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All Journal Journal of Tropical Life Science : International Journal of Theoretical, Experimental, and Applied Life Sciences Jurnal Kedokteran Brawijaya MNJ (Malang Neurology Journal) Heart Science Journal Journal of Psychiatry Psychology and Behavioral Research (JPPBR) Engagement: Jurnal Pengabdian Kepada Masyarakat
Novi Kurnianingsih
Brawijaya Cardiovascular Research Center Department Of Cardiology And Vascular Medicine Faculty Of Medicine, Universitas Brawijaya Malang
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Clinical Management of Syncope in Emergency Department Based on Risk Stratification : A Review Literature Putri Annisa Kamila; Ardian Rizal; Novi Kurnianingsih; Sasmojo Widito
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.03

Abstract

Background: Background Syncope is a frequent problem among patients who present to the ED, accounts for 3% of emergency department admission and 1% of hospitalization. It is characterized by a comparatively short and self-limited loss of consciousness, which is caused by temporary cerebral hypoperfusion.Objective: Therefore, Risk stratification performed in the ED can guide triage decisions, and Risk-stratifying patients into low, moderate, and high-risk groups can assist medical decisions and determine the patient’s disposition.Discussion: The central point of syncope progression pathophysiology is the reduction of systemic blood pressure (BP) with a drop in global cerebral blood flow. Based on the European Society of Cardiology (ESC) syncope practice guidelines, syncope is classified into three categories, Neurally-mediated syncope (neural reflex syncope), Orthostatic hypotension, Cardiac syncope. Proper evaluation of syncope cases could in turn enable timely hospitalization and treatment by syncope experts. Assessment of a patient with syncope can be difficult, requiring a wide variety of medical testing with high health care costs. Sometimes, even after a careful examina- tion, it may not be possible to determine a definitive etiology for syncope. Given these uncertainties, about one-third of emergency room (ER) syncope/collapse patients are referred for assessment to the hospital, including non to low-risk patients. establish the urgency of any further work-up.Conclusion: Syncope assessment and treatment are very difficult, and syncope cases should be treated and dispositioned properly using proper risk stratification guidelines.
New Paradigm of Complete Revascularization in Acute Coronary Syndrome with Multivessel Coronary Artery Disease: Is it Reasonable in Clinical Practice? Adhika Prastya Wikananda; Mohammad Saifur Rohman; Novi Kurnianingsih; Cholid Tri Tjahjono
Heart Science Journal Vol 2, No 3 (2021): The Science and Art of Myocardial Revascularization
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.03.2

Abstract

Coronary artery disease is the leading cause of illness and death in older adults. Around 40% to 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multiple coronary artery disease. Multiple vessel coronary disease has been shown to improve cardiac outcomes and survival in patients who have undergone complete revascularization (CR) versus patients who have undergone only incomplete revascularization (ICR). When coronary angiography and PCI of the source of the infarction are performed on patients with STEMI, the risk of adverse cardiac death or myocardial infarction is significantly reduced. Additional research is needed to determine the efficacy of PCI of non-critical lesions. However, following procedures such as CABG or PCI, these procedures may be impossible to perform due to a variety of personal, anatomical, technical, and logistical barriers. In this review, we discussed about benefit of complete revascularization in patient acute coronary syndrome (ACS) with multivessel disease and which patient can be performed aggressive revascularization to achieved CR in clinical practice.Keywords: complete revascularization, acute coronary syndrome, percutaneous coronary intervention
Endovascular Stenting for Critical Limb Ischemia Patient with Superficial Femoral Artery Occlusive Disease: A Case Report Mohammad Ryan Ramadhan; Novi Kurnianingsih; Djanggan Sargowo; Cholid Tri Tjahjono
Heart Science Journal Vol 1, No 1 (2020): The Importance of Adherence to The Guidelines
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (48.838 KB) | DOI: 10.21776/ub.hsj.2020.001.01.7

