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All Journal Journal of Biomedicine and Translational Research Medica Hospitalia Heart Science Journal
Pipin Ardhianto, Pipin
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Association between Neutrophil to Lymphocyte Ratio and Post Operative Atrial Fibrillation after Coronary Artery Bypass Graft operation. Sidiek, Aboesina; Herry, Yan; Ardhianto, Pipin; Bahrudin, Udin
Journal of Biomedicine and Translational Research Vol 10, No 1 (2024): April 2024
Publisher : Faculty of Medicine, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v10i1.20804

Abstract

ABSTRACT Background: Post operative atrial fibrillation (POAF) is associated with cardiovascular outcomes such as stroke, heart failure, and mortality. Neutrophil to lymphocyte ratio (NLR) is one of biomarker of inflammation. The use of cor pulmonary bypass(CPB), surgical trauma and reperfusion injury during cardiac surgery causes inflammation. NLR is suspected to be a biomarker that represents the inflammatory response as a modulator of POAF, but data are still lacking.This study analyzed the association between NLR and POAF after coronary artery bypass graft (CABG) operation.Methods: This was an Observational analytic study, involving patients after the CABG procedure in Kariadi Hospital between June 2022 to September 2023. NLR was assessed in the first three hours after operation. ECG Holter was attained for 96 hours post-CABG procedure.Results: The total subject was 62 patients, consisting of 57 men and 5 women with a mean age of 58,7 ± 6.39 years. Mean postoperative NLR 4.95 ± 2.17 with a median of 4.56 (1.52-11.00). There was a significant association between post-operative NLR with POAF after CABG (p=0.006, OR 4.64, 95%CI 1.50-14.35). High inotropic dose and β blocker initiation time less than 45 hours correlate significantly with POAF after CABG (p<0.001, OR 6.94 dan p=0.001, OR 0.17).Conclusions: Postoperative NLR is associated significantly with POAF after CABG. Keywords: Neutrophil to Lymphocyte Ratio, Post Operative Atrial Fibrillation, coronary artery bypass graft, ECG Holter
Correlation Between Corrected TIMI Frame Count with the Extent of Myocardial Fibrosis on ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Munandar, Reza Maulana; Herminingsih, Susi; Ardhianto, Pipin; Gharini, Putrika Prastuti Ratna; Sobirin, Mochamad Ali
Journal of Biomedicine and Translational Research Vol 10, No 1 (2024): April 2024
Publisher : Faculty of Medicine, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v10i1.20872

Abstract

Background: Microvascular injury after primary percutaneous coronary intervention (PPCI) reperfusion contributes to necrosis propagation. Corrected TIMI Frame Count (CTFC) is a surrogate marker of microvascular dysfunction and can stratify in-hospital mortality risk in patients with final TIMI flow 3. The extent of myocardial fibrosis after STEMI is associated with a higher incidence of major cardiovascular events. This study aimed to determine the relationship between CTFC in the infarct-related artery and myocardial fibrosis area based on cardiac magnetic resonance (CMR) in STEMI patients undergoing PPCI.Methods: This retrospective cohort study included 31 STEMI patients who had undergone PPCI and CMR examination between days 60 and 75 after STEMI as the sample. CTFC was measured in the infarct-related artery from post-PPCI angiogram recordings. Myocardial fibrosis area was measured from late gadolinium enhancement CMR (LGE-CMR) imaging results.Results: In this study, the mean age was 51.61±10.49 years, 90.3% were male, non-anterior infarction location was 58.1%, mean total ischemic time was 489.48±228.33 minutes, mean CTFC was 27.4±9.3 frames, and mean myocardial fibrosis was 18.33±7.87%. There was no significant correlation found between CTFC and myocardial fibrosis (p=0.530), however total ischemic time had a positive and significant correlation with myocardial fibrosis (p=0.025, r=0.403).Conclusion: CTFC in the infarct-related artery is not correlated with myocardial fibrosis area in STEMI patients undergoing PCI.
External Validation of Major Adverse Cardiovascular Events’ Predictors in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Raharjo, Robert Adrianto; Herminingsih, Susi; Ardhianto, Pipin; Herry, Yan
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 2 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (602.671 KB) | DOI: 10.36408/mhjcm.v8i2.569

