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All Journal International Journal of Integrated Health Sciences Majalah Kedokteran Bandung
Augustine Purnomowati
Departemen Kardiovaskular Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Health Professions Medicine & Pharmacology

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Association between Neutrophil-Lymphocyte Count Ratio and Matrix Metalloproteinase-9 in Patients with Acute Myocard Infarction Tiksnadi, Badai Bhatara; Akbar, Muhammad Rizki; Yahya, Achmad Fauzi; Hidayat, Syarief; Purnomowati, Augustine; Aprami, Toni Mustahsani
Majalah Kedokteran Bandung Vol 51, No 1 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (614.44 KB) | DOI: 10.15395/mkb.v51n1.1405

Abstract

The correlation between metalloproteinase-9 (MMP-9) level and neutrophil-lymphocyte count ratio (NLCR) in AMI patients has not been studied despite the fact that they are both known to predict ventricular remodeling. This study aimed to evaluate the correlation between the MMP-9 level and NLCR in patients with acute myocardial infarction. A cross-sectional study was conducted by recruiting acute coronary syndrome patients (onset within 24 hours) who were admitted to the emergency department in several hospitals around Bandung during October-December 2012. The relationship between the MMP-9 level and NLCR was analyzed using Pearson correlation test. Linear regression analysis was used to measure the strength of NLCR in MMP-9 level prediction. Thirty seven patients aged 55.8 + 11 years old were included in this study with mostly male patients (78%). Seventy-six percents of the sample were ST-elevation myocardial infarct (STEMI) patients with the onset of symptoms of 6 (3-14) hours. The mean lymphocyte-neutrophil ratio was 5.24 (1σ±2.4) and the MMP-9 plasma concentration was 370 (240-530) ng/mL. One-sided Pearson correlation showed a positive correlation between the two variables (r=0.44, p=0.003). The linear regression analysis conceived the formula of MMP-9 = 40.87 (NLCR) + 211.3 which was used to show the relationship between the MMP-9 level and lymphocyte-neutrophil ratio. There was a positive moderate correlation between the MMP-9 level and NLCR in patients with AMI. Linear regression analysis shows that NLCR is the only independent variable to predict the MMP-9 plasma level.Key words: Acute myocardial infarct, left ventricular remodeling, matrix metalloproteinase (MMP)-9, neutrophyl-lymphocyte count Ratio (NLCR) Korelasi Rasio Neutrofil-Limfosit (NLCR) dengan Kadar Matriks Metaloproteinase-9 pada Penderita Infark Miokardium AkutKorelasi antara matriks metaloproteinase-9 (MMP-9) dan rasio netrofil-limfosit masih belum pernah dipelajari, meskipun kedua variable tersebut diketahui dapat memprediksi remodeling ventrikel kiri. Studi ini bertujuan mengevaluasi korelasi antara kadar MMP-9 dan rasio netrofil-limfosit pada penderita infark miokardium akut. Penelitian dilakukan secara potong lintang menggunakan sampel darah pasien dengan diagnosis kerja infark miokardium akut (IMA) (onset nyeri dada <24 jam) yang diambil dari beberapa rumah sakit di sekitar Kota Bandung dari periode Bulan Oktober–Desember 2012. Hubungan antara kadar MMP-9 dan rasio neutrofil leukosit dianalisis menggunakan uji korelasi Pearson. Analisis regresi linier digunakan untuk mengukur kekuatan pengaruh konsentrasi rasio neutrofil-limfosit pada kadar MMP-9. Sebanyak 37 pasien berusia 55,8 +11 tahun, dan 78% di antaranya adalah pria menjadi subjek dalam penelitian ini. Tujuh puluh enam persen sampel diantaranya merupakan pasien infark miokardium dengan elevasi ST dengan onset gejala 6 (3–14) jam.  Rerata rasio limfosit-neutrofil adalah 5,24 (1σ ±2,4), dan kadar konsentrasi MMP-9 sebesar 370 (240–530) ng/ml. Uji Korelasi Pearson menunjukkan hubungan positif antara kedua variabel tersebut dengan nilai r=0,44 (p=0,003).  Dari analisis regresi linier didapatkan rumus MMP-9= 40,87 (NLCR) + 211,3, yang digunakan untuk menunjukkan hubungan antara kadar MMP-9 dan rasio limfosit-netrofil. Terdapat hubungan positif antara kadar MMP-9 dan rasio neutrofil-limfosit pada pasien penderita IMA. Analisis regresi linier menunjukkan bahwa hanya rasio neutrofil-limfosit yang menjadi variabel prediktor independen kadar MMP-9.Kata kunci: Infark neutrofil akut, matriks-metaloproteinase 9 (MMP-9), rasio limfosit-neutrofil, remodeling ventrikel kiri