Abstract

BACKGROUND: Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease (PAD), in the absence of intervention, may lead to lower extremity amputation or death. In cases where medical management is not effective or severe cases of PAD, endovascular and surgical interventions are indicated.2 Endovascular interventions become a first-line approach of CLI management and have advanced considerably within the past decade.1,3CASE DESCRIPTION: A 73-year old female with complain of left leg pain, accompanied with necrotic wound since 6 months ago. Duplex ultrasound showed no-flow from proximal to distal left superficial femoral artery (SFA). From CT-Angiography showed total occlusion from proximal left SFA to proximal poplitea artery about 7,2cm with collateral vessels. She was diagnosed with CLI left inferior extremity Fontaine IV Rutherford III. Angiography inferior extrimities was performed with total occlusion from proximal to distal left SFA with collateral vessels run to distal. We deployed a self-expanding stent with size 6mmx100mmx120cm at proximal-mid SFA. The patient showed improvement and was discharged after 5-days observationDISCUSSION: Patients with CLI have high risk of limb-loss without revascularization and high short term risk of cardiovascular events. Endovascular revascularization of femoro-popliteal occlusive offers lower initial risks than open surgery, with grade IIB-recommendation for lesion less than 25cm. Clinical success of endovascular stenting on CLI usually synonymous to limb salvageCONCLUSION:Favorable results can be achieved with endovascular stenting approach in patients with CLI, where close follow-up treatment afterwards can save limb loss.
Prognostic Value of Residual Syntax Score Combined with Acef Score in Acute Coronary Syndrome Patient After Percutaneus Coronary Intervention in Saiful Anwar Hospital, Malang Adhika Prastya Wikananda; Mohammad Saifur Rohman; Novi Kurnianingsih; Sasmojo Widito; Ardian Rizal
Heart Science Journal Vol 3, No 1 (2022): Assesment and Outcome of Coronary Artery Disease in the Reperfusion Era
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.01.4

Abstract

Background : Percutaneous coronary intervention (PCI) is one of the revascularization options in patients with clinical acute coronary syndrome (ACS) who often have multiple and complex vascular lesions. So, the decision to complete revascularization is still a topic that is widely explored to reduce the rate of rehospitalization and reinfarction. This study aims to determine the predictor value of rehospitalization and reinfarction events that can be used in ACS patients undergoing IKP using coronary angiography parameters with residual SYNTAX scores and clinical parameters using ACEF scores.  Method : The study was cohort prospective with the inclusion criteria being all ACS patients who underwent PCI in RSUD Dr. Saiful Anwar Malang from January 2017 to July 2021. All patients underwent IKP and underwent coronary angiography evaluation after IKP with a residual SYNTAX score (rSS) and divided into categories into rSS≤8 and rSS>8. All patients underwent laboratory examination of serum creatinine and post-PCI echocardiography, and an ACEF score was obtained (ACEF score = age/left ventricular ejection fraction + 1 [if serum creatinine >2 mg/dl]). Research subjects will be followed up for at least 1 year related to the incidence of post-PCI rehospitalization and reinfarction.  Results : From a total sample of 209 patients, it was found that the residual SYNTAX score data had the most significant predictive factor for the occurrence of rehospitalization at 1 year after PCI (OR 6.14 [95% CI, 1.92-1967]). At the value of rSS > 8, (AUC 0.750 [95% CI, 0.682-0.818], p 0.001) has a good predictive value for the occurrence of rehospitalization. However, combining with clinical parameters using the ACEF score provides a better predictive value. This study shows that the combination of rSS>8 and ACEF score>1.2 provides a better predictive value (AUC 0.884 [95%CI, 0.832-0.936) for the incidence of rehospitalization in post-PCI ACS patients. Conclusion : Acute coronary syndrome patients with residual SYNTAX scores > 8 and ACEF scores > 1.2 had a strong predictive value for rehospitalization events 1 year after PCI. The use of the combination of these two scores is expected to be a clinical guide to obtain the degree of completeness of revascularization in ACS patients.
Simple Clinical Predictors of Successful Fibrinolysis in Combined Assessment of ST-Segment Resolution, Myocardial Infraction Flow Grade, and Myocardial Perfusion Grade: Importance of Admission Blood Glucose and Ischemic Time Fahmy Rusnanta; Mohammad Saifur Rohman; Indra Prasetya; Ardian Rizal; Novi Kurnianingsih
Heart Science Journal Vol 2, No 3 (2021): The Science and Art of Myocardial Revascularization
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.03.3

