divided into two group. One
group was given 2520 mg/day Garcinia mangostana Linn extracts in 3 divided doses
for 90 days and the other group given placebo. Parameters were Nitrite Oxide (NO),
IL-1, IL-6, TNF a, MDA, HDL, LDL, Total Cholesterol, Fasting Blood Glucose, and
HbA1C measured at baseline and after 90 days of treatment.
Results: After 90 days of administration of Garcinia mangostana extract, we found
that there was a significant decrease in NO compared to placebo, p ¼ 0.007. Similar
to that, plasma IL-6, IL-1, MDA, and hs-CRP concentration was significantly decrease
compared to placebo (p < 0.05). However, there was no difference in TNFa level in
treatment and control groups. We observed a significant decrease of cholesterol
total, LDL, and HbA1c (p < 0.05) between treatment and control groups. There was
no difference in HDL, TG, and Fasting Blood Glucose.
Conclusion: Garcinia mangostana Linn extract is a potent adjuvant therapy for high-
risk cardiovascular patient with type 2 diabetes that has anti-inflammatory, anti-dia-
betic, and anti-cholesterol.
Keywords: Garcinia mangostana • anti-Inflammatory • anti-Diabetic • high-risk
cardiovascular
OR.201. Mean Platelet Volume and Severity of Coronary Artery Disease
Aldila N. Sulma, Safir Sungkar
Department of Cardiology and Vascular Medicine, School of Medicine, Diponegoro
University, Semarang, Indonesia
Background: Platelets play a fundamental role in thrombotic vascular occlusion at
the ruptured coronary atherosclerotic plaque, leading to acute ischemic events.
Mean platelet volume (MPV) is a measurement of the average size of platelets and
included in complete blood routine examination. An increased MPV, as an indica-
tor of larger, more reactive platelets resulting from an increased platelet
turnover.
Objective: This study want to investigate the difference between MPV value and
severity of CAD.
Method: We analyzed acute coronary syndrome patient from Januari until December
2018 hospitalized with ST Elevation Acute Coronary Syndrome (STEACS) and Non-ST
Elevation Acute Coronary Syndrome (NSTEACS) who undergo Percutaneous Coronary
Angiography (PCA) in RSUP Dr. Kariadi Semarang. MPV value was obtained from labo-
ratory record one day before or at the day of PCA procedure. Severity of CAD was
assessed from coronary angiography result and defined as significant lesion if  70%
involves one vessel (1 VD), two vessels (2 VD) and three vessels (3 VD).
Result: A total of 163 patients with ACS undergoing PCA, 10 patients were excluded
because uncomplete data or laboratory tests are conducted more than one day
before PCA. There were 44 (28.75%) patients in I VD group, 49 (32.02%) patients in 2
VD group and 60 (39.21%) patients in 3 VD group. All groups are same in age, gender,
platelet count, ureum, creatinine, haemoglobin, leucoyte, HbA1C, total cholesterol,
triglycerides, HDL, LDL, uric acid. Even though mean platelet volume tends to be
higher in the 3 VD group, but not significantly different between groups (9.8961.09
vs 9.8860.87 vs 9.9661.39, p ¼ 0.507).
Conclusion: Patients with three vessel disease tends to have higher mean MPV value
than those with one or two vessel diseases, but the difference wasn’t statistically
significant between those groups.
Keywords: mean platelet volume • ACS
Abstracts
OR.202. Pulmonary Hypertension Among Patients with Routine Hemodialysis:
What Happens with the Structure and Function of the Heart?
A. P. Rahman1,3, H. P. Bagaswoto2,3, F. Saputra2,3
1
Resident of Cardiology and Vascular Medicine at Gadjah Mada University,
Yogyakarta, Indonesia., 2Staff of Cardiology and Vascular Medicine at Gadjah Mada
University, 3Sardjito General Hospital, Yogyakarta, Indonesia.
Background: Pulmonary hypertension (PH) is common in patients with Chronic
Kidney Disease (CKD) and associated with increased mortality. CKD, especially end-
stage renal disease, has been proposed to cause pulmonary vascular remodeling and
PH. Possible mechanisms that have been suggested include endothelial dysfunction
due to increased oxidative stress from uremic toxins, chronic inflammation resulting
from exposure of the blood to dialysis membrane, vascular calcification, and
increased flow from arteriovenous fistula.
Objective: The purpose of this study was to compare structural and functional
abnormalities of the heart between CKD patients with PH and without PH.
Method: This was a retrospective analytical study of all CKD patients who were on
routine hemodialysis at Sardjito General Hospital. PH in the CKD patients were
defined by echocardiography. The echocardiographic parameter in this study were:
left atrial diameter, left ventricular diameter, right atrial diameter, right ventricular
diameter, left ventricular function, right ventricular function, and diastolic dysfunc-
tion. Each echocardiography parameter was compared using the chi-square test or
it’s alternative test (SPSS ver.23) and a p value of less than 0.05 was considered stat-
istically significant.
Result: There were 70 samples included in the study, 43 patients with PH and 27
others with no PH. The only echocardiography parameter with significant p value was
diastolic dysfunction.
Conclusion: Diastolic dysfunction was the only significant echocardiographic parame-
ter between CKD patients with PH and without PH. This study suggests that aware-
ness of PH should be higher in patients with diastolic dysfunction during echocardiog-
raphy examination.
Keywords: Pulmonary Hypertension • Echocardiography • CKD
OR.203. Community-Based Education and Exercise Program Results in improving
Quality of life and Reduce Rehospitalization Rate among Stable Coronary Artery
Disease Patients of Malang Cardiovascular Care Community
Dzikrul H. Karimullah, Mohammad S. Rohman, Setyasih Anjarwani, Tonny Adriyanto,
Muhammad R. Fadlan, Erdo P. Sidarta
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya-Dr. Saiful Anwar General Hospital, Malang East Java, Indonesia, Brawijaya
Cardiovascular Research Center, Universitas Brawijaya
Background: Previous studies suggested that community-based cardiac rehabilitation
program improve Health Related Quality of Life (HRQOL) among CAD patients.
However, whether this program more effective performed in a certain cardiac-inter-
ested group rather than in wide general population remained uncertain.
Objective: This study compared the efficacy of community-based rehabilitation (edu-
cation and exercise program) between member or not member of Malang
Cardiovascular Care Community (MC3) in improving HRQOL, rehospitalization rate
among CAD patients undergoing Primary Coronary Intervention (PCI) or Coronary
Artery Bypass Graft (CABG) with optimal medical therapy
Methods: This cohort study conducted to stable CAD patients with optimal medical
treatment and outpatient-based education. They also have undergone either PCI or
CABG as indicated by ESC guideline. The CAD patients were randomly assigned to
Control Group, not member of Malang Cardiovascular Care Community (CG ¼ 78) or
Intervention Group, member of Malang Cardiovascular Care Community (IG ¼ 70). IG
received exercise program three times a week (396 METs/min/week) for 6 months.
We used population-wide intervention focused on group discussion, posters, leaflets
and handouts for IG. Patients with poor medical compliance and inadequate treat-
ment were excluded. All participants were individually interviewed with a structured
questionnaire for collecting baseline characteristics. Quality of life (sf 36 and SAQ),
Diet (DASH diet), Physical activity (IPAQ), and Outcome (MACE and POCE) were
assessed by the individual level at the baseline and 6-month post-intervention. Body
mass index (BMI), waist to hip, and echocardiography were measured according to
standard protocol.
Results: A significant better quality of life observed in CAD patient who are the
member of Malang Cardiovascular Care Community (IG) in term of HRQOL (SAQ score
94.8066.98 vs 84.54614,8, p < 0.000), physical functioning (SF 36 score 90.2269.79
vs 82.11617,49, p < 0.001). The salt diet also more strictly taken by IG as shown by
DASH score (32.5862.85 vs 29.9861.90, p < 0.000, respectively). However, both
groups consumed higher than a standard total salt diet should be taken. The physical
activity level (IPAQ score) also showed higher IG than CG (44.3% vs 23.1%, p < 0.000)
suggesting the CAD patients of IG more active than those of CG. The rehospitaliza-
tion rate was lower in IG compare to CG (2.9% vs 20.5%, p < 0.000).
Conclusion: This study has shown that improving quality of life and reducing rehospi-
talization more effectively achieved when education and routinely exercise given in
a certain cardiac interested-group such as Malang cardiovascular care community
F85
Keywords: Malang cardiovascular care community • education • quality of life •
rehospitalization
OR.204. Chronotropic Index as A Predictor of Significant Coronary Artery Lesion
in Patient Whose Underwent Treadmill Test
Deri Arara, Rita Hamdani, Putri Yeantesa, Uvitha Yulistin Suchyar, Muhammad Fadil,
Masrul Syafri, Muhammad Syukri
Department of Cardiology & Vascular Medicine of Andalas University / RSUP Dr M
Djamil Padang
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: Treadmill test is one of the exercise stress testing that offer a non-inva-
sive, less expensive way of risk stratification prior to coronary angiography. As the
body works harder during the test, it requires more oxygen so the heart must pump
more blood to the circulation. Significant CAD lesion will lead to several changes
that can be found in some parameters that already known, with Chronotropic Index
(CI) as a one of them. Optimizing of non-invasive stress test-based CAD diagnosis is
mandatory to reduce the unnecessary coronary angiography procedure.
Objective: This study aimed to determine whether CI could be used as a predictor of
significant coronary artery lesion in patients whose underwent treadmill test.
Method: In this retrospective study, data were gathered from patients who under-
went treadmill test with Bruce protocol in M. Djamil General Hospital between
August-October 2018 with the most common diagnosis is the atypical chest pain.
Patient with a positive result of treadmill test then been planned to underwent coro-
nary angiography. The pattern of lesion was defined as a significant based on syntax
definition. Chronotropic index was calculated by comparing between the differences
of peak and resting heart rate with heart rate recovery.
Result: There were 109 subjects with positive ischemic response based on the tread-
mill test. Among the patients, 60 patients (55%) had a significant coronary lesion
that need an intervention. Smoking and dyslipidaemia (P < 0.05) were the major risk
factor in patient with a significant coronary lesion. Cardiovascular drugs prescription
was commonly found in patient with significant coronary artery lesion. The optimal
cut off value of Chronotropic Index to predict that the patient had a significant
lesion is 0.61 with AUC is 70%.
Conclusion: The result of this study show that CI may support the clinicians to pre-
dict if the patient has a significant coronary artery lesion.
Keywords: chronotropic index • coronary artery lesion • coronary artery disease •
treadmill test
OR.205. Adherence to The European Society of Cardiology Guidelines for The
Treatment of Chronic Heart Failure in North Sumatera
A. Sitepu1,2,3,4, J. Felix1,3, K. Hamdani1
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department
of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan,
Indonesia, 3Sembiring General Hospital, Deli Serdang, Indonesia, 4Grand Med General
Hospital, Deli Serdang, Indonesia
Background: In order to improve the outcome for the management of heart failure,
the treatment should be applied appropriately based on the practical and evidence-
based guidelines.
Objective: This study aims to evaluate the adherence to European Society of
Cardiology (ESC) guidelines for the treatment of chronic heart failure and to deter-
mine associated factors with guideline adherence.
Method: This study is an observational study comprising 736 patients with chronic heart
failure with reduced ejection fraction from three hospitals in North Sumatera Province,
Indonesia. This study is a continuation of our previous study conducted in Haji Adam
Malik General Hospital Medan. The guideline adherence was assessed by the use of
guideline adherence indicator (GAI), which consider GAI-3 or GAI-5, by calculating the
proportion of recommended drugs prescribed divided by a number of drugs indicated
according to the ESC guidelines, in the absence of contraindications. The demographic
and clinical data of the patients were evaluated from hospital medical records.
Result: The use of each indicated drugs were angiotensin-converting enzyme inhibi-
tors or angiotensin receptor blockers (82.5%), beta-blockers (60.9%), mineralocorti-
coid receptor antagonists (82.7%), diuretics (96.7%), and digitalis (24.6%). The pre-
dominant categories of GAI-3 and GAI-5 were moderate and high, respectively.
Furthermore, the associated factors affecting GAI-3 were blood pressure, congenital
heart disease, hypertension and acute kidney injury/chronic kidney disease
(p < 0.05); whereas, blood pressure, heart rate, ejection fraction, cardiomyopathy,
type 2 diabetes mellitus, acute kidney injury/chronic kidney disease, dyspnea, rales,
and palpitation were associated factors affecting GAI-5 (p < 0.05).
Conclusion: We found a predominance of moderate adherence for GAI-3 and high
adherence for GAI-5. This study shows improvement of guideline adherence com-
pared to our previous single center study. Also, these data suggest various associated
factors that influence the implementation of ESC guidelines and may become a hint
in managing heart failure treatment in clinical practice.
Keywords: Chronic heart failure • adherence to treatment guidelines • ESC
guidelines
F86
OR.206. The Effect Of Darapladib Administration To Inflammation Marker In Early
Development Of Atherosclerosis: In Vivo Study For Dyslipidemia Model
Titin Andri Wihastuti, PhD1, Putu Nina Belinda Saka, MD2, Djanggan Sargowo, MD3,
Teuku Heriansyah, MD4
1 Background: Timely reperfusion with percutaneous coronary intervention (PCI)
Department of Biomedicine, Faculty of Medicine, Brawijaya University, Malang,
Indonesia, 2Faculty of Medicine, Brawijaya University, Malang, Indonesia,
3 elevation myocardial infarction (STEMI). However, there are still a high proportion of
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya
University, Malang, Indonesia, 4Department of Cardiology and Vascular Medicine,
Faculty of Medicine, University of Syiah Kuala, Banda Aceh, Indonesia
Background: Dyslipidemia is a condition of chronic inflammation which related to
Lp-PLA2. Lp-PLA2 has anti-inflammatory role as it hydrolyze atherogenesis mediators
such as oxLDL to produces lysoPC and oxFA that have pro-inflammatory, proliferative
and pro-atherogenic effect. Atherosclerotic lession is characterized by high expres-
sion of Lp-PLA2. Darapladib has been shown to reduce Lp-PLA2 activity in human car-
otid plaque. Darapladib becomes a potent inhibitor of atherosclerosis.
Methods: This study aimed to discover the expression of inflammation marker of dys-
lipidemia in vivo model with darapladib treatment. True experimental laboratory
and only post test with control group design using 30 Spraque Dawley rats which is
divided into 3 main groups: normal, dyslipidemia, and dyslipidemia with darapladib
administration 20 mg/kg body weight per oral/day. The dyslipidemic rats were pre-
pared by feeding them with a high-cholesterol diet. Each group consisted of 2 serials
treatment time: 8-weeks and 16-weeks. Measurement of lipid profile is using colo-
metric method by using EnzyChromTMkit produced by BioAssay System. ELISA method
with Platelet Activating Factor (PAF) ELISA kit (Cat. No. MBS722041) is used for meas-
uring plasma PAF. The expression of Lp-PLA2 is calculated with immunofluorescence
method and rhodamin rat as labelling for secondary antibody (Biosource).
Result: The serum levels of total cholesterol (TC), Non-HDL-C, PAF significantly
increased in dyslipidemia model groups in 8 and 16 week, whereas high-density lipo-
protein cholesterol (HDL-C) in decreased (p<0.05). The expression of Lp-PLA2 is
increased in 8 and 16 weeks (p<0.05). Levels of TC, Non-HDL-C, were respectively
reduced in darapladib groups in 8 and 16 week (p<0.05), as did PAF in 16 week,
whereas HDL-C significantly increased in 8 week (p<0.05). Expression of Lp-PLA2
were respectively reduced in darapladib groups in 8 and 16 week (p<0.05).
Conclusions: This study conclude that darapladib proved to have role to decrease
PAF and Lp-PLA2 in vivo model of dyslipidemia.
Keywords: Dyslipidemia • inflammation marker • darapladib
OR.207. Correlation Between Lactate Levels and Myocardial Depression In
Elderly Patients with Sepsis
F. Wantania, L. Suoth, J. Pangemanan, P.N. Harijanto
Department of Internal Medicine, Medical Faculty, Sam Ratulangi University, Manado,
Indonesia
Background: The prevalence of complicated sepsis such as septic myocardial depres-
sion, are increasing in elderly patients. Unfortunately, this condition sometimes was
underdiagnosed. Cardiac Troponin I as a marker of sepsis severity has a limitation in
cost. Lactat levels which are increasing in sepsis may correlates with this condition.
Aim of this study was to determine the correlation between lactate acid levels and
myocardial depression in elderly patients with sepsis.
Methods: This was a preliminary study that conducted at RSUP Prof. R. D. Kandou
Manado since January to March 2019. Subjects including the elderly patients with
sepsis in C Ward Room which fullfil inclusion criteria. All of the subjects were eval-
uated their lactate acid levels and myocardial depression. The lactate acid levels
was examined using by Accutrend Plus Roche. We use Cardiac Troponin I level as a
marker of myocardial depression.
Results: There were 16 elderly subjects, consisted of 8 males (50%) and 8 females
(50%). Mean age was 70.88 6 8.04 years old. The lactate acid and Toponin I levels
was 3.32 6 1.56 mmol/L and 240.12 6 519.18 pg/dl. This study found that the lac-
tate acid levels had significant correlation with troponin I levels as a marker of myo-
cardial depression (r¼0.788, p¼0.000).
Conclusion: Lactate acid levels was correlated with the myocardial depression in
elderly patients with sepsis. It is important for clinician to check the cardiovascular
function in sepsis patients, especially elderly.
Keywords: Lactate • Myocardial Depression • Geriatric • Sepsis
OR.208. Percutaneous Coronary Intervention Beyond 12 Hours of The Onset
Reduced Mortality and Rehospitalization As Compare to Conservative Therapy in
Patients With ST-Segment–Elevation Myocardial Infarction
Hendrawati1, M. S. Rohman1,2, C. T. Tjahjono1, S. Widito1, M. T. Hapsito1,
A.R. Pratama1, O.S. Pamuna1, Y.W. Ashari1
Abstracts
1
Department of Cardiology, Faculty of Medicine, Universitas Brawijaya/dr. Saiful
Anwar General Hospital, Malang, Indonesia., 2Brawijaya Cardiovascular Research
Center.
within 12 hours of symptom onset is currently the treatment of choice in ST-segment–
patients with STEMI missing out early reperfusion even in the primary PCI era. The
late open artery study hypothesized that coronary revascularization may yield clini-
cally relevant benefit even when performed more than 12 hours from onset (late pre-
sentation) in a time-independent fashion through a variety of mechanisms, but still
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
remains debatable due to lack of data.
Objective: The aim of this study was to compare rehospitalization and mortality in
STEMI patients underwent PCI beyond 12 hours onset and conservative therapy.
Method: This retrospective cohort study recruited 213 consecutive patients admitted
to Saiful Anwar General Hospital with STEMI from December 2016 to March 2018. 64
patients were excluded due to incomplete data or loss of follow up. We compared
outcomes among STEMI patients with late presentation PCI and conservative strat-
egies during follow-up period of 12 months. STEMI patient refused for PCI included to
a conservative group. Cardiac cause mortality and rehospitalization due to recurrent
myocardial infarction (MI) or Heart Failure (HF) were assessed.
Results: STEMI patients who undergone late PCI showed significant reduction in mor-
tality compared to patients who taken conservative treatment (P ¼ 0.024).
Statistical analysis showed that late PCI as compare to medical treatment only,
higher TIMI flow, and less number of occluded vessel were significantly improve car-
diac-cause mortality (P ¼ 0.001, P ¼ 0.036, P ¼ 0.002, respectively). Patients with
higher TIMI flow even in late presentation of PCI showed significant lower incidence
of rehospitalization due to recurrent MI or HF (P ¼ 0.037).
Conclusion: Reperfusion with PCI beyond 12-hours of symptoms duration, higher TIMI
flow and less number of occluded vessel significantly reduced cardiac-cause mortality
and rehospitalization
Keywords: ST-elevation myocardial infarction • late presentation PCI • cardiac-
cause mortality • rehospitalization
OR.209. Significance of Atrial Fibrillation in Anterolateral Wall Ischemia or
Infarction
Faisal Adam, Indah P. Siregar, Zulfikri Mukhtar
Bambu Dua Heart Clinic, Medan, North Sumatera, Indonesia
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical
practice, accounting for 1–1.5% among the general population1. In clinical settings,
AF is a well-known complication after ACS, with a reported incidence of between 2.3
and 37%2. The incidence of new-onset AF was greater in patients with more severe
ACS; 3.8% in patients with non-ST-segment ACS (NSTE-ACS) and 6.5% in patients with
STEMI3. Previous study conducted by Tomasz,et.al (2017) showed that AF was
strongly related with location of ischemia/infarction4. The exact pathophysiological
mechanisms responsible for AF after ACS are not understood completely. However,
Sinno, et al demonstrated that atrial ischemia induced by the occlusion of atrial
artery led to local conduction slowing, with re-entry contributing to increaed AF1.
Since atrial ischemia plays role in developing AF, this study aims to assess the corre-
lation between atrial fibrillation and location of ischemia or infarction.
Objective: The objective of this study is to assess the correlation between atrial
fibrillation and location of ischemia or infarction.
Method: We successfully obtained 232 outpatients who admitted to Bambu Dua
Heart Clinic from February untilApril 2019. We excluded 7 patients due to insufficient
data. Subjects were included into Group AF and group non-AF. Subsequently, both
groups were divided into patients with anterolateral wall and non-anterolateral wall
ischemia or infarction group based on Electrocardiographic examination. We ana-
lyzed the correlation between categorical variables using Chi-Square Test.
Result: Of 225 eligible patients, subjects with AF was recognized in 48 patients
(21.3%). Anterolateral wall ischemia/infarction were significantly higher among AF
subjects than the other location of ischemia or infarction (p < 0.05).
Conclusion: In conclusion, the anterolateral ischemia or infarction was strongly
related with AF.
Keywords: Arrythmia • Atrial Fibrillation • Anterolateral wall
OR.210. Association between Metabolic Syndrome and Cerebro-cardiovascular
Diseases in Kapongan Subdistrict, Situbondo, East Java
Ika Christine1, Vindyanita Simanjuntak2, Della Oriyanti Tomasila2, Serafica
A. Anggraini2, Merian W. Gabriella2, Angela S. Nariswari3, Nita Kurniawati4,
Mulya Dinata5, Steven Wijono6
1
Department of Internal Medicine, Medical Faculty of Widya Mandala Catholic
University, Surabaya, Indonesia, 2Medical Faculty of Widya Mandala Catholic
Abstracts
University, Surabaya, Indonesia, 3Department of Physiology, Medical Faculty of Widya
Mandala Catholic University, Surabaya, Indonesia, 4Department of Neurology, Medical
Faculty of Widya Mandala Catholic University, Surabaya, Indonesia, 5Department of
Clinical Pathology, Medical Faculty of Widya Mandala Catholic University, Surabaya,
Indonesia, 6Department of Public Health, Medical Faculty of Widya Mandala Catholic
University, Surabaya, Indonesia.
Background: Metabolic syndrome has been a major global epidemic, with increasing
prevalence both in developed and developing countries. Instant food and high calo-
ries intake have been part of current lifestyle that trigger obesity and cerebro-cardi-
ovascular diseases. Kapongan Sub District is a sub district in East Java with low socio-
economic community status. The incidence of hypertension and type 2 diabetes mel-
litus are increasing in this area. However, no data available regarding metabolic
syndrome.
Objective: To investigate the association between metabolic syndrome and cerebro-
cardiovascular diseases in area covered by Kapongan Primary Health Care,
Situbondo.
Method: This is an analytic observational study with cross-sectional design. Data col-
lected by anamnesis, measurements of body height, weight, blood pressure, waist
circumference, and ECG. Triglyceride, HDL, and fasting blood glucose through capil-
RV R
V STEMI referral system is necessary to decrease unnecessary delays in reperfusion ther-
lary blood sampling were measured using Lipid Pro and Accu Check Performa . The
IDF 2009 criteria was used to confirm the metabolic syndrome. Cerebro-cardiovascu-
lar diseases identified were heart failure, coronary arterial disease, and history of
stroke.
Result: Eighty-five subjects were included in this study, consisted of 64 (75.3%)
female, mean of age was 57 6 13.0 years, 47 (55.3%) subjects had metabolic syn-
drome, 42 (49.4%) had heart failure, 24 (28.2%) had coronary arterial disease, and 18
(21.2%) had history of stroke. Chi square test showed that metabolic syndrome was
not a risk factor for heart failure (p ¼ 0.099; PR ¼ 1.455; 95% CI ¼ 0.915–2.315), coro-
nary arterial disease (p ¼ 0.071; PR ¼ 1.964; 95% CI ¼ 0.910–4.238), nor history of
stroke (p ¼ 0.576; PR ¼ 1.271; 95% CI ¼ 0.545–2.960) in this population. After adjust-
ment, the logistic regression showed a significant association between metabolic syn-
drome and cerebro-cardiovascular diseases (p ¼ 0.000; Adj R2 ¼ 0.949).
Conclusion: There is a significant association between metabolic syndrome and cere-
bro-cardiovascular diseases. Screening for metabolic syndrome is necessary in order
to prevent cerebro-cardiovascular diseases.
Keywords: Metabolic syndrome • cerebro-cardiovascular diseases.
OR.211. Correlation between High Sensitivity C Reactive Protein with
Hyperglycemia in Acute Myocardial Infarction Patients
Queen S. Ariyani1, Anggoro B. Hartopo1,2, Royhan Rozqie1,2
1
Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia, 2Department
of Cardiology RSUP Dr. Sardjito, Yogyakarta, Indonesia
Background: As one of cardiovascular diseases, acute myocardial infarction gives
high prevalence of death. Measurement of inflammation marker such as hs-CRP dem-
onstrates strong prediction of future acute myocardial infarction. Hyperglycemic
state may elevate inflammation and becomes comorbid of acute myocardial infarc-
tion. The aim of this study is to investigate the correlation between high sensitivity
C reactive protein and hyperglycemia in patients with acute myocardial infarction.
Method: This cross-sectional study included 195 blood samples from acute myocar-
dial infarction patients who met the inclusion criteria in ICCU RSUP Dr. Sardjito.
From the samples, the level of high sensitivity C reactive protein and admission
plasma glucose were measured. The method used in measuring high sensitivity c
reactive protein was immunoturbidimetric. The result of these measurements were
analysed using Spearman Correlation test.
Result: The correlation test showed the correlation between high sensitivity C reac-
tive protein and admission plasma glucose is r ¼ 0.01, p ¼ 0.87. There are no differ-
ence between the mean of hs-CRP in hyperglycemia and non-hyperglycemia group
(p ¼ 0.57).
Conclusion: There is no significant correlation between high sensitivity C reactive
protein and admission plasma glucose in acute myocardial infarction in this research.
Keywords: Acute Myocardial Infarction • High Sensitivity C Reactive Protein •
Hyperglycemia • Admission Plasma Glucose.
OR.212. Attitude of General Practitioners Towards ST-Elevation Myocardial
Infarction Referral System in Banten, Indonesia
Michael Susanto1, Queen S. Ariyani2, Ng Sunanto3
1
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia, 2Faculty of
Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, 3Siloam Hospital Lippo
Karawaci - Faculty of Medicine Universitas Pelita Harapan, Tangerang, Indonesia
Background: ST-elevation myocardial infarction (STEMI) requires immediate reperfu-
sion therapy which can be done through fibrinolysis or primary percutaneous
F87
coronary intervention (PPCI). Currently, there does not exist a system of referral for
STEMI patients in Banten, Indonesia which may lead to treatment delays for patients
coming to medical centers unequipped with such facilities.
Objective: The objective of this study is to find out the attitudes of general practi-
tioners (GPs) in Banten regarding STEMI in their workplace and their attitude towards
having a referral system in dealing with such patients.
Method: A survey aimed at GPs regarding the issue was done and the data received
analyzed.
Result: A total of 104 GPs from 52 different healthcare institutions in Banten took
part in the survey. 59% worked in the emergency department of 16 different hospi-
tals, while 41% worked at various clinics unequipped with reperfusion therapy. The
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
amount of STEMI cases the GPs received varied (27% >20 cases per month, 21.2% 11-
20 cases, 23.1% 6-10 cases, 23% 1-5 cases, 8.7% <1 case). 75.2% of the GPs were
interested in taking part in a STEMI referral system. Among those interested, 31.6%
worked in a place with PCI capabilities, 34.2% only fibrinolytic capabilities, and
34.2% with neither. Similarly, among those uninterested, 32.0% worked in a place
with PCI capabilities, 32.0% only fibrinolytic capabilities, and 36.0% with neither.
Conclusion: The majority of GPs in Banten were interested in taking part in a STEMI
referral system. The availability of reperfusion therapy in the workplace were similar
between the GPs interested and uninterested in taking part in such a system. A good
apy. These positive responses warrant further follow up in the creation of such a system.
Keywords: STEMI • Fibrinolytic • Primary PCI • General Practitioner • STEMI
Referral System
OR.213. Basic Demographic Characteristics OF Chronic Heart Failure Patients
Based on Left Ventriculat Ejection Fraction in Dr. M. Djamil Hospital Padang,
Sumatera Barat
Wiza Erlanda, Hauda El Rasyid, Masrul Syafri
Division of Cardiology and Vascular Medicine, Faculty of Medicine Andalas University/
General Hospital of Dr. M. Djamil Padang
Background: On the European Society of Cardiology (ESC) guidelines for heart failure
2016, heart failure based on the left ventricular ejection fraction (LVEF) is divided
into 3 classification, namely preserved EF (HFpEF 50%), mid range EF (HFmrEF 40-
49%), and reduced EF (HFrEF <40%). The purpose of this new classification is to
assess the prognosis and determine the right therapy for the patient.
Objective: Seeing the differences in the basic characteristics of chronic heart failure
(CHF) patients based on LVEF
Method: This is an observational approach with a cross sectional study design. The
data was taken retrospectively on the medical records of patients with chronic heart
failure who went to the cardiac department at Dr. M. Djamil Padang Hospital in
January-August 2018. Bivariate analysis was performed each variable with left ven-
tricular ejection fraction classification by chi-square (categoric-categoric) and one-
way anova test (categoric-numeric).
Result: There were 283 CHF patients divided into 3 categories, HfpEF (n ¼ 97),
HFmrEF (n ¼ 88), and HfrEF (n ¼ 98). Significant differences were found in gender
which HFrEF and HFmrEF were commonly found in men, while HFpEF in women (p
0,018). Smoking risk factor was more common in HFmrEF and HfrEF (p 0,029),
Coronary artery disease (CAD) commonly found in HFrEF followed by HFmREF
(p < 0,001), while Hypertension heart disease (HHD) much on HfpEF followed by HfmEF
(p < 0,001). The use of antiplatelet and diuretics is common in HFrEF followed by
HFmrEF (p < 0,001), while CCB on HfpEF followed by HFmrEF (p 0,001). From echocar-
diography concentric LVH and LV concentric remodeling were commonly found in
HFpEF (p 0,002 and p 0,023 respectively), while eccentric LVH on HfrEF (p < 0,001), LA
dimension increases with decreasing EF and TAPSE decreases with decreasing EF
(p < 0.001 ). No significant differences were found in age with an average patients age
of 58.33 6 10.28 years, presence of hypertension, dyslipidemia, diabetes mellitus,
atrial fibrillation, and use of ACEI /ARB and betablocker in each group (p > 0.05) .
Conclusion: HFrEF and HFmrEF are more commonly found in men with CAD as the
main cause, whereas HFpEF is more in women with the main cause of HHD. there
was no difference in the age of each group. there were no significant differences in
risk factors except smoking
Keywords: chronic heart failure • left ventricular ejection fraction • basic
characteristic
OR.214. Clinical Presentation and In-Hospital Mortality of Acute Coronary
Syndrome Patients in Young Adults
Annisa Tridamayanti, Trisulo Wasyanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sebelas Maret, Moewardi General Hospital, Surakarta, Indonesia.
Background: Incidence of cardiovascular disease is positively correlate with age.
However, recent studies have reported that there is rising incidence of Acute
Coronary Syndrome (ACS) in the young. The cardiovascular risk profile of these
F88
patient appears to be different. Hence, it is important to identify the major risk fac-
tors, clinical profile and prognosis of ACS in young adults so that future preventive
can be taken.
Objective: To compare the clinical presentation of Acute Coronary Syndrome in
young and old patients.
Methods: Data were analyzed from 477 patients whom diagnosed with ACS from
January 2017 until July 2018 in Moewardi General Hospital, Surakarta. ACS patients
<45 years old were compared with patients 45 years old.
Results: A total of 477 patients were analyzed. The mean age of patients was 60.08
611.04 year, which 72.9 % were men. From all sample, 8.32% of patients was <45
years old (group 1), and 91.68% was 45 years old (group 2). NSTEMI and UA incidence
are significantly higher in young group (p ¼ 0.022). While significantly higher incidence
rate of STEMI ACS was observed in old age (p < 0.001). Compared to old group, the
prevalence in young group was higher for smoking (75.9% vs 33.1%, p < 0001), diabetes
(14.6% vs 5.1%, p ¼ 0.001), and obesity (30.0% vs 20.3%, p ¼ 0.029). Both systolic and
diastolic pressures were not significantly different in the participants. High-density lip-
oproteins, fasting blood sugar, low-density lipoproteins cholesterol is slightly higher in
young group, however, it is not statistically significant. Killip >II presentation and mor-
tality was significant higher in old group (p ¼ 0.031 and p ¼ 0.02).
Conclusion: The main cardiovascular risk factor of ACS patients in young adult is
smoking, and obesity. This encourage the need for early primary prevention measure.
The young group has less prevalent of heart failure and better prognosis.
Keywords: Acute Coronary Syndrome • Cardiovascular Risk Factor
OR.215. Outcomes of Bisoprolol Treatment in Heart Failure Patients with Atrial
Fibrillation in Comparison to Sinus Rhythm: A Result of Malang Heart Failure
Registry
Olivia Handayani1, Mohammad Saifur Rohman2,
On behalf of the Heart Failure Registry Team
1
Cardiology and Vascular Medicine Resident, Faculty of Medicine Universitas
Brawijaya, 2Cardiology and Vascular Medicine Department, Faculty of Medicine
Universitas Brawijaya, Faculty of Medicine Universitas Brawijaya/ Saiful Anwar
General Hospital Malang, Indonesia
Background: Beta-blockers are indicated in patients with heart failure (HF) due to
its importance to achieve targeted resting heart rate that leads to better clinical
outcomes. Whether they are as useful in atrial fibrillation (AF) as in sinus rhythm
(SR) is uncertain and lack of supporting data in Indonesia.
Objective: This study was aimed to investigate the outcomes of bisoprolol in HF
patients with AF as compared to SR.
Method: Retrospective observational analysis study of database was performed at
inpatient unit in Saiful Anwar General Hospital, Malang, Indonesia. Subjects included
were patients aged 18 years old and above, who were admitted within 3 years and
fulfilled the inclusion and exclusion criteria. Statistical analysis was done and
p < 0.05 considered significant.
Results: Overall there were 385 subjects; consisted of 233 males (60.5%) and 152
females (39.5%). There were 56 subjects with AF (14.5%) and 329 with SR (85.5%). In
this study, all subjects were treated with bisoprolol. Mean length of stay of HF sub-
jects with AF was 4.8165.2 days, whilst with SR was 6.1763.8 days. Analysis indi-
cated significant length of stay difference between AF and SR subjects (p ¼ 0.007).
Mortality rate of AF subjects was 10.7%, whereas in SR subjects were 24.6%. Clinical
improvements could be seen in 89.3% in AF subjects, similarly in SR subjects that
was 83.2%. Furthermore, bisoprolol treatment significantly reduced the mortality
rate in HF subjects with AF (p ¼ 0.02).
Conclusion: The use of bisoprolol in HF significantly shortens length of stay as well
as reduces mortality rate in AF subjects compared to SR subjects.
Keywords: Heart failure • atrial fibrillation • sinus rhythm • beta-blocker • length
of stay
OR.216. Pre-hospital Delay in Patients with ST-segment Elevation Myocardial
Infarction: An Observational Study in Dr. Iskak General Hospital
N. A. Suyani, E. Ruspiono, A. Wibisono, T. Astiawati, F. S. Laitupa, A. W. Nugraha,
F. Caesario, S. Hayon
Dr. Iskak General hospital, Tulungagung, East Java, Indonesia
Background: The delivery of definitive treatment for acute coronary syndrome (ACS)
should begin as soon as possible after symptom onset to decrease morbidity and mor-
tality. Unfortunately, the time between the onset of symptoms and admission to hos-
pital or primary health care is unacceptably long.
Methods: Data were from a retrospective, single center, hospital-based registry of
patients with acute myocardial infarction. We evaluated the predictive value of
demographics and medical history of 309 patients with STEMI which influencing pre-
hospital delay. Pre-hospital delay was defined as the time from the onset of symp-
toms suggestive of MI to hospital or primary health care admission. Determinants
associated with pre-hospital delay  6 h were identified by univariate analysis.
Multivariate analysis by stepwise logistic regression models tested variables that
were significant at p<0.05 in the univariate analysis.
Abstracts
Results: The mean age of presentation for male and female was 59 6 0.72 and 63.3
6 1.26 years, respectively. The median pre-hospital delay was 229 min and 74.4%
patients reached the hospital within 6 hours after symptom onset. Out of 309
patients who received reperfusion therapy, thrombolysis was done in 128 (41,4%)
patients while percutaneous coronary intervention was performed in 181 (58,6%)
patients. Longer pre-hospital delay were more likely among female (OR 1.951;
p¼0.027), lower socioeconomic status (OR 1.890; p¼0.038), those having health
insurance (OR 1.890; p¼0.025), and patients with diabetes mellitus (OR 2.023;
p¼0.013). A multivariate logistic regression analysis revealed diabetes mellitus (OR
1.849; p ¼ 0.038) was an independent factor that influencing longer pre-hospital
delay.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Conclusion: Female, having health insurance, lower socioeconomic status and diabe-
tes mellitus were univariately associated with longer pre-hospital delay. However
based on logistics stepwise method, only diabetes mellitus had showed statistically
significant and sizeable odds ratio in influencing pre-hospital delay.
Keywords: Pre-hospital delay • ST-segment Elevation Myocardial Infarction
OR.217. Predictor of High Sensitive Troponin I (hs-Troponin I) Level in ST-
Elevated Myocardial Infarction in Dr. Iskak General Hospital
S. Hayon, T. Astiawati, E. Ruspiono, A. Wibisono, F. S. Laitupa, A. W. Nugraha,
F. Caesario, N. A. Suyani
Dr. Iskak General hospital, Tulungagung, East Java, Indonesia
Background: High sensitive troponin I (hs-Troponin I) is important component of myo-
cardial cells that have not been reported to occur following to injury to non-cardiac
tissues. This study explored predictor that might influence hs-Troponin level in STEMI
patients.
Method: Data were collected from Dr. Iskak General Hospital ACS registry retrospec-
tively from January 2018 – December 2018 to include patients with ST-elevated myo-
cardial infarction. Patients were divided into 2 group based on hs-Troponin I level
with cutoff point 100 ng/L. Each group were analyzed to evaluate baseline character-
istics and associated factor that influence hs-Troponin I level with bivariate analysis.
Variables that significantly associated (p < 0.05) will be adjusted with multivariate
analysis, logistic regression to determine independent predictor.
Result: From total 368 STEMI patients, mean age was 60.56 6 11.724 years. Out of
368 patients, 286 (77%) patients had higher hs-Troponin I level. Variables that were
associated with higher level of hs-Troponin I were smoker (p ¼ 0.045), heart rate
(p < 0.001), symptom onset (p ¼ 0.013), anterior infarct (OR ¼ 2.17, p ¼ 0.005), infe-
rior infarct (OR ¼ 0.391, p < 0.001), posterior infarct, (OR ¼ 0.226, p < 0.001) and
right ventricle involvement (OR ¼ 0.523, p ¼ 0.027). In-hospital mortality was also
higher for patients with higher level of hs-Troponin I (OR ¼ 2.88, p ¼ 0.015).
Multivariate analysis were also significant for heart rate (OR ¼ 1.017, p ¼ 0.01) and
posterior infarct (OR ¼ 3.204, p ¼ 0.001) as independent predictor.
Conclusion: Higher level of hs-Troponin I was associated with smoking status, infarct
location, symptom onset, heart rate, and in-hospital mortality. Whereas, the inde-
pendent predictor were heart rate and posterior infarct based on electrocardiogram.
Keywords: STEMI • hs-Troponin I • Predictor
OR.218. Clinical Characteristic Of Patients With Chronic Total Occlusion In Dr.
Kariadi General Hospital Semarang
A. Perdana, A. Pudjiastuti, A. Sidiek, LV Bramantyo, SN Sofia, S. Rifqi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University, Dr. Kariadi General Hospital, Semarang, Indonesia
Background: Chronic total occlusions (CTO) was found in 7-20 % of patients with cor-
onary artery disease (CAD) undergoing coronary angiography. CTO patients had vari-
ous clinical presentation from silent ischaemia to overt heart failure. Lack of litera-
ture describe the characteristics of CTO patients in Indonesia.
Objective: This study tried to investigate the clinical characteristics of patients with
CTO in Dr.Kariadi General Hospital Semarang.
Method: We retrospectively reviewed the CTO patients between January 2018 to
December 2018, in Dr. Kariadi General Hospital Semarang. CTO were confirmed from
the coronary angiographic showed no flow (TIMI flow 0) from antegrade other than
from collateral with estimated occlusion time more than 3 months. Estimation CTO
duration were analyzed from prior angiography data, clinical data, and collateral
development.
Result: We had 168 patients included in this study and 92,9% patients were male.
Mean age were 57,2þ8,37 years, mean BMI were 24,7þ3,38 kg/m2. The 42,3%
patients diagnosed as heart failure and 45,8% patients as stable angina, while 11,9%
CTO lessions found as non-culprit lession in acute coronary syndrome. We found
52,4% patients had dyslipidemic, 56,5% had hypertensive; 40,5% had Diabetic, 57,7%
were all male smoker, and 21,4% had positive family history of CAD. The CTO lesions
were in LAD (53%), followed by RCA(38,1%), and LCX (8,9%). The presence of Q
waves, ST Depression, and T wave inversions in respective CTO teritority were
observed in 47%, 14,3%, and 38,7% patients. The presence of Q wave in anterior lead
from LAD CTO were 31% while the Q wave in inferior from RCA CTO were 42%.
Abstracts
Conclusion: The incidence of CTO lesion was more common in male than in female.
Most clinical presentation was stable angina. The presence of CTO were not always
followed by the presence of Q wave in electrocardiography of CTO territory.
Keywords: chronic total occlusions • clinical • electrocardiography •
characteristics
OR.219. Association between Mean Arterial Pressure and Estimated Left
Ventricular Filling Pressure in Patients with Non ST-Segment Elevation
Myocardial Infarction
Imy Ginting, R. Anindita, P. Matondang, Bertha G. Napitupulu, Harris Hasan,
H. AdeP. Lubis, Nizam Z. Akbar
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Patients with myocardial infarction often have poor left ventricular
relaxation. This results in impairment in left ventricular diastolic dysfunction (LVDD).
Increase in left ventricular filling pressure (LVFP) was demonstrated in high grade
LVDD. Previous study showed that mean arterial pressure (MAP) was associated with
LV relaxation. It was a weak correlation but significant association.
Objective: This study aims to investigate the association between mean arterial
pressure and estimated left ventricular filling pessure in NSTEMI patients.
Method: Patients enrolled in this study were 69 NSTEMI patients who had been
referred for echocardiographic examination. Blood pressure was manually measured
with a sphygmomanometer device. Mean arterial pressure (MAP) was acquired during
routine vital sign examination. High left ventricular filling pressure (LVFP) was esti-
mated in grade II or III diastolic dysfunction. Grade II diastolic dysfunction is defined
when E/A value is 0.8-<2 and two or three diastolic function parameter are met,
which are TR velocity > 2.8 m/s, LAVI > 34 ml/m2, and average E/e’ >14. Grade III
diastolic dysfunction is defined when E/A value is  2.
Result: Among total 69 NSTEMI patients enrolled, high LV filling pressure was found
in 36 patients (52%). Mean MAP was 93.5. MAP exhibited a weak but proven signifi-
cant association with LV filling pressure (p 0.027, pearson correlation 0.26).
Conclusion: This study showed that MAP was weakly correlated but significantly asso-
ciated with LV filling pressure.
Keywords: MAP • LVFP • NSTEMI.
OR.220. Left Ventricular Features and Echocardiographic Data in Hemodialysis
Patients
Poundra Adhisatya Pratama, Dista Yuristia Pertiwi, Dini Rostiati
Bandung Regional Public Hospital, Bandung, Indonesia
Background: Cardiovascular complications are the most common cause of morbidity
and mortality in hemodialysis patients, where arterial hypertension is one of the most
dominant risk factors affecting it. Left ventricular hypertrophy (LVH) is a characteristic
finding that present in 50-75% of initial hemodialysis treatment, and therefore has an
important role as a predictor of cardiovascular complications in hemodialysis patients.
Objective: The aim of the study was to assess the prevalence of left ventricular and
other echocardiographic abnormalities in patients under hemodialysis.
Method: This descriptive study was conducted between September-November 2018
in patients treated with hemodialysis at Bandung Regional Public Hospital. The stable
patients were evaluated by transthoracic echocardiography. Left ventricular features
and other echocardiographic profiles were presented based on the examinations.
Result: There are 11 male patients (36.67%) and 19 female patients (69.33%) aged 35-
72 years old (55.10 6 10.819). The patients were treated with hemodialysis in average
length of 26 months, with the longest duration was 48 months. The mean of Body Mass
Index (BMI) was 22.9 (6 3.8). Transthoracic echocardiography examination showed that
Left Ventricular Hypertrophy (LVH) occurred in 21 patients (70%) and reduced ejection
fraction (EF) occurred in 5 patients (16.67%). Other echocardiographic abnormalities
were mitral regurgitation (8 patients, 26.67%), diastolic dysfunction (16 patients,
53.33%) and reduced right ventricular contractility (4 patients, 13.33%).
Conclusion: LVH and diastolic dysfunction were the most common abnormalities in
patients under the maintenance of hemodialysis. There were also valvular and con-
tractility abnormalities. Detection of echocardiographic abnormalities was important
for further prevention of cardiovascular complication in hemodialysis patients.
Keywords: Echocardiography • hemodialysis • LVH.
OR.221. The Consequences of Hyperoxia in Acute vs Chronic Settings towards
Pro-Oxidative and Anti-Oxidative Markers in Heart Tissue and Blood Plasma
Rio Alexsandro1, David Limanan1, Eny Yulianti1, Renny Benettan1, Frans Ferdinal1
1 objectively. One of the simple and rapid examination is six-minute walk test. Six-
Departemen of Biochemistry and Molecular Biology, School of Medicine,
Tarumanagara University, Jakarta
Background: Heart is highly dependent on supply of oxygen to maintain its integrity.
In many cases, high level ith over-exposure to high-level oxygen, state of hyperoxia
F89
is achieved. Hyperoxia increase the production of free radicals which will induce the
inflammatory cell, angiogenesis, and necrosis. Leading to irreversible heart damage.
Antioxidant can be very useful to counteract the oxidative-stress in the heart, how-
ever the activity remains unknown.
Objective: The purpose of this study is to observe the changes oxidative stress-
related biomarkers concentration of hyperoxia induced in plasma and heart
Method: Rats were divided into 5 groups (n ¼ 6/group). Control group (normoxia) and
Hyperoxia (75% O2, N2¼25%) for 1, 3, 7, and 14 days. At the end of this we did an
evaluation. Blood and heart samples were uof oxygen will be given to the patient
regarding of the heart disease either acute or chronic. We use for blood gas analysis
and hematology test, also for specific oxidative stress and antioxidant.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Result: All parameter in blood gas analysis is in line with the Intervention. Specific
Activity of pro-oxidant shows the MDA level in plasma and heart tissue increased signifi-
cantly from the first day. Plasma and heart tissue’s GSH which work as anti-oxidant
increased in day 1 to day 7 and shows decrease in day 14. The result of MDA level of the
cardiac already significant since 1-day (p ¼ 0.000) showing the hyperoxia works well.
There are some of endogen antioxidant to counteract like GSH began to increase signifi-
cantly in the 3- days group (p ¼ 0.005), catalase occur in the 7-days group (p ¼ 0.004),
However, the antioxidant shows a delay to achieve their peak level on Acute Settings.
Conclusion: Hyperoxia caused oxidative stress and may harm the heart tissue espe-
cially on acute settings
Keywords: Heart tissue • Glutathione • Hyperoxia • Malondialdehyde
OR.222. The Relations Of Modifiable Cardiovascular Risk Factors In Chronic
Kidney Disease Patients Undergoing Chronic Hemodialysis; A Multivariate
Approach
Shandy, D. Nindita, R. M. Santoso, W.K. Anggoro
Awal Bros Hospital Tangerang Indonesia
Background: Chronic kidney disease can bring significant morbidity and mortality if
uncontrolled. Some traditional modifiable cardiovascular (CV) risk factors that can
lead to chronic kidney disease (CKD) and its progressivity are smoking, obesity,
hypertension, dyslipidemia, and diabetes mellitus (DM).
Objective: This Study aimed to investigation the most correlated between modifiable
cardiovascular (CV) risk factors that can lead to CKD among Indonesian people.
Methods: A Cross sectional study was conducted from Januari 2018 until Desember
2018, sample subjects were 261 patient at the Renal Unit of Awal Bros Hospital
Tangerang Indonesia, The inclusion criterion was the CKD patients undergoing routine
HD. The exclusion criteria were patients undergoing acute HD or suffering from acute
diseases (infection, obstructive uropathy, etc).
Results: The result showed that Hypertension and DM was the most correlated with
increased CKD (p ¼ 0.095, p ¼ 0.081 respectively) N ¼ 261. High Total Cholesterol
with BMI >25 kg/m2 increased risk to have high MAP (105) correlated with
increased CKD risk, compared to normal total cholesterol with BMI under  25 kg/m2
(p ¼ 0.064), but smoking was weak significant correlated with CKD risk (p ¼ 0.021).
The analysis also used multiple logistic regression test and showed that Pearson test
(p ¼ 0.998) and Nagelkerke R2 test (p ¼ 0.895) had a strong correlation.
It’s mean that hypertension, diabetes mellitus (DM), obesity, dyslipidemia, and smok-
ing, had a correlated with increasing CKD and the test showed that the most corre-
lated factor was Hypertension.Conclusion: The hypertension, DM and Obesity are the
three most common risk factors in this study, so maintenance the CVD risk is impor-
tant to reduce CKD risk.
Keywords: cardiovascular risk factors • chronic kidney disease • hypertension •
diabetes mellitus
OR.223. Correlation between Increased Rate Pressure Product and 6-Minute
Walking Distance in Chronic Heart Failure Patients
P. Nugiaswari1, N. Wiryawan1, W. Aryadana1, K. Badjra1, W. Wita1, R. Widiana2,
I. Sri Iswari3, IGK Susrama4
1
Departement of Cardiology, Udayana University, Bali, Indonesia, 2Departement of
Internal Medicine, Udayana University, Bali, Indonesia, 3Clinical Microbiology,
Udayana University, Bali Indonesia, 4Agroecotechnology, Agricultural Faculty,
Udayana University, Bali Indonesia
Background: Heart failure is the highest prevalence of rehospitalization despite opti-
mal medical therapy. Chronic heart failure differs from acute heart failure. Chronic
heart failure means stable heart failure from routine control with no worsening of
symptoms. Functional capacity for chronic heart failure patients divided into subjec-
tive and objective measurements. New York Heart Association (NYHA) is commonly
used as subjective measurement. However, functional capacity needs to be measured
minute walk test is a submaximal test for chronic heart failure patients that is pro-
ven to be safe. Rate Pressure Product (RPP) is the result of systolic blood pressure
times heart rate. RPP is a parameter for oxygen supply to tissues while exercising.
Objective: The aim for this study is to know the correlation between increased RPP
and 6-minute walking distance in chronic heart failure patients.
F90
Method: There were 60 subjects of chronic heart failure in this study. Subjects were
examined through interview, physic diagnostic, and electrocardiography in polyclinic.
Then subjects went through serial blood pressure and heart rate examination before
and after six-minute walk test. Finally, the result of walking distance was measured
using the ruler on the floor of the tract in third floor of heart service building in
Sanglah Hospital.
Result: Results showed strongly negative correlation between increased RPP and 6-
minute walking distance in chronic heart failure subjects (r¼ -0.786; p ¼ 0.000). The
safe range for chronic heart failure patients is 191 until 255 meters and 1.4 until 2.5
increased in RPP in six-minute walk test.
Conclusion: It is concluded that increasing RPP correlated with decreased 6-minute
walking distance in chronic heart failure subjects.
Keywords: Rate Pressure Product • Walking Distance • Six-Minute Walk Test
OR.224. The Antiinflammatory Effect OF b-1,3/1,6-D-Glucan (Polysaccharide
Peptide) Of Misela Ganoderma Lucidum Extract Administration To Improvement
Of LV Ejection Fraction And LVMI In Post Myocardial Infarction Patients : A
Double-Blind Randomized Controlled Trial
Aditya Reza Pratama, Djanggan Sargowo
Departement of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya
University – Dr. Saiful Anwar General Hospital Malang East Java Indonesia
