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Agnes L. Panda
Universitas Sam Ratulangi
Health Professions

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Relationship between Blood Urea Level and Left Ventricular Ejection Fraction (LVEF) in Patients with ST-Elevation Myocardial Infarction Dewi U. Djafar; Marshell Luntungan; Agnes L. Panda; Steven Setiawan
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39101

Abstract

Abstract: Lower left ventricular ejection fraction (LVEF) is associated with greater mortality among patients with ST-elevation myocardial infarction (STEMI). Renal dysfunction is considered to worsen the prognosis of STEMI patients. This study aimed to determine the correlation between blood urea level and left ventricular ejection fraction in patients with STEMI. This was a descriptive and analytical study using the Spearman’s rho test. Correlation was significant at the 0.05 level.  Data were collected from iSTEMI Registry database of patients admitted in Prof. Dr. R. D. Kandou General Hospital from October 3rd, 2018 to July 28th, 2019. The results obtained 172 STEMI patients with the mean age of 59.47±9.92 years old, and most were male (77.3%). The median blood urea level was 37 mg/dL (IQR 16) whereas a mean ejection fraction was 46.43%±10.43. The Spearman’s rho test showed that higher blood urea level was significantly associated with lower left ventricular ejection fraction (p=0.01; r=-0.241). In conclusion, higher blood urea level is associated with decreased left ventricular ejection fraction in patients with ST-elevation myocardial infarctionKeywords: blood urea level; left ventricular ejection fraction; STEMI Abstrak: Fraksi ejeksi ventrikel kiri yang menurun dikaitkan dengan tingginya mortalitas pada penderita infark miokard akut (IMA) dengan elevasi segmen ST (STEMI). Disfungsi renal diketahui memperburuk prognosis penderita IMA-EST. Penelitian ini bertujuan untuk meng-evaluasi korelasi antara kadar ureum darah dengan fraksi ejeksi ventrikel kiri pada penderita STEMI. Jenis penelitian ialah deskriptif analitik menggunakan data registri iSTEMI penderita STEMI yang dirawat di RSUP Prof. Dr. R. D. Kandou dari 3 Oktober 2018 hingga 28 Juli 2019. Penyajian deskriptif dan korelasi bivariat Spearman rho dilakukan untuk menganalisis hubungan kadar ureum darah dan fraksi ejeksi ventrikel kiri. Hasil penelitian mendapatkan 172 penderita STEMI dengan usia rerata 59,47±9,92 tahun; mayoritas ialah laki-laki (77,3%); median kadar urea darah ialah 37 mg/dL (rentang interkuartil 16); dan rerata fraksi ejeksi ialah 46,43%±10,43. Hasil uji Spearman rho menunjukkan bahwa peningkatan kadar urea darah secara bermakna berhubungan dengan fraksi ejeksi ventrikel kiri yang menurun (p=0,01; r=-0,241). Simpulan penelitian ini ialah peningkatan kadar urea darah berhubungan dengan menurunnya fraksi ejeksi ventrikel kiri pada penderita STEMI.Kata kunci: kadar urea darah; fraksi ejeksi ventrikel kiri; STEMI
Correlation of Earlobe Crease and Clinically Identified Forehead Wrinkles with Severity of Coronary Artery Lesions in Patients with Stable Angina Pectoris Agnes L. Panda; Janry A. Pangemanan; Fanny D. Kojansow
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39347

Abstract

Abstract: Identification of high-risk subjects is crucial in prevention of coronary heart disease. Ear lobe crease and forehead wrinkles are easily identifiable physical signs that could potentially be an indicator of coronary artery lesion severity. This study aimed to determine the relationship between earlobe crease and forehead wrinkles morphology with severity of coronary artery stenosis in patients with stable angina pectoris using modified Gensini score. This was an observational study with a cross-sectional approach. All subjects who met the inclusion criteria were taken photos of their forehead area and both right and left ears. Assessment of scores and correlation analysis of earlobe crease and forehead wrinkles assessment with the severity of coronary artery stenosis using Gensini modification scores were later done. The results showed that from a total of 40 study subjects, 28 patients (70%) were male. Forehead wrinkle scores in patients with stable angina pectoris were mainly classified into score 1 and 2, totalling 32 (80%) patients. Earlobe crease form were dominated by type A (65% vs 35%). Patients with type B morphology on average have a Gensini value of 9 points lower than type A (reference) (p <0.001). As for the Gensini modified score in patients with non-zero forehead wrinkle scores, it was clearly 4−5 units greater than those with a zero score. However, the sample size of patients with zero forehead wrinkle score was indeed too small (n=3) to make the difference meaningful (p=0.507). In conclusion, there is a significant positive relationship between identification of earlobe crease and the severity of coronary artery stenosis but there is no strong relationship between the identification of forehead wrinkles and the severity of coronary artery stenosis in patients with stable angina pectoris, in this case with a modified Gensini score.Keywords: stable angina; earlobe crease; forehead wrinkles; modified Gensini score
Correlation between Right Ventricular Function with Revascularization Time and 30-day Mortality in ST-Elevation Myocardial Infarction Patients Underwent Right Coronary Artery Intervention Marshell Luntungan; Dewi U. Djafar; Agnes L. Panda; Agustinus M. Sarayar; Filipus M. Yofrido
e-CliniC Vol. 10 No. 2 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i2.39436

