Dual antiplatelet therapy has been proven effective to reduce recurrent cardiovascular eventin patients with coronary artery disease and recommended as standard therapy for acute coronary syndrome and patients who underwent percutaneous coronary intervention. The adverse clinical occurrence in patients who taking aspirin and clopidogrel associates with antiplatelet non responsiveness, in addition to repetitive bleeding incident in such a way that platelet reactivity and genetic polymorphisms investigation rises intense interest. Resistance to antiplatelet or antiplatelet non responsiveness means a phenomenon in which antiplatelet drug fails to deliver pharmacological target and it is determined by platelet function measurement. Recent laboratorymethods have been developed to diagnose antiplatelet resistance, but none of them was considered as standard tool since its wide inter-individual variability and poor correlation between them. The mechanism of antiplatelet resistance is not fully understood, multifactorial, involving pharmaco dynamic and pharmacokinetic of the drugs. This review is aimed to comprehend theantiplatelet resistance mechanism and provide crucial information on managing patients who take dual antiplatelet treatment with adverse clinical events.

Background: Assessment of health-related quality of life (HRQoL) are often measured as an important patient-reported outcome (PRO) in clinical studies. Pulmonary arterial hypertension (PAH) is a common complication of atrial septal defect (ASD). This study aimed to compare the HRQoL of PAH related uncorrected secundum ASD at pre and post therapy with oral sildenafil therapy. Methods: We conducted quasi experimental study at Sardjito General Hospital Yogyakarta since April 2016 to August 2017. Adults with PAH related uncorrected secundum ASD, listed on Congenital Heart Disease and Pulmonary Hypertension (COHARD-PH) registry, and met the inclusion and exclusion criteria were recruited as subject. Interview was done at pre and 12 weeks post oral sildenafil therapy 3 x 20 mg using the EQ-5D-3L questionnaire. Statistical analysis was done using paired T-test to determine the differences of EQ5D utility and EQVAS score at pre and post therapy. Results: A total of 18 adult patients with PAH related to uncorrected secundum ASD were enrolled in this study (83.33% female; mean age 38.72 ± 10.81 years old). The most frequent reported problems pre therapy were pain/discomfort (83%) and anxiety/depression (78%). Paired T-test results showed the mean value of EQ5D utility score pre and post therapy were 0.558 and 0.664 post therapy (p:0.014; 95% CI 0.024-0.187). Meanwhile, the mean of EQ-VAS pre and post therapy were 65 and 71.67, respectively (p:0.005; 95% CI 2.32-11.02). Conclusion: The administration of oral sildenafil therapy 3 x 20 mg during 12 weeks in adult patients with PAH related uncorrected secundum ASD gives better HRQoL.

Background: Assessment of health-related quality of life (HRQoL) are often measured as an important patientreported outcome (PRO) in clinical studies. Pulmonary arterial hypertension (PAH) is a common complication of atrial septal defect (ASD). This study aimed to compare the HRQoL of PAH related uncorrected secundum ASD at pre and post therapy with oral sildenafil therapy. Methods: We conducted quasi experimental study at Sardjito General Hospital Yogyakarta since April 2016 to August 2017. Adults with PAH related uncorrected secundum ASD, listed on Congenital Heart Disease and Pulmonary Hypertension (COHARD-PH) registry, and met the inclusion and exclusion criteria were recruited as subject. Interview was done at pre and 12 weeks post oral sildenafil therapy 3 × 20 mg using the EQ-5D-3L questionnaire. Statistical analysis was done using Wilcoxon test and paired T-test to determine the differences of EQ-5D utility and EQ-VAS score at pre and post therapy. Results: A total of 18 adult patients with PAH related to uncorrected secundum ASD were enrolled in this study (83.33% female; mean age 38.72 ± 10.81 years old). The most frequent reported problems pre therapy were pain/ discomfort (83%) and anxiety/depression (78%). Wilcoxon test showed the median of EQ-5D utility score were increased after sildenafil therapy (before = 0.604, after = 0.664; Z = − 2703; p:0.007), respectively. Meanwhile, the paired T-test results showed an increase of EQ-VAS mean difference 6.67 ± 8.75 (p:0.005; 95% CI 2.32-11.02) after sildenafil therapy. Conclusion: The administration of oral sildenafil therapy 3 × 20 mg during 12 weeks in adult patients with PAH related uncorrected secundum ASD gives better HRQoL.

