Indonesian Journal of Cardiology
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The Quantitative Measurement of ST-Segment Deviation and Pathological Q Wave for Predicting Hospitalization Mortality in Patient with ST-Elevation Myocardial Infarction
Get PDFBackground: The appearance of ST-segment elevation (STE) and pathological Q wave were signs of worse myocardial damage and function, the quantitative measurement of the waves have a potential prognosis role. This study assesses the performance of the quantitative measurement of the waves in predicting in-hospital mortality and compares it with the Global Registry of Acute Coronary Events (GRACE) score as the standard recommended risk score.
Methods: This was a cross-sectional study included patients with ST-elevation myocardial infarction (STEMI) that hospitalized in Abdul Wahab Sjahranie General Hospital Samarinda during January to December 2016. Standard 12-lead electrocardiograms (ECG) were assessed at patient admission as well as other data for GRACE score. The subjects were grouped into non-survivor and survivor group based on hospitalization survival state, and six quantitative ECG characteristics performance will be assessed. The performances were assessed using receiver operating characteristics (ROC) curve and area under the curve (AUC).
Results: There were 57 subjects consisting of 9 non-survivor subjects. The AUC of the four ECG characteristics highest STE amplitude, deepest Q amplitude, total Q amplitude, and total STE amplitude did not significantly different with GRACE score (p>0.05). Highest STE amplitude has the best performance than the other ECG characteristics (AUC=0.81, 95% CI:0.65 to 0.97), and cut off point 4.5mm provides 56% sensitivity and 94% specificity.
Conclusion: The quantitative measurement of ST-segment deviation and pathological Q wave have the prognosis role for predicting in-hospital mortality
Improvement of level MDA and SOD Using of Ganoderma Lucidum as Adjunctive Treatment for Statin Based Therapy in High Risk Patient Based on Framingham Score
Get PDFIt is well known from previous research on the importance of antioxidants to inhibit the progression of coronary heart disease in high-risk patients based on framingham scores. Statins are routinely administered in high-risk patients based on the Dyslipidemia 2016 ESC guidelines but the effects of adding Ganoderma are known to have antioxidant effects, in patients who have received statins. This study aims to assess the effect of antioxidants through measurement of SOD and MDA in patients given a combination of Ganoderma lucidum with statins.Method: A total of 24 patients with high-risk patients based on the Framingham score > 20% were selected as sample of study. Patients with respondents who had never received statin therapy or ACEi or ARB or CCB or beta blocker, or did not routinely consume the drug for 2 weeks were excluded from this study. The addition of Ganoderma lucidum dose of 3x250 mg was added to statins as the first group and Ganoderma lucidum dose of 3x250 mg was added to the Statin combination of Angiotensin Converting Enzym inhibitors (ACE inhibitors) or Angiotensin Receptor Blockers (ARB) and or Calcium Channel Blockers (CCB) and or Beta blockers as second group for 90 days. SOD and MDA levels were measured before and after the administration of Ganoderma Lucidum with the ELISA method.Result: After the administration of Ganoderma Lucidum with standard therapy, there was a decrease in MDA levels and an increase in SOD levels after 90 days in two groups. Conclusion: The addition of Ganoderma Lucidum to standard therapy can reduce oxidant levels in high-risk patients based on framingham scores.
Keyword: Superoxyde-dismutase, Malondyaldehide, Oxidative Stress, Antioxidant, Ganoderma Lucidum, Stati
Relationship Between of Lactate Clearance with Major Cardiovascular Events in Patients with Acute Decompensated Heart Failure
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Background: Acute decompensated heart failure (ADHF) still a major health problem with high morbidity and mortality. The risk stratification of ADHF patients is an important factor to determine the initial management. Examination of lactic acid levels is an inexpensive tool and mostly available at primary care centers. Lactate clearance, derivation of lactic acid level, is one of the modalities that can be used to assess risk stratification. The association between lactate clearance and in-hospital major cardiovascular events (MACE) of ADHF patients has not been studied yet.
Method: Observational approach with cross-sectional design. Data obtained from observations during treatment in ADHF patients at Dr. RSUP M. Djamil Padang in April-July 2018. Bivariate analysis between variables lactate clearance and KKM was carried out during the treatment using the chi-square method and the Odds ratio was obtained.
Result: From 44 subjects, 22 of subjects experienced MACE. From the results were found significant differences in lactate clearance in both of groups, -11,72 ± 4,25 %, vs 26,09 ± 9,36 % (p=0,000). The association between lactate clearance and in-hospital major cardiovascular events of ADHF patients in this study obtained OR 1,16 with 95% CI 1,12 - 4,102 (p = 0.000).
Conclusion: Lactate clearance is a valuable modality that can be used to make a risk stratification in ADHF patients.