Abstract

Background : Fibrinolytic therapy (FT) is the alternative recommendation in patients with ST-segment elevation myocardial infarction (STEMI) if primary percutaneous coronary intervention (PCI) could not be perfomed timely at initial presentation. Successful revascularization of occluded infarct-related coronary arteries depends on complex mechanisms of hemodynamic, clinical, biochemical, and mechanical parameters. The aim of study was to find outpredictors of patient characteristics to achieve complete reperfusion based on Thrombolysis in Myocardial Infarction(TIMI) 3 flow, Myocardial Blush Grade (MBG) 3, and ST-segment resolution.   Method : This retrospective study was held in Saiful Anwar, Malang Hospital during 2017-2021, including total of 142 patients. All patients received FT and coronary angiographic evaluation post-FT. Those were divided into 3 groups, which included R0,1 (0/1 highest measure of reperfusion), R2 (2 highest measures of reperfusion), and R3 (3 highest measures of reperfusion).  Results : Ischemic time (OR 0,82 [95%CI -0,39;-0,01]; p=0,04] and admission blood glucose (ABG) (OR 0,99 [95%CI -0,01;0]; p=0,046] were negatively correlated to the complete restoration of reperfusion (R3). This study revealed that ischemic time <5 hours (AUC 0,742 [95%CI 0,645-0,839]; p=0,000)  and ABG <140 mg/dL (AUC 0,701 [95%CI 0,612-0,790]; p=0,000) were significant predictor for R≥2. Coronary characteristic was not related to measure of reperfusion (p=0,25). Conclusion : Ischemic time <5 hours and ABG <140 mg/dL are important predictors of successful reperfusion post FT (R≥2). Early assessment of patients who are likely to have low parameter reperfusion (R<2) would help promptly preparing for primary PCI.
Validation of Saiful Anwar Clinical Congestion Score in Comparison with NT-proBNP for Prediction of Short-term Outcome in Acute Heart Failure with Reduced Ejection Fraction Liemena Harold Adrian; Mohammad Saifur Rohman; Muhammad Rizki Fadlan; Cholid Tri Tjahjono; Anna Fuji Rahimah; Novi Kurnianingsih
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.06

Abstract

Background : Risk stratification of acute heart failure (AHF) patient during hospital admission utilizing clinical scores emerges as an alternative to standart natriuretic peptide measurement. Development of Saiful Anwar clinical congestion score (SACS) as multivariable predictive model for prediction of short-term outcome in AHF with reduced ejection fraction (AHF-rEF) requires validation in comparison to NT-proBNP.Objective : To validate prognostic value of SACS compare with NT-proBNP in AHF-rEFMethod : This single-center, prospective cohort study was held in dr. Saiful Anwar General Hospital during January 2019 to June 2020. From total 89 AHF-rEF patients who admitted to emergency department, were assigned to SACS prospective questionnaire fulfillment and NT-proBNP measurement during first 12-hours since admission. Patients were divided into two groups based on SACS score and NT-proBNP value during admission. 90-days follow up was performed after index hospitalization with outcome of interest i.e all-cause mortality (ACM) and HF-related rehospitalization (HFR).Results : ACM and HFR rate in this study were 16.8% and 22.5%, respectively. SACS ≥6 demonstrated higher ACM and HFR rate during 90-days follow-up compared to SACS <6 (p=0.000; p=0.000, respectively). Performance of SACS ≥6 on admission showed good discriminative power for predicting 90-days ACM and HFR (AUC 0.841, p=0.000; AUC 0.788, p=0.000, respectively) compared to NT-proBNP ≥5000pg/mL (AUC 0.812, p=0.000; AUC 0.819, p=0.000, respectively). Additive value of NT-proBNP ≥5000pg/mL on top of SACS ≥6 increases discriminative power for predicting 90-days ACM and HFR after index hospitalization (AUC 0.836, p=0.000; AUC 0.90, p=0.000, respectively).Comclusion : SACS has demonstrated prognostic value compared to NT-proBNP for prediction of 90-days ACM and HFR after index hospitalization in AHF-rEF patients.
Diagnosis and Treatment of Lower Extremity Peripheral Artery Disease Novi Kurnianingsih
Heart Science Journal Vol 2, No 2 (2021): Dealing with Vascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.02.1

Abstract

Peripheral artery disease (PAD) is a chronic occlusive disease of arteries in the lower extremity due to atherosclerosis. PAD can lead to intermittent claudication, which is weakness or pain with walking alleviated with rest. Until now, the awareness of the public and medical personnel regarding PAD is still not as high as the alertness of coronary disorders. This editorial will focus on diagnosing and treating PAD focused on lower extremity artery disease (LEAD). 
Acute Aorto-Illiac Occlusion with Bilateral Limb Ischemia Underwent Direct Catheter Thrombolysis in Older Patient: A Case Report Irma Kamelia; Novi Kurnianingsih
Heart Science Journal Vol 2, No 4 (2021): Management of Thrombosis in Covid-19 Patient with Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.04.7

Abstract

BACKGROUND: Peripheral arterial diseases could be a major burden for the health system with a wide clinical spectrum from symptomatic to the limb threatening. A sudden onset of limb deteriorations represent a vascular emergency and need a proper treatment to limb preservation and life-saving. It is still challenging to choose a proper management to reduce morbidity and mortality, despite a various advance of diagnostic and therapeutic tools were available.CASE SUMMARY: A 70-years-old man came to our hospital with chief complaint leg pain at both of his legs, suddenly since 18 hours before admission. He had parasthesia and paralysis in both of his legs. And the doppler ultrasonography result was occlusion proximal to the right and left common iliac artery. Then we performed percutaneous intra-arterial thrombolysis using streptokinase and had gastrointenstinal bleeding as an adverse event.DISCUSSION: This case report provides an example of management acute limb ischemia in developing country with a limited source in comparison with the recent guideline and study. Further research is needed to establish a proper management to reduce morbidity and mortality in these cases.
Common Femoral Artery Aneurysm: A Challenging Diagnostic and Treatment of a Rare Case Ayu Asri Devi Adityawati; Novi Kurnianingsih; Budi Satrijo; Indra Prasetya
Heart Science Journal Vol 2, No 2 (2021): Dealing with Vascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.02.7

