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Idrus Alwi
Division of Cardiology, Department of Internal Medicine Universitas Indonesia, Faculty of Medicine/Dr. Cipto Mangunkusumo Hospital, Jakarta.
Medicine & Pharmacology

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Left Ventricular Diastolic Dysfunction in Liver Cirrhotic Patients: Proportion, Correlation, and Relationship of Diastolic Parameters with Stage of Liver Dysfunction Mondrowinduro, Prionggo; Hasan, Irsan; Alwi, Idrus; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Introduction. Cardiovascular complication of liver cirrhosis is relatively obscure. Pathophysiology of liver cirrhosis, involving portal hypertension made the possibility of cirrhosis complication manifested as left ventricular diastolic dysfunction. This study aims to determine proportion of left ventricular diastolic dysfunction among liver cirrhotic patients according to American Society of Echocardiography-European Association of Echocardiography (ASE-EAE) 2009 and conventional approach, to determine any correlation between left ventricular diastolic dysfunction severity stages with severity stages of liver dysfunction in cirrhotic patients represented by Child Turcotte Pugh (CTP ) score, also to asses relationship between severity stages of parameters of diastolic function according to ASE-EAE 2009 with liver cirrhosis severity evaluated by numerical CTP score. Methods. A cross sectional study was conducted among 96 liver cirrhotic patients within age of 18-60 years old consecutively due to any causes who admitted to ambulatory unit of Hepatology and Internal Medicine Cipto Mangunkusumo General Hospital wards into intended sample. The study started in November 2013 until proper sample size was obtained. Echocardiography examination was performed by two operators. Interobserver validity was assesed with level of Kappa aggrement and mean difference. Data were extracted to determine prevalence, normality test, Spearman correlation test, and multivariate linear regression test using SPSS for Windows. Results. Left ventricular diastolic dysfunction proportion among liver cirrhotic patients according to ASE-EAE 2009 was 34,3% and 21,9% of normal diastolic function subgroup has left atrial volume index ≥34 mL/m2. Meanwhile, conventional approach resulted in 68,8% of diastolic dysfuncation. All diastolic parameter showed abnormalities on CTP B 8-10. Spearman’s r values of stage of diastolic dysfunction severity according to ASE-EAE 2009 with severity of numerical CTP score was 0,42 (p<0,001) and 0,54 based on conventional approach. Exclusion of diabetic patients and spironolactone treated patients resulted in r=0,51 (p <0,001) based on ASE-EAE 2009 and 0,63 (p<0,001) based on conventional approach.. Parameters of diastolic function that had relation with liver dysfunction severity in cirrhosis measured by numerical CTP were Ar-A (p=0,004), left atrial volume index (p=0,005), and laterale e’ (p=0,026). Conclusion. Severity of left ventricular diastolic dysfunction with severity of liver cirrhosis is positively correlated. Diastolic parameters relate with severity of liver cirrhosis are diastolic ventricular filling pressure with left ventricular chamber stiffness, left atrial remodelling and regurgitant of pulmonary venous flow velocity to oppose filling pressure. Early detection for diastolic dysfunction can be started on CTP B 8. Keywords: Child Turcotte Pugh Score, diastolic dysfunction, liver cirrhosis, liver dysfunction
Pengaruh Pemberian N-Acetylcysteine Oral terhadap High Sensitivity C Reactive Protein (Hs-CRP) pada Pasien Hemodialisis Kronis Dewi, Ratih Tri Kusuma; Siregar, Parlindungan; Alwi, Idrus; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
