Claim Missing Document
Check
Articles

Validation of Self-Assessment-Based Chest Pain Algorithm (DETAK) as An Early Identification Tool for Acute Coronary Syndrome Nugraha, Krishna Ari; Rohman, Mohammad Saifur; Rahimah, Anna Fuji; Anjarwani, Setyasih; Rizal, Ardian; Astiawati, Tri; Adi, Andi Wahjono; Haryati, Lina
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.5

Abstract

BackgroundThe most common reason of prehospital delay in ACS patients is inability to pay attention to symptoms in order to act fast and effectively. Patient oriented machine learning algorithms has the opportunity to reduce the total ischemic time, that determines the clinical outcome of ACS patients.AimAssessing the accuracy of the chest pain self-assessment algorithm (DETAK) in identifying ACS.MethodThis study included seven hospitals, five PCI capable hospitals and two of non-PCI capable hospitals. The study was conducted from August 2021 to June 2022. The study included all patients with chest pain who visited the hospital and used the DETAK algorithm. Patients were interviewed after being confirmed hemodynamically stable. Patients with UAP, as well as those who died or declined to participate in this study were excluded. The area under the curve receiver operating characteristic (AUROC) was used to verify DETAK's performance in identifying SKA. We compare the DETAK algorithm's diagnosis with the definitive diagnostic based on ECG and/or troponin results.ResultsA total of 539 patients (mean age 58 years) with a higher proportion of male patients (n=424). An AUC value of 0.854 was obtained, where the cut of point accuracy of DETAK in identifying ACS for the entire sample had a sensitivity of 89.5% and a specificity of 81.2%. The algorithm's specificity decreased in certain subgroups, including type 2 diabetes (79.4%), women (77.3%), and hypertensive patients (80.9%). Algorithm reliability test obtained moderate to strong level of agreement values.ConclusionDETAK's self-assessment-based chest pain algorithm offers an excellent diagnostic performance in early identification of ACS.
Pivotal Decision for Acute Coronary Syndrome Patient with Left Main Coronary Artery Disease, When to Choose PCI over CABG Setyowati, Danti Utami; Rohman, Mohammad Saifur; Prasetya, Indra
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.12

Abstract

Background: Surgery is acceptable as a standard treatment of Left Main Coronary Artery (LMCA) Disease in a stable angina condition. But, in Acute Coronary Syndrome (ACS) setting, LMCA intervention is a still clinical challenge in many cardiac centers. Percutaneous coronary intervention (PCI) has emerged as a suitable alternative to coronary artery bypass grafting (CABG) for high-risk complex coronary artery disease (CAD) scenario. This study aimed to outline the management of NSTEMI patient include LMCA disease. Case Report: A 72-year-old male presented with persistent chest pain, with a confirmed NSTEMI. A coronary angiography was done and revealed Three Vessel Disease (TVD) and Left Main (LM) CAD with highly calcified stenosis in the distal LM and Left Anterior Descending (LAD). An early invasive procedure was successfully performed for severely calcified LAD artery and distal LM lesions, using proper selection of several bail-out pre-dilatation difficult attempts such as scoring ballon and rotational atherectomy (RA). We observed the aftercare period, which showed no subsequent ACS events. Conclusion: Managing ACS patients requires careful consideration and risk assessment before deciding on revascularization procedures, especially in high-risk case such as LMCA disease. PCI can be an effective treatment strategy for this population but require good consideration of patient’s anatomical factors, comorbidities, the availability of appropriate skill and equipment.
The Complexity of Premature Coronary Artery Disease Noverike, Nikhen; Rahimah, Anna Fuji; Rohman, Mohammad Saifur
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.2

Abstract

Premature Coronary Artery Disease presents a significant health concern globally, characterized by the onset of coronary atherosclerosis at an early age, typically before the age of 55 in men and 65 in women. This review provides a comprehensive examination of the various aspects of premature CAD, ranging from its underlying pathophysiology to diagnostic modalities such as coronary angiography. Beginning with an overview of the risk factors contributing to premature CAD, including genetic predispositions, lifestyle factors, and metabolic disorders, the review delves into the intricate mechanisms involved in the initiation and progression of atherosclerosis. Furthermore, the review discusses the clinical manifestations and challenges associated with diagnosing premature CAD, particularly in asymptomatic individuals. It examines the utility of non-invasive imaging techniques, stress testing in identifying coronary artery stenosis, cardiovascular risk and the principles of coronary angiography. The review outlines the principles of coronary angiography, including patient preparation, procedural techniques, and interpretation of angiographic findings. In conclusion, this comprehensive review provides insights into the multifaceted nature of premature CAD, elucidating its pathogenesis, clinical presentation, and diagnostic evaluation, with a focus on the pivotal role of coronary angiography in guiding therapeutic interventions and optimizing patient outcomes.
A case report: successful percutaneous coronary intervention (PCI) in unprotected left main and three-vessel coronary artery disease Kahadi, Cik; Rohman, Mohammad Saifur
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.14

