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Cellular and Hemodynamic Effect of Enhanced External Counterpulsation

Author : Starry H Rampengan
Upload Date : 19-04-2018

The enhanced external counterpulsation (EECP) procedure can be performed in the outpatient clinic, which is aimed to reduce angina attack by increasing blood perfusion to myocardial area with deficiency of blood supply due to blocked and narrowed coronary artery. Enhanced External Counterpulsation is a new concept of non-invasive procedure designed for overcoming angina in patients refractory to conventional therapy. The EECP procedure is based on the theory that increased diastolic perfusion pressure will increase coronary blood flow by 20% -40%. Enhanced External Counterpulsation has principles which is similar to an intra-aortic balloon pump (Intra-Aortic Balloon Pump/IABP) that is an increase in perfusion diastolic and reduced systolic peripheral pressure resulting in increased myocardial oxygen supply. The concept is not directly adaptable on daily practice. Around 1980, mostly cardiologists consider this technique unworkable. In the same year, pneumatic type counterspulsation developed in China. After the initial experiment, that version better made in the United States and the results of the study first reported in 1992.

Mechanism of Enhanced External Counterpulsation Therapy

Enhanced External Counterpulsation consists of lower-extremity compression sequential diastole followed by sequential decompression at systole, which is detected by using an electrocardiogram (ECG). In addition to hemodynamic effects such as intraaortic balloon installation, EECP can also increase cardiac output. The cuff is shaped like cuff tensimeter in large size, mounted on the calf, lower thighs, upper thighs, and buttocks. Cuff these are developed rapidly and sequentially based signals obtained from the ECG computer, starting from the calf up to the buttocks at diastole. The above procedure will provide a back pressure strong in the arterial system resulting in oxygen-rich blood will flow into the heart and coronary arteries. That matter will increase the cardiac backlash under pressure which increases. Shortly before the start of the systole, the third the cuff will deflate simultaneously. This deflation occurs when vascularization in the lower limb is relatively empty and will reduce vascular resistance significantly so the heart does not have to work hard to pump blood throughout the body Endothelial dysfunction is characterized by disruption bioavailability of NO (nitric oxide) that has a vasodilator effect, antiplatelet, antithrombotic, antiproliferatif, and anti-inflammatory as well as increased endothelin-1, vasoconstrictors strong which has a protrombotic, mitogenic and protective effect proinflammatory. The imbalance between vasodilation and this vasoconstriction signifies endothelial dysfunction functional.

Increased blood flow induced by EECP will increasing the endothelial shear stress which is a stimulus main for NO release. Shear stress also affects the release of endothelin-1 is more exposure long will decrease endothelin-1. For this reason EECP was assessed to improve endothelial function. Found a significant increase of NO and decreased levels of endothelin-1 levels in patients who have undergo complete EECP. Increased endothelial shear stress is a stimulus main for the formation of collateral vessels. The simplest mechanism of EECP to improve Collateral flow directly is increasing pressure and diastolic blood flow, as well as indirectly with mediators vasodilators such as NO. EECP will affect arteriogenesis, angiogenesis and increased coronary flow collateral.

The effects of EECP treatment in lowering cardiovascular events are reduced cardiovascular events through improvement of endothelial morphology and function, reduced inflammation and oxidative stress and promoted angiogenesis and vasculogenesis. Reduced Myeloperoxidase (MPO) level was associated with improvement of endothelial function and tissue damage caused by increased EECP-induced shear stress which stimulates endothelial progenitor cells (EPCs). Endothelial progenitor cells are able to differentiate into new endothelial cells and associated with improved ventricle function following myocardial infarction, angiogenesis, and re-endothelization following vascular injuries. Reduction of MPO level will prevent apoptosis, both through extrinsic and intrinsic pathways; therefore, reducing myocardial cells dysfunction. Casey et al. found that EECP promoted collateral blood vessels formation which was associated with systemic endothelial function.

Mechanical shear stress will release stem cell from endothelial surface into the circulation; thus, it will replace old endothelial cells, repair damaged tissue and promote regeneration. These correlations were assumed to be the EECP long-term effects which are beneficial to cardiac function. Significant reduction of cardiovascular events in EECP group was associated with reduced MPO level. A significant reduction of MPO level in EECP group will subsequently reduce amino acid oxidation and cytotoxic aldehyde production and will modify the cardiac ion channels. The effects of MPO in inhibiting PAI-1 activity would be also decreased. Therefore, plasmin activity would be reduced and resulting in extracellular matrix degradation; thus, ventricle remodeling and cardiac dilatation can be prevented. These were also important in reducing cardiovascular events in EECP group compared to non-EECP group.

Following the EECP treatment, there was a significant reduction in MPO levels, both in patients who had and had not had cardiovascular events. It suggests that the endothelial shear stress (ESS) pulsatile effect of EECP is very effective in reducing MPO. The MPO levels of subjects in EECP group who had cardiovascular events were compared between after treatment and at the end of observation and we found that there was increased MPO level with median of 326.60 pM and it was statistically significant. Elevated MPO levels in subjects of EECP group who had cardiovascular events were caused by acute bacterial infection, i.e. pneumonia in 3 patients. Such condition increased pro-inflammatory cytokines and induced neutrophil PMN to release abundant MPO. Myeloperoxidase will up-regulates cytokine genes and activates alveolar macrophage; therefore, increasing inflammation and cytotoxic status, and worsening lung inflammation. Non-significant elevated level following the treatment compared to the end of the study was found among subjects who had no cardiovascular events, with median of 70.35 pM. 

Rampengan et al  concluded that EECP therapy can significantly reduce MPO level and lower cardiovascular events in patients receiving therapy compared to control group. Several studies with bigger sample size and longer observation time are required to evaluate EECP therapeutic effects further in CHF patients. Further studies to prove the role of MPO as predictor of cardiovascular events in CHF are also necessary.

 

Hemodynamic effects of EECP therapy

Hemodynamic effects of EECP has been assessed through both noninvasive and invasive techniques. Taguchi et al, assessed the hemodynamic effects of EECP and compared it with the intra-aortic balloon pump (IABP) in 39 patients with uncomplicated acute myocardial infarction who underwent successful balloon coronary angioplasty within 12 hours after onset of chest pain. The radial artery and subclavian vein were cannulated to measure right atrial pressure, pulmonary capillary wedge pressure (PCWP), cardiac index, and systemic vascular resistance. Radial artery pressure tracing was used to measure area under artery pressure curves in systolic and diastolic phases. Sixty minutes treatment was administered to the patients in the EECP group. All parameters were measured before EECP, at 15, 30, 45, and 60 minutes after starting EECP, and 60 minutes after stopping EECP. After starting IABP support, measurements were obtained at 15, 30, 45, and 60 minutes. There were no significant changes in heart rate in either group before, during, and after treatments. Right atrial pressure increased significantly at 15 and 30 minutes after starting EECP, and then decreased gradually. There was no significant increase in right atrial pressure at 45 and 60 minutes after starting EECP compared with baseline. Right atrial pressure did not change in the IABP group, and there was no significant difference between 2 groups, except at 15 minutes after starting treatment.

 

In the EECP group the PCWP significantly increased at 15 and 30 minutes, and then decreased gradually, but no significant change was seen in IABP group. Between two groups, there were no significant differences at baseline and during treatment. However, 60 minutes after stopping treatment, PCWP was significantly lower in the EECP group. The cardiac index in EECP group increased significantly at 45 and 60 minutes compared with the baseline, but no significant change was noted in IABP group. The increase in cardiac index at 60 minutes in the EECP group was significantly greater than that in the IABP group. Mean values of the area under the arterial pressure curves during the diastolic phase increased significantly in both groups, and there was no significant difference between two groups at any measuring point. Mean values of the areas under the artery pressure curves during the systolic phase decreased significantly during treatment compared with baseline in the IABP group. No significant change was observed in the EECP group. In both groups, systemic vascular resistance decreased significantly during treatment compared with baseline, but no significant difference was seen between two groups. This study showed that the hemodynamic effects of EECP were similar to those of IABP for diastolic augmentation and systemic vascular resistance. However, right atrial pressure, PCWP, and cardiac index increased during EECP in contrast to IABP. These effects suggest that EECP increases venous return, raises cardiac preload, and increases cardiac output.

