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Abstract Background Mesenchymal stem cells (MSCs) are known as one of the best candidate cells to produce cardiac pacemaker-like cells (CPLCs). Upregulation of TBX3 transcription factor and inhibition of the nodal signal pathway have a significant role in the formation of cardiac pacemaker cells such as sinoatrial and atrioventricular nodes, which initiate the heartbeat and control the rhythm of heart contractions. This study aimed to confirm the effects of transfection of TBX3 transcription factor and inhibition of the nodal signal pathway on differentiating adipose-derived MSCs (AD-MSCs) to CPLCs. AD-MSCs were characterized using flow cytometry and three-lineage differentiation staining. Methods The transfection of TBX3 plasmid was carried out using lipofectamine, and inhibition of the nodal signal pathway was done using the small-molecule SB431542. The morphology of the cells was observed using a light microscope. Pacemaker-specific markers, including TBX3, Cx30, HCN4, HCN1, HCN3, and KCNN4, were evaluated using the qRT-PCR method. For protein level, TBX3 and Cx30 were evaluated using ELISA and immunofluorescence staining. The electrophysiology of cells was evaluated using a patch clamp. Results The TBX3 expression in the TBX3, SM, and TBX + SM groups significantly higher (p

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Valvular heart diseases (VHD), regardless of the arrhythmic problems, increase the risk of thromboembolism, which are even higher in those with associated atrial fibrillation. The EHRA (Evaluated Heartvalves, Rheumatic or Artificial) classification categorised AF patients with significant VHD into type 1 and type 2. Unfortunately, there are currently very limited data on risk prediction in stroke-related valvular AF, particularly in the Asian population. Aims: To investigate the clinical and echocardiographic risk factors for ischaemic stroke prediction in patients with EHRA type 2 VHD. Methods: This retrospective study enrolled 695 AF patients with EHRA type 2 VHD. The data were collected from patients' medical records who met the inclusion and exclusion criteria from 2015 until 2020. The primary outcome was ischaemic strokes within observation period. Results: There were 67 ischaemic stroke events (9,6%) of the total sample. Our analysis found that none of the analysed variables proved to be statistically significant risk factors in predicting the occurrence of ischaemic stroke. The median CHA2DS2-VASc risk prediction in the sample was 3, with an accuracy of AUC 0.502 (CI 95%; 0.429 – 0.576), sensitivity 56.7% and specificity 44.7%. Conclusion: Based on the parameters analysed in this study, no factor was statistically well-predictive to predict the ischaemic stroke incidence in EHRA type 2 VHD AF. In addition, the CHA2DS2-VAS accuracy was low in this population. Further exploration is needed to build an accurate ischaemic stroke risk prediction for EHRA type 2 VHD.

Background: Cardiovascular disease is driven by traditional risk factors, sex, and genetic differences. The Asian population, specifically Indonesians, has been known at high risk of insulin resistance and endothelial dysfunction. A possible genetic risk factor related to cardiovascular diseases is Gly972Arg polymorphism of insulin receptor substrate 1 (IRS-1) gene, as this impairs endothelial function. To date, whether there is a gender difference in Gly972Arg polymorphism of the IRS-1 gene in Indonesians is unknown. This study aimed to to define whether there is a gender difference in Gly972Arg polymorphism of the IRS-1 gene in Indonesians. Methods: We studied adults living in two areas (rural and urban) in Indonesia. We collected demographic and clinical data from the study subjects. Gly972Arg polymorphism of the IRS-1 gene (rs1801278) was detected using TaqMan real-time polymerase chain reaction. Results: A total of 378 subjects were recruited. The wild-type allele (CC) was found in 86 (22.8%) subjects, heterozygous mutant allele (CT) in 245 (64.8%), and homozygous mutant allele in 47 (12.4%). The proportion of subjects with T alleles was significantly higher among women than men (54.6% vs. 45.4%, odds ratio: 1.89; p = 0.01). Subjects with T allele more often have hypertension (odds ratio: 1.69, p = 0.058). Conclusion: There were a higher proportion of women than men carrying the T allele of Gly972Arg polymorphism among Indonesians. Individuals with the T allele appeared to show a greater prevalence of hypertension. These results may explain a possible mechanism of the high prevalence of metabolic syndrome in Indonesia, especially in women.

