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Coronary Microvascular Dysfunction Doharjo Manullang; Imran Soleh; Rukiah Chodilawati; Syamsu Indra; Ferry Usnizar; Erwin Sukandi; Taufik Indrajaya; Ali Ghanie
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 12 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i12.428

Coronary microvascular dysfunction (DMK) is a condition of patients who are accompanied by complaints of chest pain where the results of coronary angiography examination are normal and this is almost 49% with 60% of patients diagnosed with DMK. Another study said that about 40% of patients with DMK showed coronary flow reserve (CFR <2) of about 40% and the WISE study (Women's Ischaemia Syndrome Evaluation) showed that about 47% of patients with chest pain had normal coronary arteries. DMK can be divided into 4 groups; DMK with no coronary arterial disease (CAD) obstruction and myocardial disease, DMK with myocardial disease where this occurs due to remodeling of intramural coronary arteries, DMK with CAD (coronary arterial disease) or acute myocardial infarction with or without ST segment, iatrogenic typhoid DMK occurs after coronary recanalization caused by vasoconstriction and distal embolization. The mechanism of action of DMK can be caused by several factors, namely endothelial dysfunction, smooth muscle dysfunction, decreased diastolic perfusion time, damage to blood vessels and damage to the vascular and microvascular remodeling. And to enforce this DMK, there are several tests carried out in diagnosing the disease, some of which are invasive and non-invasive so that by enforcing the diagnosis of this disease, treatment for DMK can be done immediately and optimally.

Coronary Microvascular Dysfunction Doharjo Manullang; Imran Soleh; Rukiah Chodilawati; Syamsu Indra; Ferry Usnizar; Erwin Sukandi; Taufik Indrajaya; Ali Ghanie
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 12 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i12.428

Coronary microvascular dysfunction (DMK) is a condition of patients who are accompanied by complaints of chest pain where the results of coronary angiography examination are normal and this is almost 49% with 60% of patients diagnosed with DMK. Another study said that about 40% of patients with DMK showed coronary flow reserve (CFR <2) of about 40% and the WISE study (Women's Ischaemia Syndrome Evaluation) showed that about 47% of patients with chest pain had normal coronary arteries. DMK can be divided into 4 groups; DMK with no coronary arterial disease (CAD) obstruction and myocardial disease, DMK with myocardial disease where this occurs due to remodeling of intramural coronary arteries, DMK with CAD (coronary arterial disease) or acute myocardial infarction with or without ST segment, iatrogenic typhoid DMK occurs after coronary recanalization caused by vasoconstriction and distal embolization. The mechanism of action of DMK can be caused by several factors, namely endothelial dysfunction, smooth muscle dysfunction, decreased diastolic perfusion time, damage to blood vessels and damage to the vascular and microvascular remodeling. And to enforce this DMK, there are several tests carried out in diagnosing the disease, some of which are invasive and non-invasive so that by enforcing the diagnosis of this disease, treatment for DMK can be done immediately and optimally.

The Effect of Angiotensin-Converting Enzyme GenePolymorphism and Angiotensin II Levels in Coronary SlowFlow Phenomenon at Mohammad Hoesin General HospitalPalembang Karlina, Arlis; Indrajaya, Taufik; Ghanie, Ali; Sukandi, Erwin; Usnizar, Ferry; Indra, Syamsu; Chodilawati, Rukiah; Saleh, Imran
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 2
Publisher : UI Scholars Hub

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Introduction. The presence of ACE gene polymorphism is expected to have a role in cardiovascular diseases, including coronary slow flow phenomenon (CSFP). Angiotensin converting enzyme (ACE) gene polymorphism also plays an essential role in increasing angiotensin II levels. Therefore, this study aimed to analyze the effect of angiotensin-converting enzyme gene polymorphism and angiotensin II levels in the coronary slow flow phenomenon in Mohammad Hoesin General Hospital Palembang. Methods. This case-control study was started from July 2019 to July 2020 at RSMH Palembang with 32 subjects for each case (CSFP patients) and the control group (non-CSF patients). This study used a pair of primers and onetimed PCR to detect ACE gene polymorphism. Genetic analysis was carried out in the Biotechnology Laboratory Faculty of Medicine, Universitas Sriwijaya. Statistical analysis was performed using the Spearman correlation test. Results. There were 17 subjects with II genotypes (53.1%), 14 subjects with ID genotypes (43.8%), and 1 subject with DD genotypes (3.1 %) in the CSFP group. While in the non-CSFP group, there were 11 subjects with II genotypes (34.4%), 13 subjects with ID genotypes (42.2%), and 9 subjects with DD genotypes (14.1%). The median value of angiotensin II levels in CSFP and Non-CSF group was 58 pg/mL and 32.8 pg/mL, respectively. The results of the analysis showed that there was an effect of angiotensin II levels on the incidence of CSFP (p=0.001). Further analysis showed that there was a correlation between angiotensin II levels and the I/D 287 bp alu repetitive sequence polymorphism in the intron 16 ACE gene (p=0.030, r=0.822). Conclusions. There was a correlation between I/D 287 bp alu repetitive sequence polymorphism in the intron 16 ACE gene and angiotensin II levels in the coronary slow flow phenomenon at Mohammad Hoesin General Hospital Palembang.

