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Soesanto AM, Almazini P, Ariani R, Rudiktyo E, Ardini TW, Mumpuni H, Lefi A, Ghaznawie AF, Sari NMAW, Yanni M, Purwaningtyas N, Harjoko RP, Hasan M, Nauli SE, Laitupa FS, Muchtar N, Karolina W, Puspita I, Haezer Reppi GE, Syahlul DE, Rahmianti ND, Minaswary R, Hanifah Y, Kuncoro AS. Characteristics and Problems of Rheumatic Heart Disease in Indonesia: The Ina-RHD Multicenter Study. JACC. ASIA 2025:S2772-3747(25)00199-1. [PMID: 40366320 DOI: 10.1016/j.jacasi.2025.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 03/04/2025] [Accepted: 03/11/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND Rheumatic heart disease (RHD) presents a significant public health challenge. Unfortunately, there is a lack of national data regarding the incidence and prevalence of RHD in Indonesia. OBJECTIVES The purpose of this study was to evaluate the characteristics, burdens, and problems of RHD in Indonesia. METHODS We collected medical reports of RHD patients over 18 years of age from 21 hospitals. Secondary data about clinical and echocardiography was collected to describe the characteristics, disease conditions, and complications of the disease. RESULTS We recruited 3,431 patients, average age was 44 years, and 64.4% (2,209 of 3,431) were women. Dyspnea was found in 85.7% (2,939 of 3,431), and 25% (862 of 3,431) of patients with NYHA functional class III to IV. Isolated mitral stenosis was the most prevalent valve lesion in 1,357 of 3,431 patients (39.6%). A total of 62.5 % (2,146 of 3,431) of patients had atrial fibrillation (AF), with the highest prevalence being in MV lesions. Vitamin K antagonist was prescribed in 2,411 of 3,431 (70.3%) of patients. A history of stroke was reported in 227 of 3,431 (6.6%) of patients and most frequently happened in isolated mitral stenosis patients 128 of 1,357 (9.4%). Finally, secondary prophylaxis was only administered in 1,279 of 3,431 (37.3%) of patients, and only 23.2% (796 of 3,431) had it regularly. CONCLUSIONS Our patients were predominantly women and had isolated mitral stenosis. Many patients came at a later stage of the disease, with older average age, a high prevalence of AF, pulmonary hypertension, and right heart involvement. The challenges were suboptimal use of anticoagulation despite the high prevalence of AF and underused secondary prophylaxis.
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Affiliation(s)
- Amiliana Mardiani Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
| | - Prima Almazini
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Universitas Indonesia Hospital, Depok, Indonesia
| | - Rina Ariani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Tengku Winda Ardini
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sumatera Utara/Adam Malik Hospital, Medan, Indonesia
| | - Hasanah Mumpuni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Sardjito Hospital, Yogyakarta, Indonesia
| | - Achmad Lefi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga/Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Aussie Fitriani Ghaznawie
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University/Dr Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Ni Made Ayu Wulan Sari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana/Ngoerah Hospital, Denpasar, Indonesia
| | - Mefri Yanni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas/Dr M. Djamil General Hospital, Padang, Indonesia
| | - Niniek Purwaningtyas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/Dr Moewardi General Hospital, Solo, Indonesia
| | - Rille Puspitoadhi Harjoko
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Diponegoro/Kariadi Hospital, Semarang, Indonesia
| | - Melawati Hasan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Siti Elkana Nauli
- Department of Cardiology and Vascular Medicine, Tangerang District Hospital, Tangerang, Indonesia
| | - Fitranti Suciati Laitupa
- Department of Cardiology and Vascular Medicine, Dr Iskak General Hospital, Tulungagung, Indonesia
| | - Novita Muchtar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Syiah Kuala/Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Wella Karolina
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya/Dr Saiful Anwar General Hospital, Malang, Indonesia
| | - Indah Puspita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Gratiani Eben Haezer Reppi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sam Ratulangi/R. D. Kandou General Hospital, Manado, Indonesia
| | - Dyna Evalina Syahlul
- Department of Cardiology and Vascular Medicine, Gatot Soebroto Central Army Hospital, Jakarta, Indonesia
| | - Nia Dyah Rahmianti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga/Airlangga University Hospital, Surabaya, Indonesia
| | - Rinelia Minaswary
- Department of Cardiology and Vascular Medicine, Arifin Achmad General Hospital, Pekanbaru, Indonesia
| | - Yasmina Hanifah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Persahabatan General Hospital, Jakarta, Indonesia
