European Heart Journal Supplements (2018) 20 (Supplement D), D21–D34
The Heart of the Matter
doi:10.1093/eurheartj/suy011
Original Research Abstract
Relationship between Gly972Arg Variant of Insulin Receptor Substrate-1 Gene
and Endothelial Dysfunction Measured by Flow Mediated Dilation
P. Wulandari, R. Sukmawan, I. Sunu, S. F. Supari
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Insulin receptor substrate-1 (IRS-1) functions as one of the key down-
stream signalling molecules in the insulin receptor signalling pathways. Insulin has mul-
tiple physiological effects on the vascular tissues including regulation of the expression
of endothelial nitric oxide synthase (eNOS). This regulatory effect of insulin on endo-
thelial function is mediated via the activation of the signalling pathway involving the
insulin receptor/IRS-1/phosphoinositide-3 kinase (PI3K). Recent studies found that
human endothelial cells obtained from carriers of the Gly972Arg variant of IRS-1 gene
exhibited reduced eNOS expression in response to chronic exposure to insulin. A reduc-
tion in eNOS expression would be expected to be associated with impaired endothe-
lium-dependent vasodilation. However, little is known about the relationship between
Gly972Arg variant of IRS-1 gene and endothelial dysfunction in vivo.
Objective: To investigate the relationship between genetic polymorphism and endo-
thelial dysfunction in vivo, measured by flow mediated dilation (FMD).
Methods: 81 subjects were genotyped for the Gly972Arg IRS-1 polymorphism using
Taq-Man method. Flow mediated vasodilation examination in the brachial artery was
performed using Aloka Prosound at the Vascular clinic.
Results: 81 subjects were clustered into three groups according to IRS-1 genotype
(CC 17.3%, CT 64.2% and TT 18.5%). There were significant relationship between
Gly972Arg variant of IRS-1 gene and endothelial dysfunction measured by FMD
amongst those groups (p ¼ 0.019). There was also an increased risk of endothelial
dysfunction between heterozygous and homozygous group (OR 12,8; 95% CI 1.5 to
106; p 0.018 in CT group and OR 18; 95% CI 1.8 to 183.3; p 0.015 in TT group).
Conclusion: Gly972Arg variant of IRS-1 gene may be a significant genetic determi-
nant for endothelial dysfunction in vivo, measured by FMD.
Keywords: Insulin receptor substrate-1 • polymorphism • Gly972Arg variant •
endothelial dysfunction • flow mediated dilation
Garlic Metabolites increase Cholesterol Efflux from Lipid-loaded Macrophages.
B. S. Pikir
Department of Cardiology & Vascular Medicine, Medical Faculty – Airlangga
University, Surabaya, Indonesia
Experimental atherosclerosis in rabbits showed that garlic extracts increased choles-
terol plasma level during the first two months of treatment followed by decreased it
after second two months of treatment with less atherosclerosis on pathologic exami-
nations. In vitro study on primary culture of human aortic athererosclerotic plaques,
garlic extracts decreased intracellular content of free cholesterol, cholesteryl ester
as well as triglyceride.
We study the effect of Garlic metabolites DDS (Diallyl disulfide), SAC (S-
Allylcysteine), and SAMC (S¼allylmercaptocysteine) on the efflux of cholesterol from
acetylated-LDL loaded J-774 macrophages.
This research was conducted by post-test only design, The data were analysed by
oneway Anova test, followed by LSD if statistically significant for p < 0.05.
100 mM SAC decreased 43% of intracellular free cholesterol concentration.
Intracellular cholesteryl ester concentration was decrease by 62% (85%, 68% and 34%
decreased in cholesteryl arachidonate, cholesteryl linoleate and cholesteryl oleate
respectively). Why did we find no significant different of intracellular free choles-
terol content between treatment and control, because cholesteryl ester must be
hydrolysed into free cholesterol before can be transported extracellularly to ABCA1
transporter.
DDS and SAMC did not have an effect on cholesterol efflux from acetylated-LDL-
loaded J-774 macrophages. This was not a clinical problem, because DDS will be
metabolized into SAMC and SAC in the body.
It seem that 100 lM SAC were the most effective doses for cholesterol efflux from
lipid-loaded J-774 macrophages (43%). Higher dose of SAC was not effective in trans-
porting cholesterol extracellularly. Atherosclerotic regression by garlic maybe come
early and by active cholesterol mobilization from soft atherosclerotic plaque; on the
contrary atherosclerotic regression by statin maybe come late by passive mechanism
after LDL-cholesterol less than 70 mg %.
Keywords: Garlic metabolites • Diallyl disulfide • S-allylcysteine • S-allylmercapto-
cysteine • Cholesterol efflux • J-774 macrophages • free cholesterol • cholesteryl
ester • cholesteryl arachidonate • cholesteryl linoleate • cholesteryl oleate
Published on behalf of the European Society of Cardiology. All rights reserved. V
C The Author 2018. For permissions please email: journals.permissions@oup.com
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
Predictors of In-Hospital Mortality of ST-Segment Elevation Myocardial Infarction
Patients Presenting Beyond First 12 Hours from Symptom Onset: A Two Year
Retrospective Analysis National Cardiac Centre Harapan Kita (NCCHK)
W Firmanda1, DK Firmansyah1, Rizki1, Y Hendarto1, B Widyantoro1, D Zamroni1,
I Firdaus1, DA Juzar1, DPL Tobing1, Irmalita1
Department of Cardiology and Vascular Medicine, Universitas Indonesia/National
Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
Background: The 2017 European Society of Cardiology guidelines for the manage-
ment of acute myocardial infarction in patients with ST-segment elevation (STEMI)
have acknowledged primary PCI in unstable STEMI patient presenting beyond first
12 hours from symptom onset and between the first 12-48 hours for asymptomatic
stable patient. Predictors of in-hospital mortality could help to encourage to proceed
reperfusion therapy for this special population.1
Objective: To investigate the predictors of in-hospital mortality of STEMI patients
presenting beyond first 12 hours from symptom onset (late-presenter STEMI).
Method: A cohort of 514 late-presenter STEMI patients from June 2015 to 2017 in
NCCHK was analysed retrospectively. Baseline clinical characteristics, laboratory result,
and ECG patterns were correlated with in-hospital outcomes. Relative Risk (RR) of in-
hospital mortality endpoint was calculated using chi-square study. Factors that may
influence the outcome were identified using multiple logistic regression analysis.
Results: The mean age of late-presenter STEMI patients was 59 years, 83% of patient
were male. Of a total 510 late-presenter STEMI patients, about 75% was admitted
between 12 and 48 hours from symptom onset. Most of the patients treated convention-
ally, and overall in-hospital mortality was 13%. The mortality risk was significantly higher
in patient with KILLIP class II-IV at admission (RR 14, p < 0.001), had initial random blood
glucose level > 200 mg/dL (RR 6.8, p < 0.001), TIMI 6 groups (RR 4.9, p < 0.001), RV
infarction (RR 2.9, p < 0.001), STEMI involved lateral area (RR 2.6, p < 0.001), had initial
conduction abnormality (RR 2.5, p ¼ 0.001), LVEF < 40% (RR 2.2, p ¼ 0.001), underwent
PPCI (RR 2.1, p ¼ <0.001), and diabetic patient (RR 1.6, p ¼ 0.02).
After adjusting for all clinical variables, multivariate analysis showed that KILLIP
class II-IV at admission (RR: 13.1; 95% CI: 5.5-31.2; p < 0.001), initial random blood
glucose level > 200 mg/dL (RR: 7.0; 95% CI: 3.5-13.9; p < 0.001), RV infarction (RR:
4.3; 95% CI: 1.7-10.7; p ¼ 0.001), LVEF < 40% (RR: 2.6; 95% CI: 1.3-5.1; p ¼ 0.007)
and STEMI involved lateral area (RR: 2.5; 95% CI: 1.1-5.4; p ¼ 0.02) remained as inde-
pendent predictors of in-hospital mortality for late-presenter STEMI.
Conclusion: KILLIP class II-IV at admission, initial random glucose level > 200 mg/dL,
RV infarction, LVEF <40% and STEMI involved lateral area are independent predictors
of in-hospital mortality for late-presenter STEMI. Clinicians should consider reperfu-
sion therapy when these factors were found in late-presenter STEMI.
Keywords: Late-presenter STEMI • In-Hospital Mortality • Predictors
Hypoxic Preconditioning Effects on the Expression of Intracellular Heat Shock
Protein (HSP) 27, HSP 70 and HSP 90 in Cultured Adipocyte-Derived
Mesenchymal Stem Cell (AMSCs)
A. F. Ghaznawie1, I.G. R. Suryawan2, Andrianto2
1
Cardiology and Vascular Medicine Department, Medical Faculty, Hasanuddin
University Makassar, Indonesia, 2Cardiology and Vascular Medicine Department,
Soetomo General Hospital, Airlangga University Surabaya, Indonesia
Background: Mesenchymal stem cells (MSC) transplantation has been limited by diffi-
culties in maintaining stem cells survival in a pro-apoptotic microenvironment as in
myocardial infarction. Hypoxic preconditioning (HPC) is a strategy to optimize cell
survival potency by inducing intracellular upregulation of Heat Shock Proteins (HSP),
which have central roles in cytoprotection and preventing apoptosis.
Objective: To analyse the expression of intracellular HSP 27, HSP 70 and HSP 90 in
AMSCs preconditioned with HPC (1% O2) as compared to normoxia (21% O2) in vitro.
Methods: This study is an in vitro true experimental randomized post-test design
study. AMSCs were isolated from adipose tissue and cultured until 4 passages. The
characteristics of AMSCs were identified by immunocytochemistry and flowcytometry
using CD 90þ, CD 105þ and CD 45-. The samples were divided into 2 groups, hypoxia
(O2 1%) for 24 hours and normoxia (O2 21%). Immunocytofluorescence techniques
were used to evaluate the expression of HSP 27, HSP 70 and HSP 90.
Results: AMSCs identification showed positive expression of CD 90þ, CD 105þ and nega-
tive expression of CD45-. Our study showed all parameters studied (HSP 27, HSP 70 and
HSP 90) demonstrated a significant higher expression in the hypoxia group compared to
normoxia group (272.00 6 92.225 vs 86.19 6 26.362 p < 0.0001; 130.88 6 45.416 vs
120.75 6 97.113 p < 0.05; 165.75 6 58.930 vs 96.81 6 22,578). Furthermore, HSP 27
 D22
expressed higher than HSP 70 and HSP 90, presumably because HSP 27 is an ATP inde-
pendent chaperone, while HSP 70 and HSP 90 are both dependent ATP chaperones.
Conclusion: Hypoxia preconditioning in AMSCs significantly increased the expression
of HSP 27, HSP 70 and HSP 90 therefore, it could be expected to increase cell sur-
vival potency of the stem cells.
Keywords: Adipocyte-derived Mesenchymal Stem Cells • Heat Shock Proteins •
Hypoxic preconditioning
Polymorphism on CYP2C19 genes, diabetes and smoker status affect the
response to Clopidogrel therapy among Asian patients with acute coronary
syndrome
D. Rumenta1, R. Sukmawan2, R. Dharma1, F. Henrika1
1
Department of Clinical Pathology Universitas Indonesia/Cipto Mangunkusumo
Hospital, 2Department of Cardiology and Vascular Medicine Universitas Indonesia/
Harapan Kita National Cardiovascular Center, Jakarta
Background: Clopidogrel has become standard therapy in patients with acute coro-
nary syndrome (ACS) post percutaneous coronary intervention (PCI). Enzyme
CYP2C19 plays important role in clopidogrel metabolism. The prevalence of has been
known higher in Asians than Caucasians. Whether CYP2C19 gene polymorphism and
cardiac risk factors may affect variability on inhibition of platelets by clopidogrel in
Asian patients remained to be defined.
Objective: We sought to define whether polymorphisms on CYP2C19 genes and cardi-
ovascular risk factors may affect the incidence of resistance to clopidogrel in Asian
patients with ACS.
Methods: Patients post ACS who mostly underwent PCI and already receiving dual
antiplatelet therapy of aspirin and clopidogrel 75 mg at least for 4 weeks, were
recruited for the study. We measured platelet aggregation by LTA method using
20 lM ADP. Data of demography, clinical, and current therapy on each patient were
collected. Clopidogrel resistance was defined as percent platelet aggregation > 59%.
Genetic polymorphism analysis to assess the presence of CYP2C19 *2 sand *3 alleles
on each patient were performed by using a Real-time PCR.
Results: There were 100 post ACS patients recruited for study. The clopidogrel resist-
ant were found in 36 patients (36%). Genetic polymorphism studies revealed: 12% of
patients with *2 allele, and 39% of *3 allele carriers. Multivariate analysis revealed
the attributing factors to the incidence of clopidogrel resistance included: diabetes
(OR 2.3), non-smoking status (OR 2.3), and carrier of CYP2C19 *2 (OR 3,9), and *3
alleles (OR 2.7). Among them the most dominant predictor was the carrier of
CYP2C19 *2 allele (OR 3.9, p ¼ 0.03).
Conclusions: Factors that contribute to clopidogrel resistance in Asian patients with
ACS, were: diabetes, non-smoking status, and the carrier of CYP2C19 *2 and *3
alleles, with the most dominant predictor was the presence of CYP2C19 *2 allele.
These results may give insight in selecting antiplatelet for personalized therapy of
patients with acute coronary syndrome.
Keywords: clopidogrel resistance • platelet aggregation • CYP2C19 gen
Comparison of Perfusion Defect Assess by Single Photon Emission Computed
Tomography Myocardial Perfusion Imaging in Multivessel Coronary Artery
Diseases With and Without Coronary Collateral Circulation
M.K. Hazrina1, Z. Muchtar2, Edison3, H. Hasan2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department
of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital Medan,
Indonesia, 3Department of Nuclear Medicine, Haji Adam Malik General Hospital
Medan, Indonesia
Background: Coronary collateral circulation (CCC) has been known to have associ-
ated with better clinical outcome in patient with coronary artery disease due to less
infarct size, especially in acute onset of myocardial infarction (MI). The influence of
coronary collateral vessels on infarct size in stable multivessel coronary artery dis-
ease (CAD) is still unknown. The aim of this study is to investigate the influence of
CCC in myocardial perfusion defect in patient with stable multivessel CAD.
Methods: We observed patients with multivessel CAD who underwent stress and rest
cardiac SPECT with documented coronary angiography. The coronary angiography was
evaluated to determine the presence of coronary collateral. MPI studies were con-
ducted at rest and post stress using 99mTc-sestamibi intravenously. All images were
analysed by a nuclear medicine physicist using standard 17-segment model and
scored on 5-point scale. Infarct and ischaemia at rest (SRS) and stress (SSS), and also
ischaemia induced exercise (SDS) were evaluated. SDS 0-4 was considered as normal-
mild ischaemia and > 5 was considered as moderate-severe ischaemia. MPI and coro-
nary angiography were performed within 30 days interval.
Results: Total 49 patients with multivessel CAD (26 males, median age 57 6 7.8
years) with coronary collateral was found in 33 (67%) patients. SRS, SSS and SDS
were found insignificant between the two groups (SRS p value 0.617; SSS p value
0.668; SDS p value 0.079). Even though, the SRS in patients without CCC was higher
and more severe (50% vs 42%) compared with CCC group, and the SDS was higher and
more severe (52% vs 25%) in patients with CCC group.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
Abstracts
Conclusion: This study showed that CCC had no influence in infarct and ischaemia
size at rest and stress myocardium. The ischaemia size was higher in patient with
CCC which represented more viable myocardium.
Keywords: coronary collateral • SSS • SRS • SDS.
Effect of Percutaneous Coronary Intervention on Length Of Stay in Late Onset
(>12 hours) STEMI Patients with High Degree AV Block.
D. D. A. Sakti1, D. Firman1, S. Dharma1
1
National Cardiovascular Center Harapan Kita, Department of Cardiology and
Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Background: High degree atrioventricular (AV) block is a common complication in
patients with ST elevation myocardial infarction (STEMI). In late presentation STEMI
patients (>12 hours onset) with high degree AV block, the effect of percutaneous
coronary intervention (PCI) in converting the rhythm and shorten the length of stay
is still debatable.
Objective: To assess the effect of PCI on length of stay in late onset STEMI patients
with high degree AV block.
Method: We conducted a retrospective cohort study in late onset STEMI patients
with high degree AV block during the period of January 2011 until January 2017 in
National Cardiovascular Center Harapan Kita. Percutaneous coronary intervention is
the independent variable which expected to have an influence on the length of stay.
