Indonesian Journal of Cardiology
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EFFECT OF STATINS ON ENDOTHELIAL PROGENITOR CELL (EPC) MIGRATION FROM PERIPHERAL BLOOD OF STABLE CORONARY ARTERY DISEASE PATIENT
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ABSTRAK
Efek Pemberian Statin Terhadap Migrasi Endothelial Progenitor Cell (EPC) Pada Darah Tepi Penderita Penyakit Jantung Koroner Stabil
Tyagita Verdena Rani Savitri, Yudi Her Oktaviono, Djoko Soemantri
Latar Belakang: Endothlelial progenitor cell (EPC) berpartisipasi dalam perbaikan endotel dan pertumbuhan pembuluh darah baru. Farmakoterapi kardiovaskular telah dibuktikan dapat memperbaiki jumlah dan fungsi EPC pada penderita dengan risiko kardiovaskular. Banyak studi melaporkan bahwa statin memiliki efek yang menguntungkan terhadap EPC dengan meningkatkan jumlah dan fungsi EPC, termasuk didalamnya adalah fungsi migrasi. Oleh karena itu, kami melakukan penelitian untuk menganalisis efek tiga statin yang berbeda terhadap migasi EPC.
Tujuan: Untuk menganalisis efek pemberian statin terhadap migrasi EPC pada darah tepi penderita penyakit jantung koroner stabil.
Metode: Penelitian ini kami lakukan secara in vitro true experimental post-test only control group design. Sel mononuklear diisolasi dari darah tepi penderita penyakit jantung koroner stabil dan dilakukan kultur dalam medium Stemline II Hematopoietic Stemcell Expansion Medium selama 3 hari. Kemudian sampel dibagi menjadi empat kelompok yaitu kelompok simvastatin 0.5 µmol/L,, atorvastatin 0.5 µmol/L, rosuvastatin 0.5 µmol/L dan kelompok kontrol kemudian diinkubasi selama 48 jam. Metode imunositokimia dilakukan untuk identifikasi EPC dengan mengevaluasi ekspresi CD34+. Pada hari ke-5 kultur, sel di pindahkan ke bagian atas transwell system sebanyak 5x105 sel per sumur perlakuan , kemudian di inkubasi selama 1 hari. Sel yang berpindah pada sumur transwell system bagian bawah dihitung dengan automatic cell counter dengan pewarnaan typhan blue. Data dianalisis dengan independent t test dan ANOVA.
Hasil: Hasil independent t test terhadap hasil migrasi pada transwell system menunjukkan peningkatan bermakna terhadap migrasi EPC pada kelompok simvastatin, atorvastatin, dan rosuvastatin dibandingkan dengn kelompok kontrol (234000 ± 1290. 994, 265000 ± 1290. 994, 203000 ± 1290. 994 vs 174071.43 ± 1426. 785, p<0.05). Migrasi EPC juga berbeda antar kelompok statin, dimana efek tertinggi didapatkan pada kelompok atorvastatin. Migrasi EPC pada kelompok atorvastatin lebih tinggi daripada kelompok simvastatin (265000 ± 1290. 994 vs 234000 ± 1290. 994, p<0.05), dan simvastatin lebih tinggi daripada kelompok rosuvastatin (234000 ± 1290. 994 vs 203000 ± 1290. 994, p<0.05). Pemeriksaan imunositokimia menunjukkan ekspresi positif terhadap CD34+.
Kesimpulan: Statin meningkatkan migrasi EPC pada darah tepi penderita penyakit jantung koroner stabil. Efek tertinggi tampak pada kelompok atorvastatin, diikuti kelompok simvastatin, dan rosuvastatin.
Kata kunci: Migrasi EPC, simvastatin, atorvastatin, rosuvastatin
Clinical Research
ABSTRACT
Effect of Statins on Endothelial Progenitor Cell (EPC) Migration from Peripheral Blood of Stable Coronary Artery Disease Patient
Tyagita Verdena Rani Savitri
Yudi Her Oktaviono
Djoko Soemantri
Background: Endothelial progenitor cell (EPC) participates in endothelial repair and new blood vessel growth. Cardiovascular pharmacotherapy has been shown to improve the amount and function of EPC in patients with cardiovascular risk. Many studies report that statins have a beneficial effect on EPC by increasing the number and function of EPC, including the migration function. Therefore, we conducted a study to analyze the effects of three different statins on EPC migration.
