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Ganesja M Harimurti
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia National Cardiovascular Center “Harapan Kita”, Jakarta, Indonesia
Health Professions Medicine & Pharmacology

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Estimasi Tekanan Atrium Kanan Dengan Rasio Gelombang E/Ea Katup Trikuspid Yasmina Hanifah; Amiliana M Soesanto; Ismoyo Sunu; Ganesja M Harimurti
Jurnal Kardiologi Indonesia Vol. 31, No. 1 Januari - April 2010
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v31i1.151

Abstract

Background. Right atrial pressure is one of hemodynamic parameter that can guide therapy for patients in intensive care unit. Right atrial pressure is also needed for calculation of other hemodynamic parameter such as pulmonary pressure and systemic vascular resistance. Estimation of right atrial pressure using E/Ea ratio is not much studied until now. There were only three studies with different result. This study objective is therefore to asses the correlation and agreement of estimation right atrial pressure by using ratio E wave (spectral doppler) and Ea wave (tissue doppler imaging) from tricuspid valve. Methods.This is a diagnostic test with cross sectional design study in patients in Cardiovascular Care Unit (CVCU) who had been inserted central venous pressure line (CVP line). E wave was taken from tricuspid inflow with pulsed wave spectral doppler and Ea wave was taken from the lateral tricuspid annulus with tissue doppler imagingat at early diastolic filling. Correlation analysis was performed to assess the correlation of E/Ea ratio with right atrial pressure from CVP line. The result of E/Ea ratio liner regrresion is analyzed with bland altman plot to asses agreement between E/Ea ratio and invasive methods of CVP line. Data was analyzed using SPSS 15.0.Results.There were 50 from 16 sample. As many as 20 data was also also measured by second observer for interobserver variability. There was a good precision for inter and intraobserver with ICC > 0,8. There was good correlation between E/Ea ratio with right atrial pressure, r = 0.728, p < 0,001. Cut off point E/Ea >3,95 could predict right atrial pressure = 10 mmHg (sensitvity 73,1% and specificity 70,8% and positive predictive value 73% and negative predictive value 73,9%). The agreement between E/Ea ratio and CVP line for measuring right atrial prssure was poor, with Intra-class Correlation(ICC) 24% and percentage error more than 30%. Based on this agreement right atrial pressure estimated by E/Ea ratio could have difference as much as 0,01 +3,53 mmHg. Conclusion.There were good correlation but poor agreeement for right atrial pressure estimation by using E/Ea ratio.
Hiperviskositas Pada Penyakit Jantung Bawaan (PJB) Sianotik Febtusia Puspitasari; Ganesja M Harimurti
Jurnal Kardiologi Indonesia Vol. 31, No. 1 Januari - April 2010
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v31i1.157

Abstract

Increased whole blood viscosity in adults with cyanotic congenital heart disease (CCHD) is an unavoidable result of secondary erythropoiesis and it showed a significant bleeding tendency. The most frequently disturbance of hemostasis are thrombocytopenia and defective platelet aggregation. Acute phlebotomy without volume replacement in patients with hypoxic polycythemia may result in vascular collapse, cyanotic spells, cerebral vascular accidents (CVA), or seizures and repeated phlebotomies may also increase the risk of a CVA by causing chronic iron deficiency.
Hubungan Durasi QRS Awal Dengan Derajat Reperfusi Miokard Setelah Angioplasti Koroner Perkutan Primer Andre P Ketaren; Ganesja M Harimurti; Ismoyo Sunu
Jurnal Kardiologi Indonesia Vol. 30, No. 1 Januari - April 2009
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v30i1.173

