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Association of Triglyceride/High Density Lipoprotein Cholesterol Ratio and Coronary Lesion Severity in Acute Myocardial Infarction Patients at Adam Malik Hospital, Medan Sinaga, Akbar; Hasan, Refli; Reynaldo, Abdul Halim; Hasan, Harris; Akbar, Nizam Zikri; Andra, Cut Aryfa
Journal of Society Medicine Vol. 2 No. 3 (2023): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i3.30

Introduction: Coronary heart disease is the leading cause of worldwide death. A number of markers have been identified in terms of the atherogenic potential of the lipid profile.The TG/HDL-C ratio is an easy and economical non-invasive examination method as a predictor of coronary heart disease severity. The aim of this study is to assess the relationship of the TG/HDL ratio with the severity of coronary lesions. Method: This cross-sectional study included 53 acute myocardial infarction patients undergoing coronary angiography. Exclusion criteria include (1)AMI patients receiving fibrinolytic therapy, (2) Patients who have routinely consumed lipid lowering drug for 6 weeks,(3) Incomplete coronary angiography and medical records. The TG/HDL ratio is the result of dividing the triglyceride value by HDL. The TG/HDL ratio was divided into 2 groups, namely the TG/HDL ratio <4 group and the TG/HDL ratio >4 group. The severity of coronary lesions was described by the SYNTAX score, which was divided into two: the low SYNTAX score group (≤22) and patients with a low SYNTAX score (≤22) and medium-high SYNTAX score (≥23). Bivariate analysis was performed to find the relationship between the TG/HDL ratio and the SYNTAX score. The value of p<0.05 was considered statistically significant. Results: From 53 patients, 26 patients (49.1%) had a SYNTAX score ≥ 23 and 27 patients (50.9%) had a SYNTAX score < 23. Patients with NSTEMI, DM risk factors, and obesity were higher in the SYNTAX score group ≥23. From the results of statistical analysis, there was a significant relationship between the TG/HDL ratio with coronary lesion severity (p = 0,004). Conclusion: Enhancement of TG/HDL ratio is correlated with coronary lesion severity in acute myocardial infarction patients using the SYNTAX score.

Relationship Between P Wave Peak Time In Leads II And V1 With Left Ventricle Diastolic Function In Hypertension Patients Ihsan, Muhammad; Akbar, Nizam Zikri; Lubis, Hilfan Ade Putra
Journal of Society Medicine Vol. 2 No. 6 (2023): June
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i6.67

Introduction: Left ventricular diastolic dysfunction is common in patients with hypertension. Inadequate management can cause complications such as hypertensive heart disease. Electrocardiography as a tool that is easy to find in health services is known to be able to detect left ventricular diastolic dysfunction. The purpose of this study was to examine the relationship between P wave peak time in leads II and V1 by electrocardiography with left ventricular diastolic function. Method: This study was a cross-sectional study that was conducted by collecting 111 patients with a history of hypertension at RSUP HAM from October 2021 to November 2022. The P wave peak time was measured in leads II and V1 on the ECG. Diastolic function was assessed using echocardiography. A bivariate test was performed to assess the correlation between the two variables. Furthermore, ROC analysis was performed to assess the P wave peak time as a predictor of left ventricular diastolic function. Results: : Total subjects were 111 hypertensive patients consisting of 49 (31.4%) hypertensive patients with normal diastolic function and 62 (68.6%) hypertensive patients with diastolic dysfunction. In bivariate analysis, a significant difference was found between the P wave peak time in lead II of hypertensive patients with normal diastolic function and hypertensive patients with diastolic dysfunction (65.47± 2.5 vs 68.9 ± 2.7;p = 0.001). Based on the ROC analysis, it was found that the P wave peak time could predict left ventricular diastolic dysfunction in hypertensive patients with AUC = 0.81 in lead II. Conclusion: The P wave peak time in lead II can be a predictor of diastolic dysfunction in hypertensive patients.

