Indonesian Journal of Cardiology
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TNF ?, LVH, Prehypertension, Abdominal obesity
No full textIntroduction : Left Ventricular Hypertrophy (LVH) as an independentpredictor of mortality may develop in non diabetes obese. There’s a roleof inflammation because adipose tissue release the proinflammatory cytokinessuch as TNF ?. It is important to prove this inflammatory state andits impact to the healthy obese for preventing cardiovascular events in thefuture. Purpose of this study is to investigate correlation of TNF ? levelwith LVH and Prehypertension in non diabetes abdominal obesity.Methods : Eighty-two male abdominal obesity and non abdominal obesitysubjects with no history of diabetes were recruited in this cross-sectionalstudy. Tumor Necrosis Factor Alpha level were measured with radioimmunoassay,blood pressure measurement was taken 2 times. Left VentricularMass Index(LVMI) were evaluated by M-Mode and two dimensionechocardiogram and value above 115 g/m2 are indicative of LVH.Result : TNFa alpha level is higher in abdominal obesity group as compareto non abdominal obesity (0,7133+0,2072 pg/ml vs 2,395+1,5371 pg/ml,p<0,001). Most of obese subjects developed prehypertension. Subjectswith prehypertension showed higher plasma TNF alpha level as compare tosubject with normal blood pressure (2,83+1,649 pg/ml vs 1,38 + 0,3245pg/ml, p<0,001). We also found the LVH in 30 (60%) of abdominal obesitysubjects. Obese subject had larger LVMI than non obese (138,427+47,461g/m2 vs 90,188+16,06 g/m2, p<0,001), and correlates positively to plasmaTNF alpha level (r=0,727, p,<0,001).Conclusion : High level of plasma TNF alpha is associated with left ventricularhypertrophy and prehypertension in non diabetes male abdominalobesity.Pendahuluan. Hipertrofi ventrikel kiri (HVK) sebagai prediktor mortalitas dapat terjadi pada orang obesitas non diabetes.Inflamasi memegang peranan dalam proses ini melalui pelepasan sitokin proinflamasi seperti TNF alfa. Pembuktian adanyakeadaan inflamasi dan akibatnya pada orang obese yang sehat ini sangat penting dalam upaya pencegahan timbulnya penyakitkardiovaskular pada individu tersebut. Tujuan penelitian ini untuk mengetahui korelasi kadar TNF alfa dengan HVK danprehipertensi pada obesitas sentral tanpa diabetes.Metodologi Delapan puluh dua pria non diabetes dengan obesitas sentral dan tanpa obesitas sentral dimasukkan ke dalampenelitian potong lintang ini. Kadar TNF alfa diukur dengan menggunakan radioimunoassay dan tekanan darah diukur duakali. Indeks massa ventrikel kiri dievaluasi menggunakan ekokardiogram 2 dimensi dan M-Mode dimana nilai lebih dari 115g/m2 dinyatakan sebagai hipertrofi ventrikel kiri.Hasil Kadar TNF alfa lebih tinggi pada kelompok obesitas sentral dibandingkan dengan non obesitas sentral (0,7133+0,2072pg/ml vs 2,395+1,5371 pg/ml, p<0,001). Sebagian besar kelompok obes mengalami hipertensi dimana kadar TNF alfa padakelompok prehipertensi lebih tinggi dibandingkan dengan yang normotensi. Kami juga mendapatkan HVK pada 60% darikelompok obesitas sentral. Kelompok ini memiliki massa ventrikel kiri lebih besar dibandingkan non obes (138,427+47,461g/m2 vs 90,188+16,06 g/m2, p<0,001), dan berkorelasi positif dengan kadar TNF alfa (r=0,727, p<0,001).Kesimpulan Kadar TNF alfa yang tinggi berhubungan dengan hipertrofi ventrikel kiri dan prehipertensi pada pria obesitassentral tanpa diabetes
Preoperative and predischarge predictors for persistent pulmonary hypertension after mitral valve surgery in patients with chronic organic mitral regurgitation
Get PDFObjectives. This study sought to evaluate the prevalence of pulmonary hypertension after mitral valve surgery ini patients with chronic organic mitral regurgitation and to determine preoperative and predischarge predictors for persistent pulmonary hypertension after surgeryMethods. This is a cohort retrospective study involving subjects with chronic organic mitral regurgitation with preoperative systolic PA pressure > 50 mmHg undergoing surgery. Demographic and echocardiography datas were collected prior to surgery, predischarge, and follow up datas were evaluated after minimal 6 months duration. Subjects were then devided into groups based on existence of persistent pulmonary hypertension after follow up. Bivariate and multivariate analysis was done to determine contributing factors.Results.There were 92 subjects with