| | - Ario Soeryo Kuncoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Rudiktyo E, Teske AJ, Yonas E, Ambari AM, Cramer MJ, Guglielmo M, Semino T, Siswanto BB, Doevendans PA, Soesanto AM. Upstream and Downstream Cardiovascular Changes in Rheumatic Mitral Stenosis: An Update. J Clin Med 2025; 14:2639. [PMID: 40283468 PMCID: PMC12027831 DOI: 10.3390/jcm14082639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 03/06/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025] Open
Abstract
Rheumatic heart disease (RHD) and its complications are major health problems worldwide, especially in developing countries, owing to their high prevalence. Mitral stenosis (MS) is one of the most common lesions in RHD, either isolated or in combination with mitral regurgitation, and eventually leads to atrial fibrillation (AF), congestive heart failure, pulmonary hypertension (PH), and other complications, including ischemic stroke or limb ischemia, if not promptly diagnosed and treated. Recent studies have suggested that MS affects the cardiovascular system beyond mere obstructions. The presence of MS in RHD causes significant changes in the cardiovascular system, both upstream and downstream, affecting both the left and right ventricles. Rheumatic MS causes significant structural changes through inflammatory pathways and hemodynamic changes, owing to its obstructive effects. This review aims to discuss the vast changes in the cardiovascular system caused by rheumatic MS.
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Affiliation(s)
- Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia—National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia; (E.R.); (E.Y.); (A.M.A.); (B.B.S.); (A.M.S.)
| | - Arco J. Teske
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (A.J.T.); (M.J.C.); (P.A.D.)
| | - Emir Yonas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia—National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia; (E.R.); (E.Y.); (A.M.A.); (B.B.S.); (A.M.S.)
| | - Ade M. Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia—National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia; (E.R.); (E.Y.); (A.M.A.); (B.B.S.); (A.M.S.)
| | - Maarten J. Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (A.J.T.); (M.J.C.); (P.A.D.)
| | - Marco Guglielmo
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (A.J.T.); (M.J.C.); (P.A.D.)
| | - Tommaso Semino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, 16126 Genova, Italy;
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia—National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia; (E.R.); (E.Y.); (A.M.A.); (B.B.S.); (A.M.S.)
| | - Pieter A. Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (A.J.T.); (M.J.C.); (P.A.D.)
- Central Military Hospital, 3584 Utrecht, The Netherlands
- Netherlands Heart Institute, 3511 Utrecht, The Netherlands
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia—National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia; (E.R.); (E.Y.); (A.M.A.); (B.B.S.); (A.M.S.)
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Soesanto AM, Rudiktyo E, Tjubandi A, Ariani R, Azzahra FN, Adam MF, Kuncoro AS. Clinical Outcome of Rheumatic Mitral Valve Repair and Replacement Surgery in Indonesia; A Comparison with Non-Rheumatic Aetiology. Glob Heart 2024; 19:4. [PMID: 38222099 PMCID: PMC10786046 DOI: 10.5334/gh.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Mitral valve repair (MVr) has been shown to achieve better outcomes than mitral valve replacement (MVR) in degenerative aetiology. However, that cannot be applied in rheumatic mitral valve disease. Therefore, this study aims to evaluate early and late clinical outcomes and mid-term survival in RHD compared to the non-RHD group and whether mitral valve repair is a better surgical approach in RHD patients. Methods Patients who underwent mitral valve surgery with or without coronary artery bypass grafting were included in this study. All patients were divided into the RHD and non-RHD group by the type of mitral surgery performed. Early and late outcomes were evaluated, and mid-term cumulative survival was reported. Results A total of 1382 patients post MV surgeries were included. The 30-day mortality was significantly higher in the RHD group compared to the non-RHD group (8.7% vs. 4.4%, p = 0.003). There was no difference in 30-day mortality between repair and replacement in each respective group. During follow-up (12-54 months), all-cause mortality between RHD and non-RHD groups (16.7% vs. 16.2%) was not different. In the RHD group, the survival of MVr was 85.6% (95% CI 82.0%-88.5%), and MVR was 78.3% (95% CI 75.8%-80.6%), p-value log rank 0.26 However, in the non-RHD group, patients who underwent MVr had better survival than MVR, with cumulative survival of 81.7% (95% CI 72.3%-88.2%) vs. 71.1% (95% CI 56.3%-81.7%) p-value log rank 0.007. Conclusion Early mortality rate in rheumatic mitral valve surgery was higher than in non-rheumatic valve surgery. Although in rheumatic MV disease MV repair did not show a significant survival advantage over MV replacement, a trend towards more favourable survival in the repair group was observed.
