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All Journal Medical Journal of Indonesia Indonesian Journal of Cardiology
Manoefris Kasim
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta
Health Professions Medicine & Pharmacology

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QRS distortion increased risk re-occurrence acute coronary events Kasim, Manoefris; Sunanto, Sunanto; Sewianto, Albertus; Kusmana, Dede
Medical Journal of Indonesia Vol 16, No 4 (2007): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (189.679 KB) | DOI: 10.13181/mji.v16i4.287

Abstract

Nearly 50% of patients suffering inferior myocardial infarction will have complications or distinguishing features associated with an increased mortality. This study aimed to identify dominant risk factors related to re-occurrence of acute coronary events in patients with inferior myocardial infarction. This historical cohort included patients with inferior myocardial infarction who received fibrinolytic therapy at emergency department of National Cardiovascular Center Harapan Kita, Jakarta during 2001 to 2004 and was followed-up for two years. Patients with previous myocardial infarction, left bundle branch block, ventricular rhythm, and ventricular pacing were excluded. QRS distortion is ratio between J-point and R wave more than 50% at 2 or more inferior leads. Re-occurrence of acute coronary events is incident of myocardial infarction and unstable angina pectoris. Of 181 subjects with inferior AMI, there were 21 (11.6%) incidents of acute coronary event. Those who had positive than negative QRS distortion had almost three-fold increased risk for re-occurrence of acute coronary events [adjusted relative risk (RRa) 2.88; 95% confidence interval (CI) = 1.05 – 7.90]. In term of TIMI risk score, those with higher than lower risk score had 6.7 times higher risk to be re-occurrence of acute coronary events (RRa = 6.66; 95% CI = 1.94 – 22.92). However, those who had than did not have successful fibrinolysis had 57% lower risk to be re-occurrence of acute coronary event (RRa = 0.43; 95% CI = 0.18 – 1.05; P = 0.065). Re-occurrence acute coronary events were related to QRS distortion, TIMI risk score, and successful fibrinolysis. (Med J Indones 2007; 16:240-4) Keywords: QRS distortion, fibrinolysis, inferior myocardial infarction
Clinical presentation of myocarditis in pediatric: the role of cardiac magnetic resonance in diagnosis Natalia, Sisca; Lilyasari, Octavia; Wicaksono, Sony H.; Kasim, Manoefris
Medical Journal of Indonesia Vol 23, No 3 (2014): August
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1156.201 KB) | DOI: 10.13181/mji.v23i3.654

Abstract

Myocarditis is an inflammatory disease of myocard with varied onset and clinical presentation which lead to diagnosis difficulties. These difficulties often cause incoming patients with acute condition are not diagnosed as acute myocarditis that subsequently may lead to improper therapy. This circumstance will probably cause more severe myocardial injury and even sudden death. On another circumstance, patients may also come late in conditions of dilated cardiomyopathy (DCM) or aritmogenik cardiomyopathy (ARVD) due to complexities of myocarditis early detection. Therefore, myocarditis diagnosis is extremely important. This case shows how CMR is important and highly accurate in diagnosing myocarditis through a case whereby a boy had complaints of chest pain and his CMR examination showed normal cardiac morphology with normal function of right and left ventricular, but with myocardial edema and tissue fibrosis, which confirmed the diagnosis of myocarditis according to the Lake Louise Consensus criteria. CMR is an important and high accuracy non-invasive diagnostic tool in myocarditis diagnosis.
Role of cardiac MRI in acute myocardial infarction Mulia, Erwin; Wicaksono, Sony H.; Kasim, Manoefris
Medical Journal of Indonesia Vol 22, No 1 (2013): February
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (932.66 KB) | DOI: 10.13181/mji.v22i1.513

Abstract

Mortality in patients with acute myocardial infarction (AMI) has decreased significantly and appears to be the result of current reperfusion therapeutic strategies. Reperfusion itself may develop into reperfusion injury. Therefore, management of these patients poses several challenges, such as diagnosing and managing heart failure, identifying persistent or inducible ischaemia, estimating the need for anticoagulation, and assessing overall cardiovascular risk. This case presentation will demonstrate the impact of cardiac magnetic resonance imaging (MRI) in the assessment of the pathophysiology of AMI in the current reperfusion era. Cardiac MRI can provide a wide range of clinically useful information which will help clinicians to manage and choose specific therapeutic strategies for AMI patients. (Med J Indones. 2013;22:46-53)Keywords: Acute myocardial infarction, cardiac magnetic resonance imaging, reperfusion injury
Dissolution of large intracardiac thrombus, potential role of the emerging oral fibrinolytic agent Candrasatria, Rony M.; Kasim, Manoefris
Medical Journal of Indonesia Vol 25, No 1 (2016): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (526.11 KB) | DOI: 10.13181/mji.v25i1.1311