dominant mitral regurgitation included in this study with median age 40 (range 17-68) years with slight female predominance (55%). Persistent pulmonary hypertension was observed in 23 subjects (25%) predischarge and in 20 subjects (20.7%) after mean follow up of 11 + 5.5 months. Bivariate analysis revealed preoperative TAPSE, underlying etiology, severity of pulmonary hypertension preoperatively, postoperative atrial fibrilation, mean mitral valve gradient predischarge, and the presence of residual pulmonary hypertension predischarge were related with persistent pulmonary hypertension. From multivariate analysis, post operative atrial fibrillation [OR 7.3 (CI 95% 1.64-33.33, p=0.09)], mean mitral valve gradient predischarge [OR 1.67 (CI 95% 1,3-2.7, p=0.038)], and preoperative TAPSE [OR 0.143 (CI 95% 0.03-0.70, p=0.017)] were independent predictors for persistent pulmonary hypertension after mitral valve surgery.Conclusion. Persistent pulmonary hypertension was observed in 20.7% subjects after mitral valve surgery. Preoperative TAPSE, post operative atrial fibrillation, and predischarge mean mitral valve gradient were independent predictors
Electrical Alternans
Get PDFSeorang perempuan, 50 tahun datang ke poli Aritmia dengan keluhan berdebar. Rekaman EKG 12-sadapan diperlihatkan pada gambar di bawah ini:Irama dasar rekaman EKG di atas adalah irama sinus yang dibuktikan dengan morfologi gelombang P yang berasal dari lokasi nodus sinoatrial yaitu negatif di aVR dan positif di sadapan II, III dan aVF. Perhatikan di sadapan aVF pada denyutan 1 interval PR memanjang hingga 280 mdet menunjukkan suatu blok AV derajat 1. Yang menarik adalah denyutan ke 2 dan ke 4 merupakan suatu atrial premature beat dengan morfologi QRS yang berbeda dari morfologi QRS pada denyutan 1. Sebaliknya denyutan ke 3 dan ke 5 yang merupakan denyut sinus pun memiliki kompleks QRS yang berlainan. Terlihat jelas bahwa perubahan morfologi QRS itu hanya tampak pada sadapan ekstremitas tetapi kurang terlihat pada sadapan prekordial
Mitra Clip: Looking at its chance in developing country
Get PDFLooking at developed countries data on valvular heart diseases, mitral regurgitationis one of the most commonly encountered valvular lesions. Moderate to severe regurgitation present in up to 30% of patients with various clinical subsets. Mitral regurgitation severity has been positively correlated with the subsequent development of heart failure and death.1-4The 2008 ACC/AHA guidelines describe three types of MV operations: (i) MV repair; (ii) MV replacement with chordal preservation; and (iii) MV replacement with removal of the mitral apparatus. The ACC/AHA guidelines support MV surgery for patients with severe (3– 4+) MR who are symptomatic with preserved LV size and function, asymptomatic with LV dysfunction or increased LV size, who have recent onset atrial fibrillation or evidence of pulmonary hypertension, or in symptomatic patients with severe LV dysfunction (LVEF ?30%) despite optimal medical therapy.Currently, a new percutaneous approach for treating mitral regurgitation (so called MitraClip) which involves mechanical edge-to-edge coaptation of the mitral leaflets has been developed. The device mechanism is analogous to the surgical Alfieri technique.MitraClip (Abbott Vascular, Abbott Park, Illinois, USA; formerly manufactured by EvalveInc, Menlo Park, California, USA) has been approved by FDA last year.5Since 2008 almost 4000MitraClip have been implanted all over the world (Figure 1).6Overall, the procedure has proven to be safe with exceedingly low rates of fatal or life-threatening complications. Additionally, significant improvements in functional capacity and quality of life have been reported following MitraClip implantation. However, apart from these encouraging results, open questions remain to be addressed, particularly about long term durability and clinical efficacy, and the selection of the most appropriate candidates for MitraClip implantation. As the experience with this procedure continues to expand, larger studies are expected that will help to further define the role of the MitraClip procedure among established therapies.6Patient selection is utmost important to gain procedural success. Two main criteria of Endovascular Valve Edge-to-Edge Repair Study (EVEREST) for patient selection are clinical and anatomical criteria. Clinical criteria comprise of moderate-to-severe (3+) and severe (4+) mitral regurgitation, meeting class I indications for intervention (MVR or mitral valve replacement) by the ACC/AHA or ESC guidelines, mitral reguritationaetiology limited to degenerative or functional, non-rheumatic or -endocarditic origin, andhigh surgical risk by EuroSCORE or STS scores. Anatomical criteria comprise of mitral regurgitation originating from the central 2?3 of the valve, mitral orifice area ?4 cm2, meeting criteria for degenerative mitral regurgitation (i.e. flail gap <10 mm, flail width <15 mm), meeting criteria for functional mitral regurgitation (i.e. coaptation depth ? 11 mm, coaptation length ? 2 mm).7,
