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"[ABSTRAKPasien paska infark miokard sering mengalami gangguan pemenuhan kebutuhanseksual. Sampai sekarang penelitian terkait seksualitas paska infark miokardmasih terbatas. Penelitian ini bertujuan memperoleh gambaran persepsipemenuhan kebutuhan seksual pasien infark miokard. Penelitian ini menggunakanpendekatan kualitatif desain fenomenologi deskriptif, metode pengumpulan datawawancara dan catatan lapangan. Partisipan adalah pasien poli jantung RSUDPasar Rebo Jakarta Timur yang terdiagnosa infark miokard. Data dianalisa denganteknik Colaizzi. Penelitian ini mengidentifikasi 5 tema : perubahan fungsi seksual,ketakutan melakukan aktivitas seksual, alternative pemenuhan kebutuhan seksual,makna seksual bagi individu, kebutuhan pada pelayanan kesehatan. Hasilpenelitian menunjukkan pasien dengan infark miokard mengalami gangguandalam pemenuhan kebutuhan seksual dan membutuhkan bantuan tenaga kesehatansesuai tema yang ditemukan.

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ABSTRACTPatients with post Myocardial Infarction episode may experience disturbance infulfilling their sexual needs. There were limited study in exploring this area. Theaim of this study was to identify the perception of patients with MyocardialInfarction on their sexual need fulfillment. This was a qualitative study usingphenomenological descriptive, with interview and field note as data collectionmethod. The participants were from outpatients heart clinic at Pasar ReboRegional General Hospital, East Jakarta, who were diagnosed with MyocardialInfarction. Data were analyzed with the Colaizzi technique. This study identifiesfive themes : change in sexuality function, fear of doing sexual activities,alternatives way for sexual needs, the meaning of sexuality for individual patient,and the need of health services. This study concluded that patients with postMyocardial Infarction experience disturbance of sexual need fulfilment and needsupport from health personal in solving their sexual need problems;Patients with post Myocardial Infarction episode may experience disturbance infulfilling their sexual needs. There were limited study in exploring this area. Theaim of this study was to identify the perception of patients with MyocardialInfarction on their sexual need fulfillment. This was a qualitative study usingphenomenological descriptive, with interview and field note as data collectionmethod. The participants were from outpatients heart clinic at Pasar ReboRegional General Hospital, East Jakarta, who were diagnosed with MyocardialInfarction. Data were analyzed with the Colaizzi technique. This study identifiesfive themes : change in sexuality function, fear of doing sexual activities,alternatives way for sexual needs, the meaning of sexuality for individual patient,and the need of health services. This study concluded that patients with postMyocardial Infarction experience disturbance of sexual need fulfilment and needsupport from health personal in solving their sexual need problems, Patients with post Myocardial Infarction episode may experience disturbance infulfilling their sexual needs. There were limited study in exploring this area. Theaim of this study was to identify the perception of patients with MyocardialInfarction on their sexual need fulfillment. This was a qualitative study usingphenomenological descriptive, with interview and field note as data collectionmethod. The participants were from outpatients heart clinic at Pasar ReboRegional General Hospital, East Jakarta, who were diagnosed with MyocardialInfarction. Data were analyzed with the Colaizzi technique. This study identifiesfive themes : change in sexuality function, fear of doing sexual activities,alternatives way for sexual needs, the meaning of sexuality for individual patient,and the need of health services. This study concluded that patients with postMyocardial Infarction experience disturbance of sexual need fulfilment and needsupport from health personal in solving their sexual need problems]"

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Aktivitas seksual adalah kebutuhan vital bagi manusia yang dapat terganggu setelah Infark Miokard Akut (IMA) sehingga kapan kembali melakukan aktivitas seksual merupakan hal yang harus menjadi perhatian. Namun saat ini, kembali beraktivitas seksual belum menjadi prioritas dalam pelayanan keperawatan. Penelitian ini bertujuan mengidentifikasi pengaruh dari karakteristik responden, farmakologi, komorbiditas, masalah seksual, dukungan pasangan, dukungan tenaga kesehatan, pengetahuan, fungsi fisik dan faktor psikologis (ansietas-depresi) terhadap kembali beraktivitas seksual. Penelitian menggunakan desain survey analitik cross sectional pada 107 responden rawat jalan yang diambil dengan teknik consecutive sampling. Penelitian menggunakan instrumen Short-Form 12 (SF-12) untuk menilai fungsi fisik, Sex after MI Knowledge Test (SMIKT) untuk mengukur pengetahuan seksual paska IMA dan The Hospital Anxiety and Depression Scale (HADS) untuk mengukur ansietas dan depresi. Hasil penelitian yang dianalisa dengan uji chi-square dan fishers exact menunjukkan bahwa variabel yang berhubungan signifikan adalah farmakologi (beta-blocker) (p=0,020), masalah seksual (p=0,017) dan pengetahuan (p=0,038). Responden dengan beta-bloker, mempunyai masalah seksual dan pengetahuan seksual yang kurang cenderung terlambat kembali beraktivitas seksual. Program edukasi seksual dan peningkatan kolaborasi interprofesional diharapkan dapat membantu pasien lebih cepat kembali beraktivitas seksual paska IMA.