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Affiliation(s)
- Amiliana Mardiani Soesanto
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Estu Rudiktyo
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Amin Tjubandi
- Adult Cardiac Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Rina Ariani
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | | | - Mochammad Faisal Adam
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
| | - Ario Soeryo Kuncoro
- Dept. Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta Barat, DKI Jakarta, Indonesia
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Putra TMH, Rodriguez-Fernandez R, Widodo WA, Elfiana M, Laksono S, Nguyen QN, Tan JWC, Narula J. Myocardial fibrosis in rheumatic heart disease: emerging concepts and clinical implications. Front Cardiovasc Med 2023; 10:1230894. [PMID: 37564912 PMCID: PMC10411611 DOI: 10.3389/fcvm.2023.1230894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Rheumatic heart disease (RHD) remains a significant cardiovascular burden in the world even though it is no longer common in affluent countries. Centuries of history surrounding this disease provide us with a thorough understanding of its pathophysiology. Infections in the throat, skin, or mucosa are the gateway for Group A Streptococcus (GAS) to penetrate our immune system. A significant inflammatory response to the heart is caused by an immunologic cascade triggered by GAS antigen cross-reactivity. This exaggerated immune response is primarily responsible for cardiac dysfunction. Recurrent inflammatory processes damage all layers of the heart, including the endocardium, myocardium, and pericardium. A vicious immunological cycle involving inflammatory mediators, angiotensin II, and TGF-β promotes extracellular matrix remodeling, resulting in myocardial fibrosis. Myocardial fibrosis appears to be a prevalent occurrence in patients with RHD. The presence of myocardial fibrosis, which causes left ventricular dysfunction in RHD, might be utilized to determine options for treatment and might also be used to predict the outcome of interventions in patients with RHD. This emerging concept of myocardial fibrosis needs to be explored comprehensively in order to be optimally utilized in the treatment of RHD.
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Affiliation(s)
| | | | - Wishnu Aditya Widodo
- Department of Cardiology and Vascular Medicine, Jakarta Heart Center, Jakarta, Indonesia
| | - Maria Elfiana
- Research Unit, Jakarta Heart Center, Jakarta, Indonesia
| | - Sidhi Laksono
- Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang, Indonesia
| | | | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Rudiktyo E, Yonas E, Cramer MJ, Siswanto BB, Doevendans PA, Soesanto AM. Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation. Glob Heart 2023; 18:15. [PMID: 36936249 PMCID: PMC10022539 DOI: 10.5334/gh.1192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/16/2023] [Indexed: 03/19/2023] Open
Abstract
Background Mitral regurgitation (MR) burdens the left and right ventricles with a volume or pressure overload that leads to a series of compensatory adaptations that eventually lead to ventricular dysfunction, and it is well known that in rheumatic heart disease (RHD) that the inflammatory process not only occurs in the valve but also involves the myocardial and pericardial layers. However, whether the inflammatory process in rheumatic MR is associated with ventricular function besides hemodynamic changes is not yet established. Purpose Evaluate whether rheumatic etiology is associated with ventricular dysfunction in patients with chronic MR. Methods The study population comprised patients aged 18 years or older included in the registry who had echocardiography performed at the National Cardiovascular Center Harapan Kita in Indonesia during the study period with isolated primary MR due to rheumatic etiology and degenerative process with at least moderate regurgitation. Results The current study included 1,130 patients with significant isolated degenerative MR and 276 patients with rheumatic MR. Patients with rheumatic MR were younger and had a higher prevalence of atrial fibrillation and pulmonary hypertension, worse left ventricle (LV) ejection fraction and tricuspid annular plane systolic excursion (TAPSE) value, and larger left atrium (LA) dimension compared to patients with degenerative mitral regurgitation (MR). Gender, age, LV end-systolic diameter, rheumatic etiology, and TAPSE were independently associated with more impaired LV ejection fraction. Whereas low LV ejection fraction, LV end-systolic diameter, and tricuspid peak velocity (TR) peak velocity >3.4 m/s were independently associated with more reduced right ventricle (RV) systolic function (Table 3). Conclusions Rheumatic etiology was independently associated with more impaired left ventricular function; however, rheumatic etiology was not associated with reduced right ventricular systolic function in a patient with significant chronic MR.
