Wasyanto, Trisulo
Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

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Association between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with Six-Minutes Walk Test in Patients after Acute Myocardial Infarction. Wasyanto, Trisulo; Wulandari, Pipiet; Purwaningtyas, Niniek; Murti, Bhisma
Indonesian Journal of Medicine Vol 2, No 3 (2017)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: The ischemia resulting from critical coronary narrowing or total occlusion first affects the subendocardialmyofibers. Thus, abnormalities in longitudinal function can be detected before reductions in LVEF and reflects infarct size. The 6MWT provides information that may be a better index of the patients ability to perform daily activities. This study was to assess the relationship between left ventricular (LV) global longitudinal strain (GLS) and functional capacity measured with 6 minute walk test (6MWT) after AMI.Subjects and Method: This is a cross sectional study of patients with STEMI and NSTEMI, at Moewardi Hospital, Surakarta. Eligible patients underwent echocardiography global longitudinal 2D-STE that performed within 48 hour of admission and 6MWT pre- discharge or at the first follow-up visits (day 4-9). Patients were divided into 2 groups according to the LV GLS value, patients with substantial infarction (LV GLS > -13.8%) and non-substantial infarction (LV GLS < -13.8%).Results: There were 50 patients with 42 STEMI and 8 NSTEMI. Compared to patients in group LV GLS < -13.8% (n=18), patients in group LV GLS > -13.8% (n=32) were more likely to be older (57.6 y.ovs 55 y.o), less in functional capacity (10.17 1.3 ml/kg/min vs 11.04 0.98 ml/kg/min; p= 0.018) and less in 6 MWT distance (347.97 65.49 m vs392.39 49.44 m; p=0.016). Using ROC curves, the 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8%, sensitivity of 72.2% and specificity 65.6%, respectively with AUC= 0.70 (CI 95%; 0.559-0.852; p= 0.017). However, LV GLS >-13.8% and age >60 y.o remained the independent predictor in a multivariate logistic regression analysis to identify 6 MWT distance < 375 m in patients after AMI with GLS >-13.8%, (OR =7.967; CI 95%= 1.669-38.030; p=0.009) and age >60 y.o, (OR=10.898; CI95%= 2.201-53.971; p=0.003).Conclusions: In patients after AMI with substantial infarction (LV GLS >-13.8%) had less in functional capacity. The 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8% and could be used in rehabilitation program after AMI.Keywords: Acute Myocardial Infarction, LV Global longitudinal strain, functional capacity, 6 MWT.Correspondence:Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java.Indonesian Journal of Medicine (2017), 2(3): 192-206https://doi.org/10.26911/theijmed.2017.02.03.07
Pulse Pressure Initial and Arterial Pressure Mean as A Prognostic Death Information in Acute Myocardial Infarction Patients Meilus, Budi Patria; Aji, Kuncoro Bayu; Wasyanto, Trisulo
Indonesian Journal of Medicine Vol 4, No 2 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Arterial blood pressure is an easily get variable, including systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and pulse pressure (PP). Although the variable blood pressure has clinical importance in many cardiovascular diseases, the variable that has become the best predictor in clinical practice cannot be determined. The purpose of this study is to determine the prognostic value of PP and MAP at the start of hospitalization in patients with acute myocardial infarction (IMA).Subjects and Method: This was a retrospective cohort study conducted at cardiovascular intensive care unit, Dr. Moewardi Hospital, Surakarta, Central Java. A sample of 150 IMA patients from July 2013 to December 2013 was selected for this study. Blood pressure was measured the first time the patient arrives at the emergency unit to determine the value of PP and MAP. Then the patient was observed by looking at mortality during hospitalization as a final result. Basic characteristics data were analyzed using logistic regression and displayed in quartile form. The Kaplan-Meier curve was used to see mortality in each quartile. Cox proportional regression analysis was used to see the magnitude of the risk of variable PP, MAP and other variables on mortality.Results: The highest mortality was found in the first quartile group of PP (OR= 1.81; p<0.001) and MAP (OR= 1.69; p<0.001). The Kaplan-Meier curve showed the first quartile of the two groups had the lowest survival, while the third highest quartile (p <0.001). The results of the cox analysis showed a decrease in mortality risk of 0.49 per increase in PP by 10 mmHg (95% CI= 0.07 to 1.00; p= 0.044) and 0.31 each increase in MAP by 10 mmHg (95% CI= 0.09 to 0.53; p= 0.003).Conclusions: Blood pressure measurement can produce two variables as predictors of mortality in IMA patients, namely PP and MAP. Low PP and MAP are associated with higher mortality during hospitalization in IMA patients.Keywords: Pulse pressure, mean arterial pressure, acute myocardial infarction, mortalityCorrespondence: Budi Patria Meilus. Department of Cardiovascular, Faculty of Medicine, Universitas Sebelas Maret, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java.Email: budipatriamp­@gmail.com. Mobile : +6281228355615.Indonesian Journal of Medicine (2019), 4(2): 88-95https://doi.org/10.26911/theijmed.2019.04.02.02
Effect of Oral N-Acetylcystein on Galectin-3 in Acute Myocardial Infarction Patients Jalaludinsyah, Akhmad; Wasyanto, Trisulo; Purwaningtyas, Niniek