 

In another study, Taguchi et al., assessed the hemodynamic and neurohormonal changes during EECP. Sixty minutes of EECP therapy has been performed in patients with stable acute myocardial infarction who had undergone PCI. Right heart catheterization and neurohumoral parameters were assessed before, during 15, 30 and 60 minutes after EECP. Blood levels of atrial natriuretic peptide (ANP), brain (or B type) natriuretic peptide (BNP), renin, aldosterone, dopamine, and noradrenaline were assessed. Left ventricular ejection fraction and size were assessed invasively during the admission and between days 13 to 16. Cardiac index increased from 3.3±0.8 L/min before treatment to 4.1±0.8 L/min at 60 minutes (P (33±6 mmHg·sec at baseline; 29±7 mmHg·sec during EECP; P=0.008). Intracoronary Doppler flow velocity was measured using a 0.014-inch FloWire (Fig 2). The average peak velocity increased 109% from 11±5 cm/s at baseline to 23 ±5 cm/s during EECP (P=0.001). The peak diastolic velocity increased 150% from 18±7 cm/s at baseline to 45±14 cm/s during EECP (P=0.0004). The diastolic-to-systolic velocity ratio increased 100% from 1.0±0.3 to 2.0±0.7 during EECP (P=0.003). There was no significant change in peak systolic velocity. The CTFC, another measure of coronary flow velocity, significantly decreased 28% from 37±18 at baseline to 27±13 during EECP (P=0.001). This study provides solid evidence of the increase in directly measured aortic and coronary diastolic pressure and flow velocity from EECP. There is a significant reduction in left ventricular afterload and left ventricle work secondary to systolic unloading.

 

Acute hemodynamic effects of EECP can be summarized as: 1. Increased retrograde aortic blood flow; diastolic augmentation; 2. Increased coronary blood flow ; increased perfusion pressure; 3. Increased venous return; 4. Increased cardiac output; 5. Systolic unloading; 6. Decreased left ventricular workload.

 

Cellular effects of EECP therapy

 

Enhanced external counterpulsation (EECP) therapy is associated with improvements in myocardial ischaemia, angina, nitrate use, exercise tolerance,  and quality of life in refractory angina patients who fail to respond to conventional revascularization and aggressive anti-anginal medication. Furthermore, the report from the International EECP Patient Registry showed that EECP treatment decreased angina episodes and improved quality of life even in patients with severe left ventricular (LV) dysfunction (ejection fraction < or = 35%). These beneficial effects occur early after initiation of therapy and are sustained in many patients up to 5 years later.

 

EECP is a noninvasive treatment for angina that uses the sequential inflation and deflation of lower extremity pneumatic cuffs to reduce left ventricular afterload and augment diastolic flow and coronary perfusion pressure. While the haemodynamic effects are well-established, the exact mechanisms by which EECP exerts its beneficial clinical effects are unresolved. Improvement in the peripheral endothelial function of intractable angina patients as measured by reactive hyperemia-peripheral arterial tonometry after EECP has been suggested as a mechanism of action of EECP. Tao and colleagues have demonstrated that EECP improves endothelium-dependent vasorelaxation in the carotid arteries of hypercholesterolemic pigs. The pathways by which EECP can improve endothelial function and improve symptoms of angina are poorly understood.

We have recently demonstrated a reduction in circulating haematopoietic progenitor cells (HPCs), but not in endothelial precursor cells (EPCs) as currently defined, in the syndrome of coronary endothelial dysfunction. We hypothesised that EECP, owing to its documented beneficial effects on coronary endothelial function, would have an effect on specific circulating CD34+ subsets. Therefore, circulating CD34+ cells expressing CD45 (dim) and without evidence of CD45 expression were analyzed. As discussed previously, these subtypes are in keeping with HPCs and putative EPCs respectively.

 

Thirty-five EECP sessions were associated with an improvement of one CCS class in 8 (62%) patients and by two CCS classes in 2 (15%) patients, whereas 3 (23%) patients demonstrated no change in CCS class at the end of EECP treatment. Median CCS class decreased significantly in response to EECP, an effect that was maintained at one month after termination of treatment. The mean DASI score, a measure of functional status, also increased significantly with EECP treatment (baseline 12±2 vs. 19±3 at 35 days), with a corresponding increase in derived maximum VO2 (14.7±0.8 vs. 18.0±1.1) and metabolic equivalents or METs (3.4±0.5 vs. 5.5± 0.7), p=0.03 comparing 35 day values to baseline for all parameters.

 

Development of new functional collateral vessels by increasing plasma nitric oxide (NO) and decreasing endothelin-1 levels to the ischemic myocardium has been postulated as a mechanism of action for EECP therapy. EECP has been shown to augment plasma nitrate/nitrite production, an indirect measure of plasma NO production, to cause down-regulation of endothelin-1 levels and indeed these findings can be sustained through the course of EECP therapy.

 

EECP therapy has demonstrated improvement in endothelial release of nitric oxide resulting in improved endothelial function . The mechanism of how endothelial improvement is brought about in these patients is uncertain and various theories include involvement of the NF-kappa signaling pathways, an increase in cyclic guanosine monophosphate (cGMP) or an increase in vascular endothelial growth factor levels.

 

In our study we found that in patients with refractory angina undergoing EECP therapy, FACS (Flow cytometric analysis) revealed an increase in HPC counts over the course of treatment, which was statistically significant for all subtypes analyzed i.e. CD34+ CD45dim, CD133+ CD45dim and CD34 CD133+ CD45dim HPCs by one-way ANOVA (p<0.05). This increase in HPC counts remained sustained for one month after the final EECP session, and the associated clinical benefits in these patients is analogous to findings of Bonetti and colleagues, who showed that clinical and endothelial function improvement persisted at one month after EECP treatment.

 

Previous studies have shown that patients with refractory angina and multiple risk factors, as in our study cohort, have very low circulating levels of endothelial progenitor cells. Patients with low circulating progenitor cell counts have a higher incidence of cardiovascular events compared to patients with higher counts. Recent studies have shown that the number of circulating progenitor cells predict severe endothelial dysfunction independent of classical cardiovascular risk factors.  Our patient cohort also demonstrated a significant and sustained improvement in DASI scores during the EECP treatment period which correlated significantly with the HPC counts. Exercise alone has been shown to increase circulating progenitor cell counts in healthy young patients but interestingly, older patients with peripheral arterial disease appear to be unable to mount a significant increase in circulating progenitors.  It is logical to surmise that EECP and an associated improvement in functional status leading to greater exercise capacity, together may have resulted in the significant increase in HPCs demonstrated in our patient population.

This study again demonstrates a difference in effect on circulating CD34+ subsets, in this case as a response to EECP therapy. HPC counts (CD45dim subset) became significantly elevated from baseline early in the course of treatment and this effect was maintained for the remainder of the treatment course and even one month afterwards. HPC counts also correlated with DASI scores in these patients, which also improved significantly from baseline and from which estimates of METs and peak VO2 may be derived. This was not the case with cells fitting the description of the putative EPC (CD45−).

The restriction of this association to circulating haematopoeitic progenitor cell (HPC) is intruiging as these CD45dim cells do not form endothelial cells in culture - they are distinctly haematopoietic in nature.  Previous evidence has demonstrated the production of numerous growth factors including angiopoietins and VEGF by HPCs in vitro, growth factors integral in angiogenesis. Co-culture experiments have shown enhanced in-vitro angioblast cell growth in the presence of CD34+ haematopoietic progenitor cells. In addition, there is a key interplay between endothelial cells and hematopoietic progenitors in the bone marrow. It is therefore likely that circulating hematopoietic progenitors play a key role in endogenous vascular and cardiac repair. Their depletion in numbers could conceivably result in downstream deleterious effects on endogenous self-renewal in cardiovascular disease. The paracrine effects of HPCs on resident endothelial cells and progenitors via production of angiopoietins and other cytokines may represent a potential mechanism for the relationship between circulating progenitor cells of haematopoietic lineage and observed cardioprotective effects.

We therefore propose that EECP, through mechanisms as yet unclear, induces increased production of HPCs by the bone marrow or decreased senescence of HPCs in the circulation, with a resultant enhanced paracrine effect on resident progenitor cells in the vascular beds and promotion of endogenous self repair.

