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The Role of Congestion Index as Predictor Short-term Clinical Outcome in Patients AHF Veny Kurniawati; Anna Fuji Rahimah; Cholid Tri Tjahjono; Mohammad Saifur Rohman; Yoga Waranugraha
Heart Science Journal Vol 1, No 2 (2020): The Assessment of Diagnostic and Treatment Modality in Heart Failure
Publisher : Universitas Brawijaya

IntroductionCongestion is the major problem in Acute Heart Failure (AHF) patients. Despite improving clinical congestion, we should assess and treat the hemodynamic congestion to decrease the progression of the disease and improve outcome of AHF patients. This study assess the ability of congestion index, a simple echocardiography parameter using ePCWP + eRAP to predict short-term clinical outcomes of AHF patients compare with NT-proBNP.Methods This prospective cohort study was conducted at Saiful Anwar General Hospital Malang from January 2108 to July 2019. AHF patients treated according to the 2016 ESC guidelines for AHF. Hemodynamic congestion was defined if congestion index (ePCWP+eRAP) at hospital discharge ≥ 30 mmHg.NT-proBNP level, ePCWP and eRAP were measured at 0-12 hours hospital admisssion and at hospital discharge. Clinical follow-up over a period of 30 days, AHF rehospitalization and mortality due to cardiovascular was registered. ResultsThis was a prospective study of 62 patients hospitalized with AHF. All patients were NYHA functional class IV. AHF mortality and rehospitalization rates in this study were 12.9% and 20.9%, respectively. Patient with congestion index ≥30 mmHg showed a higher 30 day rehospitalization [10 [66.7%] vs 3 [6.4%]; P =0.000; CI 95% OR 7.53(3.11-18.2)] and cardiovascular mortality [7 [46.7%] vs 1 [2.1%] P=0,000; CI 95% OR 5.90(2.95-11.78)]. NT-proBNP level at hospital discharge (cut off 5853 pg/mL; sensitivity 92%; specificity 91%; AUC 0.945; P = 0.000) was better than congestion index (cut off 30 mmHg; sensitivity 92.9%; specificity 91.7%; AUC 0.914; P = 0.000) in predicting AHF rehospitalization. For predicting mortality, NT-proBNP level at hospital discharge (cut off 8733 pg/mL; sensitivity 87.5%; specificity 88.9%; AUC 0.940; P = 0.000) were better than congestion index (cut off 31 mmHg; sensitivity 87.5%; specificity 81.5%; AUC 0.890; P = 0.000). ConclusionCongestion index could predict AHF rehospitalization and mortality within 30 days in patients with AHF.

Acute ST elevation myocardial infarction (STEMI) in Young Male with Nephrotic Syndrome: A case report Ratna Pancasari; Cholid Tri Tjahjono; Anna Fuji Rahimah; Indra Prasetya
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.2021.002.03.6

Background: In young males, an acute myocardial infarction is an uncommon event. Thrombolism caused by nephrotic syndrome (NS) is one of the pathophysiologies of their infarctions.Case Illustration: A-24-y.o male patient, presenting with prolong typical chest pain since 72 hours before admission. The chest leads on an electrocardiogram (ECG) indicated ST-Elevation. Cardiac troponin was significantly raised. Since the previous two weeks, he has been experiencing nephrotic syndrome symptoms including anasarca edema.It was supported by laboratory data which is obtained proteinuria, hyperlipidemia and hypoalbuminemia. A complete acute occlusion of the proximal portion of the left anterior descending artery was revealed by coronary angiography. Increased fibrinogen levels appeared to be a contributing factor for hypercoagulable state in this patient, implying a correlation between coronary thrombosis and nephrotic syndrome.Discussion: Myocardial infarction (MI) is rare in young males, but it occurs 8 times more often in patients with NS than in the general population. Clinicians should pay closer attention to the history of previous diseases with a high risk of thromboembolism in young patients with MI, and they should specifically promote thromboembolism prevention and care in patients with renal disease to decrease the incidence of thromboembolism complications.Conclusion: Nephrotic syndrome should be considered as a contributing factor in any patient presenting with acute STEMI, particularly in young males.

Valvular aspects from echocardiography in rheumatic heart disease Noverike, Nikhen; Anna Fuji Rahimah; Yogibuana, Valerinna; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.5

Rheumatic Heart Disease is a result of an autoimmune response to group A streptococcal infection and is globally impacted and prevalent in low- and middle-income countries, especially among children and young adults. It primarily affects the heart valves, leading to damage and dysfunction. The progression of RHD can vary, with some individuals experiencing mild symptoms while others may develop severe valve damage leading to heart failure. Echocardiography plays a crucial role in the diagnosis and monitoring of RHD, as it allows to visualize and assess the structural and functional abnormalities of the heart valves. Early detection through echocardiography screening is essential for timely intervention and management of RHD. It provides valuable information about the severity of valve damage and helps determine the most appropriate treatment approach, whether it involves medication or surgical intervention. The ability of echocardiography to provide information about volumes, flows, and pressures, and to acquire quantitative hemodynamic data, highlights its importance in the assessment of patients with RHD. In conclusion, echocardiography has revolutionized the way we diagnose, monitor, and manage rheumatic heart disease, and its importance in the medical field cannot be overstated. The continued integration of echocardiography into clinical practice will undoubtedly lead to improved outcomes for patients with RHD.