Hubungan Beberapa Faktor Klinis dan Pengobatan Penyakit Arteri Koroner dengan Pembentukan dan Gradasi Kolateral Arteri Koroner Martha, Januar Wibawa; Purnomowati, Augustine
Majalah Kedokteran Bandung Vol 49, No 4 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (550.29 KB) | DOI: 10.15395/mkb.v49n4.1199

Abstract

Penyakit arteri koroner (PAK) ditandai lesi aterosklerosis yang menyebabkan penurunan suplai oksigen ke miokardium. Sebagian pasien PAK membentuk pembuluh kolateral yang menambah suplai darah ke miokardium. Pembentukan kolateral didasari proses angiogenesis dan dipengaruhi oleh berbagai faktor. Aspirin telah digunakan sebagai pencegahan angiogenesis. Penelitian ini bertujuan mencari pengaruh faktor klinis dan pengobatan terhadap pembentukan kolateral koroner. Penelitian ini menggunakan metode potong lintang pada pasien PAK yang dilakukan angiografi koroner. Klasifikasi kolateral koroner dinilai menggunakan kriteria Rentrop. Subjek penelitian dibagi menjadi kolateral baik dan kolateral buruk, ditentukan berdasar atas penilaian intervensionis. Faktor yang dianalisis adalah keluhan angina, obat-obatan, lesi stenosis, dan faktor risiko kardiovaskular. Analisis statistik menggunakan korelasi Spearman dan regresi logistik. Sebanyak 382 pasien diikutsertakan dalam penelitian. Seluruh subjek penelitian memiliki stenosis koroner di atas 80% pada salah satu arteri koroner. Analisis kolateral koroner mendapatkan 164 pasien kolateral baik dan 158 orang kolateral buruk. Secara bivariat, faktor-faktor yang berpengaruh pada pembentukan kolateral koroner yang buruk adalah: penggunaan inhibitor ACE (p=0,048), penggunaan aspirin (p=0,047), oklusi pada pembuluh left circumflex (p=0,032), tidak ada keluhan angina (p=0,036), dan diabetes (p=0,047). Regresi logistik tidak menunjukkan kemaknaan dari faktor-faktor diatas terhadap pembentukan kolateral koroner (p=0,088). Penelitian ini menyimpulkan bahwa aspirin, inhibitor ACE, oklusi pembuluh left circumflex, tidak ada keluhan angina dan riwayat diabetes memiliki potensi untuk menghambat pembentukan kolateral koroner. [MKB. 2017;49(4):274–80]Kata kunci: Faktor klinis, kolateral koroner, penyakit arteri koroner Relationship between Several Clinical and Treatment Factors in Cad Patients in Coronary Collateral Development and Gradation Coronary artery disease (CAD) involves atherosclerotic plaques that caused reduction of myocardial oxygen supply. Some CAD patients develop collaterals which augment myocardial blood circulation. Angiogenesis is a precursor for collateral development and influenced by multiple factors. Aspirin has been used as an angiogenesis inhibitor. This study was intended to elucidate clinical and treatment factors that may affect collateral development. This study employed cross-sectional methodology. Subjects were CAD patients who underwent coronary angiography. Grading of coronary collaterals was classified using Rentrop criteria. Subjects were categorized into poor collaterals and good collaterals, determined by an interventionist. Factors  analyzed were anginal symptoms, medications, stenotic lesions, and cardiovascular risk factors. Data were examined using Pearson or Spearman correlation and logistic regression. A total of 382 patients were selected. All subjects had 80% or more stenotic lesions in one or more coronary