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Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights Simbolon, Jessica Putri Natalia; Raharjo, Sunu Budhi; Santoso, Anwar; Liastuti, Lies Dina; Hermanto, Dony Yugo; Rossimaria, Vienna; Pritazahra, Armalya; Hanafy, Dicky Armein; Yuniadi, Yoga
Jurnal Kardiologi Indonesia Vol 44 No 3 (2023): Indonesian Journal of Cardiology: July - September 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1562

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Valvular heart diseases (VHD), regardless of the arrhythmic problems, increase the risk of thromboembolism, which are even higher in those with associated atrial fibrillation. The EHRA (Evaluated Heartvalves, Rheumatic or Artificial) classification categorised AF patients with significant VHD into type 1 and type 2. Unfortunately, there are currently very limited data on risk prediction in stroke-related valvular AF, particularly in the Asian population. Aims: To investigate the clinical and echocardiographic risk factors for ischaemic stroke prediction in patients with EHRA type 2 VHD. Methods: This retrospective study enrolled 695 AF patients with EHRA type 2 VHD. The data were collected from patients' medical records who met the inclusion and exclusion criteria from 2015 until 2020. The primary outcome was ischaemic strokes within observation period. Results: There were 67 ischaemic stroke events (9,6%) of the total sample. Our analysis found that none of the analysed variables proved to be statistically significant risk factors in predicting the occurrence of ischaemic stroke. The median CHA2DS2-VASc risk prediction in the sample was 3, with an accuracy of AUC 0.502 (CI 95%; 0.429 – 0.576), sensitivity 56.7% and specificity 44.7%. Conclusion: Based on the parameters analysed in this study, no factor was statistically well-predictive to predict the ischaemic stroke incidence in EHRA type 2 VHD AF. In addition, the CHA2DS2-VAS accuracy was low in this population. Further exploration is needed to build an accurate ischaemic stroke risk prediction for EHRA type 2 VHD.

Non-dominant handgrip strength is associated with higher cardiorespiratory endurance and elevated NT-proBNP concentrations in ambulatory male adult outpatients with stable HFrEF Triangto, Kevin; Radi, Basuni; Siswanto, Bambang B.; Tambunan, Tresia FU.; Heriansyah, Teuku; Harahap, Alida R.; Kekalih, Aria; Katsukawa, Hajime; Santoso, Anwar
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.1278

Understanding the significance of handgrip strength is essential for identifying frailty in heart failure patients. The aim of this study was to identify the association between handgrip strength and cardiorespiratory endurance while highlighting the importance of the musculoskeletal system in cardiac rehabilitation for patients with heart failure. An observational cross-sectional study was conducted at Harapan Kita Hospital, Jakarta, Indonesia, from April 2022 to April 2023, among patients with heart failure with reduced ejection fraction (HFrEF) attributed to cardiomyopathy or coronary artery disease. Patients were classified by a 6-minute walk test (6MWT) distance into <400 meters (low endurance) or ≥400 meters (high endurance). The short physical performance battery (SPPB), handgrip strength, ultrasonographic forearm muscle thickness, left ventricle ejection fraction, tricuspid annular plane systolic excursion, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured. Results indicated significant differences in non-dominant handgrip strength, gait speed, and sit-to-stand SPPB scores between patients achieving a 6MWT distance of ≥400 meters and those below this threshold, with values of 31.11±6.88 kg vs 27.66±6.66 kg (p=0.049), 0.52±0.08 m/s vs 0.61±0.13 m/s (p=0.001), and 10.71±2.47 seconds vs 12.85±4.11 seconds (p=0.014), respectively. Stronger non-dominant handgrip strength (>30 kg) was associated with higher endurance (odds ratio (OR): 3.80; 95%CI: 1.35–10.67; p=0.010) and thicker forearm muscles (>1.9 cm) as measured by ultrasonography (AUC: 0.713; 95%CI: 0.585–0.840, p=0.001). In conclusion, a cut-off of ≤30 kg for non-dominant handgrip strength could effectively stratify the male patients into a lower endurance group (6MWT ≤400 meters), which is associated with elevated NT-proBNP levels and reduced forearm muscle thickness.