Abstract Background Arrhythmia is a significant clinical modifier in COVID‐19 patient outcomes. Currently, data on arrhythmia and ECG characteristics in COVID‐19 from lower middle‐income countries are limited. Methods COVID‐19 was confirmed by polymerase chain reaction testing of a nasopharyngeal sample. All clinical records were systematically evaluated to obtain demographic characteristics and medical comorbidities. The ECG was recorded on admission, in‐hospital, and at discharge. Results Total documented arrhythmia events account for 22% of patients, comprising 6% of new‐onset arrhythmia and 16% of existing arrhythmia. Atrial fibrillation is the most common arrhythmia. The ECG changes were a decrease in heart rate (91 ± 22 vs. 83 ± 20, p

Background: Iron deficiency anemia (IDA) in heart failure (HF) is associated with poor functional capacity. Several studies reported the benefit of iron therapy in HF with IDA on improving functional capacity. Therefore, we attempt to investigate the effect of oral iron supplementation on functional capacity in HF patients with IDA. Results: Double blind randomized controlled trial was conducted in National Cardiovascular Center Harapan Kita Hospital Universitas Indonesia. A total 54 HFREF patients with IDA were enrolled and randomized to either oral Ferrous Sulphate (FS) 200mg 3 times a day or placebo with 1:1 ratio for 12 weeks. Primary outcome was functional capacity measured by 6-minute walk test. There were 41 participants completed the study (FS n=22, placebo n=19). Ferrous sulphate significantly improved functional capacity changes (46.23+35m vs -13.7+46m, p

ABSTRACT Background Right ventricular pacing is associated with adverse outcome including increased risks of cardiovascular morbidity and mortality. RV pacing causes abnormal ventricular activation results in an inefficient contraction pattern with ventricular dyssynchrony and loss of myocardial work that may lead to LV dilation, systolic dysfunction, and clinical HF. Pacing induced cardiomyopathy (PICM) is caused by chronic and high burden RV pacing that may occur several months or years after pacemaker implantation. Objective To present a case of pacing induced cardiomyopathy (PICM) managed by CRT-P implantation. Case Illustration A male, 56 years old, was referred from dr. M. Djamil General Hospital with CHF Fc II-III, s/p PPM DDDR due to high degree AV block (2016) and history of failed CRT-P implantation (2018). He complained DOE (+), PND (+) and OP (+) since April 2017. Physical examination revealed pansystolic murmur grade 2/6 at apex, no rales and no oedema at both legs. ECG showed pacing rhythm and intrinsic rhythm was type 2 second degree AV block and RBBB with QRS duration 150 ms. Echocardiography showed global hypokinetic and dilated LV (LV EDD 71 mm, LV ESD 63 mm) with progressively reduced EF 38% à 33% (Simpson), functional moderate MR and mild TR. CAG showed non-significant coronary artery stenosis with 20% stenosis at distal LAD. Patient was diagnosed as pacing induced cardiomyopathy (PICM). At catheter laboratory, there was stenosis of left subclavian vein. His-Bundle pacing (HBP) was planned at first, however CRT-P with biventricular epicardial pacing was then performed in which LV lead was inserted through right axillary vein. During follow up at general ward, ECG showed biventricular pacing rhythm. There was no signs and symptoms of heart failure. Patient was hospitalized for 3 days and then discharged in a good condition. Summary We reported a case of pacing induced cardiomyopathy in male patient 56 years old. Pacing induced cardiomyopathy is a complication of high burden RV pacing. Options to treat PICM once it has developed, or to prevent it from developing in the first place, may include conduction system pacing (e.g.: HBP) or CRT-P implantation.