arteries. There were 164 patients assigned as good collaterals and 158 patients was assigned as poor collaterals. Factors that hampered collateral development were: ACE (p=0.048) and aspirin (p=0.047) use, occlusion of left circumflex artery (p=0.032), no anginal symptoms (p=0.036) and diabetics (p=0,047). None of these factors was statistically significant in logistic regression (p=0.088). The study concluded that aspirin has a potential to diminish coronary collateral development. [MKB. 2017;49(4):274–80]Key words: Clinical factors, coronary artery disease, coronary collaterals
HUBUNGAN KADAR LEPTIN SERUM DENGAN KOMPLEKSITAS LESI KORONER BERDASARKAN SKOR SYNTAX PADA PENDERITA PENYAKIT ARTERI KORONER STABIL Ashari, Fajar; Aprami, Toni Mustahsani; Akbar, Muhammad Rizki; Purnomowati, Augustine; Martha, Januar Wibawa; Achmad, Chaerul; Martanto, Erwan
Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (165.975 KB) | DOI: 10.15395/mkb.v48n1.730

Abstract

Leptin memiliki peran penting dalam pembentukan plak ateroskleosis dengan mengaktifkan respons sel imun dan respons inflamasi ataupun peran langsung terhadap dinding pembuluh darah koroner. Penelitian terdahulu mengenai hubungan antara kadar leptin serum dan kompleksitas lesi koroner masih menunjukkan kontroversi. Penelitian ini bertujuan mengetahui hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. Metode penelitian berupa observasional, deskriptif, dan analisis korelasi dengan rancangan potong lintang. Subjek penelitian sebanyak 44 orang penderita penyakit arteri koroner (PAK) stabil yang memenuhi kriteria inklusi, menjalani pemeriksaan angiografi koroner di Rumah Sakit Dr. Hasan Sadikin Bandung selama bulan Januari?Mei 2014. Pengambilan sampel darah untuk pemeriksaan kadar leptin serum dilakukan sebelum tindakan angiografi. Kompleksitas lesi arteri koroner dinilai menggunakan skor SYNTAX. Hasil penelitian didapatkan subjek penelitian 84% laki-laki dengan usia rata-rata 54,68 (+10,24) tahun. Indeks massa tubuh rata-rata 24,71 (+ 3,05) kg/m2. Faktor risiko terbanyak adalah dislipidemia (84%), merokok (72%), hipertensi (38,4%), diabetes melitus (22,7%), dan obesitas (4,5%). Median kadar leptin serum 7.242 (780?36.929) pq/mL, nilai rata-rata skor SYNTAX sebesar 19,52 (+9,93). Analisis menggunakan uji korelasi rank-Spearman tidak didapatkan hubungan (p=0,61; r= 0,078). Perbedaan hasil penelitian ini dengan penelitian sebelumnya disebabkan oleh perbedaan subjek dan kriteria penilaian kompleksitas lesi arteri koroner. Simpulan, tidak terdapat hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. [MKB. 2016;48(1):26?31]Kata kunci: Kompleksitas lesi koroner, leptin serum, penyakit arteri koroner stabil, skor SYNTAXCorrelation between Serum Leptin Levels and Complexity of Coronary Artery Lesion based on SYNTAX Score in Patients with Stable Coronary Artery DiseaseAbstractLeptin has been shown to play a potential role in the atherosclerotic plaque formation by activating immune and inflammatory cells or directly acting on the vessel wall. Earlier reports of the correlation of serum leptin levels with the degree of coronary lesion stated are still controversial. This study determined the correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease (SCAD). This is an observational cross-sectional study. Data were collected from January to May 2014 in Dr. Hasan Sadikin Central General Hospital Bandung. Blood samples were collected before angiography procedures. The complexity of coronary artery lesion was assessed using SYNTAX score. There were 44 patients who met inclusion criteria, male 84%, median age 54.68 (+10.24) years. Mean body mass index 24.71 (+ 3.05) kg/m2. Dyslipidemia was the most common risk factor (84%), followed by smoking (72%), hypertension (38.4%), diabetes mellitus (22.7%), and obesity (4.5%). Median leptin level was 7,242 (780-36,929) pq/mL. Mean SYNTAX score was 19.52 (+9.93). Leptin level had no correlation with the complexity of coronary artery lesion (p=0.61, r=0.078). The difference between this study from prior studies might be caused by differences in subject selection and criteria used for complexity of coronary artery lesion. In conclusion, there is no correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease. [MKB. 2016;48(1):26?31]Key words: Complexity of coronary artery lesion, leptin, stable coronary artery disease, SYNTAX score