The dependent variable was the length of stay.
Result: There were 91 subjects in this study, that consist of 52 subjects in the percu-
taneous coronary intervention (PCI) group and 39 subjects in the non PCI group.
There were 40 subjects (76.9%) with length of stay  8 days in PCI group and 9 sub-
jects (23.1%) with length of stay  8 days in the non PCI group. From multivariate
analysis, the significant variables to determine the length of stay were PCI [OR 3,75
(IK 95% 1,06 - 13,26); p value ¼ 0.04], and duration of rhythm conversion [OR 8.83
(IK 95% 2.52 – 30.89); p value ¼ 0.001].
Conclusion: Percutaneous coronary intervention may shortening the length of stay of
patients with STEMI (> 12 hours) who had third or second degree type two AV block.
Keywords: percutaneous coronary intervention • high degree AV block • late onset
STEMI • length of stay
Proportional Pulse Pressure as a Predictor of In Hospital Mortality among
Hospitalized Patients with Heart Failure with Reduced Ejection Fraction
R.A. Farindani1, B.G. Napitupulu1, H. Hasan2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department
of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan,
Indonesia
Background: Proportional pulse pressure which is pulse pressure divided by systolic
blood pressure is known to correlate well with cardiac index in patients with chronic
heart failure and positively correlated with invasively measured stroke volume.
However, its prognostic significance is unknown in HFrEF patients, although it was
predicted that lower PPP would be associated with poorer outcomes. In this study,
we investigated the association between PPP on admission with in-hospital mortality
in HFrEF patients.
Methods: 113 HFrEF patients were enrolled in the retrospective study. The data was
collected from January 2017 to December 2017. Bivariate and multivariate analysis
were applied.
Results: We calculated 78 (69.1%) patients survive and 35 (30.9%) patients dead in
this study. In bivariate analysis between PPP and mortality, we found that PPP had
good negative correlation (r Pearson: 0.62, OR: 26.25, p ¼ 0.00) and more superior
than systolic blood pressure and ejection fraction. In the multivariate logistic regres-
sion analysis we found that PPP < 0.25 (p ¼ 0.000, OR 27.167) as a predictor of in-
hospital mortality.
Conclusion: Proportional pulse pressure <0.25 was significant to predict in-hospital
mortality among hospitalized patient with heart failure with reduced ejection
fraction.
Keywords: Proportional Pulse Pressure • HFrEF • Hospital Mortality
HYPOXIA PRECONDITIONING EFFECT ON THE EXPRESSION OF INTRACELLULAR
REACTIVE OXYGEN SPECIES (ROS) AND SUPEROXIDE DISMUTASE (SOD) LEVELS ON
CULTURED ADIPOSE MESENCHYMAL STEM CELLS
R. D. Cahyaningtias1, R. Suryawan2, Andrianto2
1
Faculty of Medicine, Airlangga University, Indonesia, 2Dr.Soetomo General Hospital
Surabaya, Indonesia
Background: We studied the stimulation effect of Hypoxia Preconditioning in ASCs
cultured on expression of Reactive Oxygen Species (ROS) and Superoxide Dismutase
(SOD) intracellular. The survival of transplanted stem cells is reported to be low and
 Abstracts
still became a main problem in regenerative medicine. Hypoxia Preconditioning
(HPC) is a sublethal hypoxia that stimulates AMSCs to a defense mechanism to pro-
tect stem cell from lethal hypoxia and ischaemic condition. This HPC may can
induced specific ROS generation from NADPH Oxidase enzyme (NOX) Family in cyto-
solic membrane and mitochondria which can play pivotal role as second messengers
and activated normal cellular processes especially in redox signalling. ROS as an dou-
ble-edged sword that in low levels of ROS as a friend not a foe.
Methods: This study using In-Vitro True Experimental with Randomized Controlled
Post Test Design in human AMSCs. Isolated human AMSCs from minimally invasive and
then cultured until passage fourth. Identification AMSCs with expression of CD 105,
CD 90 and CD 45. This sample divided into controlled group (Normoxia 21% O2) and
hypoxia group (HPC 1% O2). Expression of intracellular ROS and intracellular SOD was
evaluated with immunofluorescence methods.
Results: Expression of ROS is lower in hypoxia group than in controlled group (253.13
6 67.795 vs 342.136 116.447 p < 0.05) and SOD expression is higher in hypoxia group
than in controlled group (340.25 6 96.476 vs 234.566 38.238 p < 0.05).
Conclusion: Hypoxia Preconditioning with 1% O2 in human AMSCs gives a lower
expression of intracellular ROS and higher expression of intracellular SOD.
Keywords: Hypoxia preconditioning • Redox signalling • Intracellular ROS •
Intracellular SOD • Adipose Mesenchymal Stem cell
Direct Effect of Lisinopril, Ramipril, and Captopril on Endothelial Progenitor Cell
(EPC) Proliferation from Peripheral Blood of Stable Coronary Artery Disease
Patient
R. N. Rosyadi*, Y. H. Oktaviono*, D. Soemantri*
* Methods: Data were recorded over 190 patients undergoing cardiac surgery in
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Background: EPC has showed beneficial effect as biomarker and therapeutic material
in coronary artery disease (CAD). Efforts have tried to increase EPC level and func-
tion. Recent studies found that angiotensin converting enzyme inhibitor (ACEI)
improved circulating EPC in CAD patient. In contrast, angiotensin receptor blocker
(ARB) reduced circulating EPC in kidney transplanted patient. This controversial
effect suggests that there is direct effect of ACEI on EPC level beyond classical renin
angiotensin aldosterone system (RAAS) pathway.
Objective: To analyse the direct effect of lisinopril on EPC proliferation from periph-
eral blood of stable coronary artery disease patient.
Methods: This is an in vitro quasi experimental post-test control group study. The
MNCs were isolated from peripheral blood of stable coronary artery disease patient
and were cultured in CFU-Hill medium for 3 days. Samples put into four groups i.e.
lisinopril, ramipril, captopril and control group. Every group was divided into 3 sub-
groups with different doses, 2 mmol/L, 10 mmol/L, and 50 mmol/L. EPC proliferation
was evaluated afterwards with MTT cell proliferation assay. Colony forming were
observed to confirm functional characteristics of EPC. Data were analysed using
ANOVA test.
Results: MTT cell proliferation assay showed a significant increase of EPC prolifera-
tion in captopril, ramipril, and lisinopril groups compared with control group (0.231
6 0.013, 0.236 6 0.002, 0.246 6 0.018 vs 0.168 6 0.016, p < 0.05). It also revealed
significant difference in EPC proliferation between each experiment groups, which
lisinopril showed the highest number. There was significant difference in subgroup of
doses where the higher dose gave better effect on EPC proliferation. Highest number
of colony count found in ramipril group, followed by lisinopril and captopril.
Conclusion: ACEI increase EPC proliferation from peripheral blood of stable coronary
artery disease patient. Lisinopril showed the best effect on EPC proliferation. Each
ACEI increased EPC proliferation dose-dependently.
Keywords: ACEI • EPC proliferation • RAAS
Q/R duration as a Predictor of No-Reflow in Patients with Acute Anterior
Myocardial Infarction Who Underwent Primary Percutaneous Intervention
P. Meidianaser1, Andri1, F. Harben1, S. Masrul1
1 may provide good information of vasomotor function and histological changes in
Cardiology and Vascular Division M. Djamil General Hospital, Andalas University,
Padang, Indonesia
Background: Acute transmural ischaemia due to left anterior descending artery
(LAD) occlusion changes precordial R and Q wave durations owing to depressed intra-
myocardial activation. We investigated the prognostic value of sum of precordial Q
wave duration/sum of precordial R wave duration ratio (Q/R) in patients with first
acute anterior myocardial infarction (AAMI) treated with primary percutaneous coro-
nary intervention (PPCI). Coronary no-reflow (NR) following primary percutaneous
coronary intervention (PPCI) is associated with worsened prognosis in patients with
ST segment elevation myocardial infarction (STEMI).
Methods: In this retrospective analysis, we evaluated the no-reflow predictive value
of Q/R on 30 patients with first AAMI from January 2017 to December 2017 at M.
Djamil General Hospital Padang, Indonesia. Patients were divided into two as no-
reflow group (n ¼ 5) and control (n ¼ 25) group according to post-PPCI flow status.
Results: The patients in the no-reflow group had significantly higher Q/R on admis-
sion electrocardiography (ECG) compared to patients in the control group
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
D23
(p < 0.001). When admission ECG parameters were compared according to no-reflow
prediction, Q/R was stronger than other well-accepted parameters.
Conclusion: In patients with first AAMI treated with PPCI, Q/R in admission ECG may
have a role as an independent predictive marker of no-reflow.
Keywords: Electrocardiography • Q wave • R wave • myocardial infarction • no-
reflow
Predictive Discrimination Power of EuroSCORE II and The Addition of TAPSE to
EuroSCORE II Improving the Predictive Discrimination Power on Inhospital
Mortality After Cardiac Surgery in Indonesian Subpopulation, North Sumatra
B.G. Napitupulu1, R.A. Ginting1, Z. Syahputra1, D. Prabisma2, A.N. Nasution1,
H. Hassan1
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: The European System for Cardiac Operative Risk Evaluation
(EuroSCORE) II has been released to improve mortality prediction in cardiac surgery
but has not validated yet either over generally Asian population or Indonesian subpo-
pulation. EuroSCORE predictive ability on other race population were tend to be mis-
match for some parameters are lack on quantitative findings. The significant objec-
tive pre-operative data can improve the discriminative prediction for mortality of
EuroSCORE especially for Asian and Indonesian subpopulation.
Cardiac Centre Haji Adam Malik General Hospital Medan, North Sumatra, Indonesia.
EuroSCORE were applied from pre-operative data and the predictive and observed
inhospital mortality were analysed. Each clinical and echocardiographic parameters
were also analysed by bivariate correlation and together were compared by regres-
sion logistic analysis and receiver operator characteristic curves (ROC) to find the
best AUC model.
Results: Overall inhospital mortality rate were 9.47%, with 6% were in CABG and
3.47% in non coronary surgery while around 64.7% CABG patient were on low risk
EuroSCORE. EuroSCORE has a weak positive correlation (r 0.145; p 0.046) and TAPSE
(Tricuspid Annular Plane Systolic Excursion) has a moderate negative correlation with
inhospital mortality (r 0.318; p < 0.01) . There were a significant TAPSE difference (p
0.06) and EuroSCORE (p 0.017) on inhospital mortality incidence. EuroSCORE can be
accepted as a model with AUC 0.643 (OR 1.536; CI 1.049-2.248, p 0.027) but mortal-
ity in our population was higher than expected by the EuroSCORE (O/E¼ 18). TAPSE
< 17.5 had an influence on inhospital mortality (OR 7.749; CI 2.771-21.667) with AUC
0.721 (p 0.02). A better discrimination power (AUC 0.767; p < 0.01) were seen on
combination of TAPSE and EuroSCORE.
Conclusion: EuroSCORE underestimated inhospital mortality in our population. TAPSE
as a simple pre-operative data can be considered to predict inhospital mortality, and
the addition of TAPSE to EuroSCORE can improve the discrimination power for pre-
dicting inhospital mortality
Keywords: EuroSCORE II • Asian • Indonesia • TAPSE • mortality
The Correlation of Matrix Metalloproteinase 9 with Carotid Intimal Media
Thickness and Flow Mediated Vasodilation in Patients with Stable Angina Pectoris
G. Yoga
Faculty of Medicine, University of Sam Ratulangi, Manado, Indonesia
Background: The development of atherosclerosis is predicted to increase in line with
increasing life expectancy, the prevalence of obesity, diabetes and hypertension.
Endothelial dysfunction as an important process of the atherosclerosis pathogenesis
and an important factor of angina pectoris through impair vasodilation. Flow medi-
ated vasodilation (FMD) and the intima media thickness of the carotid artery (CIMT)
blood vessel walls into the early manifestation of atherosclerosis. Both value and
prediction of cardiovascular events has been shown to correlate with various cardio-
vascular risk factors. Matrix metalloproteinase 9 (MMP-9) has been widely demon-
strated involved in the clinical course of advanced stages of atherosclerosis.
Overview discovery of various recent study of MMP-9, indicates the possible potential
biomarkers of atherosclerosis in endothelial dysfunction phase, but some studies
showed conflicting results.
Objective: This study aims to determine the relationship of the MMP-9 with CIMT and
FMD in patients with stable angina pectoris.
Methods: This study was observational with cross sectional approach which took
place in June-September 2016. The number of samples in this study were 43
patients. All the study subjects who met the inclusion criteria made history and phys-
ical examination include age, gender, weight, height, blood pressure, family history,
smoking history, and routine laboratory tests. Then the subjects underwent vascular
Doppler ultrasound. Intima media thickness (IMT) measured at the bilateral common
carotid artery and the average and the maximum value used, also examination of
FMD on the left brachial artery. Thereafter patients blood samples was taken to
 D24
measure serum concentrations of MMP-9. Then the correlation levels of MMP-9 with
CIMT and FMD was analysed using SPSS version 23. Additionally, the relationship
between CIMT and FMD was analysed.
Results: Of the total 43 subjects research 60% of men aged between 46 and 70 years
(mean 61.00 6 7.64 years), 74.4% had hypertension, 30.2% diabetes, dyslipidaemia
48.8%, 30.2% are active smokers, and 55.8% classified as obese. A total of 83.7% of
patients had  50% percentile CIMT, 39.5% had a mean CIMT  75% percentile and
44.2% had a maximum CIMT  75% percentile. Average FMD value was 9.59%, as many
as 32.6% of patients with FMD values ??<8%. There was no significant correlation
between MMP-9 with a mean (p ¼ 0.778) neither maximum CIMT (0.925). A significant
moderate correlation of MMP-9 with FMD was found, with r¼ -0544, p ¼ 0.000. While
correlation of FMD with a mean (p ¼ 0.162) and maximum CIMT (p ¼ 0.209) was non-sig-
nificant. Sub-analysis of the correlation between MMP-9 and FMD also was not signifi-
cant, even to quartile-divided CIMT based on their age, gender, and race.
Conclusion: There was a significant moderate correlation between the levels of
serum MMP-9 and FMD. This correlation regardless of the value of CIMT, which may
shows the different mechanisms and pathology between CIMT and FMD.
CORRELATION BETWEEN GLYCAEMIC CONTROL AND ANKLE BRACHIAL INDEX IN
DIABETIC PATIENTS AT LOMBOK, NTB
M. J. P. Putra1, B. Rahmat2, J. Anggoro3, Y. Indrayana2
1 Background: Heart failure (HF) remains a major problem in Indonesia with 229.696
Faculty of Medicine, Mataram University, Mataram, Indonesia, 2Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Mataram University,
Mataram, Indonesia, 3Department of Internal Medicine, Faculty of Medicine,
Mataram University, Mataram, Indonesia
Background: The correlation between diabetes mellitus and coronary, cerebral and
peripheral vessel disease has been established but the relation between glycaemic
control in diabetes patients with prevalence of Peripheral artery disease (PAD) were
not well understood.
Method: This cross sectional study was conducted in randomly selected diabetes
patients in internal medicine outpatient clinic NTB province general hospital.
Patients with history of Peripheral artery disease (PAD), Chronic kidney disease
(CKD), DM with complication at extremity and ABI Score  1.4 were excluded from
this study. Total 60 subjects were assigned to two different groups, the well-con-
trolled diabetes and uncontrolled diabetes with cut-off point of fasting blood sugar
(FBS) is 130 mg/dL. Ankle brachial index were determined in all patients.
Result: 26 males and 34 females with mean age 58 years old who registered with DM
were examined. The mean FBS was 110 mg/dL in patients with well controlled diabe-
tes and 204 mg/dL in patients with uncontrolled diabetes. Most patients had duration
of diabetes more than 5 years. Based on ABI  0.9, PAD was diagnosed in 5 (17.9%)
patients in group uncontrolled diabetes and 5 (15.6%) in group well controlled diabe-
tes. Prevalence of PAD in uncontrolled diabetes was not significantly different with
group well controlled diabetes. Mean ABI slightly lower in uncontrolled diabetes
compared with controlled diabetes (0.95 and 1.00 respectively)
Conclusion: This study failed to show the expected relation between uncontrolled
diabetes with ABI less than 0.9. Further research is needed and should include a
large sample, more accurate method for ABI reading and controlled diabetes deter-
mination and more additional cardiovascular risk factors to evaluate the relation
between controlled diabetes and Peripheral artery disease (PAD).