Keywords: Lactate clearance, ADHF, risk stratification
ABSTRAK
Latar Belakang: Gagal jantung dekompensata akut (ADHF) masih merupakan masalah kesehatan dengan morbiditas dan mortalitas tinggi. Stratifikasi risiko pasien ADHF merupakan faktor penting untuk menentukan managemen awal. Pemeriksaan kadar asam laktat merupakan alat yang murah dan tersedia di pusat pelayanan primer, lactate clearance merupakan salah satu modalitas untuk menilai stratifikasi risiko. Hubungan antara lactate clearance dengan kejadian kardioavaskular mayor selama perawatan pada pasien ADHF belum diteliti.
Metode Penelitian: Pendekatan observasional dengan desain potong lintang. Data diperoleh dari pengamatan selama perawatan pada pasien ADHF di RSUP Dr. M. Djamil Padang bulan April-Juli 2018. Dilakukan analisis bivariat antara varibel lactate clearance dengan KKM selama perawatan dengan menggunakan metode chi-square dan didapatkan nilai Odds ratio.
Hasil Penelitian : Dari 44 subyek penelitian, 22 subjek dengan ADHF tidak mengalami KKM dan 22 subjek mengalami KKM. Hasil penelitian menemukan adanya perbedaan yang bermakna variabel lactate clerance pada kedua kelompok, yakni -11,72 ± 4,25 % vs 26,09 ± 9,36 %, dengan nilai p=0,000. Hubungan antara lactate clearance dengan kejadian kardioavaskular mayor selama perawatan pada pasien ADHF pada penelitian ini didapatkan nilai OR 1,16 dengan 95% CI 1,12 - 4,102 (nilai p=0,000).
Kesimpulan : Lactate clearance dapat digunakan sebagai stratifikasi risiko pada pasien ADHF.
Kata kunci : Lactate clearance, ADHF, stratifikasi risik
Defisiensi vitamin D pada pasien gagal jantung kronik yang menjalani rawat inap
Get PDFLatar Belakang: Gagal jantung merupakansalah satu masalah kesehatan masyarakat global dengan jumlah penderita yang diperkirakan terus mengalami peningkatan. Meskipun terdapat kemajuan dalam tata kelolanya, gagal jantung masih memiliki prognosis yang buruk. Vitamin D merupakan mikronutrien yang berpengaruh terhadap prognosis pasien gagal jantung kronik. Saat ini belum ada data mengenai kadar vitamin D serum pada pasien gagal jantung kronik yang dirawat pada populasi Indonesia. Tujuan penelitian ini adalah untuk mengetahui kadar vitamin D serum pada pasien gagal jantung kronik yang menjalani rawat inap.Metode: Penelitian observasional pada pasien gagal jantung kronik yang dirawat di RSUP. Dr. Kariadi Semarang mulaibulan November 2017 sampaiJanuar1 2018. Pemeriksaan kadar vitamin D serum [25(OH)D] dilakukan dengan metode chemiluminescence immunoassay (CLIA).Hasil: Sebanyak 102 pasien (median usia 55 (22–65) tahun) yang terlibat, terdapat 69 sampel yang memenuhi kriteria seleksi. Median fraksi ejeksi ventrikel kiri adalah 35 (10-76)%. Median kadar vitamin D serum adalah 47.25 (14.25–143.02) nmol/L.Yang menarik,  88,4% pasien menunjukkan kadar vitamin D lebih rendah dari yang direkomendasikan. Dibandingkan dengan pasien dengan kadar vitamin D normal, pasien dengan kadar rendah tersebut lebih sering disertai denganhipertensi atau diabetes, berjenis kelamin perempuan, dan memiliki riwayat rawat inap ulang yang lebih sering.Kesimpulan: Defisiensi vitamin D serum dialami olehsebagian besar pasien gagal jantung kronik yang dirawat. Data ini menunjukkan perlunya pengukuran kadar vitamin D pada pasien gagal jantung kronik dengan hipertensi, diabetes, jenis kelamin wanita dan rawat inap ulang.Kata Kunci : Gagal jantung, defisiensi vitamin D, rawat ina
Advantages of Exercise Training In Hypertrophic Cardiomyopathy: Considering risks and benefits
Get PDFBackground. Hypertrophic cardiomyopathy (HCM) is one of the most common cardiac genetic disorders. The prevalence of this disease is 1 in 500 live births. It is stated to be the most frequent cause of sudden death in young adults. Therefore, some guidelines recommend to restrict physical activity and exercise. On the contrary, latest data show that active lifestyle and exercise in HCM patient provide significant benefits in cardiovascular function with no significant adverse reactions. Following to that, some experts might be reveal that its benefits might be outweigh risks.
