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"Heart abnormalities in cirrhotic patients have been known for five decades, with atria and ventricular dilatation. Pozzi et al reported that in cirrhotic patients with or without ascites, the diastolic function was lower than control. Ascitic paracentesis improved diastolic function. The diameter of both atria was larger in cirrhotic patients with or without ascites. The diastolic diameter of left ventricle did not differ significantly in cirrhotic patients with or without ascites compared to control, but there was an increase after paracentesis. Eection fraction was lower in cirrhotic and increased after ascitic parancentesis although the increase was not significant.

The aim of the Study: To compare the function and structure o fthe heart before and afler ascitic paracentesis in cirrhotic patients.

Methods: This study tool: place from February 2000 to April 2001 in dr. Pringadi Hospital/H.Adam Malik Hospital. There were 18 samples (12 men and 6 women), 15 of which were cirrhotic patients with tense ascites and 3 cirrhotic patients with refractory ascites. The mean age was 51,8 + 8,28 years, the youngest being 29 years and the oldest 65 years. The mean ascitic fluid removed by paracentesis was 7,20 liters with a range of 5 to 9 liters. Immediately following paracentesis, Dextran 40 % was administered at a dose of 8g lL ascilic fluid aspirated.

Results: The diameter of the four heart chambers decreased after paracentesis, but the decrease was not statistically significant. There was increase in E/A ratio after ascitic paracentesis, from 0,93 + 0,3 70 to 1,06 + 0,383 (significant, p<0, 05), meaning that there was an improvement in diastolic function after ascitic paracentesis. There was also an increase in ejection fraction from 68,99 + 13,26 % to 72,10 + 11,10 %, bitt this was not significant (p>0,05).

Conclusion: after paracentesis, there was a significant inmprovement in diastolic function while diameter of the four heart chambers decreased and the ejection fraction increased insignificantly"

