Garuda - Garba Rujukan Digital

Reperfusion Arrhythmia in Acute Myocardial Infarction Setiadi, Teguh; Taufik Indrajaya; Ali Ghanie; Ferry Usnizar; Erwin Sukandi; Syamsu Indra; Erwin Azmar; Rukiah Chodilawati; Imran Soleh; Yudhie Tanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 12 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i12.894

Management of reperfusion in acute myocardial infarction is an important component of myocardial cell survival to minimize the area experiencing infarction and improve patient clinical outcomes. However, this reperfusion also contributes to myocardial injury which is preceded by the ischemic process. One of the injuries related to the ischemia-reperfusion process in the myocardium is reperfusion arrhythmia. Reperfusion arrhythmias from several studies can begin to occur in the first minutes after restoration of obstructed coronary flow. The features of reperfusion arrhythmia can include accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, and other arrhythmias. The mechanism of reperfusion arrhythmia can be excess calcium in the cells, oxidative stress due to an increase reactive oxygen species, energy metabolism disorders, and neutrophil accumulation. Excessive intracellular calcium and other mechanisms cause a delay in the depolarization of previously ischemic cells. This reperfusion arrhythmia requires special attention because it can disrupt hemodynamics and patient outcomes after reperfusion procedures. Knowledge of the mechanisms of reperfusion arrhythmias will guide clinicians to provide better management during and after reperfusion procedures.

The Role of Rituximab in the Management of Heart Failure Bastari, Rizki; Taufiq Indrajaya; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 7 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i7.1027

Rituximab is a chimeric monoclonal antibody mice/humans that bind the transmembrane antigen, CD20 specifically. The mechanism of heart failure is mediated by neurohormonal pathways: the renin-angiotensin-aldosterone system (RAAS), the sympathetic nervous system, and the natriuretic peptide system, thereby triggering activation of the immune system. This literature review will discuss the role of B cell targeted therapy, in this case rituximab in the management of heart failure. Modulation of the immune response holds great promise in the 30% of cases of myocarditis where inflammation does not resolve and progression to chronic inflammatory dilated cardiomyopathy occurs. Pharmacologically, rituximab is a monoclonal immunoglobulin G1 antibody drug that is given intravenously. Rituximab targets the CD20 antigen expressed on the surface of mature B lymphocytes, including memory B cells but not on stem cells or plasma cells. In conclusion, rituximab causes a selective and temporary decrease in the CD20+ B cell subpopulation and represents a more specific and targeted approach to B cell-induced disorders including heart failure.

Cardiac Myosin Inhibitors in Hypertrophic Cardiomyopathy: A Head-to-Head Network Meta-Analysis of Mavacamten and Aficamten Imran Saleh; Syamsu Indra; Yenny Dian Andayani; Rukiah Chodilawati; Yuniza
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1360

Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by myocardial hypercontractility. Mavacamten and aficamten are first-in-class cardiac myosin inhibitors that have demonstrated efficacy in treating obstructive HCM. However, in the absence of direct head-to-head randomized controlled trials (RCTs), their comparative effectiveness and safety remain unquantified. We aimed to indirectly compare the efficacy and safety of mavacamten and aficamten in patients with obstructive HCM. Methods: We conducted a systematic review and Bayesian network meta-analysis of RCTs. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to December 2024. Eligible studies were RCTs comparing mavacamten or aficamten with placebo in adults with obstructive HCM. The primary efficacy outcomes were the change from baseline in post-exercise left ventricular outflow tract (LVOT) gradient and the change in peak oxygen consumption (pVO₂). The primary safety outcome was the incidence of left ventricular ejection fraction (LVEF) reduction to <50%. Results: Seven RCTs involving 1,025 patients were included. In the network meta-analysis, both aficamten (Mean Difference [MD], -50.8 mmHg; 95% Credible Interval [CrI], -61.2 to -40.4) and mavacamten (MD, -44.9 mmHg; 95% CrI, -53.7 to -36.1) were significantly more effective than placebo in reducing post-exercise LVOT gradient. The indirect comparison between the two agents did not reveal a statistically significant difference (MD, -5.9 mmHg; 95% CrI, -17.8 to 6.0). For pVO₂, both mavacamten and aficamten showed significant improvement over placebo, with no significant difference between them. The odds of LVEF dropping below 50% were numerically higher with mavacamten compared to aficamten, but the difference was not statistically significant (Odds Ratio [OR], 1.52; 95% CrI, 0.65 to 3.54). Conclusion: Mavacamten and aficamten are both highly effective in improving hemodynamic and functional parameters in patients with obstructive HCM. While our indirect comparison did not establish the superiority of one agent over the other, it provides foundational evidence for clinicians. Definitive conclusions await direct head-to-head clinical trials.

