Download Young Investigator Award

European Heart Journal Supplements (2016) 18 (Supplement B), B16 – B18
The Heart of the Matter
doi:10.1093/eurheartj/suw026
Young Investigator Award
Abstracts
The Efficacy of polysaccharide peptides of Ganoderma lucidum to reduce endothelial dysfunction and dyslipidemia in high risk and stable angina pectoris patients
Cardiovascular Autonomic Neuropathy Profile in Controlled and Un-controlled
Type 2 Diabetes Mellitus by Exercise Treadmill Testing
A. Satria, K. Siwi, A. Widya, Vittryaturida, N. Ubaidillah, M. Failasufi, F. Ramadhan,
H. Wulandari, Y. Waranugraha, D.H. Putri, and D. Sargowo
Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya
University – dr Saiful Anwar General Hospital, Malang, Indonesia
E.N. Artiko and R. Romdoni
Cardiology and Vascular Medicine Department, Soetomo General Hospital, Airlangga
University, Surabaya, Indonesia
Background: Endothelial dysfunction and dyslipidemia have animportant role in the development of atherosclerotic cardiovascular disease. Ganoderma lucidum is a mushroom that
has effects of antiinflamation, immunomodulator, antioxidant and anti-lipid. High level of
circulating endothelial cells (CECs) and low level of endothelial progenitor cells (EPCs)
predict poor outcome of endothelial damage. This study was aimed to compare the efficacy
of Ganoderma Lucidum consumption on CECs, EPCs, and total cholesterol value in high risk
atherosclerotic patients to be compare with stable angina pectoris patients.
Methods: This study used true experimental study on 37 high risk patients of cardiovascular
event based on Framingham Risk Score and 35 Stable angina pectoris patients, with pre-test
and post-test design. The patients administrative with Polysacharide peptides (PsP)
3x250 mg for 3 months, as an additional therapy of their regular medications. The data
wasanalyzed by paired t-test for parametric data and Wilcoxon testfor non-parametric data.
Results: Pre test were performed to measure a baseline value of total cholesterol, CECs,
and EPCs and post test were performed after administration of PsP for 3 months. The
results shows that, total cholesterol level reduced from 219.46 + 49.49 mg/dl to
201.43 + 81.63 mg/dl (p ¼ 0.193) in high risk group and 205.48 + 48.49 mg/dl to
182.11 + 73.81 mg/dl (p ¼ 0.083) in stable angina group. There were significant reduction of total cholesterol in stable angina groups but not in the high risk groups. The level of
CECs significantly reduced 2.07 + 1.54 % to 0.64 %, (p ¼ 0.000), also the EPCs level
3.28 + 3.66 % to 1.72 + 2.24 %, (p ¼ 0.000) in high risk group. In Stable angina group,
the level of CECs is decreasing 2.52 + 3.04 to 0.71 + 1.4 %, (p ¼ 0.000) and did the
EPCs level 5.16 + 4.59 to 1.19 + 1.76 % (p ¼ 0,000).
Conclusion: The result shows Ganoderma lucidum polysaccharide peptides has the same
efficacy to reduced the level of CECs in both of groups but not in EPCs which are biomarkers of repair with therapeutic potential both in stable angina and high risk group,
because EPCs level is decreasing too. A reduction of EPC levels correlated with risk
factor of coronary artery disease that still unclear. The level of total cholesterol does
not show significant differences between pre test and post test.
Keywords: High risk patients † Stable angina patients † Ganoderma lucidum † polysaccharide peptides † dyslipidemia † CEC and EPC
Harapan Kita Score as predictor of in-hospital mortality and morbidity after
heart valve surgery
A. Husink 1, A. M. Soesanto2, O. Lilyasari 2, and A. B. Adji2
1
Faculty of Medicive, Universitas Indonesia, Jakarta, Indonesia, 2National Cardiovascular
Center Harapan Kita Hospital, Jakarta, Indonesia
Background: Valvular heart disease remains a significant health problem in Indonesia,
and surgery remains as the treatment of choice. Various scoring system available to
predict post-operative mortality and morbidity, but most were developed from different
population characteristics compare to the condition in Indonesia. A scoring system
developed from local population is required.