Background: Coronary artery disease is one of the leading causes of morbidity in the
world with high medical cost and rates of disability. Plaque atherosclerosis is a major
role in this condition. The current study evaluated anti-inflammatory of polysacchar-
ide peptide (ganoderma lucidum) has proven beneficial in the prevention of high risk
patient with coronary artery disease (CAD). Inflammatory has major role in endothe-
lial dysfunction and atherosclerotic heart disease, further contributes to ventricular
remodeling process leading to heart failure. hsCRP, IL-1, IL-6 play a pathogenic role
in the left ventricular ejection fraction in patients post myocardial infaction. The
effect of b-1,3/1,6-D-Glucan may contribute to endothelial function, LVEF and LVMI
through anti-inflammatory mechanisms.
Methods: This is single center, A randomized, double blind, placebo-controlled clini-
cal trial was conducted in 50 adults with history of STEMI and Non-STEMI patients
who undergone reperfusion therapy less than 24 hours or surviving acute phase, age
50–70 y. The patients were devided into two group. One group given 250 mg/day
Ganoderma lucidum for 90 days and the other group given placebo. Parameters were
IL-1,IL-6, TNF a,HsCRP, HDL, LDL, Total Cholesterol, echocardography measured at
baseline and after 90 day’s of treatment. Echocardiography was measured using
standard menner. We use morisky score to evaluate treatment’s adherence, and
exclude patient with morisky < 6. Independent T-test was performed for normally
distributed data and Mann-Whitney test was performed for abnormally distributed
data with significance level of p  0.05. All statistical was performed using SPSS ver-
sion 24.0.
Result: At 90 days, b-1,3/1,6-D-Glucan polysaccharide peptide (PsP) of Ganoderma
Lucidum extracts showed reduction in IL-1 and IL-6 levels (-15.7 6 27.1 vs. 3.42 6
33.1, P ¼ 0.042; and -29.6 6 104 vs. 75.7 6 130.8, P ¼ 0.005;respectively) compared
to placebo. Echocardiographic showed significant improvement in LVEF in PsP group
compared to placebo (2.3 6 9.77 vs. 02.08 6 3.35, P ¼ 0.042) and LVMI -4.55 6
14.46 vs 11.48 6 23.94, P ¼ 0.012.
Conclusion: These result suggest that consumption of of b-1,3/1,6-D-Glucan polysac-
charide peptide (PsP) of Ganoderma lucidum extracts significantly increase IL-1 and
IL-6 levels, also LVEF and LVMI in post myocardial infarction patients through anti-
inflammatory mechanism and improvement of endothelial function.
Keywords: Ganoderma lucidum • b-1,3/1,6-D-Glucan • IL-1 and IL-6 • anti-inflam-
matory • echocardiography • myocardial infarction
OR.225. Reciprocal Effect of Early Pulse Wave Reflection on Central Aortic
Pressure and Flow Velocity: Clinical Application of Pulse Wave Analysis
Audrey Adji, Alberto P. Avolio, Michael F. O’Rourke
St Vincent’s Clinic/ Faculty of Medicine University of New South Wales/ Victor Chang
Cardiac Research Institute, Sydney, Australia, Faculty of Medicine and Health
Sciences, Macquarie University, Sydney, Australia
Background: Favourable elastic properties of the aorta is to cushion, rectify and
smooth pulsatile flow from the left ventricle with each beat. Previous studies have
shown the reciprocal effects of pulse wave reflection on aortic pressure and flow
waves. Invasive and non-invasive studies of aortic blood flow have shown characteris-
tic aging changes as reduction in late systolic (ejection) flow, which corresponds to
the higher systolic (peak) of aortic pressure.
Objective: This study aimed to better understand the mechanisms of central aortic
pressure and flow changes due to early wave reflection and stiffening of arteries.
Method: Radial artery pressure waveforms were collected non-invasively from 161
males (age 21-80 years) undergoing cardiac catheterisation for suspected coronary
disease. Ascending Aortic (AA) pressure was derived from radial artery pressure using
validated SphygmoCor system. AA flow velocity waves were generated from AA
Abstracts
pressure and age-related AA impedance using mathematical relations governing flow
and pressure in the frequency domain and solved using discrete Fourier transform
analysis (Matlab v2014).
Result: Pressure (PAIx) and Flow Augmentation Index (FAIx), as manifestations of AA
impedance and wave reflection, were compared. FAIx shows significant decrease
with age, whereas PAIx increases with age (table). Findings are consistent with the
disparate effect of early wave reflection with aging; aging augments aortic pressure
in late systole while simultaneously decreasing AA late systolic flow velocity. This
inverse relationship, when combined, summates to a straight line which approxi-
mates zero.
Conclusion: Findings confirm the reciprocal effect of early wave reflection which
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
adds to AA pressure and subtracts from AA flow velocity. No such relationship was
seen with conventional Doppler blood flow measurement. This gives fresh insight into
left ventricular failure with preserved or reduced ejection fraction. ... “Might wave
reflection be the cause of both?”
Keywords: Aortic pressure • Aortic flow velocity • Augmentation index
Average (SD) p-value
Young (50) Old (>50)
No of subjects 34 127
Height (cm) 179 (6) 173 (8) <0.01
Weight (kg) 89 (15) 88 (14) NS
Pressure AIx (%) 17 (11) 27 (9) <0.01
Flow AIx (%) -17 (7) -22 (7) <0.01
Pressure þ Flow AIx 0.4 (15.4) 4.9 (13.7) NS
OR.226. Role of Omega-3 Poly Unsaturated Fatty Acid in Primary and Secondary
Prevention of Heart Failure: A Systematic Review and Meta-analysis
E. Susilowati1, Ade M. Ambari2
1
Research Assistant Division of Preventive and Rehabilitative, National Cardiovascular
Centre Harapan Kita, Indonesia, 2Department of Cardiology and Vascular Medicine,
Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan
Kita, Indonesia
Background: Omega-3 Poly Unsaturated Fatty Acid (PUFA) has widely recognised for
its beneficial role in cariovascular system. It also has been noted to be protective
against chronic heart failure and improves clinical outcome. Some studies showed its
role in supressing lipid levels, inflammation, cardiac fibrosis, and improve left ven-
tricle performance, but some of them demonstrated inconsistent results.
Objective: This study aims to review and meta analysed the role of Omega-3 PUFA in
primary and secondary prevention of Heart Failure.
Method: A systematic litrature search of Pubmed, Cochrane, Google Scholar, and
Proquest was conducted, by restricting language to English, 10 years range of recent
publications, and only randomised clincal trial (RCT) with Jadad score 3 were
included in this meta analysis. A total of 3569 subjects from 17 RCT was
analysed.The I2 statistic was used to assess heterogeneity. The pooled mean differ-
ence and associated 95% confidence intervals were calculated, and a fixed or ran-
dom-effects model was used for the meta-analysis.
Result: Heart Failure patients who received Omega-3 PUFA showed signifficant
improvement in ejection fraction (SMD¼0.629, p ¼ 0.008, I2¼96,38% ) compared to pla-
cebo groups. Pooled RR for cardiovascular mortality was decreased in intervention
groups, but not statistically signifficant (pooled RR ¼ 0.801, p ¼ 0.418). Majority of
inflammation and fibrotic biomarkers was decreased in treatment groups. CRP was
decreased with SMD of -2,22, p ¼ 0.005. TNF-a and IL-6 were also decreased (random
effect’s SMD¼-2.04, p ¼ 0.02 and SMD¼-1,23, p value¼0.001), but IL-6 parameter
showed study’s bias. BNP was decreased signifficantly (SMD¼-5.32, p ¼ 0.001). Two
studies also demontrated decrease of ST2 and pentraxin as fibrosis biomarker in heart
failure. There was signifficant result’s differences of functional capacity, assessed using
peak VO2 between both groups (total fixed effects of SMD¼0.559, p value¼0.001).
Conclusion: Supplementation of Omega-3 PUFA may be beneficial for primary and
secondary prevention of Heart Failure.
Keywords: omega-3 • prevention • heart failure
OR.227. Taurine Supplementation as Anti-Atherogenic: A Systematic Review
I. Ivan1, S. Kallista1, G. Tandecxi1, I. P. Wendi2, L. Namretta2, A. Bambang2,
A. Sumarpo2
1
Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia,
2
Department of Chemistry and Biochemistry, Atma Jaya Catholic University of
Indonesia, Jakarta, Indonesia
Background: The prevention and treatment of atherosclerotic cardiovascular dis-
eases are mediated by modulation of plasma low-density lipoprotein (LDL)
Abstracts
cholesterol level. Meanwhile, taurine supplementation has been known for its effect
in improving atherosclerosis. The aim of this systematic review is to investigate the
effect of taurine supplementation as anti-atherogenic in human.
Methods: Our methodology followed the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines using MeSH terms. PubMed database
was searched up to March 2019. The articles were included if: english-language;
human study; randomized controlled trials, and controlled clinical trial. Two authors
independently assessed the quality of each included study using Cochrane Risk of
Bias Tool 2.0 which cover 6 domains with scores of “low”, “high”, or “unclear”.
Results: We retrieved 50 studies, which later 4 articles were selected for comprehen-
sive review. All studies are randomized controlled trial including around 80 participants
with heart failure administered taurine orally with 1.5-6 gram/day for 2-7 weeks.
Taurine supplementation can significantly lower triacylglycerol level, atherogenic index,
and Castelli’s Risk Index-I/II (p < 0.05). In addition, it can attenuate the increase of
serum cholestrol after high calorie diet. One study administered taurine intravenously
with 1.5 g/L/day for 1 week revealed to lower LDL by 2.83þ30.9 mg/dL.
Conclusion: We concluded that taurine may have the potential as anti-atherogenic.
Future studies with more participants and longer period are encouraged to estab-
lished the pooled effect quantitatively.
Keywords: Taurine • lipid • cholesterol • atherogenesis • atherosclerosis
OR.228. Relationship Between Left Ventricular Hyperthropy From
Electrocardiogram by Sokolow-Lyon Criteria with Left Ventricular Diastolic
Dysfunction
Marolop C. Hutapea, Muhammad D. Pane, Harris Hasan, Nizam Akbar, Ali N. Nasution
Department of Cardiology and Vascular Medicine, School of Medicine, Universitas
Sumatera Utara, Medan, Indonesia
Background: Electrocardiogram (ECG) is generally used to predict left ventricle
hyperthropy (LVH) by using the Sokolow-Lyon criteria. LVH anatomically diagnosed by
echocardiography is the gold standard. Based on echocardiography guideline, left
ventricle remodelling is always consistent with diastolic dysfunction.
Objective: This study aims to evaluate correlation of Sokolow-lyon criteria from ECG
with diastolic dysfunction as a predictor.
Method: Total of 31 patients presenting with Hypertensive Heart Disease with normal
ejection fraction in Adam Malik General Hospital between November 2018 and
January 2019 were enrolled and compared in two groups: with and without LVH (by
Sokolow-Lyon criteria). Meanwhile E/e’, relative wall thickness (RWT), and left ven-
tricle (LV) mass were measured by echocardiography. The correlation were analyzed
using bivariate analysis (independent sample T-test).
Result: The two groups (LVH vs no LVH by ECG) consist of 15 and 16 patients with
mean of age was 56.8 vs 64.8 years (p < 0.05), and showed no significant difference
for body mass index for both groups. Statistical analysis showed significant difference
of E/e’ by echocardiography as a marker of diastolic dysfunction between two groups
(9.83 vs 7.39; p < 0.05). There were no significant difference for either RWT and LV
mass for both study groups.
Conclusion: LVH diagnosed by ECG using the Sokolow-Lyon criteria was successfully
showing positive relationship with left ventricular diastolic dysfunction by
echocardiography.
Keywords: LVH • Sokolow-Lyon • diastolic dysfunction • HHD
OR.229. Association Between Metabolic Syndrome and Heart Failure among
Middle Aged in Rural Area. (Research in Kapongan Subdistrict, Situbondo, East
Java)
Della Oriyanti Tomasila1, Ika Christine2, Angela S. Nariswari3
1 1
Medical Faculty of Widya Mandala Catholic University, Surabaya, Indonesia,
2
Department of Internal Medicine, Medical Faculty of Widya Mandala Catholic
University, Surabaya, Indonesia, 3Department of Physiology, Medical Faculty of Widya
Mandala Catholic University, Surabaya, Indonesia.
Background: Metabolic syndrome has been a major problem in developed and devel-
oping countries. Epidemiology data showed that every metabolic syndrome compo-
nent relates to increased risk of type 2 diabetes mellitus and heart failure, which
have been among the main causes of morbidity and mortality in the world.
Objective: To investigate the association between metabolic syndrome and heart
failure among rural middle aged people in area covered by Kapongan Primary Health
Care, Situbondo District, East Java.
Method: This study is an analytic observational with cross sectional design.
Measurement of body height, body weight, heart rate, blood pressure, and waist cir-
V R
cumference were collected. Capillary blood sampling used the Lipid Pro and Accu
VR
Check Performa to measure triglyceride, HDL, and fasting blood glucose. Criteria
used for defining metabolic syndrome was the IDF 2009, while heart failure diagnosis
was confirmed by history taking and physical examination. Hypothesis test used was
Chi-square test, continued with logistic regression.
Result: Fifty-one subjects, aged 25-60 years old, were included in this study.
Subjects consisted of 38 (74.51%) female with mean of age 47.71 6 8.307 years.
F91
There were 26 (51.0%) subjects with metabolic syndrome and 15 (29.4%) with heart
failure. Chi Square test showed non-significant association between the metabolic
syndrome and heart failure (p ¼ 0.406; p > 0.05; PR¼l.271; 95%¼0.742 – 2.177).
However, logistic regression indicated that diastolic dysfunction was a significant co-
variable that affect both the metabolic syndrome and heart failure (p ¼ 0.011;
p < 0.05).
Conclusion: There is a non-significant association between metabolic syndrome and
heart failure among middle aged that affected by diastolic dysfunction. Elevation of
diastolic pressure must be taken into account in preventing metabolic syndrome and
heart failure. Metabolic syndrome tends to be a risk factor for heart failure among
middle aged people in this population.
Keywords: Metabolic syndrome • heart failure • middle aged.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.230. Highly Sensitive Troponin as Possible Predictive Marker for
Cardiovascular Disease in Mild Chronic Kidney Disease Patients
A.B. Md Radzi1, K.S Ibrahim1, N.Y.C. Chua1, H.A. Zainal Abidin1, R. Najme Khir1,
C.W. Lim1, S.S Kasim1,2
1
Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai
Buloh Campus, Selangor, Malaysia, 2Institute for Pathology, Laboratory and Forensic
Medicine (I-PPerFoRM), Universiti Teknologi MARA, Sungai Buloh Campus, Selangor,
Malaysia.
Background: Metabolic syndrome is a group of metabolic disorder that also a risk
factor for heart failure. Heart failure is a non-communicable disease that has been
the major cause of death in the world. Degenerative process increases vulnerability
of the elderly to metabolic syndrome which consequently increases the risk of heart
failure.
Objective: To analyze the association between metabolic syndrome and heart failure
among elderly in area covered by Kapongan Primary Health Care, Situbondo District,
East Java.
Method: This study is an analytic observational with cross-sectional design. Data col-
lected by measuring body height, weight, heart rate, blood pressure, and waist cir-
R
V
cumference. Meanwhile, capillary blood sampling collected using Lipid Pro and Accu
RV
Check Performa to measure triglyceride, HDL, and fasting blood glucose. Metabolic
syndrome criteria used was the IDF 2009, while heart failure diagnosis was confirmed
by anamnesis and physical examination. Hypothesis test used was Chi-square test
continued with logistic regression.
Result: Forty-two subjects, aged 60-80 years old were included in this study.
Subjects consisted of female 33 (78.57%) with mean of age 67.2 6 4.29 years old.
There were 24 (83.3%) subjects diagnosed as metabolic syndrome and heart failure.
There was a non-significant association between metabolic syndrome and heart fail-
ure in the elderly (p ¼ 0.385; p > 0.05; PR ¼ 1.154; 95% CI ¼ 0.823–1.617). However,
logistic regression showed that diastolic dysfunction was a significant confounding
factor between metabolic syndrome and heart failure (p ¼ 0.022; p < 0.05).
Conclusion: There is a non-significant association between metabolic syndrome and
heart failure in the elderly that affected by diastolic dysfunction. Increase of dia-
stolic dysfunction should be considered in order to prevent the metabolic syndrome
and heart failure. Metabolic syndrome in this study tends to be a risk factor for heart
failure among elderly.
Keywords: Metabolic syndrome • heart failure • elderly.
OR.231. Highly Sensitive Troponin as Possible Predictive Marker for
Cardiovascular Disease in Mild Chronic Kidney Disease Patients
A.B. Md Radzi1, K.S Ibrahim1, N.Y.C. Chua1, H.A. Zainal Abidin1, R. Najme Khir1,
C.W. Lim1, S.S Kasim1,2
Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai
Buloh Campus, Selangor, Malaysia, 2Institute for Pathology, Laboratory and Forensic
Medicine (I-PPerFoRM), Universiti Teknologi MARA, Sungai Buloh Campus, Selangor,
Malaysia.
Background and aim: There is increasing evidence that elevations in serum troponin
levels in stable asymptomatic patients with advanced chronic kidney disease patients
are predictive of worse long-term cardiovascular outcomes and survival. The associa-
tion between highly sensitive troponin T (hs-TnP) and early CKD is not well estab-
lished. We aimed to study the presence elevated hs-TnP in patients with stage 2 CKD
patients.
Methods: Patients below the age of 55 years with stage 2 CKD and normal renal func-
tion were recruited. Demographic details, co-morbidity, risk factors, medications as
well as blood investigations including hs-TnP were collected. Arterial stiffness was
determined using carotid-femoral (aortic) PWV. Results were analysed using SPSS ver-
sion 22.0.
Results: 39 patients with stage 2 CKD and 39 control patients were recruited. The
mean age of CKD patients was 46 years þ 5.7. Stage 2 CKD patients had a significant
higher mean hs-TnP (0.026 ng/L þ 0.4) compared to controls (0.010 ng/L þ 0.02)
(p<0.001, 95% CI -2.47,-1.26). Patients with stage 2 CKD had a significant higher
mean PWV (7.5 m/s þ 1.5) compared to controls (5.7 m/s þ 1.1) (p<0.001, 95% CI
F92
-2.45,-1.21). Multiple linear regression analysis revealed pulse pressure as the inde-
pendent predictor of abnormal hs-TnP (r2¼0.568, p ¼ 0.006).
Conclusions: Our findings demonstrate an association between hs-TnP, a marker of
subclinical cardiac ischaemia in mild CKD patients. Further research is required to
establish the predictive value of hs-TnP in early renal impairment.
Keywords: highly sensitive troponin • predictive marker • cardiovascular disease •
mild chronic kidney disease
OR.232. Assessing the Impact of Switching to the Tobacco Heating System on
Cardiovascular Events: Translating Basic Science Into Clinical Benefit
C. Pater, C. Haziza, A, Elamin, S. Pouly, G. de La BourdonnayeC.T. Tran, N. Blanc,
A. van der Plas, A. Heremans
PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neucha ^tel,
Switzerland
Background: Cigarette smoke (CS) is causally linked to the development of cardio-
vascular disease (CVD). Tobacco harm reduction, by substituting cigarettes with less
harmful products, is a complementary approach to current strategies for smokers
who would otherwise continue to smoke. The Tobacco Heating System (THS) 2.2 is a
novel tobacco product that heats tobacco instead of burning it, never allowing the
temperature to exceed 350  C, thereby preventing the combustion process from tak-
ing place and producing substantially lower levels of toxicants compared with CS.
Objective: Philip Morris International’s (PMI) assessment program aims to demon-
strate that switching to THS has the potential to reduce the risk of smoking-related
diseases versus continued smoking.
Method: The program includes in vitro/in vivo toxicology, a systems toxicology
approach, and clinical studies. In order to elucidate the effects of switching to THS
on the risk of cardiovascular events, PMI also collects safety data at post-market lev-
els based on principles of Good Pharmacovigilance Practice.
Result: The results of the THS assessment program demonstrated positive cardiovas-
cular effects in both in vitro, in vivo, as well as in clinical studies. Since the start of
THS commercialization in November 2014 and cumulatively up to the end of 2018, 11
cases of myocardial infarction (MI) and 5 cases of ischemic stroke were reported by
users. In most of these cases, no information was provided about the smoking history
or the time of switching to THS, which makes it difficult to assess the causal
relationship.
Conclusion: The evidence available to date indicates that switching to THS has the
potential to reduce the risk of smoking-related diseases, such as CVD. As a next step,
PMI will complement its THS assessment program with cardiovascular outcome stud-
ies intended to further support the clinical benefits (e.g., reduction in the risk of
cardiovascular death, MI, and stroke) of switching to THS as compared with continu-
ous smoking.
Keywords: smoking • cardiovascular risk • tobacco harm reduction • cardiovascu-
lar prevention
OR.233. Which Anthropometric Measurements is the Most Correlate to Blood
Pressure?
A. F. Lubis1, R.V.P. Aruan2
1
Cengkareng District Hospital, Jakarta, Indonesia, 2Tegal Alur 2 Primary Health Care,
Jakarta, Indonesia
Background: Hypertension is already a highly prevalent cardiovascular risk factor
worldwide because of increasing longevity and prevalence of contributing factors
such as obesity. Anthropometry provides the single most portable, universally appli-
cable, inexpensive and non-invasive technique for assessing the size, proportions and
composition of the human body.
Objective: The aim of this study is to investigate which anthropometric measure-
ments will correlate the most to elevated blood pressure.
Method: This is a cross-sectional study. The research was conducted at primary health
care facility throughout February. The data was collected through monthly screening
program by visiting their house door to door. Then they had their blood pressure, body
weight, waist circumference, and their height measured using standard guideline.
Results: 122 patients participated in this study. 52 patients was diagnosed with
hypertension. The average systolic blood pressure (SBP) and diastolic blood pressure
(DBP) are 146.06 6 15.30 and 89.33 6 11.11 compared to normotensive group
111.83 6 9.0 and 74.39, respectively. The average body mass index (BMI), waist cir-
cumference (WC), waist-to-height ratio (WHtR) are 28.51 6 5.70, 94.59 6 12.2, 0.6
6 0.93 compared to normotensive group 26.64 6 5.2, 89.48 6 11.8, 0.56 6 0.95,
p > 0.05, respectively. There is a significant correlation between SBP and anthropo-
metric measurement (BMI, WC, and WHtR) (Pearson correlation¼0.27, 0.33, 0.33,
p < 0.00, respectively). DBP also showing significant correlation to anthropometric
measurement (BMI, WC, and WHtR) (Pearson correlation¼0.35, 0.40, 0.36, p < 0.00,
respectively).
Conclusion: Based on the coefficient correlation, waist circumference and weight-
to-height ratio showing the strongest correlation to blood pressure either systolic or
diastolic blood pressure.
Abstracts
Keywords: Anthropometric • Blood pressure • Correlate
OR.234. Correlation Between Neutrophyl-Lymphocyte Ratio and Global Registry
of Acute Coronary Event Mortality Risk Score on Admission in Non-ST Segment
Elevation Myocardial Infarction in North Kalimantan
Christopher A. Yandoyo, Winardi E. Setiawan, Fandi Ahmad, Donny S. Syamsul,
Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: Neutrophil-lymphocyte ratio (NLR) in peripheral blood is established to
correlate with the morbidity and mortality of heart disease patients. Studies evaluat-
ing neutrophil-lymphocyte ratio on admission and its relationship with grace mortal-
ity risk score were relatively exiguous. This study evaluated the relation between
NLR on admission and Global Registryof Acute Coronary Event (GRACE) mortality risk
score among Non-ST Elevation Myocardial Infarction (NSTEMI) patients.
Objective: This study aimed to determine the relationship between NLR and GRACE
scores for predicting the risk of in-hospital mortality in NSTEMI patients.
Methods: NSTEMI patients undergoing treatment in Tarakan Regional Public Hospital
from January 2017 to December 2018 were retrospectively analyzed. Demographic
profile, NLR, and GRACE score was measured in the emergency department prior to
further treatment in hospital ward.
Results: The mean age of the patient was 59612 years old and most of them were
male (66%). The mean (6SE) NLR on admission in the data was 5.01(61.15) and the
mean of GRACE score on admission was 107.52 6 33.75. NLR had a positive moderate
correlation with GRACE in hospital mortality score (Sig. 2-tailed p ¼ 0.02, r ¼ 0.416)
In ROC analysis, a cutoff level of NLR 3.22 had 90% sensitivity and 63.4% specificity
in predicting High risk category of In-hospital mortality by using GRACE score (ROC
area under curve: 0.768, 95% CI: 0.616-0.921, P < 0.01)
Conclusion: Patients with higher neutrophil-lymphocyte ratio on admission had a sig-
nificant higher GRACE score than patients with lower neutrophil to lymphocyte in
NSTEMI patients. NLR shows a promising inexpensive, fast, and easily accessible prog-
nostic parameter in patients with NSTEMI; it is an important inflammatory marker
that can take a role in the prognosis of NSTEMI if supported by further large-scale
prospective studies.
Keywords: Neutrophil-Lymphocyte Ratio • GRACE • NSTEMI
OR.235. Relation between In-hospital Outcome and Mode of Transport of ST-
Segment Elevation Myocardial Infarction: From Dr Iskak General Hospital ACS
Registry
S. Hayon, A. W. Nugraha, E. Ruspiono, A. Wibisono, T. Astiawati, F. S. Laitupa,
F. Caesario, N. A. Suyani
1
Dr. Iskak General hospital, Tulungagung, East Java, Indonesia
Background: Patient awareness and early recognition in first medical contact of
STEMI is key factor for a successful reperfusion and better outcome. This study inves-
tigate the risk factor between self transport and inter-facility transferal related to in
hospital mortality and morbidity.
Method: Data was observed retrospectively from January 2018-December 2018 from
Dr. Iskak general hospital ACS registry. STEMI patients who met criteria for reperfu-
sion were included and divided into self-transport and inter-facility transferred
related to in-hospital mortality. Baseline characteristic for each group were analyzed
using bivariate analysis with significance level, p < 0.05.
Result: Out of 303 STEMI patients, onset time of self transported patient is shorter
than transferred patient (median¼ 152.5 minutes vs 251 minutes, p < 0.001).
Duration between first medical contact to reperfusion time was also significantly dif-
ferent between each group (median ¼240 minutes vs 105.5 minutes, p < 0.001). In
mortality outcome, mode of transport was associated with diabetes (p < 0.001),
smoking status (p ¼ 0.022), and Killip class 2-4 (<0.001). There was no association
between in-hospital outcome and mode of transportation.
Conclusion: Compared to transferred patient, self transport patient has significantly
shorter onset time and duration between first medical contact to reperfusion.
Although there is no association between in-hospital outcome and mode of transport,
in-hospital mortality in each group was associated with diabetes, smoking status,
and Killip Class.
Keywords: STEMI • Self transport • Inter-facility transferral • in-hospital outcome
OR.236. Pork Meat Consumption and Incidence of Acute Coronary Syndrome in
Wisma Prashanti General Hospital Tabanan Bali
Mikhael Asaf, I. W. Sutarmawan
Wisma Prashanti General Hospital
Background: Acute Coronary Syndrome (ACS) is life-threatening condition that
ranges from an unstable pattern of angina pectoris to the development of a large
Abstracts
OR.237. Table1 Bivariate Analysis Result of Pork Meat Consumption and ACS
Acute Coronary Syndrome
Yes
Frequency of Pork Meat Consumption > 2x/week Count
% within ACS
 2x/week Count
% within ACS
Total Count
% within ACS
acute myocardial infarction. It is a major cause of death and disability worldwide.
However, some of the common risk factors of ACS are amendable to modification and
can help with the prevention of ACS.
Objective: To examine the relationship of pork meat consumption and incidence of
ACS as a common modifiable risk factor.
Method: An observational case control study involving a total of 50 patients that
came to the hospital emergency room from March 2018 to August 2018 was con-
ducted. The patients were divided equally into the case group and the control group.
The case group consist of patients diagnosed with ACS while the control group consist
of patients without ACS or any history of it. Each patient from both groups was
assessed retrospectively through a food frequency questionnaire for history of pork
meat consumption and classified further by the frequency into < 1x/week, 1-2x/
week and >2x/week.
Result: Hypothesis test using chi square with continuity correction analysis showed
that statistically there is a significant relationship between pork meat consumption
and incidence of ACS with p ¼ 0.034. Relationship strength parameter used is odds
ratio with OR ¼ 4.400 and 95% CI 1.283 – 15.091 which means that patients with his-
tory of pork meat consumption > 2x/week in this study have higher chance (4.400
times) to experience ACS compared to patients with history of pork meat consump-
tion  2x/week.
Conclusion: Pork meat consumption is related with the incidence of ACS. In addition,
it increases the chance of a person to present with ACS by 4.4 times if consumed
more than twice a week. The result of this study can help modify behavior regarding
pork meat consumption in order to reduce the risk of ACS.
Keywords: pork meat • acute coronary syndrome • risk factors
OR.237. Echocardiographic Characteristics in Patients with Chronic Total
Occlusion of Left Anterior Descending Artery
L.V. Bramantyo1, A. Pudjiastuti1, A. Perdana1, A. Sidiek1, S.N. Sofia1, S. Rifqi1
1
Department of Cardiology and Vascular Medicine, Medical Faculty of Diponegoro
University – Dr. Kariadi Central General Hospital, Semarang, Indonesia
Background: Chronic total occlusion defined as the presence of total occlusion with
no antegrade flow other than from collateral in respective coronary artery for more
than 3 months. CTO in LAD were found in 41 – 46% patients with CTO. LAD territority
were known as fundamental part of LV pump function.
Objective: This study tried to investigate the echocardiographic characteristics in
patients with CTO of LAD in Dr. Kariadi General Hospital Semarang.
Methods: We retrospectively investigated the echocardiographic characteristics in
patients with CTO of LAD who had CTO-PCIs experience between January 2018 to
December 2018, in a multioperator single centre Dr. Kariadi Central General Hospital
Semarang.
Results: A total of 32 patients with CTO of LAD who had CTO-PCIs were included, 11
patients (34%) had lessions in proximal, 19 patients (59%) in mid, 1 patient (3%) in
distal, and 1 patient (3%) in ostial. Sex distribution in male 29 (90.6%), female 3
(9.4%), with mean of age was 57 6 8 years old. The mean left ventricular end-dia-
stolic dimension was 5.4 6 1 cm, the mean left ventricular end-systolic dimension
was 3.9 6 1.1 cm, the mean ventricular septal thickness was 1.2 6 0.3 cm, the mean
left ventricular posterior wall thickness was 1.1 6 0.2 cm, the mean left ventricular
mass index was 175 6 76 gr/m2, the mean left ventricular ejection fraction was 48 6
13%, the mean tricuspid annular plane systolic excursion was 1.9 6 0.3 cm, the mean
aortic root diameter at the level of the sinuses was 2.8 6 0.3 cm, the mean left
atrial dimension was 3.9 6 0.5 cm. 18% had normal LV diastolic function and 66% had
grade I diastolic dysfunction. 47% had mild mitral regurgitaion and 6% had severe
mitral regurgitation due to dilatation of LV cavity.
Conclusion: Echocardiographic characteristics in patients with CTO of LAD had any
differences than normal parameters. They had more hypertrophied left ventricle,
lower ejection fraction, more abnormal left ventricular diastolic function, and more
prevalent significant mitral regurgitation.
F93
P Value OR 95% CI
No Total Min Max
12 6 18 0.034 4.400 1.283 15.091
54.5 21.4 36.0
10 22 32
45.5 78.6 64.0
22 28 50
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
100.0 100.0 100.0
Keywords: Chronic total occlusion • Left anterior descending • Echocardiographic
characteristics
OR.238. Characteristic of Arrhythmias in Acute Coronary Syndrome: An Analysis
from Tarakan Registry of Acute Coronary Syndrome
Karina Patricia, Fandi Ahmad, Donny S. Syamsul, M. Hasbi Hasyim
Tarakan Regional General Hospital, North Kalimantan, Indonesia
Background: It is known that Acute Coronary Syndrome (ACS) leads to metabolic and
electrophysiological changes that induce silent or symptomatic, even life-threatening
cardiac arrhythmias.
Objective: The prevalence of cardiac arrhythmias in Tarakan has not been previously
reported. The study results will serve as the local database for future studies.
Method: Data was collected from 271 patients of Tarakan Registry of ACS (TRACS)
from January 2017 to December 2018 by using a retrospective-descriptive study
through the medical records. Patients were first confirmed to have ACS, including ST
elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction
(NSTEMI), and unstable angina (UA).
Result: The prevalence of cardiac arrhythmia complications in TRACS was 17.7 % or
48 patients, significantly more in men (71.42 %) compared to women (28.58 %).
Among them, 47.90 % had premature ventricular contraction (PVC), 31.25 % had
atrial fibrillation (AF), 6.25 % had atrioventricular (AV) block, 6.25 % had AV nodal
reentry tachycardia (AVNRT), and 6.25 % were having sustained ventricular tachycar-
dia (VT)/ventricular fibrillation (VF). More than half of the patients (52.38 %) with
cardiac arrhythmias had STEMI, 38.09 % had NSTEMI, and 9.52 % had UA. Maximum
arrhythmias were observed in the age group ranging from 51 to 60 years old (57.14
%). Almost half of the patients had shown anterior wall infarction. About 23.8 % of
patients were smokers. Hypertension and diabetes mellitus were found in more than
half of the patients.
Conclusion: The most common arrhythmia in this study was PVC. Early diagnosis and
prompt treatment had an important role in the management of ACS patients with
arrhythmias. Since the preferred management of early ACS with arrhythmia is gener-
ally interventional, a cardiac catheterization laboratory should be developed in order
to reduce mortality and morbidity of the patients.
Keywords: Acute Coronary Syndrome • Cardiac arrhythmia • Prevalence • North
Kalimantan.
OR.239. Uric Acid and Acute Coronary Syndrome- Is It an Independent Risk
Factor?
Kent Ter Lau, Kee Tat Lee
Department of Internal Medicine, Miri General Hospital, Sarawak, Malaysia
Background: Smoking, diabetic mellitus (DM), hypertension and dyslipidemia are the
commonest and well established risk factors for developing acute coronary syndrome
(ACS). Other factor such as hyperuricemia still remain a controversial independent
risk factor leading to coronary artery disease.
Objective: Identifying hyperuricemia as one of the independent risk factor leading
to coronary artery disease. Reference value for uric acid in this study is 387lmol/L.
Method: We review the uric acid level of patient admitted to Miri General hospital
between year 2016 and 2017 with the diagnosis of Non-ST elevation MI (NSTEMI) and
ST elevation MI (STEMI). Demographic data, gout history and other comorbidities of
the patients are collected.
Result: Total of 68 patients was included in this study, 59 were men (mean age 54.1
þ/- 11.6 years) and 9 were female (mean age 65.1 þ/- 14.4 years). Of the study
patients, 58.8% of them are smokers, 31% of them had diabetes mellitus, 44.1% had
hypertension and 16.2% had dyslipidemia. Only 6 patients had history of gout and
surprisingly none of them were on treatment. There were 33 cases of NSTEMI and 35
F94
cases of STEMI. 66.2% of them had uric acid level above 387lmol/L with mean uric
acid level of 457lmol/L. 8 patients develop ACS despite not having any risk factors
and their mean uric acid level is 491lmol/L.
Conclusion: Most of the patients have at least one modifiable cardiovascular risk fac-
tor. We are not able to conclude that high uric acid level as the independent risk fac-
tor leading to ACS. However, most of the studied patients have high uric acid level
with mean uric acid level that is significantly higher than the reference level.
Notably, mean uric acid level for the group without any risk factor is high. Thus,
hyperuricemia does associated with ACS event. Larger cohort study with isolated
hyperuricemia patients can be carried out in future to identify uric acid as the inde-
pendent risk factor for developing ACS.
Keywords: - Acute Coronary Syndrome • Hyperuricemia • Risk Factor
OR.240. Grades of Body Mass Index is Correlated with Left Ventricle Mass and
Function in Patients with Hypertensive Heart Disease
M. S. Bhisma1, M. J. Al-Farabi1,2, B. S. Pikir1
1
Department of Cardiology and Vascular Medicine, Soetomo General Hospital, Faculty
of Medicine, University of Airlangga, Jl. Mayjend. Prof. Dr. Moestopo No.6-8,
Surabaya, Indonesia, 2Postgraduate School, University College London, Gower St,
Bloomsbury, London WC1E 6BT, United Kingdom
Background: HHD (hypertensive heart disease) is caused by long-standing hyperten-
sion and characterized by changes in the ventricle structure and function. It is
unclear whether different grades of BMI (body mass index) will also affect the pheno-
type of HHD. Hence, we evaluate the echocardiographic findings of HHD patients
grouped by the grades of BMI.
Material and Method: This cross-sectional study was conducted on 50 consecutive
HHD patients in Cardiovascular Departement, Soetomo General Hospital.
Antropromoteric measurement was carried out by experienced research assistants
and stratified by BMI grades (normal/underweight: <25 kg/m2, overweight: 25  BMI
< 30 kg/m2, obese: 30 kg/m2). Echocardiographic examination was carried out
with Vivid S60 Ultrasound instrument (General Electric).
Results: The research showed that the grades of BMI were positively correlated with
LA major (r ¼ 0.335), RA Major (r ¼ 0.371), LVD Mass (r ¼ 0.341), LVS Mass (r ¼ 0.303),
LVPWD (r ¼ 0.369), LVPWS (r ¼ 0.391), and inversely correlated with LVSI Dopp (r¼-
0.376). Obese patients have significantly higher LVD Mass (194.93658.05 vs
140.21636.58; p ¼ 0.001) and higher LVPWS (1.7160.36 vs 1.3960.15; p ¼ 0.001)
compared to normoweight patients. Multiple stepwise linear regression analysis
showed that the grades of BMI were significantly independently associated with the
LVDMass (b ¼ 0.356, p ¼ 0.010) and LVPWS (b ¼ 0.399, p ¼ 0.004).
Conclusion: The grades of BMI in HHD patients was correlated and can be the signifi-
cant predictor for the left ventricle mass and function, characterized by LVDMass
and LVPWS echocardiographic findings.
Keywords: Cardiomegaly • Echocardiography • Obesity • Ventricle Function.
OR.241. Correlation between Troponin I Level and Left Ventricular Ejection
Fraction in Patients with Acute Myocardial Infarction
Dwinta R. Sidabutar, Robby M. Simangunsong, Fandi Ahmad, Donny S. Syamsul,
Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: After acute myocardial infarction, the patient’s prognosis is closely
related to the degree of irreversible myocardial damage. In clinical practice the
extent of infarction can be known through a non-invasive approach such as echocar-
diography and to determine damage of the myocardium, cardiac enzymes can be
examined. The heart enzyme in this case, Troponin I has a high sensitivity and specif-
icity as an indicator of myocardial necrosis. The release of Troponin I is closely
related to the size of the infarction. The presence of myocardial necrosis results in
the failure of the heart muscle contraction so that it is related to the ability of the
heart pump which eventually decreases left ventricular ejection fraction. We evalu-
ate the calculation of Troponin I after acute myocardial infarction and its relation-
ship to decreasing ejection fraction of left ventricular in Tarakan Regional Public
Hospital.
Patients and Methods: Data were obtained from the Tarakan Registry of Acute
Coronary Syndrome (TRACS) in 2017-2018. This study was a cross-sectional study
using samples of STEMI and NSTEMI patients with consecutive sampling technique
with inclusion criteria was patients who have complete medical record data include
troponin when entering the emergency room and data of echocardiography. Data
were analyzed using pearson correlation.
Results: The mean of troponin I level in this population was 15.72 6 5.6, while the
means of ejection fraction was 53.82 6 2.74. We found a negative correlation of log-
Troponin I level and ejection fraction (r¼ -0,601; p¼0.002).
Abstracts
Conclusion: There was a significant relationship between an increasing of Troponin I
level and the reduction of left ventricular ejection fraction.
Keywords: Troponin I • ejection fraction • acute myocardial infarction
OR.242. Profile of Cardiovascular Emergencies in the Emergency Room of
Wangaya Regional General Hospital on 2017
Hendrikus G. S. A. Putra, Fredric Zulkifly, I P. Parwata Jaya
Regional General Hospital Wangaya, Denpasar, Bali
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: Based on National Basic Health Research 2018, non-communicable dis-
eases was increased significantly in Indonesia. Cardiovascular diseases (CVD) become
one of the diseases that get the most attention from health workers. Data from
National Basic Health Research 2013 shows the prevalence of coronary heart disease
is 0.4% and heart failure is 0.1% in Bali.
Objective: The aim of this study is to find the proportion of cardiology cases being
treated at the emergency room (ER) of Wangaya Regional General Hospital on 2017.
The characteristic of patients with CVD will provide current prevalence and informa-
tion of CVD in Wangaya Regional General Hospital on 2017.
Method: This study was a descriptive study towards patients attended at the ER of
Wangaya Regional General Hospital. Samples are collected using total population
sampling to show a complete picture of patients’ cases being treated at the ER of
Wangaya Regional General Hospital.
Result: Total number of patients visiting ER in 2017 was 33,879 patients. The study
shows that there are 492 cases of cardiovascular emergencies being treated at
Wangaya Regional General Hospital on 2017. This 492 cases stand for 1.45% from the
total cases treated at ER on 2017. 420 (85.4%) cases from those 492 cases are consid-
ered false emergencies such as hypertension (40.2%), chronic heart failure (34%),
coronary artery disease (16.4%), and arrhythmia (7.2%); while the rest are considered
as true emergencies. Out of true emergencies, acute coronary syndrome (ACS) has
the biggest prevalence of 47.2% followed by emergency hypertension (29.2%), acute
heart failure (18.1%). These true cardiovascular emergencies stands for 14.6% of
total cardiology emergencies treated at the ER.
Conclusion: In conclusion, true cardiovascular emergencies stands for 14.6% from
the total of cardiovascular cases treated at ER Wangaya Regional General Hospital on
2017. The biggest proportion of cardiovascular emergencies was acute coronary syn-
drome (47.2%).
Keywords: cardiovascular • emergencies • profile
OR.243. Calabash as a Novel Cardioprotective Agent towards Cardiovascular
Hypoxia due to Catalase Activity
Rio Alexsandro1, Rizal Helmi1, Michele Arviani1, Daniel F. Poso1, Grace Madeleine1,
David Limanan1, Eny Yulianti1, Frans Ferdinal1
1
Departemen of Biochemistry and Molecular Biology, School of Medicine,
Tarumanagara University, Jakarta
Introduction: Cardiovascular disease is a major health problem in some countries
with high mortality and cost burden. Hypoxia plays role in the pathogenesis of many
heart disease. Thus, the best model to achieve this is by animal experiment model.
With the high availability of Herbal in Indonesia, It will be a very promising strategy
way to counter the burden of heart disease. Calabash (Crescentia cujete) is one of
herbs known for its various potency and antioxidant capacities. However, their effi-
cacy as cardioprotective agents remain unknown.
Objective: The purpose of this study is to observe cardioprotective potency in
Calabash
Method: . Calabash leaves were made into simplicia and macerated to obtain the
extract. Control group (normoxia) and Hypoxia (8% O2) for 3, 7, and 14 days. Rats
were divided into 2 group (control and fed by the herbal extracts). At the end of this
we did an evaluation. Blood and heart samples were used for blood gas analysis and
hematology test, also for specific oxidative stress and antioxidant. Capacity of
Extract also measured.
Result: All parameter in blood gas analysis is in line with the Intervention. Specific
Activity of pro-oxidant shows the Pro-oxidant level in plasma and heart tissue
increased significantly. With Calabash leaf extracts showed antioxidant capacities
lower than that of ascorbic acid 158.46 lg/mL. Normoksia (0,00898 6 0,0008 vs
0,00781 6 0,0006), Hypoxia day-3 (0,0155 6 0,0005 vs 0,0122 6 0,001), Hypoxia
day-7 (0,00536 6 0,0007 vs 0,00365 6 0,0005), Hypoxia day-14 (0,0051 6 0,0004 vs
0,00307 6 0,0003). The pro-oxidant is lower, and the antioxidant is higher after the
mice eat the extract of calabash. Statistical Analysis show the significant different
by the use of calabash extract (Mann - Whitney, p < 0,05)
Conclusion: Calabash is a potential cardioprotective agent.
Keywords: Calabash • Hypoxia • Anti-oxidant • Pro-oxidant
Abstracts
OR.244. Incidence of Nephrogenic Systemic Fibrosis in Stage III Renal Failure
Patients After Cardiac Magnetic Resonance Imaging With Gadolinium-based
Contrast Agents: A Single-center Study
Novita G. Liman, Elen, Celly A. Atmadikoesoemah, Manoefris Kasim
Department of Cardiology and Vascular Medicine – Universitas Indonesia, National
Cardiovascular Center Harapan Kita, Indonesian Heart Association
Background: Nephrogenic systemic fibrosis (NSF) has been related to the use of
gadolinium-based contrast agents (GBCAs) in patients with renal insufficiency. There
is no consensus as to whether or not gadolinium-based contrast agents should be
administered to patients with an eGFR of 30 to 60 mL/min/1.73 m2.
Objective: This study aimed at determining the incidence of NSF in patients with
stage III renal failure.
Method: Adult patients with eGFR 30-59 ml/min/1.73m2 receiving a cardiac magnetic
resonance imaging (MRI) prescribed with GBCA were included. Subjects were divided
into group 1 (eGFR 45-59 ml/min/1.73m2) and group 2 (eGFR 30-44 ml/min/1.73m2).
Each patient was followed up to detect any dermatological event that occured 4
weeks after the examination.
Result: A total of 189 patients were included, with 138 patients (73%) in group 1 and
51 patients (26.9%) in group 2. Almost half of group 1 and two-third of group 2
received a linear GBCA. All in all, no patients reveal any evidence of NSF.
Conclusion: The incidence of NSF after a single dose of GBCA is just lower than 2% in
stage IIIA renal failure and 7% in stage IIIB renal failure. When contrast-enhanced MRI
can be essential or even decisive to the diagnosis, these results are important and
reassuring if physicians need to perform contrast-enhanced MRI in stage III renal fail-
ure patients.
Keywords: nephrogenic systemic fibrosis • stage III renal disease • magnetic reso-
nance imaging • gadolinium-based contrast agents
OR.245. Association Between Single Nucleotide Polymorphism Gen SLCO1B1 and
Simvastatin Pleiotropic Effect Measured by Endothelial Function Parameter Flow
Mediated Dilation
Mia Puspitasari, Meity Ardiana, Andrianto
Department of Cardiology and Vascular Medicine, School of Medicine, Airlangga
University, Surabaya, Indonesia
Background: Atherosclerosis is chronic inflammation of medium to large arteries.
Atherosclerosis is known to be the leading cause of coronary artery disease, stroke,
and peripheral artery disease. Endothelial dysfunction is the key of atherosclerotic
process itself. Simvastatin so far known as an agent in term of primary prevention,
not only as cholesterol lowering agent but also famous of its pleiotropic effects at
endothelial cell. Recently, interest in genetic polymorphism involvement at simvasta-
tin resistance issue has already increased. It has been suspected that this issue also
related to simvastatin pleiotropic effect, especially in recovering endothelial
function.
Objective: To determine association between single nucleotide polymorphism
c.521T>C and simvastatin’s pleiotropic effect measured by endothelial function
parameter, flow mediated dilation.
Method: This research was a multicentre cross sectional study including 71 hypercho-
lesterolemia subjects, which already taken simvastatin for at least 3 months. Single
nucleotide polymorphism c.521T>C was identified by real-time polymerase chain
reaction. Flow mediated dilation was measured by right brachial artery
ultrasonography.
Result: The prevalence of SNP c.521T>C among 71 hypercholesterolemia subjects
was 9.9%. There was no significant association between SNP c.521T>C (TC genotype)
and FMD with a p value 0.973 on chi-square analysis. Simvastatin treatment duration
had increased odds (AdjOR: 2.424; CI 1.117-5.260) with a p value 0.025 and also
decreased in systolic blood pressure (Adj.OR: 0,92; CI: 0,025-0,333) with a p value <
0.001 on logistic regression analysis.
Conclusion: There was no association between SNP c.521T>C (TC genotype) and
FMD. Simvastatin treatment duration and systolic blood pressure were significantly
contributing towards FMD.
Keywords: Simvastatin • SNP • pleiotropic • FMD
OR.246. Mortality and Re-hospitalization Among Patients with Hypertensive
Heart Disease and Atrial Fibrillation: A 5-year Retrospective Study
1 1 2 2
Faris Jaisyi Umam , Fadhian Akbar , Arieska Ann Soenarta , Bambang Widyantoro
1
Faculty of Medicine, Universitas Indonesia, 2Department of Cardiology and Vascular
Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center
Harapan Kita Hospital
Background: Hypertension may cause structural changes of myocardium and lead to
hypertensive heart disease (HHD). Atrial fibrillation (AF) is the most common arrhyth-
mia among HHD patients. Further, the presence of HHD and AF is associated with the
increased mortality.
F95
Objective: The aim of this study is to investigate factors associated with mortality
outcome and re-hospitalization in patients hospitalized with HHD and AF.
Method: We extracted 5-year retrospective data of patients with HHD and AF admit-
ted to emergency department (ED) from e-medical record in National Cardiovascular
Center Harapan Kita during 2014-2018. Contribution of demographic characteristic,
admission diagnosis, co-morbidities, length of stay, mortality outcome, and re-hospi-
talization were analyzed with bivariate and multivariate analysis.
Result: A total of 892 patients with HHD and AF were included, 62,2% were male and
35% were above 70 years old. The most common admission diagnosis was acute
decompensated heart failure (ADHF; 55,3%) and AF RVR (16,8%). In-hospital mortal-
ity, re-hospitalization within 1 year, and median length of stay were 3,6%, 19,2%, and
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
4 days (IQR 1-8), respectively. Admission diagnosis was associated with re-hospitaliza-
tion, mortality, and length of stay (p < 0,05). Multivariate analysis shows diabetes
mellitus (OR 0,68; 95% CI: 0,50-0,91), coronary artery disease (CAD) (OR 1,72; 95%
CI: 1,30 – 2,27), valvular heart disease (VHD) (OR 0,44; 95% CI: 0,31 – 0,63), and his-
tory of heart valve surgery (OR 5,96; 95% CI:1,28 – 27,6) were associated with ADHF.
While, DM (OR 0,55; 95% CI: 0,35-0,85), CAD (OR 0,22; 95% CI: 0,13-0,35), VHD (OR
0,33; 95% CI: 0,18-0,58), and Pneumonia (OR 0,32; 95% CI: 0,13-0,75) were associ-
ated with AF RVR in admission.
Conclusion: This study revealed that admission diagnosis was associated with re-hos-
pitalization, mortality, and length of stay among patients with HHD and AF. DM, CAD,
VHD, and Heart Valve surgery were associated with ADHF, while DM, CAD, VHD, and
Pneumonia were associated with AF RVR in admission.
Keywords: hypertensive heart disease • atrial fibrillation • re-hospitalization •
acute decompensated heart failure
OR.247. Major Bleeding Incidences in Dual Anti Platelet Therapy with and
without Clopidogrel in Patients with STEMI after Percutaneous Coronary
Intervention: A Meta-analysis
Y. Purnamasari1, B.A. Mahdi2, J.K. Fajar3
1
Faculty of Medicine, Brawijaya University, Malang, Indonesia, 2Emergency
Departement of Aisyiyah Islamic Hospital, Malang, Indonesia, 3Faculty of Medicine,
Syiah Kuala University, Banda Aceh, Indonesia
Background: Dual anti platelet therapy (DAPT) with or without clopidogrel has been
widely used to treat patients with ST elevation myocardial infarction (STEMI) after
percutaneous coronary intervention (PCI). However, evidences are shown to be con-
flicting. The aim of this study was to compare major bleeding between DAPT with
clopidogrel and without clopidogrel to treat patients with STEMI after PCI.
Methods: A Meta-analysis was performed during October 2018 to March 2019.
Some information related to author’s name and year, sample size, and
frequencies of patients receiving DAPT with and without clopidogrel were extracted
from each study. Overall correlation was determined using fixed or random effect
model.
Result: A total of 10 studies consisting of 75395 patients were evaluated to compare
the incidences of major bleeding between STEMI patients after PCI who treated with
DAPT with and without clopidogrel. Our overall analysis found that the use of DAPT
with or without clopidogrel for treating STEMI patients after PCI had no significant
difference (OR 0.92, 95% CI 0.76-1.13, p > 0.05). Furthermore, in sub-group analysis,
we also failed to confirm the difference between DAPT with clopidogrel and ticagre-
lor, clopidogrel and ticlopidine, and clopidogrel and prasugerol (OR 0.81, 95% CI
0.58-1.12), (OR 1.15, 95% CI 0.68-1.96), and (OR 0.98, 95% CI 0.58-1.66] to incidence
of major bleeding, respectively (p > 0.05).
Conclusion: By evaluating the major bleeding incidences, this meta-analysis reveals
that DAPT with and without clopidogrel has the same outcome. However, further
studies are required to investigate other complications.
Keywords: Major Bleeding • Percutaneous Coronary Intervention • Clopidogrel •
Dual Anti Platelet Therapy
OR.248. Effect of N-3 Polyunsaturated Fatty Acids Supplementation on Mortality
and Rehospitalisation in Heart Failure Patients with Reduced Ejection Fraction:
A Meta-Analysis
Della P. Sari, Lima Peni
RSUD Banyumas, Central Java, Indonesia
Background: European Society of Cardiology suggest the use of n-3 polyunsaturated
fatty acids (n-3 PUFAs) as adjunctive therapy in patients with symptomatic heart fail-
ure with reduced ejection fraction (HFrEF) especially to reduce mortality and reho-
spitalisation. However, some evidence shown inconsistent results.
Objective: A meta-analysis of randomised controlled trials (RCTs) was performed to
determine the benefit of N-3 PUFA on mortality and rehospitalisation in HFrEF
patients.
Method: Literature search was conducted using PubMed, Cochrane Library, and
Science Direct. RCTs comparing N-3 PUFAs supplementation ( 1 g/ daily) with pla-
cebo in HFrEF patients were included, with mortality and rehospitalisation as the
main outcome. Cochrane Risk of Bias Assessment Tool was used to assess the quality
F96 Abstracts