Keywords: Diabetes Mellitus • Ankle Brachial Index (ABI) • Peripheral artery dis-
ease • glycaemic control
Factors Associated with Visit-to-Visit Blood Pressure Variability in Hypertensive
Patients at Primary Health Care Service
G. A. R. Pertiwi1, A. A. N. Aryawangsa1, N.W.S. Ratni2
1 Background: Rapid growing of urbanization of Indonesia as developing country
Faculty of Medicine, Udayana University, Bali, Indonesia, 2General Practitioner at
PKM Tabanan III, Tabanan, Bali, Indonesia
Background: Increasing number of valid, well designed trials have demonstrated pos-
itive correlation between visit-to-visit variability (VVV) in SBP and increased risk of
stroke and coronary heart disease. Some mechanisms were proposed to explain this,
as high VVV of SBP was associated with endothelial damage, progression of artery
calcification and diastolic dysfunction. Specific intervention to factors promoting
high VVV of BP ultimately will improve cardiovascular outcomes in hypertensive
patients. This study would assess VVV of BP in hypertensive patients and its associ-
ated factors.
Method: This was a cross sectional study, performed in 74 subjects who visited out-
patient clinic at PKM Tabanan III, on April–Mei 2017. BP recorded over this year were
retrospectively retrieved from subject’s medical record. VVV of BP was classified into
low and high variability based on standard deviation (SD) of SBP. Antihypertensive
medical adherence expressed as percentage of PDC and salt intake was measured
using 24 hour food recall. Bivariate analysis was performed continued by multivariate
analysis for significant variables.
Results: Subjects were 67.6% female, mean age 62.70 6 10.00 years. BP was
measure for 4.82 6 0.78 during this year, and mean SBP was 139.65 6 10.57.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
Abstracts
Non-adherence and salt intake were significantly higher in high variability group
compared to low variability (low vs. high variability: non-adherence: 13.5% vs.
37.8%, p ¼ 0.033; salt intake: 1278.44 6 43.02 mg vs. 1495.85 6 45.26 mg,
p ¼ 0.038). After adjusted to other covariates, the difference remain significant only
for non-adherence (model I: multivariate adjusted difference, b ¼ 3.89 (95%CI: 1.23–
12.34; p < 0.05), model II: b ¼ 3.9 (1.12–14.15) (95%CI: 1.12 – 14.15; p < 0.05).
Conclusion: Non-adherence to antihypertensive medication significantly associated
with higher VVV of SBP, independent to other possible contributing factors. Further
study needed to assess whether improving adherence could also improve VVV and
cardiovascular outcome.
Keywords: visit-to-visit-variability • non-adherence • salt intake
HF Reduced EF: Demographic and Clinical Profile in National Cardiovascular
Center Harapan Kita
B.B. Siswanto2, H. Safitri1, Danny1, A. R. Hidayat1, B.A. Marsudi1, J. O. Santoso1,
P. Almazini2, R. P. Soerarso2
1
Medical Research Unit at National Cardiovascular Center Harapan Kita, 2Department
of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia,
National Cardiovascular Center Harapan Kita
patients diagnosed in 2013. Ejection fraction (EF) measurement remains crucial for
diagnosis and assessment of the disease. Multiple studies have shown HF with
reduced EF to have poorer prognosis compared to other groups.
This study evaluates clinical profile and in-hospital mortality among patients with
heart failure with reduced EF.
Method: We opted for a descriptive, retrospective study design. Data was obtained
from ESC HF Registry in 2016 at National Cardiovascular Center Harapan Kita.
Subjects include all hospitalized patients with age >18 years, with reduced ejection
fraction HF, diagnosed by transthoracic echocardiography. A total of 146 patients
were included.
Result: HFrEF was frequent in patients aged 41-65 years (N ¼ 103; 70.5%), >65 years
(N ¼ 27,18.5%), and least frequent in 19-40 years(N ¼ 16, 11%). Prevalence of HFrEF
was higher in males (N ¼ 109, 74.4%) than in women (N ¼ 37, 25.3%). Several risk fac-
tors were also identified namely, smoking (N ¼ 73, 50%), type 2 diabetes (N ¼ 60,
41.1%), alcohol consumption (N ¼ 12, 8.2%), and history of previous Atrial Fibrillation
(N ¼ 27, 18.5%). Ischaemic heart disease either documented (N ¼ 52, 35.6%) or not
documented (N ¼ 45, 30.8%) by coronary angiography is the most common aetiology
followed by hypertension (N ¼ 9, 6.2%), dilated cardiomyopathy (N ¼ 15, 10.3%),
valve disease (N ¼ 18, 12.3%), tachycardia related cardiomyopathy (N ¼ 1, 0.7%), and
other causes (N ¼ 6, 4.1%). In-hospital mortality in patient with HFrEF is 17.1% in one
year observed.
Conclusion: The clinical profile of patients with HFrEF at NCCHK is predominant in
male patients with age range 45-65 years old. Classical risk factor like smoking status
remains significant. Ischaemic Heart disease is the main aetiology in our centre.
Predicted having poor prognosis in HFrEF, number of in-hospital mortality in our
centre still high.
Keywords: Clinical profile • Aetiology • Risk factor • Heart Failure
Epidemiology of Hypertension and Associated Cardiovascular Risk Factors among
Indonesia Population
M. F. Adda’i1, 2, A. B. Setyani1, T. Indriyati2
1
Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia, 2Johar Baru
Primary Health Care, Jakarta, Indonesia
showed parallels with increasing burden of chronic disease, especially cardiovascular
disease. Report said that developing country contribute 80% of world cardiovascular
death. Indonesia strongly needs sufficient epidemiology data to undertake the
upcoming problem. Therefore, in 2015, Indonesia Ministry of Health released regula-
tion (Peraturan Menteri Kesehatan) number 71 to screen all of citizens the non-com-
municable disease risk factors including cardiovascular disease.
Objective: In the present study, data from a population-based cross-sectional in
Indonesia were used to know the prevalence of hypertension and analyse the associ-
ated cardiovascular risk factors.
Methods: Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial
blood pressure (MAP), BMI, personal and family history of cardiovascular disease risk
(smoking, diabetes mellitus, stroke, cardiac disease, dyslipidaemia) were measured
during 2017 using standardized protocol aged 18 until 87 years old among 13.472
Central Jakarta residents, Jakarta, Indonesia. Data were analysed statistically using
SPSS version 20.0.
Results: Mean SBP among males and females were 126.9620.1 mmHg and
127.29620.9 mmHg (p > 0.05). Mean DBP among males and females were
79.5611.2 mmHg and 78.9611.7 (p < 0.05). The prevalence of hypertension using
AHA 2017 criteria (total: 50.2%, males: 14.8%, females: 35.5%) was greater than
using JNC 7 criteria (total: 36.8%, males: 10.6%, females: 26.2%). High prevalence of
 Abstracts
overweight (total: 30.5%, males: 8.45%, females 22,1%) and obese (total: 15.4%,
males: 3.2%, females: 12.2%) were noted. Multivariate analysis found that risk of
hypertension was higher among overweight (BMI 25 kg/m2) with OR 1.84; 95% CI
[1.55-2.18]; p < 0.0001 and obese (BMI 30 kg/m2) with OR: 2.31; 95% CI [1.92-2.77];
p < 0.0001 compared with underweight. The increasing age (OR 7.55; 95%CI[6.23-
9.08]; p < 0.0001), presence of diabetes mellitus (OR 1.2; 95%CI[1.06-1.36]; p < 0.05)
and family history of hypertension (OR 1.94; 95%CI[1.78-2.15]; p < 0.0001) also
improved significantly hypertension risk. Age and BMI were significantly and posi-
tively correlated with SBP, DBP, and MAP, coefficient correlation (r) ranging between
0.094 and 0.357 p < 0.0001.
Conclusions: Our result revealed the high prevalence of hypertension and associated
risk factors in real-world setting. The risk of hypertension was increased with pres-
ence of DM, family history of hypertension, increasing age and BMI among Indonesia
population. Our data suggest that we need intensified action to reduce the burden of
cardiovascular disease.
Keywords: Cardiovascular Risk Factors • Hypertension • Epidemiology
Demographic and Clinical Characteristic of Pulmonary Hypertension Patients
Hospitalized in National Cardiovascular Center Harapan Kita
P. Almazini*, H.S. Muliawan*, A. Sidarta**, A. Francesca**, M. Asaf**, P.N. Candra**,
B.B. Siswanto*
*
Department of Cardiovascular and Vascular Medicine, Faculty of Medicine,
Universitas Indonesia, **Medical Research Unit, Faculty of Medicine, Universitas
Indonesia
Background: Pulmonary hypertension (PH) is a very severe disease of the cardiovas-
cular system and contributes to significant morbidity and mortality. The characteris-
tic of PH patients varies throughout the world therefore obtaining data about demo-
graphic and clinical characteristic of PH are important to improve diagnosis and
awareness to the disease.
Method: A retrospective study was conducted. Data were obtained from medical
registry of patients hospitalized in our centre from January 2016 to December 2016.
Results: Total 155 patients with diagnosis pulmonary hypertension were hospitalized
in January until December 2016 and were included. Among the 155 patients the
median age was 23 years old, range 0-66 years with 97 females (62.6%) and 58 males
(37.4%). Almost all of the patients used National Health Insurance (96.1%). The most
common presenting symptom was dyspnoea in 122 (78.7%).
Based on WHO classification of PH, group 1 pulmonary arterial hypertension (PAH)
was the most frequent cause of PH (50.9%) and was associated with congenital heart
diseases. Group 2, PH due to left heart disease was the second common cause
(45.2%) followed by group 4 chronic thromboembolic pulmonary hypertension
(CTEPH) (3.2%) and patients with group 3 PH due to lung disease (0.6%). Sixty
patients (38.7%) received specific treatment for pulmonary hypertension with pulmo-
nary vasodilator (beraprost, sildenafil). Most of the patients (90.3%) were diagnosed
by echocardiography. Right Heart Catheterization (RHC) was available in 44 patients
(28.4%). The mean pulmonary arterial pressure at the time of catheterization was
54.9 6 14.1 mmHg. Of 5 patients with CTEPH, 2 patients was diagnosed by lung
angiography CT scan, 2 patients was diagnosed by ventilation/perfusion scan (V/Q
scan), and 1 patients was diagnosed by both V/Q scan and lung angiography CT scan.
One of 2 patients who diagnosed by V/Q scan, had normal lung angiography CT scan.
Conclusion: This study provides information on the demographic and clinical features
of PH patients hospitalized in National Cardiovascular Center Harapan Kita (NCCHK).
Most of the patients was female and young age. Congenital heart disease was the
most frequent cause of PH in NCCHK. Echocardiography is the most frequent tool
used for diagnosis pulmonary hypertension.
Keywords: pulmonary hypertension • hospitalized • demographic • clinical
12-lead Electrocardiogram as a Screening Tool for Peripartum Cardiomyopathy:
A Systematic Review
H. Angkasa1
1
Bhakti Rahayu Hospital, Tabanan, Indonesia
Background: Peripartum cardiomyopathy (PPCM) is a life threatening condition for
both mother and foetus. Early detection and intervention is critical for recovery of
ventricular function. Despite paramount importance, there is a lack of standardized
screening method for PPCM in limited settings, especially in developing countries
with unequal distribution of cardiologists and limited access to echocardiography.
Electrocardiogram (ECG) is a simple, low cost screening tool to detect changes in
cardiac electrophysiology. Abnormal electrocardiogram has been shown to correlate
with PPCM. We scoured the present literature database for evidence of the value of
ECG for PPCM screening.
Methods: A comprehensive search was conducted in PubMed and Cochrane database
on the 25th of January 2018, using the following keywords [‘ECG’/‘electrocardio-
gram’ AND ‘PPCM’/‘peripartum cardiomyopathy’]. Appropriate results were selected
based on inclusion criterion (English, humans and publication within the last 20
years). Studies with < 20 patients were excluded.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
D25
Results: A total of 2 studies were identified. Both studies showed that abnormal ECG
results are highly correlated with PPCM. However, there is a lack of specific ECG
changes in PPCM.
Conclusion: Despite limited evidence, the value of ECG in resource-poor setting
should be considered as a routine screening tool for pregnant women. When possible,
early gestation or prenatal ECG screening should be conducted to provide baseline
ECG report. Abnormal ECG findings should warrant further investigation in hospitals
equipped with the necessary echocardiography and cardiologist.
Keywords: electrocardiogram • peripartum cardiomyopathy • screening • PPCM •
ECG
The effect of Syzygium polyanthum (Wight) extract on lipid accumulation and
metabolic parameters in hyperlipidaemic male Wistar Rats
H. M. Salim1, L. K. Farizqi1, T.W. Bintarti1, Handayani2
1
Department of Biomedical science, Medical Faculty of Nahdlatul Ulama Surabaya,
2
Department of Pharmacology, Medical Faculty of Nahdlatul Ulama, Surabaya
Background: Lipid accumulation in the liver and pancreas is primarily caused by
combined hyperlipidaemia. Syzygium polyanthum (Wight) Walp. var. polyanthum
leaves are consumed as a traditional Indonesia treatment. However, the effect of
extract Syzygium polyanthum (Wight) Walp in isolated hypercholesterolaemia is not
fully described. Therefore, our aim was to investigate whether extract Syzygium pol-
yanthum (Wight) Walp decreased the hypercholesterolaemia leads to alterations in
histology of hepatic lipid in Wistar rats.
Methods and Results: Hypercholesterolaemia in Wistar rat was induced by oral
administrated of high fat diet (HFD) of lard (2ml/200g). Two weeks after HFD, the
extract Syzygium polyanthum (Wight) on dose dependent (0.72mg/kg/day, 0.9 mg/
kg/day, and 1.08 mg/kg/day) was administrated via oral gavage for 4 weeks.
Treatment with extract of Syzygium polyanthum (Wight) reduced cholesterol total
levels (P < 0.05) in hyperglycaemic Rat model. Also, decreased the others metabolic
parameters high-density lipoprotein (HDL) (P < 0.05), and triglyceride (TG) (P < 0.05)
with alteration of body weight and blood glucose. Furthermore, the histology analy-
sis demonstrated that, in hypercholesterolaemia rat model, the extract of Syzygium
polyanthum (Wight) reduced the isolated hypercholesterolaemia lipid accumulation
in liver (p < 0.05).
Conclusion: Cholesterol-total lowering effects of extract Syzygium polyanthum
(Wight) were associated with the reduction of lipid accumulation in the liver in
hypercholesterolaemia Wistar Rat model. These results may provide a possible mech-
anism for hepatoprotective and cardioprotective effects of extract of Syzygium poly-
anthum (Wight).
Keywords: Hypercholesterolaemia • lipid accumulation • Syzygium polyanthum
(Wight)
Clinical and Cost Effectiveness between Treatment Methods of Hyponatraemia in
Acute Decompensated Heart Failure
S. P. Sirait, N. Hersunarti, H. Andriantoro, R. Soerarso, B. B. Siswanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Background: Hyponatraemia is found in 15-20% of hospital admissions and is
associated with adverse outcomes in patients with heart failure. The use of aquaret-
ics, which can increase free water excretion without electrolyte loss, may be
considered for its management. Adverse outcomes due to hyponatraemia
also affects health funding, and this is a potential target for intervention to decrease
health expenses. This study aims to evaluate the clinical effectiveness of
treatment methods of hyponatraemia in heart failure and analyse the associated
medical costs.
Methods: This is a cross sectional study on acute decompensated heart failure
patients with hyponatraemia from January 2014 to May 2017. Clinical and medical
cost data were acquired from medical records.
Results: 128 subjects were analysed, with 71 (55.5%) subjects receiving conventional
therapy added with AVP receptor antagonist and the rest receiving
conventional therapy only. There was a significant difference (p ¼ 0.041) in sodium
increase after three days of therapy (median of 4 (-8 – 26) in patients receiving AVP
receptor antagonist and 3 (-16 – 16) in those without), and also in length of stay
(median of 10.50 (3-40) days in patients receiving AVP receptor antagonist and 6 (3-
71) days in those without, p < 0.0001). The variable with the biggest correlation with
length of stay is day of AVP receptor antagonist initiation (p < 0.0001). Partial cost
analysis showed no significant difference in average daily cost with addition of AVP
receptor antagonist.