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Pendahuluan. Inflamasi dan stres oksidatif merupakan faktor risiko penyakit kardiovaskuler pada pasien penyakit ginjal kronis yang menjalani hemodialisis. Pasien hemodialisis kronis akan mengalami peningkatan kadar Hs-CRP. Hs-CRP merupakan marker inflamasi yang telah terbukti pada beberapa penelitian bermanfaat dalam memprediksi cardiovascular event. Pemberian N-Acetylcysteine (NAC) oral dapat digunakan sebagai strategi untuk menurunkan proses inflamasi yaitu disfungsi endotel dan stress oksidatif yang berperan pada atherosclerosis pada pasien hemodialsis. Pemberian NAC ini diharapkan dapat menurunkan angka morbiditas dan mortalitas karena penyakit kardiovaskuler. Metode. Penelitian eksperimen dengan Randomized Double Blind Controlled Trial pada 65 pasien hemodialisis kronis yang memenuhi kriteria inklusi di unit hemodialisis RS.Cipto Mangunkusumo Jakarta. Penelitian dilakukan pada Agustus sampai Oktober 2013. Hasil. Perlakuan dengan NAC oral selama 60 hari tidak memberikan perbedaan dibandingkan dengan plasebo. Analisis statistik dengan Mann Whitney menunjukkan bahwa tidak ada penurunan kadar Hs-CRP yang signifikan diantara kedua kelompok dengan p value Δ post1-baseline, Δ post2-baseline, and Δ post2-post1 kelompok NAC dibanding kelompok plasebo secara berurutan yaitu 0.796, 0.379 dan 0.712. Sementara itu, hasil uji Wilcoxon Signed Ranks untuk membandingkan penurunan kadar Hs-CRP pada tiap kelompok dalam tiga interval pengukuran Hs-CRP menunjukkan p value dari perbandingan kadar Hs-CRP untuk masing-masing kelompok baseline:Post1, baseline:Post2 dan Post1:Post2 (kelompok NAC Vs kelompok plasebo) secara berurutan 0.821vs0.651; 0.845vs0.358 dan 0.905vs0.789. Simpulan. Pemberian N-Acetylcysteine oral belum terbukti dapat menurunkan kadar Hs-CRP pada pasien hemodialisis kronis.
Pendekatan Diagnosis dan Tatalaksana Endokarditis Infektif dengan Komplikasi Emboli Septik Pulmoner pada Pasien Hemodialisis Kronik Siregar, Jeremia Immanuel; Loho, Imelda Maria; Alwi, Idrus
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
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Pendahuluan. Endokarditis infektif (EI) pada pasien hemodialisis (HD) merupakan salah satu contoh EI yang terkait dengan perawatan kesehatan dan menjadi penyebab kematian kedua pada pasien HD setelah penyakit kardiovaskuler. Penggunaan kateter intravaskuler sebagai akses HD meningkatkan risiko kejadian bakteremia sebesar sepuluh kali lipat serta infeksi “metastatik” seperti EI dan emboli septik pulmoner sebesar 10-40%. Ilustrasi Kasus. Seorang laki-laki berusia 35 tahun datang dengan keluhan dyspnea d’effort, orthopnea, dan post-nocturnal dyspnea, disertai batuk dengan bercak darah dan demam tinggi sejak lima hari sebelum masuk rumah sakit. Pasien menjalani HD kronik selama 15 bulan dengan menggunakan catheter double-lumen (CDL). Dari pemeriksaan fisik didapatkan ronki basah kasar bilateral, murmur pansistolik grade 3/6 pada sela iga keempat linea sternalis sinistra, dan gallop S3. Pada ekokardiografi ditemukan vegetasi di katup trikuspid dan pemeriksaan CT-scan toraks memberikan gambaran emboli septik pulmoner. Didapatkan satu dari tiga kultur darah yang positif untuk infeksi methicillin-resistant Staphylococcus aureus (MRSA). Pengobatan dengan vankomisin yang adekuat selama enam minggu memberikan kemajuan klinis signifikan, meskipun pada ekokardiografi evaluasi masih didapatkan adanya vegetasi. Pasien kemudian menjalani operasi pengangkatan vegetasi, perbaikan katup jantung, dan penggantian CDL, dimana kondisinya semakin membaik dan masih menjalani HD secara rutin hingga saat ini. Simpulan. Pengenalan dini EI dan emboli septik pulmoner pada pasien yang menjalani HD kronik dengan akses kateter intravaskuler sangat penting agar tatalaksana awal yang adekuat dan komprehensif dapat dilakukan. Hal ini dapat memperbaiki kondisi klinis serta memperpanjang kesintasan hidup pasien.