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Prognostic Value of Unstable Clinical Index as a Simple Tool in Short-term Mortality in Patients Admitted to Hospital with Acute Heart Failure Syndromes(N. N. Sitohang, Z. Syahputra, H. Hasan, A. N. Nasution)

Correlation between Dietary Fat Intake and Physical Activity to Small Dense Low Density Lipoprotein Level in Acute Coronary Syndrome Patients(A. Pudjiastuti, A. A. Asrial, A. Sariningrum, Haryadi, S. N. Sofia)

Clinical Picture and Risk Prediction of Short-Term Mortality of Mechanically Ventilated Patients Presented with Cardiogenic Shock in Intensive Cardiovascular Care Unit of Saiful Anwar General Hospital(H. A. Liemena*, F. W. Nugroho, D. H. Karimullah, Setyasih Anjarwani)

Right Ventricle Function as Predictor Inhospital Mortality in Acute Coronary Syndrome Patient’s in CCU Sarjito General Hospital (M. Suryantoro , H. P. Bagaswoto ,N. Taufiq , B. Y. Setianto)

Association between Left Ventricular Global Longitudinal Strain and Six Minute Walk Test Before and After Chemotherapy with Anthracycline in Breast Cancer Patients(T.W. Siagian, K.Kaban ,A.P. Ketaren, K.B Siregar, H.Hasan, A.A. Siregar, A.Sitepu)

The Effect of Coenzyme Q10 Supplementation on Diastolic Function in Heart Failure with Preserved Ejection Fraction (HFpEF) Patients( M. A. Sobirin, S. N. Sofia, M. G. D. Wahyuni, I. Uddin, M. A. Nugroho, S. Herminingsih, S. Rifqi, H)

Coronary Endarterectomy During Coronary Artery Bypass Grafting is Associated With Increased Risk Of Acute Kidney Injury And Bleeding Requiring Redo-surgery. (A. Sutandar, M. Anwar, A. Willianto, L. P. Suciadi, H. Napitupulu, R. Simanjuntak. Siloam Heart Ins)

Correlation of NT-ProBNP and sST2 level with the Severity of Mitral Stenosis (R. Rozqie, E. Maharani, H. Mumpuni.)

Testosterone Links to Interleukin-10 in Male Patients with Rheumatic Heart Disease(F Ahnaf, U. Bahrudin, P. Ardhianto, I. Pawitra, S. Budijitno, Y. Herry)

Soluble ST2 Level Correlates with Mean Pulmonary Artery Pressure in Adult with Uncorrected Secundum Atrial Septal Defect: A Novel Study(R. S. Pratama, A. B. Hartopo, D. W. Angrahini, L. K. Dinarti.)

Dimension and Functional Characteristics of Mitral Stenosis Patients: Pre-surgical Cardiac Magnetic Resonance Imaging Assesment(DG Arilaksono, M. Kasim, CA. Atmadikoesoemah,E. Sahara,)

Left Ventricular Early Inflow-Outflow Index as an Indicator for Quantification of Mitral Regurgitation Severity(R. Puspitoadhi, M.H. Cahyadi, H.H. Satoto, U. Bahrudin, M.A. Nugroho)

Correlation Between Left Atrial Volume Index and the Estimated Mean Pulmonary Artery Pressure in Patients with Mitral Regurgitation(M. H. Cahyadi, R. Puspitoadhi, P.S. Putri, U. Bahrudin, M. A. Nugroho)

The Relationship Between Fragmented QRS Complex and Coronary Artery Disease in Patient with Total Atrioventricular Nodal Block Requiring Permanent Pacemaker Implantation(M. Rusydi, Y. Yuniadi, S. B. Raharjo, D. Hanafy, D. Yugo)

Predictors of Right Ventricular Systolic Dysfunction After Undergoing Mitral Valvular Surgery(M. A. Callista , A. M. Soesanto, D. A. Juzar, A. Bono)

Hypoxia Preconditioning Effect on the Expression of Intracelullar Reactive Oxygen Species (ROS) Levels on Cultured Adipose Mesenchymal Stem Cells(R. D. Cahyaningtias, R. Suryawan, Andrianto)

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*)

The Correlation of Matrix Metalloproteinase 9 with Carotid Intimal Media Thickness and Flow Mediated Vasodilation in Patients with Stable Angina Pectoris(G. Yoga)

Correlation between Glycemic Control and Ankle Brachial Index in Diabetic Patients at Lombok, NTB(M. J. P. Putra, B. Rahmat, J. Anggoro, Y. Indrayana)

Factors Associated with Visit-to-Visit Blood Pressure Variability in Hypertensive Patients at Primary Health Care Service(G. A. R. Pertiwi, A. A. N. Aryawangsa, N.W.S. Ratni)

HF Reduced EF: Demographic and Clinical Profile in National Cardiovascular Center Harapan Kita(B. B. Siswanto, H. Safitri, Danny, A. R. Hidayat, B.A. Marsudi, J. O. Santoso, P. Almazini, R. P. So)

Epidemiology of Hypertension and Associated Cardiovascular Risk Factors among Indonesia Population(M. F. Adda’i, A. B. Setyani, T. Indriyati)

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*)

12-lead Electrocardiogram as a Screening Tool for Peripartum Cardiomyopathy: A Systematic Review(H. Angkasa)

The effect of Syzygium Polyanthum (Wight) Extract on Lipid Accumulation and Metabolic Parameters in Hyperlipidemic Male Wistar Rats(H. M. Salim, L. K. Farizqi, T.W. Bintarti, Handayani)

Clinical and Cost Effectiveness between Treatment Methods of Hyponatremia in Acute Decompensated Heart Failure(S. P. Sirait, N. Hersunarti, H. Andriantoro, R. Soerarso, B. B. Siswanto)

The Role of Community-based Health Education and Physical Exercise Programme (S.E.H.A.T) to Improve Framingham Risk Score in Farmers Population of Batu City - East Java(D. Setiawan, D. Sargowo)

Prognostic Significance of Community- Versus Hospital-Acquired Hypochloremia in Heart Failure(N.G. Liman, B. B. Siswanto)

The Clinical Outcome Comparison of Ischemic Stroke with Ischemic Heart Disease and without Ischemic Heart Disease(N.H. Karunawan, R.T. Pinzon)

The Effect of Aerobic Exercise on N-terminal pro B-type Natriuretic Peptide Expression and Cardiopulmonary Function in Patients with Chronic Heart Failure(R. Maulana, A. Santoso, F. Alzahra’, M. F. Adda’i, V. B. Kusmanto )

Neutrophil-to-Lymphocyte Ratio as Predictor of Intravenous Immunoglobulin Resistance in Kawasaki Disease: A Mini Systematic Review(A. Prabata)

Effectivity of Fixed Dose Combination of Antihypertensive Agent Compared to Free-Drugs Component: A Meta Analysis(A.Ferly, M. Aprilia, G. A. R. Pertiwi)

Angiotension Receptor Neprylisin Inhibitor as New Paradigm in Managing Patients with Heart Failure with Reduced Ejection Fraction(S. R. Wibawa, I. Y. Puspowardojo)

Simple Technique in Complex Left Main Bifurcation Disease(M. Puspitasari, R. Suryawan)

A Rare Case of Compartment Syndrome due to Massive Superficial Vein Thrombosis(A.C. Undarsa, V.A. Damay, M. Aziz, E. Oepangat)

The Difference of Admission Blood Glucose and Its Correlation with In-Hospital Cardiovascular Event on Acute Coronary Syndrome Patients at Mohammad Noer Hospital Pamekasan(A. Romdiyana, H.I. Millisani)

Preoperative Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery(R.A. Tarigan, H. Hasan, C.A. Andra, A.N. Nasution, R. Hasan, Y. Sarastri)

External Validation of Diastolic Dysfunction Scoring System (DSS study) in Hypertension Population in Gunung sari village, Pamijahan, Bogor(D. Y. Hasanah, N. Hersunarti, B. R. M. A. Soeryo.)

