Indonesian Journal of Cardiology
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Resolution of ST-Segment Depression In Reciprocal Leads As Predictor Mayor Adverse Cardiac Event For ST-Segment Elevation Myocardial Infarction With Fibrinolytic Therapy
Get PDFBackground: ST Elevation Myocardial Infarction (STEMI) may cause Major Cardiovascular Event (MACE). Revascularization needs to be done in all STEMI patients to restore coronary blood flow, hence saving myocardial perfusion. ST Segment Depression (STSD) in reciprocal ECG lead is associated with poor prognosis in STEMI patients receiving fibrinolytic therapy. The main purpose of this study is to evaluate MACE in STEMI patients receiving fibrinolytic therapy using resolution in STSD. Methods: This cohort prospective study with 60 subjects of STEMI patients which are evaluated for MACE (death, heart failure, and rehospitalization) within 30 days after myocardial infarction. Resolution in STSD is defined as resolution ≥ 50% STSD in reciprocal leads within 90 minutes after fibrinolytic therapy.Results: Bivariate analysis showed that Ejection fraction (EF) <40% with OR 8,32 (2,11-32,74), p=0,001; smoking with OR 4,17 (1,05-16,57), p=0,034; Anterior STEMI with OR 3,94 (1,11-13,90), p= 0,027; Creatinine > 1,97 mg/dl with OR 3,69 (1,18-11,55), p= 0,022; complete outpatient medication with OR 5,23 (1,61-17,01), p= 0,004; fragmented QRS with OR 5,23 (1,61-17,01), p= 0,001; resolution in STSD with OR 26,35 (5,16-134, 40), p=<0,001; resolution in ST Segment Elevation with OR 10,5 (2,97-37,24), p=<0,001; are proven to be determining factor for MACE within 30 days. Multivariate analysis showed that among those determining factors for MACE, resolution in STSD on reciprocal leads is evidently the most dominant factor for predicting MACE within 30 days in STEMI patients receiving fibrinolytic therapy [OR 11.47 (1.14-115.10), p=0.038].Conclusion: There is significant difference in MACE within 30 days after myocardial infarction (MI) between patients with and without resolution in STSD. The subjects without resolution in STSD showed higher MACE incidence. Resolution in STSD is evidently an independent predictor for MACE within 30 days after myocardial infarction in STEMI patients.Keywords: Resolution in STSD, MACE, STEMI, Fibrinolyti
Nilai Skor CHA2DS2-VAS-HSF Sebagai Prediktor Kejadian Nefropati Yang Diinduksi Kontras Pada Pasien Sindroma Koroner Akut Yang Menjalani Prosedur Intervensi Koroner Perkutan
Get PDFBackground: Contrast-Induced Nephropathy (CIN) is a serious problem that can be found in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). The development of CIN in hospitalized patients even with coronary revascularization can immediately increase morbidity and mortality both during treatment and long-term outcomes. In a recent study, a CHA2DS2-VASC-HSF score was reported to predict coronary artery severity and major cardiovascular events (MACE) as well as CIN in AMI patients without atrial fibrillation. The purpose of this study was to investigate the CHA2DS2-VASC score as a predictor of CIN in AMI patients undergoing PCI procedures.
Methods: This study was an ambispective cohort study of 53 AMI patients who were treated at cardiac care and underwent PCI procedures. The CHA2DS2-VASC-HSF score was calculated for each patient. From this study found 14 cases (26.4%) with a total CIN prevalence of 16.83%. CIN is defined as an increase in serum creatinine> 0.5 mg / dL or an increase in serum creatinine> 25% from baseline within 24 hours post PCI.
Results: Through the analysis of the ROC curve, we established the CHA2DS2- VASC-HSF score cut point> 5 as a predictor of CIN with a sensitivity of 78.57% and specificity of 66.6 %% (AUC 0.818, 95%: CI 3.018-6.142, p <0.001). By getting the equation from the linear regression assessment we also found the probability of the occurrence of CIN in accordance with the CHA2DS2-VASC-HSF score.
