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All Journal International Journal of Integrated Health Sciences Indonesian Journal on Computing (Indo-JC) Indonesian Journal of Cardiology Indonesian Journal of Obstetrics & Gynecology Science
Pramudyo, Miftah
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Correlation between MMP-9 Level and Diastolic Dysfunction in Concentric Left Ventricular Hypertrophy Patients Pramudyo, Miftah; Jungjunan, Ridho; Martanto, Erwan; Achmad, Chaerul
International Journal of Integrated Health Sciences Vol 9, No 1 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v9n1.2175

Abstract

Objective: To establish the relationship between plasma matrix metalloproteinase (MMP)-9 levels and diastolic functional abnormalities using the E/e’ measurement in concentric type Hypertensive Heart Disease (HHD) patients.Methods: A cross-sectional study was conducted from November 2014 to January 2015 in population with hypertension and concentric Left Ventricular Hypertrophy (LVH). Diastolic function was assessed with E/e’ measurement using echocardiography. The relationship between the two variables was analyzed using Spearman correlation.Results: Thirty-nine subjects (14 males, 35.9%) with the average relative wall thickness of 0.7(±0.15), average body weight of 63.45 (±12.97) kg, average height of 155.51 (±7.12) cm, average body mass index of 26.23 (±5.08) kg/m2, and mean age of 55 (±10) years were fit to be included in the analysis. The median systolic blood pressure was 140 (110-220) mmHg while the median diastolic blood pressure and median left ventricular mass index were 80 (70-110) mmHg and 119.24 (103.05-205.69) g/m2, respectively. The median MMP-9 was measured at 108 (4-460) ng/mL and the median E/e' was 10.99 (6.2-20.42). There was a significant positive correlation between MMP-9 and E/e' (r = 0.416, p = 0.004).Conclusion: There is a significant moderate positive correlation between the MMP-9 level and diastolic dysfunction in concentric LVH patients. 
Usefulness of The CHADS2 and CHA2DS2-VASc Scores in Predicting In-Hospital Mortality in Acute Coronary Syndrome Patients: A Single-Center Retrospective Cohort Study Pramudyo, Miftah; Putra, Iwan Cahyo Santosa; Pratama, Fahmi Bagus; Pranata, Raymond
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.1294

Abstract

BackgroundAlthough the GRACE risk score is widely accepted as an established scoring system to predict in-hospital mortality in acute coronary syndrome (ACS) patients, this scoring system still depends on electrocardiography and laboratory findings to determine the results. Therefore, we aim to retrospectively evaluate the association between the CHADS2 and CHA2DS2-VASc score as an anamnesis-only mediated scoring system and in-hospital mortality in hospitalized ACS patients. MethodsThis retrospective cohort study analyzed data of ACS patients from the ACS registry in Dr. Hasan Sadikin Central General Hospital from 2018 to 2021. The outcome of this study was in-hospital mortality. The association between these scoring system and in-hospital mortality were evaluated using binary logistic regression analysis. Receiver operating characteristics (ROC) analysis was also performed to assess the success rate of this scoring system in predicting in-hospital mortality. ResultsA total of 1339 patients were included in this study, and 162 (12.1%) of them died in the hospital. High CHA2DS2-VASc score group (cut-off >2) was significantly associated with higher risk of in-hospital mortality before (OR=2.56 [1.75,3.75]; p<0.001) and after adjustment of several confounding factors (OR=3.39 [1.73,6.64]; p<0.001). Meanwhile, the high CHADS2 score (cutoff >2) was only significantly increased the risk of in-hospital mortality in univariate analysis (OR=2.05[1.47,2.87];p<0.001), but was not significantly associated with in-hospital mortality after multivariate analysis (OR=1.31 [0.92,1.86];p=0.129). ROC analysis revealed that predictive accuracy of CHA2DS2-VASc score was significantly greater compared to CHADS2 score (AUC: 0.653 vs 0.609, p<0.001). However, the predictive value of CHA2DS2-VASc score was significantly lower than the GRACE risk score (AUC: 0.789 vs 0.653, p<0.001). ConclusionOur study showed that the CHA2DS2-VASc score >2 was significantly and independently associated with higher in-hospital mortality in ACS patients compared to the CHA2DS2-VASc score of 1 or lower. Despite its lower predictive accuracy compared to the GRACE risk score, CHA2DS2-VASc score can still be used in practical situations as an alternative scoring system in predicting in-hospital mortality in ACS patients, especially in primary health care settings located in rural areas that lack the diagnostic facilities.
Management of Decongestion in Acute Heart Failure: Time for a New Approach? Pramudyo, Miftah; Putra, Iwan Cahyo Santosa; Zulkarnain, Edrian; Danny, Siska Suridanda; Bagaswoto, Hendry Purnasidha; Anjarwani, Setyasih; Mazwar, Irmaliyas; Juzar, Dafsah Arifa; Pratama, Vireza; Habib, Faisal; Ispar, Akhtar Fajar Muzakkir Ali; Widyantoro, Bambang
Jurnal Kardiologi Indonesia Vol 43 No 2 (2022): Indonesian Journal of Cardiology: April - June 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1381