Objective: To analyze the effect of statins on EPC migration from peripheral blood of stable coronary artery disease (SCAD) patient.
Methods: This was an in vitro true experimental post-test only control group design. The MNCs were isolated from peripheral blood of SCAD patient and were cultured in Stemline II Hematopoietic Stemcell Expansion Medium in 3 days. Then samples were put into four groups, simvastatin 0.5 µmol/L, atorvastatin 0.5 µmol/L, rosuvastatin 0.5 µmol/L and control, then incubated for 48 hours. Immunocytochemical examination was performed to evaluate expression of CD34+. On the 5th day of culture, 5x105 cells per group were transferred to the upper chamber of the transwell system, then incubated for 1 day. Cells that migrated to the lower chamber of transwell system were calculated by automatic cell counter with typhan blue coloring. Data were analyzed by independent T-test and ANOVA.
Results: The results of independent T-tests showed a significant increase in EPC migration in the simvastatin, atorvastatin, and rosuvastatin groups compared with the control group (234000 ± 1290.994, 265000 ± 1290.994, 203000 ± 1290. 994 vs 174071.43 ± 1426 785, p <0.05). EPC migration also differed between statin groups, where the highest effect was found in the atorvastatin group. EPC migration in the atorvastatin group was higher than the simvastatin group (265,000 ± 1290,994 vs 234,000 ± 1290,994, p <0.05), and simvastatin was higher than the rosuvastatin (234,000 ± 1290,994 vs 203000 ± 1290. 994, p < 0.05). Immunocytochemical examination showed a positive expression on CD34+.
Conclusion: Statins increase EPC migration from peripheral blood of SCAD patient. Atorvastatin showed the highest EPC migration, followed by simvastatin, and rosuvastatin.
Keywords: EPC migration, simvastatin, atorvastatin, rosuvastatin
 
Padang Skoring Elektrokardiografi untuk Memprediksi Fraksi Ejeksi Ventrikel Kiri pada Gagal Jantung Kronik
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Latar Belakang: Gagal Jantung dibagi menjadi 3 kelompok yaitu gagal jantung fraksi ejeksi menurun (HfrEF <40%), rentang tengah (HFmrEF 40-49%), dan terpelihara (HfpEF ≥50%). Ekokardiografi masih menjadi pemeriksaan standar saat ini, sayangnya pemeriksaan tersebut masih terbatas dibeberapa pusat kesehatan. Perlu pemeriksaan awal yang lebih sederhana salah satunya elektrokardiografi (EKG) yang mudah digunakan. Penentuan skoring dari EKG diharapkan dapat memudahkan memprediksi fraksi ejeksi dan memberikan terapi yang tepat.
Metode Penelitian: Pendekatan observasional dengan desain potong lintang. Diambil data rekam medis pasien gagal jantung kronik (GJK) di poliklinik Jantung RSUP Dr. M.Djamil Padang bulan Januari-Agustus 2017. Dilakukan analisis bivariat pada varibel EKG terhadap fraksi ejeksi dengan metode chi-square. Analisis multivariate dengan uji regresi binari logistik untuk mendapatkan variabel pada kalkulasi skor dengan uji Hosmer-Lameshow (p<0,25). Skoring dilakukan uji sensitivitas, spesifisitas dan analisis receiver operating curve (ROC).
