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All Journal Buletin Farmatera Indonesian Journal of Cardiology Sumatera Medical Journal SCRIPTA SCORE Scientific Medical Journal Heart Science Journal Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) The Journal of Society Medicine (JSOCMED)
Lubis, Anggia Chairuddin
Departemen Kardiologi Dan Kedokteran Vaskular Fakultas Kedokteran Universitas Sumatera Utara/RS Haji Adam Malik Medan
Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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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
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v3i12.183

Abstract

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.
Early detection of subclinical rheumatic heart disease through echocardiographic screening: a study in North Sumatra, Indonesia Ardini, Tengku Winda; Ilyas, Kamal Kharazzi; Nasution, Ali Nafiah; Ketaren, Andre Pasha; Napitupulu, Bertha Gabriella; Batubara, Gio Justisia; Sarastri, Yuke; Raynaldo, Abdul Halim; Siregar, Abdullah Afif; Siregar, Yasmine Fitrina; Dewita, Auliya; Andra, Cut Aryfa; Lubis, Anggia Chairuddin
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.10

Abstract

BACKGROUND: Given the urgent need to address the significant morbidity and mortality associated with Rheumatic Heart Disease (RHD) in Indonesia, there is a growing interest in exploring cost-effective screening approaches, such as handheld echocardiography.OBJECTIVES: The purpose of this study was to ascertain the prevalence of RHD in North Sumatra, Indonesia.METHODS: This descriptive observational study was conducted within the population of North Sumatra from 2022 to 2023. Junior high school students aged 12 to 15 years were included from randomly selected schools in Langkat, Tebing Tinggi, and Labuhan Batu. Data collection encompassed various parameters, including social demographic information, parental characteristics, environmental factors, household details, anthropometric measurements, physical assessments, auscultation findings, and echocardiographic data. The data were analyzed descriptively.RESULTS: In our study, a total of 692 children were examined, with an average age of 12.9 years and a standard deviation of 1.1 years, among whom 42.5% were male. Utilizing echocardiographic evaluations, we identified RHD in four children, yielding a prevalence rate of 0.6%. Further examination of these cases revealed that the majority, accounting for three individuals (75%), exhibited borderline RHD, while one child (25%) presented with definite RHD.CONCLUSION: In our study population, the prevalence of RHD was 0.6%. A broader echocardiographic screening program is necessary to determine the overall prevalence of RHD, assess the disease burden, and identify individuals earlier to prevent adverse outcomes.
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
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i1.190

Abstract

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.
Quality of life assessment in patients after permanent pacemaker implantation at Haji Adam Malik Hospital Medan Khairunnisah, Dina; Ali Nafiah Nasution; Refli Hasan; Nizam Zikri Akbar; Anggia Chairuddin Lubis; Abdul Halim Raynaldo
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.15

Abstract

Background: PPM implantation is used to send electrical impulses to the heart muscle to correct heart rhythm disturbances also known as cardiac arrythmia. Assessing the patient's quality of life after a PPM implantation is crucial for predicting the therapy's effectiveness and success. Objectives: This study aims to assess the quality of life of patients following pacemaker implantation by using the SF-36 questionnaire. Methods: A cross-sectional study conducted from January 2021 to July 2023 on 60 outpatients with a minimum duration of PPM implantation of 6 months in the cardiology department of H. Adam Malik Hospital Medan. Patient’s quality of life was assessed based on the SF-36 questionnaire. Subjects then were grouped based on age, gender, PPM duration and location, as well as other echocardiographic parameters that may affect patient’s quality of life after PPM implantation. Results: There were 60 patients included in this study. Majority of patients were male (56.7%) with an average age of 67.98 ± 10.95 years old and most patients had comorbidities (81.7%). The majority of patients (93.3%) had a single-chamber permanent pacemaker implanted, with 68.3% of these devices’ ventricular leads positioned in the non-apical segment of the heart.  After assessing the quality of life, we found there’s a relationship between age, gender, and PPM lead locations with nearly all SF-36 domains (p<0.05). Additionally, there was a significant association between comorbidities and SF-36 scores, including physical function, physical limitations, and emotional limitations (p<0.05). There was a significant association between ejection fraction and SF-36 scores, including physical function, role limitations due to physical health problems, vitality, social function, bodily pain and general health. However, no relationship was found between IMT and PPM implantation duration with SF-36 scores (p>0.05). Conclusion: We identified a relationship between age, gender, comorbidities, PPM lead location, and ventricular ejection fraction with the quality of life of patients following PPM implantation
Determinants of Frailty Status in Elderly Patients with Permanent Pacemakers at Adam Malik Hospital, Medan Irawan, Raja Alfian; Ariestine, Dina Aprilia; Lubis, Anggia Chairuddin; Sungkar, Taufik; Nasution, Melati Silvanni
Journal of Society Medicine Vol. 4 No. 8 (2025): August
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i8.229