Objective: To develop a scoring system for the prediction of in-hospital mortality and
morbidity after heart valve surgery at Heart and Vascular Center Harapan Kita Hospital.
Methods: This is a prognostic study performed at Heart and Vascular Center Hospital
Harapan Kita, toward patients who underwent heart valve surgery with or without
coronary artery bypass since January 2012 to December 2014. Data were collected
retrospectively. Scoring systems were developed using logistic regression models.
Result: 1040 patients were acquired. Mortality and morbidity rate was 68 (6.5%), and 410
(39.4%) respectively. Factors associated with mortality were functional class, history
of hypertension, previous open heart surgery, impaired renal function, right ventricular
dysfunction, emergent operation, combined heart valve and coronary artery bypass
surgery, and tricuspid valve surgery. Male sex and double valves surgery were also
associated with morbidity. The mortality risk score has H-L test P value ¼ 0.212;
AUC ¼ 0.813 (CI 95% ¼ 0.758 – 0.867); and cut-off point of 5, predicting 14% risk of
death (sensitivity 72.1%, specificity 75.3%). The morbidity risk score has H-L test
p ¼ 0.113; AUC ¼ 0.713 (CI 95% ¼ 0.681 – 0.746); and cut-off point of 5, predicting
48% risk of morbidity (sensitivity 69.5%, specificity 60.5%).
Conclusion: Scoring system predicting mortality and morbidity after heart valve surgery
with or without coronary artery bypass graft have been made. Mortality risk score was
well calibrated, with good discriminatory power. Morbidity risk score was well calibrated,
with moderate discriminatory power.
Keywords: Scoring system † risk factor † predictor † heart valve surgery † mortality
† morbidity
Background: One of the most serious complications of diabetes is cardiovascular autonomic
neuropathy (CAN), which encompasses damage to the autonomic nerve fibers that innervate
theheartand bloodvessels,resultinginabnormalitiesinheartratecontrol and vascular dynamics. This study was to investigate the difference profile of exercise treadmill testing (ETT) in
well-controlled and un-controlled type 2 diabetes mellitus (T2DM), associated Cardiovascular
autonomic neuropathy.
Methods: impairedchronotropicresponse(CR)or chronotropicincompetence(CI)andheartrate
recovery after 1 minute and 2 minutes was documented in 48 male patients and 2 female patients
withT2DM after taking ETT, devide into2 groups based on level of HbA1c, well-controlled and
un-controlled T2DM. We used Mann-whitney U and spearman’s test to analyze both groups.
Results: compared with well-controlled T2DM group, un-controlled T2DM group had lower
chronotropic index (0.710 + 0.09 vs 0.928 +0.214; p ¼ 0.000), slower resting heart rate
(80.80 + 10.99 vs 89.67 + 12.78; p ¼ 0.015), slower peak heart rate (143.54 + 8.78 vs
163.13 + 11.94; p ¼ 0.000). There were significantly correlation level of HbA1c againts
peak heartrate (r ¼ -0.687,p ¼ 0.000)andchronotropic index (r ¼ -0.711, p ¼ 0.000). Chronotropic incompetence in un-controlled T2DM group significantly higher than well-controlled
T2DM group (85.7% vs 13.3%, p ¼ 0.000). But there were no difference in heart rate recovery
and functional capasity in both groups.
Conclusion: chronotropic incompetence was higher in un-controlled T2DM group
patients may resemble autonomic dysfunction which may associated with increased
risk of cardiovascular events in future.
Keywords: Diabetes mellitus † cardiac autonomic neuropathy † exercise treadmill
testing † HbA1c † heart rate recovery † chronotropic incompetence
The difference of blood pressure and arterial stiffness after intake of arabica
and robusta coffee in controlled hypertension
F.A. Aritonang1,2, B.S. Pikir1,2, and Andrianto Andrianto1,2
1
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga
University, Surabaya, Indonesia, 2Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Coffee are widely consumed on a daily basis. Studies on the effect of coffee
on cardiovascular risk are not conclusive. There is increasing interest for potential
mechanisms of caffeine that promote large artery stiffness, which associated with
increased morbidity and mortality of cardiovascular disease.
Aim: To find out the difference of blood pressure and arterial stiffness after intake of
arabica and robusta coffee in controlled hypertension.
