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CORRELATIONS BETWEEN SERUM LEVEL OF MATRIX METALLOPROTEINASE-9 (MMP-9) AND SERUM LEVEL OF TROPONIN-I IN PATIENT WITH ACUTE CORONARY SYNDROME (ACS) Ruchanihadi, Ruchanihadi; Setianto, Budi Yuli; Hariawan, Hariadi
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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

ABSTRACTBackground. The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, initially occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis then spread to the vascular lumen and cause total partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme that plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocytes necrosis.Objective. To know the correlation between serum level MMP-9 and serum level of Troponin-I in patients with ACSMethod. Study design was cross sectional. Data were collected by consecutive sampling from patients in ICCU board of RSUP Dr. Sardjito Yogyakarta, in June 2008-August 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once and measuring concentration of serum level of MMP-9 and Troponin-I before definitive thrombolysis. Data are expressed as means Â± standard deviation (SD). Correlation between serum level of MMP-9 and serum level of Troponin-I were assessed using Spearmanâs rank correlations test. A value of p<0.05 was considered statistically significant.Result. There were 139 patients with ACS and comprising 63 patients with STEMI, 27 patients with NSTEMI, and 49 patients with UAP. MeansÂ±SD of Troponin-I from all of samples was 9.49Â±10.47 ng/dL. MeanÂ±SD of MMP-9 from all of samples was 1296.06Â±729.97 ng/dL. There were significant correlations between MMP-9 and Troponin-I in patients with ACS (r=0.34, p=0.000).Conclusion. There were significant correlations between MMP-9 and Troponin-I in ACS patients in ICCU RSUP Dr. Sardjito Yogyakarta.Â Keywords: ACS, MMP-9, Troponin-I

Correlation between micro-RNA-21 expression and inflammation cytokine in rabbits implanted with bare metal stent with the incidence of neo intimal hyperplasia Hariawan, Hariadi; Soesatyo, Marsetyawan HNE; Munawar, Muhammad; Ghozali, Ahmad
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 51, No 1 (2019)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

In-stent restenosis after stenting in vascular occurs secondary to the accumulation of smooth muscle cell and extracellular matrix. This condition is a major complication caused by the occurrence of neointimal hyperplasia (NIH). The study aimed to prove the role of miRNA-21 as a risk predictor of the NIH event in aorta of rabbits animal model who underwent bare metal (BM) type stent implantation and to know the miRNA-21 role in IL-6 and IL-8 expressions. This study was quasi experimental, coducted in Catheterization Laboratory Dr. Sardjito General Hospital Yogyakarta. Stent implantation was observed intravascular ultrasonography. Blood vessel which was already deployed by stent taken as sample for pathologic examination. Rabbit blood samples were collected on day 0, 7, and 28. Quantification miRNA-21 expression has been done with qPCR and ELISA approach. These 10 rabbits divided into two groups in which one group as control (without stent deployment, 4 models) and another group as intervention (with BM type stent deployment, 6 models). The increase in expression of miRNA-21 on the day 7 and day 28 in the intervention group compared to the control group. Neointimal hyperplasia increased in intervention group on day 7, and 28 were from mild grade to moderate, and severe respectively. In addition, levels of IL-6 and IL-8 increased on day 28 compared with on day 7. This study showed increase of miRNA-21 expression on day 7 and NIH rise from the mild to moderate. Furthermore, on day 28, that increases of miRNA-21 expression and NIH rose from to moderate to severe. The increase of miRNA-21 was also shown on day 7 and 28 followed by the increase of IL-6 and IL-8 levels.

KADAR ADIPONEKTIN PADA SUBYEK OBES DENGAN MAUPUN TANPA RESISTENSI INSULIN Hariawan, Hariadi
Jurnal Kedokteran YARSI Vol 18, No 1 (2010): JANUARI - APRIL 2010
Publisher : Lembaga Penelitian Universitas YARSI