Abstract

Introduction: Frailty is highly prevalent among elderly patients following permanent pacemaker implantation, with rates exceeding 70%. The Comprehensive Geriatric Assessment (CGA) evaluates frailty through domains such as nutrition (Mini Nutritional Assessment, MNA), comorbidities (Charlson Comorbidity Index, CCI), functional status (Barthel Index), cognition (Mini Mental State Examination, MMSE), mood (Geriatric Depression Scale, GDS), quality of life, polypharmacy, and pacemaker implantation duration, alongside sociodemographic factors like age and sex. Identifying factors influencing frailty is essential for optimizing outcomes and quality of life in this population. Methods: This cross-sectional study included patients aged ≥60 years with permanent pacemakers attending the Arrhythmia Clinic at Adam Malik Hospital, Medan, from October to December 2024. Frailty was assessed using the CGA. Bivariate analyses employed Fisher’s exact test and chi-square tests to evaluate associations between frailty scores and variables including MNA, CCI, Barthel Index, MMSE, GDS, quality of life, polypharmacy, implantation duration, age, and sex. Multivariate logistic regression was used to identify significant predictors of frailty. Results: Of 62 participants, 62.9% were aged 60–74 years. Bivariate analysis revealed that 58.1% of malnourished patients (per MNA) were frail (p<0.008), and 94.1% of those on polypharmacy regimens were frail (p<0.001). Multivariate analysis identified polypharmacy as the only significant predictor of frailty (OR 14.0; 95% CI 2.186–89.675). Conclusion: Nutritional status and polypharmacy are associated with frailty in elderly pacemaker patients, with polypharmacy showing a significant independent effect. Targeted interventions addressing polypharmacy may improve frailty outcomes in this population.
Obstructive Sleep Apnea in Patients with Heart Failure and Atrial Fibrillation Lubis, Anggia Chairuddin; Yuke Sarastri; Cut Aryfa Andra; Nadiah Masyab; Hana Fauziyah
Sumatera Medical Journal Vol. 8 No. 3 (2025): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v8i3.16701

Abstract

Background: Obstructive sleep apnea (OSA) is an independent risk factor for heart failure and atrial fibrillation. Therefore, effective detection and management of OSA are essential. Objective: The study aimed to determine how common obstructive sleep apnea is among patients with heart failure and atrial fibrillation. Methods: We performed a cross-sectional study assessing the prevalence of OSA in hospitalized patients with both conditions, following the latest European Society of Cardiology Guidelines for heart failure assessment and using polysomnography to evaluate OSA. Results: The study included 30 subjects; 22 (73.3%) were men, and 18 (60%) were over 60 years old. Polysomnography revealed that 23 (80.0%) had OSA, with 4 (23.5%) in the severe category and an average AHI of 18.3 ± 14.7. Among participants, 11 (65%) with ejection fraction ≤ 40%, 12 (40%) had obesity, 11 (36.7%) had Type 2 diabetes, 19 (63.6%) had hypertension, 20 (66.7%) had coronary artery disease, and 3 (10%) had a history of stroke. Most participants (60%) had a history of smoking. Conclusion: This study shows a high prevalence of OSA among patients with heart failure and atrial fibrillation, especially in men and those with reduced ejection fraction.
Incidence of Bleeding Complications in Acute ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Ferhat, Muhammad; Lubis, Anggia Chairuddin; Safri, Zainal; Mukhtar, Zulfikri; Hasan, Harris; Haykal, Teuku Bob; Siregar, Yasmine Fitrina; Andra, Cut Aryfa
Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) Vol. 7 No. 3 (2025): Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI)
Publisher : TALENTA Publisher, Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/jetromi.v7i3.21143