"[Latar belakang. Durasi AV delay (DAVD) pada pasien dengan pacu jantung dual chamber menentukan derajat sinkroni atrioventrikular (AV). Pengaturan DAVD yang optimal pada pasien dapat meningkatkan kualitas hidup dan memperbaiki parameter hemodinamik jika dibandingkan dengan pasien yang tidak dilakukan optimalisasi . Namun optimalisasi DAVD merupakan prosedur yang memakan waktu dan biaya. Perlu dicari faktor-faktor yang mempengaruhi nilai DAVD yang optimal.Metode. Penelitian ini merupakan studi potong lintang. Evaluasi dilakukan pada 35 pasien blok AV total dengan pacu jantung permanen dual chamber yang datang ke poliklinik RS Jantung Nasional Harapan Kita periode bulan Oktober sampai dengan pertengahan November 2014. Dilakukan pemeriksaan ekokardiografi terhadap parameter fungsi diastolik pada saat DAVD awal (DAVD pabrikan), lalu dicari DAVD optimal menggunakan VTI-LVOT terbesar.Hasil. Terdapat korelasi lemah antara paramater fungsi diastolik rasio E/A dan nilai DAVD optimal (r - 0,356 dengan p 0,036). Analisa regresi linear antara rasio E/A dengan nilai DAVD optimal (adjusted analysis sesuai usia, fraksi ejeksi, dan DAVD pabrikan) menunjukan nilai koefisien -0.477 dengan nilai p 0,007 (IK 95% - 84.4 s.d. -14.1). Analisa regresi linear antara nilai e' medial dengan DAVD optimal menunjukkan tingkat kemaknaan dengan nilai koefisien -0.390 dan nilai p 0.026 (IK 95% -16.3 s.d. -1.1). Terdapat perbedaan rerata DAVD optimal, 173.46 ±42.23 ms untuk pasien dengan rasio E/A ≥ 1, dan 128.89 ± 42.5 ms untuk rasio E/A <1 (p:0.01).Kesimpulan. Terdapat korelasi negatif yang bermakna antara parameter fungsi diastolik (E/A dan e' medial) dengan DAVD optimal pada pasien dengan pacu jantung permanen dual chamber.;Background. AV Delay Duration (AVD) in patient with dual chamber pacemaker defines atrioventricular synchrony. Optimazation of AVD could improve quality of life and hemodynamic parameters compared to factory setting. Despite that, AVD optimization is a time consuming procedure and not cost effective. factors that influence the optimal AVD should be sought.Methods. This is a cross sectional study on 35 total AV block patients that came to National Cardiovascular Center Harapan Kita from October to November 2014. Echocardiography on left ventricle diastolic indices was performed in factory setting AVD. The AVD that gives to the biggest LVOT VTI was set as the optimal AVD. Statistical analysis was done to correlate between diastolic indices and optial AVD.Results. Weak correlation was noted between diastolic indices (E/A ratio) and optimal AVD (r: - 0,356; p: 0,036). Linear regression analysis showed a negative correlation between E/A ratio {coefficient -0.477; p: 0,007 (CI 95% - 84.4 to -14.1)} and medial e' {coefficient -0.390; p: 0.026 (CI 95% -16.3 to -1.1)} with optimal AVD (adjusted with age, ejection fraction, and factory setting AVD). Different E/A ratio showed a different optimal AVD mean, 173.46 ±42.23 ms for E/A ≥ 1 vs. 128.89 ± 42.5 ms for E/A <1 (p:0.01).Conclusion. This paper shows a negative correlation between echocardiographic diastolic function indices (E/A ratio and medial e') with optimal AVD., Background. AV Delay Duration (AVD) in patient with dual chamber pacemaker defines atrioventricular synchrony. Optimazation of AVD could improve quality of life and hemodynamic parameters compared to factory setting. Despite that, AVD optimization is a time consuming procedure and not cost effective. factors that influence the optimal AVD should be sought.Methods. This is a cross sectional study on 35 total AV block patients that came to National Cardiovascular Center Harapan Kita from October to November 2014. Echocardiography on left ventricle diastolic indices was performed in factory setting AVD. The AVD that gives to the biggest LVOT VTI was set as the optimal AVD. Statistical analysis was done to correlate between diastolic indices and optial AVD.Results. Weak correlation was noted between diastolic indices (E/A ratio) and optimal AVD (r: - 0,356; p: 0,036). Linear regression analysis showed a negative correlation between E/A ratio {coefficient -0.477; p: 0,007 (CI 95% - 84.4 to -14.1)} and medial e' {coefficient -0.390; p: 0.026 (CI 95% -16.3 to -1.1)} with optimal AVD (adjusted with age, ejection fraction, and factory setting AVD). Different E/A ratio showed a different optimal AVD mean, 173.46 ±42.23 ms for E/A ≥ 1 vs. 128.89 ± 42.5 ms for E/A <1 (p:0.01).Conclusion. This paper shows a negative correlation between echocardiographic diastolic function indices (E/A ratio and medial e') with optimal AVD.]"