Perubahan Kadar Fibrinogen Plasma dan Korelasinya dengan Perubahan Kadar hs-CRP dan Aktivitas Fibrinolisis pada Sindroma Koroner Akut Sudrajat, Dedy G.; Atmakusuma, Djumhana; Alwi, Idrus; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
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Pendahuluan: Peningkatan kadar fibrinogen yang menetap merupakan faktor risiko yang kuat untuk kejadian penyakit jantung koroner (PJK). Di sisi lain peningkatan fibrinogen plasma dapat merupakan respon fase akut. Pada kondisi ini peningkatan fibrinogen plasma bukan merupakan faktor risiko PJK. Penelitian ini bertujuan untuk mengetahui apakah kadar fibrinogen plasma meningkat pada fase akut dan tetap tinggi pada fase pasca akut dan mengetahui korelasi antara perubahan kadar fibrinogen plasma dengan perubahan aktivitas inflamasi dan fibrinolisis. Metode: Desain penelitian adalah studi prospektif dengan metode pengambilan sampel secara konsekutif. Pengambilan sampel fase akut untuk hs-CRP, aktivitas fibrinolisis, dan fibrinogen masing-masing diambil pada hari ke-2, 5, dan 6 pasca awitan sedangkan fase pasca akut diambil pada hari ke-13 pasca awitan. Fibrinogen diperiksa dengan metode Clauss, hs-CRP dengan metode ELISA, dan aktivitas fibrinolisis dengan metode ECLT manual. Analisis beda rerata dilakukan dengan uji t-berpasangan dengan alternatif uji wilcoxon. Analisis korelasi dengan uji Spearman. Hasil: Sampai akhir penelitian didapatkan 38 subyek sesuai kriteria inklusi dan eksklusi. Terdapat penurunan median kadar fibrinogen plasma pada fase pasca akut dibandingkan fase akut (415,5vs380,5mg/dL;p Simpulan: Pada sindroma koroner akut, perubahan aktivitas fibrinolisis dan inflamasi memiliki korelasi positif lemah terhadap perubahan kadar fibrinogen. Pada kelompok dengan hiperfibrinogenemia yang menetap kadar fibrinogen pasca akut masih dominan dipengaruhi aktivitas inflamasi yang masih cukup aktif.
Retraction: Correlation of Serum Uric Acid Levels with The Severity Of Coronary Artery Stenosis in Patients with Acute CoronarySyndrome: Meta-Analysis Study Prasetyo, Diding Heri; Nasution, Sally Aman; Alwi, Idrus; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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Introduction. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different. This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately. Methods. This study protocol was registered with PROSPERO (CRD42020210948), and conducted according to PRISMA guidelines, tracing studies published in vulnerable periods from January 2010 to May 2020. The Cochrane Library, EBSCO, Medline/PubMed, ProQuest and Science Direct are sources of published studies. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis, using random effect model to account for possible study heterogeneity. Heterogeneity was assessed using I2 , and the meta-analysis was performed using comprehensive meta-analysis version 3 (CMA3) software. Results. Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis, whereas publication bias was not found. There was a moderate positive correlation between serum uric acid levels and the severity of coronary artery stenosis, with a correlation coefficient of 0.548 (p value <0.001).
Characteristics of the Indonesian Pilgrims Mortality due to Cardiovascular Disease Sakti, Ali; Alwi, Idrus; Muhadi, Muhadi; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 4
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Introduction. Cardiovascular disease is one of the health problems in Indonesian pilgrims and has become the main cause of death for pilgrims in the past 3 years. Most of them are considered high risk for cardiovascular disease. Some of those risk factors are predicted to have strong association with the pilgrims mortality rate. This study is meant to seek for risk factor associated with the pilgrims mortality rate. Methods. Observational study method of the Indonesian pilgrims in 2017 was conducted to assess the characteristics of Indonesian pilgrims who follow the hajj in 2017 as well as the characteristics of pilgrims who died from cardiovascular disease. Result. The proportion of mortality from cardiovascular disease was 49.2% of all deaths in the Indonesian hajj pilgrims in 2017. Generally, pilgrims are in the category of high risk. Pilgrims who died from cardiovascular disease are mostly aged over 60 years (76.7%) with cardiovascular risk factors including hypertension (53.4%) and obesity (37.3%), and pilgrims with the final wave departure time (53%). Conclusios. The proportion of deaths from cardiovascular disease in the Indonesian pilgrims in 2017 is 49.2%. The characteristics of pilgrims who died with the cause of cardiovascular disease are generally age more than 60 years, pilgrims with hypertension, obesity, and final departure time.