Abstract

Background: This study aims to comprehensively describe the incidence, types, and associated risk factors of bleeding complications in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), addressing a critical gap in the literature given the global burden of cardiovascular disease and the inherent bleeding risks of contemporary antithrombotic therapies. Methode: This retrospective cross-sectional study will investigate the incidence and types of bleeding complications, along with associated risk factors, in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) at Adam Malik Hospital Medan, analyzing data from May 2022 to December 2024 through ethical review and statistical analysis using SPSS version 23. Result: Of 245 STEMI patients undergoing primary PCI, 42.9% experienced bleeding, predominantly minor (BARC 1 and 2, 94.2% combined), with significant associations observed between bleeding and lower hemoglobin, higher leukocyte and creatinine levels, higher TIMI score, Killip class 3 and 4, diabetes, use of maintenance heparin, and increased mortality (84.6% of all deaths occurred in bleeding patients), while hematuria and puncture site hematoma were the most common bleeding sources. Conclusion: This study found that 42.9% of 245 STEMI patients undergoing primary PCI experienced bleeding complications, predominantly minor (94.2%), with an average age of 55.22 years and a male majority. Keyword: Bleeding complications, Acute Coronary Syndrome (ACS), ST-Elevation Myocardial Infarction (STEMI), Primary Percutaneous Coronary Intervention (PPCI)
Patient-reported perceptions of life quality and longevity in chronic heart failure Lubis, Ahmad Feriansyah; Lubis, Anggia Chairuddin; Andra, Cut Aryfa; Raynaldo, Abdul Halim; Ardini, Tengku Winda; Haykal, Teuku Bob; Sarastri, Yuke
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.9

Abstract

BACKGROUND: Although heart failure therapy has advanced, many patients still experience functional limitations, which impact their quality of life. OBJECTIVES: To explore the factors influencing heart failure patients' preferences for quality of life and longevity. METHODS: This cross-sectional study was conducted at Adam Malik Hospital, Medan, Indonesia. The study was conducted from April 2023 to October 2023. A total of 143 chronic heart failure patients were included using purposive sampling. Data were collected through interviews and the EuroQol five-dimension five-level questionnaire, EuroQol visual analogue scale, and the Time Trade-Off method. Statistical analysis was performed using multivariate logistic regression. RESULTS: Of the 143 patients, 66.4% preferred quality of life over longevity, and 47.3% were willing to trade two years of their lives for a better quality of life. The main factors associated with this preference were heart failure with reduced ejection fraction (OR: 3.554; 95% CI: 1.373 - 9.198; p: 0.009), diabetes mellitus (OR: 2.705; 95% CI: 1.108 - 6.602; p: 0.029), and lower visual analog scale scores (OR: 0.889; 95% CI: 0.848 - 0.932; p: 0.000). Our results also showed that patients in the longevity group had better ejection fractions, fewer rehospitalizations, and were less likely to have diabetes mellitus or chronic kidney failure compared to the quality of life group. CONCLUSION: The majority of heart failure patients choose quality of life over longevity, and this may be influenced by symptom burden and rehospitalization history. These findings emphasize the importance of patient-centered therapy focusing on symptom management and psychosocial support.
Gambaran Hasil Pemeriksaan Ekokardiografi Pasien Gagal Jantung di RSUP H. Adam Malik pada Tahun 2021 Surbakti, Trifena Aurelya Rimna; Lubis, Anggia Chairuddin
SCRIPTA SCORE Scientific Medical Journal Vol. 5 No. 1 (2023): SCRIPTA SCORE Scientific Medical Journal
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/scripta.v5i1.10867