Platelet Indices, Infarct Site and In-Hospital Major Adverse Cardiac Events in ST Elevation Myocardial Infarction Patients Undergoing Primary PCI.(A. A. Asrial, A. Pudjiastuti, Haryadi, L Raharjoyo, N. Virginia, Y. Herry)

The Differences of Echocardiographic Features between Mitral Regurgitation Patients with Sinus Rhythm and Atrial Fibrillation (V. B Kusmanto, A. M. Soesanto, E. Rudiktyo, R. Ariani, B. R. M. A. S. Kuncoro)

Significant Relationship of 6 Minutes Walk Test Improvement after Phase II Rehabilitation Program on the state of Ejection Fraction in Post CABG Surgery Patients(S. Ginting; H. Hasan; A. H. Raynaldo; B. Napitupulu)

Comparison between Red Blood Cell Distribution Width and Neutrophil-to-Lymphocyte Ratio in Predicting Mortality among Acute Decompensated Heart Failure Patients(M.P.Wijaya, Y.W.Kusuma, K.A.Rendy, F.Utomo, N.Natasya, L.O.S.Suastika)

Correlation Between P wave axis from Electrocardiogram and Left Atrial Volume Index in Healthy Obese Young Adults(V. Victory, E. Chandra, A. Saboe, M. R. Akbar, Augustine P, T. M. Aprami)

Prognostic Significance of Hypochloremia Among Hospitalized Patients With Heart Failure and Preserved and Reduced Ejection Fractions (N. G. Liman, B. B. Siswanto)

Fixed Low Dose Warfarin As Alternative Therapy To Prevent Thromboembolic Event In Atrial Fibrillation at Remote Area(K. S. P. Adnyana, D. Y. Hermanto, Irnizarifka)

The Impact of Pulmonary Hypertension in Pregnancy with Congenital Heart Disease from Fetomaternal Outcomes Perspective(M. R. Amalia, M. B. A. Pramono, S. B. Utami)

The effect of left ventricular characters to short-term (in-hospital) and mid-term clinical outcome after aortic valve replacement due to chronic aortic regurgitation(A. R. Lubis, A. M. Soesanto, D. Firman, A. Bono)

Correlation between High Sensitive C-Reactive Protein and Left Atrial Volume Index in Young Adult with Obesity(A. Ridha, A. Saboe, M. R. Akbar, A. Purnomowati, T. M. Aprami)

Relation between Adiponektin Level with The Right Ventricular Function in Adult Uncorrected Secundum Atrial Septal Defect Patient(D. Aji,W. Himawan ,D. W. Anggraini , A. B. Hartopo , L. K. Dinarti)

Efficacy of a Community-Based Health Education with Physical Activity Program (S.E.H.A.T) for The Prevention of Cardiovascular Disease in Batu City, Indonesia(D. Sargowo)

ST-segmen depression as a strongest predictor of three-vessel disease in patients non-ST-segment elevation acute coronary syndromes with Diabetes Mellitus(M. Nasri, Z. Safri, C. A. Andra, H. Hasan, Z. Mukhtar, A. H. Raynaldo)

The Correlation between Serum TG/HDL-c Ratio and Arterial Stiffness Using Cardio-Ankle Vascular Index (CAVI) in Overweight or Obese Patients(Andrianus, R. M. Yogiarto, J. N. E. Putranto)

Correlation between Left Ventricular Ejection Fraction and Zwolle Risk Score in Post Primary Percutaneous Coronary Intervention Patients(A. Pudjiastuti, A. A. Asrial, A. Sariningrum, S. N. Sofia)

The Correlation of Polyunsaturated Fatty Acid-Monounsaturated Fatty Acid Plasma Ratio with Left Ventricular Ejection Fraction in Patients with Stabil Chronic Heart Failure (I. Puspita, M. R. Akbar, S. Hidayat)

Is Admission Hyperglycemia Associated with Reduced Ejection Fraction in ST elevation Myocardial Infarction without Diabetes?(S.P.I Nasruddin , A.A Nursidiq, N. Purwaningtyas. A. Sukmawarti, G. S. Putri)

Cardiovascular Complication in Preeclampsia: Can it be Predicted Electrocardiographically?(R.A. Raharjo, D. E. Wismiyarso, A. P. Mangkoesoebroto, A. Perdana, U. Bahrudin, A.Y.A.B. Mochtar, Y)

Association between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with 6 MWT in Patients after Acute Myocardial Infarction(P. Wulandari, T. Wasyanto, N. Purwaningtyas)

Association Between Compliance and Therapeutic Target Achievement in Hypertension Outpatient Patient in Blitar Population(M. Q. A’yun, B. H. Kuncahyo)

A Study of Correlation between Carotid Intima-Media Thickness and Left Ventricular Hypertrophy in Obese Patients (G.P. Lumentut, A. L. Panda, J. Pangemanan, M. Rotty, T. J. Sumampouw, N. O. H. Rantung, H. Pribadi)

Atrial Fibrillation is as a Predictor of in-Hospital Mortality of Acute Stroke Patients(N. H. Karunawan, R.T. Pinzon)

Distributon of Multiple Vessels Coronary Artery Disease and Risk Factors in Patient with Acute Coronary Syndrome: Study From Sardjito General Hospital Registry(A. Pradhana, H.P. Bagaswoto, N. Taufiq, B.Y. Setianto)

Hemoglobine Level as Predictor of Inhospital Mortality in ACS Patients SCIENCE Registry Sub-Study(A. R. Gemilang, H. Purnasidha, N. Taufiq, B. Y. Setianto)

Correlation between Plasma Adiponectin Levels and Mean Pulmonary Artery Pressure Amongst Grown-Up Uncorrected Atrial Septal Defect(W. Himawan, D. W. Anggrahini, A. B. Hartopo, L.K. Dinarti)

Association of ß angle with Arrhythmic Events in Brugada Syndrome with ECG type 2 and 3(C. Candra, S. B. Raharjo, D. Yugo, D.A. Hanafy, Y. Yunadi)

Percutaneous Balloon Mitral Valvuloplasty in Pregnancy with Severe Mitral Stenosis: Case Series in dr Kariadi General Hospital Semarang(A.P. Mangkoesoebroto, R. A. Raharjo, A. Perdana, M.J. Satyo, S. B. Utami, Y. Herry, S. Rifqi)

Characteristic of Hypertensive Crisis Population in Rural Area: An insight from Atambua(S.D. Putra*, E.A. Pradipta*)

Comparison of Interleukin-6 Post Percutaneous Coronary Intervention between Patients with Acute Myocardial Infarction that Underwent Complete and Incomplete Revascularization(P. K. Dewi, S. Rifqi, N. Anggriyani, N. Wijayahadi)

Pattern of Rheumatic Heart Disease: An Echocardiographic Study (G. Aditya, T. N. P. Adityaputra, I. B. R.Wibhuti, K. B.Nadha)

Comparison of TIMI Flow Between Streptokinase and Alteplase in Patients with ST Elevation Myocardial Infarction After Successful Fibrinolytic at Haji Adam Malik General Hospital Medan(D. Ashrinda, R. Hasan, C. A. Andra, Z. Mukhtar, H. Hasan)

The Relationship of Congenital Heart Defects and Birthweight in Mataram City General Hospital, West Nusa Tenggara(A.P. Rahman)

The Comparison of Sensitivity and Specificity of Point of Care Testing Next Generation Troponin I and High Sensitive Troponin I in Acute Myocardial Infarction Patients(Kriswanto, M. Aminuddin, J. Nugraha )

Correlation of Pulmonary to Systemic Flow Ratio and Adiponection Level in Grown-Up Uncorrected Atrial Septal Defect Patients(K. Mawaris, W. Himawan, D.W. Anggrahini, A.B. Hartopo, L. Krisdinarti)

Correlation Between Educational Level and Medication Adherence Using Morisky Medication Self Adherence Scale (MMAS) in Hypertensive Patients: An Analytical Study(A. F. Khalid, D. Ilmasari, M. G. Suwandi)

Association between Neutrophil to Lymphocyte Ratio and Left Ventricle Global Longitudinal Strain in Acute Myocardial Infarctions Patients(A. A. Nursidiq, N. Purwaningtyas, T. Wasyanto)

Betel Nut Chewing in Rural East Nusa Tenggara: Prevalence and Relationship to Hypertension(F. Wahyudi)

The New Mayo Clinic Risk Score Characteristics in Acute Coronary Syndrome Post Percutaneous Coronary Intervention Patients(L. Z. Amin, H. Z. Amin, S. A. Nasution, M. Panggabean, H. Shatri)

White Blood Cell Count to Mean Platelet Volume Ratio as a Novel Non-Invasive Marker Predicting Short-term Outcomes in Patients with Non-ST Elevation Myocardial Infarction(Y. Saragih, B. Napitupulu, A.N. Nasution, A.H. Raynaldo, H. Hasan)

Correlation of Left Ventricular Function and CardShock Risk Score with Altered Mental State in Cardiogenic Shock Patient Treated with Mechanical Ventilation(D.H. Karimullah, L.H. Adrian, F.W. Nugroho, S. Anjarwani)

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. Kamila, S. Rohman)

Predictive Value of CHA2DS2-VASc-HSF Score for Contrast Induced Nephropathy After Percutaneous Coronary Intervention for Acute Myocardial Infarction(H.W. Parlindungan, R. Hasan, C. A. Andra, H. Hasan, A. A. Siregar, I. N. Kaoy, Z. Mukhtar, A.N. Nasu)

Resolution of ST-Segment Depression in Reciprocal Leads as a Predictor of Mayor Adverse Cardiac Event for ST-Segment Elevation Myocardial Infarction Treated by Fibrinolytic Therapy(A. S. Adhitya, H. Hasan, A. Sitepu, Z. Mukhtar)

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, Unst(A.I.S. Putra)

Correlation between Tpeak - Tend Interval and Myocardial Blush Grade Value in Anterior ST-Elevation Myocardial Infarct Patient(R.P. Kaneko, N. Taufiq, E. Maharani.)