Abstract

Background: Left Main Coronary Artery (LMCA) Disease is the highest-risk lesion of coronary artery disease and is related to cardiovascular morbidity and mortality compared to other types of obstructive Coronary Arterial Disease (CAD). Previously, coronary artery bypass grafting (CABG) was the preferred method for revascularization in significant LMCA lesions; however, results from several trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) to CABG showed PCI was non-inferior to CABG in highly selected LMCA patients. This report was to describe the contemporary evidence for PCI to CABG in LMCA Disease.Case Presentation: A diabetic and hypertensive 59-year-old man with stable angina pectoris and Canadian Cardiovascular Society (CCS) Score III was referred to Saiful Anwar Hospital for elective PCI consideration. The patient was diagnosed with left main and three-vessel coronary artery disease from CCTA in 2009 and angiography in 2023, then suggested to CABG for revascularization. However, the patient refused CABG surgery and decided to perform PCI with high-risk criteria after an adequate consultation. Considering the high-risk category and reduced ejection fraction, an elective PCI was performed with intra-aortic balloon pump (IABP) support. Then it implanted 2 DES at distal-LM until distal-LCx. In the following procedure, the patient also implanted 1 DES at mid-distal RCA and was discharged with significant improvement in his quality of life.Conclusion: In selected left main and three-vessel coronary artery disease, PCI is successfully improves the patient's quality of life
Impact of Strict and Lenient Heart Rate Control on Six-Minute Walk Test and Quality of Life in Atrial-Fibrillation Patients with Rheumatic Mitral Stenosis : Randomized Control Trial Dwigustiningrum, Nur Kaputrin; Rizal, Ardian; Putri, Valerinna Yogibuana Swastika; Rahimah, Anna Fuji; Rohman, Mohammad Saifur; Wikananda, Adhika Prastya; Waranugraha, Yoga; Astiawati, Tri; Laitupa, Fitranti Suciati
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.8

Abstract

Background: Recent studies showed no outcome difference between strict and lenient rate control in the general Atrial Fibrillation (AF) population. However, for AF and Rheumatic Mitral Stenosis (RMS) patients, evidences were lacking.Objective: To assess the impact of strict and lenient heart rate control on the Six-Minute Walk Test (SMWT) and Health Related Quality of Life (HRQoL) in patients with AF and RMS.Material and Methods: A prospective multicenter trial across tertiary hospitals in East Java assessed strict and lenient heart rate control's impact on the SMWT and HRQoL in AF and RMS patients. Sixty-one participants were randomized into strict and lenient groups over six months from March to August 2023. Medications were adjusted to achieve target heart rates, and HRQoL was assessed using SF-36 and SMWT at baseline and three months post-target heart rate attainment.Result: In our study, 29 patients were under strict heart rate control, and 32 were under lenient control. We found a decrease in HRQoL across all subscales, with significant differences observed in general health perception and physical function among those under strict control (p=0.002 and 0.03, respectively). However, no significant disparity was found in the SMWT distance difference between lenient and strict groups (p=0.529), nor in METs (p=0.326).Conclusion: In the study, lenient heart rate control demonstrates significant effects on the general health perception and physical function subscales compared to strict heart rate control. 
Hypokalemia Induced Ventricular Arrhythmia In Heart Failure Patient With Complete Revascularization: A Case Report Rochmawati, Icmi Dian; Rizal, Ardian; Rohman, Mohammad Saifur; Prasetya, Indra
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.7

