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All Journal Indonesian Journal of Cardiology Heart Science Journal Jurnal Klinik dan Riset Kesehatan Journal of Indonesia Vascular Access Deka in Medicine
Kurnianingsih, Novi
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Factors that influence the clinical and technical success of venoplasty in patients with central venous stenosis at Saiful Anwar hospital Kurnianingsih, Novi; Akbar, Akita Rukmana
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.2025.006.04.8

Abstract

Background: Central venous stenosis (CVS) is a common complication in long-term hemodialysis patients, particularly those with a history of central venous catheterization. Percutaneous transluminal venoplasty is the primary treatment modality; however, its success varies depending on anatomical and procedural factors. Objectives: This study aimed to evaluate the procedural success of venoplasty in CVS patients and to identify anatomical and procedural factors associated with wire-crossing failure and residual stenosis of less than 30%. Materials and Methods: A retrospective study was conducted involving 55 patients with CVS who underwent venoplasty at Dr. Saiful Anwar General Hospital, Malang, between 2021 and 2025. Data collected included patient demographics, lesion characteristics, and procedural variables. Data were analyzed using SPSS version 27. Descriptive statistics were used to summarize baseline characteristics. Chi-square or Fisher’s exact tests were used for bivariate analysis, followed by multivariate logistic regression to determine independent predictors of procedural success. Results: Wire crossing was successfully achieved in 76.4% of cases, while balloon venoplasty resulted in residual stenosis <30% in 74.5% of patients. Multivariate analysis revealed that total occlusion (OR 1.619; 95% CI: 1.243–2.109; p = 0.001), presence of venous collaterals (OR 1.429; 95% CI: 0.974–2.094; p = 0.048), and vessel tortuosity (OR 2.237; 95% CI: 1.258–3.978; p = 0.000) were significantly associated with wire-crossing failure. Clinical success (residual stenosis <30%) was significantly associated with non-total occlusion (OR 1.542; 95% CI: 1.164–2.043; p = 0.014) and absence of vessel tortuosity (OR 2.610; 95% CI: 1.362–5.001; p = 0.000). No significant associations were found between procedural outcomes and factors such as wire type, balloon pressure, or puncture technique. Conclusion: Anatomical characteristics—including total occlusion, vessel tortuosity, and collateral formation—are the key determinants of venoplasty success in patients with CVS, outweighing the influence of procedural variables. Comprehensive anatomical assessment prior to intervention is essential to optimize procedural outcomes.
Beyond the procedure: A call for precision in diagnosis, risk mitigation, and sustainability of endovascular intervention in peripheral artery disease Kurnianingsih, Novi
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.2025.006.04.1

Abstract

Endovascular interventions have made a lot of advancements in managing peripheral arterial disease (PAD). The interventions of PAD were limited only to medical therapy or surgery, but as for now, it has undergone changes because of improvements in the tools used for intervention and the improved operator skill, so the patients are able to gain benefits, even if the intervention is minimally invasive. The benefit does not stop at the technical success; it extends to the precision in diagnosing, extensive risk mitigation, and sustainable outcomes. Duplex ultrasonography is now popularly used because of its ease of use, following more advanced examinations such as CT or MR angiography, resulting in accurate, on-time, and precise interventions. But, there are several challenges left, such as the low rate of use of guideline-directed medical therapy that may lead to an increased number of mortality and amputation risk. Furthermore, multidisciplinary collaboration is deemed essential in optimizing sustainability. Patency or angiography, which are usually used as parameters traditionally, are not enough to measure the success of the therapy; instead, limbs preserved, improvement of the function, and the quality of life may define success in therapy, where endovascular interventions may directly affect those parameters mentioned. In order to achieve sustainable and meaningful outcomes affecting the long-term well-being of patients, patient-centered strategies, early detection, and maximizing the use of resources are a must.
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

Abstract

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.
Risk factors associated with the incidence of Arteriovenous (AV) shunt stenosis in Chronic Kidney Disease (CKD) patients on hemodialysis Gunawan, Atma; Rifai, Achmad; Kurnianingsih, Novi; Haryanto, Ahmad Farid
Journal of Indonesia Vascular Access Vol. 5 No. 2 (2025): Available online : 1 December 2025
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v5i2.84