Abstract

Intracardiac thrombus may persist in some cases even after anticoagulant therapy. This opens a possibility to add a potent thrombolytic agent into therapeutic regimen without increasing bleeding risk any further. Increasing evidence showed a promising efficacy and safety of oral fibrin specific lumbrokinase as a thrombolytic agent. To the best of our knowledge, report of the use of lumbrokinase on intracardiac thrombus is limited. We reported two cases of intracardiac thrombi. In first patient, after two-month therapy with lumbrokinase, the previous 8 cm2 left atrial thrombus was completely disappeared. Second patient had left ventricular thrombus due to low left ventricular ejection fraction caused by coronary artery disease. A significant dissolution in thrombus size on repeated follow-up was found. Both patients did not experience any significant adverse effect. This case series aims to present the potential use of lumbrokinase as as oral antithrombotic therapy in intracardiac thrombus.
Effect of Myocardial Fibrosis on Left Ventricular Function in Rheumatic Mitral Stenosis: A Preliminary Study with Cardiac Magnetic Resonance Elen, Elen; Atmadikoesoemah, Celly A.; Kasim, Manoefris
Indonesian Journal of Cardiology Vol 38 No 4 (2017): October - December 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.v38i4.785

Abstract

Background: Left ventricular (LV) dysfunction was frequently found in rheumatic mitral stenosis. Myocardial fibrosis had been revealed in rheumatic heart disease and could be associated with LV dysfunction. We evaluate myocardial fibrosis profile related to LV function in rheumatic mitral stenosis with cardiac magnetic resonance (CMR). Methods: Eighteen patients with severe rheumatic mitral stenosis without history of coronary artery disease or its risk factors underwent 1.5T CMR examination. LV ejection fraction (LVEF), right ventricular ejection fraction (RVEF), myocardial fibrotic tissue were evaluated with CMR. Other hemodynamic data was derived from echocar­diography results. Results: These patients (40.4±10.5 years old, 72.2% female, 66.7% atrial fibrillation) had LVEF of 50.9±15.9% and RVEF of 37.7±13.9%. Volume of fibrotic tissue in these patients were 16.6 (5.5-55.8)%. In multivariate analysis, volume of fibrotic tissue was a significant predictor of LVEF that myocardial fibrotic tissue of 1% was associated with LVEF reduction of 0.87% (95% CI 0.51%-1.24%). Conclusion: LV function was determined by the extent of myocardial fibrosis in rheu­matic mitral stenosis.   Abstrak Latar Belakang: Disfungsi ventrikel kiri (LV) sering ditemukan pada mitral stenosis rematik. Fibrosis miokardium ditemukan pada penyakit jantung rematik. Fibrosis miokardium pada penyakit jantung rematik juga dihubungkan dengan disfungsi LV. Kami mengevaluasi profil fibrosis miokardium yang berhubungan dengan fungsi LV pada mitral stenosis rematik dengan cardiac magnetic resonance (CMR). Metode: Dilakukan pemeriksaan 1.5T CMR pada delapanbelas pasien dengan mitral stenosis rematik berat tanpa riwayat penyakit jantung koroner atau faktor resikonya. Fraksi ejeksi LV (LVEF), fraksi ejeksi RV (RVEF), dan jaringan fibrotik miokardium dievaluasi menggunakan CMR. Data hemodinamik lainnya didapatkan dari pemeriksaan ekokardiografi. Hasil: Pasien tersebut (40.4±10.5 tahun, 72.2% perempuan, 66.7% fibrilasi atrium) memiliki LVEF 50.9±15.9% dan RVEF 37.7±13.9%. Vol­ume jaringan fibrotic pada pasien tersebut adalah 16.6 (5.5-55.8)%. Dalam analisis multivariat, volume jaringan fibrotic adalah prediktor LVEF yang signifikan yaitu 1% jaringan fibrotic miokardium dihubungkan dengan menurunan LVEF sebesar 0.87% (95% CI 0.51%-1.24%). Kesimpulan: Fungsi LV dipengaruhi seberapa besar fibrosis miokardium pada mitral stenosis rematik
Detailed Precision of Computed Tomography Angiography Compared to Invasive Angiography in Different Coronary Vessels: Overestimate, Underestimate, or Concordance? Haykal, TM; Elen, Elen; Atmadikoesoemah, Celly A.; Putra, Abhirama N; Parlautan, Andrew; Saragih, Wendy M; Kasim, Manoefris
Indonesian Journal of Cardiology Vol 39 No 1 (2018): January - March 2018
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.30701/ijc.v39i1.790