Conclusion: There is a significant difference in sodium increase and in length of stay
between those receiving AVP receptor antagonist and those without AVP receptor
antagonist in acute decompensated heart failure patients with hyponatraemia. There
is no significant difference in cost with the addition of AVP receptor antagonist.
Keywords: hyponatraemia • acute decompensated heart failure • AVP receptor
antagonist • health cost analysis
 D26
The Role of Community-based Health Education and Physical Exercise
Programme (S.E.H.A.T) to Improve 10-Years of Cardiovascular Disease Risk Using
Framingham Risk Score in Farmers Population of Batu City - East Java
D. Setiawan1,2, D. Sargowo1,2,3,4
1
Academic Hospital University of Brawijaya, Malang, East Java, Indonesia, 2Malang
Molecular Biology Institute, 3Department of Cardiovascular Medicine, Brawijaya
University - dr. Saiful Anwar General Hospital, Malang East Java, Indonesia, 4Center
Study of Degenerative Disease, University of Brawijaya
Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortal-
ity in rural population. The World Health Organization (WHO) estimate that preven-
tive measures such as health education and physical activity programme could
reduce the global burden of disease by as much as 70%. The Framingham Risk Score
(FRS), which estimates the 10-year risk of CVD, may be utilized to evaluate the
result of the primary preventive programme.
Objective: The aim of this study was to determine whether community-based health
education and physical exercise program could improve FRS in farmers population of
Batu City, East Java.
Method: This research was an interventional pre and post-test study conducted on
102 subjects (Men 21; Women 81) aged 30 to 75. Anthropometry examination, blood
pressure measurements, blood sampling (total cholesterol, HDL cholesterol, and fast-
ing blood glucose), and history taking (age, current medication, smoking habit, and
history of known CVD) were performed. The primary preventive programme include
60-minutes of heart exercise, three times a week (396 METs/min/week) for 3-months
period, while regularly providing health counselling and education about hyperten-
sion, obesity, smoking, diabetes mellitus and balanced nutrition. After the interven-
tion, the same examinations were performed again to the subjects. Wilcoxon Signed
Ranks Test was used to evaluate pre and post-intervention results in this study.
Result: From 102 observed subjects, there were reduction in mean value of
Framingham Risk Score 6.17 6 5.75 on pre-intervention group to 4.16 6 3.92 on post-
intervention group (Z score ¼ -6.009; p ¼ 0.00). There were 81 subjects (80%) with
reduced FRS; 16 subjects (16%) with no alteration in FRS; and 5 subjects (4%) with
increased FRS.
Conclusion: The result of this study proves that community-based health education
and physical activity programme could significantly improve the FRS of farmers popu-
lation in Batu City, East Java.
Keywords: Framingham Risk Score • Cardiovascular Disease • Primary Prevention
Prognostic Significance of Community- Versus Hospital-Acquired
Hypochloraemia in Heart Failure
N.G. Liman1, B. B. Siswanto1
1 altered and normal mental status.
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia
Background: Hypochloraemia in acute decompensated heart failure (HF) is indicative
of a poor prognosis and predicts morbidity and mortality independent of hyponatrae-
mia. The present study compares hospital-acquired Hypochloraemia (HAHypoCl) with
community-acquired hyponatraemia (CAHypoCl) in HF patients.
Methods and Results: CAHypoCl was defined as a serum chloride value of < 98 mEq/L
at the time of hospital admission. HAHypoCl was defined as development of a serum
chloride level of < 98 mEq/L during hospitalization in the setting of a serum chloride
value 98 mEq/L on admission. Of 142 consecutive hospitalized patients with a diag-
nosis of HF, CAHypoCl and HAHypoCl were identified in 44 patients (30.9%) and in 29
patients (20.4%), respectively. Both types of Hypochloraemia were associated with
increased mortality, length of stay, and rehospitalization. There were no significant
differences between patients with CAHypoCl versus HAHypoCl regarding six month
rehospitalization (p ¼ 0.74) and all-cause mortality (p ¼ 0.38).
Conclusion: The present results identified HAHypoCl as a risk factor for increased
mortality and rehospitalization in HF as has been previously described for CAHypoCl.
Thus, Hypochloraemia in hospitalized patients with a diagnosis of HF, either on
admission or during hospitalization, is a prognostic marker for poor outcomes.
Keywords: heart failure • Hypochloraemia • mortality • rehospitalization
The Clinical Outcome Comparison of Ischaemic Stroke with Ischaemic Heart
Disease and without Ischaemic Heart Disease
1 1
N.H. Karunawan , R.T. Pinzon
1 years about risk stratification and mortality prediction in hospitalized acute heart
Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
Background: Stroke and Ischaemic Heart Disease are the leading cause of morbidity
and mortality in worldwide. Ischaemic stroke after ischaemic heart disease is an
important complication. The occurrence in ischaemic heart disease patients is associ-
ated with increased morbidity and mortality. This study aims to compare the clinical
outcome of ischaemic stroke patients with ischaemic heart disease and without
ischaemic heart disease.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
Abstracts
Methods: This comparative study of 200 patients were first time acute ischaemic
stroke recorded in the Bethesda Hospital Yogyakarta Stroke Registry (2012-2017).
These patients were divided into ischaemic stroke patients with ischaemic heart dis-
ease and ischaemic stroke patients without ischaemic heart disease. The primary
outcome of the study were in-hospital mortality, disability measured by modified
Rankin Scale (mRS), and length of stay. The data were analysed univariate and bivari-
ate followed by the Chi-square test and Mann-Whitney.
Results: Data of 200 patients with 100 stroke patients with ischaemic heart disease
consist of forty-two male (42.0%) and eighty-six (86.0%) were more than 50 years
old. Compare to 100 stroke patients without ischaemic heart disease consist of
fourth-two male (42.0%) and eighty-nine (89.0%) were more than 50 years old. The
mortality of stroke patients with ischaemic heart disease group is eighteen patients
(18.0%), sixty patients (60%) have poor functional outcome (mRS >2) and have length
of stay 10.26 6 8.39 days. Bivariate analysis showed stroke patients with ischaemic
heart disease group is significantly associated with higher in-hospital mortality
(RR:2.9, 95%CI:1.1–7.3, p < 0.019), worse disability (RR:2.6, 95%CI:1.3 –5.1,
p < 0.005) and prolonged hospital stay (10.2668.39 vs 4.5962.57, p < 0.001) than in
stroke patients without ischaemic heart disease group.
Conclusion: Ischaemic stroke patients with ischaemic heart disease is significantly
associated with higher in-hospital mortality, worse disability, prolonged hospitaliza-
tion than in ischaemic stroke patients without ischaemic heart disease.
Keywords: ischaemic heart disease • ischaemic stroke • comparison • outcome
Correlation of Left Ventricular Function and CardShock Risk Score with Altered
Mental State in Cardiogenic Shock Patient Treated with Mechanical Ventilation
D.H. Karimullah1, L.H. Adrian1, F.W. Nugroho1, S. Anjarwani2
1
Resident of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya Malang, Indonesia, 2Supervisor, Division of Acute Cardiovascular Care, dr.
Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya Malang,
Indonesia
Background: Altered mental status is one of hypoperfusion signs in cardiogenic
shock, the most complex form of acute heart failure.
Aim: This study was to investigate the prevalence and factors associated with altered
mental status in patients with cardiogenic shock who were treated with mechanical
ventilation.
Method: Mental status was assessed at presentation of shock in 72 adult cardiogenic
shock patients admitted to CVCU, tertiary hospital, Dr. Saiful Anwar General
Hospital, Malang East Java, Indonesia. This study was single-centre, retrospective
observational study. Clinical picture, biochemical variables, score modality, and
short-term in hospital mortality were compared between patients presenting with
Result: Altered mental status was detected in 37 (51%) patients, whereas 35 (49%)
patients had normal mental status. Patients with altered mental status were have
more decrease of left ventricle function (odds ratio/OR 9.213, p value 0.023, CI
95%). Altered mental status was associated with increase of serum lactate (OR 0.543,
p value 0.043, CI 95%) as well as with high value of CardShock risk score (OR 8.752, p
value 0.001, CI 95%). After multivariable regression, CardShock risk score (adjusted
OR 4.244, p 0.000, CI 95%) and low ejection fraction (adjusted OR 9.213, p: 0.023, CI
95%) showed as independent risk factors associated with altered mental status.
Conclusion: Decrease of left ventricular function and high CardShock risk score are
independent risk factors for the occurrence of altered mental state in cardiogenic
shock patients treated with mechanical ventilation.
Keywords: Altered mental state • cardiogenic shock • CardShock risk score
Get With The Guideline (GWTG) Score has Better Prediction than Acute
Decompensated Heart Failure National Registry (ADHERE) Score for Inhospital
Mortality in Acute Heart Failure Patients
P. A. Kamila1, S. Rohman1
On behalf of Heart Failure Registry Team, Department of Cardiology and Vascular
Medicine, Saiful Anwar Hospital, Malang, 1Department of Cardiology and Vascular
Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Hospital, Malang,
Indonesia
Background: Acute heart failure patients are closely related to mortality during hos-
pitalization. There are several studies that have been validated in the last recent
failure patients. Two of the most recent risk stratification score are Acute
Decompensated Heart Failure National Registry (ADHERE) and Get With The
Guideline (GWTG) Score. The aim of this study is to compare the performance of
ADHERE and GWTG score to predict mortality in acute heart failure patients admit-
ted to cardiovascular unit Saiful Anwar Hospital Malang.
Method: This is an observational study with consecutive random sampling method.
373 patients admitted to cardiovascular unit with diagnosis of acute heart failure
were analysed and followed until patients was discharged or died. We calculate
 Abstracts
ADHERE and GWTG score for each patient and data were analysed towards the inci-
dent of mortality using SPSS v22.
Results: Inhospital mortality were observed in 55 patients (14.7%). We found charac-
teristic of nonsurvivors patients were with lower blood pressure, higher BUN and cre-
atinine and also higher heart rate (p < 0.005). ROC curve of ADHERE and GWTG score
showed the value of 68.9% (p < 0.005) and 76.3% (p < 0.005), respectively. Sensitivity
and specificity of ADHERE score was 63.6% and 64.2%, while sensitivity and specificity
for GWTG score was 70.9% and 74.8%, respectively.
Conclusion: GWTG score uses common clinical variables, applicable to a large spec-
trum of patients with heart failure and has better prediction for inhospital mortality
in acute heart failure patients compared to ADHERE score.
Predictive Value of CHA2DS2-VASc-HSF Score for Contrast Induced Nephropathy
After Percutaneous Coronary Intervention for Acute Myocardial Infarction
HW Parlindungan, R Hasan, CA Andra, H Hasan, AA Siregar, IN Kaoy, Z Mukhtar,
AN Nasution, NZ Akbar, Z Safri, Y Sarastri, BG Napitupulu
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
Background: The CHA2DS2-VASc score, used for embolic risk stratification in atrial
fibrillation (AF), has been reported recently to predict adverse clinical outcomes so
is Contrast Induced Nephropathy (CIN) in patients with AMI regardless of having AF.
We used a formulated score CHA2DS2-VASc-HSF which included more variable like
Hyperlipidaemia (H), Smoker (S), and Family History of CAD (F) in addition to the
previous risk factor to assess the risk of CAD. We investigated these score as multi-
variable risk assessment tools to the predict CIN events in acute myocardial infarc-
tion patients who underwent percutaneous coronary intervention (PCI) strategies.
Methods: Consecutive sampling was performed in 53 patients with acute myocardial
infarction, admitted in Haji Adam Malik General Hospital, Medan, from January 2017
to December 2017 who underwent PCI strategies. We exclude patients with hypoten-
sion state during PCI or using any inotropic for stabilizing haemodynamic, cardiogenic
shock, atrial fibrillation, and patients with post cardiac resuscitation. CIN was
defined as the elevation of serum creatinine  0.5 mg/dl or  25% in baseline serum
creatinine within 24 hours after PCI.
Results: In the ROC curve analysis, the cut-off value of CHA2DS2-VASc-HSF score in
the prediction of CIN was  5 (sensitivity:78.5%, Specificity:66.6%) (AUC 0.818, 95%
CI 1.739-31.25, p ¼ 0.001). CIN (þ) was found to be higher among patients with
CHA2DS2-VASc-HSF score  5 [n ¼ 11 (78.6%)] vs score < 5 [n ¼ 3 (21.4%)]. From logis-
tic regression test, we also predict the probability events percentage of CIN (þ) and
CIN (-) with total CHA2DS2-VASc-HSF Score from AMI patients who underwent the PCI
strategies.
Conclusion: The CHA2DS2-VASc-HSF score was positively associated with CIN.
Therefore, this score can be used as a simple and reliable tools to predict CIN in AMI
patients who underwent PCI.
Keywords: CHA2DS2-VASc-HSF score • Contrast Induced Nephropathy • AMI • PCI
RESOLUTION OF ST-SEGMENT DEPRESSION IN RECIPROCAL LEADS AS PROGNOSTIC
MARKER FOR ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH
FIBRINOLYTIC THERAPY
A S Adhitya, H Hasan, A Sitepu, Z Mukhtar, M F Sarahazti, I Ginting
Department of Cardiology and Vascular Medicine, Faculty of Medicine of University of
Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia
Background: ST Elevation Myocardial Infarction (STEMI) may cause Major
Cardiovascular Event (MACE). Revascularization needs to be done in all STEMI
patients to restore coronary blood flow, hence saving myocardial perfusion. ST
Segment Depression (STSD) in reciprocal ECG lead is associated with poor prognosis
in STEMI patients receiving fibrinolytic therapy. The main purpose of this study is to
evaluate MACE in STEMI patients receiving fibrinolytic therapy using resolution in
STSD.
Methods: This study is cohort prospective study with 60 subjects of STEMI patients
which are evaluated for MACE (death, heart failure, and rehospitalization) within 30
days after myocardial infarction. Resolution in STSD is defined as resolution  50%
STSD in reciprocal leads within 90 minutes after fibrinolytic therapy.
Results: Bivariate analysis showed that Ejection fraction (EF) <40% with OR 8.32
(2.11-32.74), p ¼ 0.001; smoking with OR 4.17 (1.05-16.57), p ¼ 0.034; Anterior
STEMI with OR 3.94 (1.11-13.90), p ¼ 0.027; Creatinine > 1.97 mg/dl with OR 3.69
(1.18-11.55), p ¼ 0.022; complete outpatient medication with OR 5.23 (1.61-17.01),
p ¼ 0.004; fragmented QRS with OR 5.23 (1.61-17.01), p ¼ 0.001; resolution in STSD
with OR 26.35 (5.16-134, 40), p ¼ <0.001; resolution in ST Segment Elevation with
OR 10.5 (2.97-37.24), p ¼ <0.001; are proven to be determining factor for MACE
within 30 days. Multivariate analysis showed that among those determining factors
for MACE, resolution in STSD on reciprocal leads is evidently the most dominant fac-
tor for predicting MACE within 30 days in STEMI patients receiving fibrinolytic therapy
[OR 11.47 (1.14-115.10), p ¼ 0.038].
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
D27
Conclusion: This study showed that there is significant difference in MACE within 30
days after myocardial infarction between patients with resolution in STSD and with-
out resolution in STSD. The subjects without resolution in STSD showed higher MACE
incidence. Resolution in STSD is evidently an independent predictor for MACE within
30 days after myocardial infarction in STEMI patients.
Keywords: Resolution in STSD • MACE • STEMI • Fibrinolytic
The Benefit of Fractional Flow Reserve-Guided PCI Compared to Coronary
Angiography-Guided PCI in Patients with Coronary Artery Disease, Including all
its Four Subtypes Namely ST-Elevation Myocardial Infarction, Non ST-Elevation
Myocardial Infarction, Unstable and Stable Angina: A Systematic Review
AIS Putra1
1
Faculty of Medicine University of Indonesia, Jakarta, Indonesia
Background: Coronary artery disease (CAD) is the progressive development of athe-
rosclerotic plaque as a result of the accumulation of lipids, cholesterol, as well as
cellular debris within the walls of coronary blood vessels. Coronary Angiography
(CAG) and Fractional Flow Reserve (FFR) guided PCI use different methods to mini-
mize Major Adverse Cardiac Event (MACE) in CAD patients. The aim of this review is
to determine the benefit of FFR-guided PCI compared to CAG-guided PCI in patients
with CAD including all of its subtypes. The primary outcome is the rates of MACE,
which includes the composite of all-cause death, recurrent myocardial infarction (Q-
wave and non Q-wave MI), and any repeat revascularization (target-lesion revascula-
rization, target-vessel revascularization).