Abstract

Background: Arteriovenous (AV) shunt stenosis is a significant complication in chronic kidney disease (CKD) patients undergoing hemodialysis with AV shunt access. The risk factors associated with this event are still not fully understood. This study aims to identify factors associated with the incidence of AV shunt stenosis in CKD patients undergoing dialysis. Methods: A cross-sectional study was conducted involving 236 patients undergoing hemodialysis at Dr. Saiful Anwar General Hospital, Malang. Risk factors analyzed included age, gender, diabetes mellitus, hypertension, obesity, and AV shunt location. Results: Bivariate analysis using the Chi-square test showed significant associations between stenosis and age (p=0.020), gender (p=0.001), diabetes mellitus (p=0.001), and hypertension (p=0.031). However, obesity (p=0.608) and AV shunt location (p=0.552) were not significantly associated. Logistic regression analysis indicated that diabetes mellitus increased the risk of AV shunt stenosis by 2.46 times (95% CI: 1.42-4.26), hypertension by 2.05 times (95% CI: 1.06-3.96), and age above 60 years by 1.93 times (95% CI: 1.10-3.37) Conclusion: Diabetes mellitus, hypertension, advanced age, and smoking are key risk factors for AV shunt stenosis in CKD patients undergoing dialysis
Kasus Iskemia Tungkai Akut yang Tidak Terduga pada Pasien Sindrom Nefrotik Erickatulistiawan, Gallusena; Tjahjono, Cholid; Kurnianingsih, Novi
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.04.1.9

Abstract

Background: Acute Limb Ischemia ALI requires urgent intervention to avert irreversible tissue damage, with treatment complexity increasing in patients with nephrotic syndrome. Case Presentation: A 23-year-old female with nephrotic syndrome presented acute right leg pain. Examination showed erythema and a cold sensation in the affected leg. Ultrasound revealed no blood flow in certain leg arteries. Despite multiple thrombectomies and heparin treatment, only minimal improvement was observed. The patient underwent a below-knee amputation after unsuccessful attempts to restore blood flow. Her condition worsened with new vascular occlusions, requiring Catheter Direct Thrombolysis CDT. Post-CDT, she suffered severe bleeding, hemorrhagic shock, cardiac arrest, and multi-organ complications, leading to her death on treatment day 35. Discussion: This case illustrates the complexities of managing ALI in patients with nephrotic syndrome, which increases hypercoagulability and vascular complication risks. It highlights the need for an integrated nephrology and vascular approach, considering the high risks of hemorrhagic and thrombotic complications. A comprehensive and multidisciplinary treatment strategy is crucial, especially with vigilant monitoring for severe complications like infection and sepsis, to enhance treatment outcomes in similar cases. Conclusion: This case of a 23-year-old woman with ALI and nephrotic syndrome presented significant treatment challenges. Despite numerous interventions, including thrombectomies and CDT, severe complications ensued, emphasizing the need for comprehensive management and further research in similar complex conditions.
Peran Vital Ultrasonografi Dupleks pada Fistula Arteriovenosa sebagai Akses Hemodialisis Firdaus, Achmad Jauhar; Kurnianingsih, Novi
Jurnal Klinik dan Riset Kesehatan Vol 3 No 3 (2024): Edisi Juni
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.03.3.6

Abstract

The global incidence of end-stage renal disease (ESRD) is rising, amounting to more than 800 million individuals are suffered, in line with the rise of the number of patients undergoing hemodialysis as treatment modalities. Hemodialysis requires vascular access, and the arteriovenous fistula (AVF) access is considered the most ideal vascular access option due to its long-term patency and low complication rate compared to other access options. However, up to one-third of hospital admissions for ESRD patients are caused by AVF dysfunction, which is also one of the main causes of morbidity and mortality in ESRD patients. AVF creation requires careful pre- and post-operative evaluation to ensure the vascular access maturation and patency. While the latest guidelines have not explicitly emphasized the role of vascular mapping and surveillance, routine duplex ultrasonography before and after AVF creation procedures holds great potential advantages to ensure the success of AV access for hemodialysis.
Tindakan Invasif sebagai Pilihan Tatalaksana pada Kasus Trombosis Vena Dalam Kemala, Yuke Fawziah; Kurnianingsih, Novi
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.05.1.7

