Articles
<![CDATA[Aspirin and Clopidogrel Resistance in Coronary Artery Disease ]]>
<![CDATA[Fera Hidayati]]>;
<![CDATA[Bambang Irawan]]>;
<![CDATA[Hasanah Mumpuni]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 3, No 1 (2017) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.29683
<![CDATA[Dual antiplatelet therapy has been proven effective to reduce recurrent cardiovascular eventin patients with coronary artery disease and recommended as standard therapy for acute coronary syndrome and patients who underwent percutaneous coronary intervention. The adverse clinical occurrence in patients who taking aspirin and clopidogrel associates with antiplatelet non responsiveness, in addition to repetitive bleeding incident in such a way that platelet reactivity and genetic polymorphisms investigation rises intense interest. Resistance to antiplatelet or antiplatelet non responsiveness means a phenomenon in which antiplatelet drug fails to deliver pharmacological target and it is determined by platelet function measurement. Recent laboratorymethods have been developed to diagnose antiplatelet resistance, but none of them was considered as standard tool since its wide inter-individual variability and poor correlation between them. The mechanism of antiplatelet resistance is not fully understood, multifactorial, involving pharmaco dynamic and pharmacokinetic of the drugs. This review is aimed to comprehend theantiplatelet resistance mechanism and provide crucial information on managing patients who take dual antiplatelet treatment with adverse clinical events. ]]>
<![CDATA[Interval TpTe Diagnostic Value in Diastolic Dysfunction of Patients with Hypertension ]]>
<![CDATA[Rano Irmawan]]>;
<![CDATA[Braghmandaru Adhi Bhaskara]]>;
<![CDATA[Hasanah Mumpuni]]>;
<![CDATA[Nahar Taufiq]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 3, No 2 (2017) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.33547
<![CDATA[Introduction: Diastolic dysfunction has been shown to be associated with an increase in mortality rates in both normal and decreased systolic function. In patients with hypertension, there is elongation of transmural repolarization dispersion in left ventricular, which will cause heart diastolic relaxation disorders. The elongation of the transmural repolarization dispersion is indicated by the increase of the TpTe interval. We conducted this study to fnd out whether the TpTe interval had a good diagnostic value in detecting diastolic dysfunction in patients with hypertension.Methods: This is an analytic observational research using cross sectional design on hypertensive patients in whom echocardiography was performed. The study conducted in February 2017 until March 2017 in Dr. Sarjito general hospital Yogyakarta. Electrocardiography examination was taken after the patient was performed echocardiography. The TpTe interval was calculated using the ‘tail’ method at lead V5. Diastolic dysfunction was established using echocardiographywith the ASE / EAE 2016 algorithm.Results: Of the 112 patients met the criteria of the study subjects. The cut-off value for TpTe was 103.97 m.s., based R.O.C curve analysis. TpTe interval ≥ 103.97 m.s. had a moderate diagnostic value for detecting diastolic dysfunction with 73% accuracy, 83% sensitivity, 64% specifcity, 22% positive predictive value, and 97% negative predictive value. There were 66 (58.9%) subjectswith TpTe interval <103.97 m.s. and 46 subjects (41.1%) with TpTe interval ≥103.97 m.s. There were 12 subjects (10.7%) with diastolic dysfunction. Bivariate and multivariate analyzes showed no demographic and clinical factors that independently affected the TpTe interval.Conclusion: The TpTe interval ≥ 103.97 m.s. had a moderate diagnostic value for detecting diastolic dysfunction in patients with hypertension]]>
<![CDATA[Diagnostic Values of P-Wave Dispersion to Detect Diastolic Function in Patient with Hypertension ]]>
<![CDATA[Braghmandaru Adhi Bhaskara]]>;
<![CDATA[Rano Irmawan]]>;
<![CDATA[Lucia Kris Dinarti]]>;
<![CDATA[Hasanah Mumpuni]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 3, No 2 (2017) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.33574