Estimated Glomerular Filtration Rate (eGFR) as an In-Hospital Mortality Predictor in Acute Coronary Syndrome Patients in ICCU Dewiasty, Esthika; Alwi, Idrus; Dharmeizar, Dharmeizar; Harimurti, Kuntjoro
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Use of Clinical Parameters and Strain Echocardiography to Predict Stenosis Severity based on Gensini’s Score in Stable Coronary Artery Disease Sejati, Arif; Alwi, Idrus; Muhadi, Muhadi; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Introduction. In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical parameters and recently-developed strain echocardiography can predict severity of stenosis. Assessment of clinical parameters, altogether with strain echocardiography is expected to make better prediction. This study aim to determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain (GLS), can predict severity of coronary artery stenosis measured with Gensini score,and to further develop a prediction model based on significant parameters. Methods. This is a cross-sectional study taken at Dr. Cipto Mangunkusumo National Central General Hospital during period March – May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi-square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. A prediction model is then developed based on significant predictors by multivariate analysis. Results. The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; 95% CI:1.08-7.23), history of myocardial infartion (OR 4.04; 95% CI:1.51-10.80), typical angina (OR 5.01; 95% CI:1.91-13.14), and GLS ≥-18.8 (OR 30.51; 95% CI:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; 95% CI:1.39-14.47) and GLS ≥18.8 (OR 17.30; 95% CI:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions. Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors.
Proporsi dan Faktor-Faktor yang Berhubungan dengan Kejadian Hipotensi Postprandial pada Usia Lanjut Hamonangan, Rachmat; Alwi, Idrus; Wahyudi, Edy Rizal; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 1
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Pendahuluan: Hipotensi postprandial sebenarnya sering terjadi dan saat ini dikenal sebagai masalah klinis yang penting. Studi-studi yang ada menunjukkan bahwa prevalensi hipotensi postprandial pada usia lanjut cukup tinggi. Hipotensi postprandial merupakan prediktor mortalitas pada orang usia lanjut dan menyebabkan banyak sekuele yang signifikan pada subyek yang terkena. Hingga saat ini, penelitian-penelitian yang berkaitan dengan hipotensi postprandial lebih banyak dilakukan pada kelompok usia lanjut di negara-negara maju yang definisi usia lanjut, proporsi penyakit, proporsi obat-obatan yang digunakan serta proporsi asupan yang berbeda dengan kelompok usia lanjut di negara berkembang khususnya Indonesia. Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan kejadian hipotensi postprandial pada kelompok usia lanjut. Metode: Penelitian studi potong-lintang dilakukan pada subjek usia lanjut di RSCM. Dilakukan pengisian kuesioner dan pengukuran tekanan darah sebelum makan dan setiap 15 menit sampai 2 jam setelah makan. Makanan yang dimakan dicatat untuk dianalisis. Hasil: Selama periode Januari – Maret 2010 terkumpul 119 subjek usia lanjut dengan rerata umur 67,50 ± 5,92 tahun. Sebanyak 53,8% memiliki hipertensi dan menggunakan obat anti hipertensi, 36.1% memiliki riwayat diabetes mellitus dan menggunakan obat pengontrol gula darah, 9,2% pernah mengalami stroke, 7.6% menggunakan terapi digoksin, 29.4% menggunakan terapi nitrat dan 3.4% menjalani hemodialisis rutin. Hipotensi postprandial didapatkan pada 55% subjek. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Selain itu diketahui pula bahwa penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat. Simpulan: Penelitian ini menyimpulkan bahwa proporsi hipotensi postprandial pada subjek usia lanjut adalah 55%. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat.
