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The Effect of Exercise Training as Adjuvant Treatment on Functional Capacity in Congenital Heart Disease with Negative Vaso Reactivity Test Pulmonary Hypertension Patient at Saiful Anwar Hospital Malang Pratiwi, Irma Kamelia; Martini, Heny; Tjahjono, Cholid Tri; Anjarwani, Setyasih; Handari, Saskia Dyah
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.3

BackgroundPulmonary hypertension associated with congenital heart disease (CHD) is an important subgroup that accounts for approximately 11% of all patients with PAH. Physical limitations are one of the main symptoms of hemodynamic changes in patients with PH.Â Objective This study aimed to evaluate the effect of physical exercise therapy for 12 weeks as an additional therapy with PDE-5 inhibitors on the functional capacity of patients with Congenital Heart Disease accompanied by Pulmonary Artery Hypertension (CHD â€“ PH).Â MethodThis research was an analytic experimental study with a prospective cohort research method. This study used data sources obtained from medical records to adjust subjects based on inclusion and exclusion criteria, initial cardiac training test examination data was carried out at IPJT in patients selected as subjects. The patient's clinical outcomes were followed in the next 12 weeks.Â ResultThis research was conducted on 16 samples divided into two groups, namely the control and study groups. The evaluation after 12 weeks found that there was an increase in mileage as measured through the 6MWT submaximal test and a better duration of physical activity in the study group tested through the Endurance Shuttle Walk Test (ESWT). This is consistent with the effect of physical exercise, which suppresses systemic inflammation and causes vasodilation, thereby increasing oxygen delivery to the tissues. This causes more optimal aerobic metabolism and reduces lactate production. So that the patient did not quickly feel tired during activities. However, there was no significant increase in the Incremental Shuttle Walk Test. This could be due to the relatively short training duration of 12 weeks.Â Conclusion A positive correlation exists between physical exercise and increased functional capacity of patients with CHD who were evaluated using 6MWT and ESWT.

Proper management of pulmonary hypertension crisis Aziz, Indra Jabbar; Martini, Heny
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.4

A pulmonary hypertensive crisis is characterized by a sudden increase in the pressure in the pulmonary arteries, leading to an excessive workload on the right ventricle of the heart and a decrease in cardiac output. Typically, individuals with pulmonary hypertension (PH) have a greater mortality rate after surgical procedures, which can range from 4% to 24%. Early recognition of pulmonary hypertensive crisis is crucial. There are a limited number of comprehensive guidelines or review articles that focus on the evaluation and treatment of pulmonary hypertension crises. Hypoxia in pulmonary hypertension crisis leads to a vicious cycle of decreased cardiac output, elevated pulmonary vascular resistance, right ventricular enlargement, restricted left ventricular filling, reduced blood pumping, systemic hypotension, and metabolic and respiratory acidosis. It is crucial to monitor clinical parameters, including systemic hypotension, hypoxia, tachycardia, reduced urine output, and complete absence of urine production. The main characteristics of a pulmonary hypertension crisis are increasing pulmonary and right atrial pressures along with a decrease in cardiac output. Echocardiography can be a useful additional tool that shows the deterioration of the right ventricular (RV) function and enlargement. Confirmation of a pulmonary hypertensive crisis is achieved with the use of invasive hemodynamics. Our current review aims to discuss the proper management of Pulmonary Hypertension Crisis.

Transcatheter atrial septal defect closure: Focus on tips and tricks for interventional procedure in challenging cases Setiawan, Dion; Putri, Valerinna Yogibuana Swastika; Martini, Heny; Karolina, Wella
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.6

The ostium secundum defect is the most prevalent form of atrial septal defect (ASD). The development and refinement of devices and techniques for transcatheter ASD closure have led to its acceptance as the preferred management for most patients with secundum ASD. Meticulous planning and execution constitute the key to achieving success in a procedure. It entails a thorough assessment of the patient, beginning with selecting suitable cases, as well as detailed pre- and intraprocedural imaging, knowledge of various device deployment techniques, anticipation of potential complications, and appropriate management strategies. This review article will discuss tips and tricks to overcome the technical intricacies of achieving a successful transcatheter ASD closure and address some challenging cases associated with its use.

