Indonesian Journal of Cardiology
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CORELATION OF GLOBAL LONGITUDINAL STRAIN (GLS) – LEFT VENTRICLE AND SOLUBLE SUPRESSION OF TUMORGENICITY 2 (sST2) IN ACUTE HEART FAILURE WITH SYSTOLIC DYSFUNCTION
No full textBackground : Assessment of left ventricular function in patients with acute heart failure is important for prognostication, determination of treatment plan, for decisions related to expensive device therapies and for assessing response to treatment. Echocardiography is the "gold standard" of assessing left ventricular function, and in establishing a diagnosis of heart failure. Left ventricular Global Longitudinal Strain (GLS) assessed through Speckle Tracking Echocardiography (STE) is currently considered sensitive in assessing left ventricular motion, by analyzing multidimensional myocardial deformation
. s ST2 used to be correlated with stretch miocard and inhibid ligand of IL-33 wich also inhibit the cardioprotectve effect.
Objective : To prove the positive correlation between GLS-left ventricle with soluble ST2.
Methods : This is a correlational study with cosecutive sampling technique. Thirty subjects participate in this reseach and each subject underwent echocardiography and GLS-left ventricle and soluble ST2 blood examination. The correlation between GLS-left ventricle and soluble ST2 were evaluated using Spearman correlation test.
Results : There is a strong, significant, positive correlation between the GLS-left ventricle with soluble ST2 (r = 0.99 and p = 0.0001).
Conclusion : There is a strong, significant, positive correlation between the GLS- left ventricle with soluble ST2.
Keywords : acute heart failure, systolic dysfunction, global longitudinal strain, soluble ST2
Effect of Sweet Purple Potato (Ipomoea batatas L.) Extract and Vitamin C on Endothelial Progenitor Cell Migration in Stable Coronary Disease Patient
Get PDFBackground: Number and function of Endothelial Progenitor Cells (EPC) are reduced incoronary artery disease (CAD) patient. EPC as progenitor of mature endothelial cell has important role for angiogenesis and neovasculogenesis. Dysfunctional EPC partly because of oxidative stress. Decreasing oxidative stress with antioxidant especially with sweet purple potato extract and vitamin as easily found in Indonesia, may improve EPC migration to ischemic organ in stable CAD patient.
Purpose : To analyze effect of sweet purple potato (Ipomoea batatas L.) extract and vitamin C on Endhotelial Progenitor Cell in Stable Coronary Disease patient.
Method: This is experimental post-test control group study. Mononuclear cells (MNC) are isolated from peripheral blood of sample, and cultivated in medium for 3 days, immunofluorescence assay with CD34 as a marker for EPC. EPCs divided into sweet purple potato extract group (1 and 25 mcg/mL), vitamin C group (10 and 250 mcg/mL) and control, incubated for 2 days. 5x105 cell taken from each group and place in upper chamber of Transwell system. EPC migration was assessed in lower chamber of Transwell system after 24 hours using automated cell counters. Statistic testing using ANOVA.
Results: EPC migration was increased significantly in sweet purple potato extract and vitamin C compared with control (3.03 ± 0.01, 2.15 ± 0.03 vs control 1.21 ± 0.04, p<0.01). Increased dose of sweet purple potato extract and vitamin C shows significantly increased of EPC migration (1.81 ± 0.02 vs1.47 ± 0.04 and 3.03 ± 0.01 vs 2.15 ± 0.03, p<0.01). There is significantly diferentiation between sweet potato purple extract and vitamin C (3.03 ± 0.01 vs 2.15 ± 0.03, p<0.01).
Conclusion: Sweet purple potato extract and vitamin C increased EPC migration dose-dependently. Sweet purple potatao extract induces EPC migration better than vitamin C.
Keywords: EPC migration, Stable CAD, sweet purple potato extract, vitamin C, antioxidant
 
EFFECT OF PLATELET RICH PLASMA ON PROLIFERATION OF ENDOTHELIAL PROGENITOR CELL (EPC) OF STABLE CORONARY ARTERY DISEASE PATIENT
Get PDFABSTRACT
Effect of Platelet Rich Plasma (PRP) on Proliferation of Endothelial Progenitor Cell (EPC) of Stable Coronary Artery Disease Patient
Ronald R Hehanusa, Andrianto, Budi S Pikir
Background : Endothelial Progenitor Cell (EPC) is the progenitor of endothelial cell which has important role in regulation of vascular wall integrity and homeostasis, to protect vessels from inflamation and thrombosis, that leads into pathogenesis of coronary artery disease. Growth factors proven has important role to stimulate transduction signal in the process of proliferation of EPC. Platelet Rich Plasma (PRP) contains variety of growth factors, wellknown role in homeostasis and wound healing process. Therefore, this study was conducted to analyze the effect of PRP on proliferation of EPC of Stable Coronary Artery Disease (SCAD) patient.