of the study. Heterogeneity, 95% confidence interval and fixed effect model were
used for the meta-analysis.
Result: A total of 6 RCTs including 37.506 patients were eligible for inclusion.
Compared with patients taking placebo, patients in N-3 PUFA groups experienced
slightly lower but not significant cardiovascular death (low heterogeneity I2¼0%,
p ¼ 0.80; RR: 0.97, 95% CI: 0.92-1.03, p ¼ 0.32) and rehospitalisation due to cardio-
vascular events (moderate heterogeneity I2¼61%, p ¼ 0.02; RR: 0.98, 95% CI:0,96-
1.01, p ¼ 0,13). Subgroup analysis from 5 RCTs including 25.001 patients showed simi-
lar rehospitalisation due to heart failure risk compared to placebo group (moderate
heterogeneity I2¼64%, p ¼ 0.03; RR: 1.00; 95% CI: 0.94 – 1.06; p ¼ 0.88).
Conclusion: Daily supplementation with N-3 PUFA supplementation did not reduced
underwent cardiac magnetic resonance imaging to assess cardiac structure and
function. All study participants underwent maximal graded cardiopulmonary
exercise testing with non-invasive gas-exchange and haemodynamic
measurements.
Results: Cardiac torsion was significantly higher (8.162.0 vs. 6.261.7 deg, p ¼ 0.01)
while diastolic function (i.e. early-to-late filling ratio, E/A) was significantly lower
(1.360.5 vs. 2.760.7, p < 0.01) in older age group. Peak cardiac power output was
also significantly lower in older age group (3.360.7 vs. 4.160.8, p ¼ 0.01) as
was peak oxygen consumption (1382.96255.0 vs. 1940.36434.4 mL/min, p < 0.01).
There was a significant negative relationship between cardiac torsion and E/A ratio
(r ¼ - 0.45, p ¼ 0.01) in combined data, while no significant relationship was found

