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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Indonesian Journal of Cardiology ACI (Acta Cardiologia Indonesiana) Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Journal of Community Empowerment for Health Berita Kedokteran Masyarakat Indonesian Journal of Biomedicine and Clinical Sciences
Dyah Wulan Anggrahini
Department Of Cardiology And Vascular Medicine, Faculty Of Medicine, Public Health And Nursing Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesi
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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T Peak–T End Interval Alteration as Parameter of Successful Fibrinolysis in Patients with ST Segment Elevation Acute Myocardial Infarction Windhi Dwijanarko; Erika Maharani; Dyah Wulan Anggrahini
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.29681

Abstract

Background: In STEMI patients, the duration of action potential dispersion occurs between normal and ischemic tissue due to the lengthening of the refractory period, causing transmural dispersion of repolarization, which could be detected with Tp-Te interval prolongation on the electrocardiogram (ECG). Benefits of fibrinolytic therapy in patients with STEMI has been demonstrated, with reduced mortality significantly and improve coronary patency in order to increase myocardial perfusion. The goal of this study was to determine Tp-Te interval alteration in STEMI patients before and after the fibrinolytic therapy between successful fibrinolysis compared to failed fibrinolysis. Method: Cross-sectional study was conducted to collect ECG from medical records at Dr. Sardjito General Hospital in January–September 2016. STEMI patients with onset less than 12hours whom reperfused with fibrinolytic therapy were registered. Tp-Te interval was measured before, soon after (0 minute), and 30 minutes after fibrinolysis with successful and failed results. The unpaired t-test analysis was used to compare Tp-Te interval alteration after fibrinolysis. Then, ΔTp-Te cut-off value was determined to find sensitivity and specificity based on ROC. Result: Among 84 patients enrolled in this study, 46 patients with successful fibrinolysis and 38patients with failed fibrinolysis. Both of groups had Tp-Te interval prolongation before fibrinolysis, with mean value of 120.30 ± 13.02 ms in successful fibrinolysis group and 118.57 ± 15.24 ms in failed fibrinolysis group. In successful fibrinolysis group, Tp-Te interval reduced significantly with ΔTp-Te value of 17.55 ± 13.35 ms on 0 minute and 20.85 ± 15.62 ms on 30 minutes after fibrinolysis, while in failed fibrinolysis group there was not a decrease of Tp-Te interval with ΔTp-Te value of -0.77 ± 11.00 ms on 0 minute (p <0.001) and -1.53 ± 14.35 ms on 30 minutes after fibrinolysis (p <0.001). Cut-off value ΔTp-Te 20 ms had sensitivity 52.2% and specificity 94.7% based on ROC, with strong discriminator value of AUC (0.888). Conclusion: There was a greater reduction of Tp-Te interval in STEMI patients with successful fibrinolysis compared to failed fibrinolysis, so it may be used as a alternative parameter of successful fibrinolysisKeywords: STEMI; Tp-Te interval; fibrinolysis
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

Abstract

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.
Pericardial and Pleural Effusion in Patient with Relapse Stage IV Breast Cancer: Same Pathology, Different Etiology? Vienna Rosalinda; Anggoro Budi Hartopo; Dyah Wulan Anggrahini; Bambang Irawan
ACI (Acta Cardiologia Indonesiana) Vol 4, No 2 (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.40856

Abstract

Pericardial effusion associated with malignacy has poor prognosis. The prompt identification of etiology is mandatory, such that timely management can be performed and survival can be increased. However, difficulty in etiology determination is commonly encountered. In this case, we report female patient with relapse stage IV breast cancer who develop massive pericardial and bilateral pleural effusion. The similar characteristics were found in both effusion fluids, however the identification of etiology was not similar. Metastatic cells were found in pleural effusion, whereas they were absent in pericardial effusion.
Neurohumoral Pathway in Heart Failure Dyah Wulan Anggrahini
ACI (Acta Cardiologia Indonesiana) Vol 5, No 1 (P) (2019): Proceedings Jogja Cardiology Update 2019 (JCU2019)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (644.223 KB) | DOI: 10.22146/aci.47798

