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All Journal Indonesian Journal of Cardiology Occupational and Environmental Medicine Journal of Indonesia
Isman Firdaus
Departemen Kardiologi Dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia Pusat Jantung Nasional, Harapan Kita, Jakarta
Environmental Science Health Professions Medicine & Pharmacology Nursing Public Health

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Hemodynamic Profiles as a Predictor of Mortality and Length Of Stay in ICCU: Insight from Registry of Acute and Intensive Cardiovascular Care Outcome Firdaus, Isman; Lilihata, Gracia; Kristianto, Ardeno; Simanjuntak, Cindya K.; Danny, Siska S.; Irmalita, Irmalita; Dharma, Surya; Juzar, Dafsah A.; Tobing, Daniel P.L.
Indonesian Journal of Cardiology Vol 38 No 3 (2017): July - September 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.30701/ijc.v38i3.779

Abstract

Aims: The ability to differentiate high risk and low risk patients in ICCU is beneficial. Hemodynamic profiles can be used to describe patient’s condition immediately. Based on the presence of congestion and poor perfusion, patients can be divided into four hemodynamic profiles. We aim to evaluate the prognostic value of hemodynamic profiles for patient’s mortality and length of stay (LOS) in intensive cardiac care unit (ICCU). Methods: In this retrospective cohort study, patients who admitted to ICCU of National Cardiovascular Center Harapan Kita Jakarta, Indonesia, were classified into four hemodynamic profiles: dry-warm, dry-cold, wet-warm, and wet-cold. Bivariate analysis was performed to see the significance between hemodinamic profiles with mortality and LOS, continued with multvariate analysis to evaluate the contribution of other significant factors. Results: Of 742 patients included, the mortality rate was 7.8%. With dry-warm profile as reference, relative risk for mortality was 2.3 (95% CI 1.303-4.076), 5.8 (95% CI 1.992-16.906), and 8.7 (95% CI 3.513-21.567) for wet-warm, dry-cold and wet cold, consecutively. Mean differences of LOS (days) as follows: wet-warm (1.719; 95% CI 1.21-2.23), dry-cold (3.418; 95% CI 1.52-5.32), and wet-cold (4.654; 95% CI 2.64-6.67) compared to dry-warm. Hemodynamic profiles, especially wet-cold profile, consistently predicted mortality and longer LOS in ICCU by multivariable analysis. Conclusion: The presence of “wet” profile double the risk of death, “cold” profile has five fold risk of death, while the presence of both has the highest risk for mortality and longer LOS. Hemodynamic profiles assessme   Abstrak Latar Belakang: Kemampuan untuk membedakan pasien resiko tinggi dan resiko rendah di ICCU sangat penting. Profil hemodinamik dapat digunakan untuk mengenali kondisi pasien secara cepat. Berdasarkan adanya tanda kongesti dan perfusi yang buruk pasien dapat dikelompok­kan ke dalam empat profil hemodinamik. Studi ini bertujuan untuk mengevaluasi nilai prognostik profil hemodinamik terhadap mortalitas dan lama rawat pasien di Intensive Cardiac Care Unit (ICCU). Metode : Studi kohort retrospektif ini dilakukan di Rumah Sakit Pusat Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indo­nesia. Pasien yang dirawat di ICCU dikelompokkan ke dalam empat profil hemodinamik: kering-hangat, kering-dingin, basah-hangat dan basah-dingin. Analisis bivariate dilakukan untuk menilai hubungan antara profil hemodinamik dengan mortalitas dan lama rawat di ICCU, dilanjutkan dengan analisis multivariate untuk mengevaluasi kontribusi faktor-faktor lain yang signifikan Hasil : Total pasien yang ikut dalam studi sebanyak 742 pasien dan tingkat mortalitas sebesar 7,8%. Resiko relatif (RR) mortalitas untuk profil basah-hangat, kering-dingin dan basah-dingin berturut-turut sebesar 2.3 (95% CI 1.303-4.076), 5.8 (95% CI 1.992-16.906), dan 8.7 (95% CI 3.513-21.567) bila dibandingkan terhadap profil kering-hangat sebagai referensi. Rerata perbedaan lama rawat sebesar 1.719 (95% CI 1.21-2.23), 3.418 ( 95% CI 1.52-5.32), (4.654 (95% CI 2.64-6.67) untuk profil basah-hangat, kering-dingin, dan basah dingin berturut-turut bila dibandingkan dengan profil kering-hangat. Profil hemodinamik, terutama profil basah-dingin secara konsisten memprediksi mortalitas dan lama rawat yang lebih panjang setelah analisis multivariat. Kesimpulan: Profil “basah” memiliki resiko mortalitas dua kali lipat, profil “dingin” memiliki resiko mortalitas lima kali lipat, sedangkan ked­uanya secara bersamaan memiliki resiko mortalitas dan lama rawat lebih panjang paling tinggi. Profil hemodinamik dapat digunakan sebagai prediktor mortalitas dan lama rawat pasien di ICCU secara efektif.  
Strategi Farmako-invasif pada STEMI Akut Isman Firdaus
Jurnal Kardiologi Indonesia Vol. 32, No. 4 Oktober - Desember 2011
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v32i4.88

