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INDONESIA
Indonesian Journal of Cardiology
Published by Indonesian Heart Association
ISSN : 28303105     EISSN : 29647304     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Indonesian Journal of Cardiology (IJC) is a peer-reviewed and open-access journal established by Indonesian Heart Association (IHA)/Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI) [www.inaheart.org] on the year 1979. This journal is published to meet the needs of physicians and other health professionals for scientific articles in the cardiovascular field. All articles (research, case report, review article, and others) should be original and has never been published in any magazine/journal. Prior to publication, every manuscript will be subjected to double-blind review by peer-reviewers. We consider articles on all aspects of the cardiovascular system including clinical, translational, epidemiological, and basic studies. Subjects suitable for publication include but are not limited to the following fields: Acute Cardiovascular Care Arrhythmia / Cardiac Electrophysiology Cardiovascular Imaging Cardiovascular Pharmacotherapy Cardiovascular Public Health Policy Cardiovascular Rehabilitation Cardiovascular Research General Cardiology Heart Failure Hypertension Interventional Cardiology Pediatric Cardiology Preventive Cardiology Vascular Medicine
Arjuna Subject : Kedokteran - Cardiology and Cardiovascular Medicine
Articles 671 Documents
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Calcium Serum Levels and Blood Pressure Response in trained subjects who consumed goat milk Yusni Yusni; Ieva Baniasih Akbar; M. Rizki Akbar
Jurnal Kardiologi Indonesia Vol 38 No 3 (2017): July - September 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.778