Methods: This systematic review utilized a comprehensive computer-aided biblio-
graphic search. The literature search was performed on Pubmed, Medline, Cochrane
Review, Proquest and Google scholar. The data extracted from the selected studies
include, number of patients randomized, and number of patients in each of the
intervention groups, different types of comparison groups (stent types, PCI techni-
ques), comparison variables such as types of stents used (drug eluting vs. bare metal)
and CAD subtypes of the patients included in each trial (STEMI, NSTEMI, UA, SA).
Results: After a comprehensive searching is conducted, a total of thirteen random-
ized controlled trials (RCTs) were considered eligible for further review. Seven stud-
ies in total, including FAME trial stated that FFR guided PCI was reported to have sig-
nificantly lower rates of MACE compared to CAG guided PCI. Furthermore, it was
found that stable angina patients have significantly lower rates of MACE compared to
in STEMI, UA or NSTEMI patients. Nine RCTs comparing the use of different types of
stents showed no significant differences between the intervention and reference
groups. P-values in all different comparison groups consistently showed that the all-
cause death and recurrent myocardial infarction were not associated with the differ-
ent intervention groups.
Conclusion: The majority of the studies collected concluded that FFR guided PCI was
have significantly lower rates of MACE compared to CAG guided PCI. In general, the
rates of all-cause death and recurrent myocardial infarction, although varying, did
not show any significant differences between the intervention group and the refer-
ence group.
Correlation between Tpeak - Tend Interval and Myocardial Blush Grade Value in
Anterior ST-Elevation Myocardial Infarct Patient
RP Kaneko1, N Taufiq2, E Maharani3
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada
University, Yogyakarta, 2Cardiology Intervention Division, Department of Cardiology
and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta,
3
Arrythmia Division, Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Gadjah Mada University, Yogyakarta
Background: Anterior ST-Elevation Myocardial Infarction (STEMI) is one of the clinical
manifestation of Coronary Heart disease. In STEMI condition, there is a condition of
transmural dispersion of repolarization and microvascular dysfunction. The Tpeak-
Tend interval is an ECG parameter that describes the transmural dispersion of repola-
rization. Myocardial Blush Grade (MBG) is a assessment that can assess microvascular
dysfunction. This study aims to examine the correlation between Tpeak-Tend interval
and MBG values in anterior STEMI patients.
Methods: Analytical observational research with cross-sectional design. Data were
taken consecutive from August to November 2017. The Tpeak-Tend interval assess-
ment was based on ECG results and MBG assessment using Quantitative Blush
Evaluator (QuBE) program based on coronary angiography. The Tpeak-Tend interval is
divided into Tpeak-Tend interval > 94 millisecond group and Tpeak-Tend interval
 94 millisecond. The MBG values are divided into MBG QuBE 1, MBG QuBE 2 and
MBG QuBE 3 groups. Pearson correlation test was used for analysis correlation
between Tpeak-Tend interval and MBG value.
Results: 32 research subjects were enrolled in this study. There were 23 subjects
with Tpeak-Tend interval > 94 milliseconds and 9 subjects with Tpeak-Tend interval
 94 milliseconds. There was a negative correlation with moderate strength between
the Tpeak-Tend interval and the MBG value in the anterior STEMI patients
(r ¼ 0.501; p ¼ 0.004). The Multivariate tests showed Tpeak-Tend intervals as an
 D28
independent variable against MBG values in anterior STEMI populations (p ¼ 0.035;
95%CI: 1.283-12.725).
Conclusion: There is a negative association with moderate strength between the
Tpeak-Tend interval and the MBG values in the anterior STEMI patient and Tpeak-
Tend interval is an independent variable against the MBG values in the anterior
STEMI patient.
Keywords: ECG • Tpeak-Tend Interval • MBG • Anterior STEMI.
Relationship Of Platelet Distribution Width And Mean Platelet Volume with ST
Segmen Resolution After Fibrinolytics On ST Elevation Myocardial Infarction
Patients at Haji Adam Malik General Hospital Medan
D. Ashrinda1, H. Hasan2, N. Z. Akbar2, Z. Mukhtar2
1 and to investigate whether PSTD in IMI can be used as a predictor of MVCAD.
Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, 2Haji Adam
Malik General Hospital, Medan, Indonesia
Background: Platelet activation has an important role in occurrence and
progression of myocardial infarction. The value of Platelet Distribution Width (PDW)
indicates platelet form heterogeneity, this examination may be a sign of platelet
reactivation. Mean Platelet Volume (MPV) is the average platelet size in peripheral
blood circulation. Increased PDW and MPV values increase the incidence of coronary
thrombus and fibrinolytic failure in ST Elevation Myocardial Infarction (STEMI)
patients.
Methods: This was a cross-sectional study to assess the relationship of PDW and MPV
to ST-segment resolution (STR) in STEMI patients with fibrinolytic therapy at Haji
Adam Malik General Hospital, from January 2015 to December 2016. The sample is
divided into two groups, namely ST segment resolution (STR)  50% and STR < 50%.
STR was assessed by measuring alteration of ST segment before and after fibrinolytic.
Results: A total of 53 patients (mean age 52 6 8 years, 51 male 2 female) had fibri-
nolytic therapy with Streptokinase, 33 patients with STR  50% and 20 patients with
STR < 50%. Risk factors affecting STR was diabetes mellitus (DM) (p ¼ 0.030).
Bivariate analysis showed that DM (p¼0.030; OR 0.269), onset of chest pain ¼ 3 hour
(p ¼ 0.013; OR 2.80), MPV value < 10 fL (p ¼ 0.007; OR 4.95), PDW value <11%
(p ¼ 0.031; OR 3.59) and Troponin T ¼ 0.03mg/mL (p ¼ 0.008; OR 6.02) had a signifi-
cant relationship to STR. Then all variables were performed multivariate analysis
obtained MPV <10 fL (p ¼ 0.012; OR 5.08) and Onset Chest Pain ¼ 3 h (p ¼ 0.044; OR
4.08) have a stronger relationship with STR.
Conclusion: MPV has a strong relationship with ST segment resolution after fibrino-
lytic in STEMI patients.
Keywords: PDW • MPV • ST Segment Resolution • Streptokinase
Serum Neutrophil Gelatinase-Associated Lipocalin and Decreased Kidney
Function as Predictor of Mortality and Major Adverse Cardiac Events during
Acute Heart Failure Hospitalizations
R. Maliawan1, B. Nadha1, R. Widiana2, P. Gunadhi1, S. Ida3, W. Wita1
1
Department of Cardiology and Vascular Medicine, 2Department of Internal Medicine,
Nephrology Division, 3Department of Clinical Microbiology, Faculty of Medicine,
Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
Background: Decreased renal function occurs is associated with a poor prognosis in
acute heart failure patients. One of standard method for assessing the decline in kid-
ney function is measurement of serum creatinine levels which has many limitations
to assess worsening of acute kidney injury. Serum Neutrophil gelatinase-associated
lipocalin (NGAL) is one of predictive biomarkers for early detection of AKI in several
conditions except in acute heart failure (AHF) patients which it yield a conflicting
result. The study aimed to determine the role of serum NGAL and decreased renal
function, obtained from measurements of serum creatinine levels, in predicting mor-
tality and major adverse cardiovascular (MACE) events during hospitalization in acute
heart failure patients.
Methods: Prospective cohort study with consecutive sampling was conducted in AHF
patients who were treated at Sanglah General Hospital from July until September
2017. Serum NGAL and creatinine levels were measured at the onset of hospital
admission and observed for mortality and MACE during hospitalization.
Results: Seventy-seven patients were involved in this study. We found hazard ratio
(HR) serum NGAL to mortality was 7.8 (p ¼ 0.009) and increased to 18.9 in multivari-
ate analysis with cox proportional hazards regression test (p ¼ 0.002). There were
significant differences in survival (p ¼ 0.002) between patients with high serum NGAL
(424 hours survival rate, 95% CI 296-552) than low serum NGAL (baseline survival
680 hours; 95% CI 584-775) after log rank test. Meanwhile, the effect of serum NGAL
on MACE and decreased of kidney function on mortality or MACE did not give signifi-
cant result.
Conclusion: Serum NGAL is an independent predictor of in-hospital mortality in AHF.
Patients with high serum NGAL level had worse survival than patients with low serum
NGAL level during hospitalizations.
Keywords: Acute heart failure • serum NGAL • decreased renal function • in-hospi-
tal mortality • MACE
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
Abstracts
Precordial ST Segment Depression on Admission Electrocardiogram as a Simple
Noninvasive Tool for Predicting Coronary Artery Disease Complexity in Patients
with Inferior Myocardial Infarction
J. Suganti, A. C. Lubis, A. A. Siregar, A. Sitepu, C. A. Andra, A. N. Nasution, H. Hasan
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of
Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia
Background: The mechanism underlying precordial ST segment depression (PSTD) in
inferior myocardial infarction (IMI) remains unclear. Previous studies suggested that
PSTD in IMI was associated with a higher incidence of multivessel coronary artery dis-
ease (MVCAD) and it specifically represents a concomitant anterior ischaemia due to
left anterior descending artery (LAD) disease. Therefore, the aim of this study is to
analyse the complexity of coronary artery disease (CAD) in IMI patients with PSTD
Methods: A retrospective study was conducted on IMI patients who underwent coro-
nary angiography during hospitalization at Cardiology Department Haji Adam Malik
General Hospital between December 2013 and December 2016. Patients were divided
into two groups based on the presence of PSTD on admission ECG. The complexity of
CAD was analysed using visualization and SYNTAX score. Bivariate and multivariate
analysis were performed to study the association between PSTD and complexity of
CAD.
Results: A total of 215 patients with IMI were found in this study period, with 102
patients meet the inclusion and exclusion criteria. The incidence of MVCAD, particu-
larly LAD disease and SYNTAX score were higher in patients with PSTD than without
PSTD (66% vs 34%; p < 0.001; OR 4.696; 95% CI 1.923 to 11.463); (72% vs 28%;
p < 0.001; OR 5.674; 95% CI 2.412 to 13.350); and (20612 vs 1067; p < 0.001). A fur-
ther analysis with logistic regression model revealed that IMI patients with PSTD had
a 4-fold increased risk of MVCAD than patients without PSTD (OR 4.097; 95% CI 1.638
to 10.247; p ¼ 0.003).
Conclusion: In daily clinical practice, PSTD on admission ECG may serves as a simple
noninvasive tool for predicting MVCAD or a more complex CAD in IMI patients.
Keywords: Precordial ST Segment depression • inferior myocardial infarction • mul-
tivessel coronary artery disease • SYNTAX score.
Assessment of coronary no-reflow in patients with acute anterior STEMI
underwent primary percutaneous coronary intervention using P wave peak time
parameter
Andri1, P. Meidianaser1, M. Syaoqi1, S. Masrul1
1
Cardiology and Vascular Medicine Division M. Djamil General Hospital, Andalas
University, Padang, Indonesia
Background: Coronary no-reflow (NR) following primary percutaneous coronary inter-
vention (PPCI) is associated with worsened prognosis in patients with ST segment ele-
vation myocardial infarction (STEMI). Despite rapid developments in cardiovascular
area; there are limited data regarding prediction of NR before PPCI. P wave duration
and dispersion (PWD, PWDIS, respectively) have been studied in STEMI patients and
found to be associated with reperfusion success; however none of them has been
found to predict NR before PCI. In this study, we aimed to evaluate whether PWD,
PWDIS and a novel parameter P wave peak time (PWPT) could predict NR develop-
ment in STEMI patients.
Methods: In this retrospective analysis, we evaluate 30 patients who were admitted
with anterior STEMI from January 2017 to December 2017 at M. Djamil General
Hospital Padang, Indonesia. P wave parameters including PWD, PWDIS and PWPT were
calculated from electrocardiograms that were obtained on admission and 60 min
after PPCI
Results: Patients were divided into two groups according to the development of NR.
We observed that PWPT that were obtained from leads II (PWPTLII) and V1 (PWPTV1)
were longer in NR group than reflow group. There were a correlations between PWPT
and reperfusion parameters regarding percent of ST segment resolution, peak CKMB
level and TIMI frame count of infarct related artery. Preprocedural PWPTLII was found
to be an independent predictor of NR development.
Conclusion: In this study, we observed that PWPT could be a useful parameter in the
assessment of reperfusion success and prediction of NR development.
Keywords: P wave peak time • Myocardial infarction • Coronary No-reflow
Cardiac Power Output Predicts In-Hospital Major Adverse Cardiac Events in
Patients with Acute Myocardial Infarction
Y. F. Siregar1, K. K. Ilyas1, A. A. Siregar2, H. Hasan2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department
of Cardiology and Vascular Medicine, Haji Adam Malik Hospital, Medan, Indonesia
Background: Insufficient reliability and specificity of cardiac output (CO) as widely
used parameter for prognosis of acute myocardial infarction (AMI) outcomes led to
search for new parameters. Cardiac power output (CPO) is a novel haemodynamic
measurement that represents cardiac pumping ability as compared with invasive
 Abstracts
method. The prognostic value of CPO in patients with AMI has not been examined. The
aim of this study was to investigate the reliability and specificity of CPO in predicting
in-hospital major cardiovascular events (MACE) using non-invasive techniques.
Method: Patients with AMI who underwent haemodynamic echocardiography less
than 24 hours after admission were included. Haemodynamic data – blood pressure
(BP), mean arterial pressure (MAP), CO, CPO and ejection fraction (EF) were docu-
mented. The relationship between initial CPO [(MAP  CO)/451] and in-hospital
MACE was evaluated.
Results: Data were available for 64 patients (53 males, median age 56 6 7.5). Onset
of infarction, Killip class, previous coronary artery disease (CAD), BP, EF, MAP, CO and
CPO were statistically associated with in-hospital MACE. The mean CPO was 0.59 6
0.24 W. The in-hospital MACE rate was 37.5%. Lower CPO was associated with more
frequent in-hospital MACE (p value 0.029). Among these parameters, none was seen
to be the most superior to predict in-hospital MACE (all r Pearson < 0.8). Receiver
operating characteristic curve analysis revealed that CPO had cut off point of 0.5,
sensitivity of 80%, specificity of 50% and area under the curve of 0.66. This cut off
point is lower than 0.53 – a cut-off value previously established among patients with
cardiogenic shock.
Conclusion: Cardiac power output is a reliable predictor of in-hospital MACE after
AMI, along with onset of infarction, Killip class, previous CAD, BP, EF, MAP and CO.
Keywords: cardiac power output • ejection fraction • haemodynamic • acute myo-
cardial infarction
Predictors of Hospital Length of Stay and In-Hospital Mortality in Patients with
ST-Segment Elevation Myocardial Infarction in Sardjito General Hospital
I.H. Sulistya, H. P. Bagaswoto, N. Taufiq, B.Y. Setianto
Department of Cardiology and Vascular Medicine, Universitas Gadjah Mada/Sardjito
General Hospital, Yogyakarta, Indonesia
Background: Patients with acute coronary syndrome, particularly ST-segment eleva-
tion myocardial infarction (STEMI), occupy the first rank of hospitalization cause in
intensive care unit, that associated with high mortality and longer length of stay
(LOS). LOS is a clinical parameter for health care efficiency. Shorter LOS allows for
improved patient-centred care, lower readmission rates, and improved health
outcome.
The aim of this study was to assess factors that can predict the LOS and mortality in
STEMI patients in Sardjito General Hospital.
Methods: We performed analytic observational study. Data was obtained from
Sardjito Cardiovascular Intensive Care (SCIENCE) registry and Acute Coronary
Syndrome (ACS) registry, consists of STEMI patients from January until October 2017.
We analyse demographic baseline, coronary risk factor, comorbidities, reperfusion
therapy, echocardiographic findings, and laboratory parameter to know which factor
could possibly be predictor for mortality and LOS. Mortality define as in hospital mor-
tality of any cause. LOS was divided into two groups, 5 days and <5 days.
Results: From 298 patients with mean age 60.45 6 12.19 years old, there was mor-
tality in 30 patients (10.1%). From multivariate analysis, we obtained factors that
become independent predictor for mortality: pneumonia, ventilator use, anaemia
(Hb < 10 g/dL), elevated creatinine level, decreased RV function, and elevated trans-
aminase enzyme level. Independent predictor for LOS was reperfusion therapy.
