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All Journal Indonesian Journal of Cardiology Narra J Cermin Dunia Kedokteran
Doni Firman
Departemen Kardiologi Dan Kedokteran Vaskular FKUI Dan Pusat Jantung Nasional Harapan Kita
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Pengalaman Awal Tindakan MitraClip di Pusat Jantung Nasional Harapan Kita, Jakarta Prima Almazini; Nani Hersunarti; Rarsari Soerarso; Bambang Budi Siswanto; Doni Firman; Amiliana M Soesanto
Cermin Dunia Kedokteran Vol 43, No 3 (2016): Kardiologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v43i3.27

Abstract

Latar Belakang: MitraClip merupakan pilihan terapi untuk pasien regurgitasi katup mitral berat yang berisiko tinggi untuk operasi. Tujuan penelitian ini adalah melaporkan tindakan MitraClip di Pusat Jantung Nasional Harapan Kita Jakarta. Metode: Penelitian retrospektif di Pusat Jantung Nasional Harapan Kita, Jakarta. Data diperoleh dari database komputer dan rekam medis dari Februari 2014 sampai Januari 2015, kemudian dianalisis dengan SPSS. Hasil: Enam orang pasien berusia 51 – 75 tahun, menjalani tindakan MitraClip; 5 pasien regurgitasi katup mitral berat dan 1 pasien regurgitasi katup sedang. Satu pasien perempuan dan 5 pasien laki-laki. Dua pasien merupakan regurgitasi mitral degeneratif dan 4 pasien regurgitasi mitral fungsional. Dua pasien dipasangi satu buah MitraClip dan 4 pasien dipasangi dua buah MitraClip. Setelah tindakan, derajat regurgitasi berkurang menjadi ringan pada 2 pasien dan menjadi sedang pada 4 pasien. Dimensi diastolik akhirventrikel kiri berkurang dari 66 ± 6,5 mm saat awal menjadi 59 ± 7,3 mm (p=0,04) saat pulang. Dimensi sistolik akhir ventrikel kiri berkurang dari 50 ± 10,6 mm saat awal menjadi 48 ± 10,0 mm saat pulang (p=0,27). Satu bulan setelah tindakan MitraClip, 2 pasien dengan kelas fungsional I dan 4 pasien dengan kelas fungsional II. Tidak ada pasien yang meninggal dalam perawatan di rumah sakit. Satu pasien perawatan ulang di rumah sakit karena gagal jantung. Simpulan: MitraClip merupakan pilihan terapi yang efektif dan aman untuk pasien regurgitasi mitral degeneratif dan fungsional yang risiko tinggi untuk operasi. Dimensi ventrikel kiri, kelas fungsional NYHA, derajat keparahan regurgitasi katup, dan tingkat perawatan ulang mengalami perbaikan setelah dipasang MitraClip.
Proprotein convertase subtilisin/kexin type 9 (PCSK9) as a marker of coronary lesion severity in stable coronary artery disease (CAD) patients Andra, Cut A.; Rambe, Aldy S.; Hasan, Refli; Sembiring, Rosita; Firman, Doni; Eyanoer, Putri C.; Mukhtar, Zulfikri; Sungkar, Taufik; Rusda, Muhammad; Amin, Mustafa M.
Narra J Vol. 3 No. 3 (2023): December 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i3.409

Abstract

Coronary artery disease (CAD) remains a significant global health concern with considerable high morbidity and mortality and its development is influenced by various genetic and environmental factors. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a vital regulator of low-density lipoprotein receptor (LDLR) metabolism, directly impacting serum cholesterol levels. However, its role in development of CAD is not fully understood. The aim of this study was to assess the association between the level of PCSK9 and coronary lesion severity in patients with CAD. A case-control study using consecutive sampling was conducted among CAD patients at H. Adam Malik General Hospital and Murni Teguh Memorial Hospital, Medan, Indonesia. A total of 200 CAD patients were divided into two groups based on the SYNTAX score: control (score ≤22, n=100) and case (score >22, n=100). Plasma PCSK9 levels were measured from venous blood using quantitative sandwich enzyme immunoassay. The Chi-squared test was used to analyze the data. Our data suggested that PCSK9 level was associated with coronary lesion severity (p<0.001) of which high PCSK9 level was associated with severe coronary lesion. We also found that hypertension (p<0.001), smoking (p=0.072), diabetes (p<0.001), dyslipidemia (p<0.001), obesity (p=0.023), and family history (p=0.001) were associated with lesion severity. Using the receiver operating characteristic (ROC) curve analysis, the cut-off 70.35 ng/mL of PCSK9 had sensitivity 75% and specificity 78% to predict severe coronary lesion. This study highlights that PCSK9 level has moderate sensitivity and specificity to predict the coronary lesion severity among CAD patients.
Invasive Physiologic Study Across Various Spectrum of Coronary Artery Fistulas with Concomitant Coronary Artery Stenosis Sembiring, Theresia Sri Rezeki; Mangkuanom, Arwin Saleh; Firman, Doni; Alkatiri, Amir Aziz; Iryuza, Nanda
Jurnal Kardiologi Indonesia Vol 45 No 1 (2024): January - March, 2024
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1285