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. Ashrinda, H. Hasan, N. Z. Akbar, Z. Mukhtar)

Serum Neutrophil Gelatinase-Associated Lipocalin and Decreased Kidney Function as Predictor of Mortality and Major Adverse Cardiac Events during Acute Heart Failure Hospitalizations(R. Maliawan, B. Nadha, R. Widiana, P. Gunadhi, Ida S., W. Wita )

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)

Assessment of Coronary No-reflow in Patients with Acute Anterior STEMI Underwent Primary Percutaneous Coronary Intervention Using P Wave Peak Time Parameter(P. Andri, M. Meidianaser, Syaoqi, S. Masrul)

Cardiac Power Output Predicts In-Hospital Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction(Y. F. Siregar, K. K. Ilyas, A. A. Siregar, H. Hasan)

Predictors of Hospital Length of Stay Prolongation in Patients with ST-Segment Elevation Myocardial Infarction in Cardiovascular Care Unit Sardjito General Hospital(I.H. Sulistya , H. P. Bagaswoto , N. Taufiq , B. Y. Setianto )

Comparison of Radial Artery Occlussion Incidence Post Transradial Access Between Seldinger Technique with Modified Seldinger Technique(M. H. Gailani, M. Syukri, M. Fadil)

Can HbA1c Predict Major Adverse Events and Mortality in Coronary Artery Bypass Grafting? – A Systematic Review and Meta Analysis(A. Z. Barano, M. Abduh , E. N. Putri, M. F. Addai)

A Meta-analysis: Associations Between Polymorphisms Gene in Chromosome 9p21 and Risk Of Aortic Aneurysm(R. Mahardhika , M.F. Huda, R. Mahardina, R. M. Budiarto)

The Efficacy of Levosimendan Infusion on Hemodynamic Improvement in Patient Cardiogenic Shock (CS) after Percutaneous Coronary Intervention (PCI) or Intraaortic Balloon Pump (IABP) : a Mini Systematic Review(M. D. Jalma, W. Rahmadhani, J. M. Siahaan)

Left Ventricle Abnormality Among Chronic Obstructive Pulmonary Disease Patients in Persahabatan National Respiratory Center Hospital(H. Putrawan, B. Antariksa , M. Basalamah , F. Yunus )

Reached Blood Pressure Target in Heart Failure Patients and Its Correlation with Early Hospital Readmission(E.P. Sidarta, D.B. Bening, D. Sargowo)

Correlation of Left Ventricular Mass Index with Functional Capacity, Diastolic Parameters Changes, and Global Longitudinal Strain Based on Diastolic Stress Echocardiogrpahy in Asymptomatic Hypertensive Heart Disease Patients(R. A. Fanani, A. M. Soesanto, B. Radi)

Selvester Score in Myocardial Infarction, Could It Predict Degree of Severity in Coronary Lesion?(H. Pribadi, J. A. Pangemanan, S. H. Rampengan, A. L. Panda, I. Adriana, Ronaldi, V. F. K. Candra, N)

Estimated Glomerular Filtration Rate And Length of Stay in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention(H. Haryadi, A. A. Asrial, L. Raharjoyo, N. Virginia, K. Rizky ,Y. Herry)

Double Product and Obesity in Batam: A Descriptive Study(A.M. Zahidin, A. Sutheno)

Pregnancy Outcomes in Women with Uncorrected Congenital Heart Disease: A Single-Centre Experience(A. Wardhani, A. Yudanto, M.B.A. Pramono, Y. Herry)

Supranormal ECG: Athlete’s Heart(Aprihati, E.D. Hargiyanto, D. Wijayanti, M.Y. Alsagaff)

Correlation between Level of Blood Pressure in Hypersensitive Patients with Ankle Brachial Index(N.M.D. Yogiswari, A.A.S.M. Meiswaryasti, Y. Indrayana)

Utilization Of Rotablator And Scoring Ballon In Heavily Calcified And Diffuse Coronary Artery Disease(M.Thein, G. Yoga, M. Munawar)

Comparison of Age Profiles with “Slow Deep Breathing” Technique in Essential Hypertensive.(Y. A. Irmansyah, Y. W. Ashari, Y. Pintaningrum, Kadek Dwi P)

Correlation between Age and Length of Hospital Stay in Acute Coronary Syndrome Patients Treated with PCI In Bumi Waras Hospital, Lampung, Indonesia.(B. Setiawan, T.C. Sinatra, E. Mulia)

Correlation Between Lipid Profile and Carotid Intimal Medial Thickness in Women Systemic Lupus Erythematous Patients in Hasan Sadikin General Hospital(A. Kusumaputri, E. Chandra, Mardlatillah, S. Hidayat, L. Hamijoyo, M. R. Akbar, A. Purnomowati, T. M)

The Relationship between the Degree of Active Smoking in Non AC Bus Drivers and Incidence of Primary Hypertension at PT. Mayasari Bakti May 2016 Term(C. A. Aprilia, A.C.S. Putra, A. Harsoyo)

Association Between the Length of Congestive Heart Failure and WHO-5 Well-being Index (Z. P. Murti, S. I. Sugiarto, D. A. Paramita)

Predictors of In-hospital Mortality Following Percutaneous Coronary Intervention for Coronary Artery Disease in BP Batam Hospital An Observational Single Center Study(H. Soraya, F. N Hosea, A. A. Hakim)

Obstructive Sleep Apnea Risk Factors of Patients with Coronary Heart Disease Coronary Angiography by NTB General Hospital(N.Y. Pintaningrum, I. Hunaifi)

Differences between Platelet Immature Levels in Diabetes Mellitus Compared to Non Diabetes Mellitus Patients with Stable Coronary Artery Disease(D.R. Balti, Andrianto, B. Baktijasa)

Which Hematological Parameters are Best Correlated with Troponin in NSTE-ACS?(I. E. Hermawati, A. Subagjo, I. Alfia )

Correlation Between Undiagnosed Depression, Anxiety Disorder, and Hypertension in Cililin Primary Health Center: An Analytical Study(A. Leisyah, A. F. Khalid)

Profile of Dippers and Non Dippers Hypertension Patient in General Hospital Doctor Mohamad Saleh Probolinggo(M. A. Pasha; T. Ardhana)

Characteristics of Hypertensive Patients in Singkawang, West Borneo: Insight from a Multi-Cultural Remote Area in Indonesia(R. Arifin, A. Christopher)

Triglyceride and Non High-Density Lipoprotein Cholesterol as Predictors of Cardiovascular Disease Risk Factors(A. A. Rauf R. A. Said, Y. A. Fitrah, B. Z. Herman)

Thrombocyte-to-Leukocyte Ratio is correlated with Length of Stay in Patients with ST-Elevation Myocardial Infarction Underwent Primary Percutaneous Coronary Intervention(Y.S. Pratama, R. Puspitoadhi, N.A. Tafriend, U. Bahrudin)

The Associtaion between Uric Acid Level with Multivessel Coronary Artery Disease on Patients who Underwent Coronary Angiography in Abdul Wahab Syahranie General Hospital Samarinda(M.D.Pratama, D. Budiono, O.M.S Nasution, D. Herdianto)

Association between Statin Use as Primary Prevention and Outcomes in Acute Coronary Syndrome Patients during 2016 in Cengkareng General Hospital, Jakarta(A. Priyana, A. F. Sunjaya, A. P. Sunjaya)

