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Effect of Early Spironolactone on the ST2 Level and Clinical Changes in Acute Decompensated Heart Failure Patients Wasyanto, Trisulo; Mufidah, Atik
Indonesian Journal of Medicine Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: 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: trisulo.wasyanto@gmail.com. Indonesian Journal of Medicine (2019), 4(3): 232-240https://doi.org/10.26911/theijmed.2019.04.03.06

Blood Urea Nitrogen as a Predictor of In-Hospital Mortality in Acute Coronary Syndrome Patients Wasyanto, Trisulo; Tridamayanti, Annisa
Indonesian Journal of Medicine Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: 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: trisulo.wasyanto@gmail.com.Indonesian Journal of Medicine (2019), 4(3): 241-251https://doi.org/10.26911/theijmed.2019.04.03.07

Association between Resistin and High Sensitive Troponin I in St Elevation Myocardial Infarction and Systolic Heart Failure Wasyanto, Trisulo; Febrilia, Laurent
Indonesian Journal of Medicine Vol 4, No 4 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: 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 echocardiography 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. Resistin 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 STEMI 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 Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: trisulo.wasyanto@gmail.com.Indonesian Journal of Medicine (2019), 4(4): 346-354https://doi.org/10.26911/theijmed.2019.04.04.07

Association between Resistin and High Sensitive Troponin I in St Elevation Myocardial Infarction and Systolic Heart Failure Wasyanto, Trisulo; Febrilia, Laurent
Indonesian Journal of Medicine Vol 5, No 1 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Nearly half of all patients with acute myocardial infarction (AMI) have left ventriÂcular 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 progÂnosis. This study aimed to deterÂmine the association between levels of resistin and hs troponin I in ST elevation myocardial infarcÂtion (STEMI) patients with systolic HF.Subjects and Method: This was a cross-sectional study was conducted at Dr. Moewardi GeneÂral 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 meaÂsureÂment, LVEF < 40% and LVEF â‰¥ 40%. Blood examination and transthoracic echo-carÂdiography were performed to all patients. CorÂreÂlation test using partial and multiple corÂrelation 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:Â 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: trisulo.wasyanto@gmail.com.Indonesian Journal of Medicine (2020), 5(1): 1-9https://doi.org/10.26911/theijmed.2020.05.01.01

Association between Myeloperoxidase and High Sensitive Troponin I on Myocardial Contractility in Acute Myocardial Infarction Patients Wasyanto, Trisulo; Meilus, Budi Patria; Yasa, Ahmad
Indonesian Journal of Medicine Vol. 5 No. 4 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: 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: trisulo.wasyanto@gmail.com.Indonesian Journal of Medicine (2020), 05(04): 265-271https://doi.org/10.26911/theijmed.2020.05.04.01.

Biopsychosocial Analysis of Factors on COVID-19 Screening Awareness of Infertile Couples in Assisted Reproductive Technology Budihastuti, Uki Retno; Laqif, Abdurahman; Melinawati, Eriana; Prakosa, Teguh; Udiyanto, Hermawan; Priyanto, Heru Priyanto; Darto, Darto; Rantasari, Affi Angelia; Wasyanto, Trisulo; Anggraeni, Asih; Wijayanti, Agung Sari
Journal of Maternal and Child Health Vol. 6 No. 5 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Background: The development of screening methods for infertility patients during the Coronavirus-2019 (COVID-19) pandemic provides new challenges in the adaptation of children's want programs in the era of the COVID-19pandemic. Several screening methods have been developed but various factors affect the awareness of couples to want to do COVID-19 screening. This study aimed to analyze biopsychosocial factors associated with awareness of COVID-19 screening in infertile couples. Subjects and Method: A cross-sectional study conducted at The Sekar Polyclinic of Dr. Moewardi Regional General Hospital during the COVID-19 pandemic. A number of 60 infertile couple of reproductive age who underwent the ART program was selected by random sampling. The dependent variable was awareness for COVID-19 screening. The independent variables were anxiety, knowledge, age, and length of infertility. The data were obtained from medical record and questionnaire and analyzed by a multiple logistic regression. Results: Anxiety (OR= 26; 95% CI; p<0.001) and above-average knowledge levels (OR=16; 95% CI; p<0.001) affected awareness for COVID-19 screening. While the age and length of infertility do not affect awareness for COVID-19 screening (p >0.05). Conclusion: Anxiety and above-average knowledge levels affect awareness for COVID-19 screening.