Abstract

Abstracts: Right ventricular (RV) function provides strong prognostic information in patients treated with primary percutaneous coronary intervention (PCI) due to myocardial infarction. Longitudinal RV systolic function can be assessed by the measurement of the tricuspid annular plane systolic excursion (TAPSE). This study aimed to evaluate the correlation between TAPSE and revascularization time with 30-day mortality using TIMI risk score in patients presenting STEMI who underwent revascularization of right coronary artery (RCA). This was a descriptive amd analytical study. Data were collected from iSTEMI Registry database which consisted of 49 STEMI patients undergoing PCI in RCA and TAPSE measurement at Prof. Dr. R. D. Kandou General Hospital from October 3rd, 2018 to July 28th, 2019. Echocardiographic examination was done within 48 hours of hospitalization. A descriptive analysis and bivariate correlation with Spearman’s rho were applied between given variables. P-value of <0.05 was considered to be statistically significant. The results showed that the mean age of the patients was 57.92 10.345 years old and 79.2% were male. The mean TAPSE measurement was 18.51 mm +/- 3.63 mm. The median revascularization time was 357.5 minutes  while median TIMI score was 4. Shorter treatment time (p=0.708) and lower TIMI score (p=0.923) were not associated with better right ventricular function measured with TAPSE in patients undergoing RCA intervention. In conclusion, right ventricular function is not associated with revascularization time and thirty days mortality in patients presenting with ST-elevation acute myocardial infarction involving right coronary artery.Keywords: tricuspid annular plane systolic excursion; revascularization time; right coronary artery; ST-elevation myocardial infarction
Korelasi antara Neutrophil-To-Lymphocyte Ratio dengan Fraksi Ejeksi pada Pasien Penyakit Jantung Koroner: Studi di Sulawesi Utara, Indonesia Janry A. Pangemanan; Agnes L. Panda; Natalia C. I. Polii; Victor Bandana; Ira Posangi; Andrew E. P. Sunardi; Singgih S. Cahyadi; Filipus M. Yofrido
e-CliniC Vol. 11 No. 1 (2023): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v11i1.44305

Abstract

Abstract: Inflammation has a vital role in the pathogenesis of heart failure (HF) and coronary artery disease (CAD). Neutrophil-to-lymphocyte ratio (NLR) is an inflammation marker proposed to have a correlation with ejection fraction (EF). This is a simple examination and can be obtained routinely in clinical practice. This study aimed to evaluate the correlation of NLR with EF in hospitalized patients with CAD. This was an observational and analytical study with a cross-sectional design. Samples were eligible CAD patients from May until August 2019 at Prof Dr. R. D. Kandou Hospital in North Sulawesi. All patients underwent echocardiography for EF calculation, and blood examination for NLR measurement and risk factor screening. The patients were treated according to the guideline. Data were analyzed using the Spearman test in SPSS v26. The results showed that the majority of patients were male (70.2%) with mean age of 60 years old. Hypertension was found in 76.6% and smoking history in 51.1% patients. NLR was shown to have a significant correlation with EF in patients with CAD (p=0.014). In conclusion, NLR has a significant correlation with EF. Moreover, it could be a useful tool for the clinicians to predict heart failure in a specific population. Keywords: neutrophil-to-lymphocyte ratio; ejection fraction; heart failure; coronary artery disease. Abstrak: Peradangan memiliki peran penting dalam patogenesis gagal jantung (HF) dan juga penyakit arteri koroner (CAD). Rasio neutrofil-limfosit (NLR) merupakan penanda inflamasi yang diduga berkorelasi dengan fraksi ejeksi (EF), serta merupakan pemeriksaan sederhana yang dapat diperoleh secara rutin dalam praktik klinis. Penelitian ini bertujuan untuk mengetahui korelasi NLR dengan EF pada pasien rawat inap dengan CAD. Jenis penelitian ialah observasional analitik dengan desain potong lintang. Sampel penelitian ialah pasien CAD yang memenuhi syarat dirawat dari bulan Mei hingga Agustus 2019 di Rumah Sakit Prof Dr. R. D. Kandou, Sulawesi Utara. Pasien diperiksakan dengan ekokardiografi untuk perhitungan EF, dan dilakukan pemeriksaan darah untuk penilaian NLR dan skrining faktor risiko. Semua pasien dirawat sesuai dengan pedoman. Data dianalisis menggunakan uji Spearman dengan SPSS v26. Hasil penelitian mendapatkan mayoritas sampel ialah laki-laki (70,2%) dengan usia rerata 60 tahun. Hipertensi ditemukan pada 76,6% dan riwayat merokok pada 51,1% pasien. NLR terbukti memiliki korelasi bermakna dengan EF pada pasien CAD (p=0,014). Simpulan penelitian ini ialah NLR terbukti memiliki korelasi bermakna dengan EF pada pasien CAD. Selain itu NLR dapat menjadi alat bantu yang berguna bagi klinisi untuk memrediksi gagal jantung pada populasi tertentu. Kata kunci: neutrophil-to-lymphocyte ratio; fraksi ejeksi; gagal jantung; penyakit arteri koroner
Right Ventricle Dysfunction in COVID-19 Patients Nikita P. Toding Labi; Agnes L. Panda; Edmond L. Jim
e-CliniC Vol. 10 No. 1 (2022): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v10i1.37751

