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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Indonesian Journal of Cardiology ACI (Acta Cardiologia Indonesiana)

Krisdinarti, Lucia

Cardiology And Vascular Educational Program, Faculty Of Medicine / Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta

Author-ID : 2970872

Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Scoring system based on electrocardiogram features to predict the type of heart failure in patients with chronic heart failure Hendry Purnasidha Bagaswoto; Lucia Kris Dinarti; Erika Maharani
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 48, No 3 (2016)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

ABSTRACT Heart failure is divided into heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Additional studies are required to distinguish between these two types of HF. A previous study showed that HFrEF is less likely when ECG findings are normal. This study aims to create a scoring system based on ECG findings that will predict the type of HF. We performed a cross-sectional study analyzing ECG and echocardiographic data from 110 subjects. HFrEF was defined as an ejection fraction ≤40%. Fifty people were diagnosed with HFpEF and 60 people suffered from HFrEF. Multiple logistic regression analysis revealed certain ECG variables that were independent predictors of HFrEF i.e., LAH, QRS duration >100 ms, RBBB, ST-T segment changes and prolongation of the QT interval. Based on ROC curve analysis, we obtained a score for HFpEF of -1 to +3, while HFrEF had a score of +4 to +6 with 76% sensitivity, 96% specificity, 95% positive predictive value, an 80% negative predictive value and an accuracy of 86%. The scoring system derived from this study, including the presence or absence of LAH, QRS duration >100 ms, RBBB, ST-T segment changes and prolongation of the QT interval can be used to predict the type of HF with satisfactory sensitivity and specificity

Association between serum soluble ST2 level and right ventricle systolic function on pulmonary hypertension due to atrial septal defect Firandi Saputra; Anggoro Budi Hartopo; Hariadi Hariawan; Dyah Wulan Anggrahini; Lucia Kris Dinarti
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 3 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Pulmonary hypertension (PH) due to atrial septal defect (ASD) may cause a decline in right ventricle (RV) function. Soluble ST2 isa prognostic biomarker for left ventricle dysfunction. However, its role in RV function has not been investigated. This study aimed to investigate the association between serumsoluble ST2 with RV systolic function in patients withASD–associatedPH. This was a cross sectional study. Subjects were patients participated in the COHARD-PH registry performed in Dr. Sardjito General Hospital, Yogyakarta Indonesia. The patients with ASD and PH confirmed by right heart catheterization (RHC) were enrolled in this study. The soluble ST2 level was measured in the serum collected from pulmonary artery during RHC. Right ventricle systolic function was determined by transthoracic echocardiography using peak systolic velocity of tricuspid annulus (S’) parameter. This study was performed in 32 adults with uncorrected ASD. They predominantly females [n=29 (90.6%)] with median age of 31(22.5-44.0) years old. Mean ASD diameter was 2.69±0.53 cm. Median mean pulmonary artery pressure (mPAP) 45.0 (36.25-70.0) mmHg. Median soluble ST2 level was 23.28 ng/mL. There were no significant correlations between soluble ST2 level with S’value (r=0.071; p=0.35), with mPAP (r=0.043; p=0.815), with pulmonary vasculer resistance (PVR) (r=0.025; p=0.893) and with right ventricle (RV) diameter (r=0.200; p=0.273). Soluble ST2 level was found higher in subject with RV dysfunctionbut not statistically significant. In conclusion, serum soluble ST2 level did not associate withRV systolic function, measured by S’, in adult ASD-associated PH.

Pulmonary artery hypertension patients and the coronavirus disease of 2019 (COVID-19): are they protected from severe disease? Anggoro Budi Hartopo; Dyah Wulan Anggrahini; Bambang Budi Siswanto; Lucia Kris Dinarti
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 3 (2020): Special Issue: COVID-19
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

The coronavirus disease of 2019 (COVID-19) is a current pandemic of viral infection which mainly involves respiratory system and may progress into severe multiple organ dysfunction and mortality. Pulmonary artery hypertension (PAH) is a disease marked by increased mean pulmonary artery pressure and pulmonary vascular resistance due to pulmonary panvascular remodeling. Although rare, the prevalence of PAH is currently escalating in Indonesia due to increased diagnostic capacity and referral, treatment availability and improved survival. Despite chronic cardiac and pulmonary diseases are at increased risk to develop severe COVID-19, patients with PAH are considered to be not in higher risk to develop severe COVID-19. However, whether this population is protected from severe COVID-19 is unclear. There are protective and offensive factors need to be considered in PAH patients in respect to COVID-19.