The Relationship between D-Dimer Levels and Coronary Lesion Severity in Patients with Acute Myocardial Infarction with ST-Segment Elevation at Haji Adam Malik Hospital Medan Rialdy, M. Isfan; Akbar, Nizam Zikri; Haykal, T. Bob; Ketaren, Andre Pasha; Andra, Cut Aryfa; Sarastri, Yuke
Journal of Society Medicine Vol. 2 No. 9 (2023): September
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i9.89

Introduction: Acute coronary syndrome results from rupture or erosion of an atherosclerotic plaque. D-dimer is a direct marker of fibronolysis events and an indirect marker of hypercoagulable state associated with atherosclerotic plaque formation and acute coronary syndrome. The purpose of this study was to determine the relationship between D-dimer levels and the severity of coronary lesions in ST Elevation Myocardial Infarction patients at H. Adam Malik Hospital Medan. Method: This study was conducted with a cross-sectional method on 72 ST Elevation Myocardial Infarction patients at H. Adam Malik Medan Hospital who underwent coronary angiography from December 2022 to May 2023. Definition of ST Elevation Myocardial Infarction followed the definition of Universal Definition of Myocardial Infarction and the severity of coronary lesions was calculated based on syntax score. Data were analyzed univariately and bivariately using SPSS to assess the association of D-dimer levels with syntax score with p<0.05 considered statistically significant. Results: The total study subjects were 72 people with an average age of 56,5410,84years. Most of the study samples were male 56 people (77.8%). The median D-dimer level was 605 and mean syntax score 22.027 + 14.61. There is a significant relationship between D-dimer levels and the severity of coronary lesions based on the syntax score (p: <0.001). Conclusion: There is a significant relationship between D-dimer and severity of coronary lesions in patients with acute myocardial infarction with ST segment elevation at H. Adam Malik General Hospital, Medan.

The Relationship between Myocardial Strain Using 2D Speckle Tracking Echocardiography and Coronary Lesion Severity Measured by Syntax Score in Patients with Chronic Coronary Syndrome at Haji Adam Malik Hospital Purba, Antonius Leonardo; Akbar, Nizam Zikri; Sarastri, Yuke
Journal of Society Medicine Vol. 3 No. 4 (2024): April
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i4.137

Introduction: Coronary heart disease continues to be the leading cause of morbidity and death worldwide. The cardiac dysfunction known as chronic coronary syndrome is caused by atherosclerosis-related obstruction or constriction of coronary arteries. Currently, One interesting non-invasive technique is GLS assessment, which has shown to be useful in predicting coronary lesions in chronic coronary syndrome patients. This study aims to evaluated the correlation between myocardial strain based on 2-D Speckle-Tracking Echocardiography and the severity of coronary lesions in chronic coronary syndrome patients at Haji Adam Malik Hospital Medan Method: This research is an analytical observational study with a cross sectional design on patients who diagnosed with chronic coronary syndrome and treated at H Adam Malik General Hospital Medan which met the inclusion and exclusion criteria. Sampling was carried out starting in January to December 2023. In bivariate analysis, the Fisher Exact test is used if the data is not normally distributed, and the chi square test is used if the data is normally distributed. P values less than 0.05 indicate statistical significance in data analysis using computer statistical methods. Results: Myocardial global longitudinal strain (GLS) based on 2-D Speckle-Tracking Echocardiography was significantly associated with the severity of coronary lesions as measured by syntax score in chronic coronary syndrome patients (p value 0.0001, OR 2.732, 95% CI 1, 81-4,11). As a predictor of coronary lesions severity based on the Syntax score in patients with chronic coronary syndrome, the global longitudinal strain (GLS) cut-off value of -17.37 demonstrates a sensitivity of 92.9% and a specificity of 83.6%. Conclusion: Myocardial global longitudinal strain (GLS) with a cut-off value of -17.37 can be used as a predictor coronary lesions severity in chronic coronary syndrome patients with a sensitivity of 92.9% and a specificity of 83.6%.

Hubungan Peak Left Atrial Longitudinal Strain dengan Derajat Keparahan Penyakit Jantung Katup Mitral di RSUP Haji Adam Malik Medan Ryanti, Dina; Ketaren, Andre Pasha; Mukhtar, Zulfikri; Akbar, Nizam Zikri; Lubis, Anggia Chairuddin; Ardini, Tengku Winda
Jurnal Kardiologi Indonesia Vol 44 No 2 (2023): Indonesian Journal of Cardiology: April - June 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1541