Reperfusion Arrhythmia in Acute Myocardial Infarction Setiadi, Teguh; Taufik Indrajaya; Ali Ghanie; Ferry Usnizar; Erwin Sukandi; Syamsu Indra; Erwin Azmar; Rukiah Chodilawati; Imran Soleh; Yudhie Tanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 12 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i12.894

Management of reperfusion in acute myocardial infarction is an important component of myocardial cell survival to minimize the area experiencing infarction and improve patient clinical outcomes. However, this reperfusion also contributes to myocardial injury which is preceded by the ischemic process. One of the injuries related to the ischemia-reperfusion process in the myocardium is reperfusion arrhythmia. Reperfusion arrhythmias from several studies can begin to occur in the first minutes after restoration of obstructed coronary flow. The features of reperfusion arrhythmia can include accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, and other arrhythmias. The mechanism of reperfusion arrhythmia can be excess calcium in the cells, oxidative stress due to an increase reactive oxygen species, energy metabolism disorders, and neutrophil accumulation. Excessive intracellular calcium and other mechanisms cause a delay in the depolarization of previously ischemic cells. This reperfusion arrhythmia requires special attention because it can disrupt hemodynamics and patient outcomes after reperfusion procedures. Knowledge of the mechanisms of reperfusion arrhythmias will guide clinicians to provide better management during and after reperfusion procedures.

Cardiac Myosin Inhibitors in Hypertrophic Cardiomyopathy: A Head-to-Head Network Meta-Analysis of Mavacamten and Aficamten Imran Saleh; Syamsu Indra; Yenny Dian Andayani; Rukiah Chodilawati; Yuniza
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1360

Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by myocardial hypercontractility. Mavacamten and aficamten are first-in-class cardiac myosin inhibitors that have demonstrated efficacy in treating obstructive HCM. However, in the absence of direct head-to-head randomized controlled trials (RCTs), their comparative effectiveness and safety remain unquantified. We aimed to indirectly compare the efficacy and safety of mavacamten and aficamten in patients with obstructive HCM. Methods: We conducted a systematic review and Bayesian network meta-analysis of RCTs. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to December 2024. Eligible studies were RCTs comparing mavacamten or aficamten with placebo in adults with obstructive HCM. The primary efficacy outcomes were the change from baseline in post-exercise left ventricular outflow tract (LVOT) gradient and the change in peak oxygen consumption (pVO₂). The primary safety outcome was the incidence of left ventricular ejection fraction (LVEF) reduction to <50%. Results: Seven RCTs involving 1,025 patients were included. In the network meta-analysis, both aficamten (Mean Difference [MD], -50.8 mmHg; 95% Credible Interval [CrI], -61.2 to -40.4) and mavacamten (MD, -44.9 mmHg; 95% CrI, -53.7 to -36.1) were significantly more effective than placebo in reducing post-exercise LVOT gradient. The indirect comparison between the two agents did not reveal a statistically significant difference (MD, -5.9 mmHg; 95% CrI, -17.8 to 6.0). For pVO₂, both mavacamten and aficamten showed significant improvement over placebo, with no significant difference between them. The odds of LVEF dropping below 50% were numerically higher with mavacamten compared to aficamten, but the difference was not statistically significant (Odds Ratio [OR], 1.52; 95% CrI, 0.65 to 3.54). Conclusion: Mavacamten and aficamten are both highly effective in improving hemodynamic and functional parameters in patients with obstructive HCM. While our indirect comparison did not establish the superiority of one agent over the other, it provides foundational evidence for clinicians. Definitive conclusions await direct head-to-head clinical trials.