Association between Metabolic Panels Abnormalities and Findings During Coronary Angiography: A Cross-Sectional Observational Study (R. Pranata, E. Yonas, V. Chintya, V. Pratama, BA. Permana, B. Pamungkas)

Correlation of Lipid Profile with the Severity of Coronary Artery Disease(M.F. Rizky, P.C. Fianirazha, A.H. Rolando, M.W. Hadi, M.N. Afif, S.F. Liliana, S. Imran, U. Ferry )

Peripartum Cardiomyopathy: Big Hearted Moms A Single Institution Case Series in Tangerang(A. Christopher, I. M. Pardede)

Lipid Profile and Coronary Heart Disease Assessment among Adult in Makassar, Indonesia: A Cross Sectional Study(A. A. Rauf , R. A. Said, Y. A. Fitrah, B. Z. Herman)

Profile Patient with ST-Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention at Kariadi Hospital(Y.S. Pratama, S. Sungkar, A. Yudanto, S. Rifqi)

The Role of Primary Care Physician in Educating Hypertensive Patient(N.P.A. Laksmi, A. Hendrayana)

The Effect Of Gymnastyc Exercise In Elderly To Lowering Blood Pressure In Geriatric Social Institution Of Tresna Werdha Kendari(A.U. Ramdhani, A. Pratama, B. Bintoro, S.Soebijakto)

Association Between Glycated Hemoglobin with Severity of Coronary Artery Disease in Non-Diabetic Patients(I.M Raditya, M. Syafri, M. Yanni)

Correlation between Mean Carotid Intima-Media Thickness and Body Mass Index among Minahasa Adults (T. Sumampouw, G. P. Lumentut, N. Rantung, H. Pribadi, A. Panda, J. Pangemanan, M. Rotty)

Prevalencec of Cardiovascular Disease in Women at Sampang General Hospital During The Year 2017(A.Pramudya)

Reduced Left Ventricular Ejection Fraction as A Predictor In-Hospital Major Cardiovascular Event in Patients Admitted with Acute Myocardial Infarction at Sanglah General Hospital Bali(I. D. G. D. Sumajaya, L. O. S. Suastika, A. A. A. D. A. Yasmin, I. G. N. P. Gunadhi)

Resolution of ST-Segment, Pain Level, and Arrythmia as A Tool For Assessing The Efficacy of Reperfusion Therapy in STEMI Patient Hospital Kanjuruhan(A. N. Lukito, G. A. Pawintri , A. B. Santoso)

Clinical Profile of patients with Acute Coronary Syndrome in Public Hospital in Bekasi, West Java, Indonesia(B.A.Pratama, J.S. Purnama, K. Priyantoro)

Age, High Density Lipoprotein Cholesterol and Triglycerides are Correlated with Triple-Vessel Coronary Artery Disease(Y.S. Pratama, U. Bahrudin, S. Sungkar, I. Uddin)

The Difference on Strain and Strain Rate Parameter of Left Ventricle Function Between Controlled Hypertension and Uncontrolled Hypertension(M. Reza, B. R. M. A. Soeryo, R. Soerarso)

Difference in Prevalence of Atrial Fibrillation and Non Atrial Fibrillation in Non Valvular Heart Disease Stroke Patient (E. Pramana, K. Susila)

Profile of Cardiovascular Risk Factors of Army Personel Undergoing Medical Check-Up(R. Pranata, E. Yonas, V. Chintya, B. Pamungkas, V. Pratama, B.A. Permana, D.E. Syahlul)

Lipid Profile and It’s Association with Multivessel Coronary Artery Disease on Patients Who Underwent Coronary Angiography in Abdul Wahab Syahranie General Hospital Samarinda(D. Budiono, O.M.S Nasution, M.D.Pratama , D. Herdianto)

Relation between Serum Triglyceride Levels and Physical Activity in Army Personel Undergoing Medical Check-Up(E. Yonas, R. Pranata, V. Chintya, B. Pamungkas, V. Pratama, B. A. Permana, D. E. Syahlul)

The Role of 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* )

Left Ventricular Dimension and Ejection Fraction Values by Echocardiography in Adolescents: An Epidemiology Study in Bali, Indonesia(L. O. S. Suastika, I. B. R. Wibhuti, K. B. Nadha, M. Chowdhury, J. Chowdhury, K. Olejnik, E. Bouman,)

Predictors of Right Ventricle Function Improvement in Patients with Right Ventricle Dysfunction after Mitral Valve Surgery(W.M. Saragih, A.S. Kuncoro, R. Zahara, A. M. Soesanto)

Correlation of Blood Nitric Axide Level and Right Ventricular Systolic Function in Adult Patient with Uncorrected Secundum Atrial Septal Defect(F. S. A. Pradana, D.W. Anggrahini , A.B. Hartopo, L.K. Dinarti)

Correlation between Estimated Right Ventricular Systolic Pressure and Tricuspid Annular Plane Systolic Excursion to Perinatal Outcome in Pregnancy with Acyanotic Congenital Heart Disease(A. Pudjiastuti, A.A. Asrial, A. Sariningrum, L. Raharjoyo, Y.A.B.M. Aruman, M.A. Nugroho, Y. Herry)

Correlation between Tricuspid Anular Plane Systolic Exercusion (Tapse) and Peak Systolic Velocity on Anulus Tricuspid (S') with Mean Arterial Pulmonary Pressure (Mpap) on Atrial Septal Defect Patient(V. Rosalinda, D.W. Anggraini, B.A. Hartopo, L. Krisdinarti)

Association between Biomarkers and Plaque Vulnerability Detected by Optical Coherence Tomography in Patient with Coronary Artery Disease: a Meta-analysis(U. Bahrudin, R.A. Raharjo, S. Herminingsih, I. Uddin, Hardian, Y. Herry, S. Rifqi)

Cerebrovascular Thromboembolic Events in Periprocedural Bridging Therapy vs Uninterrupted Anticoagulation in Long-Term Anticoagulant User with Atrial Fibrillation: A Mini Systematic Review(Vidyawati, P. M. H Putri, T. Jatiman)

Outcomes of Partial Closure with Fenestrated Device in Atrial Septal Defect Accompanied by Severe Pulmonary Hypertension : A Literature Review(P. Prasetyo, R. Prakoso )

True Lumen Identification in Dissection: Role of IVUS(E.N. Aisyah, M.Y. Assegaf)

Diagnosing and Treating Left Bundle Branch Block ECG Finding as An Acute Coronary Syndrome Event in Rural Hospital of East Sumba: A Case Report(T.S.R. Sembiring)

Segmental ST-T changes in Hypokalemia Suggesting Subendocardial Injury: a Case Report(Ayu A.P., Hidayat I.R., Dewi T.T., Rakhmawati I., Pertiwi D.Y., Rostiati D.)

Succesfully Delivery by a Cesarian Section in a Parturient Woman with Unrepaired Tetralogy Fallot: Case Report(Vitryaturida, Martini, Heny)

Ventricular Septal Rupture as Complication of Acute Miocard Infarct in Adolescent Caused by Blunt Chest Trauma: A Case Report(F.M. Yusuf, S. Khairunnissa, M.F Rizky, M.N.Aditya, P.L.T. Mangiring)

Spontaneous Thrombolysis in Left Ventricular Thrombosis Post Dengue Myocarditis(H. Lim, I.B. Wibhuti, K.B. Nadha)

How to Deal with Complicated Pericardial Effusion?(G.M. Rahman, I.G.R. Suryawan)

Ventricular Tachycardia in Doubt : Usefulness of Brugada and R Wave Peak Time Criteria(Albertus , M. Setiawan )

Electrocardiographic Change Mimicking ST Elevation Myocardial infarction in Subdural Hemorrhage: Diagnostic Dilemma(P.I.N. Sigit, Y. Ahmad)

Successful Management of Severe Mitral Stenosis with the First Percutaneous Baloon Mitral Valvulotomy (PBMV) in Pregnant Woman at Sanglah Hospital Bali(G.A. P Astara, I.M.J.R. Artha)

Raynaud Phenomenon Resistant to the Initial Therapy in Patient with Systemic Lupus Erythematosus(H. Susilo, R.M. Budiarto, H. Anugrawan, R. Amalia)

Infective Endocarditis with Ischemic Stroke Complication: A Case Report(K.D. Krisnayanti, C.A. Shandy, G.A. Suryawati)

Pericarditis and Mediastinitis as a Result of Neglected Chronic Odontogenic Infection(G. A. P. Astara, W. Aryadana)

Isolated Posterior Myocardial Infarct: The Deadly Nightshade of the Electrocardiography(B.D.Guntoro, D.Ilmasari, M.G.Soewandi)

Dealing with Coronary Aneurysm(L.P.C. Dewi, Y.H. Oktaviono)

Percutaneous Transluminal Angioplasty in Thrombosed Arteriovenous Fistulae (D. Bestari, J. Nugroho)

Polycythemia Vera as the Main Risk Factor in ST Elevation Myocardial Reinfarction(W.D.S. Cyndiana, B. Kris, A. Wayan)

Peripartum Cardiomyopathy Complicated by Preeclampsia with Mitral Stenosis(T.T. Dewi, I. Rakhmawati, I. R. Hidayat, P. Aulia, D. Y. Pertiwi, D. Rostiati.)