<![CDATA[Background: Hypertension is one of the main causes of cardiovascular disease. Patients with hypertension have increase risk of heart failure compared to populations with normal blood pressure. Clinical evidence shows diastolic dysfunction (DD) can lead to heart failure. Diagnostic of DD with echocardiography is important but access to echocardiography machines is limited compared to electrocardiography (ECG). ECG research correlates P-wave dispersion (PWD) with DD. The aim of this study is to determine the value of PWD to diagnose DD in patients with hypertension.Methods: A cross sectional study was conducted in patients with hypertension at Dr. Sardjito Hospital. Patients received echocardiography, ECG, blood pressure measurement and data recording. The diastolic dysfunction was determined based on 2016 ASE/EACVI criteria. We conducted ROC analysis to determine the cut-off point of P-wave dispersion and the area under the curve (AUC) value, and bivariate analysis on demographic and clinical factors related to PWD. Multivariate analysis was performed to determine the independent factors affecting PWD.Results: 113 patients met the criteria of the study subjects, with 47 men (37.2%), mean age 58.32±11.17 years. Thirteen (11.5%) subjects had DD and 37 subjects (32.7%) with increased PWD. Results showed increased PWD above 71.4 m.s with AUC 76.2%, sensitivity 75%, specifcity 72.2%, positive predictive value 33.3%, negative predictive value 96%, and accuracy of 72.5% in diagnosing DD.Conclusion: This is the frst study to examine the diagnostic value of PWD to detect diastolic function based on 2016 ASE/EACVI criteria. We found PWD above cut-off point 71.4 m.s has a moderate diagnostic value for detecting DD in patients with hypertension.]]>
<![CDATA[Correlation between Left Ventricular Eccentricity Index and Mean Pulmonary Arterial Pressure in Secundum Type Atrial Septal Defect Adult Patients ]]>
<![CDATA[Citra Dewi Wahyu Fitria]]>;
<![CDATA[Azhafid Nashar]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Anggoro Budi Hartopo]]>;
<![CDATA[Hasanah Mumpuni]]>;
<![CDATA[Lucia Kris Dinarti]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 4, No 1 (2018) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.36634
<![CDATA[Background: Secundum type atrial septal defect (ASD) is the most common adult congenital heart disease. Hemodynamically, ASD result in a left-to-right shunt that causes right heart volume overload. This condition affects interventricular septal position and shape. Left ventricular (LV) eccentricity index (EI) suggests right ventricle (RV) overload when this ratio is >1.0. The aim of this study was to assess correlation between LV EI and mean pulmonary arterial pressure (mPAP) in secundum type ASD patients. Methods: We conducted a cross sectional study from ASD patients registry data. We enrolled subjects with secundum type ASD from the complete registry data. The LV EI was calculated from transthoracal echocardiography. The mPAP was measured by right heart catheterization as a gold standart. The correlation was performed by Spearman correlation test. Results: There were 40 adult secundum type ASD patients participated. The mean LV EI in enddiastolic was 1.55±0.39 and LV EI in end-systolic was 1.75±0.58. The median value of mPAP was 29 (12-99) mmHg. There was a moderate strength, positive and significant correlation between LV EI in end-diastolic and mPAP (r=0.37, p=0.018). The correlation was more significant and stronger between LV EI in end-systolic and mPAP (r=0.52, p=0.001). Conclusion: There was sufficiently strong and significant correlation between LV EI in both end-diastolic and end-systolic phase with mPAP in adult secundum type ASD.]]>
<![CDATA[Pulmonary Artery Hypertension Associated with HIV Infection in Nine Year-Old Child ]]>
<![CDATA[Baskoro Adi Prabowo]]>;
<![CDATA[Abdus Samik Wahab]]>;
<![CDATA[Hasanah Mumpuni]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 4, No 1 (2018) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.36638
<![CDATA[Pulmonary arterial hypertension (PAH) is a serious life threatening and severe complication ofHIV infection. A PAH presentation in patient with HIV tends to non specific, result in recognizeddiagnosis at a later stage. A 9 year-old HIV patient came to Pediatric Clinic with a chief complaint of worsening dyspneu for 1 month, leg edema and difficulty lying on a flat bed. Patient showed signs and symptoms that lead to pulmonary hypertension. An ECG findings were sinus rhythm, right axis deviation, and right ventricular hypertrophy. Echocardiography findings showed rightventricular and atrial enlargement, and high probability of pulmonary hypertension. Blood examination showed CD 4 was 84 cells/μL. The patient was managed as pulmonary arteryhypertension associated with HIV (HIV-PAH) infection.The patient was admitted for 3 weeksand eventually discharged with relieve condition.]]>
<![CDATA[Correlation between Mitral Valve Area and Right Ventricle Function based on TAPSE (Tricuspid Annular Plane Systolic Excursion) Parameter in Mitral Stenosis Patient ]]>
<![CDATA[Hashina Zulfa]]>;
<![CDATA[Erika Maharani]]>;
<![CDATA[Hasanah Mumpuni]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 4, No 2 (2018) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.40851