Abstract

BACKGROUND: Aneurysm of peripheral artery is a rare vascular pathology, especially aneurysm in common femoral artery. Here, we presented a case report of right common femoral artery aneurysm caused by infectionCASE REPORT: a 76-year-old man referred to our hospital with pulsatile groin mass at his right thigh. He had no prior history of surgery or traumas, but he has been treated in private hospital due to septic condition, hypertension, and diabetes mellitus type II. Based on findings from physical examination and radiology examination, a diagnosis of common femoral artery aneurysm was made. The patient was referred to Cardiovascular and Thoracic Surgeon Department and scheduled for routine surgery, but on third day of admission patient became hemodynamically unstable and on re-examination it was found that the aneurysm had been ruptured. Emergency surgery was conducted on that day. During surgery patient was hemodynamically stable with PRC transfusion.DISCUSSION: Aneurysms can occur in almost any artery in the body. Femoral artery aneurysm was rare. Diagnostic procedure with various modalities were needed to establish a precise diagnosis for patient which come with swelling in his/her lower extremity. Doppler ultrasound was conducted in order to find a saccular mass with neck and a yin and yang phenomenon, which can narrow down the differential diagnosis to pseudoaneurysm or aneurysm. Subsequent CT angiography clearly confirmed the involvement of 3 layer arterial wall as a sign of an aneurysm. Femoral artery aneurysms (FAA) may be caused by weakening of the arterial wall due to atherosclerosis or mycotic aneurysm. Surgical repair of aneurysm is an option when symptomatic and that should also be considered when there is ongoing hemodynamic instability or limb ischemia.CONCLUSION: The common femoral artery aneurysm aren’t common. It is very rarely to be isolated aneurysm and usually don’t tend to be rupture. Whenever a femoral artery aneurysm is found, search and follow-up for other aneurysms should take place. Annual follow-up is recommended. Straightforward surgical management brings good results in this group of patient. Keywords: Femoral artery aneurysm, Common femoral artery aneurysm, Isolated aneurysm, Mycotic aneurysm
Responders vs Non-responders to Cardiac Resynchronization Therapy: A Review Article Aris Munandar Zulkifli Ismail; Ardian Rizal; Heny Martini; Novi Kurnianingsih
Heart Science Journal Vol 1, No 2 (2020): The Assessment of Diagnostic and Treatment Modality in Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (448.148 KB) | DOI: 10.21776/ub.hsj.2020.001.02.2

Abstract

More than two decades after the introduction of cardiac resynchronization therapy (CRT) into clinical practice, respond to highly effective treatments for refractory drug heart failure (HF) approximately one-third of candidates persist to fail. This article will discuss indications for initiating a CRT, the definition of a response to a CRT, steps in response to a CRT, predictors of a CRT response, clinical judgment of patients who do not respond to CRTs, and elimination for possible reversible non-response causes. Here we have reviewed non-response CRTs in many ways. In short, multidisciplinary efforts are needed to overcome them because of the multifactorial causes of non-response (NR). So far, several factors has slowed the progress, such as limitations of NR consensus definitions and technology for therapeutic delivery.Keywords: Cardiac Resynchronization Therapy, Responder, Non-responder
Co-Authors Adhika Prastya Wikananda Agustin Iskandar Andini Putri Wulandari Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Antania Kashira Winarta Ardian Rizal Aris Munandar Zulkifli Ismail Aris Widayati Ayu Asri Devi Adityawati Budi Satrijo Budi Satrijo Cholid Tri Tjahjono Davy Reyhanditya Dian Artamevia Dian Hasanah Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Dyah Ayu Ikeningrum Edwin Widodo Eko Suyanto Fahmy Rusnanta Fatchiyah Fatchiyah Fatchiyah Fatchiyah Heny Martini Indra Prasetya Indra Prasetya Irma Kamelia Irma Kamelia Liemena Harold Adrian Mohammad Ryan Ramadhan Mohammad Saifur Rohman Monika Sitio Muhammad Rizki Fadlan Mustika Dewi Oktafin Srywati Pamuna Putri Annisa Kamila Retty Ratnawati Riskawati, Yhusi Karina Safitri, Anna Sasmojo Widito Seprian Widasmara Veny Kurniawati Viona Faiqoh Hikmawati Zainal Fathurohim