Abstract

Heart Failure is now considered as one of the leading cause for mortality and morbidity. It is affecting several organs and cause organ damages due to the myocardial failure to pump inadequate oxygenated blood to the body including metabolites, to end organs and peripheral tissues.  Heart failure results from multifactorial mechanism including neurohumoral activations including increased activity of the sympathetic nervous system, renin-angiotensin aldosteron system, vasopression and the atrial natriuretic peptide. This neurohumoral pathway has significant contribution to the development of myocardial dysfunction that lead to clinical manifestation of heart failure. Some of the markers in these pathways have now been considered as an independent predictors of prognosis in heart failure patient.
The BMPR2, ALK1 and ENG Genes Mutation in Congenital Heart DiseaseAssociated Pulmonary Artery Hypertension Anggoro Budi Hartopo; Dyah Wulan Anggrahini; Noriaki Emoto; Lucia Kris Dinarti
ACI (Acta Cardiologia Indonesiana) Vol 5, No 2 (2019)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (750.759 KB) | DOI: 10.22146/aci.50222

Abstract

The gene mutation is one of the background underlie the pathogenesis of pulmonary artery hypertension (PAH). Several genes have been recognized to be responsible for the development of PAH. The mutation in transforming growth factor-β (TGF-β) pathway is considered to be major genotype background in heritable PAH. The genetic mutation in bone morphogenetic protein receptor-2 (BMPR2), activin receptor-like kinase 1 (ALK-1) and endoglin (ENG) are known to cause heritable PAH. In congenital heart disease–associated PAH (CHDAPAH), their mutation are also presence.
LIPOPROTEIN(a) DAN KEBAHAYAAN SINDROM KORONER AKUT Ira Puspitawati; Setyawati Setyawati; Dyah Wulan Anggrahini; Diah Saraswati; Aisyah Ratna Yuniarti
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 21, No 2 (2015)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v21i2.1104

Abstract

One of the risk factors of Acute Coronary Syndrome (ACS) still controversial is Lipoprotein(a). Lp(a) is one of the lipid componentshighly homologous to plasminogen and which may compete with it in the fibrinolytic pathway and has an atherogenic effect. Prior to thestudy many variaties in results have been shown. These variations are related to different population and ethnics, thus, the researcherswere triggered to investigate the role of Lp(a) on the ACS in the Indonesian population. This case control study was conducted at theSardjito General Hospital, Yogyakarta, Indonesia consisting of 40 participants in ACS as the case group and other 40 persons sufferingfrom Stable Angina Pectoris (SAP) as a control group. This study lasted from May−December 2011. The Lp(a) was measured usingturbidimetric immunoassay method while other laboratory results were obtained from the medical records. The results of this studyshowed that high Lp(a) level (more than 30 mg/dL) was the risk factor of ACS (RR=2.818, CI: 1.069–7.426). There was no difference ofthe baseline characteristics such as: the history of hypertension, diabetes mellitus, smoking, as well as in other laboratory parameters suchas: lipid profile, hemoglobine and uric acid level in the case as well as the control group. Significant differences were found in leucocytenumber, creatinine and blood glucose level. The median level of those parameters was found higher in the case group.
The screening of heart disease by cardiac auscultation and electrocardiography examination in pregnant women in Puskesmas Tegalrejo, Yogyakarta, Indonesia Lucia Kris Dinarti; Detty Siti Nurdiati; Anggoro Budi Hartopo; Fika Humaeda Assilmi; Alifia Salsabila; Vera Dewanto; Armalya Pritazahra; Muhammad Reyhan Hadwiono; Muhammad Gahan Satwiko; Erna Ashlihah Rochmat; Nu Pravitasari; Dyah Wulan Anggrahini
Journal of Community Empowerment for Health Vol 4, No 3 (2021)
Publisher : Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jcoemph.64970