Role of Transthoracal Echocardiography in Guiding Diagnosis and Management in Successful Reversal Of Acute Severe Heart Failure Due To Peripartum Cardiomyopathy (D. G. Widyawati, W. I. B. Rangga, N. K. Badjra)

A 48-years-old Female with Stabbing Chest Pain and Pericardial Effusion: A Case Report(A.K. Ratri*,M.Y. Alsagaff*, T.P. Asmarawati**)

The Role of Cardiac Catheterization for Patient with Restrictive Cardiomyopathy and Severe Mitral Insufficiency(I. Y. Suhartono, F. Basalamah)

Acute Left Main Coronary Artery Total Occlusion Without ST-Segment Elevation in Lead aVR(R. Putra, M. Limbong, Y.S. Pratama, A. Mustika, Y. Herry)

Difficulty to Recognizing Acute Total Occlusion of Coronary Artery in Non-ST Elevation Myocardial Infarction: A pitfall of ST-segment Elevation in Electrocardiogram(Y.S. Pratama, R. Puspitoadhi A. Yudanto, I. Uddin)

Left Main Stem Stenosis in Young Female without Significant Cardiovascular Risk Factor(V Kurniawati, S.Rohman)

Pseudonormalization ST-segment in ST-elevation Myocardial Infarction Patient(F.Fathini, R. A. Seriulina,A. Ginanjar, T. T. Dewi, I.A. Rakhmawulan, D. Rostiati)

Fever Induce Brugada Syndrome: Case Report(G. Swandita)

Early Diagnosis and Prompt Treatment of Severe Stenosis in The Proximal Left Anterior Descending Coronary Artery: Wellens’ Syndrome Case Report(H. R. S. Dhilion, Haikal, B. Pamungkas, A. Harsoyo, V. Pratama)

Case Report: A 65-Year Old Man with Ventricular Tachycardia with Some Pattern Similar to Supraventricular Tachycardia and The Management(H. Oktaviani, M. Hatta)

Peripartum Cardiomyopathy in Atrial Septal Defect and Eisenmenger Syndrome(Y.S. Pratama, M.A. Nugroho)

Successful Percutaneus Revascularization of Total Occlusion of the Ostial Left Main Coronary Artery: A Rare Case Report(D. Wardana, N.A. Tafriend, U. Bahrudin, Y. Herry)

Anterior Extensive ST-Elevation Myocard Infarction With High Thrombus Burden Given Intra-Coronary, Intra-Venous Eptifibatide and Plain Old Balloon Angioplasty : A Case With Satisfying Result(I.N.G.Sudiarta, I.W. Wita)

Localized ST Elevation in ECG: Acute Myopericarditis Mimicking ST Elevation Myocardial Infarction(T. N. P. Adityaputra, L. O. S. Suastika)

Recurrent Acute Myocardial Infarction in A-63 years old Man with Hypersensitivity to Aspirin Therapy: How to Deal with it?(M. Sanjiwani, N. Wiryawan)

Diuresis in Resistant Congestion, Desperate Measures Before Ultrafiltration(H. Susilo, M.Y. Alsagaff)

Infective Endocarditis with Peripheral Embolization (Case Study)(Jefri, E. Phangestu, V. H. Wahidji)

Situs Inversus Totalis with Dextrocardia Complicated by Left Cerebral Abcess(I. Pratiwi, C. Melka, A.A. Bashori)

Double Culprit Coronary Arteries in ST Elevation Myocardial Infarction Treated with Primary Percutaneous Intervention: A Case Report(H.H. Satoto, R. Puspitoadhi, R.A. Raharjo, S. Sungkar, I. Uddin)

Coronary Artery Bypass Grafting in ST-Segment Elevation Myocardial Infarction: Option of Reperfusion (Still)(M. Puspitasari, Y.E. Sembiring, M.Y. Alsagaff)

Peri-Infarction Pericarditis, Rare Complication of Myocardial Infarction(S.A. Hutomo, Andrianto)

Diagnostic and Management Approach of Patients with Coronary Artery Fistula: Case Series(N.I. Gayatri, O. Lilyasari, P.S. Roebiono, A.U. Rahayoe, I. Sakijan, R. Prakoso, Y. Kurniawati, G.M.)

Coronary Artery Fistula : Should We Close?(D.G. Arilaksono, N. Haryono, A.S. Soerianat, D. Firman, A.A. Alkatiri, )

A Case Report : Primary Cardiac Tumor In a 1-year old girl(N.A. Tafriend, R, Puspitoadi, A. Priyatno, A. Soetadji)

Congenital Coronary-Cameral Fistula from Right Coronary Artery to Right Ventricle : a Very Rare Case Report(R. Puspitoadhi, M.H. Cahyadi, P.S. Putri, N. Virginia, A. Priyatno)

Giant biphasic T wave electrocardiogram pattern (Z syndrome) in patient with Plasmodium Vivax malaria infection(P.R. Kusuma, E. Zuhri)

Management of Degenerative Aortic Bioprosthetic : First case TAVI valve-in-valve in Indonesia(A.T. Faizal, D. Firman, D.A. Juzar, A.M. Soesanto, N. Haryono, A.A. Alkatiri, S. Soerinata)

Successful Percutaneous Balloon Mitral Valvuloplasty in Pregnant Woman with Severe Mitral Stenosis(A.P. Mangkoesoebroto, R.A. Raharjo, A. Perdana, S.B. Utami, Y. Herry, S. Rifqi)

A 55-year-old Man with Ruptured of Standford Type B Aortic Dissection Presenting with Bilateral Hemothorax (I.Tania, R. Ashriyah)

Left Ventricular Ejection Fraction in correlation with In Hospital Mortality in ACS Patients: SCIENCE Registry Sub-Study (B.A. Prabowo, H.P. Bagaswoto, N. Taufiq, B.Y. Setianto)

Strategy of Early Revascularization with Percutaneous Catheter Directed Intra-Arterial Thrombolysis for Acute Upper Limb Ischemia : A Case Report(M.R. Ramadhan, M. Failasufi, N. Kurnianingsih, D. Sargowo)

Aortic Dissection Presenting With Septic Shock(A. Satria, S. Widito)

Non-ST Elevation Myocardial Infarction Induced by Sildenafil Consumption in a Patient with No Coronary Artery Disease History: A Case Report(I.M.E.A. Wardhana, P.G. Budiana*)

Recognizing ST-Elevation Myocardial Infarction in Bundle Branch Block(Y.S. Pratama *, R. Puspitoadhi *, P. Ardhianto**, Y. Herry**)

Atrial Incisional Tachycardia Following Three Decades of Cardiac Surgery(G. Yoga, M. Thein, E. Sen, M. Munawar, B. Hartono)

A Rare Case of Multiple Intracardiac Tumors in Pediatric(B. Saunders, I. Sulistyorini I. Mappangara, Y. Patimang, B. Iskandar)

Mycobacterium Tuberculosis Endocarditis Infective at Pulmonary Valve in a Pediatric Patient with Ventricular Septal Defect. (P. Suci, A. Priyatno)

Reversible Dilation of Chambers, Tricuspid Regurgitation and Pulmonary Hypertension in Patient with Hyperthyroidism: A Case Report(Sepriyana, Haryadi)

A Case Report: Management of Systemic RV Failure on Adult Congenitally Corrected Transposition of Great Arteries (ccTGA) Complicating Symptomatic Bradycardia with Atrial Fibrillation Slow Ventricular Response (AFSVR)(M.A. Sobirin, K. Rizky,U. Bahrudin, I. Uddin)