Hasil Penelitian : 283 subjek GJK dibagi menjadi tiga kelompok. Variabel yang memenuhi persyaratan untuk dilakukan kalkulasi skor adalah pembesaran atrium kiri (LAE) (OR=6,36; p= 0.000) dengan skor 2, QRS lebar (OR=13,06; p= 0.000) dengan skor 3, interval QTc memanjang (OR=2,18; p= 0.065) dengan skor 1 dan perubahan gelombang ST-T (OR=5,05; p= 0.000) dengan skor 2. Subjek dengan HFpEF mempunyai skor <3, HFmrEF mempunyai skor 3-4, dan HFrEF mempunyai skor >4. Sistem skoring EKG memiliki sensitivitas 71,4% dan spesifisitas 88,6% dengan AUC 87,9%
Kesimpulan : Sistem skoring EKG pada penelitian ini dapat digunakan sebagai pedoman awal dalam menentukan fraksi ejeksi ventrikel kiri pada pasien GJK
Kata kunci : elektrokardiografi, gagal jantung kronik, fraksi ejeksi ventrikel kiri
Background: Heart failure (HF) are divided into HF reduced ejection fraction (HFrEF<40%), mid range (HFmrEF 40-49%), and preserved (HFpEF ≥50%). Nowadays echocardiography is used as gold standard examination, but it is limited only in several health centers. For this reason, a preliminary examination tools is needed. Electrocardiographic (ECG) examinations tool that available almost at every health center and easy to be used. Calculating the scores from ECG variables to determine the EF will make clinician’s earlier to give initial terapi
Method: An observational approach with cross sectional study design. The data was taken from patient’s medical record with chronic heart failure (CHF) who went to the Tepartement of Cardiology at Dr. M. Djamil Padang Hospital in January-August 2017. Bivariate analysis was performed on each ECG variable then correlated with LVEF by chi-square method. Multivariate analysis with logistic binary regression test was conducted to obtain variables that would go into the score calculation stage with the Hosmer-Lameshow test (p <0.25). The sensitivity, specificity test and receiver operating curve (ROC) analysis were performed.
Result: 283 subjects of CHF who had been divided into three groups. Obtained variables that met the requirements for calculating scores were left atrial enlargement (LAE) (OR = 6.36; p = 0.000) score was 2, wide QRS (OR = 13.06; p = 0,000) score was 3 , prolonged QTc interval (OR = 2,18; p = 0,065) score was 1 and ST-T change (OR = 5.05; p = 0.000) score was 2. Subjects with HFpEF if the scored were <3, HFmrEF if the scored were 3-4, and HFrEF if the scored were >4. It has sensitivity 71,4%, specificity 88,6% with AUC 87,9%.
Conclusion: Electrocardiography scoring system in this study can be used as an initial tools to determining LVEF in patients with CHF.
Keywords: electrocardiography, chronic heart failure, left ventricular ejection fractio
Value of Fragmented QRS Complex on 12-lead ECG as A Valuable Marker of Myocardial Damage of CAD Patients
Get PDFBackground: Presence of Fragmented QRS (fQRS) on a 12-lead Electrocardiogram (ECG) was associated with various cardiac diseases. This phenomenon could represent as an electrical disruption of conduction system following myocardial damage due to coronary artery disease (CAD). We aimed to investigate the value of fQRS to detect the myocardial scar as detected by SPECT Myocardial Perfusion Imaging (MPI).
Methods: A cross-sectional study of patients with clinical diagnosis of CAD who underwent Cardiac SPECT. The fQRS defined as morphologies of QRS wave (<120 ms), which included an additional R wave (R’), notching in the nadir of S wave, or >1 R’ (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. Pathological Q wave, paced rhythm, typical right or left bundle branch block pattern with QRS duration of ≥ 120 ms were excluded. MPI was interpreted by visual analysis and semi-quantitative scores on 17-segment assessment according to standard nomenclature.
Results: Total of 72 patients (49 males, mean age 54.7 ± 9.8 years). fQRS was found in 46 patients (64%). The frequency of myocardial scar was significantly higher in patients with fQRS (89% vs. 15%, p<0.05). Sensitivity, specificity, positive and negative predictive value of fQRS for any of myocardial scar as detected by SPECT analysis were 91%, 81%, 89%, and 84%, respectively. From regional scar analysis, fQRS has sensitivity and specificity of 87% and 90% for anterior wall, 76% and 80% for inferior wall, 73% and 79% for lateral wall. LVEF was significantly lower in patients with fQRS (36.9±2.1 vs. 53.2±2.2, p< 0.05).