Objective : To analyze the effect of Platelet Rich Plasma (PRP) on the proliferation of Endothelial Progenitor Cell (EPC) from peripheral blood of patient with SCAD
Methods : This is an in vitro, true experimental, post-test only control group design. The mononuclear cells were isolated from peripheral blood of SCAD patient and cultured in M-199 medium. EPC divided into 3 groups, which received Platelet Rich Plasma (PRP), Platelet Poor Plasma (PPP), and control. After 14 days of incubation, immunocytochemical examination was performed, EPC which marked with CD34, FITC labeled,was counted using immunofluoroscence microscope. Data analysis using ANOVA test.
Result : Cell counting showed significant increase of EPC proliferation in PRP group compared to PPP group (1.052 ± 0.16 vs 0.762 ± 0.19, p = 0.003), and control group as well (1.052 ± 0.16 vs 0.068 ± 0.05, p = 0.000). EPC proliferation in PPP group also increase significantly compared to control group (0.762 ± 0.19 vs 0.068 ± 0.05, p = 0.000).
Conclusion : Platelet Rich Plasma (PRP) increase EPC proliferation significantly from peripheral blood of SCAD patient.
Keywords : EPC proliferation, PRP, SCA
LEFT ATRIAL STRAIN BY SPECKLE TRACKING ECHOCARDIOGRAPHY IS NOT PREDICTED FUNCTIONAL CAPACITY IN HYPERTENSIVE POPULATION WITH PRESERVED SYSTOLIC FUNCTION AND NORMAL RESTING LEFT ATRIAL PRESSURE
No full textAbstract
Background: Hypertension is associated with diastolic dysfunction and impaired exercise capacity. LA has a substantial role to provides an optimal left ventricle diastolic filling. In this study, we aimed to assess the left atrial strain through STE as a predictor of functional capacity in the hypertensive population.
Methods: A total of 43 hypertensive women (mean age 50 ± 5.2 y.o; BMI 28.5± 4.1 Kg/m2) consecutively enrolled in this study. Patients with LVEF <50% or significant valvular pathology excluded. Two-dimensional STE performed to asses LA strain parameters, including PALS , PACS, and conduit strain. Functional capacity assessed by treadmill stress test using Bruce protocol.
Result: Mean PALS, PACS, and conduit strain in this study was lower than reference normal value 25.8%< 39%; 12.4% <17%; 13.5% <23%, respectively). All of the subjects had a preserved systolic function (mean LVEF 72.5 ± 7.6%) and normal resting LA pressure (mean PCWP 11.96 ± 2.09). Left atrial strain parameters value in the low-fair functional capacity group was not significantly different to average-good functional capacity group (p>0.05). Left atrial strain parameters value was not significantly correlated to exercise duration and achieved METS (P>0.05).
Conclusion: LA strain value in this study was below the standard reference limit. LA strain cannot predict functional capacity in the hypertensive population with preserved ejection fraction and normal resting LA pressure
PERFORMA SIMPLIFIED ACUTE PHYSIOLOGY SCORE 3 SEBAGAI PREDIKTOR MORTALITAS PADA UNIT RAWAT INTENSIF KARDIOVASKULAR
Get PDFBackground: Severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs) since 1980s. Physicians used them for predicting mortality and assessing illness severity in clinical trials. The Simplified Acute Physiology Score 3 (SAPS 3) is the only score that can predict hospital mortality within an hour of admission to ICU. Although this scoring systems has been widely used in ICUs, they have not been commonly applied in Intensive Cardiovascular Care Units (ICVCUs) since the population is quite different especially in disease subset. Therefore, the objective of this study was to evaluate the parameters in the SAPS 3 scoring system performance for predicting mortality in ICVCU population.Methods: This was an observational study with cross-sectional approach using secondary data from RAICOM (Registry of Acute and Intensive Cardiovascular Care on Outcome) taken from September 2013 – September 2014 in the ICVCU National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia. The secondary data were collected, analysed, and matched with SAPS 3 variables. All missing and invalid data were excluded. All data was processed and the SAPS 3 score was calculated in each patient. Multivariate analysis with logistic regression was conducted to evaluate the significance of the parameters in predicting mortality. Discrimination was assessed by area under the receiver operator characteristic curve (AUROC). Calibration was assessed by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed?to?expected numbers of deaths.Results: A total of 233 patients were included in this study and the observed hospital mortality was 16.7% (39/233). The patients enrolled were divided into survivors and nonsurvivors. Bivariate analyses of SAPS 3 variables showed intra-hospital location before ICVCU