Abstract

Background: Calcium plays a role in regulating blood pressure and one exogenous sources of calcium are goat milk. Indonesian society is generally believed that goat milk can lower blood pressure and useful as antihypertensive, but so far have not found scientific evidence of how the mechanism of goat milk for controlling blood pressure. This study aimed to analyze the effect of the consumption of goat milk for lowering blood pressure and its relation to calcium serum levels in people trained. Method: Subjects, 19 gymnasts (the treatment group) and 10 runners (the control group), male and female, aged 17-28 years. Treatment: goat’s milk 250 mg / day, ad­ministered after dinner (at 19:00 to 20:00 pm), for 90 days. Design research is quasy experimental pretest-posttest design. Analysis of data using normality test Kolmogorof Smirnof-Z (p>0.05), Levene homogeneity test (p>0.05), t test (p<0.05) and Pearson correlation test (p <0.05). Results: The results showed systolic blood pressure after consume goat milk decreased significantly in the treatment group compared to the control group (122 ± 7:33 and 10:54 ± 115 vs 119 ± 7.61 ± 4.83 mmHg and 118 mmHg; p <0.05), whereas diastolic blood pressure in the treatment group and the control group (80.42 ± 5:53 and 7:08 ± 78.42 mmHg vs; 78.50 ± 3:37 and 3:16 ± 79 mmHg; p> 0.05) did not show differ­ences after administration of goat’s milk. Serum calcium levels after administration of dairy goats in the treatment group increased significantly compared with the control group (9:47 ± 0:25 and 0:32 ± 9.87 mg / dl vs 9.74 ± 0:42 and 9:37 ± 0:38 mg / dl; p <0.05). The results of Pearson correlation test (r) showed r=-0.45; p=0.05, mean­ing there were nonsignificant correlation between systolic blood pressure with serum calcium levels. Conclusion: Delivery of goat’s milk can decrease systolic blood pressure and stimulates the secretion of calcium, but a decrease in systolic blood pressure was not associated with increased serum calcium levels in people trained. Abstrak Latar Belakang: Kalsium berperan dalam mengatur tekanan darah dan salah satu sumber kalsium eksogen adalah susu kambing. Masyarakat Indonesia umumnya percaya bahwa susu kambing dapat menurunkan tekanan darah dan bermanfaat sebagai antihipertensi, namun sejauh ini belum ditemukan bukti ilmiah bagaimana kerja susu kambing dalam mengontrol tekanan darah. Penelitian ini bertujuan menganalisis pengaruh konsumsi susu kambing dalam menurunkan tekanan darah dan hubungannya dengan kadar kalsium serum pada orang terlatih. Metode: Subjek, 19 pesenam (kelompok perlakuan) dan 10 atlet lari (kelompok kontrol), laki-laki dan perempuan, usia 17-28 tahun. Perlakuan: pemberian susu kambing 250 mg/hari, diberikan setelah makan malam (pukul 19.00-20.00 wib), selama 90 hari. Design penelitian adalah quasy experimental pretest-posttest design. Analisis data menggunakan uji normalitas Kolmogorof Smirnof-Z (p>0,05), uji homogenitas Levene (p>0,05), uji t (p<0,05) dan uji korelasi pearson (p<0,05). Hasil: hasil penelitian menunjukkan tekanan darah sistolik setelah pemberian susu kambing pada kelompok perlakuan menurun signifikan dibandingkan kelompok kontrol (122±7.33 dan 115±10.54 vs 119±7.61 dan 118±4.83 mmHg mmHg; p<0,05), sedangkan tekanan darah diastolic pada kelompok perlakuan dan kelompok kontrol (80.42±5.53 dan 78.42±7.08 mmHg vs; 78.50±3.37 dan 79±3.16 mmHg; p>0,05) tidak menunjukkan perbedaan setelah pemberian susu kambing. Kadar kalsium serum setelah pemberian susu kambing pada kelompok per­lakuan meningkat signifikan dibandingkan dengan kelompok kontrol (9.47±0.25 dan 9.87±0.32 mg/dl vs 9.74±0.42 dan 9.37±0.38 mg/dl; p<0,05). Hasil uji korelasi pearson (r) menunjukkan r=-0,45; p=0,05, artinya terdapat korelasi sedang yang tidak bermakna antara tekanan darah sistolik dengan kadar kalsium serum. Kesimpulan: Pemberian susu kambing dapat menurun tekanan darah sistolik dan merangsang sekresi kalsium namun penurunan tekanan darah sistolik tidak berhubungan dengan peningkatan kadar kalsium serum pada orang terlatih.
Hemodynamic Profiles as a Predictor of Mortality and Length Of Stay in ICCU: Insight from Registry of Acute and Intensive Cardiovascular Care Outcome Isman Firdaus; Gracia Lilihata; Ardeno Kristianto; Cindya K. Simanjuntak; Siska S. Danny; Irmalita Irmalita; Surya Dharma; Dafsah A. Juzar; Daniel P.L. Tobing
Jurnal Kardiologi Indonesia Vol 38 No 3 (2017): July - September 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i3.779