Conclusion: The fragmented QRS could serve as a novel ECG marker to detect and localize the myocardial damage in CAD patients. Regional fQRS patterns denote the presence of regional myocardial scar and are a valuable diagnostic marker of CAD with good sensitivity and specificity.
Keywords: fragmented QRS, SPEC
Precordial ST Segment Depression on Admission Electrocardiogram as a Simple Noninvasive Tool for Predicting Coronary Artery Disease Complexity in Patients with Inferior Myocardial Infarction
Get PDFPrecordial ST Segment Depression on Admission Electrocardiogram
as a Simple Noninvasive Tool for Predicting Coronary Artery Disease Complexity
in Patients with Inferior Myocardial Infarction
Jaya Suganti, Anggia Chairuddin Lubis, Abdullah Afif Siregar, Andika Sitepu, Cut Aryfa Andra,
Ali Nafiah Nasution, Harris Hasan
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Sumatera Utara,
Haji Adam Malik General Hospital, Medan, Indonesia
Background: Whether a precordial ST segment depression (PSTD) is merely a benign electrical phenomena or a sign of multivessel coronary artery disease (MVCAD) in inferior myocardial infarction (MI) remains unclear. The objective of this study is to analyze the complexity of coronary artery disease (CAD) in inferior MI patients with PSTD and to investigate whether PSTD can be used as a predictor of MVCAD in inferior MI.
Methods: Patients with inferior MI were divided into two groups based on the presence of PSTD on admission ECG and were compared based on the patient’s coronary artery complexities.
Results: A total of 215 patients with inferior MI were found in this study period, with 102 patients meet the inclusion and exclusion criteria. Patients with PSTD had a higher incidence of MVCAD and SYNTAX score. Further analyzes showed PSTD on admission ECG was an independent predictor of MVCAD in inferior MI [45 (66%) vs 23 (34%); OR 4.097; 95% CI 1.638-10.247; p=0.003).
Conclusion: In daily clinical practice, PSTD on admission ECG may serve as a simple noninvasive tool for predicting MVCAD or a more complex CAD in inferior MI.
Keywords: Precordial ST Segment depression, inferior myocardial infarction, SYNTAX score
 
Association between Grade of Normoalbuminuria and Left Ventricular Diastolic Dysfunction (LVDD) in Hypertensive Population of Gunungsari Village, Pamijahan-Bogor, Indonesia
Get PDFAssociation between Grade of Normoalbuminuria and Left Ventricular Diastolic Dysfunction (LVDD) in Hypertensive Population of Gunungsari Village, Pamijahan-Bogor, Indonesia Nur Z Qomara MD, Nani Hersunarti MD, Anwar Santoso MDDepartement of Cardiology and Vascular Medicine Faculty of Universitas Indonesia  ABSTRACT  Background: Albuminuria has been considered an important diagnostic marker of decreasing renal function, but lately albuminuria has also been linked to cardiovascular and peripheral vascular disease. Many studies have analyzed the association between micro- or macroalbuminuria and the increased risk of cardiovascular disease, but only few examined the association between normoalbuminuria and cardiovascular disease.Objective: To analyze the association between the degree of normoalbuminuria and the occurrence of left ventricular diastolic dysfunction in hypertensive patients.Method: This is cross-sectional analysis in hypertensive patients. Normoalbuminuric subjects are divided into three tertiles based on the cutoff of Urine-Albumin-Creatinine Ratio (UACR). To evaluate left ventricular function, all subjects undergo echocardiography examination. Left ventricular diastolic dysfunction is positive if more than fifty percent of positive findings are present from the fourth parameters stated in the 2016 American Society of Echocardiography criterias.Results: No significant difference in the occurrence of LVDD was found between the two groups according to age, sex, smoking, dyslipidemia, physical activity, BMI, hypertension therapy and HbA1c, but a significant difference was seen in the UACR tertile of the two group. This study showed that upper-limit normoalbuminuria (third tertile) was associated with the occurrence of LVDD (OR 15.57, 95% CI: 2.88-84.25).Conclusion: This study showed that normoalbuminuria in hypertensive population is associated with left ventricular diastolic dysfunction. Keywords: hypertension, normoalbuminuria, left ventricular diastolic dysfuncti
EFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL INFARCTION PATIENTS RECEIVING FIBRINOLYTIC THERAPY
Get PDFEFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL INFARCTION PATIENTS RECEIVING FIBRINOLYTIC THERAPY
Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1
1Department of Cardiology and Vascular Medicine, Faculty of Medicine,
Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia
Background: Worldwide, coronary heart disease (CHD) is a leading cause of death. Inflammation in CHD and acute myocardial infarction (AMI) is a trigger due to the formation of atheroma plaques in the coronary arteries. N-Acetylcysteine ​​(NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival.