Hubungan antara QT Variability Index dan Laju Filtrasi Glomerulus pada Penyakit Ginjal Kronik Predialisis Sugiantoro, -; Purnomowati, Augustine; Martakusumah, Abdul Hadi; Achmad, Chaerul
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (708.08 KB)

Abstract

Penderita penyakit ginjal kronik (PGK) mempunyai risiko yang tinggi untuk mengalami aritmia ventrikel dan kematian mendadak (sudden cardiac death/SCD). Angka kejadian SCD pada penderita PGK meningkat seiring dengan menurunnya laju filtrasi glomerulus (glomerular filtration rate/GFR). Mekanisme patofisiologi yang mendasari SCD pada umumnya aritmia ventrikel yang berhubungan dengan ketidakstabilan repolarisasi miokardium. QT variability index (QTVI), suatu indeks yang menggambarkan ketidakstabilan repolarisasi miokardium, merupakan prediktor yang kuat untuk terjadi aritmia fatal dan SCD. Penelitian ini merupakan studi observasi potong lintang untuk menilai hubungan antara QTVI dan GFR pada penderita PGK predialisis dengan GFR <60 mL/menit. Penelitian ini dilakukan pada penderita PGK yang berobat ke Poliklinik Ginjal Hipertensi Rumah Sakit Dr. Hasan Sadikin Bandung periode Oktober–Desember 2011. Penelitian ini melibatkan 51 subjek. Pemeriksaan elektrokardiografi (EKG) istirahat dilakukan pada semua subjek dan selanjutnya dilakukan penghitungan QTVI. Hampir semua subjek menderita hipertensi atau mendapat antihipertensi (94%). Gambaran EKG dengan hipertrofi ventrikel kiri didapatkan pada 37% subjek dan QTVI rata-rata subjek sebesar 0,16 (SD 0,24). Hubungan antara QTVI dan GFR dianalisis menggunakan Spearman’s rank correlation. QT variability index mempunyai hubungan yang bermakna baik dengan GFR (r=-0,816; p<0,001) maupun dengan estimated glomerular filtration rate (eGFR) (r=-0,460; p<0,001). Simpulan, terdapat hubungan sangat kuat antara QTVI dan GFR pada penderita PGK predialisis, makin rendah GFR makin panjang nilai QTVI. [MKB. 2012;44(4):193–98].Kata kunci: Kematian jantung mendadak, laju filtrasi glomerulus, penyakit ginjal kronik, QT variability indexCorrelation between QT Variability Index and Glomerular Filtration Rate in Predialysis Chronic Kidney DiseaseAbstractChronic kidney disease (CKD) patients are at increased risk for ventricular arrhythmia and sudden cardiac death (SCD). The rate of SCD in CKD patients increased as glomerular filtration rate decreased. Sudden cardiac death is generally mediated by ventricular arrhythmias associated with instability of myocardial repolarization. QT variability index (QTVI) as an index of myocardial repolarization instability is a strong predictor for fatal ventricular arrhythmias and SCD. The aim of this study was to evaluate correlation between QTVI and GFR(< 60 >mL/minute) in predialysis CKD patients. This study was done in Kidney and Hypertension Clinic of Dr. Hasan Sadikin Hospital Bandung, from October to December 2011. A total of 51 subjects were included in this study and had their resting electrocardiography (ECG) recorded and QTVI calculated, 94% had hypertension or received anti hypertension, while only 37% fulfilled the ECG criteria for left ventricular hypertrophy. We determined the correlation between QTVI and GFR using Spearman’s rank, with mean QTVI 0.16 (SD 0.24), we had strong and significant correlation between QTVI and GFR (r=-0.816, p <0.001) and moderate correlation between QTVI and estimated glomerular filtration rate (r=-0.460, p<0.001). In conclusions, there is a strong correlation between QTVI and GFR in predialysis CKD patients, the lower GFR the higher QTVI value. [MKB. 2012;44(4):193–98].Key words: Chronic kidney disease, glomerular filtration rate, QT variability index, sudden cardiac death DOI: http://dx.doi.org/10.15395/mkb.v44n4.214