Protokol Latihan BEST yang Disesuaikan dalam Rehabilitasi Gagal Jantung Triangto, Kevin; Radi, Basuni; Siswanto, Bambang Budi; Tambunan, Tresia Fransiska Ulianna; Heriansyah, Teuku; Harahap, Alida Rosita; Kekalih, Aria; Ambari, Ade Meidian; Dwiputra, Bambang; Desandri, Dwita Rian; Katsukawa, Hajime; Santoso, Anwar
Jurnal Kardiologi Indonesia Vol 45 No 3 (2024): July - September, 2024
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1738

Introduction Heart failure with a reduced ejection fraction (HFrEF) significantly contributes to global morbidity and mortality, necessitating effective rehabilitation programs. Exercise-based rehabilitation improves functional capacity and quality of life in HFrEF patients, though responses vary. The tailored BEST (Breathing, Endurance, and Strengthening) exercise protocol addresses both cardiac and extracardiac rehabilitation, benefiting all patients regardless of response status. This study evaluated the protocol's effects on HFrEF patients and classified responses based on VO2max changes. Methods In this etiologic study with prospective cohort design, all participants underwent a three-month cardiac rehabilitation program using the BEST Exercise Protocol. Assessments included the 6-minute walk test (6MWT), short physical performance battery (SPPB), handgrip strength, chest expansion, ultrasonographic measurements, and NT-proBNP levels before and after the intervention, with statistical comparisons made within and between groups. Groupings of responder level will be reliant on 6MWT distance achievement at the end of the program, with ≥6% improvement classified as good responders. Results Out of 107 HFrEF patients (median age 55 years, ejection fraction 29.50±7.34%), 63.56% were good responders and 36.44% were poor responders (<6% improvement). Good responders showed significant improvements in most extracardiac parameters, including a 20% increase in 6MWT distance (470.96±69.21 meters post-rehabilitation), chest expansion, handgrip strength, and SPPB scores (p<0.001 for all). Poor responders also improved in chest expansion, sit-to-stand time, and postural balance, with minor 6MWT gains (407.33±72.50 meters). NT-proBNP levels decreased in both groups but were not statistically significant (p=0.288 and 0.368 for good and poor responders, respectively). Conclusion The tailored BEST Exercise Protocol offers substantial cardiac and extracardiac benefits for HFrEF patients by enhancing functional capacity and muscle strength. Both good and poor responders exhibited significant improvements, indicating the protocol's broad applicability. However, the lack of statistically significant NT-proBNP reduction suggests further studies on cardiac biomarkers are needed. The 6MWT provides accessible rehabilitation insights, though more precise evaluations like Cardiopulmonary Exercise Testing (CPET) can offer clearer insights into cardiopulmonary adaptations.

Exploring the Relationship Between Comprehensive Respiratory Assessment and Intra-Extracardiac Biomarkers in Heart Failure Rehabilitation Triangto, Kevin; Radi, Basuni; Siswanto, Bambang B.; Tambunan, Tresia FU.; Heriansyah, Teuku; Harahap, Alida R.; Kekalih, Aria; Katsukawa, Hajime; Santoso, Anwar
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v8i-.248

Introduction: Heart failure with reduced ejection fraction (HFrEF) is well-known as a systemic disease that involves cardiac and extracardiac issues, with respiratory function playing on of the key role in rehabilitation prognosis. Biomarkers such as soluble suppression of tumorigenicity 2 (sST2), myostatin, miRNA-133, and NT-proBNP indicate disease progression. Notably, sST2, which is also produced by the lungs, predicts heart failure outcomes. This study examines the relationship between comprehensive respiratory assessments (e.g., diaphragmatic ultrasonography, spirometry) and intra-extracardiac biomarkers to improve rehabilitation strategies. Methods: Sixty-nine HFrEF patients underwent respiratory evaluations, including diaphragmatic ultrasonography, spirometry, chest expansion measurements, and a six-minute walking test (6MWT). Biomarkers assessed were sST2, myostatin, miRNA-133, and NT-proBNP. Associations between respiratory parameters and biomarkers were analyzed using t-tests and correlation analyses. Results: The median age was 56 years, and 33 (47.82%) of the subjects had diaphragmatic dysfunction, resulting in poorer 6MWT performance (378.03±58.15 m vs 409.75±63.65 m, p=0.017) and other parameters. Superior chest expansion negatively correlated with sST2 (r=−0.387, p=0.001) and positively with miRNA-133 (r=0.442, p<0.001). Similar results were found for inferior chest expansion. No significant correlations were observed for other biomarkers. Conclusion: This study highlights strong associations between chest expansion and sST2/miRNA-133, suggesting that incorporating respiratory assessments and training into HFrEF rehabilitation could enhance outcomes by addressing cardiorespiratory insufficiencies. Given sST2's predictive value for heart failure prognosis, these findings support a multi-component rehabilitation strategy incorporating respiratory training, such as aerobic and inspiratory muscle exercises, to enhance cardiopulmonary outcomes. This integrated approach offers promise for future HFrEF rehabilitation protocols.