Abstract

BACKGROUND: KARIADI risk score is a 0-to-9 point system based on Killip class, final TIMI flow, total ischemic time, creatinine level, blood glucose, systolic blood pressure, and age. This score was developed to predict the risk of in-hospital major adverse cardiovascular events (MACE) (a composite of death, stroke, urgent revascularization, cardiogenic shock, acute pulmonary edema, or arrhythmia) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI), but its performance has never been validated externally. OBJECTIVE: To perform external validation on KARIADI risk score. METHOD: This study was a prospective cohort study on 109 STEMI patients undergoing PPCI in Dr. Kariadi General Hospital during January-November 2020. Each sample underwent KARIADI risk score assessment and follow-up for in-hospital MACE. The risk score validation was performed by assessing calibration [measured with calibration-in-the-large (alpha), calibration slope (beta), and calibration plot] and discrimination performance [measured with c-statistic and receiver operating characteristic curve). RESULT: Eighteen patients (16.5%) had MACE. KARIADI risk score demonstrated unsuitable calibration (alpha -0.39, beta 0.71, unfit calibration plot) and moderate discrimination performance (c-statistic 0.75, 95% CI 0.62-0.87). CONCLUSION: KARIADI risk score is not valid in predicting in-hospital MACE in patients with STEMI undergoing PPCI. Keywords: ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, KARIADI risk score, external validation
Aspirasi Trombus Selektif Memperbaiki Aliran Koroner dan Mengurangi Tingkat Badai Trombus pada Pasien Sindroma Koroner Akut Dengan Elevasi Segmen ST yang dilakukan Intervensi Koroner Perkutan Primer Bramantyo, Liborius; Bahrudin, Udin; Ardhianto, Pipin; Uddin, Ilham; Rifqi, Sodiqur
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (286.685 KB) | DOI: 10.36408/mhjcm.v8i3.583

Abstract

Latar belakang: Embolisasi distal koroner berkontribusi terhadap tingginya kejadian kardiovaskular mayor (KKVM) pasca intervensi koroner perkutan primer (IKPP). Aspirasi trombus (AT) manual berpotensi mengurangi embolisasi distal dan memperbaiki perfusi mikrovaskular pada pasien sindroma koroner akut dengan elevasi segmen ST (SKA-EST), terutama pasien dengan badai trombus tinggi. Tujuan: Mengetahui pengaruh aspirasi trombus selektif terhadap skor TIMI trombus dan luaran klinis pasca IKPP. Metode: Penelitian retrospektif pada pasien SKA-EST dengan onset ?12 jam dan skor trombus TIMI awal ?3 yang menjalani IKPP dengan aspirasi trombus selektif di RSUP Dr. Kariadi periode Januari 2018 sampai Desember 2019. Luaran klinis yang diobservasi adalah KKVM selama rawat inap yang terdiri dari mortalitas, syok kardiogenik, edema paru akut, aritmia, revaskularisasi ulang, dan stroke. Hasil: Sejumlah 100 pasien memenuhi kriteria, terdiri dari 50 pasien kelompok AT dan 50 pasien kelompok non-AT. Rerata skor trombus TIMI awal kelompok AT dan non-AT, masing-masing 4,76 dan 3,8 (p<0,001). Kelompok AT mengalami penurunan skor trombus TIMI lebih baik dibanding non-AT (4,72 vs. 3,8, p<0,001). Terdapat 8 (16%) pasien kelompok AT dan 11 (22%) pasien non-AT yang mengalami KKVM pasca IKPP (RR 1,08, IK 95% 0,89-1.30, p=0,44). Kesimpulan: Aspirasi trombus selektif mungkin mengurangi tingkat badai thrombus. Aspirasi trombus mungkin menurunkan kejadian kardiovaskular mayor selama rawat inap pasca IKPP pada pasien dengan skor trombus TIMI di atas 4 setara dengan yang memiliki skor trombus TIMI kurang dari 4 tanpa aspirasi trombus.
Catastrophic Event Following Percutaneus Coronary Intervention Developing In-Stent Thrombosis Leading Massive Pericardial Effusion and Free Wall Rupture Suryadilaga, Yudhanta; Rohmatussadeli, Rizqon; Hadi, Marco Wirawan; Praha, Lourensia Brigita Astern; Ardhianto, Pipin
Medica Hospitalia : Journal of Clinical Medicine Vol. 11 No. 2 (2024): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v11i2.1109

