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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.

The Effect of Exercise Training as Adjuvant Treatment on Functional Capacity in Congenital Heart Disease with Negative Vaso Reactivity Test Pulmonary Hypertension Patient at Saiful Anwar Hospital Malang Irma Kamelia Pratiwi; Heny Martini; Cholid Tri Tjahjono; Setyasih Anjarwani; Saskia Dyah Handari
Heart Science Journal Vol 4, No 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascula
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.3

BackgroundPulmonary hypertension associated with congenital heart disease (CHD) is an important subgroup that accounts for approximately 11% of all patients with PAH. Physical limitations are one of the main symptoms of hemodynamic changes in patients with PH.Â Objective This study aimed to evaluate the effect of physical exercise therapy for 12 weeks as an additional therapy with PDE-5 inhibitors on the functional capacity of patients with Congenital Heart Disease accompanied by Pulmonary Artery Hypertension (CHD â€“ PH).Â MethodThis research was an analytic experimental study with a prospective cohort research method. This study used data sources obtained from medical records to adjust subjects based on inclusion and exclusion criteria, initial cardiac training test examination data was carried out at IPJT in patients selected as subjects. The patient's clinical outcomes were followed in the next 12 weeks.Â ResultThis research was conducted on 16 samples divided into two groups, namely the control and study groups. The evaluation after 12 weeks found that there was an increase in mileage as measured through the 6MWT submaximal test and a better duration of physical activity in the study group tested through the Endurance Shuttle Walk Test (ESWT). This is consistent with the effect of physical exercise, which suppresses systemic inflammation and causes vasodilation, thereby increasing oxygen delivery to the tissues. This causes more optimal aerobic metabolism and reduces lactate production. So that the patient did not quickly feel tired during activities. However, there was no significant increase in the Incremental Shuttle Walk Test. This could be due to the relatively short training duration of 12 weeks.Â Conclusion A positive correlation exists between physical exercise and increased functional capacity of patients with CHD who were evaluated using 6MWT and ESWT.

The effect of exercise training as adjuvant treatment on mean pulmonary arterial pressure by echocardiography and functional capacity in congenital heart disease with negative vaso reactivity test pulmonary hypertension patient at Saiful Anwar Hospital Malang Firdaus, Muhammad; Heny Martini; Wella Karolina; Valerinna Yogibuana; Cholid Tri Tjahjono
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.13

Background : PH is defined by mPAP >20 mmHg at rest. Exercise training enhances hemodynamics and exercise capacity in PH patients. Echocardiography is essential for assessing and evaluating PAP in PH cases. Objective : This study aims to determine the effect of 12-weel exercise training on mPAP by echocardiography and functional capacity Methods : A prospective cohort study at Saiful Anwar General Hospital (Sept 2024-Jan 2025) investigated exercise effects on mPAP and functional capacity in pulmonary hypertension patients. Participants were randomized to control (medication only) or treatment (medication plus exercise training) groups. Both underwent SMWT and echocardiography at baseline and after 12 weeks. Standardized exercise was monitored by healthcare experts. Result : This study compared 12 non-vasoreactive PH patients receiving standard therapy to 12 undergoing exercise training. The treatment group showed a significant mPAP decrease (66.8 to 63.4 mmHg, p=0.006), while the control group's reduction was non-significant (53.1 to 51.7 mmHg, p=0.061). Both groups improved 6MWT distances significantly after 12 weeks from 306.5 ± 72.7 meters to 318.3 ± 74.0 meters in the control group (p=0.041) and from 363.8 ± 63.6 meters to 382.9 ± 64.7 meters in the treatment group (p=0.000). No significant correlation was found between mPAP decrease and 6MWT increase in either group Conclusion : This study demonstrates improvements in mPAP and functional capacity following exercise training as an adjunctive therapy. However, no correlation was observed between the enhancement in functional capacity and the reduction in mPAP.

WHO risk chart associated with the presence of coronary plaque on coronary computed tomographic angiography in asymptomatic indonesian population Indrihapsari, Pratiwi; Saskia Dyah Handari; Cholid Tri Tjahjono
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.2025.006.03.11

Background: Cardiovascular risk assessment tools, like the WHO Risk Chart, often categorize asymptomatic individuals as low risk, even when they have unmanaged cardiovascular risk factors. Among these patients, estimation of CAD is associated with significant differences in CACS; however, the relationship between WHO Risk Chart and CACS has not been studied. Objective: We studied WHO Risk Chart’s ability to detect for coronary plaque throughout CACS via CCTA. Methods: A total of 440 subjects aged 40 to 74 years old, who underwent CCTA for health checkup between January 2023 and December 2024 were enrolled. Clinical information was gathered from medical records, including risk factors, CACS, and CCTA results. Statistical analysis was performed using SPSS 24, applying univariate, bivariate, and multivariate regression analyses to identify correlations. Results: The WHO Risk Chart showed a significant correlation with CACS and the presence of coronary plaque (p <0.05). In total, 148 individuals were identified with normal coronary arteries, while 292 individuals presented with coronary plaque. Notable differences were found among genders, WHO Risk Chart, smoking status, hypertension, dyslipidemia, diabetes mellitus, and CACS levels between the two groups (p<0.05). The correlation coefficient suggests that an increase in the WHO Risk Chart is associated with a rise in CACS, indicating a bidirectional relationship between these two parameters. Conclusion: In an asymptomatic population from Indonesia, the WHO Risk Chart shows a strong positive correlation with CACS.

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

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