 

 

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Sexual activity is a vital need for humans which can be distrupted due to Acute Myocardial Infarction (AMI) therefore when to resumption of sexual activity is an important matter must be concern. However, return to sexual activity have not been a priority in nursing care nowadays. The study aimed to identify influence of characteristics respondent, pharmacology, comorbidity, sexual problem, partners support, health professional support, sexual knowledge, physical function and psychology factors (anxiety-depression) on returning to sexual activity. The study used analytic survey with cross sectional approach and consecutive sampling involving 107  outpatient. The instruments used were Short Form 12 (SF-12) to assess physical function, Sex after MI Knowledge Test (SMIKT) to measure the post-IMA sexual knowledge and The Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression level. The results were analyzed by fishers exact and chi square test showed a significant relationship between  pharmacological factor (beta-blocker) (p=0,02), sexual problems (p=0,017) and sexual knowledge (0,038) with returning to sexual activity after IMA. Respondents were receiving beta-blocker, having sexual problems and lacking of sexual knowledge tend to be late resuming sexual activity. Sexual education programe and increased interprofessional collaboration are expected to help post-IMA patients regain their sexual activity  faster.

 

 

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"Meskipun kualitas hidup terkait kesehatan telah diteliti secara luas, namun faktor kontekstual pasien cenderung diabaikan. Tujuan dari disertasi ini adalah untuk menguji model kontekstual kualitas hidup terkait kesehatan (health related quality of life-HRQoL) yang diajukan oleh Ashing-Giwa (2005) pada pasien paska infark miokard (IM) dan meneliti peranan prediktor-prediktor yang memengaruhi HRQOL. Variabel yang masuk ke dalam level individual adalah kecemasan, left ventricular ejection fraction (LVEF) dan komorbiditas. Kepuasan pernikahan dan coping religius Islami termasuk dalam level sistemik. Penelitian ini menggunakan desain metode penelitian mixed method explanatory. Pada studi 1, penelitian cross sectional dilakukan terhadap 170 pasien paska IM. Pasien mengisi empat kuesioner (MacNew Health Related Quality of Life, Couple Satisfaction Index, Cardiac anxiety Questionnaire, coping religius Islami). Data LVEF dan komorbiditas pasien didapatkan dari catatan medis. Model teoritis diuji dengan menggunakan structural equation modelling (SEM). Hasil penelitian menujukan bahwa kecemasan memiliki pengaruh langsung yang negatif terhadap HRQOL. Tidak terdapat hubungan yang signifikan antara komorbiditas pasien, coping religius Islami dan LVEF terhadap HRQOL. Kepuasan pernikahan adalah moderator yang signifikan terhadap hubungan antara kecemasan dengan HRQOL. Pada studi 2 dilakukan penelitian kualitatif dengan menggunakan metode multiple case study (studi kasus ganda). Hasil penelitian menujukkan bahwa responden mengalami kecemasan terhadap kecemasan terhadap kematian, kecemasan terhadap bertambah parahnya penyakit dan efek samping pengobatan. IM dihayati sebagai kesempatan kedua untuk menebus kesalahan masa lalu dan adanya dukungan dari pasangan membuat responden lebih mudah untuk menjalani kehidupan paska IM. Aspek lain yang muncul dalam penelitian kualitatif adalah komunikasi antara pasien - dokter dan adanya peran jender terhadap HRQOL responden.

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Although health related quality of life (HRQOL) has been studied extensively, the role of patient’s contextual factors tended to be neglected. The purpose of this dissertation is to test contextual model of health related quality of life proposed by Ashing-Giwa (2005)in post myocardial infarction (MI)  patients and to examine roles of health related quality of life predictors. Variables include in the individual level are anxiety, left ventricular ejection farction and comorbidity. Marital satisfaction and Islamic religious coping are included in the systemic level. An explanatory mixed method study was conducted for this dissertation. For study 1, a cross sectional study included 170 post myocardial infarction (MI) patients was conducted. The patients filled out four questionnaires (MacNew Health Related Quality of Life, Couple Satisfaction Index, Cardiac Anxiety Questionnaire, Islamic Religious Coping. Data regarding patients left ventricular ejection fraction (LVEF) and comorbidity were gathered from patient’s medical status. The theoretical model was tested using structural equation modelling. Structural equation modelling revealed that anxiety had a negative direct relationship to HRQOL. There were no significant relationships among patient’s comorbidity, Islamic religius coping, LVEF and HRQOL Marital satisfaction was a significant moderator of the relationship between anxiety and HRQOL. In study 2, a multiple case study revealed that respondents had anxiety toward death, severity of their disease and medication’s side effects. MI was experienced as a second chance given by God to redeem their misdeed in the past. Supports from spouse made respondents feel at ease to live their daily life after MI. Other aspects emerged in the qualitative study were patients-doctor communication and role of jender in respondents HRQOL."

