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MID REGIONAL PRO ATRIAL NATRIURETIK PEPTIDE (MR PRO ANP) SEBAGAI BIOMARKER DISFUNGSI SISTOLIK VENTRIKEL KIRI JANTUNG PADA SEPSIS STUDI HUBUNGAN TNF- α – PROCALCITONIN – MR PRO ANP – DISFUNGSI JANTUNG
Full text linkLatar belakang: Sepsis merupakan masalah kesehatan karena angka kesakitan dan
kematiannya yang tinggi. Pelepasan sitokin pro inflamasi bersama faktor lain akan
mengakibatkan disfungsi sistolik ventrikel kiri/DSVK jantung. Pada sepsis terjadi
pelepasan MR pro ANP, PCT dan TNF-α karena stimuli sitokin pro inflamasi.
Tujuan penelitian: Membuktikan MR pro ANP sebagai biomarker DSVK pada
sepsis; mencari nilai AUC, sensitivitas, spesifisitas, cut off point dan probabilitas MR
pro ANP, PCT dan TNF-α sebagai biomarker DSVK dan membuktikan adanya
korelasi kadar TNF-α dengan MR pro-ANP serta adanya korelasi kadar MR pro ANP
dengan PCT dan mencari prediktor diagnostik DSVK jantung yang terbaik.
Metoda penelitian: Uji diagnostik non eksperimental dengan desain cross sectional,
dilakukan pada 71 pasien sepsis setelah simple random sampling. Variabel yang
diteliti MR pro ANP, PCT dan TNF-α serta LVEF dengan metoda Simpson. DSVK
bila LVEF ≤ 45%. Data di lakukan analisis tabel 2x2 dan kurva ROC secara statistik
menggunakan SPSS 22 for window.
Hasil penelitian: Nilai AUC kadar MR pro ANP 0,84 (95% CI 0,73-0,95), p<0,001.
Titik potong optimal pada ≥ 225,95 pmol/L dengan DOR sebesar 12,11. Nilai AUC
kadar PCT 0,81 (95% CI 0,71 -0,91), p<0,001. Titik potong optimal PCT pada ≥
7,875 ng/mL dengan DOR sebesar 5,55. Nilai AUC kadar TNF-α 0,73 (95% CI 0,60-
0,86), p<0,002. Titik potong optimal TNF-α pada ≥ 7,36 pg/mL dengan DOR
sebesar 5,03. MR pro ANP berkorelasi positif lemah dengan TNF-α (r=0,197,
p=0,100). MR pro ANP berkorelasi positif dengan PCT (r=0,309, p=0,009). Analisis
multivariat didapatkan MR pro ANP sebagai predikor DSVK yang terbaik (AUC
0,78), kemudian PCT (AUC 0,70) dan TNF-α (AUC 0,69). Penggabungan MR pro
ANP+PCT akan meningkatkan nilai diagnostik dengan AUC sebesar 0,87.
Kesimpulan: MR proANP dapat digunakan sebagai biomarker DSVK. AUC MR pro
ANP sebesar 0,84 (95% CI 0,73-0,95), p<0,001. Nilai cut off point pada ≥ 225,95
pmol/L dengan DOR 12,11. AUC PCT sebesar 0,81 (95% CI 0,71 -0,91), p<0,001 .
Nilai cut off point pada ≥ 7,875 ng/mL dengan DOR 5,55 AUC TNF-α sebesar 0,71
(95% CI 0,60- 0,86), p<0,002. Nilai cut off point pada ≥ 7,36 pg/mL dengan DOR
5,03. TNF-α berkorelasi positif lemah dengan peningkatan kadar MR pro ANP. MR
pro ANP berkorelasi positif dengan peningkatan kadar PCT. MR pro ANP prediktor
diagnostik DSVK jantung yang terbaik. Penggabungan MR pro ANP + PCT
merupakan prediktor diagnostik DSVK yang terbaik dan efisien.
