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All Journal Indonesian Journal of Cardiology Heart Science Journal Narra J Journal of Medical Science; Jurnal Ilmu Medis Rumah Sakit Umum Daerah dr. Zainoel Abidin, Banda Aceh Indonesian Journal of Case Reports
Adi Purnawarman, Adi
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Nearly catastrophe coronary perforation: Is it second drug-eluting stent effective? Munirwan, Haris; Hadi, Tjut F.; Purnawarman, Adi; Latief, Muhammad H.; Wattanasiriporn, Wittawat; Yusrizal, Teuku
Narra J Vol. 4 No. 1 (2024): April 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i1.637

Abstract

Coronary artery perforation (CAP) is an uncommon yet serious complication. Although severe perforations (Ellis III) have become more frequent, the overall mortality rate associated with perforations (7.5%) has decreased in recent years. Unfortunately, our medical facility cannot always access a cover stent. The aim of this case report was to demonstrate the effectiveness of using a second drug-eluting stent as an alternative and successful treatment approach in a CAP patient. This is the case of a 67-year-old female with stable angina pectoris Canadian Cardiovascular Society classification III (CCS III), three-vessel coronary artery disease (CAD), who declined CABG (Syntax score of 44) and had type II diabetes mellitus. The patient underwent elective percutaneous coronary intervention (PCI), and we identified diffuse stenosis in the proximal to distal portions of the left anterior descending artery (LAD) with extensive calcification. Furthermore, there was a chronic total occlusion (CTO) in obtuse marginal (OM) 2, as well as critical stenosis in OM3, 80% stenosis in the proximal part of right coronary artery (RCA), 90% stenosis in the middle of the RCA, 90–95% in the distal RCA, and diffuse stenosis ranging from 70–80% in the distal posterolateral. During the procedure to alleviate the stenosis in the left circumflex artery (LCx), we encountered a coronary perforation classified as Ellis type III while using a 2.5/20 mm NC balloon inflated to 12 atm for 12 seconds. In response, we performed stent placement from the proximal LCx to OM2 using the Xience Xpedition drug-eluting stent (DES) measuring 2.5/28 mm. Subsequently, we conducted extended balloon inflation (intermittent) for five minutes. Despite these efforts, the coronary perforation, still classified as Ellis type III, persisted. We decided to employ intrastent stenting (a second DES strategy) with the Coroflex Isar DES measuring 2.5/28 mm, followed by prolonged balloon inflation. The outcome revealed no remaining perforation, Thrombolysis in Myocardial Infarction (TIMI) III flow, and no complications such as pericardial effusion after 48 hours of monitoring. The implantation of a second DES proved to be a practical approach for managing a significant CAP.
Association between NT-proBNP level and the number of stents with major advanced cardiovascular events (MACE) in patients with multivessel coronary artery disease treated with percutaneous coronary intervention: A prospective cohort study Subkhan, Muhammad; Heriansyah, Teuku; Munirwan, Haris; Purnawarman, Adi; Dimiati, Herlina
Narra J Vol. 4 No. 1 (2024): April 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i1.710

Abstract

Complex revascularization strategies, particularly complete revascularization, are controversial in coronary artery disease (CAD), and data supporting routine revascularization in stable CAD is lacking. The importance of percutaneous coronary intervention (PCI) in CAD and N-terminal pro-brain natriuretic peptide (NT-proBNP), which has been studied as a predictor of major advanced cardiovascular events (MACE) in CAD patients, still requires further research. The aim of this study was to determine the association between NT-proBNP levels and the number of stents with MACE incidence in CAD cases. A prospective cohort study was conducted in both types of CAD (acute coronary syndrome (ACS) and chronic coronary syndrome (CCS)). The NT-proBNP levels were measured pre- and post-PCI using fluorescence immunoassay, while MACE was assessed three months post-PCI. The Student t-test was used to compare the levels of NT-proBNP between pre- and post-PCI and between those who had MACE and did not; both in patients treated with single or multiple stenting groups. A total of 32 CAD patients were recruited, consisting of 20 ACS cases and 12 CCS cases. NT-proBNP levels post-PCI increased significantly in both ACS and CCS patients compared to pre-PCI either among those treated with single and multiple stentings. MACE occurred in 4 (12.5%) out of a total of 32 patients, all of which occurred in ACS patients treated with multiple stentings. Those who had MACE had higher post-PCI NT-proBNP levels compared to those who did not have MACE (23,703.50 vs 11,600.17 pg/mL, p=0.013). This study highlights the association between elevated NT-proBNP levels and multiple stenting with the presence of MACE in CAD patients, particularly in ACS cases.
Immunoexpression of aortic endothelial P-selectin and serum apolipoprotein A-1 levels after administration of arabica (Coffea arabica) and robusta (Coffea canephora) coffee bean extracts: In vivo study in atherosclerosis rat model Ekawati, Wahyu; Heriansyah, Teuku; Kamarlis, Reno K.; Purnawarman, Adi; Sofyan, Hamny; Enitan, Seyi S.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.794