Abstract

BackgroundSudden mortality due to persistent VT or VF accounted for around half of all fatalities in these high-risk individuals. Myocardial ischemia, acute heart failure, electrolyte abnormalities, hypoxia, and drug-related arrhythmogenicity are all risk factors for electrical storms. The most common electrolyte imbalance is hypokalemia.Case illustration:A 54-year-old man was readmitted to ER with palpitations and chest pain. The patient's heart rate was recorded as sinus bradycardia however, shortly the patient developed ventricular tachycardia of approximately 300 beats per minute (bpm) and unstable. Although multiple synchronized cardioversion dosage was administered, the VT reoccurred again. Complete revascularization was demonstrated at his most recent catheterization three months ago. His potassium in the serum was 2.88 mmol/L and corrected with drip KCl. The patient's potassium levels were then normalized stable for the remainder of their hospital stay.ConclusionCareful medication reconciliation is critical for avoiding the potentially fatal cardiovascular effects of severe hypokalemia. Patients with CHF are more likely to have life-threatening hypokalemia and ventricular arrhythmias. The phenotypic expression of ventricular tachycardia in HF results from alterations in neurohormonal signaling, structural remodeling, and electrophysiology.
How to decide appropriate percutaneous coronary intervention (PCI) technique for managing heavy calcified coronary lesions: serial case-report Caesario, Fahreza; Rohman, Mohammad Saifur
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.15

Abstract

Background: Coronary artery calcification (CAC) is still challenging for interventional cardiologists. Their contribution to major adverse cardiac events occurs from the high risk of stent thrombosis or in-stent restenosis and target lesion revascularization. Optimal preparation, such as coronary plaque modification before stenting, is required to reduce the risk of periprocedural adverse events. This case presentation aimed to describe the appropriate management of heavy calcified coronary lesions.Case Presentation: Two cases of heavy calcified coronary lesions with different baselines as Acute Coronary Syndromes (ACS) and elective PCI were presented. In our ACS patients, the Primary PCI was done by coronary angioplasty without stenting because of the complexity of the heavily calcified lesion. A referral to tertiary health care was made for further PCI procedures using a combination of calcium-ablation and balloon-based techniques. A treatable complication occurred after the orbital atherectomy was performed with good results. The second case was an elective PCI patient with heavy calcified lesions findings from coronary angiography. The balloon-based technique was performed using non-compliant and scoring balloons without complication and showed good results.Conclusion: The challenging points in managing heavy calcified coronary lesions are procedure complexity and the higher stent failure rate. Many modifying coronary calcification algorithms using advanced modalities have been proposed, which could be used to select the appropriate technique as experienced and increase the success rate.
Effects of the Low-Dose Colchicine Regimen on Left Ventricular Adverse Remodeling and Systolic Function in Acute Myocardial Infarction Patients With Anterior ST Segment Elevation Undergoing Primary Percutaneous Coronary Intervention: A Randomized Controlled Trial Caesario, Fahreza; Prasetya, Indra; Rohman, Mohammad Saifur; satrijo, Budi; Anjarwani, Setyasih
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.9

Abstract

Background: Inflammation in reperfusion injury results in adverse ventricular remodeling and reduced systolic function. The anti-inflammatory effects of colchicine have shown beneficial effects in cardiovascular disease.Objective: To determine the effects of low-dose colchicine on left ventricular (LV) adverse remodeling and systolic function in acute myocardial infarction with anterior ST-segment elevation (anterior STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).Material and Methods: This prospective, randomized, double-blinded study randomly assigned anterior STEMI patients who underwent PPCI to receive either low-dose colchicine (1mg loading dose followed by 0.5mg daily) or a matching placebo for 30 days in addition to standard therapy. Outcomes included adverse LV remodeling and systolic function, determined by transthoracic echocardiography (TTE) in the first and third month.Result: Enrollment comprised 196 patients, with 92 patients in the colchicine group and 104 patients in the placebo group. Adverse LV remodeling and a decrease in systolic function were observed in both groups. No significant differences in LV remodeling were observed between the colchicine and placebo groups, as indicated by the change in LV end-systolic volume index (LVESVI) at the first month (16.5% vs. 18.25% [p=0.091]) and third month (19.5% vs. 21.5% [p=0.124]). Similar results were found in LV systolic function between the colchicine and placebo groups, with a reduction in LV ejection fraction (LVEF) observed in the first month (6.3% vs. 8.95% [p=0.083]) and third month (9.5% vs. 11.5% [p=0.163]). Diarrhea was the only reported side effect, occurring in 6.5% of patients in the colchicine group.Conclusion: Low-dose colchicine administration in anterior STEMI patients undergoing PPCI did not reduce LV adverse remodeling or systolic function.
Correlation between HbA1c levels and intrastent restenosis incidence in patients with diabetes mellitus after percutaneous coronary intervention at Dr. Saiful Anwar General Hospital Millisani, Hayla Iqda; Prasetya, Indra; Rohman, Mohammad Saifur
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.10

