Background: Coronary artery calcification reflects the chronic burden of atherosclerosis and contributes to procedural complexity during Percutaneous Coronary Intervention (PCI). While coronary calcium has been extensively studied using Computed Tomography (CT), data on Intravascular Ultrasound (IVUS)-derived calcium characteristics in Southeast Asian populations remain limited. The Southeast Asian population, particularly Indonesians, may exhibit distinct patterns of atherosclerosis influenced by genetic, lifestyle, and metabolic factors. Therefore, we sought to investigate the association between cardiovascular risk factors and IVUS-derived total coronary calcium score in an Indonesian population. Methods: This single-center, retrospective observational study included consecutive patients who underwent IVUS-guided PCI between January 2020 and December 2021. Data on patient demographics and cardiovascular risk factors were obtained from medical records. The IVUS calcium scores recorded in the database were independently reanalyzed and validated by an experienced interventional cardiologist to ensure consistency and accuracy. Associations between cardiovascular risk factors and total IVUS calcium score were assessed using Spearman's rank correlation and the Kruskal–Wallis test.Results: A total of 111 patients were included in this study with a mean age of 61.3 ± 10.2 years; 72.1% were male. Hypertension was present in 60.4%, DM in 45.0%, dyslipidemia in 38.7%, and active smoking in 40.5%. The mean IVUS total calcium score was 1.93 ± 1.41. Among individual risk factors, dyslipidemia (ρ = 0.22, p = 0.021) and smoking (ρ = −0.24, p = 0.009) were significantly associated with calcium score. Patients with ≥2 risk factors had higher mean calcium scores (2.15 ± 1.35) compared with those with ≤1 risk factor (1.15 ± 1.33; p = 0.028). Conclusion: The total IVUS calcium score correlated significantly with the presence of dyslipidemia in this Indonesian population. A cumulative increase in cardiovascular risk factors was associated with greater coronary calcium burden, suggesting that multifactorial risk exposure plays an important role in coronary calcification in this population.

Background Non-responders account for 30% of patients receiving Cardiac Resynchronization Therapy (CRT). Optimization of CRT using Electrocardiographic (ECG) and Transthoracic Echocardiographic (TTE) guidance has been proposed as a strategy to enhance therapeutic efficacy in this subset. This case report presents a young female patient with advanced heart failure secondary to ischemic cardiomyopathy, highlighting the role of ECG- and TTE-guided CRT optimization in improving clinical and hemodynamic outcomes. Case Illustration A 37-year-old female presented with advanced heart failure. Her medical history was notable for recurrent episodes of acute coronary syndrome, multiple Percutaneous Coronary Interventions (PCIs), and Cardiac Resynchronization Therapy with Pacemaker (CRT-P) implantation, despite adherence to Guideline-Directed Medical Therapy (GDMT). On admission, the ECG demonstrated atrial sensing with consistent biventricular pacing. Laboratory evaluation revealed an elevated N-terminal pro–B-type natriuretic peptide (NT-proBNP) level of 5.462 pg/mL. TTE showed a severely reduced Left Ventricular Ejection Fraction (LVEF) of 20% and an absent A wave on mitral inflow Doppler, indicating impaired diastolic filling. Additionally, the Left Ventricular Outflow Tract (LVOT) Velocity Time Integral (VTI) was reduced to 7.4 cm, consistent with low forward stroke volume.Six months after the implantation, CRT optimization was performed using ECG and TTE guidance. Optimization resulted in a reduction of QRS duration to 129 ms, distinct separation of the mitral inflow E and A waves, an increase in LVOT VTI to 10.9 cm, and an improvement in functional capacity to New York Heart Association (NYHA) class III. Conclusion CRT optimization, guided by ECG or TTE, is critical in managing non-responders. In this case, it led to improved QRS duration, hemodynamics, and NYHA functional class. Routine reassessment should be considered in patients with persistent symptoms despite optimal GDMT to enhance clinical response.

Background: Heart valve disease is still a significant health burden in the world, including Indonesia. The postoperative outcome of mitral valve surgery is influenced by many things, including decreased right ventricular (RV) function, which is the most common complication. Several studies have shown that decreased RV function after mitral valve surgery is associated with long-term outcomes. TAPSE is a routine and easy measurement of RV systolic function. A decrease in TAPSE after cardiac surgery is common because of the effects of pericardiotomy, and does not necessarily reflect a decrease in RV ejection fraction (RVEF). Regardless of whether postoperative TAPSE values ​​indicate right ventricular systolic function or only due to the effects of pericardiotomy, it is still not clear whether postoperative TAPSE values ​​have a prognostic value to long-term mortality after mitral valve surgery. Therefore, the objective of this study is to obtain information regarding the relationship of TAPSE echocardiographic parameters after mitral valve surgery with long-term mortality. Methods: This is a retrospective cohort study, looking at the effect of TAPSE on outcome after mitral valve surgery. The analysis starts from the starting point of the study when the patient was discharged alive from the hospital after mitral valve surgery (operation period January 2016 – February 2017) to the end point of the study, which was June 30th, 2021 and the observed outcome was mortality from any cause. Results: Of the 266 study subjects, 11 subjects died within 4-5 years after mitral valve surgery, the mortality is 4%. Bivariate analysis was performed on several factors and no relationship was found between the analyzed variables and mortality. Conclusion: There is no relationship between mortality and TAPSE after mitral valve surgery.