Conclusion: CHA2DS2-VASC score has a positive correlation with CIN. Therefore, this score can be used as a simple scoring system and can predict the incidence of CIN in AMI patients undergoing PCI procedures.ABSTRAK:
Latar Belakang: Contrast Induced Nephropathy (CIN) merupakan suatu permasalahan yang serius yang dapat dijumpai pada pasien Infark Miokar Akut (IMA) paska intervensi koroner perkutan (IKP). Adanya perkembangan CIN pada pasien rawatan di rumah sakit walaupun dengan tindakan revaskularisasi koroner segera dapat meningkatkan angka morbiditas serta mortalitas baik selama rawatan maupun luaran jangka panjang. Pada penelitian baru-baru ini, skor CHA2DS2-VASC-HSF dilaporkan dapat memprediksi severitas arteri koroner serta kejadian kardiovaskular mayor (KKVM) begitu juga CIN pada pasien IMA tanpa adanya atrial fibrilasi. Adapun tujuan penelitian ini adalah untuk mendapatkan nilai skor CHA2DS2-VASC sebagai prediktor CIN pada pasien IMA yang menjalani prosedur IKP.
Metode: Studi ini merupakan suatu studi kohort ampispektif pada 53 orang pasien IMA yang dirawat pada instalasi rawatan jantung dan menjalani prosedur IKP. Skor CHA2DS2-VASC-HSF dihitung pada masing-masing pasien. Dari studi ini didapatkan 14 kasus (26.4%) dengan total prevalensi CIN sebesar 16.83%. CIN didefinisikan dengan peningkatan serum kreatinin >0,5 mg/dL atau peningkatan serum kreatinin >25% dari baseline dalam 24 jam paska IKP.
Hasil: Melalui analisis kurva ROC, didapati nilai titik potong skor CHA2DS2-VASC-HSF > 5sebagai prediktor CIN dengan sensitivitas sebesar 78.57% dan spesifisitas sebesar 66.6%% (AUC 0.818, 95%:CI 3.018-6.142, p<0.001). Dengan mendapatkan persamaan dari penilaian regresi linear juga didapati probabilitas terjadinya CIN sesuai dengan nilai skor CHA2DS2-VASC-HSF.
Kesimpulan: Skor CHA2DS2-VASC mempunyai hubungan yang positif dengan CIN. Oleh karena itu, skor ini dapat digunakan sebagai suatu sistem skoring yang sederhana dan dapat memprediksi kejadian CIN pada pasien IMA yang menjalani prosedur PCI.
Kata Kunci : skor CHA2DS2-VASC-HSF, CIN, IMA, IK
Lesson learnt from Cardiovascular Risk Factors Studies in Urban Population of Jakarta and House Hold Survey in Indonesia, 1988 - 2018
Get PDFOUTCOME JANGKA PENDEK PASIEN PENYAKIT JANTUNG KORONER MULTIVESSEL STABIL KANDIDAT UNTUK OPERASI CORONARY ARTERY BYPASS GRAFTING DENGAN GAMBARAN EKG NORMAL
Get PDFPendahuluan: Berbagai studi sebelumnya yang melihat outcome pada pasien PJK multivessel stabil baik yang menjalani CABG, PCI, maupun yang hanya mendapat terapi obat tidak mempertimbangkan gambaran EKG yang mungkin berpengaruh pada outcome. Studi ini bertujuan untuk melihat outcome jangka pendek pasien PJK multivessel stabil kandidat untuk operasi CABG dengan gambaran EKG normal. Metode: Studi Kohort. Outcome primer yang dinilai berupa angina berulang, kejadian SKA, stroke dan kematian karena berbagai sebab dalam 6 bulan. Data dianalisis menggunakan SPPSS versi 16. Data dinyatakan signifikan jika nilai p<0.05. Hasil: Didapatkan 79 pasien (69 pria dan 10 wanita) dikelompokkan pada kelompok yang menjalani CABG(n=13), PCI (n=12), maupun terapi obat (n=54). Kejadian bebas SKA dalam 6 bulan pada kelompok CABG sebanyak 100%, kelompok PCI sebanyak 75%, dan kelompok terapi obat sebanyak 85.1%. Dalam ikutan selama 6 bulan, kejadian bebas angina pada kelompok CABG sebanyak 87.4%, kelompok PCI sebanyak 67% dan kelompk terapi obat sebanyak 42.9% (p=0.015 & OR=7.413). Kesimpulan: Terapi obat untuk PJK multivessel berhubungan dengan kejadian SKA yang lebih rendah dibandingkan PCI dalam 6 bulan. CABG lebih superior dibandingkan terapi obat dalam menghilangkan gejala angina. Ketiga strategi terapi berhubungan dengan tingkat kematian yang rendah dalam 6 bulan
Predictors of Appropriate Shocks and Ventricular Arrhythmia in Indonesian with Brugada Syndrome
Get PDFBackground :