Abstract

Deep Vein Thrombosis (DVT) refers to thrombus formation in the deep vein, usually legs, which causes inflammation, and potentially causing disruption of blood flow. Anatomically, DVT is classified as upper and lower extremity DVT. A study in the USA reported 375,000–425,000 new cases of VTE diagnosed per year, of which 50/100,000 cases were DVT. Pathophysiology of DVT is closely related to the Triad of Virchow, i.e. hypercoagulability, stasis and endothelial injury. Establishing DVT diagnosis comprises finding clinical presentation or calculating probability pre-test score, obtaining laboratory examinations, such as D-dimer and imaging test. Venous ultrasound is the gold standard for highly-suspected DVT, while the others are Computed Tomography Venography (CTV) and Magnetic Resonance Venography (MRV). The aim of DVT management based on onset, because immediate treatment in the acute phase, known to reduce significantly the incidence of recurrence, pulmonary embolism and major bleeding. DVT treatment can be divided into non-invasive (i.e. anticoagulation and stocking compression) and invasive. If there are no thrombolysis contraindications, endovascular techniques, such as CDT; PMT; PCDT; venous stenting; as well as IVC/SVC filter placement are recommended. Meanwhile, surgical techniques (i.e. surgical thrombectomy; surgical decompression and vein bypass) are an option if conservative management is unsuccessful, high-risked of life-threatening pulmonary embolism with a low-risk of bleeding, or has severe PTS. By knowing the diagnostic techniques and indications of invasive treatments, it is prospected to plan the appropriate management for each patient, so that increases the successful rate as well as reduce intrahospital and long-term complications.
The Effect of HbA1C Variability and Lipid Profile on Carotid Intima-Media Thickness (cIMT) and Flow-mediated Dilatation (FMD) in children and adolescent with Type 1 Diabetes Mellitus at Saiful Anwar Hospital Malang Ikeningrum, Dyah Ayu; Tjahjono, Cholid Tri; Kurnianingsih, Novi; Widito, Sasmojo; Putri, Valerina Yogibuana Swastika
Heart Science Journal Vol. 3 No. 3 (2022): Cardiovascular Disease in Young Adulthood: Who, When, and How to Screen?
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.03.4

Abstract

BackgroundThere is a correlation between diabetes mellitus type 1 (T1DM) and a higher risk of heart disease. Atherosclerosis, which can be discovered early with cIMT (Carotid Intima-Media Thickness) and Flow Mediated Dilation (FMD) tests, contributes to the development of cardiovascular disease. HbA1c fluctuation and lipid profile can have an impact on cIMT and FMD.AimThe aim of this study is to determine the influence of HbA1c variability and lipid profile on cIMT and FMD levels in children T1DM patients treated at Dr Saiful Anwar Hospital Malang.MethodsThe study utilized a cross-sectional design and included 82 participants with Type 1 Diabetes Mellitus who were routinely treated at the Dr. Saiful Anwar Hospital Malang's pediatric outpatient clinic between January - July 2019 and December 2021 and- January 2022.ResultsThe correlation test revealed no significant connection between HDL (ρ=-0,029; p=0,796), LDL (ρ=-0.213; p=0.055), TG (ρ= -0.179; p= 0.107), and total cholesterol (ρ=-0.182; p= 0.101). Association tests revealed a positive correlation between LDL (ρ=0,318; p=0,004) and total cholesterol (ρ=0,230; p=0,038) levels and IMT. The correlation coefficient between HbA1C variability and FMD as evaluated by HVS was -0.498 (ρ=0.000; p=0.05), as was the correlation coefficient between HbA1c-SD (ρ=-0.467; p=0.000) and HbA1c-CV (ρ=-0.400; p=0.000). Additionally, a significant positive connection was discovered between IMT and the value of HbA1c variability utilizing HVS (ρ=0.455; p=0.000), HbA1c-SD (ρ=0.434; p=0.000), and HbA1c-CV (ρ=0.325; p=0.003). The linear regression analysis revealed that the three variables with the greatest influence on FMD were HVS (R=0.398), LDL (R=0.316), and HbA1c-SD (R=0.293). HVS (R=0.468), LDL (R=0.268), and total cholesterol (R=0.198) were the three most impactful variables on IMT. It is known that the combination of lipid profile and HbA1c fluctuation contributes 25.1% to FMD using this model. Meanwhile, the lipid profile and HbA1c variability together accounted for 34.5% of the variance in IMT.ConclusionVariability in HbA1c and lipid profile (LDL and total cholesterol) can contribute to an increase in intima-media thickness and a decrease in brachial artery FMD in children with T1DM.  
Correlation Between Smoking and Il-1 Level and Arterial Stiffness as Measured By Cavi in the Young Adult Population Without other Cardiovascular Risk Factors. Galih Prakosa, Ardani; Tjahjono, Cholid Tri; Kurnianingsih, Novi; Sargowo, Djanggan; Anjarwani, Setyasih
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.2023.004.03.5