Kata kunci: biomarker, disfungsi sistolik ventrikel kiri, MR pro ANP, PCT, TNF-
Association between Resistin and High Sensitive Troponin I in St Elevation Myocardial Infarction and Systolic Heart Failure
Full text linkBackground: Nearly half of all patients with acute myocardial infarction (AMI) have left ventricular systolic dysfunction and one-third have symptoms of heart failure (HF). In patients with AMI the resistin level correlated inversely with left ventricular ejection fraction (LVEF). Increased levels of high sensitive (hs) troponin I are associated with poorer prognosis. This study aimed to determine the association between levels of resistin and hs troponin I in ST elevation myocardial infarction (STEMI) patients with systolic HF.Subjects and Method: This was a cross-sectional study was conducted at Dr. Moewardi General Hospital, Surakarta, from April 1 to May 31, 2018. A sample of 32 patients who admitted which diagnosed with STEMI was selected for this study. They were divided into two group according to result of LVEF measurement, LVEF < 40% and LVEF ≥ 40%. Blood examination and transthoracic echo-cardiography were performed to all patients. Correlation test using partial and multiple correlation test. To different 2 mean using Mann Whitney test.Results: Mean of patient age was 59.5 years old. Resistin decreased LVEF (r= -0.41; p= 0.009), and it was statistically significant. Hs troponin I decreased LVEF (r= -0.25; p= 0.081), but it was marginally significant. Resis-tin level and hs troponin I increased LVEF (r= 0.47; p= 0.025), and it statistically significant.Conclusion: There was an association between resistin and hs troponin I level together in STEMI patients with systolic HF. There was an association of resistin levels in STEM I patients with systolic HF. There was no association of hs troponin I levels in STEMI patients with systolic HF.Keywords: Resistin, hs troponin I, STEMI, systolic heart failure.Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hos-pital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: [email protected] Journal of Medicine (2020), 5(1): 1-9https://doi.org/10.26911/theijmed.2020.05.01.0
Effect of Early Spironolactone on the ST2 Level and Clinical Changes in Acute Decompensated Heart Failure Patients
Full text linkBackground: In spite ofmajor advances in therapy, morbidity, and mortality due to acute decompensated heart failure (ADHF) remain poor. Early initiation of mineralocorticoid antagonist (spironolactone) may increase the suppression of negative effect of renin-angiotensin-aldosterone system (RAAS) activation, even though it already uses ACEI/ARB accompanying ADHF and give a better outcome. This study aims to determine the effect of early spironolactone 100 mg a day for 3 consecutive days on the suppression of tumorigenicity 2 (ST2) level and clinical changes in patients with ADHF.Subjects and Method: This was a randomized single blind controlled trial. Thirty eight consecutive patients with ADHF hospitalized at Dr. Moewardi Hospital, Surakarta were randomized into two groups: spironolactone group (standard therapy plus spironolactone 100 mg per day for 3 day, n=19) and control group (standard therapy, n=19). Clinical sign and simptom of ADHF was monitored everyday and the difference of clinical changes was evaluated at the day-3. Venous blood samples were collected from all patients at the first day prior therapy and day-4 after therapy. The dependent variable was ST2 level. The independent variable wasSpironolacton therapy. The data were analyzed by independent t-test.Results: Decreased levels of ST2 in the spironolactone group (mean= 36.96; SD= 21.29) was higher than the control group (mean= 19.73; SD= 16.48) and it was statistically significant (p= 0.008). Spironolacton therapy 100 mg once daily at the first 3 day in patient with ADHF was safe, no hiperkalemia, or worsening renal function. There was decreasing risk of hipokalemia up to 33% (RR= 0.33; 95% CI= 0.1 to 1.0; p= 0.036) and greater proportion patient with improvement clinical simptom and sign of ADHF at day-3 in the spironolactone group vs control group.Conclusion: Administration of spironolactone 100 mg at the first 3 day plus standard therapy decreases levels of ST2, safe, decreases risk of hipokalemia and give greater proportion of clinical improvement patients ADHF.Keywords: Spironolactone, ADHF, ST2Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126. Indonesia. Email: [email protected]. Indonesian Journal of Medicine (2019), 4(3): 232-240https://doi.org/10.26911/theijmed.2019.04.03.0
Mid-regional pro-atrial natriuretic peptide as a biomarker of left ventricular systolic dysfunction in patients with sepsis
Full text linkBACKGROUND Releasing cytokine pro inflammation in patients with sepsis (tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β) and IL-6) with other factors (mid regional pro atrial natriuretic peptide [MR-proANP] and TNF-α) will cause left ventricular systolic dysfunction (LVSD). This research aimed to prove MR-proANP as a biomarker of LVSD in sepsis, area under the curve (AUC), sensitivity, specificity, cut-off point and probability of MR-proANP and TNF-α as a biomarker of LVSD.