Isolated systolic hypertension (ISH) reflects atherosclerosis. Studies reported hypertension prevalence among diabetes mellitus (DM); however, limited studies provided community prevalence. Present study aimed to explore ISH prevalence among DM in Indonesia. This study obtained data from the 2018 Indonesian basic health survey. The DM category was determined by fasting plasma glucose (PG) level ≥126 mg/dL or 2-hours postprandial and random PG level ≥200 mg/dL or previously diagnosed by a doctor. ISH is categorized if systolic blood pressure is≥140 mmHg and diastolic blood pressure is 90 mmHg. This study also explored the subject's determinants, i.e., compliance, demography, and lipid profile. A Chi-square and Binary logistic regression were used to determine the association. The study included 3,911 DM individuals and disclosed the prevalence of ISH 17.5%. ≥65 years old (OR=13.61 95%CI: 3.297-19.365) and 45-64 years old OR=4.59 95%CI: 3.297-6.383)), high HDL-cholesterol (OR=0.77; 95%CI: 0.626-0.936), and longer DM duration (OR=2.89; 95%CI: 2.405-3.474), all together were related to the ISH.  Subjects with the oldest age category, i.e., ≥65 years old, had the highest OR. Older DM individuals with low HDL-C and longer DM duration were related to the ISH, suggesting lipid profile treatments, mainly the HDL-C, is a pivotal effort to delay ISH.

Background: Rheumatic mitral stenosis is the most common valvular abnormalities found in developing countries. Mortality risk in those populations was poorly investigated. In addition, hemodynamic, morphological, and mechanical factors that influence or predict outcome of rheumatic mitral stenosis have not been identified. Aims: To determine predictive factors affecting outcome in rheumatic mitral stenosis patients. Method: This retrospective cohort study was conducted at the National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. The study recruited patients from the Valvular Heart Disease Registry from May 2014 to November 2020. New York Heart Association (NYHA) functional classification, invasive or surgical treatment, and incidence of death were recorded. The baseline rhythm from electrocardiography (ECG) was categorized as sinus rhythm and atrial fibrillation or atrial flutter. Based on the findings of trans thoracal echocardiography (TTE), subjects who had moderate to severe pure rheumatic mitral stenosis (or followed by mitral regurgitation and / or less significant tricuspid regurgitation as a natural history) and subjects with rheumatic mitral stenosis with a combination of other heart valve problems (of which severity more significantly) classified as groups I and II. The mitral valve area (MVA), mitral valve gradient (MVG), left atrial diameter (LA), and mean pulmonary artery pressure (mPAP) were then analyzed. Results: A total of 477 patients (mean age 44.08 ± 10.93 years; 71.5% female) were enrolled in this study. There were 61 deaths during the median follow up of 393 days of which 35 deaths occurred in group I and 26 deaths occurred in group II. Kaplan Meier curve shows the 1 year survival rate is higher in group I than group II which is 92.5% and 92%, respectively. Bivariate followed by multivariate analysis showed MVG and mPAP were predictive risk factors for mortality in group I with p = 0.020 and p = 0.021. MVG parameter values evaluated from echocardiography with a cut-off of more than 10 mmHg and mPAP parameters with a cut-off of more than 50 mmHg were independent predictive risk factors for mortality. Thus, patients were at higher risk of death if MVG > 10 mmHg and mPAP > 50 mmHg Conclusion: One year survival rate in group I was higher than group II. MVG and mPAP were risk factors for predicting mortality in group I.

Abstract Background: Assessment of health-related quality of life (HRQoL) are often measured as an important patient-reported outcome (PRO) in clinical studies. Pulmonary arterial hypertension (PAH) is a common complication of atrial septal defect (ASD). This study aimed to compare the HRQoL of PAH related uncorrected secundum ASD at pre and post therapy with oral sildenafil therapy. Methods: We conducted quasi experimental study at Sardjito General Hospital Yogyakarta since April 2016 to August 2017. Adults with PAH related uncorrected secundum ASD, listed on Congenital Heart Disease and Pulmonary Hypertension (COHARD-PH) registry, and met the inclusion and exclusion criteria were recruited as subject. Interview was done at pre and 12 weeks post oral sildenafil therapy 3 x 20 mg using the EQ-5D-3L questionnaire. Statistical analysis was done using Wilcoxon test and paired T-test to determine the differences of EQ5D utility and EQVAS score at pre and post therapy. Results: A total of 18 adult patients with PAH related to uncorrected secundum ASD were enrolled in this study (83.33% female; mean age 38.72 ± 10.81 years old). The most frequent reported problems pre therapy were pain/discomfort (83%) and anxiety/depression (78%). Wilcoxon test showed the median of EQ5D utility score were increased after sildenafil therapy (before= 0.604, after=0.664; Z= -2,703; p:0.007), respectively. Meanwhile, the paired T-test results showed an increase of EQ-VAS mean difference 6.67±8.75 (p:0.005; 95% CI 2.32-11.02) after sildenafil therapy. Conclusion: The administration of oral sildenafil therapy 3 x 20 mg during 12 weeks in adult patients with PAH related uncorrected secundum ASD gives better HRQoL.