Adiponektin adalah suatu adipositokin yang dihasilkan dari jaringan lemak. Adiponektin mempunyai peranan penting dalam regulasi dari metabolisme glukosa dan resistensi insulin. Penelitian klinis menunjukkan bahwa kadar adiponektin lebih rendah pada subyek obes, diabetes dan penderita penyakit arteri koroner. Studi ini meneliti perbedaan kadar adiponektin pada subyek obes dengan resistensi inulin. Tujuan penelitian ini adalah untuk mengetahui perbedaan kadar adiponektin antara subyek obes dengan resistensi insulin dibandingkan subyek obes normal. Kadar adiponektin plasma diperiksa pada 72 subyek dengan indeks massa tubuh (IMT) 25kg/m2. Resisitensi insulin diukur dengan menggunakan formula homeostasis model assessment insulin resistance (HOMA IR) dari kadar insulin dan glukosa puasa. Kadar adiponektin plasma diukur dengan teknik ELISA. Diperiksa kadar glukosa darah, insulin dan profil lipid puasa. Hasilnya menunjukkan bahwa usia rerata adalah 46.39±6.45 tahun dengan IMT 29.83±3.57 kg/m2 dan kadar adiponektin 4.2±1.79 ?g/ml. Kadar adiponektin lebih rendah bermakna pada subyek obes. Kadar adiponektin tidak berbeda bermakna antara subyek obes dengan dan tanpa resistensi insulin (P=0.41). Tidak ada perbedaan proporsi seks diantara subyek obes dengan dan tanpa resistensi insulin (p=0.374). Analisis regresi logistik menunjukkan perbedaan dalam IMT, lingkar pinggang dan kadar glukosa 2 jam setelah makan pada subyek dengan resistensi insulin. Dari penelitian ini tidak didapatkan adanya perbedaan kadar adiponektin pada subyek obes yang mengalami resistensi insulin dan yang tidak mengalami resistensi insulin.

CORRELATIONS BETWEEN SERUM LEVEL OF MATRIX METALLOPROTEINASE-9 (MMP-9) AND SERUM LEVEL OF TROPONIN-I IN PATIENT WITH ACUTE CORONARY SYNDROME (ACS) Ruchanihadi Ruchanihadi; Budi Yuli Setianto; Hariadi Hariawan
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, initially occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis then spread to the vascular lumen and cause total partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme that plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocytes necrosis.Objective. To know the correlation between serum level MMP-9 and serum level of Troponin-I in patients with ACSMethod. Study design was cross sectional. Data were collected by consecutive sampling from patients in ICCU board of RSUP Dr. Sardjito Yogyakarta, in June 2008-August 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once and measuring concentration of serum level of MMP-9 and Troponin-I before definitive thrombolysis. Data are expressed as means ± standard deviation (SD). Correlation between serum level of MMP-9 and serum level of Troponin-I were assessed using Spearman’s rank correlations test. A value of p<0.05 was considered statistically significant.Result. There were 139 patients with ACS and comprising 63 patients with STEMI, 27 patients with NSTEMI, and 49 patients with UAP. Means±SD of Troponin-I from all of samples was 9.49±10.47 ng/dL. Mean±SD of MMP-9 from all of samples was 1296.06±729.97 ng/dL. There were significant correlations between MMP-9 and Troponin-I in patients with ACS (r=0.34, p=0.000).Conclusion. There were significant correlations between MMP-9 and Troponin-I in ACS patients in ICCU RSUP Dr. Sardjito Yogyakarta. Keywords: ACS, MMP-9, Troponin-I