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

cardiovascular mortality and rehospitalisation in heart failure patients with reduced between cardiac torsion and peak cardiac power output (r ¼ - 0.19, p ¼ 0.27) and
ejection fraction compared to placebo. Therefore routine N-3 PUFA supplementation relative oxygen consumption (r ¼ 0.12, p ¼ 0.49).
should be reconsidered due to its high cost and not significant benefit. Conclusion: Cardiac function declines with age. Increased cardiac torsion correlates
Keywords: N-3 PUFA • omega-3 • heart failure • mortality • rehospitalisation with diminished diastolic function in ageing, but does not influence ability of the
heart to respond to exercise.
Keywords: cardiac torsion • cardiac function • cardiac response to exercise •
healthy women • ageing
OR.249. Taurine Has the Potential to Increase Ejection Fraction in Heart Failure:
A Systematic Review and Meta Analysis
Ignatius Ivan1, Stella Kallista1, Indra P. Wendi2, Lisca Namretta2, Alfredo Bambang2, OR.251. Filling the Gaps on Indonesian Heart Failure Real-world Data: What Can
Anton Sumarpo2 We Learn from CORE-HF Surakarta Registry?
1
Faculty of Medicine and Health Science, Atma Jaya Catholic University of Indonesia,
Irnizarifka1, H. Arifianto1, A.K. Martiana1, S.P. Mahaley2, F. Azzumar2
Jakarta, Indonesia, 2Department of Chemistry and Biochemistry, Atma Jaya Catholic 1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
University of Indonesia, Jakarta, Indonesia
Sebelas Maret, Sebelas Maret Hospital, Surakarta, Indonesia, 2General Practitioner,
Research Assistant of CORE-HF
Background: Change in ejection fraction (EF) in heart failure is closely related to
patient survivability. On the other hand, taurine supplementation has been acknowl-
Background: Heart Failure (HF) has been defined as global pandemic, since it affects
edged for its protective effect on cardiac hemodynamic particularly in EF. Therefore,
around 26 million people worldwide and still counting. The prevalence, incidence,
the aim of this systematic review is to investigate the effect of taurine supplementa-
mortality and morbidity rates reported show geographic variations, depending on the
tion on EF in human.
different etiologies and clinical characteristics observed among them. There was
Methods: Our methodology followed the Preferred Reporting Items for Systematic
lack of HF incidence and hospitalization data in Indonesia.
Reviews and Meta-Analyses (PRISMA) guidelines. PubMed database was searched up
Objective: We tried to report our registry data to fulfill those shortages of
to March 2019. The articles were included if: english-language; human study;
information.
randomized controlled trials, and controlled clinical trial while excluded if: taurine
Method: This is a COmprehensive Registry and rEsearch on HF (CORE-HF) done in UNS
mixed with other substances; and population of infant and children. Two authors
Hospital, Surakarta, Indonesia, which was part of Indonesian Working Group on HF
independently assessed the quality of each included study using Cochrane Risk of
(InaHF) national data. All HF patients were included from 2017 and followed until
Bias Tool 2.0 which cover 6 domains with scores of “low”, “high”, or “unclear”.
now.
Results: We retrieved 33 studies. After articles removal, we selected 2 articles for
Result: In 2018, 654 samples were enlisted and HFpEF became the most frequent
review. The studies are randomized, double blind, controlled trial including a total
cases (58.3%), while HFrEF and HFmrEF comprises 31.7% and 10.1% consecutively.
of 22 participants with heart failure administered orally with 0.5-3 gram/day for 8
HFpEF group was more prominent in proportion of initial class 1 functional class and
weeks-3 months. The risk of bias was judged as low in both studies. Meta analysis
hypertension which need CCB more than other groups (30.3% compared with 10.3% in
revealed a significant increase of EF (6.47 (2.98 – 9.95), p ¼ 0.0003) with moderate
HFrEF). In the other hand, HFrEF more prominent in term of echo-based PH probabil-
heterogeneity (I2 57%, p ¼ 0.13) after taurine supplementation for 8 weeks – 3
ity and usage of diuretic as symptom reliever. Etiology of CAD was proven in 26.8%,
month.
35.4%, and 31.8% among HFpEF, HFmrEF, and HFrEF consecutively, and each one-
Conclusion: Despite limited studies available, we concluded that taurine may have
fourth of cases undergone complete revascularization. Rehospitalization within 12
the potential to improve EF. Regading its limited evidence, therefore future studies
months were evidenced more in HFmrEF (21.2%) and HFrEF (20.8%). Those results
with more participants and longer period are encouraged.
are in line with 12-months mortality in which 1.4% happened in HFrEF compared to
Keywords: Taurine • heart failure • ejection fraction • hemodynamics • ventricu-
0.5% in HFpEF.
lar function
Conclusion: We evidenced that HFpEF has better initial functional class and
need more antihypertensive agent due to its HT origin. In the other hand,
HFrEF showed more extensive case in term of PH occurrence, use of diuretic,
OR.250. Relationship between Cardiac Torsion, Diastolic Function, and Cardiac cardiac rehospitalization, and also death. Further real-world data needed to get
Response to Exercise : The Impact of Age better data that can be used as reference for therapy in the region, as it may
Leroy D. Vincent1, Guy A. Macgowan2,3, Djordje G. Jakovljevic2,3 differ.
1
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 2Cardiovascular Keywords: heart failure • registry • real-world data • CORE-HF • surakarta
Research Centre, Institute of Cellular and Genetic Medicine, Newcastle University,
Newcastle Upon Tyne, United Kingdom, 3Newcastle Upon Tyne Hospital NHS
Foundation Trust, Newcastle Upon Tyne, United Kingdom

Background: With ageing, the heart undergoes structural and functional changes
that lower threshold for clinical sign and symptoms. Cardiac torsion, the wringing
motion of the left ventricle, is a variable of interest for its role in cardiac function
and ageing.
Objectives: The aim of the present study was twofold, i) to define the effect of
ageing on cardiac function and structure, and ii) to assess the relationship between
cardiac torsion, diastolic function, and cardiac response to exercise in ageing.
Methods: Thirty-five healthy women grouped according to age (young  50 years
old, n ¼ 20; old  60 years old, n ¼ 15) were selected for the study and
Abstracts F97

OR.251. Table 1 Baseline Characteristic

Variables HFrEF (207; 31.7%) N (%) HFmrEF (66; 10.1%) N (%) HFpEF (381; 58.3%) N (%)

Gender Male 203 (53.5) 51 (77.3) 130 (62.8)

Female 178 (46.7) 15 (22.7) 77 (37.2)
Glycaemic Status Normal 242 (72.7) 39 (66.1) 122 (73.1)
IFG 20 (6) 1 (1.7) 9 (5.4)
IGT 7 (2.1) 1 (1.7) 0
DM 64 (19.2) 18 (30.5) 36 (21.6)
History of HT 319 (83.7) 53 (80.3) 140 (68)

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

History of Smoking 155 (40.7) 42 (63.6) 96 (46.6)
Initial Functional Class Fc. I 61 (25.1) 9 (20) 24 (19.5)
Fc. II 144 (59.3) 30 (66.7) 67 (54.5)
Fc. III 33 (13.6) 4 (8.9) 26 (21.1)
Fc. IV 5 (1.3) 2 (4.4) 6 (4.9)
PH Probable by Echo 109 (28.8) 22 (33.3) 80 (38.8)
AFb 37 (9.8) 8 (12.1) 16 (7.8)
Initial Treatment
Furosemide 81 (21.3) 21 (32.3) 149 (72)
ACEi 313 (82.4) 56 (86.2) 182 (87.9)
ARB 67 (17.6) 9 (13.8) 25 (12.1)
Beta Blocker 343 (90.5) 62 (95.4) 202 (97.6)
Spironolactone 27 (7.1) 6 (9.2) 62 (30)
Ivabradine 8 (2.1) 3 (4.6) 4 (1.9)
Digoxin 2 (0.5) 0 6 (2.9)
Nitrate 32 (8.4) 8 (12.3) 17 (8.2)
CCB 115 (30.3) 9 (13.8) 21 (10.3)
CAD Proven by MSCT/ 100 (26.8) 23 (35.4) 63 (31.8)
Coroangiography
Complete 91 (23.9) 16 (24.2) 53 (25.6)
Revascularization
Rehospitalization
12-mo Cardiac 51 (13.4) 14 (21.2) 43 (20.8)
24-mo Cardiac 1 (0.3) N/A 3 (1.4)
Non Cardiac 38 (10) 4 (6.1) 16 (7.7)
Mortality
Within 12 mo 2 (0.5) N/A 3 (1.4)
Within 24 mo 1 (0.3) N/A N/A

OR.252. A Descriptive Statistics of Rheumatic Fever and Rheumatic Heart
Disease at Tangerang General Hospital in 2014-2019 : A New Local Data
Akhmad I. Nurudinulloh, Putri R. Indrisia, Dezar A. Putra, Siti E. Nauli, Hardja Priatna,
Pudjo Rahasto
Tangerang General Hospital
OR.253. Young Adults with ST Elevation Acute Myocardial Infarction Admitted at
Dr. Kariadi Hospital Semarang : Risk Factors, Angiographic Profile, and Outcome
P.S Putri, A.R. Andini, M.A Sobirin, S. Rifqi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University - Dr. Kariadi Central General Hospital Semarang, Indonesia