Brugada syndrome is an inherited disease characterized by an increased risk of sudden cardiac death owing to ventricular arrhythmias in the absence of structural heart disease. It has been reported that this syndrome is more prevalent in South-East Asia than in Western countries. Furthermore, genetic studies showed important contributions of several gene mutations to the phenotype of BrS. These suggest that ethnic difference play significant roles in the pathogenesis of BrS. In addition, ICD implantation remains the cornerstone management with a low rate of appropriate shocked. Therefore, it is important to investigate patients’ characteristics for risk stratification. Our objective to investigate the clinical, electrocardiography (ECG) and electrophysiological characteristics that can be used as predictor of appropriate shock due to ventricular arrhythmia (VA) in Indonesian patients with BrS.
Methods : We analyse data from Brugada syndrome registry at National Cardiovascular Centre Harapan Kita since January 2013. Total 22 patients were included. Characteristics of BrS that we analysed were baseline characteristics (age and sex), Clinical finding (syncope, cardiac arrest), ECG finding (spontaneous type 1 or drug induced) and Electrophysiology study result (inducible VA and RV ERP). We also added some new ECG characteristic (S wave in lead 1, S wave duration in V1, Fragmented QRS, Junction ST elevation and early repolarization pattern in infero-lateral) to be analysed. Our end point are appropriate shock during ICD interrogation for those who have been implanted an ICD, and documented VA for those who didn’t receive ICD.
Result : We found high incidence of appropriate ICD’s shock in our population (50% in our study vs 5-11.5% in real world). Predictors of appropriate shock and documented VA are history of syncope (p = 0.045; OR 2.57 [1.44-4.59]), spontaneous type-1 ECG (p = 0.005) and right ventricular effective refractory period (RV ERP) of <200 ms (p=0.018). Other parameters that have been reported to correlate with the occurrence of VA (S Wave in lead 1 (p = 0.530), early repolarization pattern (p = 0.578), fragmented QRS (p = 0.601), S Wave duration (p = 0.365) and J Point STE (p = 0.800) were found to be not correlated to appropriate shock in our populations.
Conclusion : History of syncope, spontaneous type-1 Brugada ECG and RV ERP of <200 ms have predictive values for risk stratification of Indonesian patients with Brugada syndrome.
Keywords : Brugada Syndrome, Ventricular arrhythmia, ICD shock  
Tindakan Ablasi pada Fibrilasi Atrium Berasal dari Vena Kava Superior
Get PDFLatar Belakang: Fibrilasi atrium (FA) merupakan aritmia yang paling sering ditemukan. Fibrilasi atrium membutuhkan adanya pemicu untuk inisiasi dan substrat untuk mempertahankan aritmia. Fokus tunggal atau multipel sebagai pemicu, paling sering di vena pulmonal tetapi dapat juga berasal dari selain vena pulmonal, seperti di vena kava superior. Patofisiologi aritmia di vena kava superior masih belum dapat dipahami.
Ilustrasi Kasus: Seorang perempuan, 72 tahun, datang ke poliklinik Pusat Jantung Nasional Harapan Kita (PJNHK) dengan keluhan utama sering berdebar-debar. Pasien pertama kali mengeluh berdebar-debar pada tahun 2000, namun baru pada tahun 2007 pasien melakukan pemeriksaan dan terapi dengan obat-obatan serta dilakukan tindakan ablasi FA. Pada tahun 2010, pasien mengeluh berdebar-debar kembali dan dapat dikontrol dengan terapi medikamentosa. Pada tahun 2016, pasien menjalani tindakan ablasi kedua dengan hasil berhasil dilakukan isolasi vena pulmonal dan angiografi koroner memperlihatkan arteri koroner normal. Pasien sempat datang ke UGD PJNHK bulan Mei 2017 dengan keluhan berdebar dan hasil pemeriksaan EKG saat di UGD menunjukkan irama FA. Dilakukan tindakan ablasi ketiga dengan hasil berhasil dilakukan isolasi vena kava superior.