The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis Lian Lanrika Waidi Lubis; Taufik Indrajaya; Ferry Usnizar; Erwin Sukandi; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1369

Background: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs). Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69). Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population.

Cardiac Myosin Inhibitors in Hypertrophic Cardiomyopathy: A Head-to-Head Network Meta-Analysis of Mavacamten and Aficamten Imran Saleh; Syamsu Indra; Yenny Dian Andayani; Rukiah Chodilawati; Yuniza
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1360

Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by myocardial hypercontractility. Mavacamten and aficamten are first-in-class cardiac myosin inhibitors that have demonstrated efficacy in treating obstructive HCM. However, in the absence of direct head-to-head randomized controlled trials (RCTs), their comparative effectiveness and safety remain unquantified. We aimed to indirectly compare the efficacy and safety of mavacamten and aficamten in patients with obstructive HCM. Methods: We conducted a systematic review and Bayesian network meta-analysis of RCTs. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to December 2024. Eligible studies were RCTs comparing mavacamten or aficamten with placebo in adults with obstructive HCM. The primary efficacy outcomes were the change from baseline in post-exercise left ventricular outflow tract (LVOT) gradient and the change in peak oxygen consumption (pVO₂). The primary safety outcome was the incidence of left ventricular ejection fraction (LVEF) reduction to <50%. Results: Seven RCTs involving 1,025 patients were included. In the network meta-analysis, both aficamten (Mean Difference [MD], -50.8 mmHg; 95% Credible Interval [CrI], -61.2 to -40.4) and mavacamten (MD, -44.9 mmHg; 95% CrI, -53.7 to -36.1) were significantly more effective than placebo in reducing post-exercise LVOT gradient. The indirect comparison between the two agents did not reveal a statistically significant difference (MD, -5.9 mmHg; 95% CrI, -17.8 to 6.0). For pVO₂, both mavacamten and aficamten showed significant improvement over placebo, with no significant difference between them. The odds of LVEF dropping below 50% were numerically higher with mavacamten compared to aficamten, but the difference was not statistically significant (Odds Ratio [OR], 1.52; 95% CrI, 0.65 to 3.54). Conclusion: Mavacamten and aficamten are both highly effective in improving hemodynamic and functional parameters in patients with obstructive HCM. While our indirect comparison did not establish the superiority of one agent over the other, it provides foundational evidence for clinicians. Definitive conclusions await direct head-to-head clinical trials.

The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis Lian Lanrika Waidi Lubis; Taufik Indrajaya; Ferry Usnizar; Erwin Sukandi; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1369

Background: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs). Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69). Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population.

The Role of Rituximab in the Management of Heart Failure Bastari, Rizki; Taufiq Indrajaya; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 7 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i7.1027

Rituximab is a chimeric monoclonal antibody mice/humans that bind the transmembrane antigen, CD20 specifically. The mechanism of heart failure is mediated by neurohormonal pathways: the renin-angiotensin-aldosterone system (RAAS), the sympathetic nervous system, and the natriuretic peptide system, thereby triggering activation of the immune system. This literature review will discuss the role of B cell targeted therapy, in this case rituximab in the management of heart failure. Modulation of the immune response holds great promise in the 30% of cases of myocarditis where inflammation does not resolve and progression to chronic inflammatory dilated cardiomyopathy occurs. Pharmacologically, rituximab is a monoclonal immunoglobulin G1 antibody drug that is given intravenously. Rituximab targets the CD20 antigen expressed on the surface of mature B lymphocytes, including memory B cells but not on stem cells or plasma cells. In conclusion, rituximab causes a selective and temporary decrease in the CD20+ B cell subpopulation and represents a more specific and targeted approach to B cell-induced disorders including heart failure.

Title

Found 7 Documents
Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 7 Documents Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 7 Documents
Search