Benefits of exercise training on pulmonary arterial pressure as measured by echocardiography in patients with pulmonary hypertension Firdaus, Muhammad; Martini, Heny
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.7

Pulmonary hypertension (PH) is a substantial worldwide health concern that impacts around 1% of the population, in especially among the elderly. PH is defined by a mean pulmonary arterial pressure (mPAP) over 20 mmHg and is linked to significant morbidity and mortality. Optimal care depends on precise evaluation of mPAP, which acts as a crucial diagnostic and prognostic marker. Recent research emphasizes the significance of exercise training as a secure and economical intervention that can result in significant enhancements in hemodynamic parameters, such as decreased mPAP and increased cardiac output. Engaging in exercise training stimulates the expansion of blood vessels in the lungs, enhances the functioning of the right ventricle, and reduces persistent inflammation, therefore enhancing the overall ability to exercise and the quality of life for those with pulmonary hypertension. Echocardiography is crucial for monitoring mean pulmonary arterial pressure and evaluating right ventricular function. mPAP is a critical parameter in the evaluation and diagnostic testing for pulmonary hypertension (PH) due to its strong correlation with disease severity and prognosis. Exercise training confers a multitude of advantages to both the cardiovascular system and skeletal muscle systems. Exercise training is generally considered safe, yet, it is important to provide thorough supervision to reduce the occurrence of negative outcomes, especially in patients with advanced illness. In summary, including exercise training into the treatment plan for patients with pulmonary hypertension shows encouraging advantages, justifying more investigation and standardization of exercise procedures to enhance patient results.

The effectiveness of supervised exercise training regarding NT-pro BNP level as a prognostic value among patients with congenital heart disease-related to pulmonary hypertension Setyowati, Danti Utami; Martini, Heny; Prasetya, Indra
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.2025.006.04.5

Congenital heart disease-related to pulmonary hypertension (CHD-PH) constitutes a significant subset of related Pulmonary Hypertension (PH), representing around 11% of all PH patients. Considering the emergence of novel medicines and enhanced patient outcomes in PH, it continues to be a life-shortening condition, and the time frame before diagnosis has not altered. Current strategies to enhance outcomes emphasize on early diagnosis and a treatment methodology designed to put individuals with PH into a low-risk category for one-year mortality. The N-terminal prohormone of BNP (NT-pro BNP) is secreted by cardiomyocytes in reaction to mechanical strain and wall stress. An increased concentration of NT-pro BNP is included in some PH risk stratification methods and screening protocols. The initial recommendation to restrict physical exertion in individuals with PH was based on its adverse impact on their clinical status. But clinicians have recently concentrated on the significance of physical exercise in those with PH. Consistent physical activity can enhance functional capacity, elevate quality of life (QoL), and increase prognosis and life expectancy as well. This literature review seeks to consolidate research about the impact of physical activity on NT-ProBNP levels in individuals with CHD-PH.

Effects of exercise training on C-reactive protein (CRP) levels and 6-minute walk distance: A preliminary study Aziz, Indra Jabbar; Martini, Heny; Anna Fuji Rahimah; Valerinna Yogibuana; Cholid Tri Tjahjono
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.2025.006.04.11

