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Timi Flow Between Streptokinase and Alteplase in Successful Fibrinolytic Ashrinda, Dika; Hasan, Refli; Andra, Cut Aryfa; Muhtar, Zulfikri; Hasan, Harris
Sumatera Medical Journal Vol. 2 No. 1 (2019): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

STEMI with onset≤12 hours, necessary to take Primary Percutaneous Coronary Intervention (pPCI), but if there is no facility, another therapy is fibrinolytic, to improve blood flow in the coronary artery and myocardial function, thus reducing infarction expansion. This is a retrospective study in STEMI patients onset≤12 hours, had performed successful fibrinolytic with Streptokinase (SK) and Alteplase (tPA) from January 2015 to August 2017. TIMI flow was assessed by coronary angiography. There were 54 patients who had performed successful fibrinolytic therapy with SK and tPA; each group had 27 patients. In the SK group, there were nine patients (33.3%) with TIMI flow 2 and 18 patients (66.7%) with TIMI flow 3. While in the tPA group there were 11 patients (40.7%) with TIMI flow 2, 16 patients (59.3%) with TIMI flow 3, (p=0.573). There is no difference in TIMI flow between SK and tPA on STEMI patients after success fibrinolytic therapy.

Predictor of Left Atrial Spontaneous Echocardiographic Contrast in Rheumatic Mitral Stenosis Patients Komaria, Komaria; Halim R, Abdul; Nst, Ali Nafiah; Hasan, Harris
Indonesian Journal of Cardiology Vol 38 No 3 (2017): July - September 2017
Publisher : The Indonesian Heart Association

Background: Previously conducted researches showed that presence of SEC in the left atrium can constitute a risk factor for thrombus formation. Some previous studies have also reported that in addition to atrial fibrillation and blood stasis in the left atrium, the pathophysiology of left atrial thrombus and SEC occurring in patients with rheumatic mitral stenosis exhibits some other mechanisms, such as autoimmunity, inflammation and increased thrombotic activity. Methods: Cross sectional study was conducted between July 2015 to July 2017 in patient who admitted to Haji Adam Malik Hospital due to rheumatic mitral stenosis. They were divided into two groups according to presence of left atrial SEC. Result: From 104 patients, 52 (mean age 40 ± 11 years; 71,2% women) were in the left atrial SEC-negative group and 52 patients (mean age 40 ± 10 years; 73,1% women) were in the left atrial SEC-positive group. There were no significant differences in the leucocyte, 8,06±1,54 were in the left atrial SEC-negative group and 7,37±1,76 were in the left atrial SEC-positive group. In multivariate analysis, atrial