Perbedaan Kadar Adiponektin, Asimetrik Dimetilarginin Plasma, dan Respons Vasodilatasi Arteri Brakialis antara Dewasa Muda dengan Riwayat Bayi Berat Lahir Rendah dan Normal Purnomowati, Augustine; K.S. Kariadi, Sri Hartini; Achmad, Tri Hanggono; C. Mose, Johanes; Setianto, Budhi
Majalah Kedokteran Bandung Vol 44, No 1 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Adiponektin mempunyai efek antiaterogenik, antiinflamasi, sensitizer insulin, dan berperan penting dalam mengatur pertumbuhan janin. Hipoadiponektinemia dapat menyebabkan disfungsi endotel. Risiko penyakit kardiovaskular meningkat pada subjek dengan riwayat bayi berat lahir rendah (BBLR). Penelitian ini bertujuan menganalisis perbedaan kadar adiponektin, asimetrik dimetilarginin (ADMA) plasma dan respons vasodilatasi arteri brakialis melalui tes flow mediated brachial artery (FMBA) antara dewasa muda dengan riwayat BBLR dan bayi berat lahir normal (BBLN), serta korelasi kadar adiponektin dengan fungsi endotel pada BBLR. Penelitian kohor retrospektif dilakukan periode November 2009–Januari 2010 berasal dari Growth Study Cohort Tanjungsari Kabupaten Sumedang. Sebanyak 134 subjek dipilih secara simple random, terdiri atas 67 BBLR dan 67 BBLN yang karakteristik umumnya sama. Analisis multivariat melalui Hotelling’s trace menunjukkan FMBA, kadar ADMA, dan adiponektin berbeda bermakna (p<0,001) antara BBLR dan BBLN. Analisis simultaneous confidence interval menunjukkan kadar adiponektin plasma dan FMBA bermakna lebih rendah (p=0,015 dan p<0,001) pada BBLR dibandingkan dengan BBLN. Korelasi tidak bermakna antara kadar adiponektin dan ADMA (r=-0,16; p=0,176) dan FMBA (r=0,13; p=0,281) BBLR. Kecil peran adiponektin pada disfungsi endotel, mungkin variabel lain berperan, seperti tumor necrosis factor α. Simpulan, terdapat perbedaan kadar adiponektin plasma dan FMBA antara dewasa muda dengan riwayat BBLR dan BBLN, tetapi kecil peran adiponektin pada disfungsi endotel dewasa muda dengan riwayat BBLR. [MKB. 2012;44(1):1–6].Kata kunci: Adiponektin, asimetrik dimetilarginin, BBLR, tes flow mediated brachial arteryDifferences of Plasma Adiponectine, Asymmetric Dimethylarginine and Brachial Artery Vasodilatation Response in Young Adult with Low and Normal Birth Weight HistoryBeside an anti-atherosclerotic, anti-inflammation effect, and a sensitizer insulin, adiponectin also play an important role in fetal growth. Hypoadiponectinemia may lead to endothelial dysfunction. Low birth weight (LBW) has increase risk of cardiovascular disease. The aim of this study was to analyze the differences of plasma adiponectin, asymmetric dimethylarginine (ADMA) level and vasodilatation response of brachial artery by doing flow mediated brachial artery (FMBA) test between young adults with LBW and normal birth weight (NBW), and the role ofadiponectin level in endothelial function of the LBW. This was a retrospective cohort study during November 2009– January 2010, 134 subjects were randomly selected from the Growth Study Cohort of Tanjungsari Sumedang. They consisted of 67 LBW and 67 NBW young adults, with similar basic characteristics. A multivariate analysis via Hotelling’s trace showed that there was a significant difference (p<0.001) for FMBA, ADMA, and adiponectin level, but simultaneous confidence interval measurements indicated that the rate of FMBA and the level of plasma adiponectin were significantly lower (p<0.001, p=0.015, respectively) in LBW compared to NBW. The correlation between adiponectin and