Objective: To determine the effect of NAC on hsCRP levels in patients with acute myocardial infarction who received fibrinolytic therapy.
Methods: This study was an experimental study with pre and post, single blind and randomization methods on the effect of NAC on hsCRP levels compared to controls carried out in July - August 2018 on the incidence of ST Elevation Myocardial Infarction (STEMI) came to Dr Moewardi Hospital and get fibrinolytic therapy.
Results: A total of 33 patients were included in this study, there were 15 patients (mean age 58.80 ± 8.54 years) of the control group and 18 patients (mean age 55.45 ± 9.92 years) the treatment group receiving additional therapy of NAC evervescent 600 mg three times a day for three days . This study showed that hsCRP levels after intervention in the control and treatment groups were significantly different with p = 0.001. The level of hsCRP in the control group after administration of NAC had a median of 114.50 mg / L (18.60 - 300.00) while in the treatment group had a median of 18.75 mg / L (5.50 - 102.90).
Conclusion: The addition of NAC 600 mg of therapy three times daily for 3 days can reduce hsCRP levels in patients with STEMI receiving fibrinolytic therapy compared to patients with acute myocardial infarction with ST segment elevation who did not receive additional NAC therapy.
Keywords: hsCRP, N-Acetylcysteine, acute myocardial infarction
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PENGARUH N-ACETYLCYSTEIN TERHADAP HSCRP PADA PASIEN INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN ST YANG MENDAPAT TERAPI FIBRINOLITIK
Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1
Departemen Ilmu Penyakit Jantung dan Pembuluh Darah, Fakultas Kedokteran
Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia
Latar Belakang: Di seluruh dunia, penyakit jantung koroner (PJK) merupakan penyebab utama kematian. Inflamasi pada PJK dan infark miokard akut (IMA) merupakan pemicu akibat terbentuknya plak ateroma pada arteri koroner. N-Acetylcysteine (NAC) dapat mencegah inflamasi, remodeling dan disfungsi ventrikel kiri, fibrosis interstisial, dan meningkatkan survival.
Tujuan: Untuk mengetahui pengaruh NAC terhadap kadar hsCRP pada pasien infark miokard akut yang mendapatkan terapi fibrinolitik.
Metode: Penelitian ini merupakan penelitian eksperimental dengan metode pre dan post, single blind dan randomisasi mengenai pengaruh NAC terhadap kadar hsCRP dibandingkan dengan kontrol yang dilakukan pada bulan Juli - Agustus 2018 terhadap paien Infark Miokard Akut dengan Elevasi Segmen ST (IMA-EST) yang datang ke Rumah Sakit Dr Moewardi dan mendapat terapi fibrinolitik.
Hasil: Sebanyak 33 pasien diikutsertakan pada penelitian ini, terdapat 15 pasien (rerata usia 58.80±8.54 tahun) kelompok kontrol dan 18 pasien (rerata usia 55.45±9.92 tahun) kelompok perlakuan yang mendapat terapi tambahan NAC evervescent 600 mg tiga kali sehari selama tiga hari. Penelitian ini menunjukkan bahwa kadar hsCRP sesudah dilakukan intervensi pada kelompok kontrol dan perlakuan berbeda bermakna dengan nilai p = 0.001. Kadar hsCRP pada kelompok kontrol sesudah pemberian NAC memiliki median 114.50 mg/L(18.60 – 300.00) sedangkan pada kelompok perlakuan memiliki median 18.75 mg/L(5.50 – 102.90).
