E-Point Septal Separation as a Surrogate Marker for Global Longitudinal Strain in Predicting MACE after ST Elevation Myocardial Infarction

Background: Global Longitudinal Strain (GLS) is a sensitive measurement and has been studied as a parameter to assess myocardial deformity and had a prognostic value in STEMI patient, but this measurement is usually taken at echocardiography laboratory with software installed only, a simple parameter of systolic function that had been known is EPSS, the aim of this study is to determine the prognostic value of this simple parameter as a surrogate marker of myocardial deformity for mayor adverse cardiac event (MACE). Methods: This is an analytic observational study using ambispective cohort study, basic and echocardiographic data were collected from 66 adult subjects of acute STEMI from July 2016 until April 2017. Each subjects were followed-up for MACE (mortality, heart failure, ventricular arrhytmia and cardiogenic shock) 30 days since admission. Cut off point were taken from ROC curve. Statistical analysis test were used to examine the association between two variables and obtained odds ratio (OR) for EPSS. To obtain the degree of relationship between EPSS and GLS we were using corelation test with the value of p<0.05 was considered statistically significant. Result: In this study the optimum cut off value for EPSS was 7 mm with sensitivity and specificity of 72% and 71%, respectively. Bivariate analysis showed among EPSS >7 mm and GLS >-10,6% were associated with MACE in 30 days after STEMI. In multivariate analysis, GLS >-10,6% (OR 10,6 95%IK 2,5-44,7 p=0,001) and EPSS >7 mm (OR 5, 95%IK 1,12-22,56 p=0,035) remained significantly associated and had 83% probability for MACE in 30-days after STEMI. Using the corelation test we found that EPSS had a stronger relationship with GLS (r=0,795, p<0,001). Conclusion: Our data show that EPSS >7 mm had a strong relationship with myocardial deformity parameter and appears to be a strong predictor for MACE in 30-days after acute STEMI. Therefore, it can be taken earlier to help the cardiologist in emergency unit for futher appropriate management planning.   Abstrak Latar Belakang: Global Longitudinal Strain (GLS) adalah parameter deformitas miokardium yang telah banyak diteliti untuk menilai fungsi sistolik ventrikel kiri serta kaitannya terhadap prognosis pasien IMA-EST, sayangnya pemeriksaannya cenderung terbatas dilakukan di laboratu­rium ekokardiografi dengan alat ekokardiografi tertentu. Parameter fungsi sistolik lainnya yang cukup dikenal karena tekniknya yang sederhana dan dapat dilakukan di Unit Gawat Darurat adalah E-Point Septal Separation (EPSS), tujuan dari penelitian ini adalah melihat nilai prognosis EPSS sebagai indikator tidak langsung deformitas ventrikel kiri terdahap Kejadian Kardiovaskular Mayor (KKvM). Metode: Penelitian ini merupakan studi kohort ambispektif, 66 orang subjek IMAEST yang memenuhi kriteria inklusi dan eksklusi yang dirawat di Rumah Sakit Haji Adam Malik mulai Juli 2016 sampai April 2017 diambil data dasar dan ekokardiografinya, kemudian pasien diikuti selama 30 hari untuk KKvM (kematian, gagal jantung, aritmia ventrikel dan syok kardiogenik). Nilai titik potong EPSS diambil dari kurva ROC. Uji statistik dilakukan untuk menilai hubungan antara variabel untuk mendapatkan nilai rasio odds (RO) EPSS, uji korelasi digunakan untuk menilai kekuatan hubungan antara EPSS dengan GLS, p<0,05 dianggap bermakna. Hasil: Nilai titik potong EPSS yang didapatkan adalah 7 mm dengan sensitivitas 72%, spesifisitas 71%. Analisis bivariat menunjukkan nilai EPSS >7 mm dan GLS >-10,6% berhubungan dengan KKvM. Pada analisis multivariat, GLS >-10,6% (RO 10,6 95%IK 2,5-44,7 p=0,001) dan EPSS >7 mm (RO 5, 95%IK 1,12-22,56 p=0,035) secara signifikan tetap berhubungan dan memiliki probabilitas sebesar 83% dalam memprediksi KKvM 30 hari setelah IMAEST. Adapun nilai EPSS dan nilai GLS memiliki hubungan yang kuat (r=0,795, p<0,001). Kesimpulan: Data menunjukkan bahwa nilai EPSS >7 mm memiliki hubungan yang kuat dengan parameter deformitas ventrikel kiri dan suatu prediktor kuat pula terhadap KKvM dalam 30 hari setelah IMAEST. Hal ini menguntungkan kita sebagai klinisi karena dengan pemer­iksaan EPSS yang sederhana ini dapat menjadi indikator adanya deformitas miokardium ventrikel kiri yang bernilai prognosis sehingga dapat dilakukan lebih dini untuk dapat menentukan strategi tatalaksana pada pasien IMAEST