Abstract

Background: Patients with chronic uncontrolled diabetes mellitus as indicated by HbA1c levels ≥ 6.5%, increase the risk of atherosclerosis, thereby increasing in-stent restenosis incidence during and after percutenous coronary intervention. Regular monitoring of HbA1c is crucial to reduce the incidence of in-stent restenosis.Objective: This study aims to ascertain the correlation between HbA1c levels and in-stent restenosis incidence in diabetes mellitus patients after percutenous coronary intervention at Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia.Methods/Design: Analytical observational study with a retrospective cohort study approach to determine the correlation between HbA1c levels and the incidence of in-stent restenosis in patients with diabetes mellitus after percutenous coronary intervention. The research sample was carried out by consecutive sampling in January 2021-December 2023.Results: This study has recruited 555 patients with coronary artery disease and diabetes mellitus. The average age of coronary heart disease patients with diabetes mellitus was 59 years. Patients with HbA1c levels ≥6.5 were more prone to experience in-stent restenosis 54 patients, while those with HbA1c levels <6.5 were more prone not to experience in-stent restenosis 388 patients, indicating a significant correlation between HbA1c and in-stent restenosis p=0.024. in-stent restenosis was most frequently observed in the LAD 44 patients, RCA 13 patients, LCx 10 patients, and LM 0 patient. The highest percentage of in-stent restenosis cases was over 70%, with 3VD lesions being the most common 55 patients. OAD therapy is most often given to coronary heart disease patients with diabetes mellitusConclusion: There is a correlation between HbA1c levels and the incidence of in-stent restenosis in diabetes mellitus patients after percutaneous coronary intervention, underscoring the necessity for routine blood glucose monitoring to prevent in-stent restenosis.
Diagnostic Test for Estimation of Plasma Volume on Assessment of Congestive Status in Acute Heart Failure Patients at Saiful Anwar General Hospital Pamuna, Oktafin Srywati; Prasetya, Indra; Astiawati, Tri; Rohman, Mohammad Saifur; Kurnianingsih, Novi
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.3