Introduction: Mitral stenosis and regurgitation, are common throughout the world. Peak Left Atrial Strain (PALS) is a parameter for assessing left atrial deformation in the evaluation of atrial function and a predictor of long-term outcome of various heart diseases. In this study, we assessed the relationship between PALS and the severity of mitral stenosis and mitral regurgitation Methods: This is a cross-sectional study on 119 subjects with mitral stenosis and 103 mitral regurgitation who met the inclusion criteria at Haji Adam Malik General Hospital. PALS measurements were taken. Data were analyzed univariate, bivariate, correlate to assess the relationship between PALS and the severity of mitral valve disease Results: 119 patients with severe mitral stenosis. In mitral stenosis, the mean PALS is 8.2 (4.9-22.8). PALS was significantly higher in patients with sinus rhythm than in the group with AF (10.29 ± 3.89 vs 8.63 ± 7.8%; P = 0.002). PALS had a significant correlation with MVA, pressure gradient, and PHT (r = 0.676, P = <0.001; r=-0.594, P= 0.001 and r=-0.594, P= 0.001). Whereas in mitral regurgitation, it has an average PALS of 15.2 (7.8-19.2). PALS was also significantly higher in patients with sinus rhythm than in the group with AF (16.36 ± 2.43 vs 11.64 ± 2.89%, P = 0.001). PALS has a correlation with VC, PISA, EROA and RVol (r = -0.533, P=0.001; r=-0.618; r=-0.563, P=0.001; r= -0.528, P=0.001). Conclusion: PALS has a significant correlation with the assessment of the severity of mitral stenosis and regurgitation.

Validasi Skor PEACH sebagai Prediktor Mortalitas Selama Rawatan Paska Operasi Penyakit Jantung Bawaan Pada Dewasa di Rumah Sakit Umum Pusat Haji Adam Malik Medan Zebua, Juang Idaman; Nasution, Ali Nafiah; Ketaren, Andre Pasha; Hasan, Harris; Akbar, Nizam Zikri
Jurnal Kardiologi Indonesia Vol 44 No 2 (2023): Indonesian Journal of Cardiology: April - June 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1546

Introduction: Congenital heart disease (CHD) is an abnormality in the structure and function of the heart that is acquired while still intrauterine where the incidence of CHD worldwide is estimated at around 8 cases per 1,000 live births. Even though the development of the medical science is currently advanced, there are still CHD patients who are lately diagnosed and found when the patient is an adult so it requires surgical interventions. The PEACH score is a score that can predict postoperative in-hospital mortality in adults CHD patients. This study aims to validate the PEACH score. Methods: This is a retrospective cohort study of 52 adult patients with CHD who underwent surgery at Haji Adam Malik General Hospital from January 2019 to April 2023. Validation was analyzed using a calibration and discrimination test to the PEACH score in predicting postoperative in-hospital mortality. Result: The incidence of in-hospital mortality was 8 (15.4%) patients. There is a relationship between the PEACH score group and the incidence of mortality (p=0.006). The results of the calibration test using the Hosmer and Lameshow analysis and the discrimination test using the Receiver Operating Characteristic analysis showed good validation (p=0.85; AUC=0.83). Conclusion: The PEACH score is valid for predicting postoperative in-hospital mortality in adult congenital heart disease at Haji Adam Malik General Hospital.

Relationship Between Neutrophil-Lymphocyte Ratio Value And Severity of Mitral Stenosis Due to Rheumatic Heart Disease in Outpatients at H. Adam Malik General Hospital Medan Achmad, Aziz; Safri, Zainal; Haykal, Teuku Bob; Siregar, Abdullah Afif; Akbar, Nizam Zikri; Ardini, Tengku Winda; Andra, Cut Aryfa; Lubis, Anggia Chairuddin
Journal of Society Medicine Vol. 3 No. 12 (2024): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v3i12.183

Introduction: Mitral stenosis (MS) is a heart valve disease characterized by narrowing of the mitral valve, commonly caused by rheumatic heart disease. Accurate evaluation of MS severity is crucial for management, with echocardiography being the gold standard. The Neutrophil-Lymphocyte Ratio (NLR), reflecting inflammation, may correlate with MS severity. This study aims to assess the relationship between NLR values and MS severity due to rheumatic heart disease. Method: This cross-sectional study was conducted at H. Adam Malik General Hospital Medan from January 2023 until the required sample size was achieved. Patients diagnosed with MS by echocardiography based on the American Society of Echocardiography (ASE) criteria were included. Echocardiographic parameters such as mitral valve area (MVA) and mean pressure gradient (MV mean PG), along with blood NLR values, were analyzed for associations. Statistical significance was set at P < 0.05. Results: Significant differences in NLR values were observed between mild-to-moderate MS (1.93; 0.82–10.64) and severe MS (3.56; 1.81–13.08) (P = 0.0001, Mann-Whitney test). An NLR threshold of 2.91 predicted severe MS with 82% sensitivity and 81.8% specificity (P = 0.0001; AUC 0.856; 95% CI 0.772–0.940). Conclusion: NLR strongly correlates with MS severity and serves as a reliable predictor for severe MS in patients with rheumatic heart disease. NLR offers a simple, cost-effective tool for assessing MS severity, complementing echocardiography in clinical practice.