"LATAR BELAKANG. Disfungsi seksual dan kecemasan sering dialami oleh pasien pasca infark miokard akut (acute myocardial infarct, AMI) dan dapat mempengaruhi kualitas hidup pasien. Tujuan penelitian ini adalah untuk menguji hubungan fungsi seksual dengan kecemasan pasien pasca AMI. METODE. Desain studi deskriptif analitik dengan disain potong lintang (crosssectional). Responden merupakan pasien rawat jalan Poliklinik Jantung Terpadu RS. Cipto Mangunkusumo yang memenuhi kriteria inklusi dan eksklusi, bersedia mengikuti program penelitian dan menandatangani surat persetujuan untuk mengikuti penelitian setelah diberikan penjelasan mengenai tujuan dan manfaat program penelitian. Kemudian responden mengisi formulir International Index of Erectyle Function (IIEF) untuk menilai fungsi seksual dan dilakukan wawancara untuk menilai kecemasan dengan Hamilton Anxiety Rating Scale (HAM-A). HASIL. Pasien pasca AMI mengalami disfungsi ereksi (82,5%), disfungsi orgasme (72,5%), disfungsi libido (93,8%). Hampir seluruh responden menyatakan ketidakpuasan dalam hubungan seksual(97,5%) dan ketidakpuasan menyeluruh (90%). Proporsi kecemasan pasca AMI adalah 52,5%. Tidak terdapat hubungan antara fungsi seksual dengan kecemasan pasca AMI. KESIMPULAN. Kecemasan dan disfungsi seksual merupakan masalah yang perlu diperhatikan pada pasien pasca AMI. Faktor-faktor yang mempengaruhi kecemasan dan disfungsi seksual pasca AMI perlu dieksplorasi lebih lanjut sehingga dapat disusun panduan tatalaksana yang terintegrasi.

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BACKGROUND. Sexual dysfunction and anxiety frequently happens by patients after acute myocardial infarction (AMI) and can affect patients quality of life.

METHODS. It was analytic descriptive study, cross-sectional design. Respondents are outpatients in Integrated Cardiac Clinic of Cipto Mangunkusumo Hospital that meet the inclusion and exclusion criteria, who were willing to follow the research program and sign an agreement to participate in the study after being given an explanation of the purpose and benefits of the research program. Respondents then completed the International Index of Erectyle Function (IIEF) form to assess sexual function and were interviewed to assess anxiety using the Hamilton Anxiety Rating Scale (HAM-A).

RESULTS. Post-AMI patients had erectile dysfunction (82.5%), orgasm dysfunction (72.5%), libido dysfunction (93.8%). Almost all respondents expressed sexual intercourse dissatisfaction (97.5%) and overall dissatisfaction (90%). The proportion of post-AMI anxiety was 52.5%. There was no relationship between sexual function after AMI with anxiety.

CONCLUSIONS. Anxiety and sexual dysfunction post-AMI is a considerable problem. Factors that affect anxiety and sexual dysfunction after AMI needs to be explored further so that an integrated management guidelines could be proposed."

"ABSTRAKLatar Belakang: Prevalensi gagal jantung semakin meningkat per tahun, 60-70% disebabkan penyakit jantung koroner (PJK). Beberapa faktor risiko penyebab gagal jantung yaitu DM, hipertensi, obesitas, sindrom metabolik, dan aterosklerosis. Patofisologi gagal jantung sangat kompleks dan melibatkan banyak sistem, terjadi hipermetabolisme yang dapat menyebabkan penurunanberat badan dan memicu terjadinya malnutrisi. Keadaan gagal jantung dekompensasi akut karena infark miokard lama membutuhkan penanganan segera di RS untuk menghindari komplikasi lebih lanjut.Metode: Laporan serial kasus ini memaparkan empat kasus pasien gagal jantung dekompensasi akut karena infark miokard lama, berusia antara 41 hingga 70 tahun, dan tiga diantaranya dengan riwayat DM tipe II. Semua pasien memerlukan dukungan nutrisi, tiga pasien memiliki status gizi obesitas dan satu pasien berat badan normal. Masalah berkaitan erat pada nutrisi keempat pasien adalah hipoalbuminemia, gangguan elektrolit, gangguan fungsi ginjal, gangguan fungsi hati, keseimbangan cairan, serta defisiensi mikronutrien. Perhitungan kebutuhan energi basal (KEB) dihitung berdasarkan rumus Harris Benedict dengan faktor stres sesuai kondisi klinis dan penyakit penyerta. Komposisi makronutrien diberikan menurutrekomendasi Therapeutic Lifestyle Changes (TLC) dan American Heart Association (AHA), pemberian protein disesuaikan dengan fungsi ginjal masing-masing pasien. Pemberian suplementasi mikronutrien juga diberikankepada keempat pasien. Pemantauan pasien meliputi keluhan subyektif, hemodinamik, analisis toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan dan kapasitas fungsional.Hasil: pemantauan selama di RS, keempat pasien menunjukkan perbaikan klinis, peningkatan toleransi asupan, perbaikan kadar elektrolit dan peningkatan kapasitas fungsional.Kesimpulan: Terapi nutrisi medik yang adekuat dapat memperbaiki kondisi klinis pasien gagal jantung dekompensasi akut karena infark miokard lama.