The Role of Cardiac Computed Tomography in Tetralogy of Fallot and Pulmonary Atresia
Get PDFCongenital heart disease (CHD) occurs in about 6 to 8 of 1000 live births with the increasing prevalence can be attributed to major improvements in diagnosis and treatment. Imaging has an important role in diagnosis of CHD. It outlines anatomy and physiology, helps to refine management, evaluates the consequences of interventions and helps guide prognosis. However, no single available imaging modality fulfills these roles for all patients and diseases. Therefore, assessment for CHD must involve multimodalities that can be used in a complementary fashion, and that together are sensitive, accurate, reproducible, and cost effective, whilst minimizing harm.In previous years, the diagnosis and the treatment of congenital malformations have often depended on cardiac catheterization. In many institutions, cardiac catheterization still remains the gold standard against which other modalities are measured. In the past decade, however, imaging methodologies have increasingly shifted toward the use of less invasive and noninvasive techniques. Although echocardiography is the most commonly used imaging modality for diagnosis and follow-up of subjects with CHD, the evolution of cardiovascular magnetic resonance (MR) imaging and increasingly computed tomography (CT) does offer new ways to visualize the heart and the great vessels
Pedoman Tata Laksana Fibrilasi Atrium Perhimpunan Dokter Spesialis Kardiovaskular Indonesia 2014
Get PDFAtrial fibrillation is the most frequent arrhythmia in clinical practice and causing huge health problem. Therefore, a national guidelines in management of AF that comprise of pathomechanism, clasifications, anticoagulants management for stroke prevention, rate and rhythm control is developed to ensure patients get best therapeutic option. The guidelines is developed in line with variable health care level in Indonesia from primary up to tertiary care.Fibrilasi atrium (FA) merupakan aritmia yang paling sering ditemui di klinik dan memiliki dampak kesehatan yang besar. Oleh karena itu dibuat pedoman tatalaksana FA yang komprehensif meliputi patomekanisme, klasifikasi, tatalaksana antikoagulan untuk pencegahan stroke, kendali laju dan kendali irama agar menjamin manfaat terbaik bagi pasien. Pedoman ini disajikan dengan memperhitungkan berbagai tingkat layanan kesehatan mulai dari primer hingga tersier
Diagnosis Sindrom Brugada
Get PDFBrugada syndrome is an inherited autosomal dominant disease that cause sudden death, which related with mutation of SCN5A gene, ? subunit of sodium channel. The risk Brugada syndrome in male is 8 times more than females. The average age is 40 years old, which can happen between age 1 to 77 years old. The Incidence is 5 to 66 per 10.000 people. The golden diagnostic tools is ECG, an abnormality QRS-T found in lead V1-V3. I report a case of Brugada syndrome with neither sign nor symptoms. The disease coincidental in routine medical examination.Sindrom Brugada adalah penyakit penyebab kematian mendadak yang diturunkan secara autosomal dominan, berhubungan dengan mutasi gen SCN5A, subunit ? dari sodium channel. Resiko laki-laki menderita sindrom Brugada adalah 8 kali lebih besar dari perempuan. Usia rerata adalah 40 tahun, dengan rentang usia antara 1-77 tahun. Insidennya adlaah 5-66 per 10.000 orang. Alat diagnosis utama adalah EKG, dimana ditemukan abnormalitas QRS-T pada lead V1-V3. Saya akan melaporkan kasus sindrom Brugada tanpa adanya keluhan dan gejala. Sindrom ini ditemukan kebetulan pada pemeriksaan rutin
Sistem Skor Baru untuk Memprediksi Kejadian Perdarahan pada Pasien Infark Miokard Akut dengan Elevasi Segmen ST yang Dilakukan Intervensi Koroner Perkutan Primer