Abstract

Pendahuluan. Angka kejadian penyakit gagal jantung masih terus meningkat di tingkat global. Dalam mendiagnosis dan mengevaluasi penyakit gagal jantung, terdapat beberapa modalitas yang dapat diandalkan, salah satunya adalah ekokardiografi. Metode pemeriksaan ekokardiografi berguna dalam banyak aspek termasuk penilaian fungsi dan diameter jantung, yang secara klinis menjadi landasan dalam pilihan pengobatan dan prognosis penderita gagal jantung. Tujuan. Tujuan penelitian ini adalah untuk mengetahui gambaran hasil pemeriksaan ekokardiografi pasien gagal jantung di RSUP H. Adam Malik Medan pada tahun 2021. Metode. Penelitian ini memiliki desain deskriptif retrospektif dengan pendekatan potong lintang (cross sectional). Hasil. Mayoritas penderita berasal dari kalangan usia produktif. 73,62% pasien berjenis kelamin laki-laki. Etiologi terbanyak pada penelitian ini adalah penyakit iskemik. Ditemukan 49,08% sampel mengalami hipertrofi eksentrik, 46,63% mengalami hipertrofi konsentrik, 1,84% mengalami remodelling konsentrik, dan 2,45% memiliki geometri LV yang normal. Rata rata LVEF adalah 44,70% dengan HFpEF yang paling mendominasi. 77,30% memiliki TAPSE normal dan dari 121 data yang tersedia, 46,63% mengalami disfungsi diastolik grade I, 14,72% mengalami disfungsi diastolik grade III, dan sisanya, 12,88% mengalami disfungsi diastolik grade II. Kesimpulan. Kebanyakan pasien gagal jantung di RSUP H. Adam Malik Medan pada tahun 2021 berasal dari kalangan usia produktif. Etiologi tersering adalah penyakit iskemik. Dimensi dan volume LV mayoritas pasien hipertrofi eksentrik. HFpEF mendominasi dan TAPSE kebanyakan normal. Dari 121 data mengenai disfungsi diastolik LV, disfungsi grade I merupakan yang terbanyak. Kata Kunci: gagal jantung, ekokardiografi, LVEF, TAPSE, gambaran
Revisiting Subspecialty Training in Cardiology in Indonesia: Structural, Regulatory, and Global Perspectives Munawar, Muhammad; Lubis, Anggia Chairuddin; Setianto, Budi Yuli; Octaviono, Yudi Her; Munawar, Andina; Rifqi, Sodiqur; Widito, Sasmojo
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1971

Abstract

The rapid expansion of cardiology as a discipline has prompted the emergence of numerous subspecialties that require structured, competency-based training. In Indonesia, however, the development of subspecialty education remains inconsistent, divided between university-based programs known as Spesialis-2 (Sp-2) and hospital-based fellowships. The interchangeable use of the terms “fellowship” and “subspecialty” has generated conceptual ambiguity and regulatory uncertainty. Globally, subspecialty training in cardiology follows a hospital-based apprenticeship model, led by accredited teaching hospitals and closely regulated by professional boards such as ACGME, ACC, or ESC. Indonesia’s deviation from these international norms has implications not only for the quality of advanced cardiovascular training but also for the nation’s ability to attract international fellows—a marker of global academic recognition. This review examines the current landscape of cardiology subspecialty education in Indonesia, contrasting it with global frameworks, and discusses structural, academic, and legal challenges, including those concerning foreign trainees. The article concludes by proposing a policy framework to harmonize Indonesia’s subspecialty education with global standards, thereby strengthening both national capacity and international credibility.
Co-Authors Abdul Halim Raynaldo Abdullah Afif Siregar Abdullah Afif Siregar Achmad, Aziz Ade Irma Ahmad Handayani Akbar, Nizam Zikri Ali Nafiah Nasution Ali Nafiah Nasution Andra, Cut Aryfa Andra, Cut Aryfa andrico tobing Ardini, Tengku Winda Ariestine, Dina Aprilia Asepty, M. Rizky Priyanka Batubara, Gio Justisia Brahmana, Andrew Timanta Budi Yuli Setianto Cut Aryfa Andra Daulay, Elvita Rahmi Dewita, Auliya Edison Bun Ferhat, Muhammad Hana Fauziyah Harris Hasan Harris Hasan Hasan, Harris Hasan, Harris Hasan, Refli Hillary, Lastri Ilyas, Kamal Kharazzi Irawan, Raja Alfian Jaya Suganti Karo, Kartika br Ketaren, Andre Pasha Ketaren, Andre Pasha Khairunnisah, Dina Lubis, Ahmad Feriansyah Lubis, Hilfan Ade Putra Muhammad Munawar Muhktar, Zulfikri Mukhtar, Zulfikli Mukhtar, Zulfikri Munawar, Andina Nadiah Masyab Napitupulu, Bertha Gabriela Napitupulu, Bertha Gabriella Nasution, Ali Nafiah Nasution, Melati Silvanni Nizam Zikri Akbar Octaviono, Yudi Her Purba, Joy Wulansari Raynaldo, Abdul Halim Ryanti, Dina Safri, Zainal Sarastri, Yuke Siregar, Abdullah Afif Sitepu, Andika Sodiqur Rifqi Surbakti, Trifena Aurelya Rimna Sutomo Kasiman Taufik Sungkar, Taufik Teuku Bob Haykal Widito, Sasmojo Yasmine Fitrina Siregar Yuke Sarastri