Background: Assessment of health-related quality of life (HRQoL) are often measured as an important patient-reported outcome (PRO) in clinical studies. Pulmonary arterial hypertension (PAH) is a common complication of atrial septal defect (ASD). This study aimed to compare the HRQoL of PAH related uncorrected secundum ASD at pre and post therapy with oral sildenafil therapy. Methods: We conducted quasi experimental study at Sardjito General Hospital Yogyakarta since April 2016 to August 2017. Adults with PAH related uncorrected secundum ASD, listed on Congenital Heart Disease and Pulmonary Hypertension (COHARD-PH) registry, and met the inclusion and exclusion criteria were recruited as subject. Interview was done at pre and 12 weeks post oral sildenafil therapy 3 x 20 mg using the EQ-5D-3L questionnaire. Statistical analysis was done using paired T-test to determine the differences of EQ5D utility and EQVAS score at pre and post therapy. Results: A total of 18 adult patients with PAH related to uncorrected secundum ASD were enrolled in this study (83.33% female; mean age 38.72 ± 10.81 years old). The most frequent reported problems pre therapy were pain/discomfort A total of 18 adult patients with PAH related to uncorrected secundum ASD were enrolled in this study (83.33% female; mean age 38.72 ± 10.81 years old). The most frequent reported problems pre therapy were pain/discomfort (83%) and anxiety/depression (78%). Wilcoxon signed rank test showed the median of EQ-5D utility score were increased after sildenafil therapy (before= 0.604, after=0.664; Z= -2,703; p:0.007), respectively. Meanwhile, the paired T-test results showed an increase of EQ-VAS mean difference 6.67±8.75 (p:0.005; 95% CI 2.32-11.02) after sildenafil therapy.(83%) and anxiety/depression (78%). Paired T-test results showed the mean value of EQ5D utility score pre and post therapy were 0.558 and 0.664 post therapy (p:0.014; 95% CI 0.024-0.187). Meanwhile, the mean of EQ-VAS pre and post therapy were 65 and 71.67, respectively (p:0.005; 95% CI 2.32-11.02). Conclusion: The administration of oral sildenafil therapy 3 x 20 mg during 12 weeks in adult patients with PAH related uncorrected secundum ASD gives better HRQoL.

Background Early repolarization pattern (ERP) in electrocardiogram (ECG) was thought to be benign in nature. However, for the last 2 decades, several cases reported sudden cardiac deaths (SCD) in patient with ERP. Case Summary A 40-year-old male with a history of several syncope episodes. The latest episode in 2019 at 5 am, a brief convulsion happened before the patient went unconscious. In emergency room, he had another convulsion with a witnessed ventricular fibrillation. After resuscitation and defibrillation, the patient awoke, and ECG was recorded showing ST-segment elevation at V2-3 which suspected to be a Brugada syndrome (BrS). Patient then referred to Sardjito hospital for echocardiography and treadmill test, and the results were within normal limit. Coronary CT Scan showed a non-significant lesion at LAD. Holter examination showed during sleeping, J-wave elevation appeared at the rate of 50 bpm. Meanwhile, during exercise, J-wave disappeared at the rate of 135 bpm. The patient was diagnosed as early repolarization syndrome (ERS) and managed with implantable cardioverter-defibrillator (ICD) implantation. Discussion Patient with ERP who suffers syncope/cardiac arrest is classified as an ERS. Particular clinical findings such as history of cardiac arrest, convulsion, apnea, and ECG findings such as short coupled premature ventricular contraction, dynamic J-wave changes, widespread J-wave are associated with a higher chance for ventricular arrhythmia. Due to its similar nature in ECG morphology and its pathophysiology, ERS and BrS are classified into J-wave syndrome.