Get PDFBackground Acute myocardial infarction still become one of the leadingmortality cause in the world. Among these patients, ST elevation myocardialinfartion (STEMI) has the greatest mortality rate among other type ofMyocardial Infarction. When a myocard infarct patient have bleeding events,mortality rate greatly increased. Up until now, there is no specific bleedingrisk assessment tool to predict bleeding events in STEMI patient.Methods A retrospective cohort study, done in National Cardiovascular CenterHarapan Kita, Jakarta in STEMI patients underwent Primary PercutaneousCoronary Intervention (PPCI). Bleeding event was defined according to definitionby Bleeding Academic Research Consortium (BARC) – European Societyof Cardiology, 2011. Categories for data obtained was basic characteristics,clinical examinations, initial therapies, lab results, x-ray, PPCI procedures, andin hospital treatments. Statistical analysis was done using multivariat analysisusing logistic regression method and then converted to a scoring system.Results 579 sampels fit the inclusion and exclusion criteria. Bleeding eventoccured in 42 patients (7.3%). Indonesia bleeding score (Range 1-100) wascreated by assignment of variables that included in the final model accordingto their Odds Ratio (OR) values. Those variables are: female gender(OR 2.91, CI 1.23-6.91), Killip class 3 / 4 (OR 5.64, CI 2.27-14.03), Age ?62 y.o (OR 2.19, CI 1.00-4.83), White blood cell >12.000 (OR 2.12, CI0.95-4.73), Creatinine >1.5 (OR 2.17, CI 0.95-4.96), Body Mass Index ?25 (OR 1.71, CI 0.83-3.51), Multiple coronary lesion (OR 1.95, CI 0.83-4.54), Femoral access (OR 2.33, CI 0.77-7.01), and TPM implantation (OR3.21, CI 1.28-8.07). These variabels was converted into two type of scoringsystem. The INA-1 contains all of the variables, and INA-2 minus variablesrelated to interventional result and procedures.Conclusion Indonesia bleeding score quantifies risk for in-hospital bleedingevent in STEMI patients underwent PPCI, which enhances baseline riskassessment for STEMI care.Latar Belakang. Kejadian perdarahan pada pasien Infark Miokard Akut (IMA) berkaitan dengan peningkatan mortalitas secarasignifikan. Angka kejadian perdarahan ditemukan lebih tinggi pada populasi Infark Miokard Akut dengan Elevasi SegmenST (IMA-EST) dibandingkan tipe lainnya. Hingga saat tulisan ini dibuat, belum ada satupun sistem skor yang dibuat khususuntuk populasi IMA-EST.Metodologi. Studi retrospektif kohort yang dilakukan di Pusat Jantung Nasional Harapan Kita, Jakarta pada pasien IMA-ESTyang menjalani intervensi koroner perkutan primer (IKPP). Kejadian perdarahan menggunakan definisi Bleeding AcademicResearch Consortium (BARC). Total 48 variabel dikumpulkan dan diuji. Data kemudian diolah dengan analisis multivariatmenggunakan metode logistik regresi dan diubah menjadi suatu sistem skor.Hasil. Sebanyak 579 sampel berhasil dikumpulkan, dengan 42 diantaranya mengalami perdarahan (7.3%). Variabel yang masukke dalam model akhir adalah: Jenis kelamin perempuan, kelas Killip 3 / 4, Umur ?62 tahun, Leukosit >12.000, Kreatinin>1.5, IMT ?25, Lesi koroner multipel, Akses femoral, dan Pemasangan TPM. Uji diskriminasi dan kalibrasi dari model akhirmenunjukkan hasil baik. Model alternatif dibuat dengan menghilangkan variabel yang berkaitan dengan hasil dan prosedurtindakan intervensif sehingga dapat digunakan untuk stratifikasi awal pre-IKPP.Kesimpulan. Sistem skor baru merupakan suatu sistem prediksi kejadian perdarahan pada populasi khusus IMA-EST yangmenjalani IKPP. Skor ini memiliki nilai kalibrasi dan diskriminasi yang baik sehingga diharapkan dapat membantu manajemenpasien IMA-ES
Model Prognostik Untuk Risiko Mortalitas Tiga Puluh Hari Pasca Transplantasi Jantung Dewasa
Get PDFObjective: To develop a prognostic model for the thirty-day mortality risk after adult heart transplantation.Methods: In this report we developed a prediction model for the 30-day mortality risk after adult heart transplantation. Logistic regression analysis was used to develop the model in 1,262 adult patients undergoing primary heart transplantation. We evaluated the accuracy of the prediction model; the agreement between the predicted probability and the observed mortality (calibration); and the ability of the model to correctly discriminate between the discordant survival pairs (discrimination). The internal validity of the prediction model was evaluated using the