Methods: Quasi experimental study enrolling 24 controlled hypertension and 24 normotensive subjects, collected by purposive sampling. Subjects received + 10.6 gr caffeinated coffee in 150 ml water with crossover protocol. Assessment of arterial stiffness using
ultrasound 2D image of common carotid artery then calculated with beta stiffness index
(BSI). Blood pressure and arterial stiffness was measured before oral administration of
coffee, 30 and 60 minutes after oral administration of coffee.
Result: Analysis using Friedman test. There was significant difference between initial systolic blood pressure (SBP), SBP 30 minutes and SBP 60 minutes after oral administration of
arabica (p = 0.002) and robusta coffee (p = 0.012) in controlled hypertension. There was
significant difference between initial diastolic blood pressure (DBP), DBP 30 minutes
and DBP 60 minutes after oral administration of arabica (p = 0.004) and robusta coffee
(p = 0.025) in controlled hypertension. There was significant difference between initial BSI,
BSI 30 minutes and BSI 60 minutes after oral administration of arabica coffee (p = 0.018) in
controlled hypertension. Analysis using Wilcoxon or pair T-test showed no significant difference of all variables after intake of arabica and robusta coffee in controlled hypertension.
Conclusion: There was significant difference of blood pressure after intake of arabica or
robusta coffee and significant difference of arterial stiffness after intake of arabica
coffee in controlled hypertension.
Keywords: Caffeine † systolic blood pressure † diastolic blood pressure † arterial stiffness
Asscociation of the biomarkers soluble ST2 and subclinical left ventricular systolic
dysfunction assessed by myocardial Global Longitudinal Strain in patients severe
aortic stenosis
H. Ramadhani, R. Sukmawan, S.F. Supari, and A.M. Soesanto
Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas
Indonesia – National Cardiovascular Center Harapan Kita
Background: In severe aortic stenosis (AS), cardiac performance measured at the ventricular chamber is typically normal. Global Longitudinal Strain providing comprehensive
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Abstracts
information on LV myocardial contractility. sST2 is a novel biomarker of mechanical
stress, fibrosis, inflamation, and myocardial injury. Whether sST2 have colleration with
subclinical LV dysfunction assessed by GLS in AS is unknown.
Objectives: To study correlation beetwen sST2 and GLS in patients with severe AS and
preserved EF.
Methods: This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area ,1.0 cm2) with preserved EF (.50%). A comprehensive transthoracic echocardiography was performed to evaluate AS severity, and
GLS was measurred by offline analysis. sST2 measurements was performed immediatly
after echocardiography.
Results: Twenty nine patient were enrolled in this study. The mean ages was 59.7 + 12.1
years. mean EF was 64.7 + 9.9. left ventricle intrinsic myocardial contractility was
decreased with mean GLS 211 + 4.5%. A Pearson correlate revealed significant positive
correlation between sST2 and GLS (r ¼ 0.429, p ¼ 0.02). Multivariate analysis with
introduced confounding factor still showed a positive correlation between sST2 and
GLS (r ¼ 0,282, p ¼ 0.036).
Conclusion: The level of soluble sST2 has a correlation with global longitudinal strain
speckle tracking in patients with severe AS and preserved EF.
Keywords: sST2 † global longitudinal strain † severe aortic stenosis
Remote ischemic conditioning reduce final infarct size in ST-segment elevation
myocardial infarction patient with succesful TIMI 3 flow primary percutaneous
coronary intervention
L.N.E. Waliy, F.A. Muslim, S. Soerianata, M. Kasim, and A.M. Soesanto
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas
Indonesia National Cardiovascular Center Harapan Kita
Background: Reperfusion injury during PPCI contributes up to 50% of the final myocardial
infarct size. Therefore, novel therapeutic interventions are required to protect the heart
against myocardial reperfusion injury. Remote ischemic conditioning has emerged as a
simple, low cost, non-invasive intervention for protecting the heart against acute ischemia-reperfusion injury.
Objectives: To determine whether RIC initiated prior to PPCI could reduce myocardial
infarct MI size in patients presenting with ST-segment elevation myocardial infarction
with postprocedural TIMI 3 flow.