Kesimpulan: Vena kava superior dapat berperan sebagai pemicu atau substrat fibrilasi atrium. Sebagai fokus, selain vena pulmonal, yang paling sering menjadi sumber fibrilasi atrium, vena kava superior menjadi target penting saat tindakan ablasi fibrilasi atrium
Aritmia Ventrikel Pasca Intervensi Koroner Perkutan : Petanda Reperfusi atau Iskemia yang Masih Berlangsung ?
No full textAritmia ventrikel setelah IKP awalnya diindikasikan sebagai reperfusi yang sukses. Namun, beberapa penelitian menyebutkan bahwa aritmia ini diakibatkan oleh iskemia yang sedang berlangsung. Aritmia yang sering terjadi adalah kontraksi ventrikel premature sustained atau nonsustained takikardi ventrikel, accelerated idioventricular tachycardia, fibrilasi atrium, dan fibrilasi ventrikel. Gangguan irama dihubungkan dengan oklusi koroner didefinisikan sebagai aritmia iskemik, sedangkan aritmia terjadi akibat peningkatan perfusi miokard yang disebut aritmia reperfusi. Accelerated idioventricular tachycardiabisa menjadi penanda dari reperfusi awal dan patensi arteri berkelanjutan.
Penatalaksanaan aritmia ventrikel pasca intervensi koroner perkutan meliputi penggunaan obat anti aritmia, overdrive pacing, ablasi radiofrekuensi, dan ICD.
Kata kunci: aritmia ventrikel, IKP, obat anti aritmia, overdrive pacing, ablasi radiofrekuensi, dan IC
Three Dangerous Loops Of Lipoproteine-Associated Phospholipase A2 Activity On Increasing LDL Aterogenecity
Get PDFBackground. Hypercholesterolemia is a major classic risk factor for cardiovascular disease, but there are 35%-40% cases of cardiovascular patients have a normal cholesterol levels. Lp-PLA2 is an enzyme that produced and secreted by macrophages as a response to the lipid peroxide formation, especially the platelet activating factor compound and phosphocholine peroxide. Lp-PLA2 is correlated with classic risk factor of cardiovascular disease, although that correlation with number of foam cell at early stage of atherosclerosis is not clear yet. This study aims to determine whether Lp-PLA2 levels correlated with classic risk factors of atherosclerosis and the number of foam cell, and the role of Lp-PLA2 enzyme in foam cells formation.Methods. This study observes the change of Lp-PLA2, F2-Isp, MDA, TC, LDL, HDL levels in rat serum at 3 levels of early atherogenesis, Ath-I, Ath-II and Ath-III were made on the number of foam cells. The number of cells was observed on all aortic cross sectional surfaces, using the Oil-Red-O staining. The LDL-C content was measure using the Fiedwall formula, MDA content was measure by using TBA-test, the observe of F2-isoprostane and Lp-PLA2 followed the procedure Elisa methods. Results. Anova test results among the 3 initial atherosclerotic levels showed a very significant difference (p<0.01) on Lp-PLA2 plasma content. The LSD test results represented an increase in Lp-PLA2 enzyme levels significantly since AthII stage. Path analysis refers that correlation value between the Lp-PLA2and the number of foam cell (r=0.48) were higher than that of the LDL (r=0.42), was neither correlated with MDA nor F2-Isp, the highest correlation occurred between Lp-PLA2 and LDL compared to the others parameters (r = 0.58). Path analysis also showed no correlation between cell numbers with MDA and F2-Isp, but LDL levels are correlated significantly with of oxidative stress markers MDA levels (r = 0.32) and correlated very significantly with F2-Isp (r = 0.69).Conclussion. It can be concluded that elevated levels of Lp-PLA2 increase atherogenecity of LDL, due to increased inflammation, stress oxidation and elevated levels of Lp-PLA2 itself, wich are interconnected with proatherogenic loops
Tingginya Risiko Penyakit Kardiovaskular Pada Populasi Dengan Risiko Tinggi Obstructive Sleep Apnea Berdasarkan Kuesioner STOP-Bang
Get PDFLatar belakang:Obstructive sleep apneu (OSA) merupakan gangguan pernafasan saat tidur (sleep-disordered breathing) yang paling tinggi prevalensinya. OSA secara independen berhubungan dengan peningkatan risiko penyakit kardiovaskular seperti gagal jantung dan penyakit arteri koroner begitu juga prediabetes dan diabetes. Penelitian yang menghubungkan risiko OSA yang dinilai menggunakan kuesioner STOP-Bang dengan risiko penyakit kardiovaskular belum pernah dikerjakan di Indonesia.