Posterior to Anterior Mitral Valve Leaflets Length Ratio as a Simple Parameter in Assessing the Severity of Mitral Stenosis

Background: Determining the severity of mitral stenosis is important for both prognostic and therapeutic reasons. TTE is the gold standard method for assessment of severity mitral stenosis by using planimetry and pressure half time (PHT). Planimetry is accurate but highly operator dependent. PHT is affected by changes in preload or left ventricular compliance. In this study, we evaluate the posterior to anterior mitral valve leaflets length ratio as a novel simple parameter that can be used in peripheral by using common ultrasound to assess the severity of MS. Methods: This cross-sectional study involved 75 patients with rheumatic mitral stenosis (MS) who evaluate echocardiography in Adam Malik Hospital . The severity of MS was classified by planimetry and PHT. The posterior to anterior mitral valve leaflets length ratio was obtained by dividing posterior mitral valve leaflet length to anterior mitral valve leaflets length in the parasternal long axis views at the end diastole. Results: Severe (61.3%), moderate (32%), mild (6.7 %) MS. There was a strong correlation with the posterior to anterior mitral valve leaflets length ratio and mitral valve area by planimetry in spearman correlation ( r=0.892, p<0.001). ROC analysis of the posterior to anterior mitral valve leaflets length ratio with cut-off point < 0.68 could predict severe MS with sensitivity of 97%, specificity of 93%, positive predictive value of 96%, LR (+) of 13.85. Intra-observer and intra-observer variability of this parameter was good (Kappa value of 0.7600.765) and significant (p< 0.001). Goodness of fit test with Hosmer-Lemeshow test showed this parameter fit with the data. Conclusion: The posterior to anterior mitral valve leaflets length ratio<0.68 can be used as a simple parameter in determining the severity of mitral stenosis with high sensitivity and specificity

A Significant Addition of Left Ventricular Fractional Shortening to Ejection Fraction correlated with Global Longitudinal Strain Value in Predicting Major Acute Cardiovascular Event in patients with Acute Coronary Syndrome