Abstract

Background.Reperfusion therapy in acute myocardial infarction aims at early and sustained reperfusion of the myocardium at risk. However, even when TIMI flow 3 is achieved, some patients have less optimal reperfusion at myocardial tissue level. QRS duration before reperfusion therapy was showed as a predictor of myocardial reperfusion after fibrinolytic therapy, but currently there is no data showing relationship between QRS dura-tion at admission with myocardial reperfusion after primary percutaneous coronary intervention (primary PCI).Methods.A case control study was conducted to study the relationship between QRS duration at admission with myocardial reperfusion after pri-mary PCI. Myocardial reperfusion was assessed by myocardial blush grade (MBG), and was grouped as optimal reperfusion (MBG 2-3) and impaired reperfusion (MBG 0-1).Results.There were 41 patients fulfilling study criteria. Thirty one patients had optimal reperfusion and 10 patients had impaired reperfusion. Impaired reperfusion group had longer QRS duration (103 +14 vs 91 +12 ms; p = 0,013) and were older (63,9 +12,2 vs 53,7 +10,3 years, p = 0,023). The two groups were similar in terms of gender, diabetes, hypertension, dyslipidemia, smoking status, pain-to-door time, pain-to-balloon time, infarct-related artery location, and TIMI flow. Multivariate analysis showed that longer QRS duration was associated with impaired reperfusion after primary PCI (OR: 21.7, p = 0.014). QRS duration of more than 105 ms was a predictor of impaired reperfusion after primary PCI, with 84% sensitivity and 62% specificity.Conclusions.Longer QRS duration at admission is a predictor of impaired myocardial reperfusion after primary PCI. Patients with STEMI who have QRS duration of more than 105 ms should be considered to be at higher risk of impaired reperfusion after primary PCI.
Hipertensi Pulmonal Persisten Segera Setelah Balloon Mitral Valvuloplasty Irwan H Siahaan; Manoefris Kasim; Amiliana M Soesanto; Ganesja M Harimurti
Jurnal Kardiologi Indonesia Vol. 29, No. 3 September - Desember 2008
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v29i3.182

Abstract

Background.Pulmonary hypertension frequently complicates mitral stenosis. Increased pulmonary artery pressure results from raised left atrial pressure, pulmonary arteriolar vasoconstriction, and obliterative changes in the pulmonary vascular bed, and usually responds to relief of mitral stenosis. However, severe pulmonary hypertension may persist after mechanical relief of mitral stenosis.Methods.A case cross sectional study was conducted in mitral stenosis patients to study the immediate effect of BMV for severe pulmonary hypertension. Pulmonary hypertension was assessed by echocardiography before procedur and 24 – 72 hours after procedure. Analysis was done to assess the relation of age, gender, left atrial size, gradient across mitral valve, mitral valve area and systolic PA pressure before procedure on the persistency of severe pulmonary hypertension.Results.There were 183 patients with mitral stenosis were found in January 2007 – December 2008. Seventy three were severe pulmonary hypertension (systolic PAP = 80 mmHg) and 61 patients were mild – moderate pulmonary hypertension ( systolic PAP < 80 mmHg). Only 54 patients were fulfilling study criteria. Of 54 cases included to analysis, 66.7% were female, 70.4% were in sinus rhytm and had age of 35.44 ± 10.55 yo. The mean mitral valve gradient (MVG) decreased from 18.53 ± 6.40 to 8.50 ± 4.84 mm Hg (p< 0.001). Mitral valve area (MVA) increased from 0.76 ± 0.26 to 1.36 ± 0.36 cm 2 (p < 0.02). LA diameter decreased from 52.87 ± 7.14 to 49.13 ± 7.35 mm (p = 0.01). The pulmonary artery systolic pressure decreased from 100.48 ± 15.77 to 79.83 ± 17.49 mm Hg (p< 0.001). Systolic PAP > 95 mmHg was associated with persistency of PH in mitral stenosis patients with 58% sensitivity and 30% specificity.Conclusions.The degree of Systolic PAP before BMV is associated with persistency of severe pulmonary hypertension. Systolic PAP > 95 mmHg was associated with persistency of PH in mitral stenosis patients with 58% sensitivity and 70% specificity.
Co-Authors Amiliana M. Soesanto Andre P Ketaren Febtusia Puspitasari Irwan H Siahaan Ismoyo Sunu Manoefris Kasim Yasmina Hanifah