METHODS Non-experimental diagnostic test with cross sectional design and simple random sampling. Variable examined consisted of MR pro ANP, TNF-α and left ventricular ejection fraction (LVEF). LVSD if LVEF was ≤45%. Statistical analysis using 2 x 2 table and receiver operating characteristic curve using SPSS 22 for window.
RESULTS There were examined 71 patients from November 2013 to March 2014 in tertiary ICU of Moewardi Hospital. There were 22 patients with mild sepsis (30.9%), 40 patients with severe sepsis (56.4%) and 9 patients with septic shock (12.7%). The AUC value of MR-proANP level was 0.84 (95% CI 0.73-0.95), p < 0.001. Optimal cut off point was ≥225.95 pmol/l and diagnostic odd ratio (DOR) was 12.11. The AUC value of TNF-α level was 0.73 (95% CI 0.60-0.86), p < 0.002. Optimal cut-off point was ≥7.36 pg/ml and DOR was 5.03. Multivariate analysis was resulted that MR-proANP was the best predictor of LVSD (AUC 0.78), and TNF-α (0.69).
CONCLUSIONS MR-proANP could be used as a biomarker and the best diagnostic predictor of LVSD
Blood Urea Nitrogen as a Predictor of In-Hospital Mortality in Acute Coronary Syndrome Patients
Full text linkBackground: Acute coronary syndrome (ACS) is one of the major causes of morbidity and mortality worldwide. Thus, it is important to effectively diagnose and determine prognosis and mortality risk. While criteria such as Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) score are clinically used to work out the prognosis of patients with ACS, the examination of Blood Urea Nitrogen (BUN) and creatinine alongside in predicting outcome may prove favorable as well. This study aimed to determine the efficacy of BUN and creatinine in mortality risk assessment of patients with ACS and to find which one is better.Subjects and Method: This was an analytical study with a cohort retrospective design included 1463 ACS patients in Dr. Moewardi hospital from January 2014 to July 2018. The relationship between admission BUN, creatinine level, and in-hospital mortality was analyzed with chi-square and logistic regression. Receiver Operating Characteristic (ROC) curve to determine which one better as a predictor of in-hospital mortality.Results: The mean age of patients was 60 years old (mean= 60.08; SD= 11.04), which 72.9% were men. From all sample, 232 (15.9%) patients were died. In binary log regression models, elevated BUN (>50 mg/dL) at admission was an independent predictor of in-hospital mortality (OR= 4.01; 95% CI= 1.0 to 7.0; p= 0.001). Similar results were obtained for elevated creatinine (>1.3 mg/dL) at admission (OR= 3.6; 95% CI= 2.2 to 5.8; p= 0.031). ROC curves showed that area under the curve (AUC) of BUN (0.87) was higher than AUC of creatinine (0.61).Conclusion: Elevated BUN and creatinine are independent predictors of in-hospital mortality in ACS patients. A high-level of BUN at admission is a more accurate predictor of in-hospital mortality than creatinine.Keywords: blood urea nitrogen, creatinine, acute coronary syndromeCorrespondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126. Indonesia. Email: [email protected] Journal of Medicine (2019), 4(3): 241-251https://doi.org/10.26911/theijmed.2019.04.03.0
Role of Copeptin in predicting of Major Adverse Cardiovascular Events (MACE) during Hospitalization on Acute Myocardial Infarction Patients
Full text linkBackground: Copeptin has been considered as a potential biomarker for AMI which also give information regarding the prognostic of the Acute myocardial infarction (AMI). The aim of this study is to understand the role of copeptin as a predictor of major adverse cardiovascular events (MACE) during hospitalization in AMI patients.Subjects and Method: This was a cohort analytical study conducted at Dr. Moewardi Hospital, Surakarta, from March to May 2021. The dependent variable was MACE. The independent variable was the copeptin level. We observe the MACE during hospitalization and analyze the cut-off point value for optimal copeptin levels to predict the occurrence of MACE using the receiver operating characteristic (ROC) curve. Linear multiple regression was conducted to predict determinants of MACE in hospitalization patients.Results: 52 patients recruited in this research (44 males, 8 females). During hospitalization, MACE occurred in 52% of these subjects, with the respective proportions for acute heart failure, cardiogenic shock, arrhythmias, cardiopulmonary resuscitation, and mortality of 28%, 10%, 8%, 4%, and 2%. The ROC curve showed that the cut-off point of copeptin was 2,141.50 pg/mL and area under curve (AUC) value of 0.710 with sensitivity of 75.0%, specificity of 68.80% and accuracy of 71.15%. Hence, the AUC values and accuracy present fair results for predicting MACE during hospitalization in AMI patients.Conclusion: Copeptin has a role as a predicttor of MACE during hospitalization in AMI patients.Keywords: copeptin, mayor adverse cardiovascular events, acute myocardial infarctionCorrespondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java. Email: trisulo.wasyanto@gmail.com.Indonesian Journal of Medicine (2021), 06(02): 230-238https://doi.org/10.26911/theijmed.2021.06.02.12.