Abstract

Background: Most CAFs are asymptomatic but it might have serious hemodynamic consequences causing signs and symptoms of myocardial ischemia and heart failure prompting intervention, be it percutaneous or surgical, to manage the hemodynamic burden. Currently, there’s no widely accepted guidelines or consensus to manage patients with CAFs. The decision to undergo intervention is usually based on the presence of symptoms, size and also the anatomic features of the fistula. Case Illustration and Discussion: We presented 5 patients with CAFs undergoing FFR/iFR in our institution. Of all patients, only one showed significant iFR suggesting significant hemodynamic burden, probably due to stealing phenomenon. Number of fistulas varied from 1 – 3 with most fistula arose from left anterior descending and terminated in pulmonary artery. Only one patient underwent RHC showing relatively normal flow ratio supported by normal iFR reading across different coronary artery segments. One patient presented with patent stents in LAD and OM2 despite existing subtotal occlusion in proximal PDA, the other one presented with insignificant stenosis in RCA, and the other two presented with no concomitant stenosis. We underwent no further intervention for 4 patients with normal FFR/iFR reading but we underwent stent implantation for one patient with significant FFR/iFR reading. Upon 1-year-follow up, all patients are currently doing well with no significant complaints of chest pain or dyspnea. Conclusion: Due to limited literature covering the issue of CAFs and coronary artery stenosis, the decision which to intervene first between these two is currently still in the discretion of the attending physician. Whenever possible, further diagnostic work up should always be performed as an objective parameter of hemodynamic burden. FFR/iFR might be considered as one of many modalities to do so. Yet, further well-designed studies are needed to confirm the role of FFR/iFR hoping this modality might someday help in guiding decision-making in patients with CAFs. Keywords: coronary artery fistula; coronary artery stenosis; free fractional reserve (FFR); instantaneous wave free ratio (iFR)
Does Chronic Inflammation Play a Role in Rheumatic Mitral Valve Restenosis after Percutaneous Transvenous Mitral Commissurotomy? Butarbutar, Maruli; Soesanto, Amiliana M.; Firman, Doni; Ariani, Rina; Alkatiri, Amir Aziz; Wicaksono, Sony Hilal
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.1398

Abstract

Background: Mitral valve restenosis is defined as decreased mitral valve area (MVA) <1.5 cm2 or decreased MVA >50% after PTMC. It is time-dependent and associated with major adverse cardiovascular events (MACE), such as congestive heart failure, cardiac death, mitral valve replacement, and redo PTMC. The mechanism is not yet known; however, chronic inflammation may have a role. This research aims to determine the association between chronic inflammation and mitral valve restenosis after PTMC. Methods: A total of 40 patients with mitral valve stenosis who underwent successful PTMC were matched and classified into restenosis/case group (n=20) and no restenosis/control group (n=20). Secondary data was taken from electronic medical records such as patient characteristics (gender, age & 2nd prophylaxis), echocardiography data before PTMC (Wilkins’ score and MVA before PTMC), and echocardiography data after PTMC (MVA after PTMC). Follow-up echocardiography examination (follow-up MVA) and laboratory assessment of chronic inflammation marker (IL-6) were done on all patients. Statistical analyses were done to look for an association between the level of chronic inflammation marker & other independent variables with mitral valve restenosis. Results: Median IL-6 concentration was 2.39 (0.03 – 11.4) pg/mL. There was no statistically significant difference in IL-6 levels between both groups (p-value >0.05). MVA decrement was 0.13 (0 – 0.62) cm2/year with rate of MVA decrement ≥0.155 cm2/year was predictor of mitral valve restenosis (p-value <0.001, OR = 46.72, 95% CI 6.69 – 326.19). Conclusion: Chronic inflammation assessed by IL-6 was not associated with mitral valve restenosis.
Co-Authors Abdul Hakim Alkatiri Abdul Hakim Alkatiri Achmad Fauzi Yahya Amiliana M Soesanto Amiliana M. Soesanto Amin, Mustafa M. Amir Aziz Alkatiri Andra, Cut A. Antonia Anna Lukito Ariani, Rina Ario S. Koencoro Arwin Saleh Mangkuanom Bambang Budi Siswanto Butarbutar, Maruli Dafsah Juzar Daniel Tobing Dicky A Hanafy Dicky A. Hanafy Dicky Hanafy Eyanoer, Putri C. Hasan, Refli Hubert Seggewiss I Irmalita Iryuza, Nanda Iwan Dakota Jajang Sinardja Jusup Endang Mangkuanom, Arwin Saleh Muhammad Fadil Mukhtar, Zulfikri Nani Hersunarti Nani Hersunarti Nani Hersunarti Prima Almazini Rambe, Aldy S. Rarsari Soerarso Rarsari Soerarso Rarsari Soerarso Rusda, Muhammad Sembiring, Rosita Sembiring, Theresia Sri Rezeki Sodiqur Rifqi Sunarya Soerianata Suryawan, I Gde Rurus Taufik Sungkar, Taufik Wicaksono, Sony Hilal Yoga Yuniadi Yoga Yuniadi