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ABSTRACT

Background: The prevalence of heart failure increase annually, 60-70% due to coronary heart disease (CHD). Some of the risk factors associated with heart failure are diabetes, hypertension, obesity, metabolic syndrome, and atherosclerosis. The phatophysiology of heart failure is very complex and involves many systems. The occurance of hypermetabolism can lead to weight loss and triger malnutrition. The state of acute decompensated heart failure due to old myocardial infarction require immediate treatment in hospital to avoid further complications.

Methods: This series of case report describes four cases of patients with acute myocardial heart failure, due to old infarction, aged between 41 to 70 years old, and three of them with a history of type 2 diabetes melitus. All patients required nutritional support, three patients had nutritional status of obese and one patient was normal in weight. The problems which closely linked to all nutrition of the four patients were hypoalbuminemia, electrolyte disturbances, impaired renal function, impaired liver function, fluid inbalance, and micronutrient deficiencies. Basal Energy Requirement was calculated using Harris Benedict formula with stress factors corresponding clinical condition and comorbidities. Macronutrients composition was given according to the recommendation of the Therapeutic Lifestyle Changes (TLC) and the American Heart Association (AHA), while the provision of proteins was

tailored with the kidney function of each patient. Micronutrients supplementation was also given to four patients. Patient monitoring parameters included subjective complaints, hemodynamic, analysis tolerance

of intake, laboratory tests, anthropometric, fluid balance and functional capacity.

Results: During the monitoring period in the hospital four patients showed clinical improvement, increased tolerance of intake, improved electrolyte levels and increased functional capacity.

Conclusion:Adequate medical nutrition therapy can improve the clinical condition of patients with acute decompensated heart failure due to old myocardial infarction."

"Tujuan : Mendapatkan perbandingan reaktifitas platelet jam pertama (dengan alat Multiplate) antara ticagrelor dan clopidogrel. Latar Belakang : Ticagrelor memiliki kemampuan inhibisi platelet lebih baik dibandingkan clopidogrel. Penelitian PLATO atau substudi PLATO-platelet, dosis clopidogrel hanya 300 mg, dibandingkan dengan ticagrelor 180 mg pada pasien STEMI. Penelitian ini dilakukan untuk menilai reaktifitas platelet pada jam-1,4 dan 8 antara ticagrelor 180 mg atau clopidogrel 600 mg pada pasien STEMI.Metode : Penelitian random clinical trial, double blind, pasien STEMI dengan naive clopidogrel atau ticagrelor, dilanjutkan tindakan intervensi perkutan primer (PPCI) di RS Jantung Harapan Kita dari April-Juni 2013. Aktifitas platelet diukur jam pertama, jam keempat dan kedelapan dengan alat Multiplate.Hasil : Didapat 22 pasien STEMI nave clopidogrel/ticagrelor, dengan 11 pasien tiap kelompok. Tidak terdapat perbedaan terhadap usia, onset iskemik, BMI, penyakit penyerta Diabetes Melitus serta waktu pengambilan sampel pemeriksaan antara 2 kelompok obat. Didapat nilai reaktifitas platelet tetap tinggi pada kelompok obat clopidogrel dibandingkan ticagrelor pada jam pertama. Hasil kelompok ticagrelor tetap konstan hingga jam ke-8. Dan penurunan rekatifitas platelet kelompok clopidogrel menurun mendekati nilai yang diharapkan hingga jam 8.Kesimpulan : Reaktifitas platelet ticagrelor lebih rendah dibandingkan clopidogrel saat jam pertama pasca loading obat. Terdapat 45% (5 pasien) pada kelompok clopidogrel yang tetap memiliki reaktifitas platelet tinggi pada pemeriksaan jam pertama, keempat dan kedelapan, serta 9% (1 pasien) pada ticagrelor yang memiliki kenaikan nilai reaktifitas platelet pada jam keempat dan kedelapan

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Objectives : This study sought to compare platelet reactivity by180 mg ticagrelor and 600 mg clopidogrel in primary PCI STEMI patients.