Abstract

Women adapt to pregnancy through multi-organ system physiologic changes, including cardiovascular adaptations. These changes affect those with pre-existing cardiovascular problems differently, and subsequently lead to higher probability of death caused by cardiovascular diseases during pregnancy. Therefore, detection of cardiovascular disease early in pregnancy is important to lower maternal morbidity and mortality by providing prompt and adequate management. This study aimed to evaluate and test the feasibility of integrating 12-lead electrocardiogram (ECG) examination and antenatal care (ANC) screening as a simple and effective method for early detection of heart abnormality in pregnant woman. Pregnant women were recruited in this study in any trimester who attended ANC for a routine pregnancy examination in Puskesmas Tegalrejo Yogyakarta. The subjects underwent primary screening which focused on cardiac auscultation and 12-lead ECG examinations, and those who had abnormal findings were further followed-up in secondary screening by using trans-thoracic echocardiography to confirm heart abnormality. A total of 523 pregnant women from Puskesmas Tegalrejo were included in this study. 15 (2.8%) pregnant woman were suspected to have heart abnormalities; from those, 3 (0.5%) were found with heart murmurs with abnormal ECG readings, 1 (0.19%) had heart murmurs with normal ECG results, and 11 (2.1%) had abnormal ECG readings only. The secondary screening of those patients resulted in 1 (0.19%) pregnant woman who was diagnosed with Atrial Septal Defect. Our study found that among 15 patients identified with suspected ECG abnormalities, one mother who underwent ANC was newly diagnosed with a pre-existing cardiac abnormality. Our study concluded this screening method is a simple and feasible integrated heart screening program that can be implemented widely. We hope this integrated heart screening program may benefit pregnant women who may have cardiac abnormalities to be detected as early as possible, thus reducing maternal morbidity and mortality.
Pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) ratio changes after sildenafil therapy in uncorrected congenital heart disease-associated pulmonary arterial hypertension Evita Devi Noor Rahmawati; Putrika Prastuti Ratna Gharini; Anggoro Budi Hartopo; Lucia Kris Dinarti; Dyah Wulan Anggrahini
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 55, No 1 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005501202305

Abstract

Pulmonary vascular resistance (PVR) to systemic vascular resistance (SVR) ratio is a prognostic predictor in congenital heart disease (CHD)-associated pulmonary arterial hypertension (PAH) after defect correction. Sildenafil, widely used as a PAH drug, can decrease PVR with minimal or without changes in SVR, resulting in decreased PVR/SVR ratio after treatment. However, there is limited evidence that PVR/SVR ratio reduced after sildenafil therapy in uncorrected CHD-associated PAH patients. This study aimed to investigate the decreasing of the PVR/SVR ratio after ≥ 1-year oral sildenafil therapy in adult uncorrected CHD-associated PAH. A total of 30 uncorrectable CHD-associated PAH subjects derived from the COHARD-PH registry were included in this study. Right heart catheterization (RHC) was performed during the first visit and further evaluations were conducted after ≥1-year oral sildenafil therapy. The PVR/SVR ratio at the baseline and after the evaluation was collected. The primary outcome of this study was the changes in PVR/SVR ratio from baseline to evaluated RHC. Characteristic analysis of subjects with decreased PVR or PVR/SVR ratio was perforemd as the secondary outcome. The mean PVR and SVR were not different from baseline and evaluated RHC (15.98± 10.67 vs. 18.38±13.93 WU, p=0.206 and 36.65±13.99 vs. 39.34±15.46 WU, p=0.262). There was no significant difference in the baseline PVR/SVR ratio and the evaluated PVR/SVR ratio after ≥1-year sildenafil therapy (0.48 ±0.32 vs. 0.49±0.36; p=0.882). As much as 15 subjects (50%) experienced decreased PVR/SVR ratio. However, there was no significant difference in the characteristics, including age, Eisenmenger syndrome, type of shunts, baseline PVR, PAH-specific treatment, and baseline NT-proBNP level (p>0.05). In conclusion, sildenafil therapy does not change PVR/SVR ratio in adults with uncorrected CHD-associated PAH.
Reconsidering the limited role of right heart catheterization on severe pulmonary hypertension-due to progressive interstitial lung disease in young male patient : a case report Megawati Abubakar; Anggoro Budi Hartopo; Ika Trisnawati; Eko Budiono; Dyah Wulan Anggrahini; Lucia Kris Dinarti
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 55, No 2 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005502202307

