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Neutrophil-Lymphocyte Ratio (NLR) as A Predictor for Non-ST Elevation Myocardial Infarction (NSTEMI) in the Emergency Room Zunardi, Lutfi Hafiz; Anjarwani, Setyasih; Prasetya, Indra; Satrijo, Budi; Rahimah, Anna Fuji
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.7

Abstract

AbstractBackground: The usefulness of the NLR as an approach to identifying cases of acute coronary syndrome (ACS) needs to be improved.Objective: This research was designed to determine the effectiveness of the NLR in identifying individuals who presented to the emergency room complaining of anginal due to ACS.Methods: The single-center cross-sectional study was performed at Saiful Anwar General Hospital in Malang, East Java, Indonesia, from July 2020 to December 2023. Patients were involved in this study with complaints of angina suspected of ACS. During further observation in the emergency room, based on the findings of the troponin I analysis, individuals were divided into unstable angina pectoris (UAP) and NSTEMI.Results: Study results were collected from 282 individuals diagnosed with Non-ST Elevation Acute Coronary Syndrome (NSTEACS), with 75.9% male and a mean age of 58.39 ± 10.27 years. The NLR threshold was 4.5 (AUC: 0.78, 95% CI: 0.765–0.867, P <.001) assessed during admission, which showed a sensitivity of 79% and a specificity of 78% in accurately predicting the probability of subsequent troponin positivity. Multivariate analysis revealed that the NLR at hospitalization remained an essential marker of troponin positivity during follow-up.Conclusions: In the end, NLR could be considered an initial test in emergency services to predict the diagnosis of NSTEMI in people experiencing angina. 
Rapid degradation of left ventricular function after permanent right ventricular pacing in patients with high-grade atrioventricular block Setiawan, Dion; Prasetya, Indra; Anjarwani, Setyasih; Rizal, Ardian
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.22

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Background: Permanent right ventricular (RV) pacing is a standard for high-grade atrioventricular (AV) block treatment. However, it may result in left ventricular (LV) dilatation, systolic dysfunction, and heart failure (HF) as a consequence of ventricular dyssynchrony and an abnormal myocardial contraction pattern. Pacing-induced cardiomyopathy (PICM) can develop months or years after implantation of a permanent pacemaker (PPM) in patients who have long-term and high-burden RVP. Case Illustration: We reported a case of a 56 years old Asian female having a record of PPM on VVIR mode implantation due to a high grade AV block presented with shortness of breath and bilateral leg swelling. Conclusion: Echocardiography showed a significant decrease in LV systolic function less than two years after PPM implantation. Coronary angiography showed widely patent vessels; subsequently, His-Bundle Pacing (HBP) was scheduled on the patient.
A 56 Year Old Male with Acute Stent Thrombosis During Percutaneous Coronary Intervention, How to Resolve This Problem? Millisani, Hayla Iqda; Rohman, Mohammad Saifur; Prasetya, Indra; Widito, Sasmojo
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.2023.004.03.8

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Background: Acute stent thrombosis is the complete occlusion of a coronary artery of the previously implanted stent. This unusual complication occurs in percutaneous coronary intervention (PCI), development of myocardial ischemia, and poor prognosis for the patient. After PCI, acute stent thrombosiscan occur within 0-24 hours and cause the symptoms like acute coronary syndrome. Incidents of stent thrombosis are about 0.6% to 3.4% for Drug Eluting Stent (DES) implantation, depending on the lesion and patient factors. The etiology of acute stent thrombosis is multifactorial, and early detectioncan reduce the mortality rate.Case Illustration: A 56 yo male visited Rumah Sakit Saiful Anwar Malang with stable angina pectoris (Class III symptoms with medical therapy) planned for elective cardiac catheterization with routine medical treatment. During PCI, he complained the chest pain, and from cine angiography evaluation showed no flow at the diagonal branch because of the acute thrombosis. Then got thrombosuction and got a white thrombus. After the PCI procedure, he got fibrinolytic with streptokinase 1.5 million units for 60 minutes. He was transferred to CVCU for observation and discharged after five days.Conclusion: Acute stent thrombosis is a severe complication during and after PCI because it is related to high mortality. The mechanisms by which ST arises are complex and multifactorial and must be early detection.
Hypothermia theraphy in patients post cardiac arrest Yudha, Tria; Prasetya, Indra; Tjahjono, Cholid Tri; Anjarwani, Setyasih
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.5