Abstract

Background: Quantitative analysis of stenosis lesions by Computed Tomography angiography (CTA) show good correlation with Invasive Coronary Angiography (ICA) examination. However, detailed precision whether CTA overestimate or underestimate have not been explored thoroughly. Objectives: This research is performed to analyze the precision of CTA compared to ICA. Materials & Methods: There are 195 patients examined by both CTA and ICA from October 2014 until December 2015 in our hospital. CTA was analyzed by a team of cardiovascular imaging cardiologists. Quantitative grading of stenosis was determined visually using 2014 Society of Cardiovascular Computed Tomography (SCCT) guidelines classification. Quantitative measurement of stenosis during ICA was classified with the same criteria so that it can be comparable. The final comparison of both tests was clas­sified as concordance, overestimate and underestimate. Results: Lesion of stenosis was found in 573 coronary vessels. Coronary vessels are significantly associated with detailed precision of quantitative analysis comparison in CTA and ICA. LM coronary stenosis quantification from CTA is predominantly overestimate (concordance in 6% vessels and overestimate in 75.9% vessels), while stenosis analysis by CTA in other major coronary vessels is spread without conspicuous domination (p<0.001). Sensitivity, specificity, PPV, and NPV of CTA to detect obstructive lesion (stenosis ≥ 50%) found by ICA is 81.4%, 80.4%, 73.9%, and 86.3%, respectively (780 vessels). Conclusions: Degree of stenosis in LM is predominantly overestimate by CTA. The precision of stenosis grading in CTA in different coronary vessels is not the same.   Abstrak Latar Belakang: Analisis kuantitatif lesi stenosis pada pembuluh koroner menggunakan modalitas Computed Tomography Angiography (CTA) memiliki korelasi yang baik dengan pemeriksaan Invasive Coronary Angiography (ICA). Namun, presisi CTA terhadap ICA masih belum ter­eksplorasi dengan baik. Terutama dari sisi apakah CTA menunjukkan presisi yang overestimate atau underestimate. Tujuan: Penelitian ini dilakukan untuk menganalisis presisi CTA terhadap ICA dalam mendeteksi lesi stenosis pada pembuluh koroner. Metode Penelitian: Terdapat 195 pasien yang diperiksa menggunakan CTA dan ICA sejak Oktober 2014 hingga Desember 2015 di RS Jan­tung dan Pembuluh Darah Harapan Kita, Jakarta. Analisis kuantitatif CTA dilakukan oleh tim kardiolog pencitraan kardiovaskular. Klasifikasi derajat stenosis ditentukan secara visual menggunakan pedoman dari Society of Cardiovascular Computed Tomography (SCCT) 2014. Analisis kuantitatif lesi stenosis dari pemeriksaan ICA diklasifikasikan menggunakan pedoman yang sama sehingga keduanya dapat diperbandingkan. Data hasil perbandingan kedua modalitas diklasifikasikan sebagai concordance, overestimate dan underestimate. Hasil Penelitian: Lesi stenosis ditemukan pada 573 pembuluh koroner. Pembuluh koroner yang berbeda secara signifikan berhubungan dengan perbandingan klasifikasi analisis semi-kuantitatif CTA dan ICA. Pembuluh koroner LM terutama menunjukkan lesi dengan kategori overestimate (75.9%). Sementara analisis stenosis pada pembuluh koroner lainnya tidak menunjukkan perbedaan yang mencolok (p < 0,001). Sensitivitas, spesifisitas, PPV, dan NPV CTA dalam mendeteksi lesi koroner obstruktif (stenosis ≥50%) terhadap ICA adalah sebesar 81.4%, 80.4%, 73.9%, dan 86.3% (780 pembuluh kroner). Kesimpulan: Analisis stenosis semi-kuantitatif pada LM terutama adalah overestimate berdasarkan pemeriksaan CTA. Presisi analisis perband­ingan derajat stenosis CT angiografi pada setiap pembuluh koroner tidak sama.
Co-Authors Albertus Sewianto Andrew Parlautan Atmadikoesoemah, Celly A. Dede Kusmana Elen, Elen Erwin Mulia Haykal, TM Octavia Lilyasari Putra, Abhirama N Rony M. Candrasatria, Rony M. Saragih, Wendy M Sisca Natalia Sony H. Wicaksono Sunanto Sunanto