Abstract

Atherosclerosis is a leading cause of cardiovascular disease-related death worldwide. Some studies suggested that the natural ingredients in coffee may negatively affect cardiovascular diseases, while other studies indicated that coffee contains anti-inflammatory compounds that are beneficial for cardiovascular diseases. The aim of this study was to measure the expression of P-selectin in aortic endothelial cells and the level of serum apolipoprotein A-1 (ApoA-1) in an atherosclerosis rat model after the administration of arabica and robusta coffee bean extracts at mild-moderate and high doses. An experimental study was conducted with a complete randomized design using 36 adult male white rats (Rattus norvegicus) divided into six groups: negative control (NC), positive control (PC), arabica mild-moderate dose (A1), arabica high dose (A2), robusta mild-moderate dose (R1), and robusta high dose (R2). Animals were induced atherosclerosis with atherogenic feed and then were treated with arabica and robusta coffee bean extracts at two different doses for four weeks. The results showed that the expression of P-selectin in the group of rats treated with robusta coffee bean extract was lower than arabica coffee bean extract group. Rats with robusta coffee bean extract mild-moderate dose had the highest ApoA-1 levels compared to other groups significantly (p<0.05). The level of ApoA-1 was higher in both mild-moderate and high dose of robusta coffee groups compared to the negative control group (both with p<0.001). In conclusion, mild-moderate intake of robusta coffee bean extract could reduce aortic P-selectin immunoexpression and increase serum ApoA-1 levels in an atherosclerosis rat model.
Enhancing Early Detection of Alzheimer's Disease through MRI using Explainable Artificial Intelligence Noviandy, Teuku Rizky; Idroes, Ghifari Maulana; Purnawarman, Adi; Imran, Imran; Lestari, Nova Dian; Hastuti, Sri; Idroes, Rinaldi
Indonesian Journal of Case Reports Vol. 2 No. 2 (2024): December 2024
Publisher : Heca Sentra Analitika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60084/ijcr.v2i2.255

Abstract

Alzheimer’s disease is a progressive brain disorder that causes memory loss and cognitive decline, affecting millions of people worldwide. Early detection is critical for slowing the disease's progression and improving patient outcomes. Magnetic Resonance Imaging (MRI) is widely used to identify brain changes associated with AD, but subtle abnormalities in the early stages are often difficult to detect using traditional methods. In this study, we used a deep learning approach with a model called ResNet-50 to analyze MRI scans and classify patients into four categories: Non-Demented, Very Mild Demented, Mild Demented, and Moderate Demented. The model was trained using MRI images, achieving an accuracy of 95.63%, with strong sensitivity, precision, and specificity. To make the model’s predictions understandable for healthcare professionals, we applied a technique called Grad-CAM, which highlights areas of the brain that influenced the model’s decisions. These visual explanations help clinicians see and trust the reasoning behind the AI's results. While the model performed well overall, misclassifications between adjacent disease stages were observed, likely due to class imbalance and subtle brain changes. This study demonstrates that explainable AI tools can improve early detection of Alzheimer’s disease, supporting clinicians in making accurate and timely diagnoses. Future work will focus on expanding the dataset and combining MRI with other clinical information to enhance the tool's reliability in real-world settings.
Rancangan Aplikasi Sindroma Koroner Akut Purnawarman, Adi; Herawati, Eka Tlaga; Hasibuan, Syariah; Nazari, Nuri; Bashori, Ahmad
Journal of Medical Science Vol 6 No 1 (2025): Journal of Medical Science
Publisher : LITBANG RSUDZA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55572/jms.v6i1.219