Indonesian Journal of Medicine Vol 4, No 1 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: The pathogenesis of heart failure after myocardial infarction is associated with the pathogenesis of cardiac remodeling. Galectin-3 (Gal-3) has a role in the pathophysiology of cardiac remodeling after acute myocardial infarction. N-Acetylcysteine (NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. The purpose of this study was to examine the effect of oral N-Acetylcysteine on Galectin-3 in acute myocardial infarction patients.Subjects and Methods: This was an experimental study with pre and post, single-blind, and randomization methods. The study was conducted at Dr.Moewardi General Hospital Surakarta, Central Java, from June to August 2018. A sample of 29 acute myocardial infarction patients with ST-segment elevation who received fibrinolytic therapy was selected for this study. 14 patients as a control group received standard therapy and 15 patients as intervention group received oral NAC supplementary therapy 600 mg three times daily for three days. The dependent variable was Gal-3 levels. The independent variable was NAC supplementary therapy. The data were analyzed by Mann Whitney test.Results : Gal-3 levels in intervention group (mean= 8.95; SD=1.76) were lowered than the control group (mean= 11.42; SD= 3.76) and it was statistically significant (p= 0.026). Conclusion: Supplementary therapy of NAC 600 mg orally 3 times a day for 3 days can reduce levels of Gal-3 in patients with acute myocardial infarction who receive fibrinolytic therapy.Keywords: galectin-3, n-acetylcysteine, acute myocardial infarction Correspondence: Akhmad Jalaludinsyah. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: dokter.akhmad@gmail.com. Mobile: +6281393098987.Indonesian Journal of Medicine (2019), 4(1): 1-8https://doi.org/10.26911/theijmed.2019.04.01.01
Procalcitonin as A Predictor of Left Ventricular Systolic Dysfunction in Sepsis Patients Wasyanto, Trisulo; Yasa, Ahmad; Murti, Bhisma
Indonesian Journal of Medicine Vol 3, No 3 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background:  Release of cytokines in sepsis can cause left heart failure and left ventricular sys­tolic dysfunction (LVSD). In sepsis, there is a releasing of Procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) because of the stimulation of cytokine pro inflammation affected by activated NF-kB. This study aimed to examine PCT as a predictor of LVSD in sepsis, the value of Area Under the curve (AUC), sensitivity, specificity, cut off point, and a probability of PCT and TNF-α as a predictor of  LVSD, and then to identify the best diagnostic predictor of LVSD.Subjects and Method: This was a cross-sectional study. A sample of 71 sepsis patients aged >18 years old admitted to the intensive care unit (ICU) from November 2016 to March 2017was selected for this study. The dependent variable was left ventricle ejection fraction (LVEF). The independent variables were PCT and TNF-α. LVEF and diastolyc function were measured by transthoracic echocardiography. Data on PCT and TNF-α level were obtained from the medical record.Results: As many as 22 patients had mild sepsis (30.9%), 40 patients had severe sepsis (56.4%), and 9 patients had a septic shock (12.7%). The AUC value of PCT level was 0.81 (95% CI 0.71-0.91; p<0.001). The optimal cut-off point was ≥7.88 ng/mL and Diagnostic Odd Ratio (DOR) was 5.55. The AUC value of TNF-α level was 0.73 (95% CI 0.60-0.86; p= 0.002). Optimal cut off point was ≥7.36 pg/ml and DOR was 5.03. The multivariate analysis resulted that PCT was the best predictor of LVSD (AUC 0.70), and TNF-α (0.69). The combination of PCT + TNFα would increase diagnostic value with AUC 0.77.Conclusion:  PCT was a better predictor of LVSD than TNF-α. This finding is significant since it will enable clinicians to easily diagnose LVSD by measuring PCT. The combination of PCT and TNFα was the best efficient diagnostic predictor of LVSD.Keywords: Left Ventricular Systolic Dysfunction, predictor, PCT, TNF-α                                  Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Univer­sitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: trisulo.­wasyanto­@gmail.com.Indonesian Journal of Medicine (2018), 3(3): 139-145https://doi.org/10.26911/theijmed.2018.03.03.03 
The Effect of Colchicine Administration on HsCRP Level and Mean Platelet Volume in Patients with Miocard Acute Infark Wasyanto, Trisulo; Yasa, Ahmad; Murti, Bhisma
Indonesian Journal of Medicine Vol 3, No 3 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Patients with coronary heart disease (CHD) who have received standard therapy to the fullest, are still at risk for further cardiovascular events. This is likely because the standard therapy fails to inhibit some inflammatory pathways and platelet aggregation which implies the disease. This study aimed to determine the effect of colchicine on reducing levels of high sensitive c-reactive protein (HsCRP) and mean platelet volume (MPV) in patients with Acute Myocardial Infarction (IMA) in the Intensive Cardiovascular Unit (ICVCU) Dr. Moewardi Hospital, Surakarta.Subjects and Method: Experimental study was conducted with pre and post design. The study was conducted from November 1 to December 31, 2016. A sample of 32 patients with Acute Myocardial Infarction was divided into two groups. The control group was given a placebo and the treatment group was given colchicine 0.5 mg orally for 5 days. Statistical analysis was done using two mean different tests with dependent t-test or Mann-Whitney and two mean analysis paired using independent t-test or Wilcoxon.Results: The HsCRP delta level in colchicine group (mean = 3.82; SD = 2.20) was higher than control group (mean = 0.57; SD = 3.12) and it was statistically significant (p<0.001). The delta MPV levels in colchicine group (mean = 2.01; SD = 1.16) were higher than control group (mean = 0.64; SD = 0.83) and it was statistically significant (p = 0.001).Conclusion: The administration of 0.5 mg colchicine by oral for 5 days was associated with levels of HsCRP and MPV among IMA patients. Keywords: Colchicine, HsCRP, MPV, Acute Myocardial InfarctionCorrespondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta57126, Central Java, Indonesia. Email: trisulo.wasyanto@gmail.comIndonesian Journal of Medicine (2018), 162-167https://doi.org/10.26911/theijmed.2018.03.03.06