admission, use of vasoactive agents, reasons for ICVCU admission, infection, Glasgow Coma Score (GCS), creatinine level, and platelet count were significantly different between nonsurvivors than survivors (P<0.05). The SAPS 3 score was significantly higher in nonsurvivors than survivors. The AUC (95% confidence intervals [CIs]) for SAPS 3 score was 0.752 (0.669–0.835). The Hosmer?Lemeshow goodness?of?fit test for SAPS 3 demonstrated a Chi?square test score of 1.729, P = 0.943. Multivariate logistic regression was conducted for all variables that were probably correlated to prognosis. Eventually, intermediate ward as intra-hospital location before ICVCU admission was selected as an independent risk factors for predicting mortality (OR 4.165; 95% CI 1.462-11.864; P=0.008), whereas surprisingly the presence of community-acquired pneumonia (CAP) before ICVCU admission was a protective factor from hospital mortality (OR 0.224; 95% CI 0.068-0.730; P=0.013).Conclusion: Parameters in the SAPS 3 score system exhibited satisfactory performance in discrimination. In predicting hospital mortality, these parameters also showed good calibration for estimating hospital mortality. Intermediate ward as intra-hospital location before ICVCU admission appeared to be independently associated with mortality whereas patients with CAP comorbid as a protective factor against mortality. Despite the good result of this study, there are still plenty room of improvement for developing similar score in the future specifically for ICVCU population
The effect of chronic usage of Renin-Angiotensin-Aldosterone System Blocking Agents on Incidence of Contrast-Induced Nephropathy in patients with Diabetes Mellitus and Renal Insufficiency. A Restropesctive Cohort Study
Get PDFBackground: This study was to investigate the effect of long term use of Renin-Angiotensin-Aldosterone System(RAAS) blocking agents on the incidence of Contrast-Induced Nephropathy(CIN) on patients with Diabetes Mellitus(DM) and renal insufficiency underwent Percutaneous Coronary Intervention (PCI).
Methods:A total 281 of subjects were included in this study and divided into two groups based on prior use of RAAS blocking agents (RAAS +, n = 146; RAAS -, n = 135). CIN was defined as an increase of ≥25% in creatinin over baseline value 48-72 hours after PCI.
Result: Total incidence of CIN was 14,95%. There was no difference in the incidence of CIN between 2 study groups (p = 0,952) and relatif risk for CIN was 1,02. Left Ventricular ejection Fraction (LVEF) ≤ 40 % (OR 2,300; 95% CI 1,028 – 5,143; p = 0,043), anemia (OR 2,628; 95% CI 1,274 – 5,422; p = 0,009) and Glomerular Filtration rate (GFR) pre PCI ≤ 60 mL/menit (OR 2,782; 95% CI 1,293 – 5,987; p = 0,009) were important predictors of CIN.
Conclusion: Long term use of RAAS blocking agents do not increase the incidence of CIN on patients with DM and renal insufficiency underwent PCI
SMASH Score as a Predictor off-in Hospital Mortality for Acute Heart Failure Patients
Get PDFBackground: The prognosis of AHF patients remain poor. The aim of this study is to design a simple, bedside clinical prognostic scoring model and validate its ability to predict hospital mortality for patients with AHF.
Methods: 255 patients with AHF were enrolled, divided into dead (n=121) and surÂvival (n=134) cohorts. The data were collected from January 2015 to September 2016.Data were collected restropectively. Multivariable analysis was applied to determine independent risk factors and develop the scoring system.
Results: The Multivariate logistic regression analysis, hospital mortality was employed as dependent variable, while age umur (p=0.014,OR 4.314 CI 95%(1.346-13.822)), Diastolic Blood Pressure (p= 0.001 OR 6.213 CI 95%(2.1210-18.205 )), Systolic Blood Pressure ( p=0.002 OR 5.043 CI 95%( 1.854-13.717)), Heart Rate ( p=0.002 OR 3.933 CI 95%(1.658-9.332)), haemoglobin ( p = 0.044 OR 2.530 CI95%(1.026-6.242)), arrhytmia ( p=0.001 OR 7.658 CI 95%(2.217-26.457)), creatinine on admission ( p=0.002 OR 4.385 CI 95% (1.731-11.104)), QRS duration (p=0.00 OR 7.684, CI 95% (3.063-19.279)), as independent variables.According to each OR of these variables, we set the new scoring system of hospital mortality for AHF with good calibration by Hosner-lemeshow test ( p =1) and discrimination by AUC 0.925 (p<0.01 CI 95 % 0.891-0.959). The optimal cutt off for prediction mortality was total 6 points, sensitivity 81% and specificity 89%. We divided the patients with AHF as low risk whom total score 0-3 points (mortality in hospital 0-2%), moderate risk whom total score 4-5 points (mortality in hospital 13-46%), and 6-12 point as high risk. In the validation cohort indicated that SMASH score as new scoring system was effective with bootstrapping.