Background: The ability of ticagrelor in inhibiting platelet functions was more potent than clopidogrel in stable CAD and UAP/NonSTEMI patients. According to the PLATO trial or PLATO-platelet substudy, patients treated with 180 mg ticagrelor had better clinical endpoint and more platelet inhibition compared to 300 mg clopidogrel. The study we conducted was to see the platelet reactivity at 1st, 4th, and 8th hour after ingestion of 180 mg ticagrelor compared

to 300 mg clopidogrel in STEMI patients Methods: This is a randomized double blind clinical trial carried out in Department of Cardiology and Vascular Medicine Universitas Indonesia/ National Cardiovascular Center Harapan Kita in April - June 2013. As many as 22 clopidogrel or ticagrelor nave STEMI

patients undergoing primary PCI with were recruited. Platelet reactivity (PRU) was assessed by

Multiplate at 1,4,8 h after LD.

Result : Both nave ticagrelor and clopidogrel goups had 11 patients each. About 45% patients

in clopidogrel group have high reactivity platelet at 1h, 4h and 8 h MEA analysis, and 9%

patients in ticagrelor group have high reactivity platelet at 4h and 8 h MEA analysis.

Conclusion: The action of Ticagrelor in platelet reactivity was lower compared to Clopidogrel in

STEMI patients. 45 % patients in clopidogrel group maintained high platelet reactivity at 1st, 4th

and 8th hour after LD, while 9% patients in ticagrelor group had high platelet reactivity started at

4th up 8th hour after LD."

"Introduction: The major cause of mortality and morbidity post-MI is the complications following the infarction. One of the most common MACE is malignant arrhythmia, this includes VF, VT and non-sustained VT. Malignant arrhythmia is caused due to the culmination of biochemical, electrophysiological, autonomic and genetic changes after an event of ischemia which results in myocardial damage and scarring, as well as left ventricular systolic dysfunction. Early risk stratification is important in AMI and cTnI and LVEF has been two accessible markers that has been studied in various aspects of AMI as prognostic markers, however there has been little studies of its role and correlation in post-AMI malignant arrhythmia. This research will therefore explore the correlation between myocardial damage (cTnI) and left ventricular systolic function (LVEF) with malignant arrhythmia in AMI patients. Methods: A retrospective cohort study was conducted on AMI patients who are admitted to the ICCU of Cipto Mangunkusumo General Hospital, Jakarta from November 2018 to May 2019. Patients who experienced severe infection and who has malignant arrhythmia when admitted were excluded. The association between cTnI and malignant arrhythmia was tested using Mann-Whitney test, while the association between LVEF and malignant arrhythmia was tested using Independent T-Test. Pearson’s Chi-Square test was done to test the relationship between systolic function status with malignant arrhythmia, All data analysis was performed on IBM SPSS Statistics. Results: Total of 110 patients were included in this study. 13.6% of total subjects experience malignant arrhythmia during hospitalisation. There is no significant correlation between cTnI and post-AMI malignant arrhythmia (p = 0.053, RR 1.2, 95%CI 1.1-1.2) but significant correlation between LVEF and post-AMI malignant arrhythmia was found, on both metric (t(108)=3.450, p = 0.001) and categorical (c2(1) = 6.132, p = 0.013, RR 4.8, 95%CI 1.15-20.4) assessment. There were major differences in the mean value of cTnI and LVEF between the two groups. Conclusion: This study has found statistically significant correlation between left ventricular systolic function (LVEF) with malignant arrhythmia in AMI patients, but no significant correlation between cTnI and malignant arrhythmia in AMI patients. Higher cTnI levels are more frequent in malignant arrhythmia group. Malignant arrhythmia is more common in AMI patients with lower LVEF.