Kesimpulan: Pemberian terapi tambahan NAC 600 mg tiga kali sehari selama 3 hari dapat menurunkan kadar hsCRP pada pasien infark miokard akut dengan elevasi segmen ST yang mendapat terapi fibrinolitik dibanding pasien infark miokard akut dengan elevasi segmen ST yang tidak mendapat terapi tambahan NAC.
Kata Kunci: hsCRP, N-Acetylcysteine, infark miokard aku
CORRELATION BETWEEN SERUM LEVEL GALECTIN-3 AND EARLY REMODELLING INDICATOR OF LEFT VENTRICLE IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION DURING PRE-PERCUTANEOUS CORONARY INTERVENTION
Get PDFBackground: Coronary heart disease (CHD) is a leading cause of death worldwide. Acute coronary syndrome (ACS) is a spectrum of CHD. Left ventricle remodelling is one of the complication with the bad outcome either short-term or long term. Early remodelling process (within 0-72 hours) post infarction can be assessed by circulating biomarker (Galectin-3), echocardiography, coronary angiography, and clinically.
Objective: The aim of study is to know the correlation between serum level of Galectin-3 and early remodelling indicator in patient with acute myocardial infarction during pre-percutaneous coronary intervention. The parameters are LVEDV, LVEF, diastolic function component, TIMI flow, MBG, and presence of acute heart failure.
Materials and Methods: This cross sectional study was conducted in Sanglah General Hospital during March-May 2018. A 62 sample was determined consecutively.
Results: Bivariate analysis with Spearman correlation shows Galectin-3 correlated with LVEDV (r = 0,808; p= 0,000), E/e’ average (r = 0,297; p = 0,019), E/A ratio (r = 0,261; p= 0,041), and MBG (QuBE) (r = 0,647; p = 0,000). No correlation was found between Galectin-3 and LVEF Teich (r = -0,213; p= 0,097), LVEF Biplane (r = -0,226; p = 0,077), LAVI (r = 0,301; p = 0,170), e’septal (r = -0,079; p = 0,539), e’lateral (r = -0,092; p = 0,476), and TR Vmax (r=0,068; p=0,600). Chi square analysis shows no association between Galectin-3 and diastolic dysfunction left ventricle (OR= 1,032, p= 0,966, CI95%= 0,239-4,462), TIMI flow (OR= 1,032, p= 0,966, CI95%= 0,239-4,462), MBG score (OR= 0,264, p= 0,197, CI95%= 0,031-2,259), and acute heart failure (OR=0,577, p= 0,476, CI95%= 0,127-2,617). Multivariat analysis with multiple linear regression shows an increase in Galectin-3 has been proven associated independently with LVEDV, LAVI, E/e’ average, and E/A ratio. Multiple logistic regression shows Galectin-3 has not been proven independently with diastolic dysfunction, TIMI flow, MBG score, and acute heart failure. LVEDV is the best outcome that can be explained as its value influenced by constant, BMI, and Galectin-3 (R2 = 0,509).
Conclusion: Galectin-3 correlated with LVEDV, average E/e’, E/A ratio, and MBG (QuBE). There is an independent association between Galectin-3 and LVEDV, LAVI, average E/e, and E/A ratio. Early remodelling process within 0-72 hours post infarction was happened pre-PCI. Anti-remodelling (including anti failure) during early phase is strongly recommended in order to prevent worse outcome in short and long term.
Keywords: Galectin-3, early remodelling left ventricle, acute myocardial infarction, percutaneous coronary intervention
Diagnostic Value Of Qtc Dispersion And And Qt Dispersion Ratio Changes On Stress Test In Detecting Significance Of Coroner Lesion In Stable Angina Pectoris Patients
Get PDFBackground : Treadmill exercise test remains an important method and often used in the initial evaluation of patients with chest pain and can be a filter for more expensive invasive diagnostic. Increased QT dispersion (QTD) occurs because of the heterogeneity of ventricular repolarization because transient ischaemia during a treadmill stress test can be a marker of coronary artery disease (CAD) and can improve the accuracy of exercise tests to diagnose CAD, but this parameter is still controversial.