Effect of Oral N-Acetylcysteine Supplementation on the Immunity System in Patients with Acute Myocardial Infarction
Full text linkBackground: inflammation, oxidative stress, and fibrosis play important roles after an acute myocardial infarction (AMI) event. The most studied inflammatory biomarker in cardiovascular disease is C-reactive protein (CRP). It has been demonstrated that myeloperoxidase (MPO) and Galectin-3 (Gal-3) have some essential roles on immune system when an AMI event occurs. We aimed to determine the effect of oral N-acetylcysteine (NAC) supplementation at the dose of 600 mg 3 times daily for 3 consecutive days on the immune system of AMI patients. Methods: our randomized single-blinded experimental study using pre- and post-treatment evaluations was performed at Dr. Moewardi Hospital, Indonesia, from May to August 2018. Thirty-two patients with AMI and ST segment elevation (STEMI) who received fibrinolytic therapy were included. There were 17 patients received standard therapy plus 600 mg oral NAC supplementation every 8 h for 3 days and 15 patients received standard therapy, which served as the control group. High-sensitivity C-reactive protein (HsCRP), MPO, and Gal-3 levels of both groups were evaluated at admission and after 72 h receiving treatment. Results: HsCRP, MPO, and Gal-3 levels between NAC and control groups at admission were not significantly different; while intergroup differences after 72 h of NAC supplementation were significant (p values of HsCRP, MPO, and Gal-3 levels were 0.0001, 0.001, and 0.017, respectively). Furthermore, in the NAC group, HsCRP, MPO, and Gal-3 levels at 72 h after treatment were significantly different from the corresponding levels at admission (p values: 0.0001, 0.0001, and 0.0001, respectively); the control group did not show these differences. There were also significant intergroup differences between the NAC and control groups regarding HsCRP, MPO, and Gal-3 levels (p values: 0.011, 0.022, and 0.014, respectively). Conclusion: oral supplementation of 600 mg NAC every 8 h for 72 h can reduce HsCRP, MPO, and Gal-3 levels in AMI patients receiving fibrinolytic therapy. Results of our study will provide more options for supplementation therapy to improve management of IMA patients
Association between Myeloperoxidase and High Sensitive Troponin I on Myocardial Contractility in Acute Myocardial Infarction Patients
Full text linkBackground: Myeloperoxidase (MPO) levels have been shown to have prognostic values for death events in acute myocardial infarction (AMI) patients. Increased levels of high sensitive troponin I (hs Trop I) are associated with poorer prognosis in AMI patients. This study aimed to determine the association between levels of MPO and hs troponin I at admisson on myocardial contractility in AMI patients.Subjects and Method: This was a prospective observational analytic study, conducted at Dr. Moewardi General Hospital, Surakarta, from November1, 2018 to January 31, 2019. The study subjects were patients who were diagnosed with AMI. A total of 23 patients were included in this study; 15 patients with ST elevation myocardial infarction (STEMI) and 8 with non ST elevation myocardial infarction (NSTEMI). The dependent variable was myocardial contractility. The independent variables were MPO and hs Trop I. Blood tests for MPO and hs Trop I was measured at admission and the left ventricular ejection fraction (LVEF) was measured when predischarge by the Simpson method to examine myocardial contractility. The data were analyzed by Pearson correlation run on SPSS 22. Results: hs Trop I (r= -0.53; p= 0.009) and MPO (r= -0.15; p=0.487) decreased LVEF.Conclusion: Hs Trop I at admission has a correlation with myocardial contractility, and no correlation of MPO at admission with myocardial contractility in AMI patients.Keywords: Myeloperoxidase, High sensitive Troponin I, Acute myocardial infarctionCorrespondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: [email protected] Journal of Medicine (2020), 05(04): 265-271https://doi.org/10.26911/theijmed.2020.05.04.01.