Conclussion: In this study, we found factors that become independent predictor for
mortality and LOS in STEMI patients. More attention and specific management is
needed for those patients. In our study, reperfusion therapy hold important factor to
determine LOS.
THE ROLE OF ORAL SILDENAFIL TOWARDS HEALTH RELATED QUALITY OF LIFE IN
ADULTS WITH PULMONARY ARTERIAL HYPERTENSION RELATED UNCORRECTED
SECUNDUM ATRIAL SEPTAL DEFECT
F. Hidayati*, P.P.R. Gharini*, A.B. Hartopo*, D.W. Anggrahini*, L.K. Dinarti*
*
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Gadjah Mada, Yogyakarta
Background: Pulmonary arterial hypertension (PAH) is a common complication of
atrial septal defect (ASD). Assessment of health-related quality of life (HRQoL) are
often measured as an important patient-reported outcome in clinical studies. This
study aimed to assess the HRQoL of PAH related uncorrected secundum ASD with oral
sildenafil therapy.
Methods: Adults with PAH related uncorrected secundum ASD (n ¼ 18) received oral
sildenafil (20 mg two or three times daily) during 12 weeks in quasi experimental
study at Sardjito Hospital Yogyakarta since April 2016 to August 2017. HRQoL data
were obtained using EQ-5D-3L questionnaire at baseline and 12 weeks after therapy.
The differences of EQ-5D utility and EQ-VAS score were analysed using paired T-test.
Results: The most frequent reported problems pre therapy were pain/discomfort
(83%) and anxiety/depression (78%). The mean value of EQ-5D utility score was 0.558
while 0.664 post therapy (p:0.014; 95% CI 0.024-0.187). Whereas, the mean value of
EQ-VAS score pre and post therapy was 65 and 71.67, respectively (p:0.005; 95% CI
2.32-11.02). Mild side effects were experienced by 11.11% subjects.
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
D29
Conclusion: Oral sildenafil for 12 weeks statistically significant improves HRQoL in
adult with PAH related uncorrected secundum ASD.
Keywords: health related quality of life • pulmonary arterial hypertension • atrial
septal defect • sildenafil
LEFT VENTRICULAR DIMENSION AND EJECTION FRACTION VALUES BY
ECHOCARDIOGRAPHY IN ADOLESCENTS: AN EPIDEMIOLOGY STUDY IN BALI,
INDONESIA
L. O. S. Suastika1, I. B. R. Wibhuti1, K. B. Nadha1, M. Chowdhury2, J. Chowdhury2,
K. Olejnik3, E. Bouman3, J. Otero3, L. Sugeng3, B. Lombo3
1
Cardiology and Vascular Medicine Department, Faculty of Medicine, Udayana
University, Sanglah General Hospital, Bali, Indonesia, 2Division of Cardiology,
Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, MA, USA, 3Division of Cardiology, Department of Internal
Medicine, Yale-New Haven Hospital, Yale University School of Medicine, New Haven,
CT, USA
Background: Echocardiographic reference ranges of left ventricular (LV) dimension
and LV ejection fraction (LVEF) in adolescents is currently not available in Indonesia.
The purpose of this study was to establish values of LV dimension and LVEF in adoles-
cents in Bali and to evaluate their correlation to clinical parameters and socioeco-
nomic status.
Methods: We performed a cross-sectional study involving junior high school students
in Karangasem, Bali, Indonesia. The end-diastolic LV internal dimension (LVIDd), LV
posterior wall thickness (LVPWd) and interventricular septum (IVSd) values were
determined by 2D echocardiographic examination. Four Terason T3200TM ultrasound
tablets were used to obtain a limited parasternal and apical views. Demographics
and socioeconomic variables were documented and followed by physical
examinations.
Results: We evaluated 213 children aged 12-17 years old (mean age 13.960.9 years,
53.5% female), 82.6% were deemed to be living in low or moderate socioeconomic
conditions. IVSd, LVPWd, LVIDd and LVEF values in male and female were 0.40-
1.50 cm (0.69 6 0.14 cm) and 0.40-0.90 cm (0.57 6 0.11 cm), 0.50-1.23 cm
(0.76 6 0.13 cm) and 0.40-0.90 cm (0.6060.09 cm), 2.71-5.00 cm (4.05 6 0.47 cm)
and 0.70-5.16 cm (3.98 6 0.52 cm), 60.00-69.00% (64.89 6 1.57%) and 52.00-79.00%
(63.54 6 4.59%). Male had significantly higher IVSd (P<0.001), LVPWd (P<0.001) and
LVEF (P¼0.004) compared to female. There was no gender difference in LVIDd. Both
gender showed positive correlation of IVSd, LVPWd and LVIDd to body weight, body
mass index and systolic blood pressure. LVIDd had positive correlation to body height
only in male; while LVEF had no correlation to any clinical parameters.
Socioeconomic status was correlated to IVSd and LVPWd in all subjects, and with
LVEF in male only.
Conclusion: These are the first echocardiographic data of LV dimension and LVEF in
adolescents in Bali, Indonesia. Boys had significantly higher IVSd, LVPWd and LVEF
compared to girls.
Keywords: adolescent echocardiography values • left ventricular dimension • left
ventricular ejection fraction
Predictors of Right Ventricle Function Improvement in Patients with Right
Ventricle Dysfunction after Mitral Valve Surgery
WM. Saragih, AS Kuncoro, R Zahara, AM Soesanto
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia
Background: In patients undergoing mitral valve surgery, right ventricular function
may decline immediately after the surgical procedure. This condition may sometimes
remain, but may also improve later on. Many factors have been proposed to account
for this phenomenon.
Objective: This study aims to identify factors that may be predictors of right ventric-
ular function improvement in patients with right ventricular dysfunction following
mitral valve surgery.
Methods: This is a retrospective cohort study, taking place at National
Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Subjects are
patients who underwent mitral valve surgery between January 2016 until February
2017. Data taken include basic characteristics, surgical data, drugs prescribed after
surgery, and echocardiography data before surgery, predischarge, and six months
after surgery.
Results: There are 100 subjects who fulfilled the criteria to participate in this study.
There are 68 (68%) cases of right ventricular function improvement and 32 (32%)
cases without improvement. The median of predischarge TAPSE increases signifi-
cantly six months after surgery, from 1.1 (0.6-1.5) to 1.4 (0.7-2.8) with p value
< 0.001. No significant association between factors and right ventricular function
improvement was found in this study. Analysis of data subset revealed that median
of percentage of TAPSE increase was higher in patients receiving: RAA inhibitor [38,
4 (-27 - 300) versus 20 (-22 – 133,3)], beta blocker [40.8 (-27 - 300) versus 17.8 (-23 –
155.5)], aldosterone antagonist [32.5 (-27 - 300) versus 32 (-23 -155.5)], and
 D30 Abstracts

pulmonary artery dilator [43 (-23 - 142.8) versus 29.6 (-27 - 300)]. This phenomenon
was not seen in those receiving digoxin [27.2 (-27 - 100) versus 38.4 (-23 - 300)]. But
these results are not significant statistically.
Conclusion: There is a significant improvement of right ventricular function six
months after mitral valve surgery. There are no factors in this study that predict
right ventricle function improvement six months after surgery.
Keywords: Right Ventricle Function • Mitral Valve Disease • Mitral Valve Surgery •
Predictors • Function Improvement
(r ¼ 0.587, p ¼ 0.006) and positive correlation between TAPSE (r ¼ 0.591, p < 0.01) to
birth weight for gestational age among all patients. No correlation were found
between EF and birth weight for gestational age (r ¼ 0.155, p ¼ 0.513).
Conclusion: Pregnancy with unrepaired eisenmenger CHD were at higher risk of
maternal in-hospital death and acute respiratory failure in comparison with non-
eisenmenger ones. Lower Birth weight for gestational age popularly known as SGA
were negatively correlate with estimated RVSP and positively correlated with TAPSE.
Keywords: pregnancy • unrepaired congenital heart disease • eisenmenger •
maternal outcome • perinatal outcome

BASELINE CHARACTERISTICS
CORRELATION OF BLOOD NITRIC OXIDE LEVEL AND RIGHT VENTRICULAR SYSTOLIC
FUNCTION IN ADULT PATIENT WITH UNCORRECTED SECUNDUM ATRIAL SEPTAL
Variables Acyanotic Acyanotic P value
DEFECT
CHD with CHD without
FSA Pradana1, DW Anggrahini2, AB Hartopo2, LK Dinarti2 Eisenmenger Eisenmenger
1
Resident of Cardiology and Vascular Medicine Universitas Gadjah Mada/RSUP dr n ¼ 10 (50%) n ¼ 10(50%)
Sardjito, 2Staff of Cardiology and Vascular Medicine Universitas Gadjah Mada/RSUP
dr Sardjito Age, years old, mean 6 SD 28.18 6 5.52 25.10 6 4.43 0.489
Gestational Age, weeks, mean 6 SD 32 6 5.59 33.70 6 4.97 0.499
Multigravida, n (%) 4 (20%) 8(40%) 0.085
Background: Atrial septal defect (ASD) is one of the most common congenital heart
Multiparity, n (%) 3 (15%) 4 (20%) 0.500
defect found in grown-adult. Uncorrected ASD in adult eventually will develop into
History of miscarriage, n (%) 1(5%) 3 (15%) 0.291
right heart failure due to volume overload in right heart chambers. This state in the
Heart Defect, n (%)
long run could result in reduced RV compliance and increased right heart chambers
ASD 6 (30%) 5 (25%) 0.500
pressure. Changes in intravascular pulmonary pressures, pulmonary vascular tone,
VSD 1 (5%) 2 (10%) 0.500
and vascular wall composition could be happen through diminished nitric oxide avail-
PDA 0 2 (10%) 0.237
ability in these structures which hypothesized will contribute in reduction of right
VSDþPDA 0 1 (5%) 0.500
ventricular systolic function. The present study assessed right ventricular systolic
ASDþVSD 1 (5%) 0 0.500
function in association with plasma nitric oxide level in uncorrected secundum ASD
CAVSD 1 (5%) 0 0.500
patients.
ASDþDextrocardia 1 (5%) 0 0.500
Methods: A cross-sectional study was orchestrated in adult, uncorrected secundum
Severe Pulmonary Hypertension, n(%) 10 (50%) 3 (15%) 0.002
ASD patient registered in ASD Registry of Dr Sardjito General Hospital.
Ejection Fraction, %, mean 6 SD 66.90 6 10.60 61.20 6 8.97 0.198
Echocardiographic structural (diameter defect, shunt direction, right ventricle func-
TAPSE, mm, mean 6 SD 23.00 6 7.42 18.10 6 3.69 0.078
tion calculated in TAPSE with cut of < 18 for diminished right ventricular function)
RVSP, mmHg, mean 6 SD 106.40 6 20.23 43.00 6 27.93 <0.001
and haemodynamic (mean pulmonary artery pressure, flow ratio, and pulmonary vas-
Maternal & Perinatal Outcome
cular resistance) parameters were measured by RHC. Plasma NO level were meas-
Preeclampsia, n (%) 0 4 (20%) 0.043
ured using pulmonary artery blood sampling conducted with ELISA technique.
Acute Respiratory Failure, n (%) 4(20%) 0 0.043
Result: 97% of 76 patients with uncorrected secundum ASD patient analysed had
Prematurity, n (%) 7 (35%) 4 (20%) 0.185
PAH. No significant correlation was obtained between NO level and mean pulmonary
Maternal Death, n (%) 4 (20%) 0 0.043
artery level (p ¼ 0.18). Hence, no significant correlation was found between Nitric
Maternal Ischaemic Stroke, n (%) 1 (5%) 0 0.500
Oxide level and right ventricular function calculated in TAPSE (p ¼ 0.83).
IUFD, n (%) 0 1 (5%) 0.500
Conclusion: Plasma nitric oxide level were not statistically significant correlated
Small For Gestational Age, n (%) 6 (30%) 2 (10)% 0.085
with right ventricular systolic function in adult patients with uncorrected ASD.
Keywords: atrial septal defect • right ventricular function • pulmonary arterial
hypertension • nitric oxide • tapse • plasma nitric oxide.

CORRELATION BETWEEN ESTIMATED RIGHT VENTRICULAR SYSTOLIC PRESSURE Correlation analysis RVSP EF TAPSE
AND TRICUSPID ANNULAR PLANE SYSTOLIC EXCURSION TO PERINATAL OUTCOME
IN PREGNANCY WITH ACYANOTIC CONGENITAL HEART DISEASE Birth Weight for Gestational Age: r ¼ 0.587 r ¼ 0.155 r ¼ 0.591
• Small For Gestational Age P ¼ 0.006 p ¼ 0.513 p ¼ 0.006
A. Pudjiastuti, A. A. Asrial, A. Sariningrum, L. Raharjoyo, Y. A. B. M. Aruman, M. • Appropriate for Gestational Age
A. Nugroho, Y. Herry
• Large for Gestational Age
Department of Cardiology and Vascular Medicine, Faculty of Medicine Diponegoro
University Dr. Kariadi Central General Hospital Semarang

Background: Haemodynamic consequences of pregnancy in unrepaired left to right
shunt or esienmengerly acyanotic Congenital Heart Disease (CHD) maternity lead to
higher risk of maternal and perinatal morbidity and mortality. Small for gestational
age (SGA) as reflection of intrauterine growth retardation (IUGR) due to chronic
maternal disease may be correlated with severity of pulmonary hypertension repre-
sent by estimated right ventricular systolic pressure(RVSP) and other echocardiogra-
phy parameter such as ejection fraction (EF) and tricuspid annular plane systolic
excursion (TAPSE). Literatures hadn’t specifically describe the pregnancy outcome in
left to right or vice versa acyanotic CHD pregnant women.
Method: We analysed medical record and echocardiography registry of 20 patients
hospitalized with unrepaired acyanotic CHD with and without eisenmenger syndrome
underwent delivery at RSUP Dr.Kariadi Semarang during August 2015 to December
2017. We exclude patients with pulmonary stenotic lession.
Result: Eisenmenger syndrome were identified in 10(50%) patients while 10(50%)
patients were without eisenmenger, in various spectrum of acyanotic CHD. Patients
with eisenmenger were older (28.18 6 5.52 vs 25.10 6 4.43 years old, p ¼ 0.499), had
less gravid history (20%vs40%, p ¼ 0.085) and less miscarriage history (5% vs 15%,
p ¼ 0.291). More patients in Eisenmenger group had severe pulmonary hypertension
(50% vs 15%, p ¼ 0.002) and higher RVSP (106.50 6 20.23 vs 43 6 27.98 mmHg,
p < 0.001). Maternal in-hospital death (20% vs 0%, p ¼ 0.043) and acute respiratory
failure (20% vs 0%, p ¼ 0.043) were significantly higher in eisenmenger group. While
pre-eclampsia were significantly higher in non-eisenmenger group (20%vs0%,
p ¼ 0.043). No statistically significant difference in prematurity, maternal ischaemic
stroke, Intrauterine Fetal Death (IUFD) and IUGR in both groups. There were signifi-
cantly negative correlation between RVSP to birth weight for gestational age
Correlation between Tricuspid Annular Plane Systolic Excursion (TAPSE) and
Peak Systolic Velocity on Annulus Tricuspid (S’) with Mean Arterial Pulmonary
Pressure (Mpap) on Atrial Septal Defect Patient
V. Rosalinda1, D.W. Anggraini1, B.A. Hartopo1, L. Krisdinarti2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada
University, Yogyakarta, Indonesia, 2Echocardiography Division Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University,
Yogyakarta, Indonesia
Background: Atrial septal defect is the most common congenital heart disease in
adult patients. Pulmonary hypertension resulting from increased blood flow to the
lungs causes increased load on the right ventricle. Pulmonary hypertension can be
calculated based on Mean Arterial Pulmonary Pressure (mPAP) as measured by right
heart catheterization. There is a correlation between pulmonary hypertension and
decreased right ventricular function. Tricuspid annular plane systolic excursion
(TAPSE) is the most commonly used check for proper ventricular function because
the examination is easier. An examination of Doppler’s features in the heart will
improve the accuracy of right ventricular function examination. Peak systolic veloc-
ity at the tricuspid annulus (S’) is a method that can improve the accuracy of the
examination for right ventricular measurements. The purpose of this study was to
determine the correlation value between TAPSE and S’ with mPAP in patients with
Atrial Septal Defect.
Methods: This research is an observational research with cross-sectional approach.
The subjects of the study were patients with atrial septal defect whose control in Dr.