"Pendahuluan. Gagal jantung merupakan penyakit kronik dengan angka perawatan ulang satu tahun yang tinggi. Program Multidisiplin (multidisciplinary program, MDP) yang melibatkan tenaga medis dan nonmedis termasuk dokter kardiologi, dokter bedah jantung, dokter rehabilitasi medik, dokter gizi klinik, perawat dan fisioterapis mampu menurunkan angka perawatan ulang satu tahun sebesar 74%. Klinik Gagal Jantung Instalasi Pelayanan Jantung Terpadu (PJT) RSCM yang mengusung penerapan MDP telah berdiri sejak bulan Nopember 2018, tetapi belum ada data yang tersedia mengenai pengaruh MDP pada angka perawatan ulang pasien gagal jantung kronik. Penelitian ini bertujuan untuk mengetahui peranan MDP terhadap penurunan angka perawatan ulang satu tahun pasien gagal jantung kronik di RSCM. Metode. Penelitian menggunakan desain studi kohort retrospektif yang menggunakan data sekunder pasien gagal jantung kronik kelas NYHA II-IV yang menjalani rawat jalan di poliklinik PJT RSCM tahun 2017 dan 2019. Pasien diikuti hingga satu tahun pasca kontrol pertama untuk dinilai apakah mengalami perawatan ulang di rumah sakit. Dilakukan analisis bivariat untuk melihat pengaruh dari MDP terhadap angka perawatan ulang rumah sakit satu tahun dan analisis multivariat untuk menilai apakah pengaruh tersebut dipengaruhi oleh usia, jenis kelamin, kelas fungsional NYHA, komorbid, kepatuhan berobat, obesitas, anemia dan pembiayaan. Hasil. Dari 133 subjek penelitian, sebagian besar subjek adalah laki-laki dengan median usia adalah 57 tahun. Angka perawatan ulang satu tahun sebelum penerapan MDP adalah 47,54%, sedangkan sesudah MDP adalah 38,89%, dengan penurunan angka perawatan ulang satu tahun pada kelompok yang sudah menjalani MDP sebesar 8,65% dan NNT 12. Dibandingkan dengan kelompok yang belum MDP, terjadi penurunan risiko perawatan ulang satu tahun pada kelompok yang sudah menjalani MDP sebesar 18,2%. Tidak didapatkan pengaruh yang bermakna secara statitistik antara MDP dan angka perawatan ulang satu tahun dengan nilai RR 0,818 (IK95%: 0,553 – 1,210, p=0,315). Faktor usia, jenis kelamin, kelas NYHA, komorbid, obesitas, anemia, kepatuhan, dan pembiayaan tidak menjadi faktor perancu pengaruh program MDP terhadap angka perawatan ulang satu tahun pasien gagal jantung kronik di RSCM. Kesimpulan. Penerapan program multidisiplin (MDP) menyebabkan penurunan risiko perawatan ulang satu tahun pasien gagal jantung kronik di RSCM sebesar 18,2%, namun diperlukan penelitian lebih lanjut dengan sampel yang lebih besar untuk meningkatkan kekuatan statistik.

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Introduction. Heart failure is a chronic disease with high readmission rate. The multidisciplinary program (MDP), involving medical and non-medical personnel including cardiologists, cardiac surgeons, cardiac rehabilitation doctors, clinical nutritionists, nurses and physiotherapists is known to reduce the one-year readmission rate by 74%. The Heart Failure Clinic in PJT RSCM has implemented MDP since November 2018, but there is no data available regarding the effect of MDP on the readmission rate of chronic heart failure patients. This study aims to determine the effect of MDP on reduction of the one-year readmission rate of chronic heart failure patients in RSCM. Method. This retrospective cohort study is conducted using medical record from NYHA class II-IV chronic heart failure patients undergoing outpatient care in RSCM Polyclinic in year 2017 and 2019. Patients were followed up in one year after the first control to assess whether they experienced readmission or not. Bivariate analysis was performed to analyze the impact of MDP on the incidence of one-year hospital readmission and multivariate analysis to assess whether the impact was influenced by age, sex, NYHA functional class, comorbidities, medication adherence, obesity, anemia and funding. Results. Of the 133 research subjects, most were male with a median age 57 age years old. The readmission rate before MDP was 47.54%, while after MDP it was 38.89%, with absolute reduction on incidence of 8,65%. Compare to subjects before MDP, subjects whose had MDP has a reduction of one-year readmission risk of 18,2% and NNT of 12. There is no statistically significance of MDP regards to one-year readmission rate of chronic heart failure patients in RSCM with RR value of 0.818 (IK95: 0.553 – 1.210, p=0.315). Age, gender, NYHA class, comorbidities, obesity, anemia, adherence, and funding were not as confounding factors for the effect of the MDP program on one-year readmssion of chronic heart failure patients in RSCM. Conclusion. The multidisciplinary program (MDP) reduced risk of one-year readmission of chronic heart failure by 18.2%, however further studies with larger samples are needed to improve statistical power."