Abstract

Aims: The ability to differentiate high risk and low risk patients in ICCU is beneficial. Hemodynamic profiles can be used to describe patient’s condition immediately. Based on the presence of congestion and poor perfusion, patients can be divided into four hemodynamic profiles. We aim to evaluate the prognostic value of hemodynamic profiles for patient’s mortality and length of stay (LOS) in intensive cardiac care unit (ICCU). Methods: In this retrospective cohort study, patients who admitted to ICCU of National Cardiovascular Center Harapan Kita Jakarta, Indonesia, were classified into four hemodynamic profiles: dry-warm, dry-cold, wet-warm, and wet-cold. Bivariate analysis was performed to see the significance between hemodinamic profiles with mortality and LOS, continued with multvariate analysis to evaluate the contribution of other significant factors. Results: Of 742 patients included, the mortality rate was 7.8%. With dry-warm profile as reference, relative risk for mortality was 2.3 (95% CI 1.303-4.076), 5.8 (95% CI 1.992-16.906), and 8.7 (95% CI 3.513-21.567) for wet-warm, dry-cold and wet cold, consecutively. Mean differences of LOS (days) as follows: wet-warm (1.719; 95% CI 1.21-2.23), dry-cold (3.418; 95% CI 1.52-5.32), and wet-cold (4.654; 95% CI 2.64-6.67) compared to dry-warm. Hemodynamic profiles, especially wet-cold profile, consistently predicted mortality and longer LOS in ICCU by multivariable analysis. Conclusion: The presence of “wet” profile double the risk of death, “cold” profile has five fold risk of death, while the presence of both has the highest risk for mortality and longer LOS. Hemodynamic profiles assessme Abstrak Latar Belakang: Kemampuan untuk membedakan pasien resiko tinggi dan resiko rendah di ICCU sangat penting. Profil hemodinamik dapat digunakan untuk mengenali kondisi pasien secara cepat. Berdasarkan adanya tanda kongesti dan perfusi yang buruk pasien dapat dikelompok­kan ke dalam empat profil hemodinamik. Studi ini bertujuan untuk mengevaluasi nilai prognostik profil hemodinamik terhadap mortalitas dan lama rawat pasien di Intensive Cardiac Care Unit (ICCU). Metode : Studi kohort retrospektif ini dilakukan di Rumah Sakit Pusat Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indo­nesia. Pasien yang dirawat di ICCU dikelompokkan ke dalam empat profil hemodinamik: kering-hangat, kering-dingin, basah-hangat dan basah-dingin. Analisis bivariate dilakukan untuk menilai hubungan antara profil hemodinamik dengan mortalitas dan lama rawat di ICCU, dilanjutkan dengan analisis multivariate untuk mengevaluasi kontribusi faktor-faktor lain yang signifikan Hasil : Total pasien yang ikut dalam studi sebanyak 742 pasien dan tingkat mortalitas sebesar 7,8%. Resiko relatif (RR) mortalitas untuk profil basah-hangat, kering-dingin dan basah-dingin berturut-turut sebesar 2.3 (95% CI 1.303-4.076), 5.8 (95% CI 1.992-16.906), dan 8.7 (95% CI 3.513-21.567) bila dibandingkan terhadap profil kering-hangat sebagai referensi. Rerata perbedaan lama rawat sebesar 1.719 (95% CI 1.21-2.23), 3.418 ( 95% CI 1.52-5.32), (4.654 (95% CI 2.64-6.67) untuk profil basah-hangat, kering-dingin, dan basah dingin berturut-turut bila dibandingkan dengan profil kering-hangat. Profil hemodinamik, terutama profil basah-dingin secara konsisten memprediksi mortalitas dan lama rawat yang lebih panjang setelah analisis multivariat. Kesimpulan: Profil “basah” memiliki resiko mortalitas dua kali lipat, profil “dingin” memiliki resiko mortalitas lima kali lipat, sedangkan ked­uanya secara bersamaan memiliki resiko mortalitas dan lama rawat lebih panjang paling tinggi. Profil hemodinamik dapat digunakan sebagai prediktor mortalitas dan lama rawat pasien di ICCU secara efektif.
Predictor of Left Atrial Spontaneous Echocardiographic Contrast in Rheumatic Mitral Stenosis Patients Komaria Komaria; Abdul Halim R; Ali Nafiah Nst; Harris Hasan
Jurnal Kardiologi Indonesia Vol 38 No 3 (2017): July - September 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i3.780

Abstract

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.
A Case Report of Elderly Woman with Supraventricular Tachycardia associated with Intracranial Bleeding Raymond Pranata; Veresa Chintya; Emir Yonas; Vito Damay
Jurnal Kardiologi Indonesia Vol 38 No 3 (2017): July - September 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i3.782