Background: Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) remains a
disease of international importance, despite its decline in incidence in developed
countries, they are still major public health problems among children and young
adults in developing countries. However, there are few local data in Indonesia that
describe RF/RHD both descriptively and inferentially study.
Objective: To give an overview of the local data on the incidence of RF/RHD in
Indonesia, especially in Tangerang–Banten.
Method: We analyzed 49 patients on ages under 18 y.o. in the time period 2014 –
2019, who were diagnosed with RF/RHD based on the Jones Criteria which was
revised by WHO in 2003 and recently by AHA in 2015, and have received Guideline
Directed Medical Therapy both primary and secondary prophylaxis.
Result: Patients consist of 44.9% of men and 55.1% of woman. The average age of
patients is 11.12 y.o. with the lowest age diagnosed with this disease is 1 y.o. (a rare
RHD case). We have found that 32.7% of patients had relapsed (50% of men, 50% of
women), 21.7% of patients had Ejection Fraction under 40%, 40.8% of patients had
cardiac sequelae (40% of men, 60% of women) consist of Mitral Stenosis moderate-
severe (5%), Mitral Regurgitation moderate-severe (100%), and Aortic Regurgitation
moderate-severe (25%), and 8.69% of patients had Pulmonary Hypertension. There
were 6.3% of patients had severe RHD and had surgical treatment.
Conclusion: These data indicate that RF/RHD events are still found, the rate of
relapse is still high, and the problem with cardiac sequel in patients is still found.
The prognosis of young Indonesian people diagnosed with RF/RHD is poor; based on
this data, early detection and prompt treatment should be done in order to reduce
the morbidity.
Keywords: rheumatic fever • rheumatic heart disease
Background: In recent decades, the incidence of myocardial infarction is increasing
in younger population, which may caused by increasing prevalence of coronary artery
disease (CAD) risk factors in young adults.
Objective: The purpose of this study was to observe the characteristics of angio-
graphic, risk factors, and outcome in young adults admitted to Dr. Kariadi Hospital
with acute ST segment elevation myocardial infarction (STEMI).
Method: This retrospective study was conducted in Dr. Kariadi Hospital, Semarang,
Central Java. Inclusion criteria including patients less than 45 years old, admitted
with acute STEMI that underwent primary PCI from January 2016 to December 2018.
We observed their clinical characteristics including CAD risk factors, coronary angio-
graphic findings and outcome.
Result: Data were available for 29 patients, 89.7% males and 10.3% females. The
mean age was 39.2 6 4.9 years. In-hospital mortality was documented in 4 patients
(13.7%). The areas of MI were anterior in 16 (55.2%) patients and inferior in 13
(44.8%) patients. Coronary angiographic findings showed that most patients (69%)
had single vessel disease, and left anterior descending (LAD) artery was the predomi-
nantly common infarct-related artery (58.6%). Most of patients had dyslipidemia
(88.9%) and smoker (78.6%), whereas other CAD risk factors were diabetes mellitus
(44.4%), family history of CAD (20.7%) and hypertension (20.7%).
Conclusion: Young adults with STEMI mostly occurred in man and dyslipidemia was
the most common risk factors. Single vessel disease and LAD as the culprit lesion
were predominantly found in coronary angiographic findings.
Keywords: young adult • acute myocardial infarction
F98
OR.254. Mean Platelet Volume was not Associated with CHAD2DS2-Vasc score in
Patients with ST-Segment Elevation Acute Coronary Syndrome
L Morlim., F Esa., Novaro A. Tafriend, Dina A. Permatasari, Sulistiyati B. Utami
Departement of Cardiology and Vascular Medicine, School of Medicine, Diponegoro
University, dr.Kariadi Hospital, Semarang, Indonesia
Backround: Mean platelet volume (MPV) is the most common measurement of plate-
let size. It is a potential marker of platelet reactivity. Elevated MPV is associated
with other markers of platelet activity, including increased platelet aggregation,
thromboxane synthesis and b-thromboglobulin release, and expression of adhesion
molecules. MPV is related to high thrombus burden in patients with ST segment ele-
vation acute coronary syndrome (STE-ACS). CHAD2DS2-Vasc score is a simple tool to
predict thrombus burden in STE-ACS patients. The aim of this study was to evaluate
the association between MPV and CHAD2DS2-Vasc score in STE-ACS undergoing pri-
mary percutaneous coronary intervention (PPCI).
Objective: The aim of this study was to evaluate the association between MPV and
CHAD2DS2-Vasc score in STE-ACS undergoing primary percutaneous coronary interven-
tion (PPCI).
Methods: This was cross-sectional study of 30 consecutive STE-ACS patients under-
went primary PCI between Januari and February 2019. MPV cut off for high thrombus
burden was  9,24 fl. CHAD2DS2-VASc score was calculated at the first admision.
Statistical analysis was performed using Pearson correlation test
Results: Baseline characteristic : age 56.93 6 11.66 years, LAD related infarct ¼ 12
(40%) vs non-LAD related infarct ¼ 18(60%). Use thrombosuction ¼ 12(26.7 %) vs
without use thrombosuction 18 (73.3%). Final TIMI flow < 3 ¼ 8 (26,7 %) vs final TIMI
flow 3 ¼ 22 (73,3%). Mean CHAD2DS2-Vasc was score 1.46 6 1.69. There was no asso-
ciation between MPV and CHAD2DS2-VASc score (p ¼ 0.8)
Conclusion: There were no association between MPV and CHAD2DS2-VASc score in
STE-ACS patients who underwent primary PCI
Keywords: Mean platelet volume • STE-ACS • CHAD2DS2-VASc score.
OR.255. Association Between Sedentary Time and WHtR as Universal Initial
Marker for Cardiovascular Disease Predictor
Devina A. Halim1, A. Stella, Vito A. Damay2
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia, 2Department
of Cardiovascular Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
Background: Obesity is now considered a world epidemic. Waist-to-height ratio
(WHtR) is a simple and universal obesity parameter which is not limited by ethnic,
gender nor age. Based on meta analysis, WHtR is more superior predicting the preva-
lence of cardiovascular disease (CVD). Recently, meta-regression analysis study found
the link between high sedentary duration and all-cause mortality in adults. Many
studies stated increasing sedentary behaviour leads to obesity, as a conventional risk
for CVD. However, there is limited data in Indonesia analyzing WHtR and sedentary
duration, especially in young adults.
Objective: The aim of the research is to find the association between the sedentary
time and WHtR as the universal initial marker for CVD predictor.
Method: This was a cross sectional study conducted in our institution at Tangerang.
Data collection started from January-March 2019. Sedentary Behaviour Questionnaire
(SBQ) was used to assess sedentary time during weekday and weekend to get average
time per day. The cut-off for sedentary duration is > 7 hours. Healthy young adults
were measured for WHtR, defining obesity with cut off higher than 0.5. Results was
analyzed using SPSS.
Result: There were 136 subjects in this study, consists of 46(33,8%) males and
90(66,2%) females, with mean age 19,8261,2. Among them, 64 subjects defined as
obese. From the measurements, WHtR in sedentary (n ¼ 77,56,62%) and non-seden-
tary (n ¼ 59,43,38%) population were found 0,5260,08 and 0,4960,07 (p ¼ 0.015),
consecutively. Between 9 mentioned sedentary activities in SBQ, there was a correla-
tion between WHtR and playing video games or sitting in front of the computer with
r ¼ 0,268 and p ¼ 0,002.
Conclusion: WHtR were significantly increased in sedentary people thus increasing
the risk of cardiovascular metabolic risk and mortality. Playing video games or sitting
in front of the computer is the only significant cause correlated with increasing
WHtR in our study based on SBQ.
Keywords: waist-to-height ratio • sedentary behaviour • obesity
OR.256. CHA2DS2 VASc Score Was Associated With The Use Of Thrombosuction In
Patient With STE-ACS Who Underwent Primary PCI
Novaro A. Tafriend, F Esa, L Morlim, A Carina, Dina A. Permatasari, Sulistiayati B. Utami
Department of Cardiology and Vascular Medicine, Scholl of Medicine, Diponegoro
University, Kariadi Hospital, Semarang, Indonesia
Background: Routine thrombus aspiration in patients undergoing primary percutane-
ous coronary intervention (PPCI) for ST-segment elevation Acute Coronary Syndrome
(STE-ACS) does not improve clinical outcomes. The 2017 ESC guideline still catego-
rized routine thrombosuction for patient with STE-ACS as class III recomendation.
Abstracts
CHA2DS2-VASc score is known closely related to thrombosis event. We aimed to inves-
tigate the association between CHA2DS2-VASc score and the used of thrombosuction
in patients with STEMI who underwent PPCI.
Method: In the study; a total of 30 consecutive STE-ACS patient underwent PPCI in
dr.Kariadi General Hospital between Desember-March 2019 were included. Patients
were divided into 2 groups, with use of thrombosuction during PPCI and without use
of thrombosuction during PPCI. CHA2DS2-VASc scores were calculated for all patients.
CHA2DS2 2 categories as high Thrombosis state. Statistic analysis using chi-square.
Result: STE-ACS patients underwent primary PCI showed baseline characteristic : age
56.93 6 11.66 (male 86%), 40 % infarct related LAD, 60% non-LAD, patients with
CHAD2DS2-Vasc < 2 ¼ 13 (43.3%),  2 ¼ 17 (56.7%), use trombosuction ¼12 (26,7 %)
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
vs 18 (733%), there were moderate correlation between CHA2DS2 VASc score with use
of thrombosuction (p < 0.036)
Conclusion: High CHA2DS2 VASc Score was associated with the use of thrombosuction
in patient with STEMI who underwent Primary PCI.
Keywords: CHA2DS2 VASc • STE-ACS • Thrombosuction.
OR.257. Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio
(PLR) as Inflammatory Markers for Outcomes Prediction of Fibrinolytic Therapy
in STEMI Patients
Ayu A.D. Adityawati1, Nizamuddin Ubaidillah2, Setyasih Anjarwani1, Indra Prasetya1
Department of Cardiology and Vascular Medicine, 1School of Medicine, Brawijaya
University, Malang, Indonesia, 2Dustira Military Hospital, Cimahi, Indonesia
Background: ST elevation myocardial infarction (STEMI) is the most common acute
coronary syndrome in adults. The platelet activation plays a central role in the initia-
tion and progression of atherosclerosis. Fibrinolysis as reperfusion therapy will be an
immediate action for restoration the blood flow. The inflammatory markers such as
neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have
been shown to be prognostic parameter outcomes among survivors of STEMI.
Objective: To evaluate the association between inflammatory marker and outcomes
in fibrinolysis.
Method: A retrospective cohort study was done to collect samples according to the
inclusion criteria. Subject was classified into two groups (success and failed fibrino-
lytic). The NLR, PLR, and also platelet value has been collected and t-test analysis
were done to evaluate an association in fibrinolysis outcomes.
Result: A total 84 STEMI patients received fibrinolytic therapy. There was significant
mean difference of leucocyte level between success and failed fibrinolytic
(1157965787 vs 1420064041/mL respectively, p ¼ 0.018). A NLR mean showed the
significant associated in successful fibrinolytic (4.689863.81736 vs 7.302463.41675
respectively, p ¼ 0.001), inversely to PLR and Platelet mean value. The success fibri-
nolytic commonly found in anterior infarct area compare with inferior (58.9% vs
32.1%, respectively, p ¼ 0.037). Interestingly, there was no differences in age, gender
and killip classification within two groups.
Conclusion: The NLR as an inflammatory marker, leukocyte value, and infarct area
were significantly association with success fibrinolytic therapy
Keywords: STEMI • Fibrinolytic • Leukocyte • NLR • PLR
OR.258. Correlation between White Blood Cells Counts and TIMI Risk Score in ST-
elevation Myocardial Infarction
Hari H. Satoto, Robert A. Raharjo, H. Haryadi, Sulistiyati B. Utami
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Diponegoro
University – Dr. Kariadi General Hospital, Semarang, Indonesia
Background: An elevated white blood cells count was an indicator of systemic
inflammation. White blood cells count is commonly elevate in acute myocardial
infarction. Both white blood cells count and TIMI risk score were known as mortality
predictors in ST-elevation myocardial infarction (STEMI). However, there is lack of
data available that correlates between white blood cells count and TIMI risk score in
STEMI.
Objective: The objective of this study was to find correlation between white blood
cells counts and TIMI Risk Score in patients with ST-elevation myocardial infarction.
Method: Patients with STEMI undergoing primary percutaneous coronary intervention
in Kariadi General Hospital between January 2016 – May 2017 were enrolled in this
study. Both white blood cells count and TIMI risk score were obtained during
patients’ admission in the emergency room. White blood cells count was obtained
using vein blood samples. TIMI risk score in STEMI was a summation of patient’s age,
history of diabetes, hypertension, and angina, systolic blood pressure, heart rate,
Killip class, bodyweight, infarct location, and time to treatment.
Result: There were 40 patients (age 56611 years old, 85% male). The mean white
blood cells count was 13,556þ4,932/microliter and the median TIMI risk score was 4
(range, 1 – 7). White blood cells count had a significant positive weak correlation
with TIMI risk score (r ¼ 0.37, p ¼ 0.018) in patients STEMI.
Conclusion: White blood cells count has a weak correlation with TIMI risk score in
STEMI patients.
Keywords: white blood cells count • TIMI risk score • STEMI
Abstracts
OR.259. Coagulation Test Profile in Non ST-Elevation Acute Coronary Syndrome
Treated by Enoxaparin Versus Fondaparinux in Adam Malik General Hospital
Nazif Fuadi Noer, Harris Hasan, Ali NafiahNasution
Department of Cardiology and Vascular Medicine, School of Medicine, University of
North Sumatera, Medan, Indonesia
Background: In recent years, low-molecular weight heparin (LMWH) has gradually
been replacing unfractioned heparin (UFH) for the prevention and treatment of
venous and arterial thrombosis. The effect of LMWH on the activated clotting time
(ACT) has been less well studied, but there is some evidence that LMWH also has less
of an effect on the ACT than UFH. Fondaparinux is a new indirect anti-factor Xa anti-
coagulant of the heparin family, a few cases of thrombocytopenia associated with
the use of fondaparinux have been reported.
Objective: Aim of this study is to compare the effect between enoxaparin and fonda-
parinux on coagulation test profile of NSTEACS patient in Adam Malik General Hospital.
Methods: Total 41 patients NSTEACS whom hospitalized in cardiovascular intensive
care unit (CVCU) of Adam Malik General Hospital from August 2017 to November
2018 were enrolled and compared into 2 groups: enoxaparin anticoagulation and fon-
daparinux anticoagulation. Thrombocyte count (TC), aPTT, and INR as target evalua-
tion of anticoagulant therapy were analysed using independent sample T-test.
Result: From baseline characteristic, 21 patients (51.2%) got enoxaparin anticoagula-
tion and 20 patients (48.8%) got fondaparinux anticoagulation which average of anti-
coagulation duration was 5 days. Mean of age was 54.56 years and majority patients
were presented as NSTEMI (75.6%). From coagulation test analysis, we found mean of
TC, aPTT post anticoagulation, aPTT ratio, and INR were 307.585, 37.59, 1.19, and
1.2 respectively. Final analysis revealed that no statistically difference of TC change
between 2 groups (p ¼ 0.59). Still aPTT post anticoagulation, aPTT ratio, and INR
were higher in fondaparinux group (p ¼ 0.36; 0.22; 0.21).
Conclusion: There is no difference of TC change in anticoagulant administration of
enoxaparin and fondaparinux. Meanwhile, coagulation test value of aPTT post antico-
agulation, aPTT ratio, and INR are higher in fondaparinux administration.
Keywords: anticoagulation test • NSTEACS • thrombocyte • enoxaparin •
fondaparinux
OR.260. The Role of Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte
Ratio Level in Acute Myocardial Infarction Events in North Kalimantan Population
Y.C. Nuraini, F. Ahmad, D.S. Syamsul, M.H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan
Background: Neutrophilia, thrombocytosis, and lymphopenia are related to systemic
inflammation severity that has become one of the main pathogenesis for acute coronary
syndrome event. Inflammation occurs from early stages of atheroma formation to plaque
rupture and thrombosis. Haematology laboratory, especially platelet-lymphocyte ratio
(PLR) and neutrophil-lymphocyte ratio (NLR) have been widely known for its role in diag-
nostic and prognostic of acute coronary syndrome patients. This study evaluates the role
of platelet, neutrophyl, and lymphocyte as associate marker for ST-elevation myocardial
infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) events in North
Kalimantan population, sampled from Tarakan Registry of Acute Coronary Syndrome.
Methodology: In this study, we used consecutive sampling where 94 patients regis-
tered with acute myocardial infarction in RSUD Tarakan, North Kalimantan for period
2017 until 2018. It consisted of 47 patients with STEMI and 47 patients with NSTEMI.
Haematology laboratory test was taken when the patients is on admission. This data
was analyzed using comparative t-test.
Results: The mean of PLR in NSTEMI patient was 147.1þ16.8 and 217.02þ58.6 in
patients with STEMI. This difference has a significant meaning with p value is 0.043.
Meanwhile, the mean of NLR in STEMI (6.4þ1.44) and NSTEMI (5.9þ1.32) patients
were not significantly different (p : 0.21). This PLR value is associated with thrombus
formation and extensive heart damage where higher PLR value leading to more
extensive myocardiac injury.
Conclusion: Our study demonstrated that there is a significant difference of PLR in
patients with STEMI and NSTEMI. STEMI patients have higher PLR level than NSTEMI
because its inflammatory response is more severe, the injury of myocardium is more
extensive, and the thrombus formation is larger leading to much less blood supply.
Higher PLR value has more tendency to the occurence of STEMI than NSTEMI. NLR is
not significantly different for STEMI and NSTEMI events.
Keywords: Acute Myocardial Infarction • Neutrophil-Lymphocyte Ratio • Non-ST
Elevation Myocaridal Infarcition • Platelet Lymphocyte Ratio • ST Elevation
Myocardial Infarction
OR.261. Admission Blood Glucose as an Independent Mortality Predictor in
Patients with Acute Coronary Syndrome
D. Rifanda, W. E. Setiawan, F. Ahmad, D. S. Syamsul, M. H. Hasyim
Tarakan Regional General Hospital, North Kalimantan
Background: Abnormal glucose metabolism carries detrimental impact to a worse
outcome in acute coronary syndrome patients. Nonetheless, the parameter is often
F99
being overlooked and does not included in any risk predictor. We believe that blood
glucose at admission is not merely ordinary glucometabolic state, but also a marker
of stress that contains prognostic value, regardless of diabetic status in all spectrum
of Acute Coronary Syndrome patients.
Objective: We inquire to evaluate whether or not the blood glucose value at admis-
sion alone carries impacts to in hospital mortality.
Method: Assessment of predictive value of death by admission blood glucose were
done by comparing patients with or without hyperglycemia and the incidence of in
hospital mortality, the comparison were conducted using chi square test.
Hyperglycemia is defined as elevated blood glucose at admission (>200 mg/dl) . The
significance of the results was determined in 95.0% confidence interval and a value
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
of p < 0.05 was considered to be statistically significant.
Result: The risk of incidence in hospital mortality was more significantly associated
in patients with elevated blood glucose at admission, they have 4.5 times higher risk
compared to patients with blood glucose below set points, (p ¼ 0,02; RR ¼ 4.5, 95%
CI 1,203 – 16,83).
Conclusion: Elevated glucose level on admission in ACS patients remains to be an
independent significant predictor of in hospital mortality
Keywords: Admission Blood Glucose • In Hospital Mortality • North Kalimantan
OR.262. Myocardial Infarction in Use of Antipsychotic Drug: A Meta-Analysis
W.A. Prastara
Bali Psychiatric Hospital, Bali, Indonesia
Background: The use of antipsychotic medication has greatly increased over the last
fifteen years. Recent evidence suggests that psychiatric patients may be at increased
risk for cardiovascular events, there is an emerging concern that antipsychotic drug
may be associated with an increased risk of myocardial infarction.
Objective: The aim of this study is to analyze published data from studies about
myocardial infarction in use of antipsychotic drug.
Methods: We made an electronic database search in Pubmed from last five years for
randomized, controlled trials of myocardial infarction in the use of antipsychotic
drug. Odds ratio (OR) and 95% confidence intervals (CI) were measured using the
RevMan 5.3 computer program.
Result: A total of 96430 patients from four major trials were included. The odds ratio
in use of antipsychotic drug associated with increased risk of myocardial infarction
was 1.65, with 95% CI was 1.12-2.43 (P ¼ 0.00001). Data were derived from the ran-
dom effects model due to the heterogeneous result between studies (I2 ¼97%).
Conclusion: The result of this meta-analysis supports an antipsychotic drug use may
be associated with an increase in risk for myocardial infarction. Further research is
required to clarify underlying biological mechanisms.
Keywords: myocardial infarction • antipsychotic drug • increased risk • meta-
analysis.
OR.263. Impact Duration of Haemodialysis on Left Ventricular Ejection Fraction
and Tricuspid Annulus Plane Systolic Excursion: Meta-Analysis
Dista Y. Pertiwi, Dini Rostiati
Department of Cardiology and Vascular medicine, Bandung Regional Public Hospital,
Indonesia
Backround: Chronic Kidney Disease (CKD) have associated with cardiovascular dis-
eases. Early diagnostic of CVD (Cardio Vascular Diseases) as risk factor in CKD espe-
cially of haemodialysis patients. Echocardiograph shown some information about
heart function and structure to know association between theirs. Decrease Left
Ventricular Ejection Fraction (LVEF) over time in haemodialysis patients may be due
to negative effect of CKD. Tricuspid Annulus Plane Systolic Excursion (TAPSE) is one
method to measure systolic function of right ventricle.
F100
Objective: To analysed Impact Duration of Haemodialysis on Left Ventricular
Ejection Fraction and Tricuspid Annulus Plane Systolic Excursion
Method: Thirty haemodialysis stable patients in September-November 2018 at
Bandung Regional Public Hospital were subjected to evaluated by transthoracic echo-
cardiographic. We were analyzed association between LVEF and TAPSE and duration
of haemodialysis. Value of these are 50% for LVEF, 16mm for TAPSE and 1 year for
duration of haemodialysis.
Result: In Normal LVEF, there are 18 (60.00%) patients doing haemodialysis over 1 year
and 6 patients (20.00%) doing less of it. In decreasing LVEF, there are 6 patients
(20.00%) doing haemodialysis over 1 year and no one doing haemodialysis less 1 year. In
Normal TAPSE, there are 23 (76.67.00%) patients doing haemodialysis over 1 year and 2
patients (6.67%) doing less of it. In abnormal TAPSE, there are 2 patients (6.67%) doing
haemodialysis over 1 year and no one doing haemodialysis less 1 year and 3 patients
(10.00%) haemodialysis less 1 year. We were analyzed association between LVEF and
duration of haemodialysis with chi-square test p 0.171. Beside that, association
between TAPSE and duration of haemodialysis with chi-square test p 0.049. In this ana-
lisis, TAPSE have associated with duration of haemodialysis, but LVEF does not have it.
Conclusion: In our analyzed, there is has association between TAPSE and duration of
haemodialysis. For different result from other analyses, we must compare and know
weakness of the research.
Keywords: Haemodialysis • LVEF • Echocardiographic
OR.264. Clinical Outcomes of Tricuspid Regurgitation in Mitral Valve Surgery
Patients
Myat Hsu Aung, Khin Mg Lwin, Aung Zaw Myo
Department of Cardiovascular surgery, University of Medicine(1), Yangon, Myanmar
Background;: Functional tricuspid regurgitation (TR) is frequently associated with
rheumatic mitral valve (MV) disease. The aim of this study is to evaluate outcomes
of TR in patients undergoing MV surgery.
Objective;: To study functional status,preoperative and postoperative echocardio-
graphic parameters of TR
Method;: This prospective descriptive study started from January 2018 to December
2018. Based on 83patients admitted for MV surgery, had moderate to severe func-
tional TR,Under replacement method of 66patients,48 underwent tricuspid valve
annuloplsty(TVA) by using flexible ring and another18patients using glutaraldehyde
treated autologous pericardium method. Under MVrepair method,17 received TVA
using flexible ring.The procedure were conducted with the results of each patient
monitored under each group of replacement and repair.
Result;: The mean age was 42.7 years.By clinical and echocardiographic follow-up
based on observations and findings after 1 week of surgery in 48patients using
ring,14 with no TR(29.2%),32 with mild TR(66.7%),2 with moderateTR(4.1%).After
3months,28 were without TR(58%)and 20 with mildTR(41.7%).The other group of
18patients using pericardium method with similar clinical and echocardiographic
findings based on after 1week ,15 with mildTR(83%),2 with moderateTR(11%),1 with
severeTR(5.6%). After 3months,8 with noTR(44%),9 with mildTR(50%),1 with
moderateTR(5.6%).Another group of MVrepair 17 patients based on findings after
1week,7 with no TR(41.2%),10 with mildTR(58%).After 3months,11 with no
TR(64.7%),6 with mildTR(35.3%). Early mortality was 2.4%in ring group.One patient
using pericardium came back with pericardial effusion.Right ventricular reverse
remodeling was marked in both groups. No patients were re-operated. All patients
had few or no symptoms(NYHA IorII) after surgery.
Conclusion;: Patients undergoing MV surgery concomitant TVA show reduced rate of
TR progression, improved right ventricular reverse remodeling and better functional
outcomes.
Keywords: • Rheumatic mitral valve disease • MV surgery • Tricuspid regur-
gitation • Tricuspid valve annuloplasty • Outcomes
OR.265. Preeclampsia is Associated with Left Ventricle Concentric Hypertrophy
and Diastolic Dysfunction
A. Chairunnisa, P.S. Putri, U. Bahrudin, S. Sungkar, M.A. Nugroho
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University - Dr. Kariadi Central General Hospital Semarang, Indonesia
Background: Pregnancy induces cardiovascular changes in order to meet the increas-
ing metabolic needs. Adaptive change of left ventricle (LV) might be modified in
pregnancy complicated by preeclampsia.
Objective: Aim of this study was to observe left ventricular function profile in
patients with preeclampsia.
Method: This was a retrospective study involved patients with preeclampsia at The Dr.
Kariadi Central General Hospital Semarang, from June 2016 to June 2018. Transthoracic
echocardiography was done and LV mass index (LVMI), relative wall thickness (RWT) and
diastolic function were analyzed by E/A ratio, E/e’, and E Deceleration time.
Result: A total of 23 patients age 30.566.3 years old with gestation week 3464
weeks were enrolled. The systolic and diastolic blood pressure 149618 mmHg and
95614 mmHg. Data showed 10 (40%) patients had left ventricular concentric
Abstracts
hypertrophy, 6 (24%) patients had eccentric hypertrophy, 2 (8%) patients had concen-
tric remodeling, 5 (20%) patients within normal limits. There were 7 (30%) patients
with reduce systolic left ventricular function (LVEF <56%). Diastolic function showed
15 patients (60%) had grade II diastolic dysfunction, 3 (12%) patients had grade I dia-
stolic dysfunction, 1 (4%) patients had grade III diastolic dysfunction, and 4 patients
can’t be evaluated.
Conclusion: Preeclampsia is associated with left ventricle concentric hypertrophy
and diastolic dysfunction. Echocardiography is a valuable tool to stratify risk and
guide management and counseling in preeclampsia.
Keywords: preeclampsia • echocardiography • left ventricular function
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.266. Echocardiography and Catheterization Data Characteristic of
Percutaneous Balloon Mitral Valvuloplasty During 2016-2019 in Doctor Kariadi
Hospital
M.G. Wahyuni, D.E. Wismiyarso, L. Effendi, M.A. Nugroho, S. Rifqi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University, Dr. Kariadi Central General Hospital Semarang, Indonesia
Background: A mitral valve gradient (MVG) that decreases to 50% post-Percutaneous
Balloon Mitral Valvuloplasty (PBMV) and a mitral valve area (MVA) that roughly
increases by 100% or > 1.5 cm2 without significant mitral regurgitation (MR) are
hemodynamic criteria used to gauge success. Aim of this study was to describe the
characteristics of echocardioraphy and catheterization findings in patients post PBMV
enrolled in Doctor Kariadi Hospital, Semarang. This study compares about MVG and
MVA which examined pre and post PBMV.
Methods: This was a retrospective study involved patients with PBMV enrolled in
Doctor Kariadi Hospital, Semarang between January 2016 and February 2019. Pre and
post- PBMV data echocardiography about Wilkins score, MVA post procedure, left
ventricular ejection fraction, MR, and complication post procedure was noted. This
study also compares MVG pre and post procedure by catheterization.
Results: Overall, number of PBMV had been done in Doctor Kariadi Hospital,
Semarang were sixteen in 2016, twenty-one in 2017, twelve in 2018, and six in
January-February 2019 – totally 55 procedures had been done. From pre PBMV echo-
cardiography, three patients had Wilkins score more than 8 (0.05%), 24 patients had
mild MR (0.43%). Post PBMV, the iatrogenic atrial septal defect found in eight
patients (14%) with estimation 1-6 mm, MVA increases >1.5 cm in 33 patients (60%).
From catheterization data, MVG decreases > 50% post procedure in 45 patients
(81%).
Conclusions: PBMV improve MVA and decrease MVG examined by echocardiography
and catheterization which analyzed pre and post procedure. Trends of procedure
were increase by years with successful criteria about 81%. The rest unsuccessful pro-
cedures need to futher investigated.
Keywords: percutaneous balloon mitral valvuloplasty • mitral valve gradient •
mitral valve area
OR.267. Platelet-to-Lymphocyte Ratio as Simple Haematological Biomarker for
Predicting Risk of Mortality in Patients with Non-ST Segment Elevation
Myocardial Infarction
Winardi E. Setiawan, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: Despite of decreasing in past 20 years, mortality rate of patient with
Non-ST segment elevation myocardial infarction (NSTEMI) was still high. Global
Registry of Acute Coronary Events (GRACE) score is a useful tool to predict in-hospital
and 6-month post discharge mortality rate in NSTEMI patients. A hematological bio-
marker platelet-to-lymphocyte ratio (PLR) was considered simple and stable parame-
ter compared to others hematological parameters for predicting clinical outcomes in
acute coronary syndromes.
Objective: This study aimed to determine the relationship between PLR and GRACE
scores for predicting the risk of in-hospital mortality and 6-month post-discharge
mortality in NSTEMI patients.
Method: Data were obtained from the Tarakan Registry of Acute Coronary Syndrome
(TRACS) in 2017-2018. This study was a cross-sectional study with NSTEMI patients as
subject. Sample of subject was taken using consecutive sampling technique. Data
were analyzed using Pearson’s correlation and the cut-off points for high risk in-hos-
pital and 6-month post-discharge mortality was determined using ROC curve.
Result: A total of 54 medical records were analyzed. The mean of PLR in the popula-
tion was 135.75 6 80.17, while the mean of GRACE score was 108.13 6 31.89. The
correlation of log-PLR and GRACE score was moderate (r ¼ 0.42, p<0.01). PLR cut-off
point for high risk in-hospital mortality prediction (>3%) was 124,96 (sensitivity 80%,
specificity 69%, p<0.01), while PLR cut off for high risk 6-month post-discharge mor-
tality (>8%) was 108,81 (sensitivity 77%; specificity 60%; p¼0,01).
Conclusion: There was a moderate correlation between PLR and GRACE score. PLR
value can be used to predict the risk of in-hospital and 6-month post-discharge
mortality.
Keywords: PLR • GRACE • NSTEMI • mortality • correlation
Abstracts
OR.268. Association of Waist-to-Height-Ratio and Resting Heart Rate in Young
Adult as a Surrogate Marker of Cardiovascular Risk Factor and Mortality – A
Preliminary Study
Stella Angelina1, Devina A. Halim1, Vito A. Damay2
1 thrombotic occlusion.
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia, 2Department
of Cardiovascular Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
Background: Increased resting heart rate (RHR) has been associated with various
metabolic-cardiovascular diseases, as well as cardiovascular mortality. One of the
contributing factors to the increase in RHR is obesity. Obesity can be assessed using
the latest universal indicator, the waist-to-height ratio (WHtR). Compared to other
more well-known parameters, namely BMI and waist circumference, WHtR is superior
in assessing cardiovascular risk. It is because WHtR accounts for distribution of fat in
abdomen and also the individual’s height, as highlighted in the latest European
Society of Cardiology (ESC) Congress 2018. Meanwhile, the young adult population is
selected considering the strong relationship between young adult obesity and
adverse cardiovascular event later in life.
Objective: The aim of this study is to analyze the association between WHtR and
resting heart rate in young adults.
Method: A cross sectional study was performed to 56 young adults aged between 18-
25 years old with no known chronic disease. The measurement of height, waist cir-
cumference, and heart rate of 1 minute was done in Universitas Pelita Harapan in
March 2019. The definition of obesity using WHtR by Ashwell indicates the value
of  0.5 as obese.
Result: The mean age of the participants are 19.8360.7 in males (n ¼ 23) and
20.0961.1 females (n ¼ 33). There were 22 subjects classified as non-obese and 34
subjects classified as obese with mean WHtR 0.45260.024 and 0.55860.061 consecu-
tively. The mean HR for non-obese dan obese group were 77.8267.268 and
85.0967.459 respectively. Based on pearson correlation test, pearson correlation
coefficient ¼ 0.432; p ¼ 0.001.
Conclusion: A positive moderate correlation was significantly found between WHtR
and RHR. Thus, WHtR might be a good predictor of resting heart rate, which has a
linear relation with risk of cardiovascular morbidity and mortality.
Keywords: waist-to-height ratio • resting heart rate • young adult
OR.269. High Atherogenic Index Plasma Correlates with Severe Coronary Artery
Stenosis in Patient with Stable Coronary Artery Disease at Sanglah Hospital
1 1 2 computed tomography (MSCT) is a widely available imaging modality with dual prop-
D. G. Widyawati , I G. N. P. Gunadhi , W. Gotera
1 erties. Beside its ability to rule out coronary problem in HF, with a more novel tech-
Cardiovascular Departement, Faculty of Medicine, Udayana University, Denpasar,
Indonesia, 2Internal Medicine Departement, Faculty of Medicine, Udayana University,
Denpasar, Indonesia
Background: Dyslipidemia identified as the most important risk factor that correlate
with coronary heart disease. Framingham study showed role of lipid profile in CAD
progression and LDL-C as a primary target therapy. However, LDL-C levels within tar-
get goal is not enough to identify patient with CAD because approximately 50% cardi-
ovascular events happened in subjects with normal LDL-C levels. Hypothetically,
residual risk factors, such as atherogenic dyslipidemia, with characteristic low HDL-C
levels, high TG levels, and high sdLDL levels, contribute to this phenomen.
Atherogenic index plasma (AIP), calculated as log TG/HDL, has reverse correlation
with LDL particle diameter and reflect sdLDL. AIP considered as CAD indicator that
more economic and can be trusted. In this research, we studied correlation between
AIP and degree of coronary artery stenosis in stable CAD patients.
Methods: A hospital based cross sectional study including 66 stable CAD patients was
conducted. AIP value and SYNTAX score were calculated based on medical record
data.
Results: The result of Pearson correlation analysis indicated that AIP was positively
and significantly associated with coronary artery stenosis (RP 7.43, p ¼ 0.001, 95% CI
1.83-30.18). In the multivariate logistic regression analysis, AIP was strongly associ-
ated with coronary artery stenosis and independent risk factor for severe coronary
artery stenosis (RP 11.51, p ¼ 0.001).
Conclusion: High AIP value associated with severe coronary artery stenosis in stable
CAD patients at Sanglah general hospital.
Keywords: stable coronary artery disease • atherogenic index plasma • coronary
artery stenosis
OR.270. Neutrophil to Lymphocyte Ratio as a Prognostic Factor of ST Elevation
Myocardial Infarction After Hospitalization at Tarakan Regional Public Hospital
North Kalimantan
Steffiany, Winardi E Setiawan, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan
Background: Myocardial infarction is one of the leading causes morbidity and mortal-
ity in the world. In 2018, North Kalimantan has the most patients with cardiac insuf-
ficiency in Indonesia. STEMI has a high early and late morbidity and mortality rate
dependent upon initial clinical presentation. Atherosclerosis has been shown as one
F101
of pathogenic mechanism leads to occlusion in ST elevated myocardial infarcts
(STEMI). Atherosclerosis comes from inflammation of the vessel wall involving initia-
tion, progression and destabilitation of plaque. In early phase of plaque, lymphocytes
and monocytes are found, whereas neutrophils play a major role in disruption and
Objective: This study aim to correlate the neutrophil to lymphocytes ratio (NLR) on
admission with the outcome after hospitalization.
Methods: This study derived from Tarakan registry of acute coronary syndrome
(TRACS) in Tarakan regional public hospital. This study involved hospitalized 60
STEMI cases from January 2017 till December 2018. STEMI patients, are admitted
either from emergency room or clinic. The blood sample was taken in 6 hours after
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
admission. Outcome was divided in good and poor outcome group. Poor outcome
include death, cardiogenic shock, arrhythmia, failed of fibrinolysis, heart failure,
valve insufficient and recurrent MI. All data was analyzed with logistic regression to
predict the ability of NLR value to outcome.
Result: There are 60 patient included in this study, consists of 51 men and 9 women.
Age mean of this study is 54.92612; and the mean of Neutrophil to lymphocytes ratio
(NLR) was 4.88 6 4.05. In this study, there’s no significant relation between NLR and
patients outcome. The P value of NLR to patients outcome was 0.820 with Odds ratio
(OR) 0.984.
Conclusions: NLR value on admission cannot be used for patients prognostic factor
after hospitalization in Tarakan regional public hospital, North Kalimantan.
Keywords: NLR • STEMI • Atherosclerosis • Prognosis • Hospitalization
OR.271. A Pilot Study of Computed Tomography Myocardial Perfusion Imaging at
Rest as A Prognostic Marker for Left Ventricular Ejection Fraction Improvement
in Heart Failure Reduced Ejection Fraction Patients with Guideline Directed
Medical Therapy
Sofina Kusnadi1, Annisa Tridamayanti2, Shigma P. Mahaley3, Habibie Arifianto4,
Irnizarifka5
1,2
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas
Maret University, Surakarta, Central Java, Indonesia, 3,4,5Department of Cardiology
and Vascular Medicine, Universitas Sebelas Maret (UNS) Hospital, Sukoharjo, Central
Java, Indonesia
Background: Heart failure (HF) has become a global pandemic and burden. Multislice
nique, it can also asses myocardial perfusion. CT myocardial perfusion imaging (MPI)
is able to detect myocardial ischemia at rest. However, only limited data is available
worldwide.
Objective: This study is aimed to prove the ability of CT MPI at rest in predicting
functional improvement of heart failure reduced ejection fraction (HFREF) in guide-
line directed medical therapy (GDMT).
Method: Forty-seven patients with HFREF were consecutively assessed at HF Clinic in
UNS Hospital from January to June 2018. Baseline left ventricular ejection fraction
(LVEF) was measured by echocardiography with biplane Simpson method. Then, con-
trast coronary CT was performed to rule out coronary artery disease (CAD) as etiology
of HF and to assess myocardial perfusion at rest. Patients were followed up for LVEF
after given approximately 6 months of GDMT.
Result: Data from 47 patients were assessed and divided into two groups of patients
with 2 and >2 perfusion defect segments. The group with 2 perfusion defect seg-
ments showed more significant improvement of LVEF compared to the other group
with mean improvement 27.9 611.85 % vs. 11.86 9.79 % (p < 0.001). A receiver
operating characteristic (ROC) curve analysis revealed perfusion defect segments 2
has an area under curve (AUC) 0.789 with 72.2% sensitivity and 81.1% specificity for
predicting improvement of LVEF.
Conclusion: This study showed that MSCT can be used as a one stop solution to evalu-
ate anatomy and function in HFREF patients. It also offers the ability as a prognostic
marker of LVEF improvement. Moreover, it is widely available, less invasive, more
convenient, and cost-effective.
Keywords: Heart failure • myocardial perfusion • rest perfusion CT • LVEF
OR.272. Comparison of Antihypertensive Effect between Valsartan 160 mg and
Candesartan 16 mg in Reducing Systolic and Diastolic Blood Pressure in Healthy
Adults
Alfianto Martin1, Johan2, Marcella E Rumawas3
1
Internal Medicine Department, School of Medicine, Tarumanagara University,
Jakarta, Indonesia, 2Pharmacology Department, School of Medicine, Tarumanagara
University, Jakarta, Indonesia, 3Public Health Department, School of Medicine,
Tarumanagara University, Jakarta, Indonesia
Background: By 2018, It is estimated that 34.1% of Indonesian population has hyper-
tension. Angiotensin II Receptor Blockers (ARB) are used as first-line therapy for
hypertension and valsartan is one of the most commonly used. In 2018, the Indonesia
F102
National Agency of Drug and Food Control (BPOM) released valsartan withdrawal due
to “impurities” that pose a potential cancer risk.
Objective: The aim of this study was to assess the substitution possibilities from
Valsartan 160 mg to Candesartan 16 mg by comparing their first twelve-hour antihy-
pertensive effect.
Method: We compared the antihypertensive effects of 160 mg valsartan to 16 mg can-
desartan on 50 healthy male subjects aged 18-55. Preliminary studies were con-
ducted to ensure subjects were eligible for the study. The 50 subjects then divided
into 2 groups, 25 subjects each. Subjects were given 1 dose candesartan or valsartan
blindly and the baseline systolic blood pressure (SBP) and diastolic blood pressure
(SDP) were taken before drug administration. The next SBP and SDP were monitored
at 1; 2; 3; 4; 7; 9 and 12 hours after dosing. To evaluate the repeated measurements,
we used the Generalized Estimating Equation (GEE) statistical procedure. Statistical
significant was determined at p < 0.05.
Result: Valsartan significantly reduced SBP (p ¼ 0.03) and DBP (p ¼ 0.02) lower than
Candesartan. Within the subject in each treatment group, mean differences of SBP
and DBP significantly lowered over time (p < 0.001 for each SBP and DBP, respec-
tively). Both treatment groups showed a parallel trend of SBP and DBP reduction,
indicated no correlation between the type of drugs and the duration of use
(p > 0.05).
Conclusion: The first 12-hour antihypertensive effect of valsartan 160 mg with can-
desartan 16 mg is significantly different with valsartan poses a greater effect than
candesartan, thus implying that candesartan 16 mg cannot substitute valsartan
160 mg.
Keywords: antihypertensive • valsartan • candesartan
OR.273. Residual Ischemia Events in Myocardial Infarction Patients Treated with
Fibrinolysis According to Chest Pain Onset in Tidar District General Hospital
Daniel Sukmadja, Nurhayadi A. Sulistyo, Bintang K. Prabowo
Department of Cardiology and Vascular Medicine, Tidar District General Hospital,
Magelang, Central Java
Background: Fibrinolysis is the main choices of reperfusion strategy besides primary
percutaneous coronary intervention (PCI) in early phase of ST-Elevation Myocardial
Infarction (STEMI), particularly in non-PCI centers. Fibrinolysis is recommended if PCI
cannot be performed in 120min from STEMI diagnosis in 3-12hour infarction. Residual
Ischemia is one of major indicators of bad prognosis after an acute myocardial infarc-
tion evaluated in risk stratification, and can be detected with positive treadmill
stress testing result.
Objective: The purpose of this study is to compare treadmill stress testing results in
STEMI patients in Tidar District General Hospital treated with fibrinolysis according
to chest pain onset.
Method: We analyzed medical records of 30 patients diagnosed with STEMI, during
the period of January 2017 to December 2018 in Tidar District General Hospital who
were treated with fibrinolysis and whose residual ischemia events were evaluated
with treadmill stress testing using Bruce protocol. The results of treadmill stress
testing and patient’s chest pain onset were obtained and studied with Chi-Square
and Fisher Exact analysis.
Result: From 30 samples diagnosed with STEMI, treated with fibrinolysis and eval-
uated with treadmill stress testing, we obtained that positive treadmill stress testing
result was found in 6 cases of < 3hour onset infarction and 6 cases of 3-12hour onset
infarction. Negative treadmill stress testing results was found in 15 cases of < 3hour
onset infarction and 3 cases of 3-12hour onset infarction. Fisher Exact test showed p
value 0.062.
Conclusion: We found 3 cases of negative treadmill stress testing results in 3-12hour
onset infarction cases. The result difference between <3hour onset infarction and 3-
12hour infarction was not significant.
Keywords: treadmill stress testing • chest pain onset • STEMI • fibrinolysis
OR.274. Baseline Characteristics of Cardio-Oncology Registry Patients: Breast
Cancer Patients with Chemotherapy Regimen of Fluorouracyl-Anthracycline-
Cyclophosphamide in RSUP Dr. Hasan Sadikin Bandung
Aang Setiawan, Astri Astuti, Mohammad R. Akbar, Erwan Martanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran
University, Bandung, Indonesia
Backgroun: Breast cancer is most common cancer among women around the world.
In Indonesia, breast cancer was second most common cancer among women after
carcinoma cervix (Riskesdas 2013). The improvement of screening and therapy make
the survival rate is increasing. Anthracycline class, fluorouracil, cyclophosphamide,
and carboplatin are most common chemotherapy drugs used for breast cancer.
Unfortunately, it was reported that one of these chemotherapy drugs that was
anthracycline class, could cause complication that was cardiomyopathy-
cardiotoxicity.
Abstracts
Objective: A prospective cohort study was performed to determine the incidence of
Fluorouracyl-Anthracycline-Cyclophosphamide (FAC) Continuous Intravenous (CIV)
cardiomyopathy-cardiotoxicity in Breast Cancer Patients.
Method: The inclusion criteria were all breast cancer patients with age more than
eighteen years old and given six cycles FAC regimen for chemotherapy as both adju-
vant and neoadjuvan from July 2018 – March 2019. All patients who were given six-
cycle-dose 5FU, doxorubicin/epirubicin, and cyclophosphamide-CIV were monitored
for cardiac function by clinical examination, echocardiography, and laboratory test
of high sensitivity troponin I.
Result: From thirty patients who were enrolled to this study, the mean age of the
patients were 47.73 67.01 years old. The mean BMI of the patients were 25.94 6
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
4.52. Nine patients were normal (30%), six patients were overweight (20%), and fif-
teen patients were obese (50%). Most of them were diagnosed with right breast can-
cer (twenty patients, 66.66%). Based on anatomical pathology, sixteen patients diag-
nosed with Invasive Ductal Carcinoma (IDC) Grade III (53.33%). The rest of patients
respectively were diagnosed with Invasive Ductal Carcinoma (IDC) Grade II (eleven
patients, 36.66%), Medullary Carcinoma (two patients, 6.66%) and Invasive Lobullar
Carcinoma (one patient, 3.33%). Almost of the patients were given 5FU, doxorubicin,
and cyclophosphamide regimen (twenty nine patients, 96.66%). Twenty four patients
received this treatment as adjuvant (80%). Seven patients had hypertension
(23.33%). Five patients had diabetes mellitus type II (16.67%) and two patients had
history of dyslipidemia (6.66%).
Conclusion: Thirty patients were enrolled to this study based on inclusion criteria.
Most of them were forties years old, obese and diagnosed with right breast cancer.
Invasive Ductal Carcinoma (IDC) Grade III became the most dominant result from
anatomy pathological examination. Some of the patients had others disease such as
hypertension, diabetes mellitus type II, and dyslipidemia.
Keywords: cardiomyopathy-cardiotoxicity • breast cancer • chemotherapy • FAC
OR.275. Left ventricular ejection fraction and gender correlate to the 6 Minute
Walking Test after Phase II Cardiac Rehabilitation Programme in Post CABG
Surgery Patients.
A.H. Raynaldo, R. Septiarini, Khairunnisaq, C.A. Andra
Department of Cardiology and Vascular Medicine, Haji Adam Malik Hospital, Medan,
Indonesia, School of Medicine, University of Sumatera Utara, Medan, Indonesia.
Background: 6 minute Walking has been widely using in patients after had cardiac
surgery. It is a simple tool and does not require expensive equipment to asses the
physical performance of the patients.
Objective: We study which factor could affect the result of 6MWT in Post CABG sur-
gery patients after complete Phase II Cardiac Rehabilitation Programme.
Method: The data were prospectively collected from ninety patients concecutively
admitted to Phase II Cardiac Rehabilitation Programme ( 80% male, mean age
5368.3) from November 2018-January 2019. 6MWT were perform at baseline and
repeating after complete the Phase II Cardiac Rehabilitation.
Result: All the participants were tollerate to 6MWT. The mean distance walked
6MWT at baseline and after phase II cardiac rehabilitation programme was 192 6 90
m and 4216 102 m. The after rehabilitation programme 6MWT distance was higher in
the Male group ( 439 6 96 m vs 364 6 107 m, p ¼ 0.01) and in the normal EF group
(435 6 105 m vs 362 6 57 m, p ¼ 0.001). There was an improvement of the 6MWT
distance after the rehabilitation programme according to gender, age, left ventricle
ejection fraction and history of diabetes. There was positive correlation between
6MWT with Left Ventricular ejection fraction (p ¼ 0.002) and negative correlation
between 6MWT with gender (p ¼ 0.02)
Conclusion: The patients were well tolerated to 6MWT even shortly right after CABG
surgery. The improvement of 6MWT distance were found in all participant. Phase II
cardiac rehabilitation give a good impact of the physical performance, eventhough
some factors might affect the result.
Keywords: 6MWT,CABG • Rehabilition • Cardiac Surgery
OR.276. Profile and Outcome of Ventricular Septal Rupture After Myocardial
Infarction : A Study Population in Dr. Kariadi Hospital, Semarang
A. Chairunnisa, P.S Putri, S. Sungkar, U. Bahrudin, I. Uddin
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University - Dr. Kariadi Central General Hospital Semarang, Indonesia
Background: Ventricular Septal Rupture (VSR) is an uncommon but well-recognized
as mechanical complication of acute myocardial infarction (MI) with high mortality
rate.
Objective: Aim of this study was to analyze profile and outcome in patients with VSR
after MI in our hospital.
Method: This was a retrospective study patients with ventricular septal rupture after
myocardial infarction at Dr. Kariadi Central General Hospital Semarang, from January
2014 to January 2019. We collect data of baseline characteristics, risk factors, man-
agement and outcome.
Abstracts
Result: A total of 18 patients with VSR after MI age 60.866.9 years old, 78% males
and 22% females were enrolled. 13 (72%) patients had Diabetes Mellitus, 12 (67%)
patients had dyslipidemia, 10(56%) patients were active smoker, 6 (33%) patients had
hypertension, and 2 (11%) patients had family history of CAD. Coronary angiography
was done in 10 patients, only 1 patient had single vessel disease, 7 patients had CAD
2VD, 2 had CAD 3VD. The outcome was described as, in hospital mortality rate was
61% (11 patients). Total patients who survived was 8 patients, with 4 patients (22%)
had VSR closure and CABG in more than 5 months after diagnosed and 4 patients dis-
charge with stable hemodynamic and planned for VSR closure.
Conclusion: VSR is a serious and rare complication of myocardial infarction with high
mortality. Optimal management and timing of surgery may provide better outcome.
Keywords: ventricular septal rupture • myocardial infarction
OR.277. OR.277. Angina Pectoris Without Plaque Deposition : A Shifting
Paradigm
B Presidiana1, A Ratri2, R. Chandra1
1 levels were obtained 135.88 mg/dl and the average levels of Troponin I enzyme were
Ibnu Sina Hospital, Gresik, Indonesia, 2Airlangga University, Surabaya, Indonesia
Background: Myocardial Bridging (MB) is another terminology causing chest pain.
Due to compression underneath coronary artery insufficient blood supply held,
instead of coexisting stenotic lesion
Objective: To evaluate the characteristics of MB
Method: Cross sectional study in 389 enrolled patients (mean age 55 years, 50,39%
men) with typical chest pain who underwent 128-slice computerized-tomography
(CT)
Results: Obstructive coronary artery were found in 37,27% patients. Normal and non-
obstructive coronary artery were found in 52% and 31,62%. MB was discovered in
10,8% which mostly occured at left coronary artery (LAD), only one case discovered
on right coronary artery (RCA). 24,93% morphology alteration occurred as atheros-
chlerotic plaque deposition along with MB. Superficial type discovered in 95,12%.
Most prevalence type was mix calsified (43,21%), followed by calsified plaque 31,43%
and soft plaque 25,36%
Conclusion: CT scan was a useful modality to differentiate the etiology behind typi-
cal chest pain and able to detect MB
Keywords: myocardial bridging • chest pain
OR.278. Ejection Fraction was not Related with Chronic Total Occlusion
Percutaneous Coronary Intervention Procedural Success
A. Sidiek, A. Pujiastuti, A. Perdana, LV Bramantyo, SN Sofia, S. Rifqi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University Dr. Kariadi Central General Hospital Semarang
Background: Left ventricular ejection fraction (LVEF) known as one of the strongest
predictors of cardiovascular events in patients with coronary artery disease.
Presence of chronic total occlusion (CTO) in ischaemic heart disease associated with
worse long-term outcome. Percutaneous coronary intervention was remain be the
last option to manage CTO patients present with reduced LVEF. We aimed to assess
the impact of LVEF in CTO PCI procedural success rates.
Objective: This study tried to investigate the relation between systolic
dysfunction and CTO PCI procedural success in Dr. Kariadi Central General Hospital
Semarang.
Method: We analyzed 67 patients underwent CTO PCI in Kariadi general hospital
Semarang during 2018. We defined CTO as total occlusion in major coronary
vessel (TIMI flow 0) with estimated occlusion duration of > 3 months, without ante-
grade flow to distal of occlusion other than from collateral. CTO was confirmed
with previous diagnostic coronary angiography data. CTO PCI procedural success
defined as successful stent implantation with residual stenosis < 20% and TIMI
flow 3.
Result: We analyzed 42 CTO patients with systolic dysfunction (reduced LVEF) and 25
CTO patients without systolic dysfunction (preserved LVEF). Patients with systolic
dysfunction commonly presented with heart failure symptoms (p ¼ 0.004) while those
without systolic dysfunction commonly presented with angina pectoris (p ¼ 0.005).
Patients in systolic dysfunction group were younger and had more multivessel coro-
nary disease although not statistically significant (57.11 þ 7.83 vs 58.24 þ 8.98;
p ¼ 0.594 and 71% vs 52%; p ¼ 0.109). No difference in LAD CTO presence (p ¼ 0.298)
and classical risk factors between groups (p ¼ 0.874 for hypertension; p ¼ 0.826 for
smoking; p ¼ 0.774 for diabetes; p ¼ 0.507 for dyslipidemia; and p ¼ 0.463 for family
history). Patients without systolic dysfunction had higher CTO PCI procedural success
but not statistically significant (72% vs 67%; p ¼ 0.649).
Conclusion: Systolic dysfunction was not related to CTO PCI procedural success.
There were no differences between clinical and coronary artery classical risk factors
in CTO patients with and without systolic dysfunction.
Keywords: CTO • PCI • success • systolic dysfunction
F103
OR.279. The Correlation between Random Plasma Glucose Level with Troponin I
Enzyme in the Non Diabetic Acute Myocardial Infarction Patient
Syahdi N. Kadafi1, Ilham Uddin2, Sefri N. Sofia2
1
Faculty of Medicine Diponegoro University, Semarang, Indonesia, 2Cardiology
Department of Faculty of Medicine Diponegoro University, Semarang, Indonesia
Background: Acute myocardial infarction (AMI) diagnosis can be confirmed through
ECG examination and/or level of Troponin I enzyme where not all health provider
have it. Random plasma glucose (RPG) level suspected of having a relationship with
the level of Troponin I enzyme.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Objective: To find out the relationship between RPG levels with the level of Troponin
I enzyme in non-diabetic AMI patients.
Method: Observational analytic method was conducted and used secondary data
from medical records. 51 patients as sample whose met certain criteria. Pearson’s
correlation coefficient (r) was used to find the correlation between RPG level and
Troponin I enzyme.
Results: Non-diabetic AMI patients were 41 men and 10 women. The average of RPG
obtained 5.89 ug/l. The Pearson correlation test showed that RPG levels had a weak
positive correlation (r ¼ 0.224) which is not significant (p ¼ 0.057) with the Troponin I
enzyme levels.
Conclusion: RPG levels had a weak positive correlation which is not significant with
the Troponin I enzyme levels in the non-diabetic AMI patients.
Keywords: random plasma glucose level • troponin I enzyme • acute myocardial
infarction
OR.280. Why We Don’t Get Fibrinolytic?: Descriptive Study From Tarakan
Registry Of Acute Coronary Syndrome (TRACS)
Muhammad A. Muttaqin, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan
Background: Fibrinolytic is one of the strategies for reperfusion therapy in patients
with acute myocardial infarction with ST segment elevation (STEMI). Tarakan
Hospital (RSUD Tarakan) is a tertiary referral hospital (and the only one) in North
Kalimantan Province that has fibrinolytic modalities as reperfusion therapy in STEMI
patients. Not all patients with STEMI get fibrinolytic therapy, there are medical and
non-medical reasons related to this.
Objective: To find out how many STEMI patients have fibrinolytic therapy or not, the
reasons for not doing fibrinolytics, and related backgrounds.
Method: This study involved 81 STEMI patients between January 2017 and September
2018. Data were collected from the Tarakan Registry of Acute Coronary Syndrome
(TRACS) Tarakan Hospital, North Kalimantan. Patients were grouped starting from
how the patient entered (referral or not), did fibrinolytic or not, and the reasons for
doing fibrinolytic or not.
Results: Of the 81 STEMI patients who came to Tarakan Hospital, whose there were
directly to the emergency department (65 patients, 80%), public health center refer-
rals (4 patients (4%), and hospital referrals (12 patients, 15%), fibrinolytics were per-
formed in 37 patients (45.7%) and 44 patients (54.3%) did not get fibrinolytic. 37
patients who did not get fibrinolytic came with late onset STEMI, 4 patients did not
get fibrinolytic because there were absolute contraindications, and 3 patients did
not get fibrinolytic due to personal rejection. 33 STEMI patients (42.9%) covered by
insurance (BPJS) received fibrinolytic therapy, while 44 patients with STEMI (57.1%)
covered by insurance (BPJS) did not receive fibrinolytic therapy. All STEMI patients
who had no insurance (4 people, 4.9%) received fibrinolytic therapy.
Conclusion: From this study, there were still many STEMI patients who did not get
fibrinolytic in Tarakan Hospital, the most common cause of patients not getting fibri-
nolytic was patients who arrived with late onset STEMI.
Keywords: Fibrinolytic • STEMI
OR.281. Blood Urea Nitrogen in Comparison to Serum Creatinine for Mortality
Risk Assessment in Patients with ST-Elevation Myocardial Infarction
Stefanus, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: Eventhough blood urea nitrogen (BUN) and serum creatinine are not
the primary laboratory examination for acute myocardial infarction, they may have a
role in predicting poor prognosis or mortality risk in patient with ST-elevation myo-
cardial infarction (STEMI).
Objective: This study aimed to compare the prognostic significance of BUN versus
creatinine levels for estimating the risk of death in patients with STEMI.
Method: The subjects of this study were patients with STEMI from Tarakan Registry
of Acute Coronary Syndrome from Januari 2017 to December 2018. BUN and the
serum creatinine were taken at the moment when the patient was admitted to the
F104 Abstracts