Abstract

Saat ini penyakit jantung masih menjadi penyebab kematian tertinggi di dunia, Indonesia, maupun Aceh. Kurangnya kesadaran tentang gejala awal serangan jantung membuat penanganan menjadi tidak maksimal atau lebih dari 20 menit yang dapat menyebabkan miokardium mengalami nekrosis. Adanya perkembangan penggunaan teknologi saat ini dapat dimanfaatkan untuk mengatasi masalah deteksi dini gejala awal serangan jantung melalui suatu sistem komputerisasi. Oleh karena itu, penelitian ini telah mentransformasikan standar deteksi dini sindrom koroner akut ke dalam Aplikasi Sindroma Koroner Akut RSUDZA yang berbasis android dan dapat diakses oleh seluruh tenaga kesehatan maupun masyarakat Aceh. Hal tersebut bertujuan menurunkan angka kematian sehingga pelayanan kesehatan jantung dapat optimal melalui meningkatnya kecepatan kunjungan pasien serangan jantung ke rumah sakit dalam waktu onset 20 menit – 2 jam. Penelitian ini telah dilakukan selama tiga bulan di RSUD dr. Zainoel Abidin dengan sistem pakar. Daftar pertanyaan faktor risiko serta tanda dan gejala awal sebagai deteksi dini serangan jantung di Aplikasi Sindroma Koroner Akut RSUDZA diperoleh dari Pedoman Tatalaksana Sindrom Koroner Akut. Hasil penelitian dari uji blackbox didapatkan bahwa semua fitur dan fungsi dari sistem berjalan sesuai dengan rancangan aplikasi. Sementara itu, hasil penelitian dari uji user acceptance test pada 100 responden yaitu 97% menyatakan tampilan aplikasi menarik, 100% menyatakan dapat mengakses aplikasi dengan mudah, 100% menyatakan pertanyaan di aplikasi mudah dipahami, 100% menyatakan aplikasi ini cukup bermanfaat, serta 100% menyatakan setuju jika aplikasi ini dipublikasikan ke dalam playstore. Oleh karena itu, Aplikasi Sindroma Koroner Akut RSUDZA dapat digunakan oleh tenaga kesehatan maupun masyarakat.
Complete Heart Block In Pregnancy: A Case Report Yafi, Dhanang Ali; Noviani, Cloudia; Saputri, Rahmi Eka; Purnawarman, Adi; Andalas, Mohammad; Yusmalinda, Yusmalinda
Jurnal Kardiologi Indonesia Vol 42 No 1 (2021): Indonesian Journal of Cardiology: January - March 2021
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1015

Abstract

Background: Complete heart block occurs due to various pathological conditions that cause an infiltration, fibrosis, or lose the connection from a part of the cardiac conduction system. Complete heart block in pregnancy is often caused by congenital anomalies. Around 30% cases, complete heart block remain asymptomatic and not detected until adulthood and may present in pregnancy state and puerperium. When the reversible cause of the AV Block cannot be found, the permanent pacemaker or temporary pacemaker may be indicated when the patients show the symptoms. Case Illusration: A-21 year old female, G2P0A1 preterm pregnancy (27-28 weeks) with bradycardia. From electrocardiograph examination revealed Total AV Block with junctional escape rhytym. Transthoracic echocardiogram shows massive tricuspid regurgitation, early phase of peripartum cardiomyopathy and ejection fraction 36-40%. Caesarean section was peformed due to PPROM. A male baby was born with birth weight of 1100 grams, 32 centimeters of body length and APGAR score of 7/9. The baby was died in NICU on day care 4th, with suspected respiratory problem. Conclusion: Complete heart block in pregnancy is a rare condition. This condition could remain asymptomatic and not detected until pregnancy. Multidisciplinary approach, close monitoring of the symptoms and cardiac functions are needed for patients with CHB.
Renal function and potassium changes in HFrEF patients treated with ACEI vs. ARNI: A prospective cohort study among Acehnese, Indonesia Munawarah, Iffah; Heriansyah, Teuku; Syukri, Maimun; Purnawarman, Adi; Buchari
Heart Science Journal Vol. 7 No. 2 (2026): The Evolving Landscape of Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.02.10