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Pendahuluan: Penyebab utama mortalitas dan morbiditas infark miokard akut (IMA) adalah komplikasi pasca infark. Salah satu MACE paling umum ditemukan adalah aritmia maligna, yang meliputi VF, VT dan VT sesaat. Aritmia maligna disebabkan oleh kombinasi perubahan biokimia, elektrofisiologi, otonomi, serta genetik setelah kejadian iskemik yang kemudian menyebabkan kerusakan dan fibrosis pada miokard. Stratifikasi risiko awal sangat penting dalam kasus IMA. cTnI serta LVEF merupakan dua marka yang mudah diakses dan telah dipelajari dalam berbagai aspek IMA. Akan tetapi, studi mengenai peran dua marka tersebut dalam aritmia maligna pasca-IMA masih sedikit. Studi ini akan mempelajari korelasi antara kerusakan pada miokard (cTnI) dan fungsi sistolik ventrikel kiri (LVEF) dengan aritmia maligna pada pasien IMA. Metode: Sebuah studi kohort retrospektif dilakukan pada pasien IMA yang dirawat di ICCU Rumah Sakit Cipto Mangunkusumo, Jakarta dalam periode November 2018 hingga Mei 2019. Pasien yang mengalami infeksi parah dan pasien yang mengalami aritmia maligna saat admisi tidak diikutsertakan dalam penelitiaan ini. Hubungan cTnI dengan aritmia maligna dianalisis melalui uji Mann-Whitney dan hubungan LVEF dengan aritmia maligna dianalisis oleh uji Independent T-Test dan pada hubungan status fungsi sistolik dengan aritmia maligna dianalisis menggunakan uji Pearson Chi-Square. Analisis data dilakukan dengan software IBM SPSS Statistics. Hasil: Total 110 pasien dilibatkan dalam penelitian ini. 13.6% dari total pasien mengalami aritmia maligna selama masa hospitalisasi. Tidak ditemukan adanya hubungan signifikan antara cTnI dengan aritmia maligna pada pasien IMA (p = 0.053, RR 1.2, 95%CI 1.1-1.2), namun ditemukan adanya hubungan signifikan antara LVEF dengan aritmia maligna pada pasien IMA, baik pada data metrik (t(108)=3.450, p = 0.001) maupun data kategorik (c2(1) = 6.132, p = 0.013, RR 4.8, 95%CI 1.15-20.4). Terdapat perbedaan besar antara nilai rata-rata cTnI and LVEF pada kedua kelompok pasien. Kesimpulan: Studi ini menemukan korelasi yang signifikan secara statistikal antara fungsi sistolik ventrikel kiri dengan aritmia maligna pada pasien IMA, namun tidak ditemukan adanya korelasi signifikan antara cTnI dengan aritmia maligna pada pasien IMA. Nilai cTnI yang tinggi lebih umum ditemukan pada kelompok pasien dengan aritmia maligna. Kejadian aritmia maligna lebih umum pada pasien yang memiliki LVEF yang lebih rendah."

"Infark Miokard Akut, satu subkelas dari Sindrom Koroner Akut, terjadi bila ada obstruksi total arteri koroner. Terapi reperfusi yang tepat waktu seperti primary angioplasty bersama dengan stratifikasi risiko diperlukan untuk mencapai prognosis yang lebih baik, yaitu ditunjukkan oleh trombolisis akhir pada aliran infark miokard (TIMI). Leukosit sangat berkorelasi dengan proses inflamasi dan dengan demikian memberikan peluang untuk menjadi prediktor yang berbiaya rendah dan efektif untuk final TIMI flow. Penelitian ini bertujuan untuk melihat apakah tingkat leukosit saat admisi dapat dihubungkan dengan final TIMI flow agar bisa dilakukan penatalaksanaan yang lebih spesifik dan agresif agar mengarah pada prognosis yang lebih baik. Penelitian ini merupakan studi cross-sectional analitik yang menganalisa data pasien yang mencakup final TIMI flow, tingkat leukosit saat admisi dan variable lain seperti gula darah saat admisi dan kadar kreatinin. Terdapat 3,704 sampel yang dianalisis dari registri Jakarta Acute Coronary syndrome (JAC) menggunakan program SPSS. Tingkat leukosit saat admisi berhubungan dengan final TIMI flow pada pasien dengan infark miokard yang sudah melakukan tindakan primary angioplasty. Terdapat hubungan statistik antara tingkat leukosit saat admisi dan final TIMI flow pada pasien (p=0.002) Terdapat hubungan bermakna antara tingkat leukosit saat admisi dengan final TIMI flow setelah dilakukan primary angioplasty pada pasien STEMI, di mana tingkat leukosit <13020/μl dikaitkan dengan aliran TIMI yang lebih baik. Hasil ini menunjukan bahwa tingkat leukosit dapat digunakan sebagai alat bedside yang murah untuk menilai prognosis pasien.

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Acute Myocardial Infarction, a subclass of Acute Coronary Syndrome, happens when there is total coronary artery obstruction. A timely reperfusion therapy by primary angioplasty along with risk stratification is needed to achieve a better prognosis denoted by the final thrombolysis in myocardial infarction (TIMI) flow. Leukocytes are strongly correlated with the inflammation process and thus present an opportunity to be a low cost and effective predictor of final TIMI flow. This research aims to see whether leukocyte level on admission can be associated with final TIMI flow in order to make a more specific and aggressive management that leads to better prognosis. The research is an analytical cross-sectional study that analyzes patient's data including final TIMI flow, leukocyte level on admission and other variables such as admission blood glucose and creatinine level. There are 3,704 samples analyzed from the Jakarta Acute Coronary syndrome (JAC) registry using the SPSS program.Admission leukocyte levels are associated with final TIMI flow of STEMI patients that has been treated with primary angioplasty. There is a statistical significance between admission leukocyte level and final TIMI flow of patients (p=0.002). There is a significant association between leukocyte level of patients on admission and final TIMI flow after primary angioplasty in STEMI patients, in which a leukocyte level of <13020/μl is associated with a better TIMI flow. This shows leukocyte level can be used as an inexpensive bedside tool to assess a patient's prognosis."