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839

by University of Groningen user
on 22 April 2018
 Abstracts D31

Sardjito hospital who has done echocardiography and right heart catheterization. To Blood Urea Nitrogen/Creatinine Ratio as a Predictor of 1-Year Survival in Patients
know the correlation between TAPSE and S’ with mPAP Pearson test was performed. with Acute Heart Failure: An Insight from HF Registry in National Cardiovascular
The data was processed using SPSS version 22. Center Harapan Kita
Results: There were 40 ASD patients included in this study with the most subjects
J.O. Santoso1, A.R. Hidayat1, H. Safitri1, B. A. Marsudi1, Danny1, P. Almazini2,
being 38 women (95%) and age with 21–30 year age range of 20 people (50%). There
B.B. Siswanto2, R.P. Soerarso2
was a significant correlation between TAPSE and mPAP (p-value ¼ 0.001; r ¼ -0.495) 1
Medical Research Unit at National Cardiovascular Center Harapan Kita, 2Department
and S’ with mPAP (p-value ¼ 0.002; r ¼ -0.484). Decrease of TAPSE and S’ value will
of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia,
decrease the value of mPAP and vice versa. The correlation value of TAPSE with
National Cardiovascular Center Harapan Kita
mPAP was higher than the S ’correlation with mPAP in patients with atrial septal
defect.
Conclusion: The correlation value of TAPSE with mPAP has a better correlation com- Introduction: Heart Failure is known to be caused by excessive activation of neuro-
pared with S’ with mPAP in patients with atrial septal defect hormonal system resulting in structural and functional disorder of the heart. This
Keywords: Tricuspid annular plane systolic excursion • Peak systolic velocity at the phenomenon not only affects the heart but also other organs e.g. kidney. BUN/Cr
tricuspid annulus • Atrial septal defect ratio is known to reflect excessive activation and treatment inadequacy which in
turn may affect the survival of patients with heart failure.
Aim: This study aims to investigate BUN/Cr Ratio as a predictor of mortality in
Comparison of Radial Artery Occlusion Incidence Post Transradial Access patients with heart failure.
Method: This single-centre retrospective cohort study was conducted using data from
Between Seldinger Technique with Modified Seldinger Technique
ESC-HF registry performed at NCCHK Jakarta in 2016. From 433 patients with acute
M. H. Gailani1, M. Syukri2, M. Fadil2 heart failure (AHF), 266 subjects were included in the study. Clinical profile and entry
1
Faculty of Medicine, Andalas University, Padang, Indonesia, 2Department of BUN/Cr value was subsequently recorded. Cut-off point of BUN/Cr was obtained using
Cardiology and Vascular Medicine, Dr. M. Djamil General Hospital, Padang, Indonesia C-Statistics and defined that patients with BUN/Cr  24 as a high risk group. The pri-
mary outcome was death followed in 1-year after index hospitalization.
Background: Transradial access is the first choice for cardiac catheterization proce- Result: Patients with BUN/Cr24 significantly older (p < 0.001) and lower systolic-dia-
dure. Although transradial access has many advantages, but it still has complication stolic blood pressure (p ¼ 0.028 and p ¼ 0.008). No significant difference in entry heart
of its own. Radial artery occlusion (RAO) is major complication of transradial access. rate, entry ECG, diabetic status, and sex between two groups. Patients with high BUN/
Two techniques exist for accessing radial artery, Seldinger and modified Seldinger Cr ratio had higher length of stay (LOS) (p ¼ 0.002) and higher mortality (p ¼ 0.006). In
technique. Data regarding how these techniques affected RAO complication is still 1-year survival assessment, patients with BUN/Cr ratio 24 had lower survival rate
limited. [Log-rank¼0.002, HR ¼ 2.71 (95% CI 1.38-5.30), p ¼ 0.003]. When adjusted by age, sys-
Methods: This study was comparative study with cohort design using consecutive tolic, and diastolic BP in index admission, HR was 2.93 (95% CI 1.32-6.51), p ¼ 0.008.
technique to obtain sample, and to assess RAO complication 30 days after transradial Conclusion: Patients with BUN/Cr24 had longer LOS and worse 1-year survival rate
access. The assessment of RAO was using Doppler vascular. that BUN/Cr ratio could be considered as predictor of mortality in patients with
Results: Total 50 patients were divided into two groups, Seldinger technique group acute heart failure.
(n ¼ 25) and modified Seldinger technique group (n ¼ 25). No difference in patient’s Keywords: Acute Heart Failure • BUN/Cr ratio • 1-year survival • Length-of-stay
baseline characteristic between two groups. Access time was significantly better in
Seldinger technique group (3.72 6 1.1 minutes vs. 5 6 2.9 minutes, p ¼ 0.048).
Although not statistically significant, this study also showed number of attempts, first
Improvement of Left Ventricular Function Following Bromocriptine Therapy in
attempt access, and crossover were better in Seldinger technique group (1.12 6 0.69
PPCM: Tangerang General Hospital PPCM Registry
vs. 1.44 6 1.02, p ¼ 0.12; 22 (88%) vs. 17 (68%), p ¼ 0.17; 1 (4%) vs. 5 (20%), p ¼ 0.18,
respectively). No incidence of RAO was observed in two groups with Doppler vascular D. R. Desandri, E. Hindoro, I. Nadia, D. Yaniarti, S. E. Nauli, A. M. Soesanto
examination. Faculty of Medicine Universitas Indonesia, Tangerang General Hospital Indonesia
Conclusions: RAO complication is not affected by the choice of the access techni-
ques. Seldinger technique is significantly better in the term of access time compared
Background: Bromocriptine treatment has been associated with high rate of LV
to modified Seldinger technique.
recovery in PPCM patients. But we still have no data regarding this effect in PPCM
Keywords: transradial access • radial artery occlusion • Seldinger technique.
patients in Indonesia.
Objective: To compare the effect of bromocriptine added to standard heart failure
treatment in PPCM patients in Indonesia.
Methods: Fifteen patients were included in this retrospective cohort study, divided
The Role of Insulin Resistance to Subclinical Left Ventricle Systolic Dysfunction in into standard treatment group and standard treatment plus bromocriptine group.
Metabolic Syndrome Bromocriptine was given right after onset of PPCM diagnosis and continued until
A Gayatri1, R Sukmawan1, A Santoso1 three weeks, added to standard optimal heart failure treatment. The primary end
Department of Cardiology and Vascular Medicine, Universitas Indonesia/National point was left ventricular ejection fraction (LVEF) from onset of diagnosis to range of
Cardiovascular Centre Harapan Kita, Jakarta, Indonesia, 1Department of Cardiology 6 – 12 months after.
and Vascular Medicine, Faculty of Medicine Universitas Indonesia Results: LVEF was increased from 31.4 6 13.30% to 47.1 6 14.34% in standard treat-
ment group only (p 0.03), but with very wide confidence interval (95% CI 1.36 to
30.0). In bromocriptine group, LVEF was significantly increased from 29.63% to 49% (p
Background: Subclinical myocardial dysfunction is a dangerous consequence of the 0.001, 95% CI 10.61 to 28.13). Full LVEF recovery was achieved in one patient (14%)
metabolic syndrome, which is assumingly caused by insulin resistance. The disorder in standard treatment group and three patients (37.5%) in bromocriptine group.
is an early pathological condition, which poses a risk of heart failure in the future. Conclusion: Bromocriptine has more beneficial effect on improvement of LV function
Through Two Dimensional-Speckle Tracking Echocardiography (2D-STE) with the compared to standard heart failure treatment only in PPCM patients in Indonesia.
Global Longitudinal Strain (GLS) parameters that have high sensitivity and specificity,
these myocardial dysfunctions can be detected earlier. Table 1.1. Baseline Characteristics
Methods: A cross-sectional study, using 483 secondary data from employees of the
National Heart Center of Harapan Kita. 119 subjects were included in the inclusion Standard Standard therapy
and exclusion criteria, which were performed using 2D-STE with GLS parameter. The Therapy þ Bromocriptine
subjects were divided into two groups of non-insulin resistance and insulin resistance (n ¼ 7) (n ¼ 8)
based on the value of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR)
with a cut-off value of 2.0. Age (years), mean 6 SD 32.2 6 7.76 29.7 6 6.42
Result: There were significant differences in GLS values between the insulin resist- Female sex, n (%) 7 (100) 8 (100)
ance group and non-insulin resistance [mean -18.3 (SD 3.05) vs -19.7 (2.2)%; CI of Weight (kg), mean 6 SD 55.7 6 12.90 56.0 6 14.66
95% -2.39 - (- 0.37)], P ¼ 0.008). Insulin resistance has the greatest risk followed by Height (cm), mean 6 SD 158.2 6 3.77 157.2 6 2.81
triglyceride levels (adjusted OR of 2.8, P ¼ 0.009 and OR of 2.4, P ¼ 0.03) respec- BMI (m2/kg), mean 6 SD 22.1 6 4.63 22.6 6 5.78
tively to subclinical left ventricular systolic dysfunction in the metabolic syndrome. PPCM History, n (%) 2 (28.5) 0 (0)
Conclusion: Insulin resistance showed a lower left ventricle systolic function (as Severe Preeclampsia, n (%) 2 (28.5) 3 (37.5)
expressed by GLS score) significantly than the non-insulin resistance in the metabolic syn- NYHA functional status, n (%):
drome. Insulin resistance and triglycerides is an independent marker of subclinical left  Class II 0 (0) 1 (12.5)
ventricular systolic dysfunction among other components of the metabolic syndrome.  Class III 7 (100) 7 (87.5)
Keywords: insulin resistance • HOMA-IR • subclinical left ventricle systolic dys-
function • GLS • metabolic syndrome • triglycerides (continued)

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839

by University of Groningen user
on 22 April 2018
 D32 Abstracts

Table 1.1. Continued Background: Cardiovascular autonomic neuropathy (CAN) is defined as an impair-
ment of cardiac autonomic nerve fibres in the cardiovascular system. The prevalence
Standard Standard therapy of CAN varies between 16.1% and 22.1% on performing at least two abnormal cardio-
Therapy þ Bromocriptine vascular heart rate tests. CAN may contribute to chronotropic incompetence (CI)
(n ¼ 7) (n ¼ 8) which is the inability of the heart rate (HR) to rise in proportion to an increase in
metabolic demand. Determination of CI is widely based on measurement of maxi-
Medications, n (%): mum HR during exercise testing. This study aimed to evaluate contribution of CAN to
 Loop diuretics 6 (85.7) 8 (100) determine CI.
 ACE-I/ARBs 7 (100) 8 (100) Methods: We included 105 patients, 50 patients with CI and 55 patients with non-CI
 Beta blockers 8 (100) 8 (100) determined by exercise treadmill test. CAN was assessed by analysing heart rate var-
 MRA 7 (100) 8 (100) iations during three standard tests (deep breathing, lying to standing and Valsalva
 Digitalis 1 (14.2) 1 (12.5) manoeuvre).
 Warfarin 2 (28.5) 4 (50) Results: Definite CAN was present in 72 patients (68.6%) and 49 patients had CI. CI
 Bromocriptine 0 (0) 8 (100) group showed significantly CAN than non-CI group (p < 0.001). CI group showed signif-
Heart Rate (bpm), mean 6 SD 96.5 6 16.60 93.7 6 25.65 icantly lower values of among three standard test of heart rate variations (p < 0.05).
SBP (mmHg), mean 6 SD 115.0 6 22.22 115.7 6 10.54 All three standard tests were found to be an independent risk factor for CI from mul-
DBP (mmHg), mean 6 SD 72.7 6 15.37 68.7 6 9.48 tivariate regression analysis. Valsalva manoeuvre showed the best predictor to the CI
Creatinine (mg/dL), mean 6 SD 0.8 6 0.21 0.7 6 0.11 (p < 0.001). The accuracy of different CAN parameters in the prediction of CI was
Echocardiographic parameters: described by the receiver operating curve (ROC) analysis. Regarding Valsalva
 LVEF pre-treatment (%), mean 6 SD 31.4 6 13.30 30.5 6 11.57 manoeuvre, the cut-off value was 0.9 and the area under the curve (AUC) was 0.867,
 LVEF post-treatment (%), mean 6 SD 47.1 þ 14.34 50.1 þ 11.09 with a sensitivity of 92% and a specificity of 44%. ROC curve analysis for deep breath-
ing and lying to standing showed AUC 0.662 and a cut-off value of 10 (sensitivity 62%
and specificity 54%) and AUC 0.670 and a cut-off value of 0.9 (sensitivity 67% and
Table 1.1 Differences of Left Ventricular Ejection Fraction parameters in pre-treatment specificity 46%), respectively.
and post-treatment following standard therapies of Peripartum Cardiomyopathy (PPCM) Conclusion: The decrease in heart rate variations during CAN parameters seems to
be related to the development of chronotropic incompetence, especially during
LVEF (%) Mean 6 SD Mean differences 6 SD CI95% P value Valsalva manoeuvre.
Keywords: cardiovascular autonomic neuropathy • chronotropic incompetence.
Pre-treatment 31.4 6 13.30 15.7 6 15.52 1.36 to 30.00 0.03
Post-treatment 47.1 6 14.34
GENETIC POLYMORPHISM OF ANGIOTENSINOGEN M235T GENE AND ESSENTIAL
HYPERTENSION ON ETHNICS IN SOUTHEAST SULAWESI
Table 1.2 Differences of Left Ventricular Ejection Fraction parameters in pre-treatment
and post-treatment following standard therapies plus Bromocriptine of Peripartum A. F. Tasruddin, A. Pratama, B. Bintoro, S. Soebijakto
Cardiomyopathy (PPCM) Faculty of Medicine, Halu Oleo University

LVEF (%) Mean þ SD Mean differences þ SD CI95% P value
Pre-treatment 29.6 6 11.04 19.3 6 10.47 10.61 to 28.13 0.001
Post-treatment 49.0 6 10.77
The Influence of Contrast on Growth of Adipose Mesenchymal Stem Cell Culture
G. R. Soekarno1, I. G. R. Suryawan1, Andrianto1
1 which the result of DNA electrophoresis taken from the sample which had been PCR
Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Background: Stem cell therapy in the field of cardiology is increasingly being used.
Adipose Mesenchymal Stem Cell is a cell culture that is expected to provide clinical
improvement in patients receiving the therapy. One way of stem cell delivery is to use car-
diac catheterization assisted by the use of contrast to see where the stenosis is and where
the stem cell will be administered. Until now, no studies have looked at the effect of con-
trast on the proliferation or viability of stem cells. This study was conducted to see how
the effect of contrast on the growth of Adipose Mesenchymal Stem Cell culture in vitro.
Objective: To analyse the effect of contrast on the growth of Adipose Mesenchymal
Stem Cell.
Methods: This research is an experimental post-test control group study. Adipose
Mesenchymal Stem Cell (AMSC) samples were obtained from the thawing process at ITD
Unair. The samples were then cultured and checked for markers that showed the sam-
ples were mesunchymal stem cells immunohistochemically, then divided into 2 groups
i.e. the treated group in the form of contrast iodixanol and the control group. The
treatment group was subdivided into 7 subgroups, which received dose of 1 mg/mL,
500 lg/mL, 250 lg/mL, 125 lg/mL, 62.5 lg/mL, 31.25 lg/mL and 15.625 lg/mL, and
incubated for 24 hours. AMSC proliferation was assessed using MTT Cell Proliferation
Assay. Data analysis was performed by using T 2 free sample test and ANOVA.
Results: MTT Cell Proliferation Assay showed no significant increase or decrease in AMSC
proliferation with iodixanol contrast at each dose when compared to the control group.
Conclusion: Contrast of iodixanol has no effect on AMSC proliferation.
Keywords: AMSC proliferation • contrast iodixanol
Studies on genetic polymorphism of angiotensinogen M235T gene has been conducted
in several countries showed that the emergence of allele 235T to people of asia has
increased the risk of hypertension compared to caucasians. Nevertheless, relations
between angiotensinogen gene polymorphism and essential hypertension risk on
intra-populations of asian people between ethnics is still indicated less consistent.
Therefore, this study aims to examine the relationship of polymorphism of angioten-
sinogen M235T gene as a risk factor causing essential hypertension.
This research used “cross sectional study” design, Angiotensinogen M235T variant
towards Essential Hypertension. This experiment used molecular biology method in
and RFLP.