Background Mortality rates increase among those with intermediate to high-risk pulmonary arterial hypertension, demonstrating the importance of improved diagnostic methods, treatment algorithms, and the development of new approaches to therapy for severely ill patients. Inflammation contributes to pulmonary hypertension progression, and exercise has been shown to suppress this process. Objective This study evaluated the relationship and differences between CRP levels and functional capacity after a 12-week exercise training program. Methods A clinical prospective cohort preliminary study was conducted with 26 consecutive patients who had already received pulmonary hypertension treatment and were enrolled in the LET-SHINE registry. Patients were divided into two groups: one control group (PH therapy only) and one treatment group (receiving adjuvant physical exercise). The study was conducted for 12 weeks, 6MWT and CRP tests were performed both before and after the study. Result This study found that the majority of cases were ASD, consistent with the fact that ASD is the most common congenital heart defect. The analysis of C-reactive protein levels showed non-significant changes in both groups after 12 weeks. The treatment group exhibited a modest reduction from 0.8 ± 2.4 mg/dl to 0.5 ± 1.0 mg/dl (p=0.514), while the control group maintained stable levels, ranging from 0.7 ± 1.0 mg/dl to 0.7 ± 0.8 mg/dl (p=0.166). An intergroup comparison revealed a non-significant greater mean decrease in the treatment group (-0.3 ± 1.5 mg/dl vs -0.1 ± 0.2 mg/dl, p=0.514). There was no significant correlation between the reduction in CRP levels and improvements in 6MWT distance in either the treatment group (correlation coefficient: -0.367, p=0.240) or the control group (correlation coefficient: 0.021, p=0.948). Conclusion This study showed that exercise training had no statistically significant impact on C-reactive protein levels, indicating a limited effect on systemic inflammation. No significant correlation was found between decreases in CRP levels and improvements in 6MWT distance in either the treatment or control groups.

Impact of supervised physical activity as adjunctive therapy on functional capacity and NT-pro BNP in patients with negative-reactivity test pulmonary hypertension related to congenital heart disease patient in Saiful Anwar Hospital Malang : A preliminary study Setyowati, Danti Utami; Martini, Heny; Prasetya, Indra; Tjahjono, Cholid Tri; Yogibuana, Valerinna
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.2025.006.04.10

Background: Appropriate levels of physical activity (PhA) provide health benefits to patients with chronic diseases, including patients with pulmonary hypertension-related to congenital heart disease (CHD-PH), representing around 4-10% of all PH patients. Objective: The purpose of this analysis was to determine the benefits and effectiveness of PhA as an additional therapy to optimal medication vs. control group on the functional capacity and N-terminal prohormone of B-type natriuretic peptide (NT-pro BNP) in patients with inoperable CHD-PH. Methods: A clinical preliminary study was conducted with 26 consecutive patients in stable condition before the study. Each patient was educated about the benefits of PhA and efficacy parameters of the six-minute walking distance (6MWD) and NT-Pro BNP levels have been evaluated at baseline and after 12 weeks. Results: The study included participants aged 33 ± 11 years, 84% of whom were female. All patients tolerated PhA without severe adverse events. Patients significantly improved the mean 6MWD compared to baseline by 382.9 ± 64.7 (p=0,000) and 318.3 ± 74 (p=0,041) meters after 12 weeks (training vs. control group). Ln NT-pro BNP improved significantly in the training group (p=0,002). There were no differences at week 12 in the delta 6MWD and NT-pro BNP levels, with all P values >0,05. Likewise, there is no correlation between the two variables Conclusions: PhA as an add-on to medical therapy may enhance work capacity and other prognostic relevant parameters in patients with inoperable CHD-PH. However, further larger, multi-center randomized controlled trials, is warranted to validate these preliminary findings

Predictors of prolonged use of mechanical ventilation in patients with acute respiratory failure and acute heart failure in the CVCU RSUD Dr. Saiful Anwar Malang Lestari, Puspa; Anjarwani, Setyasih; Kurnianingsih, Novi; Prasetya, Indra; Martini, Heny
Jurnal Kardiologi Indonesia Vol 46 No 3 (2025): July - September, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1335