Summary. There is a paucity of studies that examine the effectiveness of exercise for HCM. American Heart Association (AHA) and (European Society of Cardiology) ESC established exercise recommendations for HCM individuals based on discussion and consensus of experts. We found three studies that investigate the efficacy of exercise in HCM individuals. Outcomes of our interest were differences in cardiovascular function, quality of life and safety issues. All studies found positive significant differences in main outcomes measure in which the HCM subjects on exercise had better or improved outcomes. None reported adverse reaction such as fatal arrhythmia or sudden death related to exercise.
Brief Conclusion. Old belief regarding exercise restrictions on HCM need to be reconsidered, given that at present exercise have been shown to provide significant benefits for reducing cardiovascular risk factors. Nevertheless, exercise in patients with HCM must be specifically considered regarding the risk and benefit. Practicing active lifestyle and exercise on HCM individual is an exciting possibility that need further study.
Keywords: hypertrophic cardiomyopathy, exercise training, risks and benefit, physical activit
Uji Jalan 6 Menit (UJ6M) pada Pasien Pasca Sindrom Koroner Akut
Get PDFKualitas hidup dan prognosis pasien dengan penyakit kardiovaskular merupakan hal yang penting dan direkomendasikan untuk dievaluasi, salah satunya melalui pengukuran kapasitas fungsional. Uji jalan 6 menit (UJ6M) merupakan sebuah metode non-invasif sederhana dan reliabel untuk mengukur kapasitas fungsional yang sebelumnya telah banyak diaplikasikan pada penderita penyakit paru-paru dan gagal jantung. Saat ini, penggunaannya terus dikembangkan, salah satunya pada pasien pasca Sindrom Koroner Akut (SKA). Uji jalan 6 menit (UJ6M) dapat dilakukan secara dini, selain berguna untuk menentukan jenis aktivitas dan latihan di rumah untuk pasien, juga dapat memberikan prediksi morbiditas dan mortalitas pada kasus sindrom koroner akut tertentu. Walaupun studi prognostik mengenai UJ6M pada pasien pasca SKA masih terbatas, pasien dengan jarak tempuh UJ6M yang lebih rendah dapat dipertimbangkan memiliki risiko terjadinya kejadian jantung yang tidak diinginkan yang lebih tinggi di kemudian hari.
 
The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients
No full textWorldwide, ischemic heart disease is the most common cause of death and its frequency is increasing. ST-segment elevation myocardial infarction or STEMIis as form of ischemic heart disease with the highest mortality rate.
Based on ESC (European Society of Cardiology) guideline 2017 for STEMI management, reperfusion therapywhich is primary PCI strategy is recommended over fibrinolysis within induced timeframes, but if timely primary PCI cannot be performed after STEMI diagnosis, fibrinolytic therapy is recommended within 12 hours of symptom onset in patients without contraindications. In fibrinolytic therapy, oral aspirin should be given, and Clopidogrel is indicated as an addition to aspirin. Although Clopidogrel is a recommended P2Y12receptor inhibitorin fibrinolytic therapy,PERKI guideline 2018 in ACS management also mention thatswitching to Ticagrelor can be considered in patients whowillundergo PCI treatmentafter fibrinolytic.
In PLATO study, patients who have acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke. However, patients who received fibrinolytic therapy within 24 hours before randomization were excluded. WhileinSET-FAST study, Ticagrelor provides more prompt and potent platelet inhibition compared with Clopidogrel in patients undergoing PCI within 24 hours of receiving fibrinolysis for STEMI. TREAT study was conducted to evaluate the safety of ticagrelor in STEMI patients receiving fibrinolytic therapy within 24 hours.TREAT study concluded, at 30 days observation, in patients younger than 75 years with STEMI, delayed administration of Ticagrelor after fibrinolytic therapy was noninferior to Clopidogrel for TIMI major bleeding.
Based on the result from PLATO study and preliminary TREAT study result on 30 days, the use of Ticagrelor within 24 hours after fibrinolytic therapy can be considered with comparable safety profile to Clopidogrel.
Keywords: STEMI, fibrinolysis, ticagrelo
PERANAN ACETAMINOPHEN (PARASETAMOL) DALAM PENUTUPAN DUCTUS ARTERIOSUS
Get PDFAbstrak
Patent ductus arteriosus (PDA) adalah kelainan kongenital yang ditandai adanya kegagalan penutupan duktus arteriosus (DA) segera setelah lahir. Dampak tidak menutupnya DA akan terjadi gangguan hemodinamik ,memperberat masalah lain yang menyertai bayi prematur sehingga akan meningkatkan morbiditas dan mortalitas. Parasetamol merupakan obat yang relatif baru digunakan untuk menutup PDA jika dibandingkan dengan indometasin ataupun ibuprofen dengan tinkat keberhasilan yang tinggi.