fibrillation (OR = 51,311, 95% CI 3,723 – 707,100, p = 0,003) neutrophil/lymphocyte ratio (OR = 21,641, 95% CI 5,174 – 90,528, p < 0,001), mitral valve area (OR = 14,423, 95% CI 1,665 – 124,908, p = 0,015), and RDW (OR = 5,743, 95% CI 1,349 – 24,445, p = 0,018), These study show that neutrophil/lymphocyte ratio with cut off point of >3,2 had sensitivity, spesificity, positive predictive value, and negative predictive value to predict left atrial SEC is the same 81%, respectively. Conclusion: Atrial fibrillation, neutrophil/lymphocyte ratio, RDW and mitral valve area can predict left atrial spontaneous echocardiographic contrast in rheumatic mitral stenosis patients.   Abstrak Latar Belakang: Penelitian sebelumnya menunjukkan adanya SEC di atrium kiri menjadi faktor risiko untuk pembentukan trombus. Pada pasien stenosis mitral rematik, risiko trombosis dan perkembangan SEC di atrium kiri tinggi. Beberapa penelitian sebelumnya melaporkan bahwa patofisiologi trombus dan SEC di atrium kiri selain fibrilasi atrium dan stasis aliran darah di atrium kiri juga adanya beberapa mekanisme lain seperti respon imun, inflamasi dan peningkatan aktifitas trombotik. Metode: Ini adalah penelitian observasional yang bersifat cross sectional, dilakukan dari Juli 2015 sampai Juli 2017 terhadap pasien stenosis mitral rematik yang datang ke rumah sakit Haji Adam Malik. Pasien dibagi 2 kelompok berdasarkan kehadiran SEC di atrium kiri menurut hasil pemeriksaan ekokardiografi. Hasil: Didapatkan 104 pasien, dimana 52 pasien (usia rata-rata 40 ± 11 tahun, 71% wanita) merupakan kelompok tanpa SEC, dan 52 pasien (usia rata-rata 40 ± 10 tahun, 73% wanita) merupakan kelompok dengan SEC. Tidak ada perbedaan bermakna pada lekosit, dimana kelompok tanpa SEC (8,06±1,54) dan kelompok dengan SEC (7,37±1,76). Dari analisis multivariat regresi logistik, didapatkan fibrilasi atrium (OR = 51,311, nilai IK 95% antara 3,723 – 707,100, p = 0,003) rasio netrofil/limfosit (OR = 21,641, nilai IK 95% antara 5,174 – 90,528, nilai p < 0,001), area katup mitral (OR = 14,423, nilai IK 95% antara 1,665 – 124,908, nilai p = 0,015), dan RDW (OR = 5,743, nilai IK 95% antara 1,349 – 24,445, nilai p = 0,018), merupakan prediktor independen untuk terjadinya SEC. Titik potong untuk nilai rasio N/L > 3,2 memiliki angka sensitivitas, sensitifitas, nilai prediktif positif dan nilai prediktif negatif yang sama yaitu masing-masing 81% untuk memprediksi kejadian SEC di atrium kiri pada pasien stenosis mitral rematik. Kesimpulan: Fibrilasi atrium, rasio netrofil/limfosit, RDW dan area katup mitral dapat menjadi prediktor SEC di atrium kiri pada pasien stenosis mitral rematik.