Cardiac Myosin Inhibitors in Hypertrophic Cardiomyopathy: A Head-to-Head Network Meta-Analysis of Mavacamten and Aficamten Imran Saleh; Syamsu Indra; Yenny Dian Andayani; Rukiah Chodilawati; Yuniza
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1360

Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by myocardial hypercontractility. Mavacamten and aficamten are first-in-class cardiac myosin inhibitors that have demonstrated efficacy in treating obstructive HCM. However, in the absence of direct head-to-head randomized controlled trials (RCTs), their comparative effectiveness and safety remain unquantified. We aimed to indirectly compare the efficacy and safety of mavacamten and aficamten in patients with obstructive HCM. Methods: We conducted a systematic review and Bayesian network meta-analysis of RCTs. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to December 2024. Eligible studies were RCTs comparing mavacamten or aficamten with placebo in adults with obstructive HCM. The primary efficacy outcomes were the change from baseline in post-exercise left ventricular outflow tract (LVOT) gradient and the change in peak oxygen consumption (pVO₂). The primary safety outcome was the incidence of left ventricular ejection fraction (LVEF) reduction to <50%. Results: Seven RCTs involving 1,025 patients were included. In the network meta-analysis, both aficamten (Mean Difference [MD], -50.8 mmHg; 95% Credible Interval [CrI], -61.2 to -40.4) and mavacamten (MD, -44.9 mmHg; 95% CrI, -53.7 to -36.1) were significantly more effective than placebo in reducing post-exercise LVOT gradient. The indirect comparison between the two agents did not reveal a statistically significant difference (MD, -5.9 mmHg; 95% CrI, -17.8 to 6.0). For pVO₂, both mavacamten and aficamten showed significant improvement over placebo, with no significant difference between them. The odds of LVEF dropping below 50% were numerically higher with mavacamten compared to aficamten, but the difference was not statistically significant (Odds Ratio [OR], 1.52; 95% CrI, 0.65 to 3.54). Conclusion: Mavacamten and aficamten are both highly effective in improving hemodynamic and functional parameters in patients with obstructive HCM. While our indirect comparison did not establish the superiority of one agent over the other, it provides foundational evidence for clinicians. Definitive conclusions await direct head-to-head clinical trials.

Faktor-Faktor yang Berhubungan dengan Massa Otot, Kekuatan Otot, dan Performa Fisik pada Lansia Riviati, Nur; Indrajaya, Taufik; Chodilawati, Rukiah; Dibyantari, Ridzqie; Indra, Bima
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Introduction. Despite its high prevalence and significant impact on health, comprehensive studies are still needed to explore the factors affecting sarcopenia parameters, such as muscle mass, muscle strength, and physical performance. This study aimed to identify the factors influencing sarcopenia parameters in the elderly, including muscle mass, muscle strength, and physical performance. Methods. A cross-sectional study was conducted from July to December 2022 on elderly individuals (>60 years old) at the Geriatric Polyclinic, Moh. Hoesin General Hospital, Palembang, selected through consecutive sampling. Muscle mass was measured using bioimpedance analysis, expressed in ASMI values; muscle strength was measured using a handheld dynamometer; and physical performance was assessed using the five-time sit-to-stand test. The SARC-F score was classified as normal (<4) and abnormal (≥4). Data on age, gender, serum albumin levels, comorbidities, and Mini Nutritional Assessment Short Form (MNA-SF) scores were collected for correlation analysis and comparison with muscle mass, muscle strength, and physical performance. Results. Of the 41 subjects, the average age was 70.75 (SD 7) years, with 56.1% being female. All subjects had low muscle mass, with an average ASMI of 3.31 (SD 0.59) kg/m² in females and 4.89 (SD 1.06) kg/m² in males. The average muscle strength for females was 16.9 (SD 6.1) kg and for males 27.5 (SD 8.3) kg. The five-time sit-to-stand test result for females was 24.2 (SD 14.2) seconds and for males, 21.8 (SD 11.1) seconds. Based on SARC-F, 8 subjects (19.5%) were categorized as at risk for sarcopenia. Serum albumin levels for all subjects were within the normal range [4.3 (SD 0.3) g/dl]. Malnutrition was found in 14 subjects (34.1%) according to the MNA-SF results. Comorbidities were present in 35 patients. Statistical analysis showed a significant correlation between serum albumin levels and muscle strength (r=0.35; p=0.005) and physical performance (r=-0.5; p<0.001). Nutritional status had no significant effect on the three parameters, but it did significantly affect muscle mass in elderly males (p=0.002). Comorbidities, including cardiovascular disease, non-insulin-dependent diabetes mellitus, and musculoskeletal disorders, were not significantly related to any of the sarcopenia parameters. Conclusions. Serum albumin is significantly associated with muscle strength and physical performance, while nutritional status is significantly associated with muscle mass in elderly males. Comorbidities were not significantly related to muscle mass, muscle strength, or physical performance in the elderly.