Faktor-Faktor yang Memengaruhi Kualitas Hidup Pasien Gagal Jantung Kronik Fraksi Ejeksi Terjaga (HFpEF) Rawat Jalan di RSUPN Dr. Cipto Mangunkusumo Pratama, Derin Anugrah; Nasution, Sally Aman; Muhadi, Muhadi; Mansjoer, Arif; Alwi, Idrus; Purnamasari, Dyah; Lydia, Aida; Tahapary, Dicky Levenus
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 1
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Introduction. The prevalence of heart failure in Indonesian adults is 1.5%, at least half of which categorized as heart failure with preserved ejection fraction (HFpEF). Quality of life assessment plays an important role in the management of heart failure, one of the tools widely used is the Minnesota Living with Heart Failure (MLHF) questionnaire. In Indonesia, there is still no data regarding risk factors that affect the quality of life of HFpEF patients. This study aimed to determine the quality of life profile of HFpEF patients and the relationship between the risk factors (age, hypertension, DM, smoking, and obesity) on the quality of life of HFpEF patients. Methods. A cross-sectional study was conducted. Data was collected from adult HFpEF (based on echocardiography in the last 6 months) patients (>18 years old) who visited the Cardiology Clinic at Cipto Mangunkusumo Hospital from January 2022 to December 2023. Quality of life was measured using the MLHF questionnaire. Bivariate analysis was performed to find the relationship between risk factors (age, gender, hypertension, DM, smoking, and obesity) and patients’ quality of life. Multivariate analysis was performed for hypertension, DM, gender, and age variables. Results. Out of 206 subjects, 72.33% of patients were dominant in the physical domain items, and 27.67% of patients were dominant in the emotional domain items. The majority of patients dominant in physical items had overall good quality of life. The majority of patients dominant in emotional items also had good quality of life. No significant relationship was found between the dominant domain item and the quality of life in HFpEF patients. We also found that there was no significant relationship between socio-demographic factors and risk factors for dominant domain items. However, there was a significant relationship between age (p=0.005), gender (p=0.001), and smoking history (p=0.001) with the quality of life in HFpEF patients. Adult patients had a poorer quality of life compared to elderly patients (OR= 0.33 [95% CI 0.17-0.66]). No significant relationship was found between hypertension, diabetes mellitus, dyslipidemia, and obesity with the quality of life in HFpEF patients. Conclusions. There is a statistically significant relationship between age, gender, and smoking history with the quality of life in HFpEF patients. Meanwhile, there is no significant relationship between hypertension, diabetes mellitus, and obesity with the quality of life in HFpEF patients.
Co-Authors A M. Rahman A. M. Rahman A.A. Ketut Agung Cahyawan W Abdulmuthalib Abdulmuthalib Agus Kosasih, Agus Aida Lydia, Aida Aina Nadila, Aina Ali Sakti, Ali Amanda, Clara Riski Ardian Saputra, Ardian Arif Mansjoer Arif Sejati Aru W Sudoyo Ary H Reksodiputro, Ary H Asmarinah, A Auda Aziz, Auda Bambang Budi Siswanto Bambang Sutrisna Cleopas Martin Rumende Cosphiadi Irawan Dasnan Ismail Dedi Afandi Dedi Wihanda, Dedi Dedy G Sudrajat, Dedy G Dharmeizar . Dharmeizar Dharmeizar Dicky Levenus Tahapary Diding Heri Prasetyo Djumhana Atmakusuma, Djumhana Djumhana Atmakusumah, Djumhana Dyah Purnamasari E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri E. Mudjaddid E. Mudjaddid, E. Mudjaddid Edy Rizal Wahyudi Endang Ratnaningsih Esthika Dewiasty, Esthika Faisal Yunus H. Prabowo Hananto Andriantoro Hardjanti Soelistijo Hari Utomo HB B. Trisnohadi Ika P Wijaya, Ika P Iman Firmansyah Imelda Maria Loho, Imelda Maria Irsan Hasan Jeremia Immanuel Siregar, Jeremia Immanuel Karmel L. Tambunan Kuntjoro Harimurti Laurentius Lesmana Linda Lison, Linda Lukman H. Makmun Lukman Hakim Lyana Lyana, Lyana Marulam M Panggabean, Marulam M Marulam M. Panggabean Merry Wintery, Merry Miftah Suryadipradja Mondrowinduro, Prionggo Muhadi Muhadi, Muhadi Muhammad Yamin Mulyadi M Djer, Mulyadi M Murdani Abdullah Nikmah S Idris, Nikmah S Nurhay Abdurachman Nurhay Abdurahman Nury Nusdwinuringtyas Parlindungan Siregar Pradana Soewondo Pratama, Derin Anugrah Pudji Rahardjo Rachmat Hamonangan, Rachmat Rahmad Isnanta, Rahmad Ratih Tri Kusuma Dewi, Ratih Tri Kusuma S. Harun Sally A. Nasution Sally Aman Nasution, Sally Aman Santoso, Fidiaji Hiltono Sarwono Waspadji Satrio Sukmoko Shufrie Effendy Sidartawan Soegondo Simon Salim Siti B. Kresno Siti Setiati Slamet Suyono Soehardjono Soehardjono Sri Inggriani, Sri Sudrajat, Dedy G. Suzanna I Teguh Santoso Todung Silalahi Wahyu Dewabrata Widjajalaksmi Widjajalaksmi