Background: Global longitudinal strain (GLS) was a proven predictor of systolic function improvement and myocardial remodeling after acute coronary syndrome (ACS) for a residual left ventricular function defined their prognosis. However, not all echocardiography devices are equipped by speckle tracking (STE) as compare to the availability of M-mode modality which capable on assessing fractional shortening (FS) instead. Methods: This study evaluated clinical and echocardiography parameters on myocardial infarction (MI) and non-MI ACS patients.&nbsp; Clinical outcome was defined as composite major acute cardiovascular event (MACE) on 6 months of follow up. Results: Over 145 patients, GLS&gt;-9.4% was found to be an independent predictor of MACE despite of troponin, age, ejection fraction (EF), prior reperfusion and infarct location [(HR 5.89 (1.82-16.51)]. There is negative correlation between FS and GLS (Spearman r -0,717; p&lt;0,01). By using logistic regression analyses, it was found that the addition of FS&lt;25% to biplane Simpson EF&lt;50% could be useful to rule in the presence of GLS&gt;-9.4% (AUC 0.831). Conclusion: GLS had a prognostic value in patients with ACS. Left ventricular conventional M-mode FS in addition to Simpson EF were well correlated with GLS as well they can be considered as an alternative in predicting the incident of MACE in patient with ACS. &nbsp; Keywords: global longitudinal strain, prognostic, fractional shortening, acute coronary syndromeLatar belakang: Global longitudinal strain (GLS) secara signifikan terbukti dapat digunakan sebagai prediktor perbaikan fungsi sistolik dan remodeling miokard pada pasien dengan sindroma koroner akut (SKA), dimana fungsi sistolik residual dari ventrikel kiri akan sangat mempengaruhi prognosis pasien. Namun, tidak semua alat ekokardiografi memiliki modalitas speckle tracking (STE) dibandingkan dengan ketersediaan modalitas M-mode yang dapat menghitung Fractional Shortening (FS). Metode: Penelitian ini mengevaluasi parameter klinis dan ekokardiografis ventrikel kiri pada pasien SKA dengan atau tanpa infark. Perjalanan klinis pasien akan dinilai ada tidaknya kejadian kardiovaskular mayor akut (KKVM) dalam waktu 6 bulan. Hasil: Dari 145 pasien, nilai GLS&gt;-9.4% didapatkan signifikan sebagai prediktor KKVM dan independen terhadap status troponin, umur, fraksi ejeksi, tindakan reperfusi, dan lokasi infark [(HR 5.89 (1.82-16.51)]. Terdapat korelasi negatif yang baik antara FS dan GLS (Spearman r -0,717; p&lt;0,01). Dengan menggunakan analisa regresi logistik, didapati bahwa penambahan parameter FS &lt;25% terhadap EF Simpson&lt;50% dapat digunakan untuk menginklusikan pasien dengan nilai GLS&gt;-9.4% (AUC 0.858). Kesimpulan: GLS memiliki nilai prognostik pada pasien SKA. Nilai FS ventrikel kiri konvensional yang didapatkan dari M-mode, jika ditambahkan pada EF Simpson, memiliki korelasi yang baik dengan GLS, sehingga dapat dipertimbangkan sebagai parameter alternatif yang dapat memprediksi KKVM pada pasien SKA Kata kunci: global longitudinal strain, prognosis, fractional shortening, sindroma koroner aku

Gambaran Pengetahuan Ibu Hamil Tentang Hiperemesis Gravidarum pada Trimester I Kehamilan

Background: Nausea and vomit are problems that often occur in the first trimester of pregnancy, and this can cause problems for pregnant women. Many people still have the perception that this is a normal occurrence, leading pregnant women to avoid medical examinations, resulting in potential side effects. This relates to the knowledge. Pregnant women with poor knowledge can lead to complications during pregnancy, while those with good knowledge will prevent complications. Objective: To describe pregnant women’s knowledge about hyperemesis gravidarum in the first trimester of pregnancy based on age, gravida, and academic. Methods: This research is an observational descriptive study with a cross-sectional research design, employing consecutive sampling method. Data were collected using primary data sources derived from questionnaire responses. Results: Based on data from 100 respondents, 28 people (28%) have good knowledge. 27 people (27%) have moderate knowledge. 45 people (45%) have poor knowledge. Conclusion: Most of pregnant women in this research belonged to the age group of 19-34 years, with primigravida and majority have poor knowledge. Keyword: Hyperemesis gravidarum, knowledge, pregnant women   Latar Belakang: Mual dan muntah merupakan masalah yang sering terjadi pada trimester pertama kehamilan dan hal ini dapat menimbulkan masalah pada ibu hamil. Masih banyak masyarakat yang memiliki pandangan bahwa hal tersebut normal terjadi, sehingga ibu hamil tidak melakukan pemeriksaan dan akan menimbulkan efek samping. Hal ini berkaitan dengan pengetahuan yang dimiliki oleh ibu hamil. Ibu hamil yang memiliki pengetahuan yang kurang terhadap hiperemesis gravidarum menyebabkan terjadinya komplikasi pada ibu hamil, sedangkan ibu hamil dengan pengetahuan yang baik akan mencegah terjadinya komplikasi. Tujuan: Untuk mengetahui tingkat pengetahuan ibu hamil terhadap hiperemesis gravidarum pada trimester I kehamilan berdasarkan usia, pendidikan terakhir dan gravida. Metode: Penelitian ini adalah penelitian deskriptif observasional dengan desain penelitian cross sectional. Pengambilan sampel dengan consecutive sampling. Data yang diambil menggunakan sumber data primer yang berasal dari pengisian kuesioner. Hasil: Berdasarkan data yang diperoleh dari 100 responden terdapat 28 orang (28%) memiliki pengetahuan baik. 27 orang (27%) memiliki pengetahuan cukup. 45 orang (45%) memiliki pengetahuan kurang. Kesimpulan: Mayoritas ibu hamil pada penelitian ini merupakan kelompok usia 19-34 tahun, dengan primigravida, dan mayoritas memiliki pengetahuan yang kurang. Kata Kunci: Hiperemesis gravidarum, ibu hamil, pengetahua