ADMA level (r=-0.16, p=0.176), and FMBA (r=0.13, p=0.281) in LBW were not significant, suggesting a small role of plasma adiponectin in endothelial dysfunction of young adults with LBW, other variables could play a role such as tumor necrosis factor α. In conclusions, the level of plasma adiponectin and FMBA are different between LBW and NBW, but the role of adiponectin may be small in endothelial dysfunction in young adults with LBW. [MKB. 2012;44(1):1–6].Key words: Adiponectin, asymmetric dimethylarginine, flow mediated brachial artery, LBW test DOI: http://dx.doi.org/10.15395/mkb.v44n1.72
Hubungan Kadar Apelin dengan Disfungsi Diastol pada Penderita Gagal Jantung dengan Fraksi Ejeksi Normal Rostiati, Dini; Erwinanto, -; Yahya­, Achmad Fauzi; Achmad, Chaerul; Tedjokusumo, Pintoko; Hidayat, Syarief; Purnomowati, Augustine; Aprami, Toni Mustahsani
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Apelin merupakan peptida yang berperan dalam mempertahankan performa jantung pada beban tekanan kronik. Penelitian ini bertujuan menilai hubungan antara kadar apelin dan disfungsi diastol pada penderita gagal jantung dengan fraksi ejeksi normal. Analisis statistik korelasi Spearman-Rank. Penelitian dilakukan di Instalasi Rawat Jalan Jantung dan Divisi Diagnostiik Noninvasif Departmen Kardiologi dan Kedokteran Vaskular Rumah Sakit Dr. Hasan Sadikin Bandung periode Januari–April 2014. Hasil penelitian didapatkan 50 penderita laki-laki sebanyak 24 (48%) dan perempuan 26 (52%), usia rata-rata 58,72 (11,02) tahun, durasi hipertensi 1–30 tahun, median 5 tahun. Indeks massa tubuh rata-rata 24,13 kg/m2. Median tekanan darah sistol 130 (120–180) mmHg, median tekanan darah diastol 90 (70–110)mmHg. Fraksi ejeksi median 65 (49–77%), pengobatan dengan Angiotensin converting enzyme inhibitor (ACEI) sebanyak 48%, calcium channel blocker (CCB) 27%, beta bloker 6%, angiotensin receptor blocker (ARB) 3%, dan diuretik 1%. Pengukuran fungsi diastol, tissue doppler imaging (TDI) rata-rata 10,32, deceleration time rata-rata 228,2 detik, median rasio E/A (early/atrial (late) ventricular filling velocities) 0,77 (0,43–1,53), median isovolumic relaxation time (IVRT) 92 (60–177) detik. Median kadar apelin 1080,5 (993,2–1113) pg/mL. Sebagai simpulan, terdapat korelasi positif antara kadar apelin dan disfungsi diastol yang dihitung dengan TDI (R=0,3445, p=0,014). Apelin dapat digunakan untuk menilai gejala dan prognosis pada penderita gagal jantung dengan fraksi ejeksi normal karena kadarnya meningkat pada beban tekanan disertai fibrosis yang  sedikit dan menurun pada beban tekanan disertai fibrosis yang luas.[MKB. 2015;47(2):91–5]Kata kunci: Apelin, disfungsi diastol, fraksi ejeksi normal, gagal jantung, TDICorrelation between Plasma Apelin Level and Diastolic Dysfunction in Heart Failure Patients with Preserved Ejection Fraction AbstractApelin ia a novel multifunction peptide implicated in cardiovascular performance regulation in chronic pressure overload. Plasma apelin level and its correlation to diastolic dysfunction in patient heart failure with preserved ejection fraction were investigated. Hypertensive patients with heart failure but without coronary artery disease, atrial fibrillation, obese, and diabetes mellitus were enrolled in this study. Each patients underwent plasma apelin measurement and echocardiographic assessment of left ventricular diastolic function. Statistical analysis was conducted using Spearman Rank. Fifty patients,  24 males (48%) and 26 females (52%),  met the inclusion criteria.  