Procalcitonin as A Predictor of Left Ventricular Systolic Dysfunction in Sepsis Patients
Full text linkBackground: Release of cytokines in sepsis can cause left heart failure and left ventricular systolic dysfunction (LVSD). In sepsis, there is a releasing of Procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) because of the stimulation of cytokine pro inflammation affected by activated NF-kB. This study aimed to examine PCT as a predictor of LVSD in sepsis, the value of Area Under the curve (AUC), sensitivity, specificity, cut off point, and a probability of PCT and TNF-α as a predictor of LVSD, and then to identify the best diagnostic predictor of LVSD.Subjects and Method: This was a cross-sectional study. A sample of 71 sepsis patients aged >18 years old admitted to the intensive care unit (ICU) from November 2016 to March 2017was selected for this study. The dependent variable was left ventricle ejection fraction (LVEF). The independent variables were PCT and TNF-α. LVEF and diastolyc function were measured by transthoracic echocardiography. Data on PCT and TNF-α level were obtained from the medical record.Results: As many as 22 patients had mild sepsis (30.9%), 40 patients had severe sepsis (56.4%), and 9 patients had a septic shock (12.7%). The AUC value of PCT level was 0.81 (95% CI 0.71-0.91; p<0.001). The optimal cut-off point was ≥7.88 ng/mL and Diagnostic Odd Ratio (DOR) was 5.55. The AUC value of TNF-α level was 0.73 (95% CI 0.60-0.86; p= 0.002). Optimal cut off point was ≥7.36 pg/ml and DOR was 5.03. The multivariate analysis resulted that PCT was the best predictor of LVSD (AUC 0.70), and TNF-α (0.69). The combination of PCT + TNFα would increase diagnostic value with AUC 0.77.Conclusion: PCT was a better predictor of LVSD than TNF-α. This finding is significant since it will enable clinicians to easily diagnose LVSD by measuring PCT. The combination of PCT and TNFα was the best efficient diagnostic predictor of LVSD.Keywords: Left Ventricular Systolic Dysfunction, predictor, PCT, TNF-α Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: trisulo.wasyanto@gmail.com.Indonesian Journal of Medicine (2018), 3(3): 139-145https://doi.org/10.26911/theijmed.2018.03.03.03
Effect of Oral N-Acetylcystein on Galectin-3 in Acute Myocardial Infarction Patients
Full text linkBackground: The pathogenesis of heart failure after myocardial infarction is associated with the pathogenesis of cardiac remodeling. Galectin-3 (Gal-3) has a role in the pathophysiology of cardiac remodeling after acute myocardial infarction. N-Acetylcysteine (NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. The purpose of this study was to examine the effect of oral N-Acetylcysteine on Galectin-3 in acute myocardial infarction patients.Subjects and Methods: This was an experimental study with pre and post, single-blind, and randomization methods. The study was conducted at Dr.Moewardi General Hospital Surakarta, Central Java, from June to August 2018. A sample of 29 acute myocardial infarction patients with ST-segment elevation who received fibrinolytic therapy was selected for this study. 14 patients as a control group received standard therapy and 15 patients as intervention group received oral NAC supplementary therapy 600 mg three times daily for three days. The dependent variable was Gal-3 levels. The independent variable was NAC supplementary therapy. The data were analyzed by Mann Whitney test.Results : Gal-3 levels in intervention group (mean= 8.95; SD=1.76) were lowered than the control group (mean= 11.42; SD= 3.76) and it was statistically significant (p= 0.026). Conclusion: Supplementary therapy of NAC 600 mg orally 3 times a day for 3 days can reduce levels of Gal-3 in patients with acute myocardial infarction who receive fibrinolytic therapy.Keywords: galectin-3, n-acetylcysteine, acute myocardial infarction Correspondence: Akhmad Jalaludinsyah. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: [email protected]. Mobile: +6281393098987.Indonesian Journal of Medicine (2019), 4(1): 1-8https://doi.org/10.26911/theijmed.2019.04.01.0
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