<![CDATA[Background: Mitral stenosis is the most common mitral valve disease found in Indonesia. Mechanical obstruction of blood flow from left atrium to left ventricle is compensated by pressure elevation in the left atrium and pulmonary circulation. It leads to right ventricle dysfunction which can be scored using TAPSE (Tricuspid Annular Plane Systolic Excursion) Parameter.Aim: The goal of this study is to assess the relationship between mitral valve area and right ventricle function based on TAPSE parameter in mitral stenosis patient.Methods: This study was conducted in Dr. Sardjito Hospital from May until July 2017. This was a part of mitral stenosis registry study. The parameter used was planimetry mitral valve area and TAPSE from echocardiography. The relationship between mitral valve area and TAPSE score we reanalyzed using Spearman correlation test in SPSS software.Results: The total sample included in this study was 132 people, consisted of thirty-eight (28.79%) males and ninety-four (71.21%) females. The range of the subjects’age was 18 68 year oldand the mean was 43.31±11.13 year old. The body mass index median was 21.24 (14.24–35.38) kg/m2. The subjects were dominated by severe degree mitral stenosis patients, those were ninety-three (70.45%) people, followed by moderate degree patients, those were thirty-two (24.24%) people, and mild degree patients, those were seven (5.30%) people. Twenty-eight (21.21%) people had isolated mitral stenosis. The mitral valve area median was 0.8 (0.27–1.90) cm2. The TAPSE score range was 6–30 mm and the mean was 17.48±4.58 mm. The result from Spearman correlation test showed that the relationship strength between mitral valve area and TAPSE score were very weak (r=0.167) with significant p-value (p=0.028).Conclusion: There is a statistically significant positive relationship with very weak strength between mitral valve area and TAPSE score as a right ventricle function parameter in mitral stenosis patients (r = 0.167, p = 0.028).]]>
<![CDATA[Correlation between Level of Soluble Suppression of Tumorigenicity-2 (sST2) with Global Longitudinal Strain (GLS) of Left Ventricle in Patients with Acute Myocardial Infarction ]]>
<![CDATA[Dyah Adhi Kusumastuti]]>;
<![CDATA[Nahar Taufiq]]>;
<![CDATA[Hasanah Mumpuni]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 5, No 1 (2019) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.44553
<![CDATA[Background: Epidemiological data show that the incidence of heart failure after myocardial infarction is about 20%. The incidence of heart failure after acute myocardial infarction is also known to increase post-infarct mortality. The incidence of heart failure is related to the remodelling process after acute myocardial infarction. The acute remodelling process after acute myocardial infarction involves a mechanical mechanism in which there is a change in left ventricular geometry as an adaptive response to the incidence of infarction and then results in increased left ventricular wall stress. Increased left ventricular wall stress can be assessed by measuring global longitudinal strain (GLS) using echocardiography. On the other hand, mechanical overload in the myocardium is known to increase sST2 levels. The relationship between increased levels of sST2 and left ventricular GLS in patients with acute myocardial infarction has never been studied before.Methods: An analytic observational study with a cross-sectional design conducted from July to September 2018 at Dr Sardjito Hospital. Patients diagnosed with acute myocardial infarction and fulfilling the inclusion and exclusion criteria were included in the study. Measurement of sST2 levels and echocardiographic examination was performed on the first day after admission. Correlation test analysis was conducted to determine the relationship between sST2 levels and left ventricular GLS.Results: There were 72 subjects, with 62 STEMI subjects and 10 NSTEMI subjects. The mean level of sST2 in this study was 4,252 ± 198 pg / mL. Measurement of the left ventricular function obtained a mean ejection fraction of 47 ± 9%, LVIDd 45.79 ± 6.2 mm and GLS values of -9.3 ± 3.3%. Correlation test using Spearman test showed that there was no correlation between increased sST2 levels and decreased GLS values in patients with acute myocardial infarction (r = -0.133; p = 0.344).Conclusion: Increased sST2 levels were not correlated with decreased GLS values in patients with acute myocardial infarction.]]>
<![CDATA[Newest Update in Heart Failure Guidelines Recommendation ]]>
<![CDATA[Hasanah Mumpuni]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 5, No 1 (P) (2019): Proceedings Jogja Cardiology Update 2019 (JCU2019) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.47679