Abstract

As the primary cause of hospitalization in acute heart failure (AHF) patients, congestion was responsible for a higher risk of mortality, rehospitalization, and renal dysfunction in AHF patients. Although loop diuretic was routinely used as the mainstay of AHF therapy, it is still ineffective to obtain the euvolemic state in most hospitalized AHF patients. Therefore, a higher loop diuretic dose was often required to increase the decongestion effect. However, consequently, it can cause several detrimental complications, including renal dysfunction, neurohormonal activation, hyponatremia, hypokalaemia, and reduced blood pressure, which eventually result in poor prognosis. Hence, the new approach may be proposed to optimize decongestion in acute phase, including the use of arginine vasopressin V2 receptor antagonist – Tolvaptan. As an additive therapy to loop diuretic in AHF patients, it can be considered due to its several beneficial effects, including greater decongestion effect, lowered worsening renal function incidence, counteract neurohormonal activation, neutralized hyponatraemic state, no alteration of potassium metabolism, stabilize the blood pressure, and reduced requirement of a higher dose of loop diuretic to achieve an equal or even greater decongestion effect compared to a high dose of loop diuretic alone. Tolvaptan provided favourable outcomes in several specific populations and was considered safe with several mild adverse effects. Several guidelines across countries have approved the use of Tolvaptan in AHF patients with or without hyponatremia. The initial dose of Tolvaptan was 7.5 to 15 mg and can be titrated up to 30 mg. However, further studies were still required to determine the timing dose and optimal dose of Tolvaptan in general and elderly populations with AHF, respectively.
Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry Juzar, Dafsah Arifa; Muzakkir, Akhtar Fajar; Ilhami, Yose Ramda; Taufiq, Nahar; Astiawati, Tri; R A, I Made Junior; Pramudyo, Miftah; Priyana, Andria; Hakim, Afdhalun; Anjarwani, Setyasih; Endang, Jusup; Widyantoro, Bambang
Jurnal Kardiologi Indonesia Vol 43 No 2 (2022): Indonesian Journal of Cardiology: April - June 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1406

Abstract

Background Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia. Methods IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes. Results Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients. Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%). Conclusion Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy.
Mexiletine in the treatment of LQT2, LQT3, and acquired LQTS: a meta-analysis Ihsan, Dhiya; Iqbal, Mohammad; Cool, Charlotte Johanna; Achmad, Chaerul; Pramudyo, Miftah; Prameswari, Hawani Sasmaya; Akbar, Mohammad Rizki
Jurnal Kardiologi Indonesia Vol 46 No 2 (2025): April - June, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1835

Abstract

Background: High mortality in patients with Long QT Syndrome (LQTS) can be reduced with proper treatment. Gene-specific therapy is crucial, as many treatments are not equally effective across different LQTS types. While mexiletine has been established in the treatment of LQT3, its use in other types of LQT need further evaluation. Methods: A meta-analysis was conducted using systematic electronic searches of PubMed, Embase, and Cochrane Library. We assessed QTc reduction and cardiac events after Mexiletine treatment. Inclusion criteria: any study with no language restriction that diagnoses any type of LQTS, uses mexiletine treatment, and provides QTc comparison before and after treatment. Animal studies were excluded. The NIH Study Quality Assessment Tools and Newcastle-Ottawa Scale were used to evaluate bias. Data were analyzed using Review Manager 5.4 and MedCalc software Results: Nine studies (n=281) were included. Mexiletine reduced QTc by -64ms (mean difference [MD], -64.22; 95% confidence interval [CI] -76.13 to -52.30; p<.001; I2 60%). Sensitivity and subanalyses showed consistent efficacy. In five studies (n=76), the number of patient with high-risk QTc (>500ms) significantly decreased (Risk Ratio [RR], 0.38; 95% CI 0.26-0.55; p<.001). Five studies (n=141) showed a significant reduction in cardiac events (RR, 0.25; 95% CI 0.14-0.44; p<.001). Two studies reported gastrointestinal (GI) problems and vertigo as side effects of mexiletine treatment. Conclusion: Mexiletine significantly reduces QTc and cardiac events in LQT2, LQT3, and aLQT patients. Mexiletine also significantly reduces the number of Long QT patients with high-risk QTc Funding: No external funding was received for this study Registration: CRD420250652574
Profile and Pregnancy Outcome in Preeclampsia with and Without Cardiac Abnormalities Complication Aqilah, Nurjihan Syarifah; Pribadi, Adhi; Cool, Charlotte Johanna; Aziz, Muhammad Alamsyah; Pramudyo, Miftah; Astuti, Astri; Putra, Ridwan Abdullah
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 3 November 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i3.742

