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Munirwan, Haris
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Journal : Narra J

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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.
Impact of colchicine on hs-CRP, neutrophil levels, neutrophil-to-lymphocyte ratio and major adverse cardiac events (MACEs) in Thai patients with acute coronary syndrome undergoing percutaneous coronary intervention Wattanasiriporn, Wittawat; Rattanasidha, Paruj; Munirwan, Haris; Arayangkoon, Chantisa
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3079

Abstract

Acute coronary syndrome (ACS) is strongly associated with inflammation, which contributes to plaque instability, thrombosis, and adverse cardiovascular outcomes. High-sensitivity C-reactive protein (hs-CRP), neutrophil count, and neutrophil-to-lymphocyte ratio (NLR) are inflammatory markers that have been associated with poor prognosis in patients with ACS. Colchicine has emerged as a potential adjunctive anti-inflammatory therapy in cardiovascular disease. This study aimed to evaluate the effects of colchicine on inflammatory markers and clinical outcomes in Thai patients with ACS undergoing percutaneous coronary intervention (PCI). This single-center, retro-prospective observational cohort study included adult patients with ACS who underwent PCI at Rajavithi Hospital, Bangkok, Thailand, in 2024. Patients were classified into colchicine and non-colchicine groups based on treatment exposure after PCI. Hs-CRP, neutrophil count, and NLR were assessed at baseline, 1 month, and 3 months. Major adverse cardiac events (MACE) during follow-up were also recorded. A total of 56 patients were included, comprising 38 in the colchicine group and 18 in the non-colchicine group. Compared with the non-colchicine group, the colchicine group showed significantly greater reductions from baseline to 3 months in hs-CRP levels (2.29±3.37 vs 0.45±1.03; p=0.044), neutrophil count (21.86±10.62 vs 4.13±12.92; p=0.001), and NLR (2.98±2.93 vs 1.68±3.60; p=0.025). No significant differences in MACE were observed between the two groups. This study highlighted that colchicine was associated with greater reductions in inflammatory markers during the early post-PCI period, although no significant difference in short-term clinical outcomes was identified. Larger prospective studies are needed to confirm these findings.
Global longitudinal strain and left ventricular ejection fraction for early detection of chemotherapy-related cardiac dysfunction in breast cancer: A prospective comparison of doxorubicin-based and paclitaxel–carboplatin regimens Faradilla, Rizka; Heriansyah, Teuku; Novita, Novita; Munirwan, Haris; Fitra, Maha
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3095

Abstract

Left ventricular ejection fraction (LVEF) is widely used in routine practice to assess cardiotoxicity; however, reductions in LVEF often reflect relatively advanced myocardial damage. Global longitudinal strain (GLS) quantifies myocardial deformation and has demonstrated greater sensitivity for identifying early systolic dysfunction, yet comparative evidence on myocardial strain changes between doxorubicin-based regimens and non-anthracycline chemotherapy in breast cancer patients remains limited. The aim of this study was to compare changes in left ventricular GLS and LVEF between breast cancer patients receiving doxorubicin-based chemotherapy and those treated with paclitaxel–carboplatin regimens. A prospective cohort study was conducted among 106 women with histopathologically confirmed breast cancer, who were allocated to receive either a doxorubicin-based regimen (n=53) or a paclitaxel–carboplatin regimen (n=53). Transthoracic echocardiography was performed within seven days before chemotherapy initiation and repeated after four months. Left ventricular GLS was measured using two-dimensional speckle-tracking echocardiography from apical views and analyzed offline using the 17-segment model. Baseline GLS values did not differ significantly between the doxorubicin and paclitaxel–carboplatin groups (−20.47±0.45 vs −20.38±0.53; p=0.410). After four months, GLS was significantly reduced in the doxorubicin group compared with the paclitaxel–carboplatin group (−15.04±0.35 vs −19.54±0.50; p<0.001). The change in GLS (ΔGLS) was also greater in the doxorubicin group (5.43±0.12 vs 0.84±0.11; p<0.001). No significant differences were observed in LVEF before chemotherapy (55.26±1.78 vs 55.39±1.99; p=0.720), after chemotherapy (51.32±1.51 vs 51.60±1.64; p=0.359), or in ΔLVEF (p=0.484). In conclusion, doxorubicin-based chemotherapy was associated with early subclinical systolic dysfunction detectable by GLS before measurable LVEF decline, whereas paclitaxel–carboplatin was associated with relatively preserved myocardial deformation. These findings support the incorporation of strain imaging into routine cardiac surveillance for earlier identification and management of chemotherapy-related myocardial injury.
Co-Authors Adi Purnawarman, Adi Arayangkoon, Chantisa Faradilla, Rizka Fitra, Maha Hadi, Tjut F. Herlina Dimiati, Herlina Kurniawan, Ferry D. Kusyanto, Fahmi A. Latief, Muhammad H. Muhammad Ridwan Nina Widasari Novita Novita Rattanasidha, Paruj Subkhan, Muhammad Teuku Heriansyah, Teuku Wattanasiriporn, Wittawat Yusrizal, Teuku Zanisa, Zanisa