"ABSTRAKLatar Belakang : Infark miokard masih menyisakan banyak masalah morbiditaspasca infark. Upaya regenerasi miokard pasca infark mendorong berbagaipenelitian tentang terapi sel punca sumsum tulang. Endothelial Progenitor Cellsebagai bagian dari Bone Marrow Mononuclear Cell merupakan komponen selpunca yang berperan dalam proses neovaskularisasi. Fungsi sistolik merupakansebagai salah satu pertimbangan dalam pemilihan kandidat terapi sel puncasumsum tulang. Hingga saat ini belum diketahui pengaruh penurunan fungsisistolik ventrikel kiri terhadap jumlah absolut Endothelial Progenitor Cell dalamBone Marrow Mononuclear Cell.Tujuan : Mengetahui apakah terdapat hubungan antara fungsi sistolik ventrikelkiri serta faktor klinis dan demografis lain, dengan jumlah absolut EPC dalamBMMC sumsum tulang terhadap jumlah absolut EPC dalam BMMCMetode : Penelitian ini merupakan studi potong lintang yang dilakukan di PusatJantung Nasiona Harapan Kita dengan subyek pasien yang menjalani terapi selpunca pasca infark. Penelitian dilakukan pada bulan Oktober 2016. Dilakukanpencatatan karakteristik pasien, faktor resiko penyakit jantung koroner,pengukuran fungsi sistolik ventrikel kiri dan pengambilan serta analisa aspirasisumsum tulang.Hasil : Total sampel penelitian ini adalah 21 sampel, yang menjalani terapi selpunca pasca infark miokard selama periode Oktober 2015-September 2016.Faktor-faktor yang dianalisa hubungannya dengan kadar EPC dalam BMMCadalah fungsi sistolik ventrikel kiri, usia, indeks massa tubuh serta faktor resikopenyakit jantung koroner yaitu hipertensi, diabetes dan merokok. Hasil analisastatistik menunjukkan tidak terdapat korelasi antara fungsi sistolik ventrikel kiridengan jumlah absolut EPC. Fungsi sistolik ventrikel kiri, indeks massa tubuh danhipertensi berpengaruh secara signifikan terhadap jumlah absolut BMMC Kesimpulan : Fungsi sistolik ventrikel kiri tidak menunjukkan korelasi yangsignifikan dengan jumlah absolut Endothelial Progenitor Cell dalam sumsumtulang pasien dengan penyakit jantung iskemik

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ABSTRACTBackground Myocardial infarct still carries significant morbidity in postinfarction patients. This condition trigger many study in stem cell therapy formyocardial regeneration after infarctio. Endothelial Progenitor Cell as thecomponent of Bone Marrow Mononuclear Cell was one of determinant factor inmigration capacity of Bone Marrow Mononuclear Stemcell. Left Ventriclesystolic function has becoming one of determinant factor in selection of stem cellpatient. No previous study has evaluate the influence of decreased LV systolicfunction to the numbers of Endothelial Progenitor Cell in Bone MarrowMononuclear CellObjective Evaluating correlation of LV systolic function and other risk factorsof coronary heart disease to the numbers of Endothelial Progenitor Cell in BoneMarrow Mononuclear Cell from Ischemic Heart Disease patients with stem celltherapyMethods This is a cross sectional study that was conducted in NationalCardiovascular Centre Harapan Kita on october 2016. Patients from 2 previousstem cell study in NCCHK enrolled to this studyResults There were 21 patients in this study that undergo stem cell therapy fromOctober 2015 until September 2016. Factors that being analyzed in this studywere LV systolic function and risk factors of coronary heart disease includinghypertension, diabetes melitus and history of cigarrete smoke. Statistical analysisshowed no significant correlation between LV systolic function and absolutnumbers of Endothelial Progenitor Cell in Bone Marrow Mononuclear Cell frompatients with ischemic heart disease. Significant result showed by correlation ofBone Marrow Mononuclear Cell with LV systolic function, body mass index andhypertensionConclusion LV systolic function has no significant correlation with absolutnumbers of Endothelial Progenitor Cell in Bone Marrow Mononuclear Cells frompatients with Ischemic Heart Disease."