SMASH Score as a Predictor off-in Hospital Mortality for Acute Heart Failure Patients Syahputra, Zunaidi; Lubis, Hilfan Ade Putra; Safri, Zainal; Hasan, Harris
Indonesian Journal of Cardiology Vol 38 No 4 (2017): October - December 2017
Publisher : The Indonesian Heart Association

Background: The prognosis of AHF patients remain poor. The aim of this study is to design a simple, bedside clinical prognostic scoring model and validate its ability to predict hospital mortality for patients with AHF. Methods: 255 patients with AHF were enrolled, divided into dead (n=121) and survival (n=134) cohorts. The data were collected from January 2015 to September 2016.Data were collected restropectively. Multivariable analysis was applied to determine independent risk factors and develop the scoring system. Results: The Multivariate logistic regression analysis, hospital mortality was employed as dependent variable, while age umur (p=0.014,OR 4.314 CI 95%(1.346-13.822)), Diastolic Blood Pressure (p= 0.001 OR 6.213 CI 95%(2.1210-18.205 )), Systolic Blood Pressure ( p=0.002 OR 5.043 CI 95%( 1.854-13.717)), Heart Rate ( p=0.002 OR 3.933 CI 95%(1.658-9.332)), haemoglobin ( p = 0.044 OR 2.530 CI95%(1.026-6.242)), arrhytmia ( p=0.001 OR 7.658 CI 95%(2.217-26.457)), creatinine on admission ( p=0.002 OR 4.385 CI 95% (1.731-11.104)), QRS duration (p=0.00 OR 7.684, CI 95% (3.063-19.279)), as independent variables.According to each OR of these variables, we set the new scoring system of hospital mortality for AHF with good calibration by Hosner-lemeshow test ( p =1) and discrimination by AUC 0.925 (p<0.01 CI 95 % 0.891-0.959). The optimal cutt off for prediction mortality was total 6 points, sensitivity 81% and specificity 89%. We divided the patients with AHF as low risk whom total score 0-3 points (mortality in hospital 0-2%), moderate risk whom total score 4-5 points (mortality in hospital 13-46%), and 6-12 point as high risk. In the validation cohort indicated that SMASH score as new scoring system was effective with bootstrapping. Conclusion : The SMASH Score is a new scoring system of hospital mortality for AHF can predict with good performance in terms of discrimination, calibration and internally validation.   Abstrak Latar Belakang : Prognosis pasien dengan gagal jantung akut ( GJA ) masih buruk, dan stratifikasi resiko mungkin dapat membantu para klinisi dalam penatalaksanaan, dimana pasien yang tergolong buruk, harus dilakukan tindakan agressif dan pemantauan yang ketat. Namun ketersediaan sistem skoring pada GJA masih terbatas. Studi ini bertujuan untuk membuat model skoring prognostik yang sederhana dan validasinya dalam prediksi kematian di rumah sakit pada pasien GJA. Metode : 255 pasien GJA dibagi 2 kelompok yang mengalami kematian kardiovaskular dan survival di rumah sakit. Data dikumpulkan dari Januari 2015 sampai September 2016. Kriteria inklusi memenuhi panduan GJA berdasarkan ESC guidelines 2016. Dilakukan analisa multivariat dalam mencari faktor resiko yang bebas dan pembuatan sistem skoring. Hasil : Setelah dilakukan analisa multivariat logistik regressi, kematian di Rumah Sakit sebagai variable bebas, sementara umur (p=0.014,OR 4.314 KI 95%(1.346-13.822)) Tekanan darah diastolik saat masuk ( p= 0.001 OR 6.213 KI 95%(2.1210-18.205 )), tekanan darah sistolik saat masuk ( p=0.002 OR 5.043 KI 95%( 1.854-13.717)), Denyut nadi( p=0.002 OR 3.933 KI 95%(1.658-9.332)), hemoglobin ( p = 0.044 OR 2.530 KI95%(1.026-6.242)), arritmia ( p=0.001 OR 7.658 KI 95%(2.217-26.457)), kreatinin masuk ( p=0.002 OR 4.385 KI 95% (1.731-11.104)), QRS duration (p=0.00 OR 7.684, KI 95% (3.063-19.279)) sebagai variabel independen.Berdasarkan masing-masing OR dari variabel ini, diformulasikan sebuah sistem skoring . Sistem skoring yang baru memiliki kalibrasi dan diskriminasi yang sangat memuaskan menurut Hosner-lemeshow test ( p =1) dan AUC 0.925 (p<0.01 CI 95 % 0.891-0.959). Nilai titik potong yang optimal untuk prediksi kematian di rumah sakit adalah 6 poin dengan sensitivitas 81% and spesifisitas 89%. Kami menggolongkan pasien GJA sebagai resiko kematian rendah dengan total skor 0-3 poins (mortalitas di Rumah sakit 0-2%), resiko sedang dengan total skor 3-5 points (mortalitas di Rumah Sakit 13-46%), and 6-14 poin sebagai resiko tinggi. Pada validasi internal bahwa SMASH score sebagai sistem skoring kematian yang baru menunjukan nilai optimisme yang baik secara bootsrapping. Kesimpulan : SMASH Score adalah sebuah Sistem Skorring baru dalam Prediksi Kematian di Rumah Sakit pada Sindroma Gagal Jantung Akut dengan kalibrasi dan diskriminasi serta validasi yang baik.

E-Point Septal Separation as a Surrogate Marker for Global Longitudinal Strain in Predicting MACE after ST Elevation Myocardial Infarction Sarahazti, Mustika Fadhilah; Hasan, Harris; Ketaren, Andre Pasha
Indonesian Journal of Cardiology Vol 39 No 1 (2018): January - March 2018
Publisher : The Indonesian Heart Association