Abstract

Background The neurogenic cardiac injury is related to brain injury-induced cat­echolamine and neuro-inflammatory responses and is more likely in those with the most severe neurological insult. Case Report A 78 years-old female presented to the emergency department after being found lying on the floor with a laceration on the head. On physical examination GCS 3, BP 140/90 mmHg, HR 190 bpm, respiratory rate 25x/minute. PMH of hypertension and diabetes were denied. ECG showed supraventricular tachycardia of 186 bpm. Labora­tory exams showed hyponatremia, hypokalemia, and leukocytosis. CT scan revealed subarachnoid hemorrhage, intracerebral hematomas, chronic subdural hematoma, midline shift and subfalcine herniation. The systemic catecholamine ‘storm’ driven by the central neuroendocrine axis massively increases sympathetic outflow, activates the adrenal gland and may lead to arrhythmia. Increased ICP, Midline shift, and subsequent physical compression of the brainstem and hypothalamic autonomic centers can trigger catecholamine responses that could instigate an arrhythmia. Suboptimal cardiac output and cerebral perfusion worsen secondary brain injury leading to a worse prognosis. Since cardioversion failed, amiodarone was administered. Cardioversions failed to convert to sinus rhythm and amiodarone was administered. Therapy to reduce intracranial pressure was also administered. The patient passed away 4 hours after admission. Conclusion Arrhythmia related to brain injury may lead to suboptimal cerebral perfu­sion and leads to further autonomic derangements leading to a vicious cycle of cerebral and cardiovascular injuries. This condition should be accounted for swiftly to prevent secondary brain injuries and myocardial ischemia. Abstrak Latar Belakang Respons katekolamin dan radang terhadap cedera otak menyebabkan cedera jantung neurogenik yang lebih sering terjadi pada kerusakan neurologis yang berat. Laporan Kasus Seorang perempuan 78 tahun datang ke IGD setelah ditemukan tergeletak di lantai dengan robek pada kulit kepala. Pada pemeriksaan fisik ditemukan GCS 3, TD 140/90 mmHg, detak jantung 190 kali/menit, laju pernafasan 25 kali/menit. Riwayat hipertensi dan diabetes disangkal. EKG menunjukan takikardia supraventrikular takikardi 186 kali/menit. Pemeriksaan laboratorium menunjukan hipona­tremia, hipokalemia dan leukositosis. CT scan menunjukan perdarahan subaraknoid, perdarahan intraserebral, perdarahan subdural kronis, midline shift dan herniasi subfalcine. Badai katekolamin sistemik yang dicetuskan oleh aksis neuroendokrin pusat meningkatkan outflow simpatetik yang mengaktifkan kelenjar adrenal dan menyebabkan aritmia. Peningkatan tekanan intrakranial, midline shift, dan penekanan batang otak serta pusat autonomik hipotalamus dapat mencetuskan respon katekolamin yang dapat menyebabkan aritmia. Curah jantung yang tidak optimal dan perfusi otak yang buruk menyebabkan cedera otak sekunder yang mengarah pada prognosis yang buruk. Karena kardioversi gagal merubah irama menjadi sinus maka amiodaron diberikan. Pengobatan untuk menurunkan tekanan intrakranial juga diberikan. Pasien meninggal 4 jam setelah masuk rumah sakit. Kesimpulan Aritmia yang berhubungan dengan cedera otak dapat menyebabkan perfusi otak yang suboptimal serta menyebabkan ketidaktera­turan otonom dan menyebabkan lingkaran setan kerusakan otak dan jantung-pembuluh darah. Hal ini harus segera ditangani untuk mencegah cedera otak sekunder dan iskemi miokardial.
Perioperative Antithrombotic Management Andrianto Andrianto; Amelia Arindanie
Jurnal Kardiologi Indonesia Vol 38 No 3 (2017): July - September 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.783