Abstract

Introduction: This study was conducted to determine the profile of maternal characteristics and outcomes, as well as neonatal outcomes of mothers giving birth with preeclampsia and complications of cardiac abnormalities compare to preeclampsia without complications of cardiac abnormalities.Methods: This study used a descriptive cross-sectional research method with purposive sampling.Results: Out of 78 samples, there were 10 pregnant women with cardiac abnormalities. The predominant age is in the 18 - 35 years range at 51 (65.4%) samples. Comorbidities found were eclampsia 8 (10.3%) and HELLP syndrome 3 (3.8%). There was no maternal mortality. The major method of delivery was perabdominal in preeclampsia with cardiac abnormalities 10(100.0%). The neonatal outcome obtained APGAR scores of 7-10 as many as 57 (73.1%) babies, 8 (10.2%) babies with score 4-6, and 13 (16.7%) babies with score 0-3. There were 16 (20.5%) babies born with SGA, 58 (74.4%) with AGA, and 4 (5.1%) with LGA. Most neonatal born with normal APGAR score (58 babies or 74.4%). In the PE group with heart defects, there was 1 (10.0%) baby with severe asphyxia as in stillbirth. While in preeclampsia without cardiac abnormalities 11 (16.2%) babies were born with severe asphyxia and 8 (10.2%) stillbirths.Conclusion: The maternal outcomes were (1) comorbidities of eclampsia and HELLP syndrome, (2) the majority of delivery methods being caesarean section., and in neonatal outcomes, most babies were born with normal APGAR score and appropriate gestational age (AGA).Profil dan Luaran Kehamilan pada Preeklamsia dengan dan Tanpa Komplikasi Kelainan JantungAbstrakPendahuluan: Penelitian ini dilakukan untuk mengetahui profil karakteristik dan luaran maternal, serta luaran neonatal ibu melahirkan dengan preeklamsia dengan komplikasi kelainan jantung dan preeklamsia tanpa komplikasi kelainan jantung.Metode: Penelitian ini menggunakan metode penelitian deskriptif potong lintang dan pengambilan sampel penelitian purposif.Hasil: Dari 78 sampel, didapatkan 10 ibu hamil dengan kelainan jantung. Usia paling banyak ada pada rentang usia 18 - 35 tahun 51(65.4%) sampel. Penyakit pernyerta didapatkan eklamsia 8(10.3%) dan sindrom HELLP 3(3.8%). Tidak ditemukan kematian ibu. Metode persalinan terbanyak yaitu perabdominal pada PE dengan kelainan jantung 10(100.0%). Hasil luaran neonatal kelahiran bayi tunggal, didapatkan skor APGAR 7-10 sebanyak 57(73.1%) bayi, 8(10.2%) bayi dengan skor 4-6, dan 13(16.7%) bayi dengan skor 0-3. Terdapat 16(20.5%) bayi lahir dengan SGA, 58(74.4%) dengan AGA, dan 4(5.1%) dengan LGA. Hasil luaran neonatal terbanyak dengan kondisi APGAR normal (58 bayi atau 74.4%). Pada kelompok PE dengan kelainan jantung ditemukan 1(10.0%) bayi dengan luaran asfiksia berat begitu pun dengan stillbirth. Sedangkan pada PE tanpa kelainan jantung sebanyak 11(16.2%) lahir dengan asfiksia berat dan 8(10.2%) stillbirth.Kesimpulan: Luaran kehamilan yang ditemukan yaitu (1) penyakit penyerta berupa eklamsia dan sindrom HELLP, (2) metode persalinan terbanyak yaitu caesarean section, dan hasil luaran neonatal terbanyak adalah dengan kondisi APGAR normal dan AGA.Kata kunci: Luaran kehamilan; Luaran neonatal; Preeklamsia dengan kelainan jantung
Study of Machine Learning Algorithm on Phonocardiogram Signals for Detecting of Coronary Artery Disease Mandala, Satria; Pramudyo, Miftah; Rizal, Ardian; Fikry, Maurice
Indonesian Journal on Computing (Indo-JC) Vol. 5 No. 3 (2020): December, 2020
Publisher : School of Computing, Telkom University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34818/INDOJC.2020.5.3.536