The result of this study demonstrate that the chi-square is 1.194 with p-value
0.275 > a (0.005). This frequency of homozygous (genotype TT) is 8 (13.1%) on nor-
motensive sample and 46 (75.4%) on hypertension sample. There are 7 (8.6%) of
hypertension found on the heterozygous (genotype MT) and not found in the normo-
tensive sample. Tolaki ethnic who had homozygous (genotype TT) were 27 sample
(44.3%) and homozygous (genotype MT) were 6 sample (9.8%). Muna ethnic who had
homozygous (genotype TT) were 22 sample (36.1%) and there were no found hetero-
zygous (genotype MT). Buton ethnic who had homozygous (genotype TT) were 5 sam-
ple (8.2%) dan heterozygous (genotype MT) sebanyak 1 sample (1.6%). The number of
patient homozygous (genotype TT) were 54 sample (88.5%), pasien homozygous (gen-
otype MT) were 7 (11.5%) and no patients were homozygous (genotype MM).
This study concludes that there is not a relationship between polymorphism of
Angiotensinogen M235T gene and essential hypertension on ethnic Southeast
Sulawesi.
Keywords: angiotensinogen M235T gene • essential hypertension • ethnic •
Southeast Sulawesi
The Role of New Two Parameters to Improve Diagnostic Accuracy of Treadmill
Exercise Test Detect Significant Coronary Artery Disease
MA Effendy, GR Endamatriza, BB Tiksnadi, MR Akbar, A Purnomowati, TM Aprami
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Padjadjaran Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Cardiovascular Autonomic Neuropathy is a Predictor for Chronotropic
Incompetence Measured by Treadmill Exercise Test
F. Rusnanta1, F. S. Laitupa1, Vidyawati2, A. Rizal3
1
Resident of Department of Cardiology and Vascular Medicine, Faculty of Medicine,
University of Brawijaya, Malang, Indonesia, 2General practitioner, 3Division of
Electrophysiology and Arrhythmia, Department of Cardiology and Vascular Medicine,
Faculty of Medicine, University of Brawijaya, Malang, Indonesia
Background: The new criteria of positivity of exercise stress testing for diagnostic
methods to detect coronary artery disease (CAD) are the ST/HR Hysteresis and ST/
HR index. The study sought to analyse the relation between combining ST/HR
Hysteresis and ST/HR index with the presence of significant CAD.
Method: We conducted a single-centre retrospective descriptive analytic study in
patients with positive ischaemic response from exercise stress test, and had both
parameters data. All patients should underwent coronary angiography in Hasan
Sadikin Hospital within the period December 2015 to August 2017. The value of

Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839

by University of Groningen user
on 22 April 2018
 Abstracts
ST/HR hysteresis and ST/HR index was calculated automatically from stress test
machine. Significant CAD was defined based on coronary angiography finding of sten-
otic lesions  70% at the major coronary arteries and/or  50% at the left main coro-
nary artery.
Results: Of 90 enrolled patients meet inclusion criteria, 36 underwent coronary
angiography. We identified 22 patients had significant CAD (PPV: 61.1%). The Mann-
Whitney test revealed a significant difference ST/HR hysteresis between patients
with significant CAD and those without (median 0.075 (0.022 – 0.380) vs 0.032 (0.001
– 0.177)), p-value <0.001) but not significant difference ST/HR index between
patients with significant CAD and those without (median 0.91 (0.06 – 4.88) vs 0.71
(0.14 – 2.60)), p-value 0.620). Based on the receiver operating characteristic (ROC)
analysis, ST/HR hysteresis >0.045 had area under curve (AUC) of 0.864, resulting in
sensitivity of 95.2% and specificity of 71.4% (p < 0.001). Combining ST/HR hysteresis
and ST/HR index increasing specificity 5.5% (p < 0.001).
Conclusions: In patients with positive ischaemic response in exercise stress test, the
value of ST/HR hysteresis is associated with significant CAD but not with ST/HR
index. Combining ST/HR hysteresis and ST/HR index could increase specificity to
detect significant CAD.
Keywords: Coronary artery disease • Exercise stress test • ST/HR hysteresis • ST/
HR index
Cardiovascular Autonomic Neuropathy in Hypertensive Patient with
Prediabetes
G. D. Sinaka1, Ismugi2, M. A. Pangaribuan2, R. Soerarso1, A. Santoso1, N. Hersunarti1, B.
B. Siswanto1
1 testing. Besides, the role of biomarkers such as matrix metalloproteinase-9 (MMP-9)
Division of Clinical Cardiology, Department of Cardiology and Vascular Medicine,
Faculty of Medicine Universitas Indonesia- National Cardiovascular Center Harapan
Kita, Jakarta, Indonesia, 2Department of Cardiology, National Police Hospital Raden
Said Sukanto, Jakarta, Indonesia
Background: The highest prevalence of prediabetes is in patients with hypertension.
Furthermore, prediabetes has a higher risk of developing complications. One of the
complications that is often underdiagnosed is Cardiovascular Autonomic Neuropathy
(CAN).
Objective: The aim of this study is to determine the relationship between prediabe-
tes and CAN in hypertensive patients.
Method: This cross-sectional study was conducted at National Police Hospital, Raden
Said Sukamto Jakarta on subjects with hypertension. All subjects had their blood
sugar profile (OGTT and HbA1C) and Heart Rhythm Variability (deep breathing, stand-
ing, and valsalva) examined. Based on the blood sugar profile, subjects were diag-
nosed with prediabetes (IFG, IGT, and high risk based on HbA1C level). Subjects pre-
senting with a minimum 2 out of 3 abnormal RR ratio were diagnosed with CAN.
Subjects with diabetes was excluded.
Results: There were 96 subjects included, with 18 of them were subjects with CAN.
After adjusted with other factors (BMI, triglyceride and LDL level, IFG, and resting
heart rate), age and IGT were significantly increase the incidence of CAN (p ¼ 0.013,
OR 1.1, CI95% 1.023-1.221, and p ¼ 0.020, OR 6.767, IK95% 1.349-33.941). In 38 pre-
diabetic subjects, RR ratio were significantly lower in deep breathing test.
Conclusion: Subjects with prediabetes especially IGT have a higher risk of developing
CAN. This finding shows acute episodes of hyperglycaemia in hypertensive patients
have a major role in the development of CAN. Early sign of autonomic imbalance was
already found in prediabetic patient, hence emphasizing the importance of screening
and comprehensive management of prediabetes in hypertensive patients.
Keywords: cardiovascular autonomic neuropathy • hypertension • prediabetes
Correlation between Dipeptidyl Peptidase-4 Activity and Arterial Stiffness Using
Cardio-Ankle Vascular Index in Hypertensive Patients
R. Myrtha, H. Sulastomo, N. Purwaningtyas
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Sebelas Maret/Dr. Moewardi General Hospital, Surakarta, Indonesia
Background: Cardiovascular disease (CVD) remains the leading cause of death world-
wide, despite highly effective preventive treatments. Arterial stiffness is associated
with atherosclerotic risk factors and is considered to be a surrogate marker for the
development of cardiovascular disease. Subjects with uncontrolled hypertension had
a greater prevalence of arterial stiffness (89.9%) than controlled hypertension
(59.7%). The risk for CVD events rose from normotension without arterial stiffness to
normotension with arterial stiffness and from hypertension without arterial stiffness
to hypertension with arterial stiffness. A substantial proportion of treated hyperten-
sives have high arterial stiffness, a finding that may explain some of the notable
residual CVD risk associated with even well-controlled hypertension. The aim of this
study is to analyse the correlation between plasma DPP-4 activity and arterial stiff-
ness using CAVI in hypertensive subjects.
Methods: A cross-sectional study was conducted at outpatient clinic, Department of
Cardiology and Vascular Medicine, Dr. Moewardi General Hospital, Surakarta, in 44
consecutive hypertensive patients. Plasma DPP-4 activity and CAVI were measured in
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
D33
eligible patients. Clinical, biochemical, and echocardiographic baseline characteris-
tics were analysed using independent T-test or chi square. Correlation between
plasma DPP-4 activity and CAVI was analysed using Pearson correlation test. p < 0.05
was considered significant.
Results: Plasma DPP-4 activity was increased in hypertensive subjects with high
CAVI, but it was not statistically significant. Increased age (r ¼ 0.476; p ¼ 0.001) and
decreased creatinine clearance (r ¼ -0.338; p ¼ 0.025) were correlated with CAVI.
Sub group analysis in hypertensives treated with ACE inhibitor, plasma DPP-4 activity
was strongly correlated with CAVI (r ¼ 0.885; p ¼ 0.008).
Conclusion: Plasma DPP-4 activity was not correlated with arterial stiffness using
CAVI in hypertensive patients. In hypertensives treated with ACE inhibitor, plasma
DPP-4 activity was strongly correlated with CAVI.
Keywords: Dipeptidyl peptidase-4 • cardio-ankle vascular index • hypertension.
THE CORRELATION BETWEEN DUKE CLINICAL SCORE AND MATRIX
METALLOPROTEINASE-9 TOWARDS MODIFIED GENSINI SCORE IN STABLE ANGINA
PECTORIS
H. A. KUNCORO, G. YOGA, A. KUSUMAJAYA, R. LEFRANDT, J. PANGEMANAN
DEPARTMENT OF CARDIOVASCULAR, UNIVERSITY OF SAM RATULANGI MANADO
Background: The incidence of coronary heart disease (CHD) is predicted to increase
in line with increasing life expectancy, the prevalence of obesity, diabetes and
hypertension. An initial evaluation of patients with suspected CHD using Duke clinical
score performed for risk stratification and define the benefits of further diagnostic
potential as biomarkers of atherosclerosis has been widely tested. Rate the severity
of lesions in coronary blood vessels using a modified score Gensini is one of the scor-
ing system that is most widely used. Until now, few studies linking SKD and MMP-9 on
the severity of coronary artery lesions in patients with stable angina pectoris, where
the results obtained were conflicting. Therefore, further research is needed to
determine the relationship between the Duke clinical score and MMP-9 on the degree
of severity of coronary lesions using a modified score Gensini in patients with stable
angina pectoris.
Objective: This study aims to determine the relationship of the Duke clinical score
and the levels of MMP-9 against the severity of coronary lesions using a modified
Gensini score in patients with stable angina pectoris.
Methods: The design used in this study was observational with cross sectional
approach which took place in January-March 2017. The number of samples in this
study were 42 patients. All the study subjects who met the inclusion criteria made
anamnesis and physical examination include age, gender, weight, height, blood pres-
sure, family history, smoking history, and routine laboratory tests. After that, the
research subjects will undergo with Duke clinical score, taken blood samples to
measure serum concentrations of MMP-9. Then the correlation analysis was per-
formed between DCS and the levels of MMP-9 against modified Gensini score.
Results: Of the total 42 research subjects, there were 29 patients (69%) of men aged
between 37 and 70 years (mean 59.09 6 8.78), 73.8% had hypertension, 33.3% diabe-
tes, 45.2% dyslipidemia, 35.7% were current smokers, and 50% classified as obese. A
total of 16.7% had SKD  30% percentile, 28.6% had a 30% > SKD  70% percentile
and 54.8% had SKD > 70% percentile. In the analysis of the basic characteristics of
the age, sex, risk factors found significant differences between groups percentile
SKD with the patient’s age and a history of MI. Variations in the levels of MMP-9 seen
in this study with an average of 522.70 6 349.32 ng/mL, there was a strong relation-
ship between age, history of MI and obesity against the levels of MMP-9 (p ¼ 0.000,
p ¼ 0.000 and p ¼ 0,000). Modified Gensini score characteristics based on severity of
the lesions were divided into groups with mild lesions of 10 patients, the group with
moderate lesions of 24 patients, the group with severe lesions of 8 patients. SKD
relationship with modified Gensini score found statistically significant (p ¼ 0.003).
While the levels of MMP-9 with modified Gensini score were significantly not related
(p ¼ 0.07).
Conclusion: There is a significant relationship between DCS against modified Gensini
score, but there is no significant relationship between the level of MMP-9 against
modified Gensini score in stable angina pectoris patient.
Clinical Outcomes of Heart Failure Patients with Optimal Dose of Angiotensin-
Converting Enzyme (ACE) Inhibitor
Y.B. Utomo1, M.S. Rohman2, S. Widito2, D. Sargowo2
1
Faculty of Medicine Universitas Brawijaya, Malang, Indonesia, 2Dr Saiful Anwar
General Hospital, Malang, Indonesia
Background: Optimal dose of Angiotensin-Converting Enzyme inhibitors (ACEI)
can lower mortality and morbidity of heart failure patients, but in daily practice,
achieving optimal doses is often challenging because of side effects or co-morbidity,
and also related to patient’s compliance. Only 33% of patients with heart failure
receive the target dose, despite good tolerability of that dose in up to 80% of clinical
trials.
Aim: Assess the clinical outcome of optimal doses ACEI in heart failure patients.
 D34
Methods: This prospective cohort study included 300 heart failure patients treated
in Saiful Anwar Hospital, with inclusion criteria’s were all heart failure patients aged
over 18 years treated by cardiologist and got ACEI therapy. The data was analysed
with significance cut off p  0.05. Clinical outcomes were inhospital and 30 days post
discharge mortality due to cardiovascular causes, also rehospitalization within 30
days after discharge.
Results: From 300 samples, 171 got therapy ACEI and only 29 patients got the optimal dose
of ACEI. The patient’s average age was 58 6 12 years, and 61.4% were male. Inhospital mor-
tality significantly decrease in optimal dose of ACEI group (p ¼ 0.009). 30-days mortality
after discharge and rehospitalization also decreased with optimal dose of ACEI therapy, but
not statistically significant (p ¼ 0.375 and p ¼ 0.184). Subanalysis showed optimal dose of
ramipril was more superior than captopril in decreasing inhospital mortality (p ¼ 0.032).
Conclusion: Heart failure patients with suboptimal doses ACEI seemed to have
greater risk of death and heart failure rehospitalization compared with they who got
optimal doses.
Keywords: ACEI • Heart Failure • Mortality • Rehospitalization
ASSOCIATION BETWEEN LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN AND
SIX MINUTE WALK TEST BEFORE AND AFTER CHEMOTHERAPY WITH
ANTHRACYCLINE IN BREAST CANCER PATIENTS
T. W. Siagian1, K. Kaban1,A. P. Ketaren2, K. B. Siregar3, H. Hasan2, A. A. Siregar2,
A. Sitepu2
1
Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia, 2Department
of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan,
Indonesia, 3Department of Oncology, University of Sumatera Utara, Adam Malik
Hospital, Medan, Indonesia
Downloaded from https://academic.oup.com/eurheartjsupp/article-abstract/20/suppl_D/D21/4975839
by University of Groningen user
on 22 April 2018
Abstracts
Background: Anthracycline-induced cardiotoxicity is associated with a poor progno-
sis. Breast cancer patients who fall in heart failure have a mortality rate of 60%
within 2 years .We can use Global longitudinal strain (GLS) to detect subclinical
left ventricular (LV) dysfunction in chemotherapy patient. The distance of 6-
minute walk test (6MWT) has been used as a prognostic factor in cancer patients
has a relationship with other health aspects of breast cancer. This study aimed to
prove whether there is a correlation between LV dysfunction before there are clin-
ical signs of heart failure and decreased functional capacity of 6MWT in breast
cancer patients.
Methods: This is a cohort prospective study of 35 breast cancer patients who have
chemotherapy with anthracycline regimen. The patients were evaluated before the
initiation of anthracycline therapy, after 3 and 6 cycles. Patients underwent echocar-
diography and 6MWT at the first visit. After 3 and 6 cycle patient underwent echocar-
diography and 6MWT after 6 cycle. Association between GLS, cardiac parameter and
functional capacity was assessed using Pearson’s correlation for continuous normally
distributed variables and Spearman’s correlation for categorical and non-normally
distributed variables. p value < 0.05 was considered to indicate statistical
significance.
Results: The mean age was 45.83 6 6.96 years. There was a significant difference in
percentage reduction of GLS after chemotherapy 3 cycles and 6 cycles (10.49 6 4.94
vs. 20.717 6 9.616, p ¼ 0.001). GLS is correlated with a decrease in total distance
6MWT after 6 cycles (R2 ¼ -0.084) and the correlation of percentage reduction of
GLS and distance of 6MWT has p ¼ 0.028 and R2 ¼ -0.112.
Conclusion: There is a correlation between the percentage reduction of GLS and dis-
tance of 6MWT in breast cancer patients with anthracycline chemotherapy for 6
cycles (R2 ¼ -0.112).
Keywords: GLS • 6MWT • anthracycline • chemotherapy • breast cancer.