Abstract

The management of antithrombotic therapy in the perioperative setting is a common problem, balancing haemorrhagic risk with thrombotic risk. High-quality evidence is lacking regarding the optimal approach for patients on oral anticoagulants or antiplatelet agents. The two main issues that need to be considered in perioperative antithrombotic management is the patient’s risk of a thromboembolic event when therapy is interrupted and the risk of bleeding associated with the surgery or procedure. An assessment of these factors will determine the optimal perioperative anticoagulant management ap­proach. The overall objective of this review is to provide a practical approach relating to perioperative management which can be used in everyday clinical practice. Abstrak Masalah tatalaksana terapi antitrombotik perioperatif yaitu menyeimbangkan risiko perdarahan dan risiko trombosis masih sering dijumpai sehari-hari. Bukti klinis yang kuat mengenai tatalaksana yang optimal dari terapi antikoagulan atau antiplatelet masih sangat sedikit. Dua hal yang perlu dipikirkan dalam tatalaksana terapi antitrombotik perioperatif adalah risiko kejadian tromboemboli ketika terapi antitrombotik dihentikan dan risiko perdarahan akibat tindakan pembedahan yang dilakukan. Penilaian faktor-faktor tersebut akan menentukan pendekatan yang optimal dari tatalaksana antikoagulan perioperatif. Tinjauan pustaka ini bertujuan memberikan pendekatan praktis tentang tatalaksana antitrombotik perioperatif yang dapat dipakai dalam praktik klinis sehari-hari.
Correlation of Waist to Height Ratio with Leptin Serum Level in Coronary Artery Disease Vito Damay; Alberta Claudia Undarsa
Jurnal Kardiologi Indonesia Vol 38 No 4 (2017): October - December 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i4.784

Abstract

Background: Adiposity assessment plays an important role in coronary artery disease (CAD) prevention. One of the adiposity parameter in major CAD management guide­line is waist to height ratio (WHtR). Adiposity promotes the pathogenesis of coronary atherosclerosis by involving adipokines released by adipose tissue. Leptin is obesity identic adipokine which is used as prognostic predictor of cardiovascular event. This study aims to analyze correlation between WHtR and leptin serum level. Method: A cross sectional study was performed to 37 stable CAD patients undergone elective coronary angiography in Heart Catheterization Laboratory Dr Hasan Sadikin Hospital, Bandung, West java in July 2014 Results: Mean age of the subjects was 56.7± 9.12 years old with mean age of men (n=32) and women (n=5) were 55.9±9.47 years old and 62±3.54 years old consecu­tively. There were 30 (81%) subjects classified as obese (WHtR≥0.5) with mean WHtR 0.54±0,06. Median value of leptin serum was 8599.90 pg/ml (780-36929.3 pg/ml). Based on rank-spearman correlation test, a positive moderate correlation was significantly found between WHtR and Leptin serum level (Spearman’s rho = 0.5, p= 0.001). Conclusion: Positive correlation was found between WHtR and leptin serum level. Hence, WHtR might be useful as indicator of leptin serum level which has been used as a prognostic biomarker in CAD patients Abstrak Latar belakang: Penilaian adipositas merupakan bagian dari upaya preventif penyakit jantung koroner (PJK). Salah satu parameter antropometri adipositas yang digunakan pada panduan tatalaksana PJK adalah pengukuran rasio lingkar pinggang/tinggi badan (LP/TB). Adipositas diketahui berperan dalam patomekanisme terbentuknya aterosklerosis koroner melalui pelepasan adipositokin oleh jaringan adiposa. Leptin merupakan adipositokin identik adiposit yang digunakan sebagai biomarka indikator prognostik kejadian kardiovaskular. Penelitian ini bertujuan untuk menganalisa korelasi LP/TB dengan kadar leptin serum. Metode: Studi potong lintang dengan menganalisis antropometri LP/TB dan kadar leptin serum pada 37 pasien PJK yang menjalani angiografi elektif di Laboratorium Kateterisasi Jantung RSUP Dr.Hasan Sadikin, Bandung, Jawa Barat pada bulan Juli 2014. Hasil: Rerata usia subjek adalah 56.7± 9.12 tahun dengan rerata usia pria (n=32) dan wanita (n=5) secara berurutan adalah 55.9±9.47 tahun dan 62±3.54 tahun. Terdapat 30 (81%) subjek tergolong obesitas (nilai LP/TB ≥0,5) dengan rata-rata LP/TB 0.54±0,06. Nilai median leptin serum 8599.90 pg/ml (780-36929.3 pg/ml). Berdasarkan uji korelasi rank-spearman, terdapat korelasi positif bermakna antara LP/TB dengan kadar leptin serum (Spearman rho = 0.5, p= 0.001). Kesimpulan: Terdapat korelasi positif bermakna antara pemeriksaan antropometri LP/TB dengan kadar leptin serum. Rasio lingkar pinggang/tinggi badan dapat digunakan sebagai salah satu indikator kadar leptin serum yang merupakan biomarka prognostik kardiovaskular.
Effect of Myocardial Fibrosis on Left Ventricular Function in Rheumatic Mitral Stenosis: A Preliminary Study with Cardiac Magnetic Resonance Elen Elen; Celly A. Atmadikoesoemah; Manoefris Kasim
Jurnal Kardiologi Indonesia Vol 38 No 4 (2017): October - December 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i4.785