Secundum Atrial Septal Defect with Significant Pulmonary Arterial Hypertension: Treat And Repair Strategy(N.G. Liman, R. Prakoso)

Role of Supporting Examination in Investigating Non Specific Chest Pain to Diagnose Thoracic Aorta Aneurysm in Rural Setting: A Case Report(M. Abduh, H. Nainggolan, J. Endang)

Facial Cold Stimuli to Treat Supraventricular Tachycardia at Makasar Subdistrict Primary Health Care, Jakarta, Indonesia : A Case Report(Aisyah, E. A. Pratama, S. Nurwulan)

ST-Segment Elevation Myocardial Infarction (STEMI) Caused by Left Atrial Myxoma – How to Treat : A Case Report(D. Irawan, J. E. Saragih, B. Satrijo)

Succesful Retrieval Of Stent Dislodged In Distal Left Main Coronary Artery And Proximal Left Circumflex Artery During Percutaneous Coronary Intervention With Small Balloon Technique (D.G. Widyawati, W. Aryadana)

Challenges in the Diagnosis and Acute Management of Idiopathic Left Ventricular Tachycardia : A Case Report(D. A. S. Ratnasari, I. A. Kusuma)

Total Occlusion of Left Main Coronary Artery in NSTE-ACS Patient : A Case Report(D.U. Setyowati, A. Kailani, M. Silalahi, M. Zaini)

Vena Cava Filter on Patient with Deep Vein Thrombosis(I.F. Ramdhani, J.Nugroho)

Symptomatic Bradycardia in a Hyperkalemic Patient: A Case Report(A. Halimi, Y. Pintaningrum)

New ST-Segment Elevation After Coronary Artery Bypass: A Case Report(N. O. H. Rantung, L. A. Natalino, V. Sariowan, A. E. Haurissa, A. Tangkilisan, H. Abraham, J.A. Pang)

Role of Trans Thoracal Echocardiography (TTE) in Assessing Aortic Abnormalities in Patient with suspected Marfan Syndrome: A Case Report(A.W. Sari, B. Nadha, R. Wibhuti)

Extensive Anterior ST elevation Myocardial Infarction in Reproductive Woman Using Oral Contraceptive Pills (D.Ilmasari, A.F.Khalid, M.G.Soewandi)

Cardiorenal Syndrome in Peripartum Cardiomyopathy Patient: A Case Report(I.A. Rakhmawulan, F. Fathini, T.T Dewi, I.R. Hidayat, A.P. Ayu, D.Y Pertiwi, D. Rostiati,)

Converting Persistent Non-Valvular Atrial Fibrillation to Sinus Rhythm in Critical Stenosis of Left Circumflex (LCX) Artery: Is it Ischaemic-related?: A Case Report(F. Ratih, M.F. Rizky, K. Agoes)

Cardiomyopathy in Patient with Malignant Lymphoma: A Case Report(D.Y. Pertiwi, T.T. Dewi, I. Rakhmawati , I.R. Hidayat, A.P. Ayu, D. Rostiati)

The Problem of Systemic Lupus Erythematosus Diagnosis In A Pregnant Woman With Early Clinical Manifestations Suspected Pulmonary Embolism(A. Munandar, D. Rachmaniah, S. Widito)

Hemorrhagic Transformation Following Ischemic Stroke in Patient with Infective Endocarditis Complicated with Atrial Fibrilation and Rheumatic Heart Disease(P. Setiawan, L.O.S Suastika)

Infective Endocarditis with Suspicion of Superimposed Acute Rheumatic Fever(M.I. Amin, D.W. Anggrahini, B. Irawan)

Definite Sub Acute Stent Thrombosis after Primary Percutaneous Coronary Intervention(G.Aditya, W. Aryadana)

Transient Segment ST Elevation: Spontaneous Coronary Reperfusion(A.Jalaludinsyah, T.Wasyanto)

Post infarction ventricle septal rupture: it is not always a lethal condition.(N.E. Damaiati, R. A. Sukaton, H. Isnanijah)

Subacute Coronary Stent Thrombosis in Patient after Elective Percutaneous Coronary Intervention : Causes, Risk Factors and Management(A. Chairunnisa, A. Wardhani, Y. Herry, I. Uddin, Safir)

Acute Pericarditis : A case report(I.R. Hidayat, A. P. Ayu, T. T. Dewi, I. Rakhmawati, D. Y. Pertiwi, D. Rostiati)

Rheumatic Heart Disease with Coronary Artery Disease and Stroke: A Case Report(D.Y. Pertiwi, T.T. Dewi, I. Rakhmawati, I Sofyan , I.R. Hidayat, A.P. Ayu, D. Rostiati)

Double-Outlet Right Ventricle with Dextrocardia in a One-year-old girl: A Case Report(D. Hertriwibowo, K. N. Hapsara, F. S. Hasibuan)

Successful Simple Recanalization Technique of in Stent-Left Anterior Descending-Chronic Total Occlusion: A Case Report(A.D. Anggraeni and B. Baktijasa)

Acute Pulmonary Embolism Mimicking an Acute Myocardial Infarction : A Case Report(O. M. Siregar, Y. Sarastri, Z. Safri, H. Hasan, )

Triple Valve Replacement in Patient with Rheumatic Heart Disease: Case report(M.Limbong, A. Sariningrum A. Yudanto ,S. Fatah)

Silent Myocardial Ischemia in Hyperglycemia Patient with LBBB Finding: A Case Study(M.Q. A’yun, Muzaiwirin)

Pericardial Effusion: Acute Management and Therapy(A.A. Akis, C. M. Gultom, D. D. Miranti, M. A. P. Prabowo, N. R. Simatupang, A. F. Chandranegara, H.)

Myocardial Infarction with Non Obstructive Coronary Artery Associated with Myocardial Bridging: A Case Report(A.Sariningrum, Elen, C.Anantaria, M.Kasim)

Uncommon LAD Coronary T-Wave Inversion : Wellens’ Syndrome : A Case Report(M.R. Felani, M.N. Adhitya, S. Revan, M.F. Yusuf, M.W. Hadi, S. Khairunnisa, M.N. Afif, S.F. Liliana)

Truncus Arteriosus: Pulmonary Vascular Disease Screening(N.G. Liman, G.M. Harimurti)

The Features of Electrocardiography on Dextrocardia with Situs Inversus in Adult Patient(I.N. Shabrina, M.G. Soewandi)

Regional Pericarditis with Reciprocal ECG Changes Mimicking Inferior STEMI(G. M. Rahman, M.Y. Alsagaff)

Normalizing T-Wave Inversion after Exercise Stress Test (Treadmill) on a Cycling Race Athlete : A Case Report(E.D.Hargiyanto)

How To Manage Total Atrioventricular Block In Inferior-Posterior AMI; Is PCI More Superior Than Permanent Pacemaker?(N.D Nuarisa, Y.H Oktaviono)

Wellen’s Syndrome Like Pattern on a Healthy Roller Skate Athlete : A Case Report(E. D. Hargiyanto, D. Hertriwibowo. )

Huge Mediastinal Mass with Massive Pericardial Effusion: Role of Echocardiography-Guided Pericardiosintesis(D.P. Kartikasari, D. Soemantri)

Coronary Vasospasm in ST-Segment Elevation Myocardial Infarction with Non-Obstructive Coronary Arteries(H. Lim, W. Aryadana)

A Benign Case of Supraventricular Extra Systole in Acute Coronary Syndrome: Is It Harmful?(R. Pranata, W.Wiharja, V. A. Damay)

Peripartum Cardiomyopathy: A Devastating Sequlae of Uncontrolled Hypertension in Preganancy(W. Wiharja, R. Pranata, V. A. Damay)

Treatment of Choice for Nonreperfused Patient in Total Atrioventricular Block Complicates Inferior Wall Myocardial Infarction with Right Ventricular Infarction(P.F. Sitohang)

Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus: High Interarterial Course of Right Coronary Artery(D. A. Paramita, S. Suhendro, T. V. Yoshinta, E. Leonid)

Silent Until Twilight : A Case Report of Ebstein Anomaly in 63 Years Old Woman(A.E. Prasetia, D. W. Angrahini, R. K. Marsam, L. Krisdinarti)

A Case Report: Transient ST Elevation Myocardial Infarction After Initial Treatment in Emergency Department(R.R. Aryanti, Z. Choa, R.D. Tureno, S. H. Putra)

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