Conclusion : The SMASH Score is a new scoring system of hospital mortality for AHF can predict with good performance in terms of discrimination, calibration and internally validation.
Abstrak
Latar Belakang : Prognosis pasien dengan gagal jantung akut ( GJA ) masih buruk, dan stratifikasi resiko mungkin dapat membantu para klinisi dalam penatalaksanaan, dimana pasien yang tergolong buruk, harus dilakukan tindakan agressif dan pemantauan yang ketat. Namun ketersediaan sistem skoring pada GJA masih terbatas. Studi ini bertujuan untuk membuat model skoring prognostik yang sederhana dan validasinya dalam prediksi kematian di rumah sakit pada pasien GJA.
Metode : 255 pasien GJA dibagi 2 kelompok yang mengalami kematian kardiovaskular dan survival di rumah sakit. Data dikumpulkan dari Januari 2015 sampai September 2016. Kriteria inklusi memenuhi panduan GJA berdasarkan ESC guidelines 2016. Dilakukan analisa multivariat dalam mencari faktor resiko yang bebas dan pembuatan sistem skoring.
Hasil : Setelah dilakukan analisa multivariat logistik regressi, kematian di Rumah Sakit sebagai variable bebas, sementara umur (p=0.014,OR 4.314 KI 95%(1.346-13.822)) Tekanan darah diastolik saat masuk ( p= 0.001 OR 6.213 KI 95%(2.1210-18.205 )), tekanan darah sistolik saat masuk ( p=0.002 OR 5.043 KI 95%( 1.854-13.717)), Denyut nadi( p=0.002 OR 3.933 KI 95%(1.658-9.332)), hemoglobin ( p = 0.044 OR 2.530 KI95%(1.026-6.242)), arritmia ( p=0.001 OR 7.658 KI 95%(2.217-26.457)), kreatinin masuk ( p=0.002 OR 4.385 KI 95% (1.731-11.104)), QRS duration (p=0.00 OR 7.684, KI 95% (3.063-19.279)) sebagai variabel independen.Berdasarkan masing-masing OR dari variabel ini, diformulasikan sebuah sistem skoring . Sistem skoring yang baru memiliki kalibrasi dan diskriminasi yang sangat memuaskan menurut Hosner-lemeshow test ( p =1) dan AUC 0.925 (p<0.01 CI 95 % 0.891-0.959). Nilai titik potong yang optimal untuk prediksi kematian di rumah sakit adalah 6 poin dengan sensitivitas 81% and spesifisitas 89%. Kami menggolongkan pasien GJA sebagai resiko kematian rendah dengan total skor 0-3 poins (mortalitas di Rumah sakit 0-2%), resiko sedang dengan total skor 3-5 points (mortalitas di Rumah Sakit 13-46%), and 6-14 poin sebagai resiko tinggi. Pada validasi internal bahwa SMASH score sebagai sistem skoring kematian yang baru menunjukan nilai optimisme yang baik secara bootsrapping.
Kesimpulan : SMASH Score adalah sebuah Sistem Skorring baru dalam Prediksi Kematian di Rumah Sakit pada Sindroma Gagal Jantung Akut dengan kalibrasi dan diskriminasi serta validasi yang baik
E-Point Septal Separation as a Surrogate Marker for Global Longitudinal Strain in Predicting MACE after ST Elevation Myocardial Infarction
Get PDFBackground: Global Longitudinal Strain (GLS) is a sensitive measurement and has been studied as a parameter to assess myocardial deformity and had a prognostic value in STEMI patient, but this measurement is usually taken at echocardiography laboratory with software installed only, a simple parameter of systolic function that had been known is EPSS, the aim of this study is to determine the prognostic value of this simple parameter as a surrogate marker of myocardial deformity for mayor adverse cardiac event (MACE).