Metabolic Syndromes and Cardiovascular Disease: What is on the horizon? Santoso, Anwar
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.1

Metabolic syndrome (MetS) is characterised by the simultaneous occurrence of at least three out of fivecardio-metabolic disorders.1, 2 These problems consist of visceral obesity, hypertension, high blood glucose, hightriglyceride, and low HDL cholesterol levels.2 It is unclear to what extent communities with diverse ethnicbackgrounds differ in the contributing factors. Additionally, the risk of cardio-vascular disease (CVD) mortalitymay vary depending on the frequency of MetS and its components in various ethnic groups and nations.3 Inappropriately,information on the CVD mortality risk associated with MetS is still quite limited, especially in Asiancountries. The majority of investigations were limited to determining the prevalence of MetS and its contributingvariables among Asians. Due mostly to unhealthy lifestyle such as an imbalanced diet high in carbohydrate andsedentary habits, the prevalence of MetS has been rising along with urbanisation.4

Dyslipidemia management among patients with high and very high cardiovascular risk in Indonesia: a multi-center registry Ng, Sunanto; Santoso, Anwar; Sukmawan, Renan; Erwinanto, Erwinanto; Adam, Erika; Desandri, Dwita Rian; Zahra, Rita; Wicaksono, Sony Hilal; Putra, Magma Purnawan; Heriansyah, Teuku; Tiksnadi, Badai Bhatara; Pintaningrum, Yusra
Jurnal Kardiologi Indonesia Vol 46 No 2 (2025): April - June, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1880

Background Indonesia, the world's largest archipelago, faces significant challenges in equitable healthcare delivery due to its geographical and infrastructural disparities. Atherosclerotic Cardiovascular Disease (ASCVD) remains the leading cause of mortality, with over 659,000 deaths recorded in 2019. Effective dyslipidemia management is crucial for preventing adverse ASCVD events. Unfortunately, the lack of implementation of an updated national lipid management registry might hinder optimal strategy for the adverse events. This study evaluated dyslipidemia cholesterol management practices among high- and very high-risk patients across the country. Methods The study recruited 322 patients from eight centers across six provinces in Indonesia between May 2022 and March 2023. Patients were stratified based on the ASCVD risk and followed over three visits. Baseline clinical characteristics, lipid profiles, and treatment regimens were analyzed. Descriptive statistics summarized continuous and categorical variables, and low-density lipoprotein cholesterol (LDL-C) achievement was assessed. Results Of the 322 patients, 98.8% were very high-risk, with only 4.9% achieving <55 mg/dL and 21.2% achieving <70 mg/dL. Moderate-intensity statins were the most prescribed (51.2%), followed by high-intensity (36.6%). LDL-C reduction was most pronounced in private insurance patients, achieving a mean LDL-C of 69.8 mg/dL at the third visit compared to 98.9 mg/dL in National Health Insurance (Jaminan Kesehatan Nasional/JKN) participants. Missed visit rates increased over time, with 57.5% of patients missing the third visit, predominantly among JKN participants and low-income groups. Conclusion Majority of the population failed to achieve the recommended target of LDL-C levels. Dyslipidemia management in Indonesia remains suboptimal, with disparities driven by socioeconomic factors. Improved policies addressing medication availability, national lipid registry establishment, and equitable healthcare access are essential to enhance lipid management and reduce the burden of ASCVD in Indonesia.