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Affiliation(s)
- Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Emir Yonas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Maarten J. Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bambang B. Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Pieter A. Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
- Central Military Hospital Utrecht, the Netherlands
- Netherlands Heart Institute Utrecht the Netherlands
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Tayal B, Freeman P, Ericsson F, Kragholm KH, Andersen NH, Hagendorff A, Aaroe J, Sogaard P, Zaremba T. Characterisation of patients with and without cardiac magnetic resonance imaging abnormalities presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA). Acta Cardiol 2021; 76:760-768. [PMID: 32594904 DOI: 10.1080/00015385.2020.1785134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of the current study is to determine the characteristics of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients with and without cardiac magnetic resonance (CMR) abnormalities. METHODS We evaluated patients admitted with a presentation of acute myocardial infarction (MI) with no coronary obstruction on invasive angiography in our institution between 2012 and 2017. Patients with prior cardiac disease, myocarditis, Takotsubo cardiomyopathy and type 2 myocardial infarction were excluded. Myocardial fibrosis was determined by late gadolinium enhancement (LGE). Patients were divided into two groups based on the presence or absence of CMR abnormalities (LGE or oedema). Major adverse cardiovascular events (MACE) were defined as non-fatal MI, all-cause mortality, ventricular arrythmias or heart failure hospitalisation at follow-up. RESULTS Thirty-four patients fulfilling the inclusion criteria were identified. Myocardial changes with CMR were observed in 20 (59%) patients with signs of subendocardial infarct by LGE in 13 (38%) patients, transmural infarct by LGE in 6 (18%) patients and one patient had myocardial oedema. ECG and echocardiographic features were similar between patients with and without CMR abnormalities. Troponin T was significantly higher among patients with CMR abnormalities. The median duration of follow-up was 702 (IQR 456-1394) days. Two patients had MACE (both heart failure). One of them had LGE changes. CONCLUSIONS A significant number of patients with MINOCA have ischaemic LGE changes or myocardial wall oedema. The patients with CMR abnormalities have similar ECG and echocardiographic features except higher biomarker, highlighting the role of CMR in patients with MINOCA.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Filip Ericsson
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Jens Aaroe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Schreiber JM, Frank LH, Kroner BL, Bumbut A, Ismail MO, Gaillard WD. Children with refractory epilepsy demonstrate alterations in myocardial strain. Epilepsia 2020; 61:2234-2243. [PMID: 33053223 DOI: 10.1111/epi.16652] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/18/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test whether children with epilepsy have impairments in myocardial mechanics compared to controls without epilepsy. METHODS Children with refractory epilepsy with epilepsy duration of at least 3 years underwent echocardiography including conventional measurements and speckle tracking to assess longitudinal and circumferential strain. Parent-completed surveys, capturing critical aspects of the children's seizure history and cardiac risk factors, complemented retrospective chart reviews, which also included antiepileptic drug history. Normal echocardiograms from controls, matched for age and gender, were obtained from our institutional database and evaluated for strain. RESULTS Forty-one patients (median age = 10 years, interquartile range [IQR] = 5-15; 58.5% male) were enrolled. Epilepsy etiology included genetic (n = 26), structural (n = 6), genetic and structural (n = 5), infection (n = 3), and unknown (n = 1). No cardiac structural abnormalities were identified. Both longitudinal and circumferential strain were impaired (P < .03) in patients compared to controls (median [IQR] = 22.7% [21.2-24.2] vs 23.6% [22.2-26.1] and 22.0% [20.3-25.4] vs 