Abstract

Recently, primary percutaneous coronary intervention (PCI) is the best option for reperfusion in STEMI patients, in clinical trials has lower rates of reinfarction, stroke and mortality than fibrinolytic therapy. Because of system delays in routine practice, prehospital administration of fibrinolytic therapy may lead to similar clinical outcomes, especially in those patients who present in early onset after symptom. Assessment of failed reperfu-sion for rescue PCI and invasive strategy after fibrinolitic therapy leading similar outcome with primary PCI. This review focuses on the timing of, and indications for, an invasive strategy after fibrinolytic therapy, including that for failed pharmacological reperfusion.
Fibrilasi Atrium Pada Penyakit Hipertiroidisme Patogenesis dan Tatalaksana Isman Firdaus
Jurnal Kardiologi Indonesia Vol. 28, No. 5 September 2007
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v28i5.224

Abstract

Fibrilasi atrium (atrial fibrilation, AF) merupakan aritmia jantung yang paling sering terjadi pada pasen usia diatas 65 tahun. Prevalensi semakin tinggi dengan bertambahnya usia, dan merupakan penyebab utama terjadinya stroke. AF sering timbul sebagai manifestasi hipertiroidisme, dan menjadi predisposisi terbentuknya trombus dan emboli. AF dan disritmia supraventrikular lainnya yang disebabkan oleh hipertiroidisme, menambah angka kematian penyakit vaskular. Pada sepuluh hingga limabelas persen pasen dengan hipertiroidisme akan berlanjut menjadi AF, dan insiden ini semakin tinggi bila disertai penyakit jantung.
Ablasi Takikardia Ventrikular dengan Pemetaan Elektro-Anatomikal 3 Dimensi Yasmin Tadjoedin; Yoga Yuniadi; Isman Firdaus; Ganesja M Harimurti; Muhammad Munawar
Jurnal Kardiologi Indonesia Vol. 28, No. 2 Maret 2007
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v28i2.258

Abstract

Tingginya keberhasilan serta rendahnya morbiditas, telah menjadikan ablasi frekuensi radio transkateter sebagai terapi lini pertama pada beberapa jenis aritmia. Angka kesuksesan pada aritmia stabil dengan lokasi anatomis yang dapat diprediksi atau gambaran elektrogram intrakardiak yang khas seperti takikardia ventrikular idiopatik, atau atrial flutter yang bergantung pada ismus telah mencapai 90%.Namun, ablasi dari beberapa aritmia yang lebih kompleks seperti beberapa takikardi atrial, atrial fibrilasi, serta kebanyakan takikardia ventrikular masih merupakan tantangan besar. Hal ini disebabkan antara lain oleh keterbatasan teknik pemetaan kateter konvensional secara fluoroskopi dalam melokalisasi substrat aritmogenik. Ketidak-mampuan untuk menghubungkan secara akurat EKG intrakardiak dengan lokasi endokardium yang spesifik karena gerakan ujung kateter, juga membatasi reliabilitas pemetaan.
PERFORMA SIMPLIFIED ACUTE PHYSIOLOGY SCORE 3 SEBAGAI PREDIKTOR MORTALITAS PADA UNIT RAWAT INTENSIF KARDIOVASKULAR Akhtar Fajar Muzakkir; Dafsah Arifa Juzar; Andi Alfian Zainuddin; Dwi Yuda Herdanto; Bambang Widyantoro; Dian Zamroni; Siska Suridanda Danny; Isman Firdaus; Daniel PL Tobing; Irmalita Irmalita
Jurnal Kardiologi Indonesia Vol 39 No 4 (2018): Indonesian Journal of Cardiology: October-December 2018
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v39i4.702