Abstract

Background: Renin-Angiotensin-Aldosterone System (RAAS) acceleration commonly occur in Heart Failure (HF). Drugs such as Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor-Neprilysin Inhibitors (ARNI) become essential part of HF treatment. Long-term consumption may impair kidney function and potassium imbalance, which could potentially limit the therapy, therefore we conducted this study to assess the effects of ACEI and ARNI on renal function and potassium level in Indonesian patients with heart failure with reduced ejection fraction (HFrEF), as no local studies exist. Method: A prospective cohort was performed in Banda Aceh, which comprise of 40 ACEI and 40 ARNI patients on standard therapy. Left ventricular ejection fraction (LVEF), serum creatinine level then converted into estimated Glomerular Filtration Rate (eGFR), and serum potassium level were measured at baseline and after 3 months into the therapy. Independent t-test was applied to compare groups. Result: Both ARNI and ACEI groups showed significant improvement in eGFR (p < 0.005). The intergroup difference was 11 mg/dL (p = 0.038) showed that ACEI had a better outcome in eGFR improvement compare with ARNI. Potassium rose slightly in both groups, with an intergroup difference of 0.082 mmol/L (p = 0.623), indicating no meaningful difference. Conclusion: Both ACEI and ARNI improved eGFR after 3 months, with a modest potassium increase.
Efektivitas Pemeriksaan APTT, PT Dan INR pada Pasien Post Percutaneous Coronary Intervention (PCI) di Rumah Sakit Umum Daerah dr. Zainoel Abidin Nazari, Nuri; Herawati, Eka Tlaga; Purnawarman, Adi; Hendra
Journal of Medical Science Vol 7 No 1 (2026): Journal of Medical Science
Publisher : LITBANG RSUDZA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55572/jms.v7i1.247

Abstract

Tingginya angka kejadian penyakit jantung koroner di Indonesia, khususnya di Aceh, berdampak pada meningkatnya beban pembiayaan kesehatan, termasuk oleh BPJS Kesehatan, sehingga diperlukan upaya untuk mengefektifkan prosedur klinis yang tetap aman dan berdampak signifikan bagi pasien. Di RSUD dr. Zainoel Abidin, seluruh pasien pasca-percutaneous coronary intervention (PCI) tetap menjalani pemeriksaan activated partial thromboplastin time (APTT), prothrombin time (PT), dan international normalized ratio (INR) sebelum tindakan pelepasan femoral sheath, tanpa mempertimbangkan kondisi hemodinamik. Sementara itu, di beberapa pusat layanan kardiovaskular seperti Rumah Sakit Narayana Hrudayalaya, India, pemeriksaan tersebut tidak rutin dilakukan pada pasien dengan kondisi hemodinamik stabil. Penelitian ini bertujuan untuk membandingkan efek samping tindakan sheath removal femoral antara pasien yang dilakukan pemeriksaan APTT, PT, dan INR dengan pasien yang tidak dilakukan pemeriksaan tersebut. Penelitian ini menggunakan desain kuasi-eksperimental dengan jumlah sampel sebanyak 30 responden, yang dilaksanakan pada periode 12 Juni hingga 12 September 2023. Analisis data dilakukan menggunakan uji Mann-Whitney. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan yang signifikan terhadap efek samping sheath removal femoral antara kedua kelompok, baik setelah 6 jam (p=0,146) maupun setelah 24 jam (p=0,086). Kesimpulan dari penelitian ini adalah pada pasien post PCI dengan kondisi hemodinamik stabil dan tanpa komplikasi, pemeriksaan APTT, PT, dan INR tidak diperlukan sebelum tindakan sheath removal femoral. Temuan ini menunjukkan bahwa prosedur dapat dilakukan secara lebih efisien tanpa meningkatkan risiko efek samping, sehingga berpotensi meningkatkan kenyamanan pasien serta menurunkan beban biaya pelayanan kesehatan.
Co-Authors BASHORI, AHMAD Buchari Dian Lestari, Nova Ekawati, Wahyu Enitan, Seyi S. Hadi, Tjut F. Hamny Sofyan Hasibuan, Syariah Hendra Herawati, Eka Tlaga Herlina Dimiati, Herlina Idroes, Ghifari Maulana Imran Imran Kamarlis, Reno K. Latief, Muhammad H. Maimun Syukri, Maimun Mohammad Andalas Munawarah, Iffah Munirwan, Haris Nazari, Nuri Noviani, Cloudia Rinaldi Idroes Saputri, Rahmi Eka Solly Aryza Subkhan, Muhammad Teuku Heriansyah, Teuku Teuku Rizky Noviandy Wattanasiriporn, Wittawat Yafi, Dhanang Ali Yusmalinda, Yusmalinda Yusrizal, Teuku