Abstract

BACKGROUND: One extremely unusual but serious side effect of an acute myocardial infarction is left ventricular free wall rupture. It was reported to happen either during the sub-acute phase with overt cardiac remodeling (type III, 45%) or early after the beginning of Myocardial Infarction (MI) (type I or II, about 55%). Large infarct sizes, female gender, and advanced age have all been linked to an increased risk of free wall rupture. Clinicians continue to face significant challenges in diagnosing and treating this condition because of the diverse clinical manifestations linked to elevated death rates. AIMS: This case report aims to highlight a rare occurrence of mechanical complication of acute myocardial infarction CASE: A 69-year-old male patient was referred because of chest pain and dyspneu. He had a primary Percutaneous Coronary Intervention (PCI) and was diagnosed with posterior ST-Evelation Myocardial Infarction (STEMI). The patient had a stent inserted into his ostial-distal Left Circumflex (LCx) artery. Three weeks later, a reangiography revealed a left ventricle (LV) aneurysm and stent thrombosis. Massive pericardial effusion with free wall rupture was seen on the echo. He was breathing heavily while in our emergency room. His blood pressure was 125/74 (94) heart rate was 94 bpm respiratory rate 24 times/minute, SpO2 was 98%, there were no rales, and his ankles had pitting edema. By the bedside, Echo revealed an LV aneurysm, a large, localized pericardial effusion without tamponade, and a possible free wall rupture. Later, he was taken to the intensive care unit and had heart surgery DISCUSSION: Complications from an acute myocardial infarction may be ischemic, mechanical, arrhythmic, embolic, or inflammatory. Significant short-term clinical improvement and long-term survival are linked to the emergence of mechanical problems following acute myocardial infarction. CONCLUSION: the fact that primary Percutaneous Coronary Intervention (PCI) has significantly reduced the prevalence of this deadly event. Our results indicate that one of the key predictors and primary causes of this problem is a longer symptom of angiography time.
Successful ablation of double accessory pathways: a rare case of coexistence between right inferoseptal WPW and left lateral AVRT Yudha, Ardi; Ardhianto, Pipin
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.18

Abstract

BACKGROUND: Managing double accessory pathways (APs) in the clinical setting presents significant challenges, primarily due to the rarity of this condition and the complexities involved in both diagnosis and treatment.CASE PRESENTATION: A 51-year-old male presented with recurrent episodes of palpitation. Electrocardiography (ECG) revealed sinus rhythm with a pre-excitation pattern characterized by a delta wave morphology showing a negative deflection in V1, a transitional zone in V2, and negativity in lead III and aVF, indicating an accessory pathway through the right infero-septal pathway. Further evaluation with electrophysiological study (EPS) confirmed the presence of accessory pathways, with the right infero-septal pathway exhibiting pre-excitation during sinus rhythm. Radiofrequency ablation (RFA) successfully eliminated the right infero-septal accessory pathway. Subsequently, coronary sinus propagation shifted from a concentric to an eccentric pattern, indicating another accessory pathway from the left lateral region. Another mapping was performed retrogradely at the mitral annulus, revealing ventriculoatrial (VA) fusion at the left lateral area and demonstrating inducible atrioventricular reentrant tachycardia (AVRT). RFA successfully eliminated the left lateral accessory pathway, with the final result showing retrograde block.CONCLUSION: This case highlights the importance of thorough diagnostics and tailored treatment strategies in managing dual APs, emphasizing the effectiveness of EPS-guided RFA for complex arrhythmias.
Co-Authors ABOESINA SIDIEK Bramantyo, Liborius Gharini, Putrika Prastuti Ratna Hadi, Marco Wirawan Herminingsih, Susi Herry, Yan Ilham Uddin Lourensia Brigita Astern Praha, Lourensia Brigita Astern Mochamad Ali Sobirin Munandar, Reza Maulana Raharjo, Robert Adrianto Rohmatussadeli, Rizqon Sodiqur Rifqi Suryadilaga, Yudhanta Udin Bahrudin, Udin Yudha, Ardi