Abstract

Cardiovascular disease is the leading cause of death in several developing countries, and many of these deaths occur before reaching the hospital due to cardiac arrest. Most patients who return to spontaneous circulation (ROSC) and are brought to the hospital experience severe neurological damage during cardiac arrest, and this damage is the cause of in-hospital mortality. Improvements in survival and neurologic improvement of patients with CA have focused on two main therapy areas. The first area is improved education and skills of medical and paramedical personnel to improve perfusion post CA. The second area is a greater emphasis on post-resuscitation care which includes optimizing oxygenation and ventilation, avoiding hypotension, treating causes of CA such as acute coronary ischemia, and initiating hypothermia therapy if necessary, as in the 2020 guidelines and recommendations from the American Heart Association (AHA), International Liaison Committee of Resuscitation, and European Resuscitation Council covering the entire spectrum of post-resuscitation care.  The AHA guidelines 2020 recommend optimizing hypothermia therapy for 24 hours with a target temperature between 320C - 360C in ROSC patients to improve clinical outcomes of neurological status after cardiac arrest. This is contrast to the study of Martinell et al in their research which concluded that there was no significant difference in survival rates within 30 days after cardiac arrest in patients who received either hypothermia therapy or those who did not. Hypothermia therapy, which is currently part of the post-resuscitation care recommendations, has varied variables and remains controversial in its implementation. Based on this, this referent will discuss the effects of hypothermia therapy on post-cardiac arrest patients, the stages, and the practical aspects of implementing hypothermia therapy.
Continous renal replacement therapy: revisited Aryanugraha, Teguh; Prasetya, Indra
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.7

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Patients in condition of acute kidney injury (AKI) and critically ill often benefit from renal replacement therapy (RRT). Patient with hemodynamically unstable in cardiac intensive care, such as those with congestive heart failure, acute myocardial dysfunction, or excessive hemodilution during cardiac surgery, continuous renal replacement therapy (CRRT) is considered to be the suitable renal replacement therapy modality. This paper discusses indications, techniques, and CRRT in cardiac critical care.
Use of SAPS 3, APACHE IV, and GRACE as prognostic scores for acute coronary syndrome patients in the cardiovascular care unit Yudha, Tria; Prasetya, Indra
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.3

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A grading system based on disease severity has been widely used in intensive care units (ICUs) since around 1980. These systems are used to predict mortality and assess severity in clinical trials. Simplified Acute Physiology Score 3 (SAPS3) and Acute Physiology and Chronic Health Evaluation Score (APACHE IV) are prognosis ratings that can predict in-hospital mortality within the first hour of ICU care. Although these technologies have been widely employed in the ICU, they have yet to be commonly deployed in the cardiovascular care unit (CVCU) due to different patient populations. Intensive care doctors typically employ the standard prognostic scores, SAPS3 and APACHE IV, which were generated from diverse populations of critically ill patients. Although these scores are the most widely used early versions, APACHE IV and SAPS 3 do not include acute coronary syndrome patients. The Global Registry of Acute Coronary Events (GRACE) score has performed the best; this may be because of its straightforward design, which does not distinguish between individuals with SCA and those without ST-segment elevation. Our review article attempts to evaluate the performance of standard predictor scores, namely SAPS 3, APACHE IV, and GRACE, on patients with cardiovascular emergencies. Thus, these score systems can precisely assess the relationship between mortality prediction scores and outcomes of patients admitted to the CVCU rapidly and comprehensively.    
The complex relationship between arterial carbon dioxide levels and acute heart failure: implications for prognosis and management Afifah, Yuri; Prasetya, Indra; Anjarwani, Setyasih; Pashira, Andranissa Amalia
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.2

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Acute Heart Failure (AHF) can affect carbon dioxide levels in the body by altering the balance between ventilation and carbon dioxide production, leading to either hypocapnia or hypercapnia. Arterial carbon dioxide (CO2) levels are essential for maintaining respiratory function and acid-base balance. However, the relationship between arterial CO2 levels and AHF remains complex and not fully understood. Diverse factors affect arterial CO2 levels in patients with AHF, including neurohormonal activation, respiratory compensation for hypoxemia, and changes in pulmonary perfusion. Hypocapnia, characterized by low arterial CO2 levels (PaCO2 < 35 mmHg), is commonly observed in AHF due to hyperventilation-driven respiratory alkalosis secondary to pulmonary congestion. It showed a strong connection with the survival rates of patients following a cardiac arrest. Nevertheless, elevated levels of carbon dioxide in the blood, known as hypercapnia, with a partial pressure of arterial carbon dioxide (PaCO2) exceeding 45 mmHg, can also arise in the later phases of acute heart failure (AHF), indicating fatigue in respiratory muscles or deterioration in pulmonary edema. Abnormal arterial CO2 levels have been associated with increased morbidity and mortality in AHF patients, serving as a valuable prognostic marker.  
Predictive value of PaCO2 on mortality in patients with acute heart failure Afifah, Yuri; Prasetya, Indra; Baskoro, Shalahuddin Suryo; Anjarwani, Setyasih
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.9