Background: Global Longitudinal Strain (GLS) is a sensitive measurement and has been studied as a parameter to assess myocardial deformity and had a prognostic value in STEMI patient, but this measurement is usually taken at echocardiography laboratory with software installed only, a simple parameter of systolic function that had been known is EPSS, the aim of this study is to determine the prognostic value of this simple parameter as a surrogate marker of myocardial deformity for mayor adverse cardiac event (MACE). Methods: This is an analytic observational study using ambispective cohort study, basic and echocardiographic data were collected from 66 adult subjects of acute STEMI from July 2016 until April 2017. Each subjects were followed-up for MACE (mortality, heart failure, ventricular arrhytmia and cardiogenic shock) 30 days since admission. Cut off point were taken from ROC curve. Statistical analysis test were used to examine the association between two variables and obtained odds ratio (OR) for EPSS. To obtain the degree of relationship between EPSS and GLS we were using corelation test with the value of p<0.05 was considered statistically significant. Result: In this study the optimum cut off value for EPSS was 7 mm with sensitivity and specificity of 72% and 71%, respectively. Bivariate analysis showed among EPSS >7 mm and GLS >-10,6% were associated with MACE in 30 days after STEMI. In multivariate analysis, GLS >-10,6% (OR 10,6 95%IK 2,5-44,7 p=0,001) and EPSS >7 mm (OR 5, 95%IK 1,12-22,56 p=0,035) remained significantly associated and had 83% probability for MACE in 30-days after STEMI. Using the corelation test we found that EPSS had a stronger relationship with GLS (r=0,795, p<0,001). Conclusion: Our data show that EPSS >7 mm had a strong relationship with myocardial deformity parameter and appears to be a strong predictor for MACE in 30-days after acute STEMI. Therefore, it can be taken earlier to help the cardiologist in emergency unit for futher appropriate management planning.   Abstrak Latar Belakang: Global Longitudinal Strain (GLS) adalah parameter deformitas miokardium yang telah banyak diteliti untuk menilai fungsi sistolik ventrikel kiri serta kaitannya terhadap prognosis pasien IMA-EST, sayangnya pemeriksaannya cenderung terbatas dilakukan di laboraturium ekokardiografi dengan alat ekokardiografi tertentu. Parameter fungsi sistolik lainnya yang cukup dikenal karena tekniknya yang sederhana dan dapat dilakukan di Unit Gawat Darurat adalah E-Point Septal Separation (EPSS), tujuan dari penelitian ini adalah melihat nilai prognosis EPSS sebagai indikator tidak langsung deformitas ventrikel kiri terdahap Kejadian Kardiovaskular Mayor (KKvM). Metode: Penelitian ini merupakan studi kohort ambispektif, 66 orang subjek IMAEST yang memenuhi kriteria inklusi dan eksklusi yang dirawat di Rumah Sakit Haji Adam Malik mulai Juli 2016 sampai April 2017 diambil data dasar dan ekokardiografinya, kemudian pasien diikuti selama 30 hari untuk KKvM (kematian, gagal jantung, aritmia ventrikel dan syok kardiogenik). Nilai titik potong EPSS diambil dari kurva ROC. Uji statistik dilakukan untuk menilai hubungan antara variabel untuk mendapatkan nilai rasio odds (RO) EPSS, uji korelasi digunakan untuk menilai kekuatan hubungan antara EPSS dengan GLS, p<0,05 dianggap bermakna. Hasil: Nilai titik potong EPSS yang didapatkan adalah 7 mm dengan sensitivitas 72%, spesifisitas 71%. Analisis bivariat menunjukkan nilai EPSS >7 mm dan GLS >-10,6% berhubungan dengan KKvM. Pada analisis multivariat, GLS >-10,6% (RO 10,6 95%IK 2,5-44,7 p=0,001) dan EPSS >7 mm (RO 5, 95%IK 1,12-22,56 p=0,035) secara signifikan tetap berhubungan dan memiliki probabilitas sebesar 83% dalam memprediksi KKvM 30 hari setelah IMAEST. Adapun nilai EPSS dan nilai GLS memiliki hubungan yang kuat (r=0,795, p<0,001). Kesimpulan: Data menunjukkan bahwa nilai EPSS >7 mm memiliki hubungan yang kuat dengan parameter deformitas ventrikel kiri dan suatu prediktor kuat pula terhadap KKvM dalam 30 hari setelah IMAEST. Hal ini menguntungkan kita sebagai klinisi karena dengan pemeriksaan EPSS yang sederhana ini dapat menjadi indikator adanya deformitas miokardium ventrikel kiri yang bernilai prognosis sehingga dapat dilakukan lebih dini untuk dapat menentukan strategi tatalaksana pada pasien IMAEST.

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