Predicting lesion complexity in premature coronary artery disease: The utility of clinical risk scores Firdaus, Achmad Jauhar; Mohammad Saifur Rohman; Budi Satrijo; Cholid Tri Tjahjono; Anna Fuji Rahimah
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.12

Background: Premature coronary artery disease (PCAD) has been recognized as a significant global health issue, with its prevalence increasing due to earlier exposure to various risk factors. Emerging evidence suggests that PCAD may be as aggressive, if not more so, than in older populations. The clinical implications and angiographic characteristics for more aggressive management strategies remain poorly explored. Objectives: This study aims to develop and validate a clinical scoring system in predicting lesion complexity in patients with PCAD. Methods: A retrospective cohort study was conducted on 645 patients who underwent invasive coronary angiography (ICA) from January 2023 to December 2024 in Dr. Saiful Anwar General Hospital, East Java, Indonesia. Patients were divided into developmental (n = 322) and validation (n = 323) groups. Clinical information was gathered from medical records, including risk factors and angiographic results. Predictors of complex CAD (SYNTAX ≥ 33) were identified by multiple logistic regression analysis. A clinical scoring system was developed and validated. Results: This study found complex CAD in 252 (39.1%) of all PCAD patients. Smoking (OR 2.3; p 0.006), dyslipidemia (OR 2.8; p < 0.001), diabetes mellitus (OR 3.9; p < 0.001), history of previous myocardial infarction (OR 6.5; p < 0.001), and family history of CAD (OR 5.7; p < 0.001) were independent predictors of complex CAD. A clinical scoring system was developed with a cut-off score ≥ 4 predicting complex CAD, with an area under the curve (AUC) value of 0.836 (95% CI 0.791-0.880), sensitivity of 71.3%, and specificity of 85.0%. Conclusion: The PCAD population continues to represent a high-risk group of concern. While the short-term prognosis is optimistic, the long-term outlook for this cohort is less promising due to the high recurrence rate and prolonged complications, especially in individuals with complicated CAD, leading to impaired quality of life

Effects of exercise training on C-reactive protein (CRP) levels and 6-minute walk distance: A preliminary study Aziz, Indra Jabbar; Martini, Heny; Anna Fuji Rahimah; Valerinna Yogibuana; Cholid Tri Tjahjono
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.11

Background Mortality rates increase among those with intermediate to high-risk pulmonary arterial hypertension, demonstrating the importance of improved diagnostic methods, treatment algorithms, and the development of new approaches to therapy for severely ill patients. Inflammation contributes to pulmonary hypertension progression, and exercise has been shown to suppress this process. Objective This study evaluated the relationship and differences between CRP levels and functional capacity after a 12-week exercise training program. Methods A clinical prospective cohort preliminary study was conducted with 26 consecutive patients who had already received pulmonary hypertension treatment and were enrolled in the LET-SHINE registry. Patients were divided into two groups: one control group (PH therapy only) and one treatment group (receiving adjuvant physical exercise). The study was conducted for 12 weeks, 6MWT and CRP tests were performed both before and after the study. Result This study found that the majority of cases were ASD, consistent with the fact that ASD is the most common congenital heart defect. The analysis of C-reactive protein levels showed non-significant changes in both groups after 12 weeks. The treatment group exhibited a modest reduction from 0.8 ± 2.4 mg/dl to 0.5 ± 1.0 mg/dl (p=0.514), while the control group maintained stable levels, ranging from 0.7 ± 1.0 mg/dl to 0.7 ± 0.8 mg/dl (p=0.166). An intergroup comparison revealed a non-significant greater mean decrease in the treatment group (-0.3 ± 1.5 mg/dl vs -0.1 ± 0.2 mg/dl, p=0.514). There was no significant correlation between the reduction in CRP levels and improvements in 6MWT distance in either the treatment group (correlation coefficient: -0.367, p=0.240) or the control group (correlation coefficient: 0.021, p=0.948). Conclusion This study showed that exercise training had no statistically significant impact on C-reactive protein levels, indicating a limited effect on systemic inflammation. No significant correlation was found between decreases in CRP levels and improvements in 6MWT distance in either the treatment or control groups.

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