Kata kunci: Patent ductus arteriosus (PDA), gangguan hemodinamik, parasetamol
Abstract
Patent ductus arteriosus (PDA) is a congenital disorder characterized by a failure to close the ductus arteriosus (DA) immediately after birth. The impact of not closing the DA will occur hemodynamic disturbances, aggravating other problems that accompany premature babies so that it will increase morbidity and mortality. Paracetamol is a relatively new drug used to close PDAs when compared with indomethacin or ibuprofen with the high success rates.
Keywords: Patent ductus arteriosus (PDA), hemodynamic problem, paracetamo
Left Atrial Thrombus Resolution Using Unfractionated Heparin and Warfarin in a Patient with Mitral Stenosis
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Background: Though the use of Low Molecular Weight Heparin (LMWH) in general is preferred due to its convenient and eliminates the need for activated Partial Thromboplastin Time ( aPTT) monitoring but Unfractionated Heparin (UFH) is still widely used in clinical setting due to its availability and low price. Besides UFH, the use of oral anticoagulant therapy with warfarin, has been the standard therapy for the prevention of thromboembolism in patients with AF. Our aim is to report a case of the resolution of left atrial thrombus in a patient with mitral stenosis.
Case Illustration: A Case report of a female patient aged 54 years who admitted with a sudden neurological deficits and mitral stenosis with atrial fibrillation. Transthoracal Echocardiography (TTE) showed mobile thrombus which moved and obstructed the mitral valve during diastolic phase. Unfractionated heparin (UFH) was administered 3000 unit bolus intravenously and maintained with 600 unit per hour with the combination of warfarin 2 mg for five days. TTE evaluation showed the resolution of LA thrombus.
Conclusion : The administration of the combination of UFH and warfarin had successfully caused resolution of the LA thrombus and prevented the patient from surgical intervention. This case report indicated that Unfractionated Heparin and Warfarin were still the treatments option in LA thrombus patients with mitral stenosis and atrial fibrillation.
Key words :Left atrial thrombus, unfractionated heparin, thrombus resolution
 
Hemodynamic Congestion at Hospital Discharge Predicts Rehospitalization during Short Term Follow Up in Acute Heart Failure Patients
Get PDFBackground: Hemodynamic congestion is an increase in left ventricular diastolic pressure (LVEDP) without clinical symptoms and signs of congestion. Current acute heart failure (AHF) treatment goals only focused on improving clinical congestion. The purpose of this study was to investigate whether hemodynamic congestion measured by NT-proBNP level and ePCWP at hospital discharge could predict short term clinical outcomes in AHF patients.
Method: This prospective cohort study was conducted at dr. Saiful Anwar General Hospital Malang from January to July 2018. All patients got AHF treatment according to the 2016 ESC guidelines for heart failure. All patients were discharged without symptoms and signs of clinical congestion. Hemodynamic congestion at hospital discharge was defined as failure of treatment during hospitalization to achieve a reduction in NT-proBNP level >30% and/or ePCWP at hospital discharge >16 mmHg. NT-proBNP level and ePCWP were measured at 0-12 hours after hospital admisssion and at hospital discharge. ePCWP was measured using echocardiography. The clinical outcomes assessed were AHF rehospitalization and cardiovascular mortality within 30 days after hospitral discharge. Subgroup analysis was performed to determine therapeutic regimens that are effective in improving hemodynamic congestion.
Result: A total of 33 AHF patients were included in this study. 48% patients were discharged with hemodynamic congestion and 52% patients discharged without hemodynamic congestion. Patients with hemodynamic congestion at hospital discharge showed a higher rehospitalization within 30 days (8 [50%] vs 1 [5.9%]; P = 0.007). Mortality within 30 days in both groups did not show a significant difference (2 [12.5%] vs 0 [0%]; P = 0.277). Treatment regiment of optimal dose of ACEi/ARB, β-blockers, and diuretics was associated with improvement of hemodynamic congestion (P = 0.026; r = 0.454), a decrease in NT-proBNP> 66% (P = 0.02; r = 0,574), and achievement of ePCWP <16 (P = 0,013; r = 0,493) at hospital discharge in HFrEF patients.
Conclusion: This study showed that hemodynamic congestion assessed with NT-proBNP level and ePCWP at hospital discharge increased 30 day rehospitalization in AHF patients. In HFrEF, improvements in hemodynamic congestion can be achieved by giving the treatment regiment of optimal dose of ACEi/ARB, β-blockers, and diuretics.
Keyword: Acute heart failure, hemodynamic congestion, NT-proBNP, ePCW