Abstract

Background: Patients with AHF may experience fluctuations in carbon dioxide levels, resulting in either hypercapnia or hypocapnia. Recent research has highlighted the significance of the relationship between CO2 fluctuation and patient outcomes. Objective: The aim of this study was to explore the relationship between arterial carbon dioxide pressure (PaCO2) upon admission to the ICCU in patients with AHF. Methods: A single centre retrospective observational study was performed, the patient were enrolled from patient medical record between 2021 and 2023. Participants were divided into three groups based on PaCO2 levels. The study end point was length of hospitalization, mortality at ICCU and mortality in hospital. Statistical analysis used various tests to compare outcomes, with significance set at p<0.05, and ROC analysis evaluated mortality prediction. Result: The study included 150 patients: 97 with hypocapnia, 33 with normal PaCO2, and 19 with hypercapnia. In-hospital mortality was 37.5%, and 1-month mortality was 33.3% in the hypercapnia group. PaCO2 >45 mmHg was linked to higher in-hospital mortality (OR 6.900, p <0.001) and 30-day mortality (OR 5.600, p <0.001), PaCO2 <35 mmHg showing a protective association in ICCU and in-hospital mortality (OR 0.202, p<0.001) and 30-day mortality (OR 0.237, p<0.001). Length of stay was not significantly affected by either hypocapnia or hypercapnia. The ROC for predicting in-hospital mortality was 0.648 and for 30-day mortality was 0.626 in the PaCO2 >45 mmHg group. Conclusion: PaCO2 levels at ICCU admission predict mortality in AHF patients. Hypercapnia is associated with higher in-hospital and 30-day mortality, while hypocapnia appears protective.
Pengaruh Keadilan Organisasi Terhadap Perilaku Inovatif Dengan Kepercayaan Organisasi Sebagai Mediasi Handayani, Ririn; Prasetya, Indra; Burhan, Burhan
Jurnal Penelitian Dan Pengkajian Ilmiah Sosial Budaya Vol 3 No 1 (2024): Jurnal Penelitian Dan Pengkajian Ilmiah Sosial Budaya - JPPISB
Publisher : LPPM Universitas Dharma Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47233/jppisb.v2i1.701

Abstract

The purpose of this research is to see the effect of organizational justice on innovative work behavior, as well as to prove the role of organizational trust in mediating the effect of organizational justice on innovative work behavior. The method used in this research is quantitative research which explains that the research paradigm emphasizes understanding of problems in social life based on the conditions of reality or natural settings that are holistic, complex and detailed. This research is descriptive and verificative in nature. The population of this research is members of Battalion Arhanud 13/PYB, totaling 525 people. Using the N population table developed by Krejcie and Morgan, the sample size is 217. The sample determination method used in this study is simple random sampling method. Data collection was carried out by means of field research, by submitting a structured questionnaire. Perceptions of organizational justice are measured by OJS (Moliner, 2004), organized by 12 items. Organizational trust is measured using Gabarro and Athos (1976) in Interpersonal Relations and Communications; which consists of 7 items as follows (Alshaabani, et al., 2022). Innovative behavior is measured by assessing how far each individual contributes to work based on Janssen (2000), totaling 9 items. The analysis technique used is the structural equation modeling (Structural Equation Modeling-SEM) based on variance or partial least squares (PLS). The results of the study found that organizational justice had a significant positive effect on innovative work behavior and organizational trust mediated the effect of organizational justice on innovative work behavior.
Hypocapnia and its relationship with in-hospital mortality in acute heart failure patients: Insights from the Indonesian multicenter ICCU registry Prasetya, Indra; Afifah, Yuri; Anjarwani, Setyasih; Juzar, Dafsah A.; Bagaswoto, Hendry P.; Muzakkir, Akhtar F.; Habib, Faisal; Astiawati, Tri; Wirawan, Hendy; Ilhami, Yose R.; Djafar, Dewi U.; Sungkar, Safir; Danny, Siska S.; Rohman, Mohammad S.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.1638