Abstract

Background: Left ventricular (LV) dysfunction was frequently found in rheumatic mitral stenosis. Myocardial fibrosis had been revealed in rheumatic heart disease and could be associated with LV dysfunction. We evaluate myocardial fibrosis profile related to LV function in rheumatic mitral stenosis with cardiac magnetic resonance (CMR). Methods: Eighteen patients with severe rheumatic mitral stenosis without history of coronary artery disease or its risk factors underwent 1.5T CMR examination. LV ejection fraction (LVEF), right ventricular ejection fraction (RVEF), myocardial fibrotic tissue were evaluated with CMR. Other hemodynamic data was derived from echocar­diography results. Results: These patients (40.4±10.5 years old, 72.2% female, 66.7% atrial fibrillation) had LVEF of 50.9±15.9% and RVEF of 37.7±13.9%. Volume of fibrotic tissue in these patients were 16.6 (5.5-55.8)%. In multivariate analysis, volume of fibrotic tissue was a significant predictor of LVEF that myocardial fibrotic tissue of 1% was associated with LVEF reduction of 0.87% (95% CI 0.51%-1.24%). Conclusion: LV function was determined by the extent of myocardial fibrosis in rheu­matic mitral stenosis. Abstrak Latar Belakang: Disfungsi ventrikel kiri (LV) sering ditemukan pada mitral stenosis rematik. Fibrosis miokardium ditemukan pada penyakit jantung rematik. Fibrosis miokardium pada penyakit jantung rematik juga dihubungkan dengan disfungsi LV. Kami mengevaluasi profil fibrosis miokardium yang berhubungan dengan fungsi LV pada mitral stenosis rematik dengan cardiac magnetic resonance (CMR). Metode: Dilakukan pemeriksaan 1.5T CMR pada delapanbelas pasien dengan mitral stenosis rematik berat tanpa riwayat penyakit jantung koroner atau faktor resikonya. Fraksi ejeksi LV (LVEF), fraksi ejeksi RV (RVEF), dan jaringan fibrotik miokardium dievaluasi menggunakan CMR. Data hemodinamik lainnya didapatkan dari pemeriksaan ekokardiografi. Hasil: Pasien tersebut (40.4±10.5 tahun, 72.2% perempuan, 66.7% fibrilasi atrium) memiliki LVEF 50.9±15.9% dan RVEF 37.7±13.9%. Vol­ume jaringan fibrotic pada pasien tersebut adalah 16.6 (5.5-55.8)%. Dalam analisis multivariat, volume jaringan fibrotic adalah prediktor LVEF yang signifikan yaitu 1% jaringan fibrotic miokardium dihubungkan dengan menurunan LVEF sebesar 0.87% (95% CI 0.51%-1.24%). Kesimpulan: Fungsi LV dipengaruhi seberapa besar fibrosis miokardium pada mitral stenosis rematik
SMASH Score as a Predictor off-in Hospital Mortality for Acute Heart Failure Patients Zunaidi Syahputra; Hilfan Ade Putra Lubis; Zainal Safri; Harris Hasan
Jurnal Kardiologi Indonesia Vol 38 No 4 (2017): October - December 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i4.786