"ABSTRAKLatar Belakang: Perkembangan ilmu pengetahuan berhasil meningkatkan harapan hiduppasien yang mengalami infark miokardium. Namun pengobatan yang ada saat ini hanyamemperbaiki kondisi klinis pasien, tanpa adanya perbaikan otot jantung yang telah rusak.Hal inilah yang mendasari berkembangnya penelitian yang mempelajari tentang upayaregenerasi sel otot jantung dengan pemanfaatan sel punca yang salah satunya adalahMesenchymal Stem Cell MSC . Namun hasil yang didapatkan dari beberapa penelitianmenunjukkan hasil yang belum optimal. Hal ini disebabkan oleh beberapa faktordiantaranya adalah kadar dan fungsi dari sel punca yang tidak adekuat. Hingga saat inibelum ada penelitian yang mengevaluasi faktor-faktor yang mempengaruhi kadar MSCdalam Bone Marrow Mononuclear Cell BMMC pada pasien penyakit jantung iskemikkhususnya pengaruh fungsi sistolik ventrikel kiri.Tujuan: Menilai hubungan fungsi sistolik ventrikel kiri dengan kadar MSC dalam BMMCpada pasien penyakit jantung iskemik yang menjalani terapi sel punca Metode: Penelitian ini merupakan studi potong lintang dengan menggunakan datasekunder. Subjek penelitian adalah pasien penyakit jantung koroner dengan fungsi sistolikventrikel kiri

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ABSTRACTBackground The development of science succeeded in increasing the life expectancy of patients with myocardial infarction. However, existing treatments only improve the clinical condition of the patient, without any improvement of the damaged heart muscle. Thus supposrt the development of research that studies to regenerate heart muscle cells with stem cells, for example Mesenchymal Stem Cell MSC . However, the results from several studies have shown modest results. It is caused by several factors including the levels and function of stem cells is inadequate. Until now, no study has evaluated the factors affecting the levels of MSC in Bone Marrow mononuclear cell BMMC in patients with ischemic heart disease in particular the influence of left ventricular systolic function.Objective To assess the association of left ventricular systolic function with MSC levels in BMMC in patients with ischemic heart disease who underwent stem cell therapyMethods This was a cross sectional study using secondary data. Subjects were patients with coronary heart disease with left ventricular systolic function "