Clinical cardiac manifestations in patients with coronavirus disease 2019 (COVID-19) Hafizha Herman; Putrika PR Gharini; Lucia Kris Dinarti
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 3 (2020): Special Issue: COVID-19
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 2 million people worldwide with case fatality rates between 3-15%. The pathophysiology of this newly emerging disease in affecting cardiovascular system is poorly understood. This review aimed to understand from various retrospective studies and case reports that have been published and updated during the pandemic of COVID-19 related to the underlying mechanism and cardiovascular interaction with coronavirus. A literature search was done with Google search, PubMed, European Society of Cardiology (ESC) and Journal of American Medical Association (JAMA) network since the early days of COVID-19 pandemic. Clinical presentation may be asymptomatic or the severe cases will have acute respiratory distress syndrome (ARDS). Protein spikes of SARS-CoV-2 virus use the angiotensin-converting enzyme 2 (ACE2) as viral entry to host cells. Due to the upregulation of ACE2, people with any pre-existing cardiac diseases are more vulnerable to the infection and more likely to have a severe condition of COVID-19 infection with a higher risk of mortality. On the other hand, ACE2 has protective effects against myocardial inflammation and lung injuries. Several cases of COVID-19 infection may have cardiac manifestations as a chief complaint or acute cardiac injury as the complication. Recent case reports show that acute cardiac injury, myocarditis, cardiogenic shock, thromboembolism, and arrhythmias could be the complications of COVID-19 even without history or risk factors of cardiovascular disease. There are several hypotheses related to the mechanism of acute cardiac injury in COVID-19 patients, including damage through ACE2 receptors, hypoxia, cardiac microvascular damage, and inflammatory response.COVID-19 infection can cause many interactions in the cardiovascular system, whether the patients already had chronic heart disease or not. Considering the lack of evidence of the RAS inhibitor in COVID-19, the use of ACE inhibitor/ARB should be continued unless contraindicated and may be beneficial in patients with hypertension, heart failure and diabetes mellitus. Early recognition of cardiac manifestations from COVID-19 infections will be the key to prevent short and long term cardiac adverse events.

Pulmonary arterial hypertension after atrial septal defect closure: a case report Lucia Kris Dinarti; Dyah Wulan Anggrahini; Muhammad Reyhan Hadwiono; Abdul Majid Halim Wiradhika; Vera Dewanto; Anggoro Budi Hartopo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 53, No 4 (2021)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005304202111

Most patients with congenital heart disease (CHD) who underwent successful shunts defect repair can be remained asymptomatic for years. It leads to a high number of losses to follow-up after patients discharge. After closure, pulmonary hypertension (PH) prevalence seems to be high and associated with increased morbidity and mortality. We reported a 55 y.o. female diagnosed with pulmonary arterial hypertension (PAH) and atrial fibrillation (AF) 31 years after atrial septal defect (ASD) closure by surgery, who never had routine follow-up evaluation because she remained asymptomatic for years. Physical examination revealed heart enlargement with irregular rhythm and pan systolic murmur in the fourth left sternal border. Electrocardiogram showed AF normal ventricular response, right axis deviation and suggestive for right ventricular hypertrophy. Laboratory testing found the NT pro-BNP level was 2,476 pg/mL. The chest X-ray showed enlargement of the heart and was representative of PH. From echocardiography study, transthoracic and transoesophageal echocardiography, we found no sign of residual shunt. There were right atrial and right ventricular dilatation, severe tricuspid regurgitation (TR) and a high probability of PH with TR velocity of 4.46 m/s. Right heart catheterization concluded mean pulmonary arterial pressure 46 mmHg, flow ratio 1.1, and pulmonary artery resistance index 15.5 Woods unit.m-2. We highlight this case because of the high incidence of PH long after defect closure. The high number of lost to follow-up patients can lead to morbidity and mortality.

Perbedaan Rasio Kadar Serum MMP-9/TIMP- 1 pada Kejadian Infark Miokard Akut Elevasi Segmen ST (IMA-EST) dan Sindroma Koroner Akut Non Elevasi Segmen-ST (SKA-NEST) Basuki Rahmat; Lucia Kris Dinarti; Irmalita I; Budi Yuli Setianto
Jurnal Kardiologi Indonesia Vol. 34, No. 3 Juli - September 2013
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v34i3.337

Background: Differences between the pathogenesis of ST-Elevation Myocardialinfarction (STEMI) and Non-ST Elevation Acute Coronary Syndrome(NSTE-ACS) had yet unknown. Matrix metalloproteinase-9 (MMP-9) as thematrix degradation enzyme secreted by inflammatory cells play a role in thepathogenesis of plaque rupture. MMP-9 proteolytic activity is inhibited byspecific inhibitors of the Tissue Inhibitor of metalloproteinase-1 (TIMP-1).MMP-9/TIMP-1 ratio describes the actual proteolytic activity of MMP-9.This ratio may distinguish the pathogenesis of STEMI and NSTE-ACS.Objective: To examine the difference serum level ratio MMP-9/TIMP-1 inpatients with STEMI and NSTE-ACS.Methods and subjects: This is a cross-sectional study which recruits patientsconsecutively with ACS admitted to ICCU of Dr. Sardjito General Hospital Yogyakartawithin 24 h onset. Acute infection, chronic inflammation, acute stroke,kidney failure requiring renal replacement therapy, chronic heart failure, liver cirrhosis,acute exacerbation of COPD and pneumonia, thromboembolic disease,malignancy, pregnancy and the use of steroids and steroid anti-inflammatorydrugs are excluded. Serum levels of MMP-9 and TIMP-1 examined using themethod of sandwich enzyme-linked immunosorbent assay (ELISA).Results: The total of 60 subjects with STEMI patients 31 (51.7%) and NSTEACS29 (48.3%). Level of serum MMP-9/TIMP-1 ratio is significantly higher inSTEMI compared to NSTE-ACS (1.106 ± 0.065 vs. 1.046 ± 0.057, p <0.001).MMP-9/TIMP-1 ratio in serum is an independent factor for STEMI (p = 0.003)followed by blood sugar level (p = 0.013) and MMP-9 (p = 0.033). Interestingly,patients with serum MMP-9/TIMP-1 ratio> 1.0639 has a prevalence riskof 1.7 times having STEMI (p = 0.039; KI95% from 1.040 to 8.508). Levels ofserum MMP-9/TIMP-1 ratio significantly higher in STEMI compared to NSTEMIgroup (p = 0.003) and in the STEMI and UAP group (0.026), but did not differsignificantly in NSTEMI and UAP group (p = 0.045).Conclusion: High levels of serum MMP-9/TIMP-1 ratio in patients withSTEMI than NSTEACS may explain the role of serum MMP-9/TIMP-1 ratioin differentiating the pathogenesis of STEMI and NSTE-ACS.(J Kardiol Indones. 2013;34:160-6)