<![CDATA[Heart failure remains a global burden despite important progress that has been made in the management of heart failure. Guidelines from ESC and AHA are still widely used as a guidance for diagnosis and management of heart failure. We will discuss the new recommendation from ESC and AHA guideline for heart failure.]]>
<![CDATA[Relationship of P Terminal Force V1 on Electrocardiogram with Left Atrial Function in Chronic Kidney Failure Patients on Hemodialysis ]]>
<![CDATA[Kartika Apshanti]]>;
<![CDATA[Putrika Prastuti Ratna Gharini]]>;
<![CDATA[Hasanah Mumpuni]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 5, No 2 (2019) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.50216
<![CDATA[Background: Chronic kidney failure is a worldwide public health problem.Cardiovascular disease is a common complication and the main cause of mortality in this population.Impaired left atrial function is an early marker of cardiovascular involvement and a prognostic factor that correlated with mortality in chronic kidney disease patients. We aimto investigate the relationship between P terminal force V1 (PTFV1), an ECG parameter, with left atrial function in chronic kidney failure patients on hemodialysis.Method: This cross sectional study was done in chronic kidney failure patients on hemodialysis in Dr. Sardjito General Hospital Jogjakarta. Electrocardiogram and echocardiography were done after hemodialysis procedure. P terminal force V1 was measured by multiplying amplitude and duration of negative deflection of terminal P wave in V1. Abnormal PTFV1 was defined as PTFV1 value ≥ 40 mm.msec. Left atrial function was measured using left atrial peak global longitudinal strain (LA PGLS).Results: This study was done in 71 patients with mean age 50 years old. Forty three subjects (61%) were men. Sixty four subjects (90%) had hypertension. Forty four subjects (62%) had abnormal PTFV1 on ECG. Mean LA PGLS was 24.89 ± 8.23%. No significant correlation was found between PTFV1 value with LA PGLS (r= -0.178; p=0.138). By multivariate analysis, left ventricular ejection fraction, left atrial diameter and hemodialysis duration (in months) were variables that independently correlated with LA PGLS. In subanalysis, amplitude of negative deflection of terminal P wave in V1 was significantly correlated with LA PGLS(r= -0.257, p= 0.031).Conclusions: This study reveals no correlation between P terminal force V1 and left atrial function in chronic kidney failure patients on routine hemodialysis. There is significant correlation between amplitude of negative deflection of terminal P wave in V1 with LA PGLS.]]>
<![CDATA[Hemoglobin Variability as Risk Factor of Left Ventricle Dilation in Chronic Kidney Disease Patient on Routine Hemodialysis ]]>
<![CDATA[Iqbal Maulana]]>;
<![CDATA[Hasanah Mumpuni]]>;
<![CDATA[Irsad Andi Arso]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 5, No 2 (2019) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.50217
<![CDATA[Background: Several patients with chronic kidney disease (CKD) undergoing routine hemodialysis (HD) have abnormalities of left ventricle (LV) morphology with feature LV dilation due to volume overload and chronic ischemia, which has high risk of mayor adverse cardiovascular event. Anemia causes LV dilation through high output state mechanism. Anemia management in CKD patients causes hemoglobin (Hb) fluctuations or hemoglobin variability (Hb-Var) which is thought to cause LV dilation through relative repetitive ischemia mechanisms. Research linking Hb-Var as risk factor for LV dilation has never been done.Method: Matched case-control study was carried out by taking echocardiographic data of CKD patients undergoing routine HD in HD Unit Dr. Sardjito hospital. The LV diameter is divided into samples with LV (+) dilated profile as a case group, and LV (-) dilated as a control group. Matching was done on variables of age, gender and HD frequency. The HbVar parameter was calculated by the residual SD method based on the Hb value in the last 6 months. Fisher-Exact hypothesis test was used to assess the relationship between Hb-Var and LV dilation, while the logistic regression test was used for multivariate testing.Result: Total of 79 subjects entered in this study, there were 23 subjects of case groups and 28 subjects of control group after matching and adjusting the control formula. The proportion of high Hb-Var in the group with dilated LV (+) and dilated LV (-) were 21.7% and 17.9%, respectively. The Fisher-Exact test shows that there is no relationship between HbVar and LV dilation, with OR 1.28 (95% CI 0.32-5.10). Logistic regression test shows that there are no variables that affect independently of LV dilation.Summary: CKD patients undergoing routine HD with high Hb-Var profiles do not have a higher risk of LV dilation than patients with low Hb-Var profiles.]]>