Corelation Between Sum of Precordial ST Depression in Acute Inferior Myocardial Infarction with Stenosis Severity of Left Anterior Descending Artery

Background : There were many studies proved that precordial ST depression in Inferior STEMI show LAD disease from angiografi, but there were also many who unproved . Altought LAD disease was not the main cause of precordial ST depression in Inferior STEMI, but there were many patients with Inferior STEMI who had high grade LAD disease. Sum of precordial ST depression is one of ECG criteria that can help us to prove it . The aim of this study in to know if there is corelation between sum of precordial ST depression with LAD disease and the severity of LAD disease in Inferior STEMI patients with precordial ST depression . Methods : We analized 60 patients inferior STEMI with precordial ST depression onset less than 24 hours that hospitalized in Haji Adam Malik General Hospital since December 2013-June 2017. Patients were divided in to 4 groups based on sum of precordial ST depression. Bivariate analysis were made to see the corelation between sum of precordial ST depression with LAD disease and severity of LAD, p value &lt; 0.05 is statistically significant.&nbsp; Result : Bivariate analysis show that there is strong corelation between sum of precordial ST depression with LAD disease (p=0.01). Sum of precordial ST depression also corelate with severity of LAD (p=0.01). There are also corelation with location of the lesion in proximal LAD and the complexity of the lesion but not statistically significant (p=0.233 and p=0.102). Analysis ROC curve&nbsp; sum of precordial ST depression to LAD disease give the cut off ≥5.15 mm with sensitivity 70% and spesificity 76.2%(AUC 0,752 ,95% CI: 0,620 – 0,883 p&lt;0,001) Conclusion : There is strong corelation between sum of precordial ST depression with high grade LAD disease. The more the sum of precordial ST depression the more posibility high degree LAD disease ( p=0.01)

Early detection of subclinical rheumatic heart disease through echocardiographic screening: a study in North Sumatra, Indonesia

BACKGROUND: Given the urgent need to address the significant morbidity and mortality associated with Rheumatic Heart Disease (RHD) in Indonesia, there is a growing interest in exploring cost-effective screening approaches, such as handheld echocardiography.OBJECTIVES: The purpose of this study was to ascertain the prevalence of RHD in North Sumatra, Indonesia.METHODS: This descriptive observational study was conducted within the population of North Sumatra from 2022 to 2023. Junior high school students aged 12 to 15 years were included from randomly selected schools in Langkat, Tebing Tinggi, and Labuhan Batu. Data collection encompassed various parameters, including social demographic information, parental characteristics, environmental factors, household details, anthropometric measurements, physical assessments, auscultation findings, and echocardiographic data. The data were analyzed descriptively.RESULTS: In our study, a total of 692 children were examined, with an average age of 12.9 years and a standard deviation of 1.1 years, among whom 42.5% were male. Utilizing echocardiographic evaluations, we identified RHD in four children, yielding a prevalence rate of 0.6%. Further examination of these cases revealed that the majority, accounting for three individuals (75%), exhibited borderline RHD, while one child (25%) presented with definite RHD.CONCLUSION: In our study population, the prevalence of RHD was 0.6%. A broader echocardiographic screening program is necessary to determine the overall prevalence of RHD, assess the disease burden, and identify individuals earlier to prevent adverse outcomes