hospital. Mortality risk assessment was calculated with Thrombolysis in Myocardial Conclusion: Young patients with CAD mainly found in male gender, hypertension,
Infarction (TIMI) score and the Global Registry of Acute Events (GRACE) risk score. hypercholesterolemia and diabetes mellitus respectively. Critical CAD in young adults
The data was processed using IBM SPSS Statistics 24 and analyzed using spearman is quite high. Angiographically, TVD is more common.
correlation. Keywords: Coronary artery disease • risk factor • critical • young.
Result: The mean age of this study was 52.73 6 11.06 with the mean BUN and serum
creatinine are 14.02 6 4.74 and 1.19 6 0.33. It was found that both BUN and serum
creatinine had a predictive value for long-term prognosis. BUN was found to be a
better mortality predictor when correlated to TIMI risk score (p ¼ 0.000; r ¼ 0.495)
and GRACE risk score (p ¼ 0.004; r ¼ 0.342) compared to serum creatinine when cor-
related to TIMI risk score (p ¼ 0.033; r ¼ 0.255) and GRACE risk score (p ¼ 0.026;
r ¼ 0,266).

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019

Conclusion: Eventhough BUN and serum creatinine can be used to predict poor prog-
nosis, BUN was found to be a more significant risk factor for STEMI in predicting
mortality.
Keywords: Blood urea nitrogen • Serum creatinine • TIMI • GRACE • STEMI

OR.282. Effect of Blood Donation on Ferritin Levels and Lipid Profile in Subjects
with Central Obesity
Frans Wantania, Linda Rotty
Medical Faculty, Sam Ratulangi University, Manado, Indonesia