Method : This is an analytic observational approach with a cross sectional study. Data was taken retrospectively at the Heart Center Installation at RSUP Dr. M. Djamil Padang, from March to April 2019, stable angina pectoris patient with a positive treadmill stress test who underwent coronary angiography as the subject. Bivariate analysis was performed on changes in QTcD (∆QTcD) and QTdR (∆QTdR) variables on the significance of coronary lesions by the chi-square method, after which a diagnostic test was based on receiver operating curve (ROC) analysis.
Study Result : There were 122 subjects and found that older age, male and smoking were more common in groups with significant coronary lesions. Cut off point for ∆QTcD is ≥13 ms with a sensitivity of 87,1% and specificity 85,2% and AUC 95,1%, while ∆QTdR ≥5.5% with sensitivity 85,7% and specificity 81,9% and AUC 90,5% are related to significancy of coronary lesion. Obtained subjects with significant lesions generally had a value of ∆QTcD ≥ 13 ms (p <0.001) and ∆QTdR ≥ 5.5% (p <0.001).
Conclusion : The use of ∆QTdR dan ∆QTdR parameters as ECG variables, which are easily obtained in evaluating stress tests, can improve the diagnostic accuracy of exercise tests. In addition, evaluation of ∆QTdR dan ∆QTdR can provide information about the incidence of CAD.
Keywords : ∆QTcD, ∆QTdR, Treadmill Exercise Test, Coronary Lession Significancy
 
Perlukah kriteria hipertensi baru dan target pengendalian tekanan darah yang lebih agresif? Telaah paska studi SPRINT serta panduan ACC/AHA 2017 dan ESH/ESC 2018
Get PDFThe Hypoxic Preconditioning Effect On Senescence Cell Process In Cultured Adipose-Derived Mesenchymal Stem Cells (AMSCs)
No full textIntroduction : Stem cell therapy for myocardial regeneration is expected to increase cardiomyocyte proliferation and trigger neovascularization to improve cardiomyocytes. Mesenchymal Stem Cells (MSCs) are ideal candidates for regenerative medicine and immunotherapy. But low viability of MSCs is a major challenge in this alternative therapy. Therefore, a cytoprotective strategy is needed, one of them is hypoxic preconditioning which can significantly increase survival stem cells after being transplanted. MSCs are known to have a limited life span, after experiencing several splits MSC will enter the senescence process. It is known that hypoxia can also increase cell proliferation and differentiation potential in vitro and in vivo through the role of Octamer-4 (Oct-4) as a regulator of the pluripotency gene.
Methods : Experimental laboratory studies (in vitro studies) using human-AMSCs which were given hypoxic preconditioning, observed as a immunocytochemistry.
Results : The results showed that hypoxic precondition (1% O2) inhibited the senescence process. It can be seen in the lower expression of senescence in hypoxic conditions at P6, P7, P8, P9, P10 compared to normoxic ((p=0,004, p=0,001, p=0,009, p=0,013, p=0,024. There is a significant difference in the senescence expression of each passage in hypoxic and normoxic conditions with the highest expression at P10. In addition, we also observed AMSCs differentiation through the Oct-4 expression. It is showed that Oct-4 expression were higher in hypoxia compared to normoxia on P7, P8, P9, P10 (p=0,009, p=0,009, p=0,030, p=0,0001).
Conclusions : Hypoxic preconditioning have the effect of inhibiting the senescence process on Adipose-derived MSCs (AMSCs) or prolonging their life span. The longer life span of AMSCs is also seen by higher cell differentiation potential from increased expression of Oct-4. However, the mechanism of inhibiting the senescence process in hypoxia in stem cells is still remain unknown.
Keywords: human-Adipose derived Mesenchymal Stem Cell Cultures (h-AMSCs), Hypoxic Preconditioning, Senescence cell, Oct-4