Abstract

BackgroundHeart failure is a severe health issue with high death and morbidity rates globally, including in Indonesia. Congestion is the main symptom of acute heart failure. B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are well-known markers to confirm the condition. Plasma volume estimation (ePVS)is one of the procedures currently being developed to assess a patient's congestive status at a lower cost. MethodsThis is descriptive observational research with a cross-sectional study method that included all patients with acute heart failure between May 2019-February 2022. Baseline characteristics, medication history, and echocardiography were also included in the statistical analysis. We used univariate and multivariate analysis to assess the effect of each variable on the patient's congestive condition. A diagnostic test of plasma volume estimation was carried out using Receiver Operating Characteristics (ROC) Analysis compared to NT pro-BNP as the gold standard.   Results A total of 506 subjects were diagnosed with acute heart failure at Dr. Saiful Anwar Malang Hospital, who met the inclusion and exclusion criteria. The mean age was older in congestive patients with 62.5% being male. Patients with congestive conditions have a lower ejection fraction with a higher estimated right atrial pressure from echocardiography. The estimation plasma volume status was also higher in congestive conditions (6,90 vs 3,5). The ePVS from ROC analysis has a good diagnostic value with a sensitivity of 91, 7% and specificity of 92,6%. ConclusionThe estimation of plasma volume status has a good sensitivity and specificity value to assess congestive status in patients with acute heart failure who are fluid-overloaded. 
Co-Authors Achmad Rudijanto Adhika Prastya Wikananda Adi, Andi Wahjono Aditha Satria Maulana Ahsan Ahsan Ainan, Shafa Akbar, Naufal Zulfikar Alfata, Fandy Hazzy Anditri Weningtyas Anita Surya Santoso Anjarwani, Setyasih Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Annisa Hasanah Ardhani Galih Prakoso Ardhino, Ardhino Ardian Rizal Ardian Rizal Ardian Rizal Arief Wibisono Arif Wicaksono Arina Madjidi Ashari, Yordan Wicaksono Astiawati, Tri Aulanni'am Aulanni'am Ayu Asri Devi Ayu Asri Devi Adityawati Aziz, Indra Jabbar Bagus H Kuncahyo Bahar, Mokhamad Aswin Bambang Kusbandono Bambang Rahardjo Bayu Aji Bayu Lestari Budi Satrijo Budi Satrijo Budi Satrijo Caesario, Fahreza Cholid Tri Tjahjono Cholid Tri Tjahjono Cholid Tri Tjahjono Candra Chomsy, Indah Nur Citra Tarannita Dadang Hendrawan Dea Arie Kurniawan Dedy Irawan Dhani, Fauzan Kurniawan Dian Nugrahenny Dian Nugrahenny Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Dwi Adi Nugroho Dwi Adi Nugroho Dwi Adi Nugroho Dwi Sarbini Dwigustiningrum, Nur Kaputrin Efris Kartika Sari, Efris Kartika Endah Kusuma Rastini Evit Ruspiono Fahmi Rusnanta Fahmy Rusnanta Fahmy Rusnanta Fajar, Jonny Karunia Fandy Hazzy Alfatta Faris Wahyu Nugroho Filano, Marco Firdaus, Achmad Jauhar Firdaus, Dylan Hanny Fitranti Suciati Laitupa Ghazyarda Aqilah Setya H Hendarto Harumsari, Stefani Haryati, Lina Hendrawati Hendrawati Heny Martini Hidayat Sujuti Hikmawan Wahyu Sulistomo Hose, Victor Alvianoes Guterez Husnul Khotimah Ika Setyo Rini Ikhwan Handirosiyanto Imelda Krisnasari Imelda Krisnasari Indra Prasetya Indra Prasetya Indra Prasetya Inggita Kusumastuty Irma Kamelia Pratiwi Kahadi, Cik Karolina, Wella Krishna Ari Nugraha Kuhn, Corinna Maria Kurnianingsih, Novi KURNIAWAN, ARY Laitupa, Fitranti Suciati Laukkanen, Noora Julia Lenny Kartika Lestari, Puspa Liemena Harold Adrian Lowry Yunita Lukitasari, Mifetika Martini, Heny Maulidiyatun Nuril Faizah Mifetika Lukitasari Mifetika Lukitasari Mifetika Lukitasari Mifetika Lukitasari Millisani, Hayla Iqda Mohammad Aris Widodo Muchammad Dzikrul Haq Karimullah Muhamad Bayu Aji Muhammad Rizki Fadlan Muhammad Rizki Fadlan Muhammad Rizki Fadlan Nashi Widodo Nashi Widodo Noverike, Nikhen Novi Kurnianingsih Novi Kurnianingsih Novi Kurnianingsih Nugraha, Krishna Ari Nugraha, Yudha Tria Nugrahanti Prasetyorini Nugroho, Ira Vori Nur Ida Panca Nugraheini Nur Ida Panca Nugrahini Nur Permatasari Oktafin Srywati Pamuna Olivia Handayani Olivia Handayani Pamuna, Oktafin Srywati Pande Made Dwijayasa Pawik Supriadi Pawik Supriadi Purbaningroom, Dian Laila Putri Annisa Kamila Putri Annisa Kamila Putri, Valerinna Yogibuana Swastika Rahimah, Anna Fuji Rahma, Oktivani Adelathifa Rahmi, Koyuki Atifa Ratih Kusuma Wardani Ratna Pancasari Ratna Pancasari Renny Suwarniaty Rislan Faiz Muhammad Riswati, Harnanik Puji Riza, Mochamad Faishal Rizal , Ardian Rizal, Ardian Rochmawati, Icmi Dian Rohman, Ibrahim Abdur Sakti, Pradhika Perdana Salvatore Di Somma Sasmojo Widito Satrijo, Budi Seprian Widasmara Setiawan, Dion Setyasih Anjarwani Setyasih Anjarwani Setyowati, Danti Utami Suprayoga, Imam Mi'raj Suryanto Taufieq Ridlo Makhmud Taufiq Nur Budaya Teguh Aryanugraha Teguh Wahyu Sardjono Titi A W Tonny Adriyanto Veny Kurniawati Veny Kurniawati Wella Karolina Widito, Sasmojo Widodo Nashi Widodo Widodo Wikananda, Adhika Prastya Wira Kimahesa Anggoro Wira Kimahesa Anggoro Wiwit Nurwidyaningtyas, Wiwit Yoga Waranugraha Yoga Waranugraha Yoga Waranugraha Yogibuana, Valerinna Yoseph Budi Utomo Yusuf Arifin Zhao, Zihan