Evaluation of Cardiometabolic Factors Affecting Chronotropic Incompetence: A Cross-Sectional Retrospective Study in Sanglah General Hospital, Bali

Background: Recent studies have identified that chronotropic incompetence is correlated with poor cardiometabolic health and systemic inflammation that results in exercise intolerance, impaired quality of life and death due to cardiovascular disease (CVD). Unfortunately, there’s still paucity of data regarding cardiometabolic factors associated with chronotropic incompetence. The purpose of this study was to identify the cardiometabolic factors associated with chronotropic incompetence. Methods: This study was a cross-sectional retrospective study using cardiac treadmill stress test data at Sanglah General Hospital from May 2018 - May 2020 and 136 patients were enrolled. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on cardiometabolic risk factors in chronotropic incompetence. Results: Patients were divided based on the characteristics of age, gender, smoking status, body mass index, coronary artery disease, heart failure, hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), the levels of HbA1C, total cholesterol, LDL, HDL, and triglyceride. In this study, it was found that T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), high total cholesterol (PR 2.396; 95%CI 1.650-3;481), and high LDL level (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related. Conclusion: Chronotropic incompetence can impair quality of life and contribute to cardiovascular mortality. However, T2DM, high HbA1C, dyslipidemia, high total cholesterol and LDL levels were found to be associated with chronotropic incompetence. This may contribute to higher cardiovascular risk attributed to those factors

Ratio C-Reactive Protein Terhadap Albumin Dalam Memprediksi Lauren Rumah Sakit Dan Jangka Panjang Pasien STEMI Dengan Infeksi SARS-CoV2 Yang Menjalani Terapi Fibrinolitik

Background: The choice of reperfusion therapy in STEMI patients with COVID-19 is unclear. CRP to Albumin ratio (CAR) found to be a predictor of thrombus burden. This study was to determine the relationship and predictive value of CAR to in-hospital and long-term outcome of STEMI patients with COVID-19 treated with fibrinolytic. Methods: 297 COVID-19 patients with STEMI underwent fibrinolytic were enrolled. In-hospital outcomes were in-hospital mortality due to cardiovascular death which was divided into mortality <48 hours and >48 hours, fibrinolytic failure, and cardiogenic shock. The presence of reinfarction post fibrinolytic and mortality after the patient discharged was assessed as the long-term outcome. Results: During follow-up, 19.8% experienced in-hospital mortality and 16.1% had reinfarction. In the in-hospital outcome, patients with in-hospital death, failed fibrinolytic and cardiogenic shock had higher CAR (6.7+2.4 vs 4.7+1.9; 6.3+1.9 vs 2.1+1.6; 5.5+2.1vs1.8+1.5) with all p-value <0.05. CAR with an optimal cut-off >4.46 can be a predictor of fibrinolytic failure with sensitivity of 86.7% and specificity of 93.6% (PR19.82; 95%CI 10.32-38.06) and predictor of in-hospital death <48 hours with sensitivity of 84.6% and specificity of 82.7% (PR5.02; 95%CI 3.20-7.90). In the long-term outcome, patients who experienced reinfarction and out-hospital death had higher CAR (5.1+1.2vs2.5+2.4; 5.2+1.3vs2.6+2.4) than those who did not experience the event respectively with all p-value <0.05. CAR with an optimal cut-off >3.67 can be predictor of reinfarction with sensitivity of 87.5% and specificity of 73.5% (PR12.250; 95%CI 5.38-27.87). The Cox regression model showing CAR >3.67 was also associated with higher reinfarction event (p=0.001). Conclusion: CAR has the potential to be a predictor of in-hospital and long-term outcomes for STEMI patients with COVID-19 which can help determine which patients need more invasive strategy to prevent mortality and morbidity.Latar Belakang: Pemilihan terapi reperfusi pada pasien STEMI dengan COVID-19 masih belum jelas. Rasio CRP terhadap Albumin (CAR) ditemukan sebagai prediktor beban trombus. Penelitian ini bertujuan untuk mengetahui hubungan dan nilai prediktif CAR terhadap outcome rawat inap dan jangka panjang pasien STEMI COVID-19 yang diobati dengan fibrinolitik. Metode: 297 pasien COVID-19 dengan STEMI yang menjalani fibrinolitik terinklusi pada studi. Outcome di rumah sakit adalah mortalitas di rumah sakit akibat kematian kardiovaskular yang dibagi menjadi mortalitas <48 jam dan >48 jam, kegagalan fibrinolitik, dan syok kardiogenik. Kehadiran reinfarction pasca fibrinolitik dan kematian setelah pasien dipulangkan dinilai sebagai hasil jangka panjang. Hasil: Selama masa tindak lanjut, 19,8% mengalami kematian di rumah sakit dan 16,1% mengalami reinfark. Dalam hasil di rumah sakit, pasien dengan kematian di rumah sakit, gagal fibrinolitik dan syok kardiogenik memiliki CAR yang lebih tinggi (6,7+2.4 vs 4.7+1.9; 6.3+1.9 vs 2.1+1.6; 5.5+2.1vs1.8+1.5) dengan semua nilai p < 0,05. CAR dengan cut-off optimal >4,46 dapat menjadi prediktor kegagalan fibrinolitik dengan sensitivitas 86,7% dan spesifisitas 93,6% (PR19,82; 95%CI 10,32-38,06) dan prediktor kematian di rumah sakit <48 jam dengan sensitivitas sebesar 84,6% dan spesifisitas 82,7% (PR5.02; 95%CI 3,20-7,90). Dalam hasil jangka panjang, pasien yang mengalami reinfark dan kematian di luar rumah sakit memiliki CAR lebih tinggi (5.1+1.2vs2.5+2.4; 5.2+1.3vs2.6+2.4) dibandingkan mereka yang tidak mengalami kejadian tersebut masing-masing dengan semua p -nilai <0,05. CAR dengan cut-off optimal >3,67 dapat menjadi prediktor reinfark dengan sensitivitas 87,5% dan spesifisitas 73,5% (PR12.250; 95%CI 5.38-27.87). Model regresi Cox yang menunjukkan CAR >3,67 juga dikaitkan dengan kejadian reinfark yang lebih tinggi (p=0,001). Kesimpulan: CAR berpotensi menjadi prediktor hasil rawat inap dan jangka panjang pasien STEMI dengan COVID-19 yang dapat membantu menentukan pasien mana yang memerlukan strategi lebih invasif untuk mencegah mortalitas dan morbiditas