"Infark Miokard Akut dengan elevasi segmen ST/ ST-Segment Elevation Myocardial Infarction (STEMI) adalah bagian dari sindrom koroner akut yang berat dan menetap akibat oklusi total arteri koroner sehingga diperlukan tindakan revaskularisasi segera untuk mengembalikan aliran darah dan reperfusi miokard secepatnya. Tindakan revaskularisasi dilakukan dalam 12 jam onset serangan angina pektoris dan didapatkan elevasi segmen ST yang menetap atau ditemukan Left Bundle Branch Block (LBBB). Tatalaksana Intervensi Koroner Perkutan primer lebih disarankan dibandingkan fibrinolisis. Penelitian mengenai mortalitas selama 3 tahun pada pasien pasca STEMI dengan IKP primer belum pernah dilakukan di Indonesia sehingga peneliti tertarik untuk melakukan penelitian tersebut. Penelitian ini menggunakan desain kohort retrospektif dengan waktu pengamatan selama 3 tahun. Populasi studi adalah adalah semua pasien diagnosis STEMI dengan terapi IKP primer berusia ≥ 18 tahun dan keluar rawat hidup Tahun 2011-2012 di RSJPD Harapan Kita. Kriteria inklusi sampel adalah pasien didiagnosa STEMI dan keluar rawat dalam keadaan hidup 01 Januari 2011- 31 Desember 2012 dan Pasien STEMI yang berusia ≥ 18 tahun dengan total sampel sebanyak 466 orang. Data pasien diperoleh dari Jakarta Acute Coronary Syndromes (JACS) dan rekam medis. Analisis data dilakukan dengan Stata 12. Pada analisis multivariat dengan menggunakan uji cox regression time independent, didapatkan pasien STEMI dengan IKP primer yang tidak teratur kontrol memiliki risiko kematian lebih tinggi dibandingkan kontrol teratur ( Adj HR = 5,7 ; 2,447 ? 13,477 ; p value = 0,0001). Pasien STEMI yang DM memiliki risiko kematian lebih tinggi dibandingkan tidak DM ( Adj HR = 2,66 ; 1,149 - 6,150; p value = 0,034). Pasien STEMI dengan kelas killip II memiliki risiko kematian lebih tinggi dibandingkan kelas killip I (Adj HR = 2,31 ; 0,99 ? 5,363 ; p value = 0,05). Model estimasi risiko hazard: H(1095h,t)=ho (1095h) exp [(0,91DM )+ (0,84 x Killip Admisi) + ( 1,75 x Kontrol)]. Keteraturan kontrol, diabetes mellitus dan kelas killip admisi memengaruhi risiko mortalitas pasien STEMI dengan IKP primer di RSJPD Harapan Kita.

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ST -Segment Elevation Myocardial Infarction ( STEMI ) is a part of the heavy acute coronary syndromes and settled due to total occlusion of the coronary arteries that required immediate revascularization to restore blood flow and myocardial reperfusion as soon as possible . Revascularization performed within 12 hours of onset of angina pectoris and ST segment elevation obtained were settled or discovered Left Bundle Branch Block ( LBBB ) . Primary Percutaneous Coronary Intervention (PPCI) Procedures more advisable than fibrinolysis. The purpose of this study to determine the factors that affect the risk of 3 years mortality and resulted in a scoring system STEMI patients with primary IKP based on demographic and clinical patients at the Hospital Cardiovascular Harapan Kita . This study used a retrospective cohort design with observation time for 3 years . The study population was is all STEMI patients with a diagnosis of PPCI ≥ 18 years old and alive at discharge at 2011-2012 in RSJPD Harapan Kita . The inclusion criteria were patients diagnosed STEMI alive at discharge at January 2011 - December 2012 and STEMI patients ≥ 18 years old with a total sample of 466 people . Data obtained from the patient Jakarta Acute Coronary Syndromes ( JACS ) and medical records . Data analysis was performed with Stata 12. In multivariate analysis using Cox regression test time independent , STEMI patients with PPCI who irregular control have a higher mortality risk than regular controls ( Adj HR = 5.3 ; 2.345 to 13.026 ; p value = 0.0001 ) . STEMI patients with DM have a higher mortality risk than not DM ( Adj HR = 2,66 ; 1,149 to 6,150 ; p value = 0,034 ) . STEMI patients with killip class II had a higher mortality risk than Killip class I ( Adj HR = 2,31 ; 0,991 to 5,363 ; p value = 0,035 ) . Hazard risk estimation model : H(1095h,t)=ho (1095h) exp [(0,91DM )+ (0,84 x Killip Admisi) + ( 1,75 x Kontrol)]."