Abstract

Abstract: Coronavirus disease 2019 (COVID-19) has become a global pandemic. Related to its pathomechanisms and complications, COVID-19 is identified as a complex multi-organ disease. Cardiac involvement is reported in COVID-19 patients. One of the cardiovascular complications of COVID-19 is right ventricular dysfunction. This study aimed to provide an overview of right ventricular dysfunction in COVID-19 patients and its association with the patient's clinical outcomes. This was a literature review study conducted by searching and reviewing literatures on online databases as follows: PubMed, ScienceDirect, and ProQuest. There were 14 literatures obtained in this study with a total of 1,435 patients. All articles were observational studies conducted in January-April 2020 across various countries. Samples of patients with right ventricular dysfunction ranged from 3.6 to 41.7% of the total population of each study. Most studies defined right ventricle dysfunction as TAPSE<16-17 mm. Several echocardiography parameters and their threshold values were as follows: RV S' <9,5-10 cm/s; RVFAC <35%; right ventricular free wall strain (RVFWS); and right ventricular global longitudinal strain (RVGLS) according to ASE guidelines. In conclusion, right ventricular dysfunction has a high prevalence and is associated with poor outcomes of COVID-19 patients. Transthoracic echocardiography examination might become a risk stratification modality in hospitalized COVID-19 patients.Keywords: right ventricular dysfunction; coronavirus disease 2019; transthoracic echocardiography Abstrak: Coronavirus disease 2019 (COVID-19) telah menjadi pandemi global. Terkait dengan patomekanisme dan komplikasinya, COVID-19 dinyatakan sebagai penyakit multi-organ kompleks. Telah dilaporkan adanya keterlibatan jantung pada COVID-19. Salah satu komplikasi kardiovaskular dari COVID-19 ialah disfungsi ventrikel kanan. Penelitian ini bertujuan untuk memberikan gambaran disfungsi ventrikel kanan pada pasien COVID-19 dan hubungannya terhadap luaran klinis pasien. Jenis penelitian ialah literature review. Melalui penelusuran pada tiga database (PubMed, ScienceDirect, ProQuest), didapatkan 14 literatur dengan total 1.435 pasien. Semua artikel merupakan studi observasional yang dilakukan pada Januari-April 2020 dan tersebar di berbagai negara. Sampel pasien dengan disfungsi ventrikel kanan tercatat berkisar antara 3,6-41,7% dari total populasi tiap studi. Sebagian besar studi menetapkan definisi disfungsi ventrikel kanan dengan nilai TAPSE<16-17 mm. Beberapa parameter ekokardiografi lain beserta nilai ambang yang digunakan yaitu: RV S' <9,5-10 cm/s; RVFAC <35%; serta right ventricular free wall strain (RVFWS) dan right ventricular global longitudinal strain (RVGLS) berdasarkan panduan ASE. Simpulan penelitian ini ialah disfungsi ventrikel kanan pada COVID-19 memiliki prevalensi tinggi dan berhubungan dengan luaran pasien yang buruk. Pemeriksaan ekokardiografi transtorakal dapat menjadi modalitas stratifikasi risiko pada pasien COVID-19 yang dirawat inap.Kata kunci: disfungsi ventrikel kanan; coronavirus disease 2019; ekokardiografi transtorakal
Co-Authors Agustinus M. Sarayar Andrew E. P. Sunardi Dewi U. Djafar Edmond L. Jim Fanny D. Kojansow Filipus M. Yofrido Filipus M. Yofrido Ira Posangi Janry A. Pangemanan Marshell Luntungan Natalia C. I. Polii Nikita P. Toding Labi Singgih S. Cahyadi Steven Setiawan Victor Bandana