The Differences of Average Level Serum N Terminal Prob-Type Natriuretic Peptide (NTPROBNP) in Hypertension Patients with and without Left Ventricular Hypertrophy At Cardiology Outpatients Dr. Sardjito General Hospital Yogyakarta Gusti Hariadi Maulana; Lucia Krisdinarti; Hariadi Hariawan
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Introduction. Hypertension cause changes in the structure and function of cardial as triggers neurohormonal and vascular changes that concentric cardiac hypertrophy. Myocyte volume expansion or increased pressure will trigger the synthesis of pre-proBrain Natriuretic Peptide (BNP) in the ventricular myocardium. Pre-proBNP will be converted into proBNP and proBNP will be converted into the form of BNP and N-terminal proBNP (NT proBNP).Aim. This study aimed to determine differences in BT pro BNP in hypertensive patients without LVH and hypertensive patients with LVH. The study design was cross-sectional in cardiology polyclinic`s outpatient at Dr. Sardjito General Hospital Yogyakarta from August 2009 until the sample number is fulfi lled.Method. To analyze the difference between the two groups of hypertensive patients using the t-test for normal distribution, while for abnormal distribution were analyzed with the Mann-Whitney U test. To analyze the normality of data conducted by Kolmogorov-Smirnov. The differences of two groups of hypertensive patients considered as signifi cant if p < 0.005 with confi dence interval of 95%.Results. The results showed 73 study subjects grouped subjects into 2 groups: hypertensive subjects without LVH (31 subjects) and with LVH (42 subjects) based on echocardiography parameters (IVSD, LVPWd, LVIDd, LVM, and LVMI) consisting of 24 males and 49 females. The baseline characteristics between the study groups of hypertensive subjects with and without LVH did not differ signifi cantly either in age, BMI, blood pressure, duration of hypertention therapeutic characteristics of the use of drugs such as ACEI, ARB, β-blocker, CCB, spironolactone and furosemide. Mean NT proBNP levels in hypertensive group without LVH (46.60 ± 45.51) and hypertention with LVH group (201.60 ±192.30 ng/ml). From the results of the Kolmogrov-Smirnov test result that the data distribution was not normal then used Mann-Whitney U test, obtained a statistically significant differences.Conclusion. There were significant differences in the mean levels of serum NT proBNP in hypertensive patients without LVH and hypertensive patients with LVH.

The Difference of Average Mean Platelet Volume (MPV) Values in Stable Angina Pectoris Patients with Symptoms of Depression and without Symptoms of Depression Arief Wibawa; Agus Siswanto; Hariadi Hariawan
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: Depression is an independent predictor of cardiovascular events. Increased platelet reactivity is one of several possible mechanisms proposed to explain the relationship between psychosocial factors to coronary heart disease. Mean platelet volume (MPV) is an indicator of platelet activation. MPV associated with major cardiovascular events in coronary heart disease.Objective: This study aimed to determine the average difference of mean platelet volume (MPV) in stable angina pectoris patients with symptoms of depression and without symptoms of depression.Methods: The study design was a cross-sectional study. Sampling was carried out in sequence from Stable Angina Pectoris patients who were treated in the internal medicine department of Dr. Sardjito hospital Yogyakarta. MPV and HAD score were measured once on admission. Data presented as a descriptive analysis of the subjects' characteristics on average and standard deviation. The difference average of MPVbetween Stable Angina Pectoris patients with symptoms, depression and without symptoms depression assessed with Pearson's correlation. The results were considered at the signifi cance level of p <0.05.Results: There were 40 subjects, consisting of 20 Stable Angina Pectoris patients with symptoms, depression and 20 Stable Angina Pectoris without symptoms depression. The difference average of MPV in this study was 7.56 ± 0.95 fl . Average MPV in Stable Angina Pectoris patients with symptoms depression was 8.45 ± 0.82 fl and without symptoms depression was 7.68 ± 0.99 fl with p = 0.009.Conclusion: In this study, there was a statistically signifi cant difference of average MPV values in stable angina pectoris patients with symptoms of depression and patients without symptoms of depression.

The Role of Anticoagulant and Thrombolysis in The Management of Deep Vein Thrombosis Anggia Endah Satuti; Hariadi Hariawan; Hasanah Mumpuni
ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17792

Deep vein thrombosis (DVT) is a clinical challenge encountered by clinicians of all specialties. The major complication to date is thrombus embolization into the lung which can be fatal. The mainstay of DVT therapy is an anticoagulant to prevent the thrombus development and recurrence. However, anticoagulant has no direct thrombolysis effect and recanalization of DVT largely depends on the effectiveness of the endogenous fi brinolytic system. Many agents are developed to improve the outcome and prevent a post thrombotic syndrome (PTS). The aim of this review is to give explanation on the use of anticoagulant, especially vitamin K antagonist, warfarin and thrombolytic therapy in DVT.