Metabolic Syndromes and Cardiovascular Disease: What is on the horizon? Santoso, Anwar
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.1

Metabolic syndrome (MetS) is characterised by the simultaneous occurrence of at least three out of fivecardio-metabolic disorders.1, 2 These problems consist of visceral obesity, hypertension, high blood glucose, hightriglyceride, and low HDL cholesterol levels.2 It is unclear to what extent communities with diverse ethnicbackgrounds differ in the contributing factors. Additionally, the risk of cardio-vascular disease (CVD) mortalitymay vary depending on the frequency of MetS and its components in various ethnic groups and nations.3 Inappropriately,information on the CVD mortality risk associated with MetS is still quite limited, especially in Asiancountries. The majority of investigations were limited to determining the prevalence of MetS and its contributingvariables among Asians. Due mostly to unhealthy lifestyle such as an imbalanced diet high in carbohydrate andsedentary habits, the prevalence of MetS has been rising along with urbanisation.4

Adiponectin and Endothelin-1 are Correlated with the Development of Normal-tension Glaucoma in Metabolic Syndrome Patients Prayitnaningsih, Seskoati; Oktarina, Virna Dwi; Nusanti, Syntia; Diarsvitri, Wienta; Rif'ati, Lutfah; Siswanto, Bambang Budi; Santoso, Anwar
The Indonesian Biomedical Journal Vol 16, No 5 (2024)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v16i5.3196

BACKGROUND: Glaucoma can lead to irreversible blindness, but normotension glaucoma (NTG) often shows no early symptoms. However, to date, there is limited knowledge regarding the potential parameters for early detection. Therefore, in this study, various metabolic parameters and biomarkers which may contribute to NTG in metabolic syndrome (MetS) patients were evaluated.METHODS: A retrospective cross-sectional study was conducted in the National Cardiac Center Harapan Kita Hospital. Mets were confirmed following the IDF criteria. NTG was determined based on normal intraocular pressure (IOP) with a mean defect (MD) of the visual field, thinning of the retinal nerve fiber layer (RNFL), and enlargement of cup disc ratio (CDR) by ocular coherence tomography (OCT). Metabolic parameters results of waist circumference (WC), body weight, body height, body mass index (BMI), blood pressures, HbA1c, fasting blood glucose (FBG), lipid profiles; and biomarkers including thiobarbituric acid reactive substance (TBARS) and ferric reducing antioxidant power (FRAP), leptin, adiponectin, high-sensitivity C-reactive protein (hs-CRP), and endothelin-1 (ET-1) were analyzed. Statistical analysis was performed using comparative and correlative tests.RESULTS: From 29 subjects, 19 subjects (65.5%) were included in the NTG group and 10 subjects (34.5%) were included in the non-NTG group. In the NTG group, we found significant correlation between MD with systolic blood pressure (p=0.035); CDR with ET-1 (p=0.049); and CDR with adiponectin (p=0.010). The non-NTG group had a significant correlation between MD with BMI (p=0.043); CDR with LDL (p=0.042); and CDR with TG (p=0.031).CONCLUSION: There are correlation between adiponectin and ET-1 with NTG in MetS patients. Therefore, they might be considered as potential early detectors for NTG in MetS patients.KEYWORDS: normal tension glaucoma, metabolic syndrome, biomarker, endothelin-1, adiponectin

Cardiovascular Disease and COVID-19: What’s the Issue? Putra, Bayushi Eka; Santoso, Anwar
Majalah Kedokteran Indonesia Vol 70 No 4 (2020): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.70.4-2020-231

What’s our status? As per 17 April 2020, Indonesia has the most confirmed cases (5.923 cases) of Coronavirus Disease (COVID-19) among Southeast Asian Countries.1 Considering the daily increase of cases, we are considered nowhere near the plateau of the epidemic curve. It was predicted that the peak may be reached from May to June.2 Predictably, this will not end soon. COVID-19 contracted patients may also vary in severity. The patient may present with no symptoms, mild to moderate, and severe condition. Mild (81%) depicted as COVID-19 patients with no evidence or mild pneumonia, severe (14%) for COVID-19 patients with hypoxia and greater than 50% lung involvement within 24-48 hours, critical (5%) if the patient develops shock, acute respiratory distress syndrome, myocarditis, or even organ failure which need intensive care, and 2.3 % were fatal which end up in death.3,4

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