Abstract

Several methods of detecting coronary artery disease (CAD) have been developed, but they are expensive and generally use an invasive catheterization method. This research provides a solution to this problem by developing an inexpensive and non-invasive digital stethoscope for detecting CAD. To prove the effectiveness of this device, twenty-one subjects consisting of 11 CAD patients and 10 healthy people from Hasan Sadikin Hospital Bandung were selected as validation test participants. In addition, auscultation was carried out at four different locations around their chests, such as the aorta, pulmonary, tricuspid, and mitral. Then the phonocardiogram data taken from the stethoscope were analyzed using machine learning. To obtain optimal detection accuracy, several types of kernels such as radial basis function kernel (RBF), polynomial kernel and linear kernel of Support Vector Machine (SVM) have been analyzed. The experimental results show that the linear kernel outperforms compared to others; it provides a detection accuracy around 66%. Followed by RBF is 56% and Polynomial is 46%. In addition, the observation of phonocardiogram signals around the aorta is highly correlated with CAD, giving an average detection accuracy for the kernel of 66%; followed by 44% tricuspid and 43% pulmonary.
Association Between Cardiovascular Risk Factors and CAD Severity by CAD-RADS Categories and Comprehensive CTA Score Raharjo, Pradana Pratomo; Purnomowati, Augustine; Kusumawardhani, Nuraini Yasmin; Astuti, Astri; Achmad, Chaerul; Pramudyo, Miftah; Karwiky, Giky; Akbar, Mohammad Rizki
International Journal of Integrated Health Sciences Vol 13, No 2 (2025)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v13n2.4173

Abstract

Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide, including in Indonesia. Risk factors (RFs) play an important role in both pathogenesis and management of cardiovascular (CV) diseases. Coronary computed tomography angiography (CTA) is a reliable non-invasive diagnostic method. Coronary Artery Disease Reporting and Data System (CAD-RADS) categories and comprehensive CTA score describes CAD severity on coronary CTA and provides additional prognostic value.Objective: To explore the link between traditional cardiovascular risk factors and CAD severity based on CAD-RADS and comprehensive CTA scores.Methods: This retrospective, single-center study was conducted at a tertiary hospital using data from the Cardiovascular Imaging Database of the hospital from January 2020 to June 2022. Data meeting the inclusion and exclusion criteria were analyzed using ordinal and binary regressions.Results: A total of 423 patients' data were analyzed. Ordinal regression revealed significant links between age ≥ 65 years, male gender, hypertension, diabetes, and higher CAD severity based on both CAD-RADS and comprehensive CTA scores. Binary regression showed that older age and male gender were independently associated with CAD-RADS ≥ 3 and comprehensive CTA score ≥ 6. Diabetes was linked to CAD-RADS ≥ 3, and hypertension was tied to a comprehensive CTA score ≥ 6. The number of risk factors showed a trend toward CAD severity (p=0.069) and a significant link with comprehensive CTA score (p=0.012).Conclusion: There is a significant association between traditional cardiovascular risk factors and CAD severity as quantified by both CAD-RADS and comprehensive CTA score.
Co-Authors Adhi Pribadi Akbar, Mohammad Rizki Andria Priyana Anjarwani, Setyasih Aqilah, Nurjihan Syarifah Astiawati, Tri ASTRI ASTUTI Augustine Purnomowati Aziz, Muhammad Alamsyah Bambang Widyantoro Chaerul Achmad Cool, Charlotte Johanna Daniel Happy Putra Endang, Jusup Erwan Martanto Fikry, Maurice Habib, Faisal Hakim, Afdhalun Hendry Purnasidha Bagaswoto Ihsan, Dhiya Ilhami, Yose Ramda Ispar, Akhtar Fajar Muzakkir Ali Jungjunan, Ridho Juzar, Dafsah Arifa Karwiky, Giky Kusumawardhani, Nuraini Yasmin Mazwar, Irmaliyas Muzakkir, Akhtar Fajar Nahar Taufiq, Nahar Prameswari, Hawani Sasmaya Pranata, Raymond Pratama, Fahmi Bagus Pratama, Vireza Putra, Iwan Cahyo Santosa Putra, Ridwan Abdullah R A, I Made Junior Raharjo, Pradana Pratomo Rizal, Ardian Satria Mandala Siska Suridanda Danny Zulkarnain, Edrian