Methods: This is an analytic observational study using ambispective cohort study, basic and echocardiographic data were collected from 66 adult subjects of acute STEMI from July 2016 until April 2017. Each subjects were followed-up for MACE (mortality, heart failure, ventricular arrhytmia and cardiogenic shock) 30 days since admission. Cut off point were taken from ROC curve. Statistical analysis test were used to examine the association between two variables and obtained odds ratio (OR) for EPSS. To obtain the degree of relationship between EPSS and GLS we were using corelation test with the value of p<0.05 was considered statistically significant.
Result: In this study the optimum cut off value for EPSS was 7 mm with sensitivity and specificity of 72% and 71%, respectively. Bivariate analysis showed among EPSS >7 mm and GLS >-10,6% were associated with MACE in 30 days after STEMI. In multivariate analysis, GLS >-10,6% (OR 10,6 95%IK 2,5-44,7 p=0,001) and EPSS >7 mm (OR 5, 95%IK 1,12-22,56 p=0,035) remained significantly associated and had 83% probability for MACE in 30-days after STEMI. Using the corelation test we found that EPSS had a stronger relationship with GLS (r=0,795, p<0,001).
Conclusion: Our data show that EPSS >7 mm had a strong relationship with myocardial deformity parameter and appears to be a strong predictor for MACE in 30-days after acute STEMI. Therefore, it can be taken earlier to help the cardiologist in emergency unit for futher appropriate management planning.
Abstrak
Latar Belakang: Global Longitudinal Strain (GLS) adalah parameter deformitas miokardium yang telah banyak diteliti untuk menilai fungsi sistolik ventrikel kiri serta kaitannya terhadap prognosis pasien IMA-EST, sayangnya pemeriksaannya cenderung terbatas dilakukan di laboratuÂrium ekokardiografi dengan alat ekokardiografi tertentu. Parameter fungsi sistolik lainnya yang cukup dikenal karena tekniknya yang sederhana dan dapat dilakukan di Unit Gawat Darurat adalah E-Point Septal Separation (EPSS), tujuan dari penelitian ini adalah melihat nilai prognosis EPSS sebagai indikator tidak langsung deformitas ventrikel kiri terdahap Kejadian Kardiovaskular Mayor (KKvM).
Metode: Penelitian ini merupakan studi kohort ambispektif, 66 orang subjek IMAEST yang memenuhi kriteria inklusi dan eksklusi yang dirawat di Rumah Sakit Haji Adam Malik mulai Juli 2016 sampai April 2017 diambil data dasar dan ekokardiografinya, kemudian pasien diikuti selama 30 hari untuk KKvM (kematian, gagal jantung, aritmia ventrikel dan syok kardiogenik). Nilai titik potong EPSS diambil dari kurva ROC. Uji statistik dilakukan untuk menilai hubungan antara variabel untuk mendapatkan nilai rasio odds (RO) EPSS, uji korelasi digunakan untuk menilai kekuatan hubungan antara EPSS dengan GLS, p<0,05 dianggap bermakna.
Hasil: Nilai titik potong EPSS yang didapatkan adalah 7 mm dengan sensitivitas 72%, spesifisitas 71%. Analisis bivariat menunjukkan nilai EPSS >7 mm dan GLS >-10,6% berhubungan dengan KKvM. Pada analisis multivariat, GLS >-10,6% (RO 10,6 95%IK 2,5-44,7 p=0,001) dan EPSS >7 mm (RO 5, 95%IK 1,12-22,56 p=0,035) secara signifikan tetap berhubungan dan memiliki probabilitas sebesar 83% dalam memprediksi KKvM 30 hari setelah IMAEST. Adapun nilai EPSS dan nilai GLS memiliki hubungan yang kuat (r=0,795, p<0,001).
Kesimpulan: Data menunjukkan bahwa nilai EPSS >7 mm memiliki hubungan yang kuat dengan parameter deformitas ventrikel kiri dan suatu prediktor kuat pula terhadap KKvM dalam 30 hari setelah IMAEST. Hal ini menguntungkan kita sebagai klinisi karena dengan pemerÂiksaan EPSS yang sederhana ini dapat menjadi indikator adanya deformitas miokardium ventrikel kiri yang bernilai prognosis sehingga dapat dilakukan lebih dini untuk dapat menentukan strategi tatalaksana pada pasien IMAEST
Clinical Research
No full textAbstracts of the 6th Annual Scientific Meeting of the Indonesian Heart Rhythm Society
Jakarta, 21-22 September 2018
Original Article
Case Reports
No full textAbstracts of the 6th Annual Scientific Meeting of the Indonesian Heart Rhythm Society
Jakarta, 21-22 September 2018
Case Report