Aditya, Muhammad Reva
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Could Cardiac Shockwave Therapy be the Breakthrough Solution for Refractory Angina? A Systematic Review and Meta-Analysis Pramesuari, Florentina Dewi; Aditya, Muhammad Reva; Mahbubi, Mustika
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1851

Abstract

Background: Refractory angina (RA) is a chronic condition unresponsive to standard treatments like PCI or CABG, leaving limited options for many patients. Cardiac shockwave therapy (CSWT) is a novel, noninvasive approach that enhances myocardial perfusion through microvascular regeneration. This systematic review and meta-analysis evaluate the effectiveness of CSWT in managing RA. Methods: A comprehensive literature search was conducted using electronic databases (Cochrane, PubMed, and ScienceDirect), including comparative studies with controls that evaluated CSWT in RA patients between 2010 and 2024. Studies not in English, with irrelevant outcomes, or lacking full-text access, were excluded. Data were extracted and analyzed using a random-effects model to address heterogeneity. Results: Seven studies, including 3 randomized controlled trials (RCTs) and 4 observational studies, with a total of 417 patients were analyzed. CSWT demonstrated significant improvements in multiple clinical outcomes. CSWT reduces angina severity in CSWT reduces angina severity in CCS grade (MD -0.76, 95% CI -0.97, -0.55, P < 0.00001) and in NYHA class (MD -0.62, 95% CI -0.95, -0.30, P = 0.0002), increased the 6- Minute Walk Test (6MWT) distance by 57.63 meters (MD 57.63, 95% CI 16.71, 98.54, P = 0.006), increased SAQ scores by 10.96 points (MD 10.96, 95% CI 1.66, 20.26, P = 0.02), improved LVEF by 4.43% (MD 4.43, 95% CI: 2.66 to 6.21, P< 0.01), and decreased nitroglycerin usage by 1.62 intake per week (MD -1.62, 95% CI -2.61, -0.62, P = 0.001). However, there was no significant difference in LVEDD between the two groups. Conclusion: CSWT appears to be a promising therapeutic option for patients with RA, demonstrating improvement in CCS angina class, NYHA class, 6-min walk test distances, SAQ score, LVEF, and reduces nitroglycerin usage. Keyword: Cardiac Shockwave Therapy, Refractory Angina, Non-invasive Cardiac Therapy, Chronic Angina Treatment, Innovative Angina Therapies
A case of oligoarthritis juvenile idiopathic arthritis in a 3-year-old male child: challenges in early diagnosis and management Heksa Trisnawati; Setyagisna, Farhan Ardiyanta; Aditya, Muhammad Reva; Barlianto, Wisnu; Wulandari, Desy
Pediatric Sciences Journal Vol. 6 No. 2 (2025): In Press Online : December 2025
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/pedscij.v6i2.126

Abstract

Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease in children, characterized by persistent joint inflammation. However, early diagnosis is often challenging due to heterogeneous clinical manifestations. Among its subtypes, oligoarthritis is the most common, involving up to four joints within six months of symptom onset. This case is distinctive due to its very early onset at the age of 3 years, prolonged diagnostic delay despite multiple healthcare visits, and diagnostic challenges related to nonspecific initial symptoms. Delayed diagnosis can result in joint deformity, growth retardation, and long-term disability, highlighting the importance of early recognition and timely management. Case Presentation: A 3-year-old male child presented with progressive joint pain, morning stiffness, and recurrent joint swelling that was initially associated with a history of trauma. Symptoms had been present since the age of 1.5 years, leading to a significant delay in definitive diagnosis. Based on clinical evaluation, imaging findings, and laboratory investigations, a diagnosis of oligoarticular Juvenile Idiopathic Arthritis was established according to the International League of Associations for Rheumatology (ILAR) criteria. The diagnostic process was further complicated by trauma-associated symptom onset and involvement of the temporomandibular joint (TMJ), which underscores the need for heightened clinical suspicion. The patient received multidisciplinary management, including pharmacological therapy, physical rehabilitation, and nutritional support. Conclusion: This case illustrates the complexity of diagnosing and managing oligoarticular JIA in pediatric patients, particularly in cases with very early onset, delayed diagnosis, and TMJ involvement. A comprehensive multidisciplinary approach, along with increased clinical awareness and early diagnosis, is essential to control inflammation, preserve joint function, and prevent long-term complications in children with JIA.