Purpose Biggest cause of death in chronic kidney disease-hemodialysis (CKD-HD) patients is cardiovascular disease (CVD). Cardiovascular disease is often associated with mineral bone disorders (MBD), especially vascular and valvular calcification. Biomarkers such as C-terminal-fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) were investigated. Only few studies have focused on valvular calcification in CKD-HD patients, with controversial results. The present study aimed to investigate whether high C-terminal-FGF-23, iPTH, and IL-6 can be used as determinants of valvular calcification in CKD-MBD patients undergoing regular HD. Patients and Methods This was an analytical cross-sectional study which involved CKD-HD patients aged 18–60 years with no history of CVD, malignancy, and diabetes mellitus. C-terminal FGF-23 was measured using enzyme-linked immunosorbent assay (ELISA) kit, iPTH using chemiluminescent immunometric method, and IL-6 using sandwich enzyme immunoassay technique. Valvular calcification on aortic and mitral valves was examined with echocardiography. Data analysis was done using Chi-squared test or Fisher’s exact test as appropriate and multivariate logistic regression analysis. Results Bivariate analysis with Fisher’s exact test showed significant association of prevalence ratio (PR) of C-terminal FGF-23 (PR = 1.33; p = 0.003; CI (1.017–1.748)), iPTH (PR = 1.361; p = 0.002; CI (1.02–1.816)), and IL-6 (PR = 1.2; p = 0.019; CI (1.000–1.446)) with valvular calcification. Multivariate analysis with logistic regression showed high C-terminal FGF-23 (exp (B) value of 16.44; p = 0.045; CI (1.07–252.75)), iPTH (exp (B) value of 33.312; p = 0.016; CI (1.94–571.71)), and IL-6 (exp (B) value of 21.58; p = 0.0381; CI (1.18–394.87)) were determinants of valvular calcification in CKD-MBD patients undergoing regular HD. Conclusion This study demonstrated that high C-terminal FGF-23, iPTH, and IL-6 were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.

Coronary heart disease or coronary artery disease is caused by the atherosclerosis process in the coronary blood vessels. The high number of patients with this condition is significantly due to the influence of modern and all instant lifestyle. Among the factors suspected to be capable of influencing the increase in the number of coronary artery lesions in coronary heart patients is the Glomerulus Filtration Rate (GFR). This result is related to the high mortality and morbidity of coronary heart patients. Aim: The purpose of this research is to determine the relationship between the decrease in glomerulus filtration rate (GFR), the disturbance variables (age, gender, hypertension history, diabetes mellitus history, smoking history) and the increase in the number of coronary artery lesions in Sanglah General Hospital. Methods: This research is an analytical observational design with the cross-sectional design using secondary data from the medical records in Sanglah General Hospital Denpasar. This study attains 196 sample. Results: A significant relationship is attained between GFR (<60 ml/ minute) and the increase in the total vessel score (p = 0.017) with an OR 2.47 (CI95% 1.014-6.041). Furthermore, there is a significant relationship between risky age (male >45, female >55) and the increase in total vessel score (p = 0.015) with an OR 3.54 (CI 95% 1.217-10.307). Diabetes mellitus and the increase in the total vessel score also shows a significant relationship (p = 0.016) with an OR 2.99 (CI 95% 1.189-7.539). While other risk factors such as gender, hypertension, and smoking have an insignificant relationship (p > 0.05). In the multivariate analysis, GFR (<60 ml/ minute) is a predictor of the vessel score (p=0,050) with an adjusted value of OR 1.86 (CI 95% 0.735-4.725). There are some other variables in which are significant predictors of the increase in vessel score. Risky age (male >45, female >55) (p=0,048) with an adjusted OR value of 3.08 (CI 95% 1.012-9.407) and also diabetes mellitus (p=0.044) with an adjusted OR value of 2.65 (CI 95% 0.145-0.973) are those predictors. Conclusion: Hence, it appears that GFR (<60 ml/ minute), risky age (male >45, female >55) and diabetes mellitus have a significant relationship with the increase in vessel score and are predictors of the increase in vessel score. While gender, hypertension, and smoking do not have significant relationships with the increase in the amount of vessel score.

Background: Effective risk stratification is an integral part of acute myocardial infarction (AMI) management. Meanwhile, the stratification system should be performed by using easy instruments or methods, where appropriate management, intervention timing, and prognosis can be determined. A previous study established acute ischemia implicate the diastolic function of the left ventricle. In this situation, echocardiography is an easy-to-use and effective diagnostic tool. Therefore, this study evaluates left ventricular diastolic function using the tissue Doppler imaging (TDI) method to analyze the reduction of early diastolic velocity (e’) as a predictor for numerous cardiovascular events in patients with AMI. Method: The study design was an observational study with a prospective cohort design. The data for the septal and lateral Early Diastolic Velocities (e’) was acquired using the transthoracic echocardiography procedure on AMI patients. The Hazard Ratio (HR) and survival curve from prognostic factors of major adverse cardiovascular events were also produced. Results: There were 66 patients diagnosed with AMI. The median was 6.625cm/s, and the cut-off point was to determine the decreasing or abnormal mean e’. Subsequently, this value at RR 2.8 was shown by the multivariate analysis via Cox regression as an independent factor of major adverse cardiovascular events. Conclusion: Decreased means e’ has been proven as an independent predictor of major adverse cardiovascular events in hospitalized patients with AMI.

Background Infective endocarditis (IE) presents a major therapeutic challenges due to difficulties in diagnosis and a high risk of morbidity. Despite numerous complications of IE, reported cases complicated by abscesses on the heart valve leaflets were extremely rare as illustrated in this case report Case Summary A 46-year-old man was admitted with severe shortness of breath since August 14, 2020. The patient also had cough and fever, emerging since 1 month before hospitalized. A history of PND, orthophnea, and DOE was experienced since the 1 month ago. Upon physical examination, abnormal findings include: tachycardia, tachypnea, visible and diastolic murmur at the right second intercostal alongside the parasternal line and systolic murmur at apex, respectively, as well as ronchi at 2/3 of the lung bases. Electrocardiogram revealed both sinus tachycardia and anteroseptal ischemia. An echocardiography was performed; thereby generating a vegetation at RCC and NCC of aortic valve, pocket-shaped echodense structure on anterior mitral leaflet with suspected abscess. Discussion Definite infective endocarditis was navigated depicting the suspicion of: a vegetation in the aortic valve of NCC and RCC diagnosis, an abscess of the anterior mitral valve and ADHF of B profile with a potential of VHD and CAD with severe aortic valve regurgitation.