24.5% [22.3-27.0], respectively), indicating decreased myocardial deformation/contraction. Shortening fraction was higher in patients (37.6% [35.7-39.7] vs 34.9% [32.5-38.7], P = .009); mitral valve E wave inflow velocity (84.8 cm/s [78.4-92.8] vs 97.2 cm/s [85.9-105.8], P = .005) and tissue Doppler lateral E' wave (13.9 cm/s [12.3-16.1] vs 17.3 cm/s [15.4-18.5], P < .001) were decreased compared to controls. Findings were similar in the pairs with epilepsy patients distinguished by the ability to independently ambulate. There was no difference between patients and controls in ejection fraction. Among the epilepsy patients, there were no associations between cardiac measurements and epilepsy characteristics, including seizure type and frequency and cardiotoxic antiseizure medication exposure after correction for multiple comparisons. SIGNIFICANCE Children with refractory epilepsy had impaired systolic ventricular strain compared to controls, not correlated with epilepsy history. Further studies are needed to determine the significance of these changes.
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Affiliation(s)
- John M Schreiber
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - Lowell H Frank
- Department of Cardiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Barbara L Kroner
- Division of Biostatistics and Epidemiology, RTI International, Rockville, Maryland, USA
| | - Adrian Bumbut
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - Moussa O Ismail
- Department of Cardiology, Children's National Hospital, Washington, District of Columbia, USA
| | - William D Gaillard
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
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Putra TMH, Sukmawan R, Desandri DR, Atmadikoesoemah CA, Elen E, Kasim M. Left Ventricular Dimension after Mitral Valve Surgery in Rheumatic Mitral Stenosis: The Impact of Myocardial Fibrosis. J Tehran Heart Cent 2020; 15:119-127. [PMID: 33552207 PMCID: PMC7827121 DOI: 10.18502/jthc.v15i3.4222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Patients with rheumatic mitral stenosis (MS) experience changes in left ventricular (LV) dimensions after mitral valve surgery. We sought to investigate changes in LV dimensional parameters after mitral valve surgery and find out whether the same changes occurred in different extents of myocardial fibrosis. Methods: This prospective observational study comprised 43 patients with rheumatic MS planned for mitral valve surgery between October 2017 and April 2018 in National Cardiovascular Center Harapan Kita (NCCHK) Jakarta. All the patients underwent cardiac magnetic resonance imaging based on the late gadolinium enhancement (LGE) protocol for myocardial fibrosis assessment prior to surgery. The patients were classified according to the estimated fibrosis volume considered to influence hemodynamic performance (myocardial fibrosis <5% and myocardial fibrosis ≥5%). Serial transthoracic echocardiographic examinations before and after surgery were performed to detect changes in LV dimensional parameters. Results: This study consisted of 31 (72.1%) women and 12 (27.9%) men at a mean age of 46±9 years. The LGE protocol revealed myocardial fibrosis of less than 5% in 32 (74.4%) patients. A significant increase was detected in the LV end-diastolic diameter postoperatively, specifically in the patients with myocardial fibrosis of less than 5% (44.0±4.8 mm vs 46.6±5.6 mm; P value=0.027). A similar significant increase was not found in the other group (45.0±6.6 mm vs 46.7±6.9 mm; P value=0.256). Other changes in echocardiographic parameters showed similar patterns in both groups. Conclusion: Our patients with rheumatic MS who had myocardial fibrosis of less than 5% demonstrated better improvements in terms of increased preload. Myocardial fibrosis of less than 5% is associated with more favorable improvements in LV geometry.
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Affiliation(s)
- Teuku Muhammad Haykal Putra
- Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
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Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2020; 36:769-787. [PMID: 32281010 DOI: 10.1007/s10554-020-01845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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