Abstract

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.
Pulmonary Atresia with Intact Ventricular Septum in a Neonate Emir Yonas; Raymond Pranata; Nuvi Nusarintowati
Jurnal Kardiologi Indonesia Vol 38 No 4 (2017): October - December 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i4.787

Abstract

Introduction: Pulmonary atresia with an intact ventricular septum is a condition that is characterized by a complete obstruction to right ventricular outflow with varying degrees of right ventricular and tricuspid valve hypoplasia. This condition is uniformly fatal if untreated. In this case report, we present a case of a neonate with a pulmonary atresia with intact ventricular septum Case Presentation: A 2 days-old female Indonesian newborn was referred to our facility. The newborn was delivered from a G4P3A0 mother with a gestational age of 39 weeks (term delivery). Chest x-ray done at the referring facility is significant for a seemingly right heart hypertrophy, casting a “boot-shaped” appearance of the right heart border. Laboratory results done at the referring facility is significant for a neutrophilia of 82% and lymphocytopenia of 13% An episode of hypoglycemia was reported on referring facility with a blood sugar level of 50 mg/dl. Multiple episodes of cyanosis were reported at referring facility, CPAP was administered but the improvement was limited. Pulse oximetry averaged between 72-80% at the referring facility. Physical examina­tion shows an actively moving neonate, with a strong cry. Perioral cyanosis was seen. Vital signs were as follows; heart rate 128 x / minute, temperature 37oC, respiratory rate 54 x / minute, pulse oximetry 74%, capillary refill time < 3 seconds. The rest of the physical examination was within normal limits. Laboratory result on admission at our facility is significant for low hematocrit, low erythrocyte count, leukopenia with neutrophilia and thrombocytopenia. Patient was admitted to NICU and given CPAP. Echocardiography 2 days upon arrival at our facility reveals a patent ductus arteriosus with the pressure of 4-5 mmHg and diameter of 0.3 cm, no forward flow from the right ventricle to the pulmonary artery, doppler mode demonstrated pulmonary artery filling from ductus arteriosus. The rest of the findings were within normal limits. Conclusion: Pulmonary atresia with an intact ventricular septum is a condition that relies on the patent ductus arteriosus for pulmonary blood supply, the patency of it is of paramount importance. Abstrak PENDAHULUAN: Atresia arteri pulmonalis dengan septum ventrikel yang utuh merupakan kondisi yang dikarakterisasikan dengan sumbatan total pada right ventricular outflow dengan berat hipoplasia ventrikel kanan dan trikuspid kanan yang beratnya bervariasi. Pada umumnya kondisi tersebut fatal apabila tidak ditangani. Pada laporan kasus ini, kami melaporkan suatu kasus neonates dengan atresia arteri pulmonalis dengan septum ventrikel yang utuh. PRESENTASI KASUS: Neonatus perempuan berumur 2 hari dirujuk ke rumah sakit kami. Bayi dilahirkan dari G4P3A0 usia kehamilan 39 minggu. Ronsen thoraks yang dilakukan oleh fasilitas kesehatan yang merujuk memperlihatkan hipertrofi jantung kanan serta bentuk “boot-shaped” pada batas jantung kanan. Hasil laboratorium pada fasilitas kesehatan tersebut menunjukan neutrofilia dan limfositopenia. Terdapat juga riwayat hipoglikemi. Episode sianosis berulang terjadi pada fasilitas kesehatan yang merujuk. Pemasangan CPAP kurang membuahkan hasil dengan saturasi O2 72-80% ketika tiba pada rumah sakit kami. Pemeriksaan fisik menunjukan tangis kuat dan gerak aktif dengan sianosis perioral. Detak jantung 128 kali/menit, suhu 37oC, laju naas 54 kali/menit, oksimetri nadi 74% dan waktu isi kapiler <3 detik. Pemeriksaan laboratorium saat pasien dating menunjukan hematocrit, hitung eritrosit, leukosit dan thrombosit yang rendah. Pasien dirawat di NICU dan diberikan CPAP. Ekokardiografi 2 hari kemudian menunjukan duktus arteriosus patent dengan tekanan 4-5 mmHg dan diameter 0.3 cm, tidak ada aliran maju dari ventrikel kanan kepada arteri pulmonalis, mode Doppler menunjukan pengisian arteri pulmonalis dari duktus arteriosus. Pemeriksaan lainnya dalam batas normal. KESIMPULAN: Atresia arteri pulmonalis dengan septum ventrikel yang utuh merupakan suatu kondisi dimana aliran darah menuju paru bergantung pada duktus arteriosus yang paten sehingga patensi daripada duktus tersebut sangatlah penting
Exercise training in heart failure: role, prescription and program Raymond Pranata; Emir Yonas; Bambang B. Siswanto; Budhi S. Purwowiyoto
Jurnal Kardiologi Indonesia Vol 38 No 4 (2017): October - December 2017
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v38i4.788