"Latar belakang: Pada era intervensi koroner perkutan primer (IKKP), angka kematian akibat infark miokard akut dengan elevasi segmen ST (IMA-EST) berhasil ditekan. Peningkatan angka sintasan tersebut berbanding dengan peningkatan insiden gagal jantung. Proses remodeling pascamiokard infark yang belum sepenuhnya dihambat oleh standar terapi saat ini akan berujung pada kondisi gagal jantung. Doksisiklin sebagai anti-matriks metaloproteinase (MMP) menunjukkan hasil yang baik dalam mencegah proses remodeling. Biomarker remodeling merupakan surrogate dini yang baik untuk memprediksi kejadian remodeling. Namun, efek doksisiklin terhadap biomarker remodeling dan luaran klins pasien IMA-EST belum diketahui.Tujuan: Penelitian ini bertujuan untuk mengetahui efek doksisiklin terhadap penurunan kadar biomarker remodeling pascainfark miokard.Metode: Penelitian ini menggunakan desain uji klinis tersamar tripel. Pasien IMA-EST dengan keterlibatan anterior atau Killip 2-3 dengan onset kurang dari 12 jam yang menjalani IKKP terbagi acak kedalam grup yang mendapat doksisiklin 2x100 mg selama 7 hari sebagai tambahan dari standar terapi dan grup dengan standar terapi. Pemeriksaan biomarker (netrofil, hs-Troponin T, hs-CRP, NT-pro BNP) dilakukan saat admisi rumah sakit dan evaluasi intraperawatan. Ekokardiografi dilakuan saat admisi dan hari ke-5 untuk menilai dimensi dan fungsi ventrikel kiri.Hasil: Terdapat 94 subyek yang diikutkan dalam penelitian dan terbagi rata ke dalam kedua grup. Karakteristik demografis dan klinis kedua grup homogen. Grup doksisiklin menujukkan nilai netrofil jam ke-24 yang lebih rendah dibanding grup kontrol (69,1±5,8% vs 71,9±8,0%, p=0,049). Peningkatan hs-Troponin T didapatkan lebih rendah pada kelompok dengan onset lebih dari 6 jam yang mendapatkan doksisiklin, namun tidak pada grup kontrol. Insiden gagal jantung 11,3% lebih rendah pada grup doksisiklin. Perbaikan fraksi ejeksi signifikan didapat pada grup doksisiklin dibanding grup kontrol (4,5±10,4% vs 0,3±10,3%, p=0,05). Peningkatan tersebut lebih besar pada pasien dengan onset lebih dari 6 jam dengan rerata peningkatan 5,9% (95%IK 0,05-11,7%, p=0,048).Kesimpulan: Doksisiklin memiliki efek perbaikan biomarker remodeling ventrikel, terutama netrofil dan hs-troponin T, serta fraksi ejeksi ventrikel kiri. Jumlah insiden gagal jantung lebih rendah pada grup doksisiklin.

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Background: In era of primary percutaneous coronary intervention (PPCI), mortaliry rate was reduced significantly. The increament in survival rate was followed by increament in heart failure cases. Cardiac remodelling after myocardial infarction was not fully anticipated by current therapy hence the patent would suffer for hear failure. Doxycycline as antimatrix metaloproteinase (MMP) inhibitor showed a promising results in modulation cardiac remodelling. Cardiac biomarkers for remodelling are surrogate parameters for early indentifying of remodelling. However, the effect of doxycyline to cardiac remodelling and its clinical implication are unknown.

Objective: To determine the effect of doxycycline on cardiac remodelling biomarkers after myocardial infarction.

Methods: We conducted triple blinded-randomized control trial. Patients with STEMI anterior or with Killip class 2-3 who underwent PPCI were randomly assigned to doxycycline (100 mg b.i.d for 7 days) in addition to standard therapy or to standar care. Cardiac remodelling biomarkers (neutrophils, hs-Troponin T, hs-CRP, NT-proBNP) were obtained on admission and during hospitalization. Echocardiography were assessed on admission and at 5 days to evaluate left ventricle dimmension and function.

Results: There were 94 patients assigned into doxycycline and control group. Baseline demographics and clinical characteristics were comparable between 2 groups. Doxycycline group showed lower percent neutrophils at 12 hours compare to control group (69.1±5.8% vs 71.9±8.0%, p=0.049). hs-Troponin T changes were lower in patients with onset >6 hours who received doxycycline and there were no differences among control group. Heart failure incidence was 11.3% lower in doxycycline group to control group. The improvement of left ventricle ejection fraction was sifnificantly higher in doxycycline group than in control group (4.5±10.4% vs 0.3±10.3%, p=0.05). The imrpovement was even higher in those with onset >6 hours with mean increament of 5.9% (95%CI 0.05-11.7%, p=0.048).

Conclusion: Doxycycline had effect in improving cardiac remodelling biomarkers, ie percent neutrophils and hs-Troponin T and left ventricle ejection fraction. Incidence of heart failure was lowe in doxycycline group."