Abstract

Acute heart failure (AHF) presents serious risks for hospitalized patients. The aim of this study was to explore the relationship between arterial partial pressure of carbon dioxide (PaCO2) levels and outcomes in AHF patients admitted to the intensive cardiovascular care unit (ICCU), utilizing data from the IndONEsia ICCU Registry (One ICCU Registry). A multicenter retrospective observational study was performed covering data between August 2021-2023. Participants were categorized by PaCO2 levels: hypocapnia (<35 mmHg), normocapnia (35–45 mmHg), and hypercapnia (>45 mmHg). The primary outcomes included ICCU mortality, in-hospital mortality, and 30-day mortality, whereas the length of the stays in the ICCU or hospital and ventilation requirement were set as the secondary outcomes. Mortality risks were assessed using Cox proportional hazards models. Of the 1,870 patients, 1,102 (58.96%) had hypocapnia, 645 (34.5%) had normocapnia, and 123 (6.5%) had hypercapnia. Hypocapnia patients had significantly higher ICCU, in-hospital, and at 30-day mortality rates compared to normocapnic patients (all p<0.001), along with longer lengths of stay in ICCU and in hospital (p<0.001). Hypocapnia significantly increased noninvasive and mechanical ventilation requirement compared to normocapnia patients. Multivariate analysis identified factors impacting patients’ survival, including age, treatment with angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARBs) drugs, and severity scores such as the quick sequential organ failure assessment (qSOFA) and simplified acute physiology score II (SAPS II). In conclusion, hypocapnia in AHF patients could increase in-hospital, ICU and 30-days mortality rates and length of hospital stays, as well as noninvasive and mechanical ventilation requirements.
Co-Authors Adlan El Fatih, Muhammad Afifah, Yuri Agung Sasongko Ahmad Aviv Mahmudi Aji, Nugroho Priyo Anjarwani, Setyasih Anna Fuji Rahimah Arista Candra Irawati Aryanugraha, Teguh Astiawati, Tri Atma Gunawan Bagaswoto, Hendry P. Bahar, Mokhamad Aswin Baskoro, Shalahuddin Suryo Burhan Burhan, Burhan Caesario, Fahreza Cholid Tri Tjahjono Cholid Tri Tjahjono Dadang Suprijatna Danny, Siska S. Dewi U. Djafar, Dewi U. Dewi Utari Djafar, Dewi Utari Dilla Maulida Dyah Puspita Saraswati Dzaki Ilhami, Muhammad Efendi, Rizki Arief Firdaus, Achmad Jauhar firmansyah, Yoki Habib, Faisal Hakim, Dennis I. Hakim, Dennis Ievan Hedi Pudjo Santosa Hendry Purnasidha Bagaswoto Ilhami, Yose R. Ilhami, Yose Ramda Juzar, Dafsah A. Juzar, Dafsah Arifa Karolina, Wella Kurnianingsih, Novi Kushandajani . Lestari, Puspa Martini, Heny Millisani, Hayla Iqda Mohammad S. Rohman Mohammad Saifur Rohman Muhammad Sony Maulana Muzakkir, Akhtar F. Muzakkir, Akhtar Fajar Nita Sari, Nita Noverike, Nikhen Novi Rahmawati Nugraha, Tria Yudha Nugraha, Yudha Tria Nurudinulloh, Akhmad Isna Pamuna, Oktafin Srywati Pashira, Andranissa Amalia Perani Rosyani Prastya, Andhika Primada Qurrota Ayun Priyatno Harsasto Putri, Valerinna Yogibuana Swastika Raden Djuniarsono Rahimah, Anna Fuji Ratna Pancasari Rhiza Amdi, Muh Ririn Handayani Rizal, Ardian Rochmawati, Icmi Dian Rudi, Hasrian Saputri, Vemmy Lian Saskia Dyah Handari Satrijo, Budi Setiawan, Dion Setyowati, Danti Utami Siska Suridanda Danny Sungkar, Safir Wanty Eka Jayanti Widito, Sasmojo Windya Harieska Pramujati Wirawan, Hendy Yogibuana, Valerinna Yudha, Tria zunardi, Lutfi hafiz