Abstract

Background: Severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs) since 1980s. Physicians used them for predicting mortality and assessing illness severity in clinical trials. The Simplified Acute Physiology Score 3 (SAPS 3) is the only score that can predict hospital mortality within an hour of admission to ICU. Although this scoring systems has been widely used in ICUs, they have not been commonly applied in Intensive Cardiovascular Care Units (ICVCUs) since the population is quite different especially in disease subset. Therefore, the objective of this study was to evaluate the parameters in the SAPS 3 scoring system performance for predicting mortality in ICVCU population.Methods: This was an observational study with cross-sectional approach using secondary data from RAICOM (Registry of Acute and Intensive Cardiovascular Care on Outcome) taken from September 2013 – September 2014 in the ICVCU National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia. The secondary data were collected, analysed, and matched with SAPS 3 variables. All missing and invalid data were excluded. All data was processed and the SAPS 3 score was calculated in each patient. Multivariate analysis with logistic regression was conducted to evaluate the significance of the parameters in predicting mortality. Discrimination was assessed by area under the receiver operator characteristic curve (AUROC). Calibration was assessed by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed?to?expected numbers of deaths.Results: A total of 233 patients were included in this study and the observed hospital mortality was 16.7% (39/233). The patients enrolled were divided into survivors and nonsurvivors. Bivariate analyses of SAPS 3 variables showed intra-hospital location before ICVCU admission, use of vasoactive agents, reasons for ICVCU admission, infection, Glasgow Coma Score (GCS), creatinine level, and platelet count were significantly different between nonsurvivors than survivors (P<0.05). The SAPS 3 score was significantly higher in nonsurvivors than survivors. The AUC (95% confidence intervals [CIs]) for SAPS 3 score was 0.752 (0.669–0.835). The Hosmer?Lemeshow goodness?of?fit test for SAPS 3 demonstrated a Chi?square test score of 1.729, P = 0.943. Multivariate logistic regression was conducted for all variables that were probably correlated to prognosis. Eventually, intermediate ward as intra-hospital location before ICVCU admission was selected as an independent risk factors for predicting mortality (OR 4.165; 95% CI 1.462-11.864; P=0.008), whereas surprisingly the presence of community-acquired pneumonia (CAP) before ICVCU admission was a protective factor from hospital mortality (OR 0.224; 95% CI 0.068-0.730; P=0.013).Conclusion: Parameters in the SAPS 3 score system exhibited satisfactory performance in discrimination. In predicting hospital mortality, these parameters also showed good calibration for estimating hospital mortality. Intermediate ward as intra-hospital location before ICVCU admission appeared to be independently associated with mortality whereas patients with CAP comorbid as a protective factor against mortality. Despite the good result of this study, there are still plenty room of improvement for developing similar score in the future specifically for ICVCU population.
A Cohort Retrospective Study of Framingham Score and ECG Abnormality among Coal Mining Workers Anandita, Faizal Ablansah; Firdaus, Isman; Gani, Rino Alvani; Werdhani, Retno Asti; Mansyur, Muchtaruddin
Occupational and Environmental Medicine Journal of Indonesia Vol. 1, No. 1
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Introduction. ECG is widely used for detecting cardiovascular disease in coal mine worker’s medical check-up. As the study has proven, coal mine workers have a double cardiovascular risk from their workplace hazard and their own medical risks as individuals. An early detection and risk assessment method is needed to predict ECG abnormalities in the future. This study will analyze the relationship between ECG abnormality and Framingham Risk Score on coal mine workers’. Methods. We examine ECG result from medical check-up of male coal worker during 2018 and 2021. Using Minnesota Code, we determine ECG abnormality categories in the 2021 result, then compare it with coal handling type worker and Framingham Score in 2018 as the main medical factor. Results. Among 755 male coal workers with normal ECG in 2018, 158 (20,9%) were found with ECG abnormalities in 2021. Cohort’s multivariate study shows that type of coal worker is considered a determinant, but Framingham risk score still has the highest influence (p multivariate
Timeframe Factors of Door-to-Device Time During Pandemic Situation in a Tertiary Cardiovascular Centre in Indonesia Firdaus, Isman; Juzar, Dafsah Arifa; Dewanggi, Bunga; Nurfitri, Syafira; Utarini, Adi; Djasri, Hanevi
Jurnal Kardiologi Indonesia Vol 44 No 4 (2023): Indonesian Journal of Cardiology: October - December 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1649