Abstract

Pulmonary hypertension (PH)-associated with interstitial lung disease (ILD) develops as a consequence of progressive underlying lung disease or disproportionately to the underlying disease. The PH investigation by right heart catheterization (RHC) for defining PH severity is recommended in patients with ILD who show more severe symptoms than expected from lung disease, appearance of right heart failure, and clinical deterioration not matched by the declining lung function. In patient with progressive ILD, RHC is only considered if it affects the future treatment such as lung transplantation or enrollment in clinical trial/registry. The decision to undertake the RHC in progressive ILD was still fraught with doubts. Here we reported a young adult male patient with ILD whom developed progressive signs and symptoms.  By RHC, he had severe precapillary PH with hemodynamic parameters indicated the presence of pulmonary vascular disease. A PH-specific treatment, sildenafil citrate, was administered, and patient responded well and was clinically stable during the addition of sildenafil citrate. This case highlights the clinical implication of performing RHC in progressive ILD, which can change the treatment decision by PH-specific drugs. Therefore, the RHC decision making in patient with progressive ILD need reconsideration.
Congenital heart disease screening program in elementary schools: a research-based policy Lucia Kris Dinarti; Anggoro Budi Hartopo; Muhammad Reyhan Hadwiono; Abdul Majid Halim Wiradhika; Andreasta Meliala; Likke Prawidya Putri; Prahesti Fajarwati; Dyah Wulan Anggrahini
BKM Public Health and Community Medicine Vol 39 No 01 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v39i01.5783

Abstract

Purpose: CHD is a condition where heart abnormalities develop before birth and can lead to severe complications such as heart failure and premature death, especially among younger adults. Delayed diagnosis and treatment worsen the situation for CHD patients. Early screening can prevent CHD and ensure timely interventions. This study discusses the latest advancements in CHD screening for primary school children and the valuable insights gained from the program. Method: The CHD screening program in Yogyakarta province involved three stages: consolidation, implementation, and incorporation. During the consolidation stage, key decision-makers in the province and local health offices were involved. Primary healthcare workers and primary school teachers were trained to deliver the screening during the implementation stage. Stakeholders, health workers, and teachers were invited to discuss the results, and the Provincial Governor's office was engaged during the incorporation stage. Results: In 2018–2019, 18 CHDs were identified from 6,116 school-age children in 4 districts in Indonesia. The screening program was led by academics in the Universitas Gadjah Mada through 3 stages: consolidation, implementation, and incorporation. Strong collaboration with local stakeholders has contributed to the program's success in engaging 130 schools, 60 community health centers, and 190 health workers. Several opportunities for improvement are: strengthening the capacity and number of health providers at health centers to screen CHDs using 12-lead electrocardiography, addressing patients' reluctance to visit the health facility due to the COVID-19 pandemic, and motivating parents to have their children checked. Conclusion: CHD screening using 12-lead electrocardiography and auscultation should be part of primary school health screenings. Academics can train health workers, and local governments can provide funding and prepare health facilities for follow-up treatment.
Co-Authors Abdul Majid Halim Wiradhika Abdul Majid Halim Wiradhika Abdul Majid Halim Wiradhika Abdus Samik Wahab Ahmad Hamim Sadewa Aisyah Ratna Yuniarti Alifia Salsabila Andreasta Meliala Anggia Endah Satuti Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Anggoro Budi Hartopo Armalya Pritazahra Armalya Pritazahra Azhafid Nashar Bambang Budi Siswanto Bambang Irawan Budi Yuli Setianto Citra Dewi Wahyu Fitria Detty Siti Nurdiati Diah Saraswati Eko Budiono Erika Maharani Erna Ashlihah Rochmat Evita Devi Noor Rahmawati Fika Humaeda Assilmi Firandi Saputra Gharini, Putrika Prastuti Ratna Hariadi Hariawan Hasanah Mumpuni Hendry Purnasidha Bagaswoto Ika Trisnawati Ira Puspitawati Krisdinarti, Lucia Likke Prawidya Putri Lucia Kris Dinarti Lucia Kris Dinarti Lucia Kris Dinarti Lucia Kris Dinarti Lucia Kris Dinarti Lucia Kris Dinarti Lucia Krisdinarti Lucia Krisdinarti Maemonah, Maemonah Megawati Abubakar Muhammad Gahan Satwiko Muhammad Gahan Satwiko Muhammad Reyhan Hadwiono Muhammad Reyhan Hadwiono Muhammad Reyhan Hadwiono Muhammad Reyhan Hadwiono Ni Made Elva Mayasari Noriaki Emoto Nu Pravitasari Prahesti Fajarwati Putri, Naila Vinidya Rochmat, Muflihatul Baroroh Setyawati Setyawati Vera Dewanto Vera Dewanto Vienna Rosalinda Windhi Dwijanarko