Abstract

Heart failure is one of the most common cardiovascular diseases and is a final pathway of various cardiac pathologies. Exercise intolerance and dyspnea accompanied by dete­riorating quality of life are common issues in those suffering from heart failure and may persist despite optimal medical therapy. Exercise training in heart failure theoretically helps to slow down the deterioration of the heart by antagonizing excess neurohormonal activity in heart failure, which translated into better functional capacity and quality of life. Exercise prescription is a mean of assessing and interpreting clinical information and applying the principles of training to develop an appropriate regimen and should be tailored to patient’s clinical condition. Resistance training improves peak VO2, exercise capacity and quality of life in heart failure patients. Both continuous and interval exercise training are linked to better quality of life despite ambiguous results in mortality. The aim of this article is to discuss the benefits of exercise in patients with congestive heart failure, exercise prescription, and exercise program including high-intensity interval training, continuous training and resistance exercise. Abstrak Gagal jantung adalah salah satu penyakit kardiovaskular yang paling sering ditemui dan merupakan akhir daripada banyak jenis patologi jantung. Intoleransi olahraga dan sesak nafas disertai dengan memburuknya kualitas hidup merupakan beberapa masalah yang sering dihadapi oleh pasien gagal jantung, meskipun telah diberikan pengobatan yang optimal. Latihan olahraga pada gagal jantung secara teoritis dapat memperlambat menurunnya fungsi jantung dengan melawan aktivitas neurohormonal yang meningkat pada kondisi gagal jantung yang dicerminkan dengan kapasitas fungsional dan kualitas hidup yang lebih baik. Preskripsi olahraga meliputi pemeriksaan dan interpretasi dari informasi klinis dan aplikasi dari prinsip latihan untuk membentuk regimen yang sesuai dan harus di sesuaikan dengan keadaan klinis pasien. Latihan beban memperbaiki fungsi VO2 puncak, kapasitas olahraga dan kualitas hidup pada pasien dengan gagal jantung. Kedua metode olahraga baik secara kontinu ataupun interval dihubungkan dengan kualitas hidup yang lebih baik meskipun masih ambigu dalam hal mortalitas. Tujuan artikel ini adalah membahas manfaat latihan fisik pada pasien dengan gagal jantung kongestif, cara peresepan serta membahas program high intensity interval training, continuous training serta latihan beban.

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