Background: Several studies showed that inflammation is associated with the dyslipi-
demia. Ferritin is one of the inflammation markers which its level influenced by
blood donation. Central Obesity in young adults may have benefit by blood donation
OR.283. Figure 1 Coronary Artery Disease in Young Adult
because of this mechanism. Aim of this study was to compare the ferritin levels and
lipid profile between routine blood donation and non-routine blood donation subjects
with central obesity.
Methods: Fourty-one apparently health male obese subjects were enrolled in this
study. To further investigate this topic, a lipid profile and ferritin level were eval-
uated in 21 routine blood donation male obese subjects and the other 20 non routine
blood donation subjects as control. We use t-test to determine the difference of the
mean level of Total Cholesterol, LDL, TG, and HDL.
Results: Mean level of Total Cholesterol in routine blood donation is lower than con-
trol group (198,2 vs 224,52; p ¼ 0,011). The LDL level was lower in routine blood don-
ation than non-routine group (130,10 vs 153,76; p ¼ 0,013), while Triglycerides level
was significantly lower in this group (97,75 vs 137,38, p ¼ 0,010). In this study, mean
level of HDL (46,75 vs 43,57; p ¼ 0,276) and Feritin (228,93 vs 269,4) was not signifi-
cantly different between routine blood donation subjects as compare to control
group.
Conclusion: Total Cholesterol, LDL, and TG level in routine blood donation subjects
were significantly lower as compare to non-routine blood donation subjects Frequent
OR.283. Figure 2 Angiographic characteristic of CAD in young adult
blood donate improve lipid profile in men with central obesity aged 18-40 years. As a
recommendation socialization about blood donation benefit in lipid profile donors
with central obesity is needed
Keywords: Blood Donation • Ferritin • Lipid Profile • Central Obesity
OR.284. Clinical presentations and Comorbid Factors in Patients with Acute
Coronary Syndrome in North Kalimantan
Daniel Licindo, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
OR.283. Characteristic of Coronary Artery Disease in Young Adult An Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Observational Single Center Study
Fauziah, Robert E. Saragih Background: Based on RISKESDAS 2018, North Kalimantan was the province with the
Department Cardiology Awal Bros Bekasi Hospital, West Java highest prevalence of heart disease in Indonesia. Among all heart disease, coronary
heart disease / acute coronary syndrome (ACS) was the most common heart disease
worldwide. However, there wasn’t any enough informations about the clinical pre-
Background: Coronary artery disease (CAD) is remains leading cause of death world- sentations and comorbidities of patients with ACS in North Kalimantan.
wide. CAD occurring below age of 45 is termed as young CAD. However various stud- Objectives: This study aimed to describe the proportion of clinical presentations and
ies have defined young CAD in varying age from 15 to 60 years old (table 1). Latest comorbid factors in patients with ACS in North Kalimantan.
guidelines recommended to perform revascularization in patients with CAD. Method: Data were obtained from the Tarakan Registry of Acute Coronary Syndrome
Objective: This study aim to analyze characteristic of coronary heart disease in adult (TRACS) in 2017-2018. This study was a cross-sectional study with ACS patients as
patient younger and equal to 45 years old presented to Awal Bros Bekasi Barat subject. Sample of subject was taken using consecutive sampling technique. Data
hospital. were analyzed to describe the proportion of clinical presentations and comorbities of
Method: This descriptive cross sectional study was conducted retrospectively. A the subjects.
patient aged less than and equal to 45 years who were evaluated angiographically Results: A total of 186 medical records were analyzed. We found that 94.51 % subjects
for chronic stable angina or acute coronary syndrome for consecutive 12 months experienced chest discomfort during admission, 81.01 % experienced retrosternal pain,
were included. Out of 240 patients, there was 27 patients less than equal to 45 83.19 % experienced resting chest pain, 66.67 % experienced refer pain to the jaws
years. Out of which there was 20 patients who underwent coronary angiogram. and/or left arm and/or back, and 75.36 % admitted with diaphoresis. We also found
Single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease that 32.84% subjects had history of previous ACS, 44.72 % had history of smoking behav-
(TVD) were noted down. Risk factor of diabetes mellitus, hypertension and hypercho- ior, 35.10 % had history of diabetes mellitus, 53.61% had history of hypertension.
lesterolemia were also noted. Conclusion: In this study, we found that chest discomfort was the most common clin-
Result: There was 11.25% patient aged less than and equal to 45 noted for chronic ical presentation in patients with ACS in North Kalimantan. We also found that more
stable angina and acute coronary syndrome. Out of them 92.6% were male and 7.4% than half of the patients who were diagnosed with ACS had a history of hypertension.
were female. Among of them 55,5% had hypertension, 37% had diabetes mellitus and Patients with comorbid factors of ACS should be treated to prevent the occurrence
44,4% had hypercholesterolemia. Those who underwent coronary angiogram were of ACS. A comprehensive assesstments of ACS clinical presentations and comorbid
74%. About two- third of the cases had critical CAD. About half of the cases 50% had factors is needed for an early diagnosis and prompt managements of ACS.
TVD, followed by 35% had SVD, and 15% had DVD. Keywords: Clinical presentation • comorbid factor • ACS • north kalimantan
Abstracts
OR.285. High Platelet Distribution Width (PDW) Values As Predictors of Major
Cardiovascular Events in Patients with Acute Myocardial Infarction
Sang AyuN. Yuli Sutarmini, D. GdeA. Diprabawa, Raka Widiana, Wayan Wita
Departemen of Cardiology and Vascular Medicine, School of Medicine, Udayana
University, Denpasar, Bali
Background: Coronary heart disease (CHD) is the highest cause of death, although it
has been declining since the last few years because management has progressed.
Platelets have an important role in pathogenesis of acute myocardial infarction, where
the occurrence of plaque rupture is followed by platelet activation and thrombus forma-
tion which causes occlusion of coronary arteries. Platelet distribution width (PDW) is a
marker of platelet reactivity which can be used as a simple and inexpensive marker into
risk stratification and predict the prognosis of patients with myocardial infarction
Objective: Our objective was to examine the association high platelet distribution
width (PDW) with major adverse cardiovascular events in pastients with acute myo-
cardial infarction during hospitalization
Method: This prospective study included 60 consecutive patients admitted with
acute myocardial infarction to RSUP Sanglah between April 1st and June 30th 2018.
All patients were examined by PDW level that analyzed using abbott cell-dyn ruby.
The study population was divided into two groups consisting of high PDW groups and low
PDW using the Receiver Operating Curve (ROC) curve. To describe the characteristics of
the research subjects based on high and low PDW groups, univariate analysis was carried
out followed by bivariate analysis which was displayed in the graph of Kaplan-meier sur-
vival estimates with log rank statistical tests. Therefore, a multivariate analysis using
the Cox regression statistical test was conducted to determine whether a high PDW
value was an independent predictor of major cardiovascular events.
Result: Based on the ROC curve analysis the optimal cut-off value is 20.55, there are
28 patients with high PDW (> 20.55) and 32 patients with low PDW( 20.55). From
60 patients there are 24 (40%) who experienced major cardiovascular events.
Bivariate analysis showed that patients has Diabetes Melitus (DM) (HR 3.195 CI 95%
1.08-9.44 p ¼ 0.036) and High PDW (HR 4.94 CI 95% 1.67 p ¼ 0.004) correlate with
major cardiovascular events in patients with acute myocardial infarction.
Multivariate analysis with cox regression showed that high PDW has been shown to be
related to major cardiovascular events (HR 3.878 CI 95% 1.078-13.952 p ¼ 0.038)
Conclusion: High PDW values as an independent predictor of major cardiovascular
events in patients with acute myocardial infarction during hospitalization.
Keywords: Platelet distribution width • Acute myocardial infarction • Major adverse
cardiovascular events
OR.286. Six Minute Walking Test Upon Discharge May Predict 30 Day Readmission
in Acute Decompensated Heart Failure Patients
Minsy T. Sari, Lia Valentina Astari
Department of Cardiology and Vascular MedicineArifin Achmad General Hospital,
Pekanbaru-Riau
Background: Readmission is a common and costly problem in heart failure patients.
Aproximately, 23%of patients are readmitted within 30 days and up to 75% of these early
readmission may be preventable. Six minute walking test (6MWT) is a simple and inex-
pensive methodeof indirectly assesing excersice tolerance. Limited studies showed that
the walking distance during a 6MWT is an independent predictor of hospital readmission.
Objective: The goal of this study was to examine the 6MWT of the hospitalized heart
failure patients at their discharge from Arifin Achmad General Hospital and their
readmission within 30 days.
Method: This is a descriptive observational study. During March 2019, there were
twelve patients eligible to studied. Six minute walking test was performed prior to
their discharge and the patients were followed up for their 30 day readmission.
Result: Median 6MWT were 301,2 (161,4-427,5) meters. Three patients (25%) were
readmitted and had 6MWT <400 meters. Only 1 patient had 6MWT > 400 meters.
Median heart rate at discharge was 76 (66-94) beat per minute. Median Ureum was
25 (11-49) mg/dl. Only 58% patients received Angiotensin Converting Enzyme
Inhibitor or Angiotensin II Receptor Blocker and 8,3% patients received beta blocker
during hospitalization.
Conclusion: 6MWT may predict early hospital readmission in patient with heart fail-
ure. Low 6MWT was found in readmitted and non readmitted patients.
Optimalization of heart failure therapy and cardiac rehabilitation program may help
increase 6MWT in heart failure patients and reduce readmission rate.
Keywords: Six minute walking test • heart failure • readmission • 30-day readmission
OR.287. Medical Adherence of Hypertension Management in Primary Health
Care Settings
S. A. Yuwono1, N. G. Arviana1, S. Adiwena1, S. Ng1,2
1 Method: We conducted a survey to determine the clinical profile and medical adher-
Faculty of Medicine, University of Pelita Harapan, Banten, Indonesia, 2Siloam
Hospital Lippo Village, Banten, Indonesia.
Background: Hypertension is an important risk factor in developing cardiovascular
disease and mortality. Compliance to treatment plays an important role for better
F105
outcome. The objective of this study was to evaluate medication adherence charac-
teristic of hypertensive patients in primary health care settings.
Methods: We performed a cross-sectional study at a primary health care center in
Tangerang. Two hundred ninety-seven out of 433 home-care participants diagnosed
with hypertension were included. Patient’s socio-demographic status, medical status,
present of co-morbidities, smoking habits were assessed by interview and question-
naire. Adherence to medication was assessed using the Morisky Medication
Adherence Scale (MMAS-8).
Results: The mean age of participants was 58 þ 9 years and 254 (89%) were female.
Two hundred and sixteen participants (75%) had low antihypertensive medication
adherence. Among those, 26% is not having adequate medication due to them wait-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
ing for monthly visit from the health care workers, followed by forgetful and laziness
(22% and 21%, respectively). Due to limited drug availability, the facility only gave 10
pills per patients. The majority, 167 (58%) never received any formal education.
Even in patients with high medical adherence, the systolic blood pressure remains
above guideline recommendations (157 þ 23). The low medical adherence was not
significantly corelated with education level, hypertension in family, smoking habits,
history of heart disease, diabetes mellitus, and physical activity.
Conclusion: The study demonstrates a poor blood pressure control in primary health
care settings, even in patients with high medical adherence. Adherence toward
hypertension medication remains very low.
Keywords: Hypertension • Medication adherence • MMAS-8 • Primary health
care • Risk factors
OR.288. Clinical Characteristics and Mortality Following Primary Percutaneous
Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction in
Adam Malik General Hospital
M. Fahrial, H. Hasan, Z. Mukhtar, A. Nafiah, H.A. Putra
Department of Cardiology and Vascular Medicine, School of Medicine, North
Sumatera University, Medan, North Sumatera
Background: ST-segment elevation myocardial infarction (STEMI) is a mayor health
problem In Indonesia, including Medan. It is important to evaluate clinical character-
istics of STEMI patients and mortality after reperfusion therapy for STEMI patients,
especially primary PCI.
Objective: This study aims to investigate the clinical features and mortality follow-
ing primary percutaneous coronary intervention for ST-segment elevation myocardial
infarction (STEMI) patients in Adam Malik General Hospital.
Method: We investigated the clinical characteristic and mortality on acute ST seg-
ment elevation myocardial infarction registry in cardiac catheterization from
October 2018 to February 2019. The registry included consecutive patients of all
ages with acute ST-segment elevation myocardial infarction (12 hours from onset)
who underwent primary PCI in Adam Malik General Hospital. All data was analyzed
by using SPSS.
Result: From clinical characteristic analysis, we found that male was higher than
female (81.5% vs 18.5%) for acute STEMI event, which dominated by STEMI Inferior
(77%). Risk factors analysis revealed that smoking had the highest prevalence. Major
cardiac event findings as an outcome in this study were death (7.4%), pulmonary
edema (7.4%), cardiogenic shock (3.7%), malignant arrhythmia (3.7%). Average length
of stay duration in this study was 5 days (3 – 11 days).
Conclusion: Mortality of STEMI patients is still relatively high (7.4%) in STEMI patient
underwent primary PCI in Adam Malik General Hospital. In the future, education to
early recognition of ACS symptoms and improved cardiac care in PCI capable hospital
are needed to reduce mortality and length of stay in hospital.
Keywords: clinical characteristic of primary PCI • mortality in primary PCI
OR.289. Clinical Profile and Medical Adherence of Hypertension Patients in
Sikumana Primary Health Center, Kupang, East Nusa Tenggara
Queen S. Ariyani1, Michael Susanto2, Leonora J. Tiluata3
1
Sikumana Primary Health Center, Kupang, Indonesia, 2Faculty of Medicine
Universitas Pelita Harapan, Tangerang, Indonesia, 3Department of Cardiology, Prof
WZ Johannes General Hospital, Kupang, Indonesia
Background: Hypertension is a highly prevalent chronic disease in Indonesia that
may cause significant morbidity and mortality. Medical adherence plays an important
role in achieving optimal medical therapy and good clinical outcomes in patients
with hypertension. However, there exists a challenge to achieving high medical
adherence among patients with chronic diseases such as hypertension. This research
aims to determine the clinical profile and medical adherence of hypertension
patients in Sikumana Primary Health Center, Kupang, East Nusa Tenggara.
ence of hypertension patients in Sikumana Primary Health Center, Kupang, East Nusa
Tenggara. The Morisky Medical Adherence Score-8 (MMAS-8) was used to assess the
level of medical adherence.
Result: A total of 69 subjects took part in this study. 62,5% of the subjects were
female and 50.7% aged between 60-69 years old. Flores (24,6%), Rote (24,6%) and
F106
Timor (23.2%) tribes dominate the research population. 14,5% of the subjects had
experienced a stroke. Comorbidities include diabetes mellitus (31,9%), dyslipidemia
(30,4%), and heart problems (7,2%). Risk factors include family history of hyperten-
sion (40,6%) and smoking (11,6%). 73,6% claimed to only have had hypertension for 
5 years and were mostly diagnosed in a primary health center (65.2%). According to
the MMAS-8, 49.3% have high medical adherence, 27.5% have medium adherence,
23.3% have low adherence.
Conclusion: Half of the subjects in this study have high medical adherence.
However, more educational intervention and health promotion must be made to
improve medical adherence among patients with hypertension especially in the pri-
mary health care setting. In this situation, healthcare professionals play a key role in
ensuring patients to take their medications regularly in order to achieve a better
clinical outcome.
Keywords: Hypertension • Clinical profile • Medical Adherence • Primary Health
Center • East Nusa Tenggara
OR.290. Does Diabetes Truly Obscure Typical Presentation of Chest Pain Among
Acute Coronary Syndrome?Analysis from Banda Aceh
M. Hustiar Hakim, Muhammad Ridwan, Teuku M. Haykal, Yusni
Department of Cardiology and Vascular Medicine, School of Medicine, Syiah Kuala
University, Banda Aceh, Indonesia
Background: As an important major risk factor of cardiovascular disease, diabetes is
common among Acute Coronary Syndrome (ACS). Identifying ACS based on clinical
presentation alone is difficult in patients with diabetes. Diabetes patients usually
develop atypical characteristic of chest pain. We sought to investigate whether
patients with diabetes truly have atypical characteristic of chest pain rather than
patients without diabetes. Other descriptions of chest pain among diabetic patients
with ACS were also analyzed.
Methods: This is a cross-sectional study in patients presented with ACS in Zainoel
Abidin hospital, Banda Aceh, between November 2018 to January 2019. All patients
were interviewed by a physician during hospitalization. The data obtained from
interview included detailed descriptions of chest pain and detailed risk factors char-
acteristic. Medical data regarding diagnostic examination and therapeutic interven-
tion was obtained from medical record. Statistical analysis using bivariate analysis
was performed to identify association between variables.
Results: Fifty patients presented with ACS were enrolled prospectively for the study.
Diabetes was identified in 34% patients. The mean age was 55.8 6 9.6 years old and
80% of the subjects were male. Diagnosis of myocardial infarct were made in 28
patients (56%) while others were admitted as Unstable Angina Pectoris (UAP). Typical
presentation of chest pain as described as heavy or tight sensation was identified in
86% cases. No association was detected between atypical presentation of chest pain
and diabetes condition (p ¼ 0.23). Radiating sensation of chest pain was also not
associated with diabetes (p ¼ 0.30) as well as the presence of diaphoresis (p ¼ 0.49).
In contrast, nausea was significantly common among ACS patients without diabetes
(p ¼ 0.04).
Conclusion: In ACS population, no association was identified between diabetes and
typical presentation of chest pain with its detailed descriptions. The proposition
stating that diabetic patients usually presented with atypical characteristic of chest
pain need to be reinvestigated.
Keywords: Angina Pectoris • Diabetes Mellitus • Acute Coronary Syndrome
OR.291. Random Blood Glucose Level and Hospital Readmissions in Heart Failure
Patients: A Study From RSBA Heart Registry
Vidyawati, R.R. Menaldi, R.A. Fanani, M.B.R. Jati, R. Rasmin
Departemen of Cardiology and Vascular Medicine, Budhi Asih General Hospital,
Jakarta, Indonesia
Background: Hospital readmission remains a continued challenge in the care of heart
failure (HF) patients. The Framingham Heart Study (FHS) first demonstrated an
increased risk of congestive heart failure (CHF) in patients with diabetes. But the
relationship between random blood glucose (RBG) at admission and hospital readmis-
sions in HF patients remain unknown.
Objective: We aim to analyze the relationship between RBG level and hospital read-
missions in HF patients with mid-range and reduced ejection fraction (EF).
Method: BA-HF (Budhi Asih Heart Failure) Registry is a single center registry which
prospectively enrolls all hospitalized HF patients at Budhi Asih Regional Hospital
since 2017. We searched the inpatient medical records of 270 individuals with mid-
range and reduced EF (<50%) between 2017-2018. Patients with sub-optimal HF
treatment were excluded.
Result: A total of 126 patients with mid-range and reduced EF were included in the
study, represented 46% of all HF populations in BA-HF Registry. Mean age of
58.45611.8 years, 65.9% were male, mean EF of 31.69610.56, 25.4% were re-admit-
ted between 2017-2018. All patients were treated with ACE-inhibitor and/or ARB,
and beta blocker. Based on statistical analysis using SPSS, no association was found
between RBG and hospital readmission (v2(2) > ¼3.740, p ¼ 0.053).
Abstracts
Conclusion: Several studies showed significant association between diabetes and HF,
but our findings suggested the association between RBG and HF was not significant.
We acknowledge this is a relatively small study, thus limits its statistical power. More
samples are needed to better determine the association between RBG and HF.
Keywords: random blood glucose • heart failure • diabetes • readmission
OR.292. Echocardiography Profile of Indonesian Athletes
Irma Kartikasari, Davin E. Frizzy
Department of Cardiology and Vascular Medicine, Dr. Soegiri Public Hospital,
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Lamongan, East Java, Indonesia
Background: Sudden death arising from rigorous physical sports is on the rise in
many countries. Intense training affects the athlete’s body, such as the physiological
remodeling of the heart due to the hemodynamics changes. In such cases, echocar-
diography is widely used, as it is non-invasive and highly reliable. Existing studies
show the echocardiography values in each races are varied. Besides, some concen-
trated on the heart morphologies of athletes and non-athletes have primarily focused
on Caucasian subjects in North America and Europe, with very limited studies on
Asian athletes.
Objective: This study aims to provide the anthropometry and echocardiography
results that can be used as a reference values for Asian athletes.
Method: A total of 24 asymptomatic Indonesian athletes from Lamongan, who did
not have any history of past illnesses, were screened before the football season using
echocardiogram to measure the heart structure and function. The results were then
compared to the reference values of Asian non-athletes.
Result: In both athletes and non-athletes, the diameter of left ventricle and the
thickness of intraventricular septum were considerably similar, although the left ven-
tricle’s posterior wall was thinner and the ejection fraction was slightly increased for
the athletes. In addition, the volume of the left ventricle in systolic and diastolic
phases was markedly enlarged in athletes, as was its mass, with the respective mean
values consecutively 61.68611.97 ml/m2; 21.6566.86 ml/m2 and 86.12616.12 g/m2.
However, other than the left ventricle, no significant difference was evident in both
groups.
Conclusion: Intense training in athletes generates adjustments of the heart because
of the remodeling due to hemodynamic changes. As observed in this study, there
were significant changes of the left ventricle in athletes compared to non-athletes.
Hence, further studies are essential to obtain reference values of Asian athletes.
Keywords: Athlete’s Heart • Echocardiography • Cardiac Volume
OR.293. Formula to Predict Functional Capacity in Patients with Multivessel
Coronary Artery Disease After Coronary Artery Bypass Grafting Surgery
Ervan Zuhri, Ade M. Ambari, Bambang Dwiputra, Basuni Radi, Dede Kusmana,
Budhi Setianto, Anwar Santoso
National Cardiovascular Center of Harapan Kita, Jakarta, Indonesia, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia
Background: Pre-operative surgical risk assessment is crucial for weighing the risk
and benefit of cardiac surgery. The European System for Cardiac Operative Risk
Evaluation (EuroSCORE) II and the Society of Thoracic Surgeons (STS) score risk pre-
diction model is widely employed to evaluate the risk of perioperative mortality and
morbidity in patients undergoing cardiac surgery. But, these scoring system do not
include prediction of the functional capacity after cardiac surgery, especially coro-
nary artery bypass grafting (CABG) surgery. Functional capacity after CABG surgery is
very essential because high functional capacity is strongly related to good outcome
in quality of life, morbidity, and mortality after years later. Prediction of good func-
tional capacity after CABG surgery is very useful for weighing prognosis after CABG
surgery.
Objective: To construct formula to predict good functional capacity after CABG sur-
gery based on pre-operative patient’s characteristic data.
Method: We make retrospective study with multivariate regression analysis from
medical record data of patients with multivessel coronary artery disease (CAD)
undergoing isolated CABG surgery who had undergone cardiac rehabilitation from
September 2009 until June 2017 in National Cardiovascular Center of Harapan Kita
(NCCHK). We make prediction whether the patient can get good functional capacity
(METs > 6.00) or not, based on pre-operative patient’s characteristic data.
Result: The developmental dataset had 839 patients. The multivariate regression
analysis showed six variables that can significantly predict METs score > 6.00. The
variable was age  71 years old (OR 0.05, 95%CI 0.01 to 0.55, p ¼ 0.013), gender
male (OR 11.25, 95%CI 6.86 to 18.44, p < 0.001), BMI  25 kg/m2 (OR 0.58, 95%CI
0.37 to 0.91, p ¼ 0.019), moderate LVEF 40-49% (OR 0.52, 95%CI 0.35 to 0.78,
p ¼ 0.002), reduced LVEF < 40% (OR 0.31, 95%CI 0.17 to 0.59, p < 0.001), and atrial
fibrillation (OR 0.25, 95%CI 0.07 to 0.87, p ¼ 0.029). The regression formula was
y ¼ 0.851 – (2.925 x age  71 years old) – (0.544 x IMT  25 kg/m2) þ (2.42 x Male) –
(0.652 x LVEF 40-49%) – (1.16 x LVEF < 40%) – (1.371 x AF). In the formula, valued 1 if
age  71 years old, IMT  25 kg/m2, male, LVEF 40-49%, LVEF < 40%, or AF was
present and valued 0 if the variable was absent. The patient’s probability got METs
Abstracts
score > 6.00 was P ¼ 1/ {1þexponent (-y)}. Calibration by Hosmer Lemeshow Chi
Square was (8) ¼ 9.192 (p ¼ 0.327) and the area under the ROC curve was 0.779
(95%CI 0.742 to 0.817, p < 0.001).
Conclusion: Formula to predict good functional capacity after CABG surgery had
been constructed with good quality.
Keywords: Functional capacity • coronary artery bypass grafting surgery
OR.294. Formula to Predict Functional Capacity in Patients with Multivessel
Coronary Artery Disease After Coronary Artery Bypass Grafting Surgery
Ervan Zuhri, Ade M. Ambari, Bambang Dwiputra, Basuni Radi, Dede Kusmana,
Budhi Setianto, Anwar Santoso
National Cardiovascular Center of Harapan Kita, Jakarta, Indonesia, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia
Background: Leucocyte count especially measured using neutrophil-lymphocyte ratio
(NLR) is considered a more specific determiner than the neutrophil or leucocyte
count for cardiovascular events and mortality in acute coronary syndromes (ACS).
Left ventricular systolic dysfunction (LVSD) is an important cause both of mortality
and morbidity in patients with ACS and develops more frequently in patients with ST-
elevation myocardial infarction (STEMI) who have a high NLR on admission to the hos-
pital. This study aimed to investigate the the predictive value of NLR for LVSD in
patients both with STEMI and non-ST elevation myocardial infarction (STEMI).
Objective: This study aimed to determine a predictive value of LVSD in patient with
Acute Myocardial Infarction.
Methods: STEMI and NSTEMI patients undergoing treatment in Tarakan Regional
Public Hospital from January 2017 to December 2018 were retrospectively analyzed.
Demographic profile, NLR was measured in the emergency department prior to fur-
ther treatment in hospital ward while EF was measured during treatment period in
hospital (EF for STEMI patient was focused for anterior infarction involvement).
Results: The mean age of the patient was 56612 years old and most of them were
male (75%). The mean (6SE) NLR on admission in the data was 4.66(64.06) and the
mean of EF was 46,98 6 16.5. In this study, NLR had no significant negative correla-
tion with EF for STEMI patient (Sig. 2-tailed p ¼ 0.200, r¼-0.213) as well as for
NSTEMI patient (Sig. 2-tailed p ¼ 0.555, r¼-0.123).
Conclusion: Higher neutrophil-lymphocyte ratio on admission may had a lower EF in
STEMI and NSTEMI patients. While this study wasn’t concluding a strong negative cor-
relation statistically, there was a tendency towards it. It is a clinically important
inflammatory marker that can take a role in the management and the prognosis of
patient with Acute Coronary Syndrome. Further larger study is needed to observe
the relation between NLR and left ventricular systolic dysfunction.
Keywords: Neutrophil-Lymphocyte Ratio • EF • STEMI • NSTEMI
OR.295. Neutrophil-Lymphocyte Ratio on Admission as A Predictive Value of Left
Ventricular Systolic Dysfunction in Patients with Acute Myocardial Infarction in
North Kalimantan
Christopher A. Yandoyo, Winardi E. Setiawan, Fandi Ahmad, Donny S. Syamsul,
Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: Children with heart disease are serious conditions that have significant
impact on morbidity, mortality, and healthcare costs. There were no reported data
in Sampang Hospital that measure epidemiological profile of heart disease in children
in this region.
Objective: This study was aimed specifically to determine the most lesion and type
of heart disease in children in one populated area in Sampang, Madura.
Method: The retrospective observational study was conducted during January 2016
to Agustus 2018. Inclusion criteria are children of age ranged from 0 days to 17 years
old, first time diagnosed with their clinical and echocardiographic. The data of in
and out pediatric patients with heart disease in children taken from medical record.
Children with heart disease with more than single lesion was simplified as one lesion
which had most major impact on hemodynamic circulation. Data were entered in Ms
Excel and analyzed by SPSS.
Result: We had total 85 patients with heart disease in children registered to
Sampang Hospital during January 2016 to Agustus 2018. Gender based percentage
showed 39% for female and 61% male. Ventricle septal defect (VSD) was the most
common lesion of congenital heart diseases (CHD) among children (17 patients, 20%)
followed by atrial septal defect (ASD) 11 patients (13%) and persistent ductus arte-
riosus (PDA) 10 patients (12%). The highest incidence of cyanotic heart diseases was
Tetralogy of Fallot (TOF) 3 patients (4%). Rheumatoid Heart Disease were found in 21
patients (25%) and 13 patients (15%) with others heart diseases. The highest age
ranged of CHD are 0 days to 2 years old and 10 to 17 years old for rheumatoid heart
disease.
Conclusion: The most common lesion of acyanotic heart disease in children was VSD
and the highest incidence of cyanotic heart disease was TOF. Early diagnosis is
F107
important and follow up early in the course of the disease in order to improve out-
come and reduces mortality rates.
Keywords: Incidence • heart disease • children.
OR.296. Incidence and Pattern of Children with Heart Disease: A Two Year Study
in Moh Zyn Regional Public Hospital of Sampang, Madura, East Java, Indonesia
I.A Rakhmawati, A.I Sadiati, F. Diastyarini
Moh Zyn Regional Public Hospital of Sampang, Madura
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Background: Acute coronary syndrome (ACS) is one of the causes of morbidity and
mortality in human with 12.9% percentage of all cases. Octogenarian are individuals
aged 80 years or more and are called elderly. Data showed coronary heart disease
incidence in elderly in Indonesia by 33% and will keep increasing in line with increas-
ing population of elderly. Data stated that the population of elderly in Indonesia in
2000 reached 7.23% and is predicted to keep increasing up to 11.34% in 2020.
According to the prediction of Bureau of Census USA in 1993, by 2045, the number of
elderlies in Indonesia will increase to 414%. Even though data showed an increase of
survivability in acute coronary syndrome patients, this does not apply to elderly pop-
ulation. Anatomical and physiological changes become some of the causes of acute
coronary syndrome. Endothelial dysfunction that triggers arteriosclerosis in the ves-
sels becomes the base of anatomical changes that cause acute coronary syndrome.
Anatomical changes, comorbid factors (hypertension, diabetes mellitus, dyslipide-
mia) become the physiological cause of acute coronary syndrome in elderly. Along
2018, there was 62 octogenarian patients diagnosed with acute coronary syndrome
admitted in the ER and received treatment in ICCU of Buleleng General Hospital.
Objectives: This study was to determine the prevalence and comorbid in octogenar-
ian patients with acute coronary syndrome during 2018 in Buleleng General Hospital.
Methods: This study was a descriptive retrospective, conducted in octogenarian
patients admitted to ER and and receive treatment in ICCU of Buleleng General
Hospital during 2018. This clinical study involved gender, the type of ACS experi-
enced, comorbid factors (Hypertension, diabetes mellitus, dyslipidemia) according to
the data obtained through the patients medical records.
Results: During 2018, there were 62 octogenarian patients admitted with acute coro-
nary syndrome in Buleleng General Hospital. The average age of patients was 84.5
years. Males consisted of 27 people (43.5%) and female were 35 people (56.5%).
From above data, 16 patients (19.7%) were diagnosed with STEMI and 46 patients
(80.3%) were diagnosed with NSTEMI. Hypertension was found in 31 patients (50%).
Diabetes mellitus was found in 9 patients (14.5%). Dyslipidemia was found in 31
patients (50%).
Conclusion: Out of all octogenarian patients admitted to Buleleng General Hospital,
there were more female patients compared to males. The average age of octogenar-
ian with ACS was 84.5 years old. The number of NSTEMI type ACS patients were more
dominant compared to STEMI type. The highest comorbid factors in octogenarian
with ACS were hypertension and dyslipidemia.
Keywords: Acute Coronary Syndrome • Octogenarian • Hypertension •
Dyslipidemia.
OR.297. The Distribution of Coronary Artery Lession in Patient with
Hypertention and Diabetes Mellitus History in Jakarta Heart Center Hospital
Todung Silalahi1, Andreas M Siborutorop1, Simon Salim2
1
Division of Cardiovascular, Department of Internal Medicine, Jakarta Heart Center
Hospital, Jakarta, and Faculty of Medicine, Universitas Kristen Krida Wacana,
Indonesia., 2Division of Cardiology, Department of Internal Medicine, University of
Indonesia, Jakarta, Indonesia
Background: WHO stated that around 7.4 million people died from Coronary Artery
Disease (CAD) in 2012. Based on data released by The Center of Information and Data
of Health Secretary Indonesian Republic known, prevalence of CAD in Indonesia on
2013 is 1,5% or around 2.650.340 cases. Risk factors that contribute to CAD are :
non-modifiable (age, gender) and modifiable (smoking, dyslipidemia, hypertension,
obesity, and diabetes).
Objective: We sought to see the pattern of CAD based on the underlying modifiable
risk factors such as Diabetes and Hypertension to describe distribution of CAD corre-
lated with location and amount of coronary artery lessions.
Methods: The design was a descriptive cross sectional study, that conducted by col-
lecting data from medical records of patients with CAD, who has CAD with history of
hypertention and diabetes mellitus and been catheterized in Jakarta Heart Center
Hospital (JHC),Jakarta ,from April 2015 to March 2016. The number of samples who
have fulfil the criteria of inclusion and exclusion is 706 patients.
Result: From706 patients who enrolled in this study, patients with hypertention his-
tory who has CAD1VD is 162 (31.57%), CAD2VD is 130 (25.34%), CAD3VD is 160
(31.18%), CAD3VDþLMD is 61 (11.89%). Patients with Diabetes Mellitus history who
has CAD1VD is 12 (31.57%), CAD2VD is 10 (26.31%), CAD3VD is 11 (28.94%),
CAD3VDþLMD is 5 (13.15%). Patients with both hypertention and diabetes mellitus
F108
history who has CAD1VD is 38 (24.51%), CAD2VD is 17 (10.96%), CAD3VD is 67
(43.22%), CAD3VDþLMD is 33 (21.29%).
Conclusion: Majority of Hypertension only patients, and DM only patients have 1 VD,
and majority of HT þDM have 3VD. CAD 3VD was found in 31.18% of patients with
hypertension only, 28.94% of patients with DM only, and 43.22% of patients with DM
þ HT combined.
Keywords: Distribution CAD • Hypertension • Diabetes Mellitus
OR.298. Association of Serum Sodium, Potassium and Chloride Value on
Admission With ST Elevation Myocardial Infarcts Patient’s Global Registry of
Acute Coronary Event at Tarakan Regional Public Hospital, North Kalimantan
Steffiany, Winardi E Setiawan, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan
Background: Myocardial infarction is one of the leading causes morbidity and mortal-
ity in the world. In 2018, North Kalimantan placed in the first rank with in patients
with cardiac insufficiency in Indonesia. In ST elevated myocardial infarcts (STEMI),
there is an occlusion that lead to infarction of cell and necrosis of cell. Serum elec-
trolytes imbalance after an episode of myocardial infarct are common. Serum
sodium, potassium are considered associated with electrophysiological property of
myocardial membrane. While, global registry of acute coronary event (GRACE) score
was a parameter to assess patient’s mortality prognosis in 6 months after event.
Objective: This study aim to correlate the serum electrolyte STEMI patients on
admission with patient GRACE score.
Methods: This study derived from Tarakan regional public hospital medical record.
Study involved hospitalized 77 STEMI cases from January 2017 till December 2018.
STEMI patients are admitted either from emergency room or clinic. The serum elec-
trolyte was taken in 6 hours after admission. All data was analyzed with independent
T test in SPSS statistic 20.
Result: There are 56 patient included in this study. Age mean of this study is 54.48 6
13.56; sodium mean ¼ 137.262.89 mEq/L; potassium mean ¼ 3.8260.49 mEq/L;
and chloride mean ¼105.4963.79 Mmol/L. There is a significant result between
patients GRACE score mean in hyponatremia patients and normonatremia patients
(180.33642.43 vs 138.47629.48, p < 0.01; p¼ 0.001 ). Meanwhile, there is no signif-
icant result between potassium (p ¼ 0,79) and chloride value ( p ¼ 0.172) to GRACE
score in STEMI patients.
Conclusions: There is a significant result between sodium value to GRACE score in
STEMI patients at Tarakan regional public hospital, North Kalimantan. The lesser
sodium value would lead to better prognosis rather than higher sodium value patient
on admission.
Keywords: Myocardial infarction • STEMI • dyselectrolytemia • GRACE.
OR.299. Correlation between Anemia And Global Registry of Acute Coronary
Events Score in Patient With Non-ST Elevation Myocardial Infarction : An Analysis
from Tarakan Registry of Acute Coronary Syndrome
Juliana, Ahmad Fandi, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan
Background: Cardiovascular disease are the number 1 cause of death globally. An
estimated 17.9 million people died from cardiovascular disease in 2016, representing
31% of all global death. National epidemiology data 2018 shows that the highest
prevalence of heart disease is in the North Kalimantan province. Anemia can
adversely influence prognosis in patients by various mechanisms, such as decreasing
the oxygen content of the blood supply. This study evaluated the relationship
between anemia and Global Registry of Acute Coronary Events (GRACE) risk score
with in-hospital death in patients with Non-ST Elevation Myocardial Infarction
(NSTEMI).
Methodology: The retrospective study included 59 patients admitted for NSTEMI
from January 2017 until December 2018. Patients with anemia were identified
(hemoglobin <12g/dl for women and <13g/dl for men) using convenient sex-specific
thresholds by World Health Organization. GRACE risk score was calculated upon first
arrival to the hospital.
Result: The study population included 59 patients with a mean age of 58.3 61.7
years, 64% male. Anemia was present in 20 (33.9%) patients, the mean of hemoglobin
on admission was 13.09 62.09. The mean of GRACE risk score was 101.75639.8.
Anemic patients were seen in older and more often in male, higher proportion of dia-
betics and hypertensive. There was a correlation between lower hemoglobin with
higher GRACE in hospital mortality score (Sig 2-tailed p ¼ 0.001, r¼-0.439).
Abstracts
Conclusions: Our study results demonstrated that patient with lower hemoglobin on
admission had a significant higher GRACE score and it was associated with in-hospital
cardiovascular mortality in NSTEMI.
Keywords: NSTEMI • GRACE • anemia • hemoglobin
OR.300. Does Diabetes Truly Obscure Typical Presentation of Chest Pain Among
Acute Coronary Syndrome?Analysis from Banda Aceh
M. Hustiar Hakim, Muhammad Ridwan, Teuku M. Haykal, Yusni
Department of Cardiology and Vascular Medicine, School of Medicine, Syiah Kuala
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
University, Banda Aceh, Indonesia
Background: As an important major risk factor of cardiovascular disease, diabetes is
common among Acute Coronary Syndrome (ACS). Identifying ACS based on clinical
presentation alone is difficult in patients with diabetes. Diabetes patients usually
develop atypical characteristic of chest pain. We sought to investigate whether
patients with diabetes truly have atypical characteristic of chest pain rather than
patients without diabetes. Other descriptions of chest pain among diabetic patients
with ACS were also analyzed.
Methods: This is a cross-sectional study in patients presented with ACS in Zainoel
Abidin hospital, Banda Aceh, between November 2018 to January 2019. All patients
were interviewed by a physician during hospitalization. The data obtained from
interview included detailed descriptions of chest pain and detailed risk factors char-
acteristic. Medical data regarding diagnostic examination and therapeutic interven-
tion was obtained from medical record. Statistical analysis using bivariate analysis
was performed to identify association between variables.
Results: Fifty patients presented with ACS were enrolled prospectively for the study.
Diabetes was identified in 34% patients. The mean age was 55.8 6 9.6 years old and
80% of the subjects were male. Diagnosis of myocardial infarct were made in 28
patients (56%) while others were admitted as Unstable Angina Pectoris (UAP). Typical
presentation of chest pain as described as heavy or tight sensation was identified in
86% cases. No association was detected between atypical presentation of chest pain
and diabetes condition (p ¼ 0.23). Radiating sensation of chest pain was also not
associated with diabetes (p ¼ 0.30) as well as the presence of diaphoresis (p ¼ 0.49).
In contrast, nausea was significantly common among ACS patients without diabetes
(p ¼ 0.04).
Conclusion: In ACS population, no association was identified between diabetes and
typical presentation of chest pain with its detailed descriptions. The proposition
stating that diabetic patients usually presented with atypical characteristic of chest
pain need to be reinvestigated.
Keywords: Angina Pectoris • Diabetes Mellitus • Acute Coronary Syndrome
OR.301. Correlation Between Body Mass Index and Cardiorespiratory Fitness
Among Youth in Jakarta, Indonesia
Stephanie Widodo Subagio, Yudistira Panji Santosa
Department of Internal Medicine, School of Medicine and Health Sciences Atma Jaya
Catholic University of Indonesia, Jakarta, Indonesia
Background: Cardiovascular disease is the number one cause of death every year
globally and one of the most common cause of death in Indonesia, besides stroke and
diabetes. The predictive factor of cardiovascular disease can be seen since the age
of youth (15-24 years). Parameters that can be used in predicting cardiovascular dis-
ease are cardiorespiratory fitness (VO2max) and nutritional status (BMI). Several
studies shown that low cardiorespiratory fitness accompanied with high body mass
index has association with cardiovascular disease.
Objective: To determine the correlation between body mass index and cardiorespira-
tory fitness (VO2max) among youth in Jakarta, Indonesia.
Method: A cross-sectional study was conducted to 80 youth in Jakarta, Indonesia.
Weight and height were measured using standard methods to assess the body mass
index. VO2max measurements were collected with the Queen’s College Step Test
methods to assess the cardiorespiratory fitness. The obtained data was analyzed with
Pearson’s correlation.
Result: The majority of respondents who are overweight and obese have poor
VO2max (91.1%) similar results were obtained among the respondents with normal
body mass index (91.4%). Statistically, there was no significant correlation between
body mass index and cardiorespiratory fitness (r ¼ 0.05; p ¼ 0.64) because the cardi-
orespiratory fitness among youth tends to be the same and it’s not influenced by
weight.
Conclusion: There was no significant correlation between body mass index and cardi-
orespiratory fitness (VO2max) among youth in Jakarta, Indonesia.
Keywords: cardiorespiratory fitness • body mass index • Queen’s college step test
Abstracts
OR.302. Clinical Factors Correlation to Patient Medication Adherence in
Hypertensive Patients
Dylan Hadi1, Filemon M. W. Sondakh1, Ng Sunanto1,2
1 Weights and heights were measured using standard methods to assess the body mass
Faculty of Medicine, Universitas Pelita Harapan , 2Siloam General Hospital,
Tangerang, Indonesia
Background: Blood Pressure (BP) Control is important in controlling Cardiovascular
Diseases (CVD) and it has been shown that non-adherence to therapy are one of the
reasons most patients don’t achieve optimal BP control. There are several studies in
the correlation between various clinical factors to patient adherence but no similar
research has been done in Tangerang which has a different demographic characteris-
tic thus there may be a need to examine these factors on these patients.
Objective: Examining the Correlation between various clinical factors to patient
adherence in Hypertensive Patients.
Method: The study was designed as a cross-sectional observational study with con-
secutive sampling done from March to April 2019. Sixty two patients that were diag-
nosed with Primary Hypertension were included, and the following informations were
obtained; Name, Age, Sex, Duration of HT, Patient adherence and knowledge in HT,
Patient Motivation, and Family as well as Medical Staff Support. Patient adherence
was determined using the MMAS-8 (Morisky Medication Adherence Scale)
questionnare.
Result: The results were obtained on 62 samples and presented as follow [Median,
[min-max)] : There were 43 females (69.4%), 52 patients (83.9%) were recently diag-
nosed with Hypertension, Patient’s age was varied [54, (23-74)]. From 62 patients,
30 Patients (48.4%) were adherent, 31 (50%) Patients has good knowledge about HT
,37 patients (47%) had good motivation, 49 Patients (79%) has good family support,
and 37 (59.7%) Patients received good medical staff support. Of those 30 Adherent
Patients, 20 were females, 22 had good knowledge about HT, 26 had good motiva-
tion, 27 had good family support and 26 had good medical staff support. The correla-
tions between age and sex was insignificant with adherence with P values of 0.071
and 0.657 respectively, However the correlation between patient knowledge, moti-
vation and both family and medical staff support were significant with odds ratio of
7.0 ,12.4, 4.09, 0.2 and P values of 0.001, 0.001, 0.040 and 0.016 respectively.
Conclusion: There were significant correlations between patient knowledge, motiva-
tion and both family and medical staff support to adherence.
Keywords: Hypertension • Medication Adherence • Knowledge in Hypertension.
OR.303. Neutrophil-Lymphocyte Ratio as a Useful Hematologic Biomarker in
Predicting Mortality in Non-ST Elevation Myocardial Infarction
Stefanus, Winardi E. Setiawan, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: Previous studies have shown that the neutrophil-lymphocyte ratio (NLR)
and the thrombolysis in myocardial infarction (TIMI) risk score have been described
as a predictor of mortality in patients with acute coronary syndrome.
Objective: This study aimed to determine the correlation between NLR and TIMI risk
score in predicting mortality in patients with acute coronary syndrome especially
non-ST elevation myocardial infarction (NSTEMI).
Method: The subjects of this study were patients with NSTEMI from Tarakan Registry
of Acute Coronary Syndrome. The NLR was taken from the laboratory result when
the patient was admitted to the hospital and the mortality assessment was calcu-
lated using TIMI risk score. The data was processed using IBM SPSS Statistics 24 and
analyzed using spearman correlation.
Result: The subject’s mean age was 60.08 6 9.82 years with the mean TIMI score of
the studied patients was 2.61 6 1.89 and the mean of the neutrophil-lymphocyte
ratio was 4.49 6 8.51. It was found that there was a correlation between neutorphil-
lymphocyte ratio and TIMI risk score (p < 0,05) with its correlation coefficient was
0,29.
Conclusion: Based on the findings of the present study, the neutrophil-lymphocyte
ratio was found useful in predicting risk at 14 days of all-cause mortality, new or
recurrent myocardial infarction or severe recurrent ischemia requiring urgent
revascularization.
Keywords: Neutrophil-lymphocyte ratio • TIMI • NSTEMI
OR.304. Correlation of Elevated Blood Pressure on Cardiorespiratory Fitness
Among Youth in Jakarta, Indonesia
Stephanie Widodo Subagio, Yudistira Panji Santosa
Department of Internal Medicine, School of Medicine and Health Sciences Atma Jaya
Catholic University of Indonesia, Jakarta, Indonesia
Background: Cardiovascular disease is a major cause of morbidity and mortality
worldwide and one of the most common cause of death in Indonesia, besides stroke
and diabetes. Many factors can contribute to this disease, including hypertension,
obesity, dyslipidemia, etc. These risk factors are often shown in youth, so that pre-
ventive measure should be initiated since youth age.
F109