bootstrapping procedures.Results: Recipients’ age and sex, pre-transplant diagnosis, transplant status, waiting time, cardiopulmonary bypass time, donors’ age and sex, donor-recipient mismatch for BMI and blood type were independent predictors for 30-day mortality risk after adult heart transplantation. The model showed a good calibration and reasonable discrimination (the corrected area under the receiver operating characteristic curve was 0.71). The internal validity of the prediction model was acceptable. For practical use, we converted the prediction model to score chart.Conclusion: The accuracy and the validity of the prediction model were acceptable. This easy-to-use instrument for predicting the 30-day mortality risk after adult heart transplantation would benefit decision-making by classifying recipients according to their mortality risk and allowing optimal allocation of a donor to a recipient for heart transplantation.Tujuan: Membuat model prognostik mortalitas 30-hari setelah transplantasi jantung.Metode: Kami melaporkan pembuatan model prognostik mortalitas 30-hari setelah transplantasi jantung pada pasien dewasa. Analisis regresi logistik digunakan untuk membuat model menggunakan data 1,262 pasien dewasa yang menjalani transplantasi jantung. Akurasi model dinilai dari aspek kalibrasi (kesesuaian antara probabilitas yang diprediksi dengan mortalitas yang diobservasi) serta diskriminasi (kemapuan model untuk membedakan pasien dengan probabilitas kematian yang tinggi dan rendah dalam waktu 30 hari setelah transplantasi). Validitas internal dinilai menggunakan teknik bootstrapping.Results: Usia dan jenis kelamin resipien, diagnosis pre-transplantasi, status transplantasi, waktu tunggu, durasi operasi bypass kardiopulmoner, usia dan jenis kelamin donor, serta ketidaksesuaian indeks masa tubuh dan golongan darah donor-resipien terpilih sebagai prediktor independen mortalitas 30-hari setelah transplantasi jantung. Model menunjukkan kalibrasi dan diskriminasi yang cukup baik (area di bawah the receiver operating characteristic curve adalah 0.71). Validitas internal model memadai. Untuk penggunaan dalam praktik sehari-hari, kami mentransformasi model logistik menjadi score chart.Conclusion: Model prognostik mortalitas 30-hari setelah transplantasi jantung pada pasien dewasa ini memiliki akurasi dan validitas yang memadai. Model ini dapat membantu pengambilan keputusan melalui stratifikasi resipien berdasarkan probabilitas kematian setelah transplantasi dan memungkinkan alokasi donor transplantasi jantung secara lebih optimal
Dampak varian arteri radialis pada prosedur transradial
Get PDFNowadays, transradial approach has become the most chosen procedure by the intervention cardiologists, either in diagnostic or coronary intervention. Possibilities of vascular variants of the radial artery and along the vascular axis until the aortic arch are not a reasonable challenge for not using this transradial approach. Complications due to the transradial approach are very rare and mostly are easier to be managed than due to the other approaches. Besides that, eary ambulation, comfortability and satisfaction of the patients, and a relative low cost lead it to be the most preferable one. Data and publication of variants along the axis of the radial artery to the aortic arch are very supporting to the procedure success. A thorough understanding and consideration about the variants can diminish the failure of this transradial approach or the crossover to another approach.Dewasa ini akses transradial telah menjadi prosedur pilihan para ahli kardiologi intervensi baik pada tindakan diagnostik maupun intervensi koroner. Kemungkinan terdapatnya varian vaskuler pada arteri radialis dan aksis vaskular sampai ke arkus aorta tidak merupakan halangan untuk menggunakan akses tersebut. Komplikasi yang terjadi pada akses transradial umumnya jarang dan lebih mudah ditangani daripada akses lainnya. Selain itu, ambulasi dini, kenyamanan dan kepuasan pasien selama pelaksanaan prosedur, serta biaya yang relatif rendah juga menyebabkannya menjadi prosedur pilihan pasien. Pendataan dan publikasi mengenai jenis varian sepanjang aksis arteri radialis sampai ke arkus aorta sangat membantu keberhasilan prosedur transradial. Pemahaman dan pertimbangan preoperatif yang cermat mengenai adanya varian dapat menekan terjadinya kegagalan tindakan transradial atau beralihnya ke akses lain