Methods: We randomly assigned 117 ST-segment elevation myocardial infarction
patients with onset less than 12 hours to receive RIC (4 5-min cycles of cuff inflation/deflation on lower extremities) or control (uninflated cuff for 40 minutes) protocols prior to PPCI. After PPCI, we excluded subjects with TIMI , 3. The primary study
endpoint was final infarct size, measured by CMR in 40 subjects on weeks 4 to 6 after
admission. Secondary endpoint was the left ventricular ejection fraction assessed
by CMR.
Result: RIC reduced MI size by 35%, when compared with control subjects (14,7% [n ¼ 19]
vs 22,7% [n ¼ 21]; p ¼ 0.049) in STEMI patient underwent PPCI. There was no significant difference in LV function at 4 to 6 weeks after admission (EF CMR, 52,6% versus
48,3%; p ¼ 0,476) between the RIC and control groups.
Conclusion: This randomized study demonstrated that RIC, initiated prior to PPCI,
reduced final MI size in ST-segment elevation myocardial infarction patients treated by
PPCI with good postprocedural TIMI flow. However, it has no effect on left ventricular
function.
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Keywords: acute myocardial infarction † cardiovascular magnetic resonance † infarct
size † primary percutaneous coronary intervention † remote ischemic conditioning †
reperfusion injury
Elevated plasma interleukin-6 associates with left ventricular diastolic
dysfunction by tissue doppler imaging in chronic heart failure
S.R. Siswardana 1, A.M. Soesanto 2, A.S. Kuncoro 2, R. Sukmawan2, K.B Nadha 3, W. Wita 3,
and A. Santoso 2
1
Department of Cardiology and Vascular Medicine, Saiful Anwar Hospital, Faculty of Medicine, Brawijaya University, East Java, Indonesia, 2Department of Cardiology and Vascular
Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia, 3Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia
Background: Inflammatory responses have been known playing a role in heart failure.
However, the association of inflammatory response and intrinsic LV diastolic function in
chronic heart failure was not clearly elucidated. We sought to investigate the correlations of inflammation, mediated by plasma interleukin-6 (IL-6) and hs-CRP and LV intrinsic
diastolic function measured by Tissue Doppler Imaging (TDI) Echocardiography in chronic
heart failure.
Methods: We studied 53 subjects (58.96 + 11.01 years, 75.5% male) with chronic heart
failure. We compared their TDI echo findings and their laboratory results.
Result: There was an inverse correlation between plasma IL-6 and septal and lateral wall
e′ velocity (r ¼ 20.341; p ¼ 0.012). In addition, there was a significant positive correlation between plasma IL-6 and septal and lateral wall E/e′ ratio representing LV filling
pressure (r ¼ 0.426; p ¼ 0.001). After being adjusted, plasma IL-6 was significantly
correlated with variables of diastolic function.
Conclusions: The plasma IL-6 as inflammation marker correlates with e′ velocity and E/e′
ratio as LV intrinsic diastolic function in chronic heart failure.
Keywords: Interleukin-6 † left ventricular diastolic dysfunction † tissue Doppler
imaging † chronic heart failure
Association between serum ST2 levels and early myocardial fibrosis in
disglycemic patients
T.I.M. Perdan, S. Adiarto, M. Kasim, B.B. Siswanto, and A.M. Soesanto
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas
Indonesia – National Cardiovascular Center Harapan Kita
Background: Disglycemia is a state of glucose intolerance include increased blood sugar
levels associated with risk of cardiovascular disease. Over time, eventually diabetes will
cause damage to the target organ, especially the cardiovascular system, which include
coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease,
and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart
failure. Gold standard examination to detect the occurrence of early myocardial fibrosis
is histopathological examination of myocardial tissue via biopsy. However, these tests are
very invasive and uncomfortable for the subject. Examination which later evolved is
imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are
Figure 1 Scatter plot of IL-6 and mean E/e′ ratio (n ¼ 27; r ¼ -0.53; r2 ¼ 0.28; p ¼ 0.004; CI ¼ 95%; SEE ¼ 0.17); and IL-6 and mean e′ velocity (n ¼ 27; r ¼ 0.67; r2 ¼ 0.45; p ¼ 0.000;
CI ¼ 95%; SEE ¼ 0.15), both were adjusted for old myocardial infarction.