Efficacy of Lumbrokinase and Warfarin Compared to Single Warfarin on Thrombus Resolution in Deep Vein Thrombosis Anggia Endah Satuti; Hariadi Hariawan; Hasanah Mumpuni
ACI (Acta Cardiologia Indonesiana) Vol 1, No 2 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17798

Background: Deep vein thrombosis (DVT) is a challenging condition for clinician in all specialities. Prognosis after vein thromboembolism is worse and much worse after pulmonary embolism. Anticoagulant is the mainstay therapy for deep vein thrombosis, but there is still slow thrombus resolution even with the use of optimal anticoagulant. The use of intravenous thrombolytic agentsis one of the methods to signifi cantly lyse thrombus. Since there is increasing risk of bleeding with the use of the agents, indication is limited. Lumbrokinase is oral thrombolytic that may give significant thrombus lyses without increasing the risk of bleeding for deep vein thrombosis. This study was conducted to compare single warfarin therapy with combination of lumbrokinase andwarfarin for thrombus resolution in deep vein thrombosis patients. Methods: This study was a randomized open labeled trial comparing deep vein thrombosis patients using single warfarin therapy group to group using combination lumbrokinase and warfarin. 22 patients meet the inclusion and exclusion criteria. Patients were followed for 30 days and in the end of the trial, evaluation using vascular Doppler ultrasonography was done. Chi-square analysis was used to compare the outcome between two therapy groups. Results: In this trial, group therapy with added lumbrokinase to warfarin yielded a tendency toward better thrombus resolution compared to group with single warfarin therapy (58.3% vs.30%, p=0.231). Conclusion : Added therapy with lumbrokinase to warfarin may give better thrombus resolution as compared to single warfarin therapy, although there is no signifi cant difference between groups.Keywords: deep vein thrombosis, lumbrokinase, warfarin

High Apo B/Apo A-1 Serum Ratio As a Predictor of in-Hospital Major Adverse Cardiovascular Events in Acute Coronary Syndrome Patients Diyantie Saputri; Hariadi Hariawan; Bambang Irawan
ACI (Acta Cardiologia Indonesiana) Vol 1, No 2 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17799

Background: An increased level of apo B and decreased level of apo A-1 are thought to be better predictors of myocardial infarction than conventional lipid parameters in healthy individuals and/ or have coronary artery disease risk factors. Literatures said that HDL, LDL and apolipoprotein may have a role in haemostatic and thrombotic process. The present study aimed to investigate whether apo B/ apo A-1 ratio has a predictive role in hospitalised ACS patients to develop major adverse cardiac events (MACE). Methods: We performed a prospective cohort study and examined 182 ACS patients hospitalised in dr. Sardjito General Hospital Yogyakarta consecutively since September 2013, and evaluated ischaemia heart disease risk factors, measured concentration of apo B/apo A-1 ratio and conventional lipid parameters from plasma, and finally assessed the in-hospital MACE outcome. Apo B/Apo A-1 ratio cut off point in this study was taken from ROC curve analysis. Relation between in-hospital MACE with level of apo B/apo A-1 ratio was analysed using SPSS. Results: From 182 ACS subjects, 51 patients had MACE (MACE group) and 131 patients didn’t develop MACE (non-MACE group). From ROC curve, we set cut off point for apo B/apo A-1 ratio was 0,865. Subjects with an apo B/apo A-1 ratio ≥0,865 had a signifi cantly increased risk to suffer a cardiovascular event (MACE) during in-hospital follow-up. In a multiple logistic regression model, elevated apo B/apo A-1 ratio was an independent predictor for MACE during in-hospital follow-up (OR 3,17; 95%CI 1,299 - 7,738; p = 0,011). Conclusion: The results showed that the elevated apo B/apo A-1 ratio ≥0,865 was an independent predictor of MACE, with three-folds increase of risk compared to group of apo B/apo A-1 ratio < 0.865, during in-hospital follow-up in ACS patients.Keywords: apolipoprotein B; apolipoprotein A-1; apolipoprotein ratio; acute coronary syndrome; major adverse cardiovascular events

Electrical and Mechanical Activity of The Heart Erdiansyah Zulyadaini; Hariadi Hariawan; Budi Yuli Setianto
ACI (Acta Cardiologia Indonesiana) Vol 1, No 2 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17812

The regularity and rhythm of contraction of the heart muscles (myocardium) depends on how electrical impulses spreads through the conduction system organized. The process is initiated by electrical stimulation which thencauses depolarization. Depolarization is a series of ion transfer through channels that are specifi c to myocardial cell membrane (sarcolemma). These canals spread across the sarcolemma, which include:the Na+ channels, Ca2+ channels, channelK+, Na+-Ca2+exchanger, Na+-K+-ATPase pump and Ca2+active pump. The infl ux of Na+ ions into cell will start depolarization and then spread through conduction system to the rest of the myocardium.

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