The Sub-Analysis of HFmrEF and HFrEF Group in CORE-HF Registry : When being Good is Not Enough Wasyanto, Trisulo; Irnizarifka, Irnizarifka; Chau, Titus H.; Arifianto, Habibie
Jurnal Kardiologi Indonesia Vol 44 No 1 (2023): Indonesian Journal of Cardiology: January - March 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1545

Background : As the prevalence of heart failure (HF) kept rising each year, the burden caused by it also escalating, especially in terms of economic burden. This is urging the physician to quickly tackle the problem. Although HFrEF medications were developing vastly, the outcome of HF in real world still varies. This indicates another approach is still needed to manage HFrEF/HFmrEF comprehensively. This paper is aimed to give an overview of HFrEF and HFmrEF epidemiological data, based on CORE-HF real world data. Methods : The CORE-HF is a single-center, prospective-cohort registry, which enrolls all patients with chronic HF, that were recruited consecutively from the outpatient Sebelas Maret HF Clinic. Both enrollment and follow-up have been performed since January 2018 until December 2022. Variables recorded consists of baseline characteristics, risk factors, subjective indicators, objective diagnostic assessments, therapies, and outcomes (readmission and mortality). Results : The population of this registry was younger (58.7 ± 12.14) compared to other HF registries, with more multi comorbidities. The number of HFrEF patient was higher than HFmrEF (77.7% vs 22.3%), with clinically higher mortality rate (7.2% in the 1st year and 18.2% in the next year). Although triple therapy initiation and uptitration were excellent in number, the mortality rate during second year of follow-up was higher than other registries. We found non-compliant behavior to be responsible for those results. Conclusion : Based on CORE-HF sub-analysis of the HFrEF and HFmrEF groups, adherence to HF guidelines is the main but not the only key leading to lower mortality and rehospitalization. Our data provide satisfying low hard outcomes, but solving the non-compliance behavior and optimizing the non-pharmacological approach should be done comprehensively by the HF team.

Role of Copeptin in predicting of Major Adverse Cardiovascular Events (MACE) during Hospitalization on Acute Myocardial Infarction Patients Wasyanto, Trisulo; Raynantha, I Putu; Yasa, Ahmad
Indonesian Journal of Medicine Vol. 6 No. 2 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: 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.

Anticoagulant Management of Mechanical Heart Valve Patients During Perioperative Surgery: A Case Report Wasyanto, Trisulo; Yudhistira, Yoga; Anggraini, Nutria; Yasa, Ahmad; Irnizarifka, Irnizarifka
Indonesian Journal of Medicine Vol. 8 No. 4 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.4.667