Alteration of Right Ventricular-Pulmonary Arterial Coupling Before and After Decongestion in Non-Preserved Fraction Acute Heart Failure Patients at Adam Malik Hospital Medan Brahmana, Andrew Timanta; Ketaren, Andre Pasha; Andra, Cut Aryfa; Lubis, Anggia Chairuddin; Haykal, Teuku Bob; Siregar, Yasmine Fitrina; Lubis, Hilfan Ade Putra; Purba, Joy Wulansari; Akbar, Nizam Zikri
Journal of Society Medicine Vol. 4 No. 1 (2025): January
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i1.190

Objective: To assess whether there is right ventricular-pulmonary artery (RV-PA coupling by tricuspid annular plane systolic excursion/pulmonary artery systolic pressure TAPSE/PASP) changes in determining the clinical results of decongestion in patients with acute heart failure (AHF) with non-preserved ejection fraction (non-HFpEF) before and after decongestive at Adam Malik Hospital Medan. Methods: This study is an observational study with a prospective approach and consecutively collected, in patients AHF with non-HFpEF at Adam Malik Hospital Medan in the period from September 2023 until November 2024d. The sample is an eligible population that meets the inclusion and exclusion criterias. Results: This study consisted total 44 subjects with majority of 37 men (75%), an average age of 61 years old. A total of 28 subjects (63.6%) had hypertension as comorbid. There were 33 people (75%) who had sinus rhythm. The most acute heart failure phenotype commonly found was acute decompensated heart failure (ADHF) with 21 subjects. The longest length of stay AHF was cardiogenic shock with a median of 9 days. A significant decrease in median heart (p 0.0001), tricpuspid valve gradient (TVG) examination showed a significant decrease in (p 0.0001), PASP examination had a significant decrease in the average (p 0.0001), RV-PA coupling showed a significant increment (p 0.0001). A significant relationship was found between RV-PA coupling changes and decongestion in all acute heart failure groups (p 0.005). No significant relationship between RV-PA coupling ratio with length of stay was found. Conclusion: There were differences found in RV-PA coupling as increment with significant value in complete and partial decongestion groups, with a RV-PA coupling cut-off value of 0.65 and sensitivity and specificity of 68.8% and 67.9%, respectively.

Triglyceride/High-Density Lipoprotein Ratio as a Predictor of Major Cardiovascular Events Within 6 Months Post-Treatment in Patients with Acute Myocardial Infarction and Type 2 Diabetes Mellitus at Haji Adam Malik General Hospital, Medan Taufik, Yasdika Imam; Hasan, Refli; Akbar, Nizam Zikri
Journal of Society Medicine Vol. 4 No. 8 (2025): August
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i8.227

Introduction: Cardiovascular disease (CVD) remains the leading global cause of death, with coronary artery disease (CAD) and stroke contributing to 15 million deaths in 2016. Type 2 diabetes mellitus (DM) increases the risk of complex CAD, characterized by diffuse, calcified, and multivessel lesions. While the triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio is a potential independent predictor of CVD, its prognostic value for mortality in diabetic CAD patients undergoing statin therapy remains unclear. This study aimed to analyze the association between the TG/HDL-C ratio and cardiovascular and all-cause mortality in this population. Methods: This cross-sectional analytical study examined the relationship between the TG/HDL-C ratio and major cardiovascular events in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients with type 2 DM receiving statin therapy. Data were collected through clinical observation and medical records. Statistical analysis utilized the Chi-square or Fisher’s Exact test to assess associations, with statistical significance defined as p <0.05. Results: The study included 72 patients (72.2% male; mean age 58.6±8.5 years) with type 2 DM (mean duration 10.5±3.9 years) and acute coronary syndrome (61.1% NSTEMI). Among participants, 61.1% were smokers, 48.6% had hypertension, and lipid profiles revealed 100% hypertriglyceridemia, 87.5% elevated LDL, and 33.3% low HDL. A high TG/HDL ratio was observed in 72.2% of subjects and was significantly associated with major adverse cardiovascular events (OR=3.32; p=0.025), indicating a 3.32-fold higher risk in the high TG/HDL ratio group. Conclusion: The TG/HDL-C ratio can serve as an effective parameter for estimating the risk of MACE in ACS patients with T2DM.

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