Abstract

Background: Recent studies have shown that arterial stiffness is a strong predictor of cardiovascular events and all-cause mortality, with CAVI (Cardio-Ankle Vascular Index) as a non-invasive arterial stiffness testing method indaily practice.Objective: This study was conducted to examine the relationship between smoking -as a risk factor for arterial stiffness- and CAVI values, as well as levels of IL-1β (Interleukin 1β) as a cytokine that plays a role in the pathophysiology of arterial stiffness.Methods: Eighty-four participants, including smokers and non-smokers without other cardiovascular risk factors, were included in the study. Demographic data, medical history, and smoking behavior were taken using a questionnaire, then IL-1β and CAVI levels were examinedResults: The mean level of IL-1β in smoking subjects was significantly higher (15.09 ± 0.48) than in non-smoking subjects (5.53 ± 0.79; p=0.001). CAVI values in smoking subjects were also significantly higher (8.0 ± 0.06) than in non-smoking subjects (6.9 ± 0.02; p=0.001). Further analysis showed a strong positive correlation between smoking and IL-1β levels (r=+0.776; p=0.001) and CAVI values (r=+0.759; p=0.001).Conclusion: This study shows that smoking significantly correlates with IL-1β levels and CAVI values. The greater number of cigarettes used per day and the longer duration of smoking, there was a positive correlation between IL-1β levels and arterial stiffness as measured by CAVI.
Troubleshooting for Kinked Coronary Catheter: How to Manage? ; A Case Series Noverike, Nikhen; Satrijo, Budi; Widito, Sasmojo; Kurnianingsih, Novi; Abusari, Muchamad
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.2023.004.03.7

Abstract

Background: Catheter entrapment and knotting are two problems that might arise during coronary angiography, regardless of the method used. It is not uncommon for the catheter shaft to become kinked during diagnostic or interventional procedures. Still, if the manipulation fails, an invasive retrieval method is usually necessary for cases with extensive catheter kinking.Case Illustration: We present two cases illustrating how different angiography approaches could lead to severe catheter kinking. Because of the significant tortuosity of the vasculature, even a gentle opposite rotation maneuver and the antegrade advancement of multiple guidewires failed to untwist the guide catheter. Once a twisted catheter has been identified via fluoroscopy, the twist can be eased by gently twisting the catheter in the opposite direction. It is not always easy. It could lead to using other interventional techniques such as snare, balloon, or surgical procedures. In our cases, we used a snare to snag the catheter's tip and untied the loop's knot. This prevented the need for unscheduled surgical intervention. We evaluated from angiography. There were no further complications. The patients were released from the hospital the following day.Conclusion: Although a kinked catheter could become entrapped, various approaches can be taken to deal with this difficulty and prevent the need for surgical intervention.
Co-Authors Abusari, Muchamad ACHMAD RIFAI Afifuddin, Mokhammad AJI, BAYU Akbar, Akita Rukmana Anjarwani, Setyasih Arif Wicaksono Astiawati, Tri Atma Gunawan Cholid Tri Tjahjono Djanggan Sargowo Elizabeth Damanik, Gracelia Ruth Erickatulistiawan, Gallusena Fahmi, Hanim Isyfi Fathurohim, Zainal Firdaus, Achmad Jauhar Galih Prakosa, Ardani Haryanto, Ahmad Farid Ikeningrum, Dyah Ayu Indra Prasetya Kemala, Yuke Fawziah Kurniawan, Catur Rizky Kurniawan, Dea Kurniawan, Dea Arie Lestari, Defyna Dwi Lestari, Puspa Maimun Zulhaidah Arthamin, Maimun Zulhaidah Martini, Heny Mohammad Saifur Rohman Newary, Yola Niazta, Nisa Amnifolia Noverike, Nikhen Pamuna, Oktafin Srywati Putri, Valerina Yogibuana Swastika Rahimah, Anna Fuji Rizal, Ardian Ruspiono, Evit Satrijo, Budi Satwikajati, Sawitri Sekarsari, Calysta Citra Suprapta, Aloysius Yuwono Suprayoga, Imam Mi'raj Swastikaputri, Valerina Yogibuana Titin Andri Wihastuti Tjahjono, Cholid Veliawan, Zhafran Vori, Ira Widito, Sasmojo zunardi, Lutfi hafiz