In “Triglyceride Glucose Index as a Predictor of 30-Day Readmission and 6 Months Mortality After Hospitalization in Acute Decompensated Heart Failure” (Indonesian Journal of Cardiology, 44(2), 53-60. https://doi.org/10.30701/ijc.1380), there are an errors noted. An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1380. The error occurs only in the PDF; the DOI listed in the article metadata is already correct. An error also occurred in the author’s name. We have corrected the author’s name from “Vienna Rossiamarina” to “Vienna Rossimarina.” There is also an error in the page numbering on the first page of the article. At the top, it says “57-64,” but we have changed it to the correct page numbers (53-60). The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.1380

Background: Premature Ventricular Complexes (PVCs) are a common cardiac arrhythmia typically of benign nature. Their origin, the right ventricular outflow tract (RVOT), is often a point of interest due to its implications in treatment strategies. While the vast majority of PVC RVOT cases remain uneventful, there are isolated incidents that challenge this common perception. Continuous monitoring methods, such as the Holter monitor, have provided invaluable insights into the real-world dynamics of arrhythmias, capturing rare events that can be of paramount clinical significance. Case Illustration: A 60-year-old female, presented to Harapan Kita Hospital Jakarta in May with palpitations. Over several visits, physical examinations consistently indicated a heart within normal parameters, absent of murmurs or gallop. Successive ECGs revealed persistent PVCs of RVOT origin. Despite medical intervention, her arrhythmic pattern persisted. By September, her symptoms had diversified, including occasional chest pain, nausea, and dyspnea. An ECG, yet again, confirmed PVCs with RVOT origin. During a Holter monitoring session on September, a distressing sequence of events was captured. The monitor initially registered a non-sustained Ventricular Tachycardia (VT). which escalated to sustained VT, ventricular fibrillation, and culminating in asystole, marking the patient's final moments. Conclusions: The pathophysiological journey from benign PVCs of RVOT origin to a fatal arrhythmic event underscores the unpredictability and inherent dangers of cardiac arrhythmias. This case is a reminder of the critical importance of persistent monitoring, timely interventions, and the nuanced understanding of conditions conventionally deemed 'benign'.

In “Management of Decongestion in Acute Heart Failure: Time for a New Approach?” (Indonesian Journal of Cardiology, 43(2), 77-89. https://doi.org/10.30701/ijc.1381), there is an error noted. An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1381. The error occurs only in the PDF; the DOI listed in the article metadata is already correct. The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.1381

The number of morbidity and mortality caused by Pulmonary Embolism (PE) has increased as of recent. Diagnosing PE during pregnancy and postpartum period is particularly challenging given the overlapping symptoms with physiological changes of pregnancy. Recent evidence suggests that the pregnancy-adapted YEARS algorithm, combining clinical probability assessment with D-dimer measurement, may exclude PE without the need for thoracic imaging, thereby reducing unnecessary radiation exposure. This systematic review and meta-analysis intends to evaluate the diagnostic accuracy of the pregnancy-adapted YEARS algorithm in comparison with thoracic imaging among pregnant and postpartum individuals that are suspected of PE. Three databases were searched systematically, including PubMed, Scopus, and Cochrane. Eligible studies included pregnant or postpartum women suspected of having PE who were assessed with the YEARS algorithm, using CT pulmonary angiography (CTPA) or ventilation–perfusion (V/Q) scan as the reference standard. Risk of bias was assessed meticulously using the QUADAS-2 tool. Pooled sensitivity, specificity, as well as the area under the curve (AUC) were calculated by Meta-Disc utilizing a random-effects model. Five studies comprising 1,036 patients, ultimately with low risk of bias were included. The pregnancy-adapted YEARS algorithm showed a pooled sensitivity of 1.00 (95% CI: 0.94–1.00), pooled specificity of 0.12 (95% CI: 0.10–0.14), and an AUC of 0.72, which indicated adequate rule-out ability but limited utility for ruling in PE. The YEARS algorithm that has been adapted for pregnancy may be safely used as a screening tool in excluding PE in pregnant and postpartum women, thereby reducing unnecessary maternal and fetal exposure to radiation. However, confirmatory thoracic imaging remains essential for positive cases.