Objective: To determine the correlation between elevated blood pressure and cardi-
orespiratory fitness (VO2max) among youth in Jakarta, Indonesia.
Method: A cross-sectional study was conducted to 52 youths in Jakarta, Indonesia.
index. Blood pressures were measured by standardized sphygmomanometer and
VO2max measurements were collected with the Queen’s College Step Test methods
to assess the cardiorespiratory fitness. The obtained data was analyzed with
Pearson’s correlation.
Result: Similar results were obtained among respondents who have overweight and
normal body mass index. The majority of respondents have an elevated systolic and
diastolic blood pressure and a decreased VO2max. There was no significant difference
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
between respondents with overweight and normal body mass index. Statistically,
there was no significant correlation between elevated blood pressure and cardiores-
piratory fitness (p > 0.05) because the cardiorespiratory fitness among youth tends to
be the same and it’s not influenced by blood pressure.
Conclusion: There was no significant correlation between elevated blood pressure
and cardiorespiratory fitness (VO2max) among youth in Jakarta, Indonesia.
Keywords: blood pressure • cardiorespiratory fitness • body mass index • Queen’s
college step test.
OR.305. Effect of Guideline Directed Medical Therapy (GDMT) in patients Heart
Failure with Reduce Ejection Fraction (HFrEF) in the Left Ventricular Ejection
Fraction (LVEF) Improvement in Cibinong General Hospital Indonesia : a Single
Centre Experience
Dian Yaniarti Hasanah, Zul Effendi, Rarsari Soerarso, Nani Hersunarti
Department of Cardiology and Vascular Medicine, School of Medicine, Indonesia
University, Jakarta
Background: Improvement in functional status, long term survival, and quality of life
has always been the goal of therapy in patients heart failure with reduced ejection
fraction. Neurohormonal modulating medications help patients achieve these goals
and, in a subgroup of patients, can promote reverse remodeling resulting in the
recovery of left ventricular systolic function. Optimal medical therapy appears to be
a key component of achieving myocardial recovery, with recovery more likely in
patients with a shorter duration of heart failure and a non-ischemic etiology. We
evaluate 94 patients HFrEF due to ischemic (all not revascularized ) and non ischemic
cause such as myocarditis that got optimal GDMT and comorbid treatment. LVEF was
compared from the first admission an after 12 months GDMT.
Objective: To assess the effect of optimal GDMT for improvement of LVEF in HFrEF
patients in Cibinong General Hospital.
Method: This study was conducted in Cibinong General Hospital, Indonesia, from
November 2017 to 2018. Ninety four patients were included in this prospective cohort
study with all patients had standard heart failure therapy based on guideline (Loop diu-
retic, MRA, Ace inhibitor/ARB/ uperio, beta blocker). The primary end point of this
study was LV EF recovery that was follow up to 12 months. NYHA, heart rate, and blood
pressure were compared from first admission and after 12 months therapy. We also
evaluate the dose of optimal Ace inhibitor/ARB and beta blocker that can be achieved
in this study compared to definition of optimal therapy based on the guideline.
Result: EF and heart rate were significantly different between baseline (30.2 6 8.9)
and follow up (43.8 6 11.9 with p < 0.001, as well as NYHA Functional Class. Optimal
drug dose for Ace-i/ARB and beta blocker were not associated with EF recovery, with
p value were 1.000 for all drug type, with definition of optimal therapy based on
guideline. The average dose for Ace I in this studi is 7.3 mg, the average dose for
ARB is 18.3 mg, and the average dose for beta blocker is 6.4 mg. This result showed
that optimal therapy is very individual for each patient. In this study we cannot
meet the optimal dose in the guideline due to heart rate and blood pressure consid-
eration. In the CAD group, the percentage of EF recovery is 95.8%, while in the non
CAD group, the percentage of EF recovery is 91.3%.
Conclusion: Optimal drug dose for Ace-I, ARB, and BB were not associated with EF
improvement although the dose of Ace-i/ARB and beta blocker in this study is quite
high and EF improvement is achieved in this study.
Keywords: heart failure • guideline directed medical therapy • left ventricular
ejection fraction
OR.306. Clinical Characteristics of Adult Uncorrected Acyanotic Congenital
Heart Disease in Sanglah General Hospital
Hendrikus G. S. Adhi Putra1, M. S. Yudha Dewangga1,2, E. Gunawijaya3
1
Sanglah General Hospital, Denpasar, Indonesia, 2Department of Cardiology and
Vascular Medicine, Faculty of Medicine Udayana University, Indonesia, 3Division of
Pediatric Cardiology, Department of Child Health, Faculty of Medicine Udayana
University/Sanglah General Hospital Denpasar, Indonesia
Background: Congenital heart disease (CHD) in adults is a problem for the health
care system because the number continues to increase every year both globally and
Indonesia in particular. More than 90% of children who experience CHD manage to
survive into adulthood.
F110
Objective: The aim of the study is to describe the clinical characteristics of adult
uncorrected acyanotic CHD.
Method: The study design was cross-sectional. The subjects were enrolled consecu-
tively from outpatient clinics and inpatient wards. The data were collected and
recorded in case report form. Descriptive statistics was applied to describe the char-
acteristics of subjects.
Result: Seventy eight subjects were enrolled in this study. The majority were women
53 (67.9%) subjects and productive age of 18-60 years old 72 (92.3%) subjects. The
most common symptom were dyspnea, easily fatigue, and palpitation. The mean
peripheral oxygen saturation was 96%. Based on electrocardiography, 70 (89.7%) sub-
jects had sinus rhythm and 8 (10.3%) subjects had atrial fibrillation. Meanwhile, 13
(16.7%) subjects had tachycardia and 6 (7.7%) had bradycardia. Based on echocar-
diography examination, 43 (55.1%) of subjects had suffered from pulmonary hyper-
tension. The mean diameter of defects were 26.6 mm in ASD subjects, 13,6 mm in
VSD subjects, and 11,3 mm for ampulla diameter in PDA subjects. The direction of
blood flow was mostly left to right 46 (58.8%) subjects and bidirectional shunt 14
(18.4%) subjects. The mean of left ventricular ejection fraction was 64.7%. Twenty
eight (35.9%) subjects have undergone catheterization, the mean of mean pulmonary
arterial pressure was 37.2 mmHg with PARi<5 17 (60,7%) subjects and >5 11 (39.3%)
subjects. Twelve (85.7%) subjects had reaction to oxygen test and 2 (14.3%) subjects
had not reaction to oxygen test.
Conclusion: In conclusion, most adult uncorrected acyanotic congenital heart disease
had developed pulmonary hypertension, mostly young women and productive ages,
mainly visited to hospital due to dyspnea.
Keywords: clinical characteristics • congenital heart disease • uncorrected
OR.307. Correlation between Blood Glucose Levels in Admission with Length of
Stay in Patients with Acute Myocardial Infarction
Robby M. Simangunsong, Dwinta R. Sidabutar, Fandi Ahmad, Donny S. Syamsul,
Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: Hyperglycemia has been considered to be one of the risk factors for
acute coronary syndrome. Short and long-term mortality rates of patients with acute
coronary syndrome with hyperglycemia are higher than those who do not have hyper-
glycemia. We evaluated the relationship between admission random blood glucose
and length of stay of patients with myocardial infarction in Tarakan Regional Public
Hospital.
Patients and Methods: Data were analyzed from 130 patients with the final diagnosis
of ACS during January 2017 to December 2018 obtained from the Tarakan Registry of
Acute Coronary Syndrome (TRACS). This was a cross-sectional study with consecutive
sampling study. Inclusion criteria in this study was all patients with acute myocardial
infarction (STEMI and NSTEMI) who have complete medical record data including
blood glucose level data on the emergency room and length of stay data. Data were
analyzed using Pearson Correlation.
Result: The mean blood glucose level in admission in this population was 147,65 6
68.07, while the means of length of stay was 5,91 6 1,635. The correlation of log-
blood glucose level in admission and length of stay was strong (r ¼ 0,504;
p ¼ <0,001).
Conclusion: Admission hyperglycemia has strong correlation with length of stay in
patients admitted with acute myocardial infarction.
Keywords: Acute myocardial infarction • blood glucose level in admission • length
of stay
OR.308. Characteristics, Treatment and In-hospital Outcomes of Patients with
Acute Coronary Syndrome in North Kalimantan : an Initial Report of Tarakan
Registry of Acute Coronary Syndrome
Haris Jauhari, Fandi Ahmad, Donny S. Syamsul, Muhammad H. Hasyim
Tarakan Regional Public Hospital, North Kalimantan, Indonesia
Background: Acute coronary syndrome (ACS) comprises a group of entities including
acute ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation
myocardial infarction (NSTEMI) and unstable angina (UA). These manifestations are
common causes of medical consultations and admissions at emergency departments,
as well as morbidity and mortality worldwide. North Kalimantan is a province in
Indonesia with the highest prevalence of heart disease based on physician diagnosis,
adopted from RISKESDAS 2018.
Objective: To identify the characteristics, treatment and in-hospital outcomes of
patients diagnosed with the acute coronary syndrome in Tarakan Regional Public
Hospital, North Kalimantan, Indonesia.
Method: Tarakan Registry of Acute Coronary Syndrome (TRACS) is a single-center,
two years retrospective registry from January 2017 to December 2018. Web-based
data entry was used and the data were centrally managed and analyzed.
Abstracts
Result: The mean age was 54.5 6 12.06 years, and 75.1% were male. More than
half (52.7%) had STEMI, 40.6% had NSTEMI, and 6% had UA. The smoking rate was
31.5%, and diabetes mellitus was found in 21.2%. Most patients (80.6%) came
directly to the emergency department. For patients with STEMI, the median of
symptom to hospital time was 129 minutes (IQR 50-1440), and the median of door-
to-needle time was 141 minutes (IQR 50-210). Thrombolysis was found in less than
half of total patients of STEMI (48,2%). During hospitalisation, only a minority of
the patients did not receive beta-blockers and ACE inhibitors or angiotensin recep-
tor blockers therapy.
Conclusion: STEMI is the most common type of acute coronary syndrome. The num-
ber of thrombolysis is still low. Interventions of patient management and revasculari-
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
zation with invasive strategy is needed to improve the system.
Keywords: acute coronary syndrome registry • STEMI • NSTEMI • UA
OR.309. Clinical Spectrum of Endocarditis in Brunei Darussalam
NAS Nor Amin1, FI Idris2, N Luqman3, S Johar3
PAPRSB Institute of Health Sciences Universiti Brunei Darussalam, Senior Lecturer
and Clinical Academic Universiti Brunei Darussalam, Consultant Cardiologist
Department of Cardiology Raja Isteri Pengiran Anak Saleha Hospital
Introduction: This study investigated the demographic and clinical profile of patients
diagnosed with endocarditis in Brunei Darussalam. This study also determined the
use of Duke Criteria in establishing the diagnosis of endocarditis as well as patients’
outcomes 2 months after diagnosis. In addition, this study explored whether there is
any association of endocarditis with patients’ medical conditions, underlying heart
disease, as well as association of patients’ outcomes with their medical history,
results of blood culture and echocardiogram.
Materials and Methods: A cross sectional study of 38 patients diagnosed with endo-
carditis from January 2015 to December 2018 from two hospitals in Brunei
Darussalam was conducted. Data collected included patients’ demographics, medical
history, presence of underlying heart disease, patient outcomes 2 months after diag-
nosis, clinical profile and criteria of patient’s diagnosis using Duke’s criteria.
Results: The mean age of 38 patients diagnosed with endocarditis was 54.5 6 16.0
years old. Majority of patients suffered from hypertension (78.9%, n ¼ 30) and renal
insufficiency (60.5%, n ¼ 60.5%). Fever was the most common clinical manifestation
(76.3%, n ¼ 29) and Staphylococcus aureus was the main causative microorganism
(52.6%, n ¼ 20). Vegetations were found upon echocardiography in 89.5% (n ¼ 34) of
patients with affected mitral valve in 57.9% (n ¼ 22) of patients. 86.8% (n ¼ 33) of
patients were diagnosed with definite endocarditis according to Duke Criteria.
Majority of the patients’ outcomes were unremarkable (76.3%, n ¼ 29) while nine
(23.7%) patients died. There was no association of endocarditis with medical condi-
tions, risk factor of intravenous drug use and underlying heart disease as well as
patients’ outcomes with their medical history, results of blood culture and
echocardiogram.
Conclusion: Our study findings potentially provided new knowledge and greater
understanding of the clinical and demographic profile of endocarditis patients in
Brunei Darussalam. Identifying the underlying heart diseases and risk factors com-
monly associated with endocarditis could also help in raising preventive measures
and early diagnosis of the disease.
OR.310. Percutaneous Transvenous Mitral commissurotomy in University Malaya
Medical Centre Malaysia
MF Mohd Al-Baqlish1,2, ZA Imran1;WA Wan Azman1
1
University Malaya Medical Centre, Kuala Lumpur, Malaysia, 2Kulliyyah of Medicine,
International Islamic University Malaysia, Kuantan, Malaysia.
Introduction: PTMC is a procedure of choice for the treatment of severe mitral
stenosis. This is a descriptive study of all patient that undergone PTMC procedure in
our centre from 2012 to 2018.
Method: Patient that underwent PTMC procedure was trace through hospital online
database . The patient detail echocardiogram parameter pre procedure, post proce-
dure and outcome was documented.
Results: Eleven patient was underwent PTMC in our centre from 2012 to 2018. One
patient was failed PTMC and underwent Mitral valve replacement . One patient that
had successful PTMC but subsequently underwent mitral valve replacement. All the
other patient who underwent PTMC had a good improvement in the echocardio-
graphic parameter post PTMC. 5 patients were complicated with significant mitral
regurgitation.
Conclusion: Despite small number of patient underwent PTMC in our centre, we had
a good success rate and outcome.
Keywords: PTMC • Mitral Stenosis
Abstracts
OR.311. Characteristics of Chronic Heart Failure Patients in Abdul Moeloek
General Hospital
BA Pratama1, N Imansyah1, R Handayani1, DCD Valentina2, RA Prakasa2,
NR Rachmawani2, R Abdiana2
1 Objective: The aim of the study was to assess factors associated with hypertension
Abdul Moeloek General Hospital, Bandar Lampung, Indonesia, 2Medical, Faculty
Lampung University, Bandar Lampung, Indonesia
Background: Chronic Heart Failure (CHF) is one of health issues in cardiovascular dis-
ease. Instead of its prevalence that increases every year, there is no data about char-
acteristics of CHF in Abdul Moeloek General Hospital (AMGH). This study was
obtained to determine the characteristics of CHF patients in AMGH.
Methods: We conducted a retrospective descriptive study with analysis from medical
record between January–June 2018 at AMGH. Patients diagnosed with CHF based on
Framingham criteria then classified into HFrER, HFmrEF, HfpEF. Data was analyzed
using SPSS24 to asses characteristics of CHF patients.
Results and Discussion: There we re 117 data obtained with 67 patients (57.3%)
HFrER, 8(6.8%) HFmrEF, 42(35.9%) HfpEF. The mean age was 57616 years old with
the youngest of 19 and the eldest of 97 years old. There were 60(51.3%) females and
57(48.7%) males and 82(70.1%) living in rural areas. Fifty four patients had multiple
risk factors with the major of hypertension with 66(56.41%) followed by diabetes
with 27(23.08%), 15(12.8%) had ACS and 17(14.53%) were smokers. Of 117, 83(70.9%)
included into NYHA FC III, followed by 23(19.7%) and 11(9.4%) were NYHA FC IV and II
respectively. Thorax x-rays showed 100% patients had cardiomegaly. The mean length
of stay was 6.6562.98 days. There were 109(93.2%) survived and remaining 8(6.8%)
were deceased. Based on study, CHF was the most case admitted in AMGH. Most
patients suffered from HFrEF. Females were dominant than male. Hypertension and
diabetes were the main risk factors of CHF.
Conclusion: CHF remains a public concern in our healthcare. This study showed that
CHF was related to hypertension and diabetes, thus, early control may reduce its
prevalence.
Keywords: CHF • HFrER • HFmrEF • HFpEF
OR.312. Clinical Characteristics of Adult Uncorrected Acyanotic Congenital
Heart Disease in Sanglah General Hospital
Hendrikus G. S. Adhi Putra1, M. S. Yudha Dewangga1,2, E. Gunawijaya1,3
1
Sanglah General Hospital, Denpasar, Indonesia, 2Department of Cardiology and
Vascular Medicine, Faculty of Medicine Udayana University, 3Division of Pediatric
Cardiology, Department of Child Health, Faculty of Medicine Udayana University
Background: Congenital heart disease (CHD) in adults is a problem for the health
care system because the number continues to increase every year both globally and
Indonesia in particular. More than 90% of children who experience CHD manage to
survive into adulthood.
Objective: The aim of the study is to describe the clinical characteristics of adult
uncorrected acyanotic CHD.
Method: The study design was cross-sectional. The subjects were enrolled consecu-
tively from outpatient clinics and inpatient wards. The data were collected and
recorded in case report form. Descriptive statistics was applied to describe the char-
acteristics of subjects.
Result: Seventy eight subjects were enrolled in this study. The majority were women 53
(67.9%) subjects and productive age of 18-60 years old 72 (92.3%) subjects. The most
common symptom were dyspnea, easily fatigue, and palpitation. The mean peripheral
oxygen saturation was 96%. Based on electrocardiography, 70 (89.7%) subjects had sinus
rhythm and 8 (10.3%) subjects had atrial fibrillation. Meanwhile, 13 (16.7%) subjects had
tachycardia and 6 (7.7%) had bradycardia. Based on echocardiography examination, 43
(55.1%) of subjects had suffered from pulmonary hypertension. The mean diameter of
defects were 26.6 mm in ASD subjects, 13,6 mm in VSD subjects, and 11,3 mm for
ampulla diameter in PDA subjects. The direction of blood flow was mostly left to right
46 (58.8%) subjects and bidirectional shunt 14 (18.4%) subjects. The mean of left ven-
tricular ejection fraction was 64.7%. Twenty eight (35.9%) subjects have undergone
catheterization, the mean of mean pulmonary arterial pressure was 37.2 mmHg with
PARi<5 17 (60,7%) subjects and >5 11 (39.3%) subjects. Twelve (85.7%) subjects had
reaction to oxygen test and 2 (14.3%) subjects had not reaction to oxygen test.
Conclusion: In conclusion, most adult uncorrected acyanotic congenital heart disease
had developed pulmonary hypertension, mostly young women and productive ages,
mainly visited to hospital due to dyspnea.
Keywords: clinical characteristics • congenital heart disease • uncorrected
OR.313. Factor Associated with Hypertension Control in Hypertensive Patients in
Tangerang Primary Health Care
Filemon M. W. Sondakh1, H Dylan1, Sunanto Ng1,2
1 hypertension and cognitive function in elderly.
Faculty of Medicine, Universitas Pelita Harapan, 2Siloam General Hospital,
Tangerang, Indonesia
Background: Hypertension is known to be the major risk factor for global
Cardiovascular dieases (CVD) morbidity and mortality. Controlling hypertension (HT)
F111
can leads to significant reductions in the prevalence and incidence of target organ
damage, and mortality from CVD. Hypertension is also one of the most poorly con-
trolled risk factors. Limited studies have been conducted on prevalence of uncon-
trolled hypertension and associated factors among adult hypertensive patients.
control among patients attending primary health care in Tangerang, Indonesia.
Method: A cross-sectional study was conducted among sixty two hypertensive
patients in Tangerang Primary Health Care between March-April 2019. Blood pressure
was measured with Omron automatic sphygmomanometer based on AHA guideline.
Several variables were measured such as patient adherence using the Morisky
Medication Adherence Scale (MMAS-8), knowledge in HT, patients’ motivation, family
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
support and healthcare support. Uncontrolled hypertension was defined as systolic
blood pressure  140mmHg and diastolic blood pressure  90mmHg with current use
of antihypertensive medication. Data analyses were done using SPSS 23.
Result: A total of sixty two patients, 69.4% of subjects were female, median age 54
(23-74), 83.9% had < 5 years of hypertension duration, 50% use single drug amlodi-
pine therapy, 35% didn’t have any formal education, 75.8% had uncontrolled HT, 48%
with good adherent, and 50% good knowledge about HT. In this study we found that
patient adherence (p ¼ 0.001, OR 11.4) and patient knowledge (p ¼ 0.0001, OR 3.52)
significantly related to adequately control of hypertension. While gender, duration of
hypertension, formal education, patient motivation, family support and healthcare
support did not significantly related to adequately control of hypertension.
Conclusion: These data strongly suggest that improving patient’s adherence and
knowledge are important factors in the control of hypertension in the primary health
care setting.
Keywords: hypertension • knowledge • adherence
OR.314. Health-Related Quality of Life in Hemodialysis Patients: a Comparison
with Hypertensive Heart Disease
Jesslyn N. Hariyanto, Sunanto Ng, Ingrid M. Pardede, Indah Sukmawati
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Pelita
Harapan University, Tangerang, Indonesia
Background: Quality of life research endpoints have emerged as valuable research
tools in assessing the outcome of therapeutic intervention in chronic diseases. In
Indonesia, previous studies involved comparing the quality of life of hemodialysis
patients to that of healthy patients without chronic disease. The effects of cardiac
compensation associated with end-stage renal disease and hypertensive heart dis-
ease plays a major role in determining physical health, which ultimately determines
the quality of other functional domains such as role limitations, bodily pain and gen-
eral health perceptions.
Objective: This study aimed to compare the health-related quality of life of hemo-
dialysis patients with patients of hypertensive heart disease.
Method: This cross-sectional study was carried out in the hemodialysis centre and
outpatient department of an academic hospital. Demographic information was
obtained from all patients. 33 patients undergoing hemodialysis for a minimum of 3
years and 22 outpatients with hypertensive heart disease were enrolled. Assessment
of quality of life for both populations was conducted with a validated Indonesian ver-
sion of the SF-36.
Result: There is no difference between hemodialysis and hypertensive heart disease
patients in domains of physical functioning (72% 6 20 vs 72% 6 23), role limitations
due to physical health (58% 6 41 vs 63% 6 41), role limitations due to emotional
problems (70% 6 41 vs 80% 6 29), vitality (76% 6 24 vs 73% 6 14), emotional well-
being (85% 6 20 vs 73% 6 14), social functioning (94% 6 18 vs 94% 6 11), general
health (60% 6 16 vs 63% 6 15) and health changes (71% 6 31 vs 58% 6 31).
Conclusion: In comparison to the hypertensive heart disease patients, there is no
evidence to support a significant difference of quality of life in hemodialysis patients
in any of the 8 domains assessed by the SF-36.
Keywords: quality of life • hemodialysis • hypertensive heart disease
OR.315. The Role of Hypertension in Cognitive Impairment in Elderly
Giovanni Jessica, Denio A. Ridjab, Kevin Wibawa, Irvan Cahyadi, Joshua Henrina
Medical Education Unit, School of Medicine and Health Sciences, Atma Jaya Catholic
University of Indonesia, Jakarta, Indonesia
Background: Cognitive impairment is highly prevalent in elderly and impacts quality
of life. Although several studies showed that hypertension increases risk of cognitive
impairment, it is still unclear whether hypertension is a modifiable risk factor for
cognitive impairment.
Objective: The purpose of this study was to investigate the relationship between
Method: This is a cross sectional study of elderly in nursing home in Jakarta and
Tangerang during February - March 2019. Hypertension defined as blood pressure 
140/90 mmHg measured by digital sphygmomanometer or has history of hypertension
with ongoing antihypertensive therapy. Cognitive function was assessed using
Montreal Cognitive Assessment Indonesia (MoCA-Ina). Score  26 is classified as
F112
normal and <26 suggests cognitive impairment. Subjects with history of stroke were
excluded. Data were analyzed with Fischer’s exact test using IBM SPSS 25th.
Result: We examined 33 elderly, 26 (78.8%) females and 7 (21.2%) males. Mean age
was 74.8 6 1.7 (range 48 to 92). Average systolic and diastolic blood pressure was
126.4 6 2.4 (range 100 to 162) mmHg and 78.5 6 1.7 (range 60 to 100) mmHg, and
17 (51.5%) cohorts had hypertension. Average MoCA-Ina scores was 17.3 6 0.9 (range
8 to 28). Thirty one (93.9%) from 33 cohorts has cognitive impairment. Data was ana-
lyzed with Fischer exact test and showed no significant relation between hyperten-
sion and cognitive impairment in elderly (p ¼ 0.485, p < 0.005).
Conclusion: Although hypertension is hypothesized to be an important, modifiable
risk factor for cognitive impairment, we found no significant relation between
hypertension and cognitive impairment in our elderly cohort. This could be due to
the complexity of blood pressure and brain function, which is dependent on varieties
of factors such as age, duration of hypertensive blood pressure and antihypertensive
treatment.
Keywords: hypertension • cognitive impairment • MoCA-Ina • elderly
OR.316. Overexpression of Toll-Like Receptors 2 and 4 May Predict Incidence of
Atrial Fibrillation: A Systematic Review
Ignatius Ivan1, Indra P. Wendi2, Anton Sumarpo2
1
Undergraduate Medical Program, 2Department of Chemistry and Biochemistry,
1,2
School of Medicine and Health Sciences, Atma Jaya Catholic University of
Indonesia, Jakarta, Indonesia
Background: Atrial fibrillation (AF) is the most common sustained arrhythmia.
Growing evidences suggest a possible association between innate immune response
and AF particularly in relation to TLR2/4.
Objective: This systematic review aims to evaluate association of TLR2/4 on AF and
its potentials as novel immune-related biomarker.
Method: This systematic review was in accordance with the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched
PubMed for scientific articles published in English from 1985 to 2015. Titles of
articles extracted were reviewed for their relevance. Two authors independently
assessed the quality of each included study using Modified Newcastle-Ottawa Quality
Assessment Scale for the studies to determine the quality of selection, comparability
and outcome. Study qualities were categorized into three categories: high (>7);
moderate (5-7); low (<5).
Result: Seven relevant full-text articles met our inclusion criteria with high quality
assessment score (9.0). Most of the studies showed that an overexpression of TLR2/4
level on AF is evident. One study reported no significant difference in TLR4 expres-
sion level between sinus rhythm and AF group. One study showed that TLR2 and
TLR4 overexpression might predict new-onset AF after myocardial infarction
(OR: 1.08 and 1.02, respectively; P < 0.005) while another revealed the potential to
predict recurrent AF (HR: 1.090 and 1.075, respectively; p < 0.001)
Conclusion: We concluded that overexpression of TLR2/4 may be potential for pre-
dicting AF incidence. More studies are necessary to elucidate the causal link between
TLR2/4 on AF.
Keywords: Toll-like receptor • innate immune response • innate immunity • atrial
fibrillation • arrhytmia
OR.317. The Effect of Resveratrol on Arterial Stiffness Measured by Flow-
Mediated Dilation: A Systematic Review of Randomized Controlled Trial
I. Ivan1, I. P. Wendi2, L. Namretta2, A. Sumarpo2
1
Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia,
2
Department of Chemistry and Biochemistry, Atma Jaya Catholic University of
Indonesia, Jakarta, Indonesia
Background: Cardiovascular disease (CVD) has been associated with endothelial dys-
function, an early feature of vascular disease. Improvement in endothelial function
assessed with flow mediated dilation (FMD) above 7.1% is associated with lower risk
of the coronary events. Resveratrol has been acknowledged for its potential in
improving FMD.
Objective: This systematic review aimed to assess and present the current evidence
of the effect of resveratrol toward arterial stiffness measured with FMD as a poten-
tial agent for lowering the risk of cardiovascular events.
Methods: Our systematic review followed Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines. We performed literature search in
Pubmed from 2005 to February 2019 using MeSH terms: "resveratrol", "endothelium",
“atherosclerosis”, “arterial stiffness”, “vascular stiffness”, “blood pressure”,
“hypertension”, “vasodilation”, “blood flow velocity”. Titles of articles extracted
were reviewed for their relevance. Two authors independently assessed the quality
of each included study using Cochrane Risk of Bias Tool 2.0 which cover 6 domains
with scores of “low”, “high”, or “unclear”.
Results: Initially, we identified 82 relevant articles, which later we selected 2
articles that both randomized, cross-over, double-blind, placebo-controlled trial,
with a total of 51 participants. Supplementation of resveratrol was associated with
Abstracts
significantly higher FMD compared with placebo controlled group (p < 0.05) after
acute treatment with a single dose of resveratrol 75 mg (5.48 þ 0.69 vs. 7.42 þ 0.62,
p ¼ 0.002) or 300 mg (4.3 þ 0.6 vs. 6.1 þ 0.8, p ¼ 0.026). Chronic supplementation
with 75 mg/day for 6 weeks also suggest significant improvement on FMD (7.21 þ
0.51 vs. 5.83 þ 0.68, p ¼ 0.021)
Conclusion: Despite limited studies available, a significant results from both low-bias
studies indicating higher FMD may encourage more future studies with more partici-
pants and longer period.
Keywords: resveratrol • flow-mediated dilation • endothelium • arterial stiffness
• blood pressure • atherosclerosis
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.318. Sacubitril/Valsartan Superiority over Angiotensin Receptor Blockers in
Hypertension: A Mini Systematic Review of Randomized Controlled Trials
Rizky E. P. Yuriza, Muhammad I. R. Hasibuan, Afif Anshari
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Rantauprapat
General Hospital, Rantauprapat, Indonesia; Kanujoso Djatiwibowo Regional General
Hospital, Balikpapan, Indonesia
Background: Limited data is available on the efficacy and safety Sacubitril/Valsartan
compared to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor
blockers (ARBs) as an antihypertensive agent.
Objective: We decided to perform a mini systematic review of previous randomized
controlled trials (RCTs) to determine the efficacy and safety of Sacubitril/Valsartan
compared to ARBs for clinical treatment of hypertension.
Method: PubMed, EBSCO, JSTOR, ProQuest, ScienceDirect, and Cochrane Library
were thoroughly searched for relevant RCTs. The review incorporated exclusively
RCTs in which Sacubitril/Valsartan was compared with ARBs. Full-texts of studies
that met the inclusion criteria were further evaluated by two independent investiga-
tors. The primary outcome was mean systolic and diastolic blood pressure (BP)
reduction.
Result: Six RCTs involving a total of 4297 patients were included for analysis. Five
studies compared Sacubitril/Valsartan with Olmesartan, 1 study compared
Sacubitril/Valsartan with Valsartan alone. Three studies were conducted in a period
of 8 weeks, 1 study was conducted in 14 weeks period, and 2 studies in 52 weeks
period. Sacubitril/Valsartan at the dose of 200 mg was better than 20 mg Olmesartan
and Valsartan in reducing mean office systolic BP for both short-term (8-14 weeks
period) and long term (52 weeks) treatment. Sacubitril/Valsartan at the dose of
200 mg was also superior to 20 mg Olmesartan and Valsartan in reducing mean office
diastolic BP in 8-14 weeks period. However, there was no difference in mean office
diastolic BP reduction for 52 weeks period of treatment between Sacubitril/Valsartan
and Olmesartan. All studies showed no significant difference in terms of adverse
events between Sacubitril/Valsartan and ARBs treatment.
Conclusion: Sacubitril/Valsartan was proven to be superior to ARBs in blood pressure
reduction and is generally safe and well-tolerated in hypertensive patients.
Sacubitril/Valsartan showed promising efficacy and safety for the treatment of
hypertension.
Keywords: Sacubitril/Valsartan • LCZ696 • ARNI • ARB • hypertension
OR.319. Prognostic Value of 6-Minutes Walk Test for Predicting Mortality in Heart
Failure Patients: A Literature Review
Rizki Radhitya, Vidyawati, R Rasmin
Asih General Hospital, Jakarta Timur
Background: Cardiopulmonary exercise testing (CPET) is broadly used for assessing
functional limitation in patients with heart failure (HF), but hard to perform in cen-
ters with limited facilities. 6-minutes walk test (6MWT) is simple, easy to conduct,
cheap and considered to closely approximate the capacity to perform activities of
daily living.
Objective: We aim to analyze the prognostic value of 6MWT and CPET for predicting
mortality in HF patients in increasingly used 6MWT.
Method: Structured literature search was performed on several databases such as
Cochrane, Wiley Online Library, PubMed, and Elsevier, analyzing prognostic value of
6MWT and CPET. 53 studies were retained for full-text examination, but only 4 cohort
studies fulfilled the inclusion criterias.
Result: 6MWT and CPET (bicycle ergometer in 3 studies, treadmill in 1 study) were
conducted in all studies with 860 heart failure patients as the subject. Out of 860
patients from all studies 79.4% was male, mean age of all study was 56 6 11.2 years
old, and mean left ventricular ejection fraction (LVEF) was 29.9 6 11.7 %. Duration
between 6MWT and CPET were varied. A study by Opasich et al. showed 6MWT has
0.6 sensitivity and 0.52 specificity in predicting all-cause death in HF patients.
Meanwhile, pVO2 was proven to be significant in 2 out of 3 studies. One study by
Rubim et al. did not analyze the value of pVO2. When compared to CPET in univari-
ate and multivariate analysis, 6MWT distance lost its significance in all studies.
Conclusion: 6MWT is a simple, cheap, and reliable test, but our findings suggested
6MWT, as an alternative test, was proven to not have a better prognostic value
Abstracts
compared to CPET. However, larger studies with more samples are needed to better
determine the prognostic value of 6MWT.
Keywords: heart failure • mortality • 6-minute walking test
References:
Zugck C, Kruger C, Durr S, Gerber SH, Haunstetter A, Hornig K, et al. Is the 6-minute
walk test a reliablie substitute for peak oxygen uptake in patients with dilated
cardiomyopathy?Eur Heart J (2000); 21: 540-9
Opasich C, Pinna GD, Mazza A, Febo O, Riccardi R, Riccardi PG, et al. Six-minute
walking performance in patients with moderate-to-severe heart failure. Eur
Heart J (2001); 22: 488–96
Guazzi M, Dickstein K, Vicenzi M, Arena R. Six-minute walk test and cardiopulmonary
excercise testing in patients with chronic heart failure: A comparative analysis
on clinical and prognosis insights. Circh Heart Fail (2009); 2: 549–55.
Rubim VSM, Neto CD, Romeo JLM, Montera MW. Prognostic value of the six-minute
walk test in heart failure. Arquivos Brasileiros de Cardiologia (2006); 86.
OR.320. Right Ventricular Out Flow Tract Stenting VS Modified Blalock-Taussig
Shunt as an Initial Procedure for Symptomatic Tetrealogy of Fallot: A Systemic
Review
Jimmy O. Santoso, Ferry Liwang, Matthew Billy, Radityo Prakoso
Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan
Kita, Department of Cardiology and Vascular Medicine Universitas Indonesia
Introduction: Management of the Tetralogy of Fallot (TOF) remains a challenge in
which some cases require initial management before total repair. BT shunt has
remained the primary initial management since the 1940s. However, because of its
high level of risk, several studies have investigated right ventricular outflow tract
(RVOT) stenting as an alternative to modified Blalock-Taussig (BT) shunt.
Objective: This study provides an overview and evaluation of the effects of RVOT
stenting compared to modified BT shunt as the initial procedure on TOF.
Methods: A systematic search was performed in PubMed, SpringerLink, LILACS, and
Proquest databases from 2012 to 2017 for studying about RVOT stenting, BT shunt, and
TOF. Outcomes studied were PICU admission, length of stay, and time to total repair.
Risk of bias was assessed regarding randomization, allocation sequence concealment,
blinding, incomplete outcome data, selective outcome reporting, and other biases.
Results: Three articles showed lower PICU admission, shorter length of stay, and
shorter time-to-complete repair in the RVOT stenting group. No difference found of
30-day mortality and mortality until total repair between the two groups.
Subclinically, RVOT stenting provides better pulmonary arterial growth and oxygen
saturation.
Conclusion: RVOT had a better clinical and subclinical outcome as initial therapy in
TOF compared to modified BT shunts. However, the three articles had a disadvantage
of retrospective cohort as study design.
Keywords: RVOT stenting • TOF • mBT shunt
OR.321. Percutaneous Closure of Atrial Septal Defects Safety and Outcome in
Infants Weighing Less Than 10 kilogram : A Systematic Review
Prissilia Prasetyo1, Radityo Prakoso2
1
Faculty of Medicine, Universitas Indonesia, 2Division of Pediatric Cardiology and
Congenital Heart Disease, Departement of Cardiology and Vascular Medicine, Faculty
of Medicine Universitas Indonesia, National Cardiovascular Center of Harapan Kita.
Background: Percutaneous closure of secundum atrial septal defects (ASDs) is cur-
rently considered as the treatment of choice in adult and older children. However,
this procedure in small infants remains challenging due to procedure-related vascular
complications. Reports on the outcome of transcatheter ASD closure in adults and
older children have shown an excellent efficacy with lower complication rate.
Unfortunately, few data exists on feasibility, efficacy, and outcome of ASD closure in
infants weighing less than 10 kg.
Objective: The aim of this study was to analyze feasibility, safety, and clinical out-
come of percutaneous ASD device closure in infants with a bodyweight less than
10 kg.
Method: Journal searching in PubMed, MEDLINE and COCHRANE databases from ear-
liest available to 2018 was conducted. After screening the titles and abstracts by
inclusion and exclusion criteria, four studies were critically appraised. The results
from 4 studies comprising 168 patients were included in this review. These studies
using the Amplatzer septal occluder (ASO) and the Gore Helex septal occluder
(GHSO).
Result: All of studies in this review showed a consistent result. The mean age was
1.08 (range 0.2-2.85 year). The mean weight was 6.34 kg (range 2.3-10 kg). The
pooled successful rate of percutaneous ASD closure in infants weighing less than
10 kg were 97.5%. One patient experienced acute occluder embolization to the right
atrium. Minor complications observed in the patient including transient arrhythmias
(0.04%) and small residual shunt (0.1%). However, no other major procedure-related
F113
complications such as death, pericardial effusion or tamponade, vascular injury, and
impingement to adjacent structure were found in these studies.
Conclusion: Transcatheter ASD closure in infants weighing less than 10 kg is techni-
cally feasible with high successful rate and relatively safe. However, device selection
and technique of implantation are critical to minimize the risk of vascular complica-
tion. Furthermore, a large multicenter study is needed to evaluate clinical safety
and efficacy, in order to support this practice widely.
Keywords: atrial septal defect • transcatheter closure • small infants
OR.322. Role of The Third Generation of Beta Blocker in Increasing Ejection
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
Fraction for Patients with Heart Failure
Swastya D. Putra, Risca Rini Rini, Hananto Andriantoro
National Cardiovascular Center Hospital Harapan Kita, Jakarta, Indonesia
Background: Heart failure is still a problem with its increasing number of morbidity
and mortality worldwide. This condition is due to structural and functional myocar-
dial problems, thus resulting in decreased cardiac output and increased intracardial
pressure. Beta blocker as the first line treatment for heart failure works as a beta
adrenergic antagonist. Nebivolol is the third generation of beta blocker and has an
effect of nitric oxide which can vasodilate and fix endothelial myocardium functions.
Objective: To evaluate whether the third generation of beta blocker can increase
ejection fraction in patients with heart failure.
Method: Articles were searched through online database such as Pubmed, Clinical
Key, EBSCO and Cochrane. Keywords and MeSh terminology were applied. Screening
of titles and abstracts was performed by two investigators to review selected
articles. Relevant articles were included by following inclusion and exclusion crite-
ria. Data were extracted and critically appraised afterwards.
Result: There were four articles that fulfilled criteria to be critically appraised. Total
subjects were 2128 patients from all studies included. All articles were Randomized
Control Trials (RCTs) with Nebivolol as the third generation of beta blocker as the
intervention. Those studies found that Nebivolol can increase ejection fraction (RR
2.09 from Ghia S et al. study) in patients with heart failure.
Conclusion: The third generation of Beta belocker has beneficial effect in increasing
ejection fraction for heart failure patients.
Keywords: Third generation of beta blocker • nebivolol • heart failure • ejection
fraction.
OR.323. S1Q3T3 Pattern As a Predictor of Mortality in Acute Pulmonary
Embolism
M. Rizky Felani1, E.D. Nabila1, S. Budhi2
National Cardiovascular Heart Center Hospital, Jakarta, Indonesia
Background: Pulmonary embolism is a cardiovascular emergency that often occurs
with a variety of clinical manifestations from asymptomatic to life-threatening con-
ditions. One of its ECG findings is S1Q3T3, which can be attributed to one of the
prognostic factors of mortality.
Objective: To investigate S1Q3T3 pattern in ECG as a predictive factor for overall
mortality in patients with acute pulmonary embolism.
Method: Eligible articles were searched through online database namely Pubmed,
Cochrane, and EBSCO using MeSh keywords and terminology. Selected studies were
included based on inclusion and exclusion criteria. Data were then extracted and
critically appraised following appropriate study design used.
Result: There were three articles, which consist of two meta-analysis and one retro-
spective cohort, be included and critically appraised in this study. Total subjects of
three studies were 9.653 people. All studies evaluated S1Q3T3 pattern as a predictor
for mortality in pulmonary embolism patients. The two meta-analysis studies showed
that S1Q3T3 pattern can predict mortality in patients with acute pulmonary embo-
lism, OR 2.06 for study by Shopp et al. and OR 3.38 for study by Qaddoura et al.
However, one retrospective cohort showed otherwise (OR 0.8).
Conclusion: S1Q3T3 is one of ECG patterns that can be found in patients with acute
pulmonary embolism. This finding may predict mortality during hospitalization and
up to 30 days after the diagnosis of acute pulmonary embolism.
Keywords: Pulmonary Embolism • S1Q3T3 • Electrocardiography • Mortality
OR.324. Atrioventricular Block Event in Ticagrelor Therapy: A Systematic
Literature Review
Sheilla E.S. Pambayun1, Dyonisa N. Pakha, Annisa N. Hafika3
1
Nirmala Suri Hospital, Sukoharjo, Indonesia, 3Sebelas Maret Hospital, Sukoharjo,
Indonesia
Background: Ticagrelor was found to be more potent than clopidogrel as it produced
faster and stronger inhibition of platelet aggregation. However, ticagrelor has been
demonstrated to increase adenosine concentrations which is correlated to cardiac
conduction abnormalities, such as atrioventricular block.
F114
Objective: A systematic review was conducted to understand the effect of ticagrelor
on atrioventricular block event.
Method: A literature search was conducted using Pubmed, Cochrane, Springer Link,
DOAJ, and Europe PMC with the collection of data from the last five years. Ticagrelor
and atrioventricular block were used as the search terms. A systematic review of
published studies was performed with PRISMA. Studies which had randomized con-
trolled trial as design study were included. Furthermore, we analyzed the effect of
ticagrelor with the incidence of atrioventricular block.
Result: Recent studies (n ¼ 9) showed the incidence of atrioventricular block which
was induced by Ticagrelor. This drug inhibits cellular uptake of adenosine, resulting
an increase of adenosine concentration plasma. Thus, it will affect the autonomic
innervation in the heart by inhibition of the A1 receptors, which leads a negative
chronotropic and dromotropic effect in the conduction system. On contrary, the RCT
showed that ticagrelor didn’t contribute in bradyarrhytmia (including atrioventricu-
lar block) compared to clopidogrel which had similar role in acute coronary syndrome
(p ¼ 0.75). However, this study cannot be generalized in all patients, especially
patients who have advanced conduction disease (such as second and third degree
atrioventricular block) since such patients were excluded.
Conclusion: Bradyarrhythmia (including atrioventricular block) event did not have
correlation with an increase risk in Ticagrelor used, according to the RCT.
Furthermore, it is recommended to have further studies with larger population and
various characteristic samples, for instance advance bradyarrhythmia.
Keywords: ticagrelor • atrioventricular block • bradyarrhytmia • adenosine
OR.325. Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA):
The Underestimated Diagnosis.
D. Adrian
Panti Secanti Hospital Gisting, Tanggamus, Indonesia
Background: Myocardial infarction with no obstructive coronary arteries (MINOCA) is
a syndrome with different causes. The pathophysiology is poorly understood which
makes diagnostic of MINOCA is challenging. One in ten myocardial infarction fulfilled
MINOCA diagnostic criteria. To diagnose this condition, it is important to evaluate
the pathophysiology that may be responsible, thus require different treatments.
Objective: The objective of this paper was to systematically review the available lit-
erature on outcomes of patient with MINOCA versus myocardial infarction due to cor-
onary artery disease (MI-CAD).
Methods: Quantitative assessment using a systematic review approach evaluated the
underlying mechanisms of MINOCA and prognosis of MINOCA compared to MI-CAD.
Results: Mechanisms that cause MINOCA based on Cardiac Magnetic Resonance (CMR)
are myocarditis in 33% of patients, myocardial infarct in 24% of patients, Takotsubo
cardiomyopathy in 18% of patients and no abnormality found in 26% of MINOCA
patients. Thrombophilia disorders were detected in 14% of patients and coronary
artery spasm was founded in 27% of MINOCA patients. Mortality rate of MINOCA less
Abstracts
than MI-CAD in hospital (0.97% vs 3.1%) and in 12 months follow-up (4.3% vs 6.7%).
Mortality rate of MINOCA in 4.5 years follow-up is 13.6%.
Conclusions: Physicians should consider to evaluate a patient with myocardial infarct
further to differentiate if it is a MINOCA or a MI-CAD. MINOCA should be considered
as a working diagnosis that require evaluation so that directed therapies may
improve patient’s outcome. Diagnosis of MINOCA should be a red flag for a need of
further cardiac evaluation and minimized a “false-positive” acute myocardial infarct
(AMI) patients whom discharged without appropriate treatment.
Keywords: MINOCA • MI-CAD • myocardial infarction • mortality • prognosis.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/21/Supplement_F/F33/5570992 by guest on 18 September 2019
OR.326. Neutrophil Extracellular Traps Promote the Risk of Venous
Thromboembolism: A Future Potential Biomarker
Eka P. B. Mulia1, Yoga A. Noor1, Ismail Damanik1, Osca Imatsu1, Rendra M. Putra1,
Mohammad Budiarto1,2
1
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, 2Department of
Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Neutrophil extracellular traps (NETs) are bundles of chromatin fibres
released from activated neutrophils that enmesh microorganisms. NETs also promote
thrombus formation by serving as a scaffold that activates platelets and coagulation.
The thrombogenic involvement of NETs has been described in various settings of
thrombosis in animals. However, the evidence of NETs in the development of venous
thromboembolism (VTE) in human is still limited.
Objective: This literature review aimed to determine whether NETs is associated
with the risk of VTE.
Method: Major medical databases (PubMed, MEDLINE, Clinical Key, Cochrane Library,
EMBASE) were systematically searched until March 2019. The search was limited to
clinical trials published within the last ten years, human subjects, written in English,
full-text availability. We used Newcastle Ottawa Quality Assessment Scale (NOS) to
measure the quality of evidence.
Result: Four clinical studies: one cohort and three case controls study met our inclu-
sion criteria with a total of 1,430 patients for analysis. The scientific quality of all
four studies were good. One cancer population study showed that NETs increase the
risk of VTE, two studies showed NETs was associated with deep vein thrombosis
(DVT), and one study showed increased NETs in residual vein obstruction and ele-
vated D-dimer. A significant association between NETs and the occurrence of VTE was
found in all four of the studies (p ¼ 0.003; p < 0.001; p < 0.01; p ¼ 0.018). Several
limitations include non-random trial assignment, various population, small sample
size, and variations in NETs measurement (biomarker) and study outcome.
Conclusion: This literature review shows evidence that NETs is associated with the
risk of VTE. However, further research is needed to establish the role of NETs as a
diagnostic tool or therapeutic target in VTE.
Keywords: neutrophil extracellular traps • nets • venous thromboembolism • risk
Appendix