Background: Patients with mechanical heart valves require lifelong oral anticoagulation. It will be a dilemma if a patient with a mechanical heart valve has surgery. This case report aims to discuss how to interrupt oral anticoagulants and bridging therapy in patients with mechanical heart valves who will be undergoing non-cardiac surgery. Case Report: A 26-year-old pregnant woman, G1P0A0, aterm with a mechanical mitral valve, will have elective Sectio Caesarian Transperitonealis (SCTP) surgery and Intra Uterine Device (IUD) insertion. The patient had a history of mitral valve replacement surgery (MVR) in 2014 and was routinely treated with 4 mg of warfarin at night. From the examination, blood pressure was 120/80 mmHg, heart rate was 90 beats per minute, and pulse rate was 90 beats per minute. The ECG examination found sinus rhythm with 1st-degree atrioventricular block, right axis deviation, 90 beats per minute, and left atrial enlargement. We decided to have oral anticoagulant interruption and bridging therapy by stopping warfarin three days before surgery. When the international normalized ratio (INR) falls <2, patients are given heparin injections (UFH) with an APTT target of 1.5-2.0 times from basic APTT. When the patient was about to be operated on, UFH was stopped 6 hours before surgery and resumed 12 hours after surgery. Warfarin was given one day postoperatively. Patients were adjusted to the dose of UFH according to the target. This patient had no thromboembolic events or bleeding before, during, or after surgery. The patient was allowed to be an outpatient and was given home therapy with Warfarin 5 mg at night. Results: We report a case of a 26-year-old female patient with a mechanical mitral valve who was going to undergo elective SCTP surgery and an IUD insertion. Patients at high risk of thrombo¬embolism due to surgery with a high risk of bleeding. Bridging therapy was performed using UFH. In the perioperative period, the patient did not experience thromboembolic events, and bleeding before, during, and after surgery could be well controlled. Conclusion: Perioperative management of patients with mechanical heart valves must be done carefully. Interruption of oral anticoagulants should be carefully considered considering the risk of thromboembolism and bleeding during the perioperative period. Guidelines recommend that in patients with mechanical heart valves, anticoagulation interruption for minor surgeries is avoided. Whereas in patients with major surgery, it is necessary to do bridging therapy with fast-acting anticoagulants such as UFH or LMWH. Keywords: mechanical heart valve, anticoagulant interruption, perioperative, bridging therapy Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas Maret University / Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: trisulo.wasyanto@staff.uns.ac.id. ORCID ID: 0000-0001-9900-0497. Mobile: +62811294225.

Pulmonary Hypertension in Pregnancy: A Case Report Wasyanto, Trisulo; Anggraini, Nutria Widya Purna
Indonesian Journal of Medicine Vol. 8 No. 4 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.4.683

Background: Pulmonary Hypertension (PH) is a disease characterized by distressing symptoms and decreased life expectancy due to the narrowing of the blood vessels of the lungs, which often leads to right heart failure. The prevalence of PH in women is 97 cases per million, with 64% of the main causes of PH in pregnancy congenital heart defects, resulting in a very high maternal and fetal mortality rate. Case Report: A 38-year-old G4P1A2 31-week gestational age complained of shortness of breath for 5 days. Physical examination revealed blood pressure was 107/62 mmHg, Heart Rate was 98 beats per minute, respiration 40x per minute, and SpO2 88% with NRM 10 Lpm. The heart examination obtained heart sound I -II regular and a systolic murmur was heard between the left 2nd ribs. Abdominal examination was single fetus, intrauterine, breech presentation, His (+), fetal heart rate 160 beats per minute. vaginal toucher 2 cm in labour. ultrasound examination singles fetal, transverse lies, with an estimated fetal weight of 1600 grams. Echocardiography finding: ASD II L to R shunt with LV EF 60%(T), 62% (S), dilated RA-RV, TR severe, MR mild, High Probability of Pulmonary Hypertension. The patient was diagnosed with Dyspnea, Pulmonary edema caused by cardiogenic, ASD II, High probability of PH, NYHA IV, and Breech presentation in labor. Decided to perform a caesarian section and sterilization. The Male baby was born with 1570 grams Apgar Score 3-5-7. post operation patient was admitted to ICU. Twelve hours after the operation the patient had decreased control and became a PH crisis then the patient was declared dead. Results: The death of the patient, in this case, was caused by cardiogenic shock due to Pulmonary Hypertension Crisis. Conclusion: Early diagnosis along with collaborative and comprehensive management of pulmonary hypertension is needed for good maternal and fetal outcomes. Keywords: pulmonary hypertension, pregnancy, heart disease. Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas Maret University / Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: trisulo.wasyanto@staff.uns.ac.id. Mobile: +62811294225.

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