Background Acute respiratory failure (ARF) is a critical condition that often complicates hospitalization and commonly arises from cardiopulmonary dysfunctions such as acute heart failure. Prolonged mechanical ventilation (PMV) in these patients is associated with increased morbidity, mortality of about 30%, and greater healthcare resource utilization. Identifying predictors of PMV is essential to improve outcomes and optimize management strategies. Methods A retrospective cohort study was conducted on all patients who underwent endotracheal intubation in the Cardiovascular Care Unit (CVCU) of RSUD Dr. Saiful Anwar Malang from 2015 to 2021. Patients with incomplete medical records or who died within 14 days of mechanical ventilation were excluded. Univariate and multivariate logistic regression analyses identified independent predictors of PMV. Receiver operating characteristic (ROC) curves were generated to assess model discrimination using the area under the curve (AUC), with corresponding sensitivity and specificity. Data were analyzed using SPSS 22.0. Results Five independent predictors of PMV were identified: tachycardia (p = 0.013), metabolic acidosis (p = 0.002), impaired renal function (p = 0.009), shock (p = 0.006), and major bleeding (p = 0.002). Multivariate analysis showed the following odds ratios(OR, 95% CI): tachycardia 2.06 (1.09–5.99), metabolic acidosis 2.03 (1.09–6.33), impaired renal function 2.87 (1.28–6.46), shock 2.83 (1.13–7.06), and major bleeding 1.36 (1.18–2.15). The model demonstrated good discrimination with an AUC of 0.83 (95% CI 0.77–0.88), sensitivity 0.87, and specificity 0.73. Conclusion In patients with respiratory failure due to acute heart failure, tachycardia, metabolic acidosis, impaired renal function, shock, and major bleeding were independent predictors of prolonged mechanical ventilation. The predictive model showed high sensitivity and acceptable specificity, supporting its clinical usefulness for early identification of high-risk patients and targeted intervention.

Pengaruh Latihan Fisik terhadap Kadar Marker Inflamasi pada Pasien Hipertensi Pulmonal Aziz, Indra Jabbar; Martini, Heny
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.7

Pulmonary hypertension (PH) is characterized by pulmonary vascular dysfunction, which can lead to right heart failure and death, as well as the accumulation of inflammatory cells in the perivascular area. Chronic inflammation plays an important role in the pathophysiology of pulmonary hypertension. Inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are often elevated in patients with pulmonary hypertension. The accumulation of inflammatory cells accelerates the remodeling process of pulmonary blood vessels and pulmonary hypertension. Despite the current therapeutic approaches for pulmonary hypertension (PH), which aim to improve functional capacity and hemodynamics, pulmonary hypertension remains incurable but remains controllable. Inflammatory processes play a critical role in progressive pulmonary hypertension. Physical exercise can reduce the risk of chronic disease, and recent research has shown that it improves inflammatory marker profiles. This literature review aims to combine evidence on the influence of physical exercise on levels of inflammatory markers in patients with pulmonary hypertension.

Sebuah Laporan Kasus Penurunan Fungsi Sistolik Ventrikel Kiri pada Pasien Hamil dengan Tetralogy of Fallot yang Telah Dikoreksi : Kardiomiopati Peripartum atau yang Lainnya? Gultom, Yosafat Hasiholan Marthin; Martini, Heny
Jurnal Klinik dan Riset Kesehatan Vol 5 No 1 (2025): Edisi Oktober 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.05.1.8

Background : Tetralogy of fallot (TOF) is the most common cyanotic congenital heart disease (CHD) worldwide. It is estimated that TOF occupies 5 to 8% of total CHD and twice as many among other CHD simple defect. By far, TOF can only be managed by surgical correction. In most cases, post corrected TOF patients may tolerate pregnancy well. The majority of post corrected TOF patients also have good LV function and just about 23% of them have moderate LV dysfunction. Meanwhile, peripartum cardiomyopathy is one of the cause of LV systolic dysfunction in pregnancy. Case Presentation : A 31-years-old 33 weeks pregnant woman was reffered with chief complain of shortness of breath since 1 month before and preceded with bilateral leg edema (NYHA functional class III). Patient with history of TOF and was corrected surgically with residual tricuspid regurgitation. Patient with normal left ventricle (LV) systolic function by echocardiography at the second semester of pregnancy and deteriorated at the third semester of pregnancy. Due to the rapid deterioration of LV systolic function, the pregnancy was decided to be terminated by surgery. Patient was treated with bisoprolol, bromocriptine, captopril and warfarin. During the hospitalisation, patient didn’t develop any of arrhytmia or hemodynamic issue. After the termination, patient was with improvement of shortness of breath (NYHA functional class II) and improvement of LV systolic function. Conclusion : A pregnant, post corrected TOF, woman with rapid deterioration LV systolic function and clinical manifestation of heart failure underwent pregnancy termination by surgery. After the termination, patient still with shortness of breath and improvement of LV systolic function.

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