Background Acute myocardial infarction is relatively rare in young patients. The age of onset gradually decreases due to multiple risk factors. The causes of Myocardial Infarction (MI) among patients aged less than 45 can be divided into four groups: atheromatous coronary artery disease, non-atheromatous coronary artery disease, hypercoagulable states, and MI related to substance misuse. Case Illustration A 25-year-old female came to the emergency department with chest discomfort for the past 40 minutes, has a history of diabetes for the past 3 years, and a Polycystic Ovary Syndrome (PCOS) history. Her vital signs show elevated Blood Pressure (BP) 150/100 mmHg. ECG showed sinus rhythm with ST elevation in the anterior leads. Random Blood Glucose (RBG) was 477 mg/dL, High Sensitivity (HS)-troponin 403 ng/L, and blood ketone3.1 mmol/L. She was initially treated with: ticagrelor 180 mg, Acetosal 320 mg, insulin 4 u/hour. She was diagnosed with ST-Segment Elevation Myocardial Infarction (STEMI) and Diabetic Ketoacidosis (DKA). Coronary angiography revealed 95% stenosis in proximalLeft Anterior Descending (LAD) and was treated as the culprit lesion, while 85% stenosis in mid Right Coronary Artery (RCA) was considered as the residual stenosis. Primary Percutaneous Coronary Intervention (PCI) was initiated at the proximal LAD, and post-PCIangiography showed a good result with TIMI 3 flow to the distal LAD. Conclusion PCOS increases cardiovascular risk primarily by promoting insulin resistance and metabolic dysfunction. Young individuals suspected of elevated cardiovascular risk should undergo acomprehensive cardiometabolic evaluation. PCI remains the cornerstone treatment for STEMI across all ages due to its well-established mortality benefit.

Background Indonesia, the world's largest archipelago, faces significant challenges in equitable healthcare delivery due to its geographical and infrastructural disparities. Atherosclerotic Cardiovascular Disease (ASCVD) remains the leading cause of mortality, with over 659,000 deaths recorded in 2019. Effective dyslipidemia management is crucial for preventing adverse ASCVD events. Unfortunately, the lack of implementation of an updated national lipid management registry might hinder optimal strategy for the adverse events. This study evaluated dyslipidemia cholesterol management practices among high- and very high-risk patients across the country. Methods The study recruited 322 patients from eight centers across six provinces in Indonesia between May 2022 and March 2023. Patients were stratified based on the ASCVD risk and followed over three visits. Baseline clinical characteristics, lipid profiles, and treatment regimens were analyzed. Descriptive statistics summarized continuous and categorical variables, and low-density lipoprotein cholesterol (LDL-C) achievement was assessed. Results Of the 322 patients, 98.8% were very high-risk, with only 4.9% achieving <55 mg/dL and 21.2% achieving <70 mg/dL. Moderate-intensity statins were the most prescribed (51.2%), followed by high-intensity (36.6%). LDL-C reduction was most pronounced in private insurance patients, achieving a mean LDL-C of 69.8 mg/dL at the third visit compared to 98.9 mg/dL in National Health Insurance (Jaminan Kesehatan Nasional/JKN) participants. Missed visit rates increased over time, with 57.5% of patients missing the third visit, predominantly among JKN participants and low-income groups. Conclusion Majority of the population failed to achieve the recommended target of LDL-C levels. Dyslipidemia management in Indonesia remains suboptimal, with disparities driven by socioeconomic factors. Improved policies addressing medication availability, national lipid registry establishment, and equitable healthcare access are essential to enhance lipid management and reduce the burden of ASCVD in Indonesia.

Background: The implantation of a permanent pacemaker (PPM) can reduce right ventricular function. Echocardiography using speckle tracking can detect a decreasing in right ventricular function earlier. The value of right ventricular global longitudinal strain (RVGLS) based on the location of the pacemaker lead between the apex and non-apex was currently unknown, although the placement of the correct pacemaker lead location was very important for evaluating right ventricular dysfunction to prevent right heart failure. This study aims to determined the comparison of RVGLS between pacemaker lead position in patients with permanent pacemaker. Methods: This study was a nested case-control study to assess the comparison of RVGLS between pacemaker lead position in patients with permanent pacemaker, who were divided into the right ventricular apex group (RVA) and the non-right ventricular apex group (NRVA). This study used data from the pacemaker registry and medical records of patients who had undergone pacemaker implantation since June 2021. The shapiro-wilk normality test was performed before analyzing all numerical data, followed by an independent t-test or Mann-Whitney test to determine the differences between groups. Results: In this study, there were 38 patients with permanent pacemakers, consisting of 18 samples with RVA group and 20 samples with NRVA group. In this study, no significant differences were found in age, sex, diagnosis, comorbidities, therapy, pacemaker mode, baseline QRS duration, pacing burden, puncture site, and initial echocardiography between of two groups. There was a significant difference in paced QRS duration between the RVA and RVNA groups (160 + 20 ms vs 140 + 28 ms, p=0.024). Based on statistical analysis, there was a significant difference in the value of RVGLS in the RVA group compared to the RVNA group (-14.87+4.48% vs -18.40+3.21%, p=0.015). Conclusion: The position of the apex right ventricular lead resulted in a lower value of RVGLS compared to the position of the non-apex right ventricular lead.