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All Journal Jurnal Penelitian Pendidikan IPA (JPPIPA) Narra J
Munirwan, Haris
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Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Chemistry Education Health Professions Immunology & microbiology Materials Science & Nanotechnology Medicine & Pharmacology Physics Public Health

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Chronic total occlusion percutaneous coronary intervention (CTO PCI) in an intractable heart failure patient: Is there any benefit? Munirwan, Haris; Kusyanto, Fahmi A.; Zanisa, Zanisa; Latief, Muhammad H.
Narra J Vol. 3 No. 2 (2023): August 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i2.140

Abstract

One of the most difficult procedures in interventional cardiology is the percutaneous coronary intervention (PCI) on a chronic total occlusion (CTO) lesion case. To rate the difficulty of guidewire crossing, several angiographic scoring methods have been developed such as the Japan CTO (J-CTO) score. Here we demonstrate the advantages of revascularization using PCI procedure in a CTO case with intractable heart failure. A 53-year-old man presented to the emergency room of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia with acute decompensated heart failure. The patient had a history of past PCI with two patent drug eluting stents (DES): one in the left main (LM)-left anterior descending (LAD) artery and one in the distal left circumflex (LCX) artery. The patient had three times rehospitalizations in the last three months. According to single-photon emission computed tomography (SPECT) imaging, the right coronary artery was remained functional; however, the lesion was categorized into very difficult level (J-CTO >3). The PCI was carried out on the right coronary artery and the blood vessel was successfully revascularized after applying multiple techniques. Following the procedure, the heart failure was treated and the 6-minute walking test (6MWT) that performed 12 days after the PCI increased from 220 to 260 meters. The success of this case depended on a comprehensive history taking, adequate imaging methods, and the selection of the proper tools and PCI strategy. In conclusion, despite the challenges, PCI is still an option for patients with persistent complete occlusion. The PCI requires comprehensive preparation and the use of angiographic scoring systems, such as the J-CTO score, to determine the approach and the likelihood of success.
Correlation between high sensitivity C reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity in post COVID-19 syndrome patients Widasari, Nina; Heriansyah, Teuku; Ridwan, Muhammad; Munirwan, Haris; Kurniawan, Ferry D.
Narra J Vol. 3 No. 2 (2023): August 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i2.183

Abstract

Post coronavirus disease 2019 (COVID-19) syndrome is one of the causes of reduced functional capacity and work productivity, in particular for healthcare workers. The pathophysiology of the post COVID-19 syndrome is related to complex and multisystem inflammatory mechanisms, and cardiopulmonary exercise rehabilitation program is one of the efforts to improve the recovery process for patients with post COVID-19 syndrome. The aim of this study was to determine the correlation between the level of high sensitivity C-reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity (VO2max) in individuals with post-COVID-19 syndrome who received moderate- and high-intensity supervised cardiopulmonary exercise. A prospective cohort study was conducted at the Integrated Cardiac Rehabilitation Center of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The supervised cardiopulmonary exercise was conducted for six weeks according to the participant's baseline VO2max. Spearman's and Pearson's correlation tests were used to assess the correlations. A total of 30 individuals (19 and 11 had moderate and high intensity exercise, respectively) were involved in this study. At moderate intensity exercise, the average Hs-CRP and NLR were 3.3 mg/L and 1.99, respectively; while at high intensity, the values were 3.8 mg/L and 1.79, respectively. No significant correlation between Hs-CRP level and functional capacity in both moderate-intensity and high intensity groups. In contrast, NLR was negatively correlated with functional capacity (r=-0.545, p=0.016) in moderate intensity exercise group. In conclusion, NLR value was negatively correlated with functional capacity in individuals with post-COVID-19 syndrome after receiving moderate intensity supervised cardiopulmonary exercise program. Therefore, moderate intensity of cardiopulmonary exercise maybe be used as a program to accelerate the recovery for those with post COVID-19 syndrome.
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.
Relationship between the Left Atrial Volume Index and Left Ventricular Geometry and the Incidence of Atrial Fibrillation in Hypertensive Patients with Cardiovascular Complications Djeni, Chairatu Sadrina; Heriansyah, Teuku; Mudatsir; Novita; Munirwan, Haris
Jurnal Penelitian Pendidikan IPA Vol 11 No 8 (2025): August
Publisher : Postgraduate, University of Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jppipa.v11i8.12031

Abstract

This study aimed to evaluate the relationships of the left atrial volume index (LAVI) and left ventricular geometry with the incidence of AF in hypertensive patients with cardiovascular complications such as heart failure or coronary arterial disease.  This study employed a retrospective observational cohort design. A total of 202 subjects met the inclusion and exclusion criteria for the study. The subjects were selected from hypertensive patients with cardiovascular complications treated at Dr. Zainoel Abidin General Hospital Banda Aceh, a tertiary referral center in Indonesia, between July and December 2024. 12At the end of the study, the participants were divided into two groups: those with newly diagnosed atrial fibrillation (n=37) and those without atrial fibrillation (n=165). The diagnosis of new-onset atrial fibrillation was based on medical records obtained during hospitalization and continued through a three-month follow-up after discharge via outpatient clinic visits and 12-lead ECG monitoring. The study revealed a significant association between increased LAVI and AF incidence (p < 0.01). The mean LAVI in the AF group was 49.9 ± 19.2 ml/m², whereas it was 33.34 ± 15.6 ml/m² in the non-AF group. Additionally, changes in left ventricular geometry were correlated with increased AF incidence (p value = 0.03), with eccentric hypertrophy showing the highest AF incidence (29.5%). A strong association was also found between increased LAVI and left ventricular geometric changes, with eccentric hypertrophy resulting in the highest mean LAVI (43.2 ± 16.9 ml/m²). The odds ratio (OR) analysis demonstrated that patients with LAVI above the threshold had a significantly greater risk of developing AF (OR: 5.2; 95% CI: 2.475–11.161). Similarly, patients with normal ventricular geometry had a significantly lower risk of AF compared to those with eccentric hypertrophy (OR: 0.148; 95% CI: 0.049–0.449). Increased LAVI and left ventricular geometry changes, particularly eccentric hypertrophy, are significant risk factors for AF in hypertensive patients with cardiovascular complications such as heart failure and coronary arterial disease. Clinical practice should incorporate echocardiographic monitoring of left ventricular geometry and LAVI to prevent the progression of AF and detect risk early
Co-Authors Adi Purnawarman, Adi Djeni, Chairatu Sadrina Hadi, Tjut F. Herlina Dimiati, Herlina Kurniawan, Ferry D. Kusyanto, Fahmi A. Latief, Muhammad H. Mudatsir Muhammad Ridwan Nina Widasari Novita Subkhan, Muhammad Teuku Heriansyah, Teuku Wattanasiriporn, Wittawat Yusrizal, Teuku Zanisa, Zanisa