"Latar belakang : Pasien gagal jantung kronik memerlukan evaluasi pemeriksaan ekokardiografi. Berbagai metode pemeriksaan digunakan dalam pemeriksaan ekokardiografi, diantaranya pemeriksaan LAEF, LAVI, dan LVEF yang terkait dengan penelitian ini. Metode pemeriksaan LAEF dan LAVI memiliki peran dalam menilai remodelling atrium kiri, sedang LVEF terkait dengan fungsi sistolik ventrikel kiri.Tujuan : Penelitian ini bertujuan menilai korelasi nilai LAEF dan LAVI dengan nilai LVEF pada < 40% dan ≥ 40%.Metode : Studi potong lintang pada 150 pasien gagal jantung kronik yang dilakukan pemeriksaan ekokardiografi trans-torakal di eko-lab PJT RSCM.Pemeriksaan ekokardiografi metode LAEF dengan metode area length (2 dimensi) pada minimal 2 view eko, sedangkan LAVI dengan metode 2 dimensi. Pemeriksaan LVEF dengan metode Simpson.Hasil : Pada penelitian didapatkan 150 subjek dengan nilai median LAVI 30,9mL/m2 (RIK 22,08-40,80), nilai median LVEF 55,75 % (RIK 40,75-61,85), nilai LAEF median 31,8 % (RIK 23,98-38,30). Korelasi nilai LAEF dengan nilai LVEF pada LVEF < 40% dengan hasil korelasi positif sedang bermakna (r = 0,614; p <0,001), pada LVEF ≥ 40% dengan hasil korelasi positif sedang bermakna (r =0,580 ; p < 0,001). Korelasi nilai LAVI dengan nilai LVEF pada LVEF < 40% dengan hasil berkorelasi negatif lemah dan tidak bermakna (r = -0,093; p = 0,722), sedangkan pada LVEF ≥ 40% dengan hasil berkorelasi negatif lemah bermakna (r = -0,299; p < 0,001). Dilakukan sub-analisis pada LVEF 40-50%, didapatkan nilai LAEF dan nilai LVEF berkorelasi positif lemah bermakna (r = 0,492; p <0,001). Lalu sub-analisis pada LVEF ≥ 50%, didapatkan korelasi nilai LAEF dan nilai LVEF positif lemah tidak bermakna (r = 0,205; p = 0,063).Kesimpulan : Terdapat korelasi positif nilai LAEF dengan nilai LVEF pada pasien gagal jantung kronik baik pada HFrEF (LVEF < 40%) dan LVEF ≥ 40%, sehingga nilai LAEF pada cut-off nilai LVEF 40% dapat menjadi salah satu marker menilai proses remodelling atrium kiri. Sedangkan nilai LAVI dengan LVEF pada pasien gagal jantung kronik ditemukan korelasi lemah atau tidak adanya korelasi.

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Background : Patients with chronic heart failure require echocardiographic evaluation. Various examination methods were used in echocardiographic examinations, including LAEF, LAVI, and LVEF examinations related to this study. LAEF and LAVI examination methods have a role in assessing left atrial remodeling, while LVEF is related to left ventricular systolic function.

Objective : This study aims to assess the correlation between LAEF and LAVI values with LVEF values at LVEF < 40% and LVEF 40%.

Methods : A cross-sectional study of 150 patients with chronic heart failure who underwent transthoracic echocardiography at the RSCM PJT eco-lab. Echocardiographic examination using the LAEF method with the area length method (2 dimensions), in at least 2 eco views, while the LAVI using the 2-dimensional method. LVEF examination by the Simpson method.

Results : The study found 150 subjects with a median LAVI value of 30.9 mL/m2 (IQR 22.08-40.80), a median LVEF value of 55.75% (IQR 40.75-61.85), a median LAEF value of 31 ,8% (IQR 23.98-38.30). The correlation between the LAEF value and the LVEF value at LVEF < 40% has a moderately significant positive correlation (r = 0.614; p < 0.001), while at LVEF ≥ 40% has a moderately significant positive correlation (r = 0.580 ; p < 0.001). The correlation between the LAVI value and the LVEF value at LVEF < 40% has a weak and insignificant negative correlation (r = -0.093; p = 0.722), while at LVEF ≥ 40% has a weak negative significant correlation (r = -0.299; p < 0.001). Sub-analysis was performed on LVEF 40-50%, and the LAEF value and LVEF value were positively and significantly correlated (r = 0.492; p < 0.001). Then the sub-analysis at LVEF > 50%, it was found that the correlation between the LAEF value and LVEF value were weak positive and not significant correlated (r = 0.205; p = 0.063).

Conclusion : There is a positive correlation between LAEF values and LVEF values in chronic heart failure patients both at HFrEF (LVEF < 40%) and LVEF ≥ 40%, so that the LAEF value at the cut-off LVEF 40% can be one of the markers to assess the left atrial remodeling process. While the value of LAVI with LVEF in patients with chronic heart failure found a weak correlation or no correlation."