Beyond Cholesterol: The Independent Roles of Inflammation and Renal Dysfunction in Carotid Atherosclerosis Among Indonesian Elders Rukiah Chodilawati; Taufik Indrajaya; Ferry Usnizar; Sudarto; Irsan Saleh
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1386

Background: Atherosclerosis remains a leading cause of mortality in aging populations, driven by a complex interplay of metabolic and inflammatory factors. While dyslipidemia is a cornerstone of risk, the contributions of systemic inflammation, marked by high-sensitivity C-reactive protein (hsCRP), and declining renal function are increasingly recognized. This study aimed to elucidate the independent associations of hsCRP, dyslipidemia, and renal function with the presence of carotid atherosclerosis in an understudied elderly Indonesian population. Methods: We conducted a single-center, case-control study at a tertiary hospital in Palembang, Indonesia, from January to June 2024. One hundred participants aged ≥60 years were enrolled from the geriatric outpatient clinic. Cases were defined by the presence of carotid plaque, identified via B-mode Doppler ultrasound, and defined according to international consensus criteria. Controls had no evidence of plaque. We performed multivariate logistic regression to identify independent predictors of atherosclerosis, including hsCRP, lipid parameters, and estimated glomerular filtration rate (eGFR). Results: After multivariable adjustment, three factors emerged as significant, independent predictors of carotid atherosclerosis. High total cholesterol (≥200 mg/dL) was the most powerful predictor, associated with a more than seven-fold increased odds of plaque (Adjusted Odds Ratio [aOR]: 7.38; 95% Confidence Interval [CI]: 2.87–18.94; p<0.001). Elevated hsCRP (≥2 mg/L) (aOR: 3.38; 95% CI: 1.33–8.59; p=0.005) and abnormal eGFR (≤90 mL/min/1.73m²) (aOR: 3.36; 95% CI: 1.10–10.22; p<0.001) were also robustly associated with atherosclerosis, each conferring over a three-fold increase in odds. Conclusion: In this elderly Indonesian study, dyslipidemia remains a dominant risk factor for carotid atherosclerosis. However, systemic inflammation (high hsCRP) and mild renal dysfunction (abnormal eGFR) are also powerful, independent contributors. These findings highlight the multifactorial nature of atherosclerosis and underscore the importance of a comprehensive risk assessment that extends beyond traditional lipid profiling to include markers of inflammation and renal health.

Beyond Cholesterol: The Independent Roles of Inflammation and Renal Dysfunction in Carotid Atherosclerosis Among Indonesian Elders Rukiah Chodilawati; Taufik Indrajaya; Ferry Usnizar; Sudarto; Irsan Saleh
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1386

Background: Atherosclerosis remains a leading cause of mortality in aging populations, driven by a complex interplay of metabolic and inflammatory factors. While dyslipidemia is a cornerstone of risk, the contributions of systemic inflammation, marked by high-sensitivity C-reactive protein (hsCRP), and declining renal function are increasingly recognized. This study aimed to elucidate the independent associations of hsCRP, dyslipidemia, and renal function with the presence of carotid atherosclerosis in an understudied elderly Indonesian population. Methods: We conducted a single-center, case-control study at a tertiary hospital in Palembang, Indonesia, from January to June 2024. One hundred participants aged ≥60 years were enrolled from the geriatric outpatient clinic. Cases were defined by the presence of carotid plaque, identified via B-mode Doppler ultrasound, and defined according to international consensus criteria. Controls had no evidence of plaque. We performed multivariate logistic regression to identify independent predictors of atherosclerosis, including hsCRP, lipid parameters, and estimated glomerular filtration rate (eGFR). Results: After multivariable adjustment, three factors emerged as significant, independent predictors of carotid atherosclerosis. High total cholesterol (≥200 mg/dL) was the most powerful predictor, associated with a more than seven-fold increased odds of plaque (Adjusted Odds Ratio [aOR]: 7.38; 95% Confidence Interval [CI]: 2.87–18.94; p<0.001). Elevated hsCRP (≥2 mg/L) (aOR: 3.38; 95% CI: 1.33–8.59; p=0.005) and abnormal eGFR (≤90 mL/min/1.73m²) (aOR: 3.36; 95% CI: 1.10–10.22; p<0.001) were also robustly associated with atherosclerosis, each conferring over a three-fold increase in odds. Conclusion: In this elderly Indonesian study, dyslipidemia remains a dominant risk factor for carotid atherosclerosis. However, systemic inflammation (high hsCRP) and mild renal dysfunction (abnormal eGFR) are also powerful, independent contributors. These findings highlight the multifactorial nature of atherosclerosis and underscore the importance of a comprehensive risk assessment that extends beyond traditional lipid profiling to include markers of inflammation and renal health.

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