Metode Penelitian : Penelitian deskriptif analitik dengan rancangan cross-sectional, dilakukanpada 62 orang penduduk di kota Mataram dengan rentang umur 40-74 tahun. Penilaian risiko terjadinya OSA dilakukan dengan menghitung skor total dari kuesioner menurut STOP-Bang. Individu memiliki risiko tinggi OSA jika memiliki skor total ?3. Penilaian risiko penyakit kardiovaskular dihitung menggunakan skor risiko Framingham yang selanjutnya dikonversikan menjadi persentase yang menggambarkan probabilitas penyakit kardiovaskular dalam 10 tahun kedepan.
Hasil Penelitian : Sebanyak 38 orang (61,29%) subyek penelitian memiliki risiko rendah dan 24 orang (38,71%) memiliki risiko tinggi untuk mengalami OSA. Persentase risiko penyakit kardiovaskular secara signifikan lebih tinggi pada kelompok risiko tinggi OSA dibandingkan dengan risiko rendah OSA (p=0,007). Selain itu didapatkan juga pada kelompok risiko tinggi OSA lebih banyak berjenis kelamin laki-laki (p=0,001), memiliki lingkar leher lebih besar (p=0,001), lingkar pinggang lebih besar (p=0,036), hipertensi lebih banyak (p=0,001) dan kadar gula darah puasa yang lebih tinggi (p=0,025).
Kesimpulan : Jumlah subyek penelitian yang terdeteksi memiliki risiko tinggi OSA berdasarkan skrining sederhana menggunakan kuesioner STOP-Bang cukup besar. Dalam penelitian ini, risiko penyakit kardiovaskular secara signifikan lebih tinggipada kelompok risiko tinggi OSA
Age Criteria As Operative Mortality Predictor After Modified Blalock-Taussig Shunt
Get PDFBackground: Modified Blalock-Taussig shunt (MBTS) is considered as a simple procedure but has a considerable operative mortality rate. Patient’s characteristics who underwent MBTS in Indonesia is quite different than other country. There was no predictor of operative mortality has been identified in Indonesian.Objectives: To compare mortality rate based on age criteria and to identify mortality and morbidity predictors after MBTS procedure.Methods: A retrospectively cohort study was conducted on 400 patients who underwent MBTS at National cardiovascular center Harapan Kita (NCCHK) between January 2013 and december 2017.Results: There were 32,1% death at age ≤ 28 days, 19,9% at age 29-365 days, 3,6% at age 366-1825 days and 8% at age > 1825 days. Body weight < 3 kg, haematocrite level > 45% before procedure and activated partial thromboplastine time level (aPTT) < 60 seconds were operative mortality predictors. Postoperative morbidity rate was 32,9%. Packed red cell transfusion (PRC) more than 6 ml/kg, mechanical ventilator use before procedure, prostaglandin E1 use before procedure, aPTT level less than 60 seconds after procedure were identified as postoperative morbidity predictors.Conclusion: Operative mortality rate significantly different among age criteria but it was not proven as an operative mortality predictors. Body weight < 3 kg increase mortality rate and haematocrite level higher than 45% and aPTT level less than 60 seconds decrease mortality rate. Postoperative morbidity predictors were PRC transfusion more than 6ml/kg, mechanical ventilator use before procedure, prostaglandine E1 use and aPTT level less than 60 seconds