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quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac
enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available.
Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial
fibrosis in disglycemic patients.
Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular
comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI.
Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time.
Results: A total of 35 patients were included in this study. The range values of serum ST2
levels were between 12.40-53.22 ng/dL (median 19.97 ng/dL). The mean value of T1 relaxation time were 439.38 + 114.16 ms. There is a significant correlation between serum
levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r ¼ -0.543, p ,0.01).
Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r ¼ -0.428, p ¼ 0.032).
Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic
population.
Keywords: dysglycemia † diabetic cardiomyopathy † diffuse myocardial fibrosis †
ST2 serum † T1 relaxation time
Effect of respiratory training as adjuvant exercise training for improving
pulmonary function and functional capacity among patients undergoing second
phase cardiovascular rehabilitation after coronary artery bypass graft surgery
V. Rossimarina, B. Radi, D.A. Hanafy, and A.M. Soesanto
Department of Cardiology and Vascular Medicine, Universitas Indonesia, Jakarta,
Indonesia
Background: Patients undergoing coronary artery bypass graft (CABG) surgery develop
pulmonary dysfunction due to inflammation and respiratory muscle weakness, hence
ventilation/perfusion mismatch occurs then leads to low functional capacity. Respiratory
training has been identified to improve functional capacity by recovering pulmonary
function faster.
Objectives: To study respiratory training benefit as adjuvant training in 2nd phase of cardiovascular rehabilitation program after CABG in order to improve pulmonary function
measured by maximum inspiratory volume (MIV) and functional capacity measured by
6 minutes walk test (6MWT) distance.
Methods: This single blind clinical trial randomized subjects into intervention group or
standard group. Intervention group received 10-12 sessions (30 minutes for each
Abstracts
session) respiratory training up to 60% MIV as an adjuvant to the standard program in
our hospital. Then MIV and 6MWT distance were evaluated.
Result: Twenty eight subjects participated, 14 subjects were in intervention group
and others were in standard group. Intervention group experienced better MIV improvement compared to standard group (1357 + 691.4 VS. 589 + 411.5 mL;
p ¼ ,0.001). However, 6MWT distance tended to improve better in intervention
group but the difference was not significant (67 + 62.9 VS. 53 + 65.7 meters respectively; p ¼ 0.556). This might be influenced by small sample size and inadequate
respiratory training exposure.
Conclusion: Respiratory training as adjuvant training improves pulmonary function
faster, however 6MWT distance between group was not yet significantly different.
Keywords: Respiratory training † coronary artery bypass graft surgery † second phase
cardiovascular rehabilitation † pulmonary dysfunction † 6 minutes walk test distance
Expression of IL-10 on mitral valve and myocardium in patients with rheumatic
mitral valve disease
Y. P. Rachmawan 1, I. Uddin2, S. Fatah 2, Y. Herry2, and S. Rifqi2
1
Faculty of Medicine, University of Diponegoro, Semarang, Indonesia, 2Dr. Kariadi Central
General Hospital Semarang, Indonesia
Background: The pathophysiology of rheumatic heart disease (RHD) is still not completely understood. The progressive and persistent inflammatory process on the cardiac valves
compared to the myocardium in RHD is suspected to be related to the different expression
of IL-10 as an anti-inflammatory cytokine.
Objective: This study aims to evaluate the difference of IL-10 expression on mitral valve
and myocardium in patients with rheumatic mitral valve disease (RMVD).
Methods: A cross sectional study in which mitral valves and anterior papillary muscles
were obtained from 20 RMVD patients undergoing mitral valve replacement surgery at
Dr. Kariadi Central General Hospital. IL-10 expressing cells were detected by using immunohistochemical staining technique.
Results: Seventy percent of 20 samples has shown lower IL-10 expression on the mitral
valve compared to the myocardium. IL-10 expression on mitral valve and myocardium
were significantly different, p ¼ 0.001 (p , 0.05). IL-10 expression on mitral valve was
not correlated with sex, age and cardiac rhythm.
Conclusion: This study showed that expression of IL-10 at the mitral valve significantly
lower than the myocardium, which may play a role in the progression of valve damage
in patients with RMVD.
Keywords: Interleukin-10 † mitral valve † rheumatic heart disease