Recurrent Hemoptysis in Patient with Primary Pulmonary Hypertension – A Case Report and Literature Review Indra Widya Nugraha; Bambang Irawan; Lucia Kris Dinarti
ACI (Acta Cardiologia Indonesiana) Vol 3, No 1 (2017)
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.29703

Pulmonary hypertension (PH) is defned as an increase in mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg at rest as assessed by right heart catheterization (RHC). The symptoms of PH are non-specifc and mainly related to progressive right ventricular (RV) dysfunction. In some patients the clinical presentation may be related to mechanical complications of PH andthe abnormal distribution of blood ﬂow in the pulmonary vascular bed, include hemoptysis related to rupture of hypertrophied bronchial arteries. Hemoptysis is a serious complication that is rarely reported in patients with pulmonary arterial hypertension (PAH). Hemoptysis severity ranges from mild to very severe leading tosudden death. Hemoptysis are reported to be a terminal stage ofa complication due to PAH with prevalence is variable, from 1% to 6%. Although the incidence is quite rare, the presence of recurrent hemoptysis in patients with pulmonary hypertension is a sign of poor prognosis. Bronchial artery embolization is suggested as an acute emergency procedure in the case of severe hemoptysis or as elective intervention in cases of frequent mild or moderate episodes.

Diagnostic Values of P-Wave Dispersion to Detect Diastolic Function in Patient with Hypertension Braghmandaru Adhi Bhaskara; Rano Irmawan; Lucia Kris Dinarti; Hasanah Mumpuni
ACI (Acta Cardiologia Indonesiana) Vol 3, No 2 (2017)
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.33574

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.

Correlation between Left Ventricular Eccentricity Index and Mean Pulmonary Arterial Pressure in Secundum Type Atrial Septal Defect Adult Patients Citra Dewi Wahyu Fitria; Azhafid Nashar; Dyah Wulan Anggrahini; Anggoro Budi Hartopo; Hasanah Mumpuni; Lucia Kris Dinarti
ACI (Acta Cardiologia Indonesiana) Vol 4, No 1 (2018)
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.36634

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.

The Shared Pathogenesis of Pulmonary Artery Hypertension Anggoro Budi Hartopo; Lucia Kris Dinarti
ACI (Acta Cardiologia Indonesiana) Vol 4, No 1 (2018)
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.36635

Pulmonary artery hypertension is defined as an increased in pulmonary artery pressureexceeding 25 mmHg with normal pulmonary wedge pressure. The pathogenesis of pulmonaryartery hypertension involves interaction among vascular, cellular and biomarker componentsin the pulmonary tissue; with eventual result is elevated pulmonary artery pressure. Vascularcomponents are remodeling of intimal, medial and adventitial layers. Cellular components areplayed by apoptosis-resistant endothelial cells, proliferative-prone pulmonary artery smoothmuscle cells, fibroblasts and inflammatory cells. The functional biomarkers are produced andmediated by these cellular changes, mainly endothelin-1, thromboxane, serotonin, nitric oxide,and prostacyclin. The pulmonary vascular remodeling in pulmonary artery hypertension arediverse and may present in various severity based on underlying etiology. Understanding theshared pathogenesis in pulmonary artery hypertension is of paramount importance in order toimprove the disease management and treatment approach.

Co-Authors Abdul Majid Halim Wiradhika Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Azhafid Nashar Bambang Budi Siswanto Bambang Irawan Basuki Rahmat Braghmandaru Adhi Bhaskara Budi Yuli Setianto Citra Dewi Wahyu Fitria Dyah Wulan Anggrahini Erika Maharani Evita Devi Noor Rahmawati Firandi Saputra Gharini, Putrika Prastuti Ratna Hafizha Herman Hariadi Hariawan Hasanah Mumpuni Hendry Purnasidha Bagaswoto Indra Widya Nugraha Irmalita I Muhammad Reyhan Hadwiono Putrika PR Gharini Rano Irmawan Vera Dewanto

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