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected every aspect of life, especially in the field of cardiovascular services. This creates many challenges in the treatment of highly time-sensitive and potentially lethal conditions such as ST-elevation acute myocardial infarction (STEMI). STEMI patients at high risk for COVID-19 are recommended to be evaluated with additional testing for COVID-19 and possibly require respiratory support, all of which can delay Door-to-device time (DTDT). Objective: In this study, we sought to determine the DTDT for primary percutaneous coronary intervention (PCI) in acute STEMI, the various timeframes influencing the DTDT, and which time factor has the most significant correlation to DTDT in the COVID-19 pandemic era. Methods: A longitudinal retrospective study was conducted at the largest tertiary referral hospital in Indonesia from March 2020 to February 2021. The following timeframes were measured during the study: Door-to-Diagnosis Time [Δt1], Diagnosis-to-Activation Time [Δt2], Informed Consent Time [Δt3], Preparation at Emergency Room (ER) Time [Δt4], Preparation at Catheterization Laboratory Time [Δt6], and PCI Initiation-to-Balloon Time [Δt7]. Spearman’s correlation (ρ) was used to ascertain the correlation among time factors. Results: 238 patients met the inclusion criteria of this study. The observed DTDT was 110 [47 – 437] minutes. Of the variables, DTDT had a strong positive correlation with preparation at the ER time (median 28,0 (1 – 344) minutes; r = 0.702; p-value < 0.0001). Conclusion: This study sheds light on preparation at the ER time as a significant influencing factor for Door-to-device time in the COVID-19 pandemic era.
Acute Anterior Reinfarction Complicating with Transient Symptomatic Total Atrioventricular Block Hendiperdana, Mochamad Rizky; Firdaus, Isman
Jurnal Kardiologi Indonesia Vol 43 No 3 (2022): Indonesian Journal of Cardiology: July - September 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1216

Abstract

Background Acute stent thrombosis is a frequent cause of myocardial infarct (MI) after stent placement. Total atrioventricular (AV) block is frequently become the conductive disturbance complication of acute reinfarct. Inferior MI has Low long-term mortality and greater reversibility than anterior MI which has higher in-hospital and long-term mortality. Case Illustration A 44-year-old man, came to emergency department Cardiovascular Centre Harapan Kita with altered mental status since 12 hours ago. PPCI stenting at proximal LAD of his acute anterior MI 2 days ago. Patient had acute stent thrombosis then underwent urgent PCI at referring hospital. Patient present with blood pressure 57/30, heart rate 20 -30 with TAVB rhythm. Laboratory showed increased serum lactate level 5.2. Patient was diagnosed with Total AV block caused by MI. Patient was planned for emergency temporary pacemaker (TPM) implantation. After 24 hours close monitoring, the patient intrinsic rhythm resolved with spontaneous recovery. Patient was hemodynamically stable until discharge. Discussion Stent thrombosis of proximal stent of LAD will cause TAVB because of the source of the distal portion of the AV node is originating from septal branch of LAD. It is caused by extensive necrosis with higher in-hospital and long-term mortality, often culminated in permanent pacemaker. However, spontaneous recovery of TAVB into sinus rhythm take place. This could be caused by transient reversible ischemia of infra nodal region of AV node which supplied by septal perforator branch Conclusion This case reporting a complete atrioventricular block during the course of acute anterior reinfarct and had spontaneous resolution of the AV block. Mechanisms of spontaneous resolution of complete AV block in the setting of acute MI is associated transient ischemia after occlusion of proximal LAD.
Co-Authors Adi Utarini Akhtar Fajar Muzakkir Anandita, Faizal Ablansah Andi Alfian Zainuddin Ardeno Kristianto Bambang Widyantoro Cholid T. Tjahjono Daniel PL Tobing Danny, Siska S. Dewanggi, Bunga Dian Zamroni Dwi Yuda Herdanto Ganesja H. Harimurti Ganesja M Harimurti Hanevi Djasri Harmani Kalim Hendiperdana, Mochamad Rizky Irmalita Irmalita Irmalita, Irmalita Juzar, Dafsah A. Juzar, Dafsah Arifa Lilihata, Gracia Muchtaruddin Mansyur Muhammad Munawar Muhammad Munawar Nurfitri, Syafira Poppy S. Roebiono Retno Asti Werdhani Rino Alvani Gani Simanjuntak, Cindya K. Siska Suridanda Danny Surya Dharma Tobing, Daniel P.L. Yasmin Tadjoedin Yoga Yuniadi Yoga Yuniadi