The mean age of the participants was 58.72 (11.02) years with a duration of hypertension between 1–30 years, median 5 year. Mean body mass index was 24.13 kg/m2. Systolic blood pressure median was 130 (120–180)mmHg while the diastolic blood pressure median was 90 (70–110)mmHg. Left ventricular ejection fraction median was 65 (49–77)%, treatment with Angiotensin converting enzyme inhibitor (ACEI) was 48%, calcium channel blocker (CCB) was 27%, beta blocker was 6%, angiotensin receptor blocker (ARB) was 3%, and diuretic was 1%. Diastolic function assessment with tissue doppler imaging (TDI) resulted in a mean of 10.32, deceleration time mean of 228.2, E/A (early/atrial (late) filling velocities) ratio median of 0.77 (0.43–1.53),and IVRT (isovolumic relaxation time) median of 92 (59–177). Plasma apelin measurement median was 1080.5 (993.2–11) pg/mL. In conclusion, there is a positive correlation between plasma apelin level and diastolic function (TDI) (R=0.3445, p=0.014). There is no significant correlation between plasma apelin level and diastolic function using other criteria. In conclusion, apelin can be used for assessing symptoms and prognosis of heart failure patients with preserved ejection fraction because apelin level is upregulated when pressure overload occurs with less fibrosis and down-regulated when pressure overload occurs with marked fibrosis. [MKB. 2015;47(2):91–5]Key words: Apelin, diastolic dysfunction, heart failure, preserved ejection fraction DOI: 10.15395/mkb.v47n2.459
Association Between Cardiovascular Risk Factors and CAD Severity by CAD-RADS Categories and Comprehensive CTA Score Raharjo, Pradana Pratomo; Purnomowati, Augustine; Kusumawardhani, Nuraini Yasmin; Astuti, Astri; Achmad, Chaerul; Pramudyo, Miftah; Karwiky, Giky; Akbar, Mohammad Rizki
International Journal of Integrated Health Sciences Vol 13, No 2 (2025)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v13n2.4173

Abstract

Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide, including in Indonesia. Risk factors (RFs) play an important role in both pathogenesis and management of cardiovascular (CV) diseases. Coronary computed tomography angiography (CTA) is a reliable non-invasive diagnostic method. Coronary Artery Disease Reporting and Data System (CAD-RADS) categories and comprehensive CTA score describes CAD severity on coronary CTA and provides additional prognostic value.Objective: To explore the link between traditional cardiovascular risk factors and CAD severity based on CAD-RADS and comprehensive CTA scores.Methods: This retrospective, single-center study was conducted at a tertiary hospital using data from the Cardiovascular Imaging Database of the hospital from January 2020 to June 2022. Data meeting the inclusion and exclusion criteria were analyzed using ordinal and binary regressions.Results: A total of 423 patients' data were analyzed. Ordinal regression revealed significant links between age ≥ 65 years, male gender, hypertension, diabetes, and higher CAD severity based on both CAD-RADS and comprehensive CTA scores. Binary regression showed that older age and male gender were independently associated with CAD-RADS ≥ 3 and comprehensive CTA score ≥ 6. Diabetes was linked to CAD-RADS ≥ 3, and hypertension was tied to a comprehensive CTA score ≥ 6. The number of risk factors showed a trend toward CAD severity (p=0.069) and a significant link with comprehensive CTA score (p=0.012).Conclusion: There is a significant association between traditional cardiovascular risk factors and CAD severity as quantified by both CAD-RADS and comprehensive CTA score.
Co-Authors - Erwinanto, - - Sugiantoro, - Abdul Hadi Martakusumah Achmad Fauzi Yahya, Achmad Fauzi Akbar, Mohammad Rizki ASTRI ASTUTI Badai Bhatara Tiksnadi Budhi Setianto Chaerul Achmad Dini Rostiati, Dini Erwan Martanto Fajar Ashari, Fajar Januar Wibawa Martha Johanes C. Mose Karwiky, Giky Kusumawardhani, Nuraini Yasmin Muhammad Rizki Akbar, Muhammad Rizki Pintoko Tedjokusumo, Pintoko Pramudyo, Miftah Raharjo, Pradana Pratomo Sri Hartini K.S. Kariadi Sri Hartini KS Kariadi Syarief Hidayat Toni Mustahsani Aprami, Toni Mustahsani Tri H Achmad, Tri H Tri Hanggono Achmad Yahya­, Achmad Fauzi