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"[ABSTRAKLatar Belakang : Atherosklerosis adalah suatu proses penyakit yang difus, dengan adanya satu pembuluh darah yang rusak akan memprediksikan adanya kelainan pada pembuluh darah lain. Ankle Brachial Indeks (ABI) dan Toe Brakhial Indeks (TBI) adalah test non invasif terbukti sensitive dan spesifik untuk mendeteksi beratnya penyakit arteri perifer.Tujuan : Mengetahui hubungan derajat Penyakit Arteri Perifer (PAP) Asimtomatis dengan beratnya Penyakit Jantung Koroner (PJK) stabilMetode : Dilakukan studi potong lintang pada tujuh puluh tiga pasien PJK stabil yang menjalani angiografi koroner. Derajat stenosis arteri coroner dinilai dengan skor Gensini > 40 (berat) dan < 40 (ringan-sedang). PAP dinilai dengan pemeriksaan ABI dan TBI dengan metode Oscillomtreic. Analisis menggunakan uji Spearman correlation test dan uji Pearson correlation test.Hasil : Proporsi PAP asimtomatis pada PJK stabil 47 pasien (64,4%). Nilai median ABI adalah 1,07 (kisaran 0,57-1,27), nilai rerata TBI adalah 0,57 (SB 0,155) dan nilai rerata skor Gensini adalah 46,60 (SB 33,64). Analisis bivariat ABI dengan skor Gensini menunjukkan tidak terdapat korelasi (r=-0,099, p 0,407) dan analis bivariate TBI dengan skor Gensini juga menunjukkan tidak terdapat korelasi (r= -0,153, p= 0,196)Simpulan : ABI dan TBI dengan metode Oscillometric tidak berkorelasi dengan derajat stenosis arteri koroner berdasarkan skor Gensini. ABI dan TBI tidak memiliki kemampuan yang baik untuk membedakan pasien PJK ringan-sedang dan berat berdasarkan skor Gensini.

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ABSTRACTIntroduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores., Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.]"

"Latar Belakang: Derajat kompleksitas lesi koroner yang berat merupakan prediktor mortalitas dan Major Adverse Cardiovascular Event (MACE) serta penentuan revaskularisasi pada penyakit jantung koroner (PJK). Fragmented QRS (fQRS) dinilai sebagai penanda iskemia atau cedera miokardium PJK. Hubungan fQRS dan derajat kompleksitas lesi koroner perlu diteliti lebih lanjut pada pasien PJK di Indonesia. Tujuan: Mengetahui hubungan fQRS dan derajat kompleksitas lesi koroner pada pasien penyakit jantung koroner. Metode: Penelitian potong lintang di Rumah Sakit Cipto Mangunkusumo, mengambil data sekunder pada 172 pasien jantung koroner yang menjalani percutaneous coronary intervention (PCI) di Cath Lab pada bulan Januari-Juni 2018 secara total sampling. Pasien dibagi berdasarkan adanya tidaknya fQRS. Data demografi, klinis, dan deajat kompleksitas (skor Gensini) diteliti. Hubungan antara adanya fQRS dan derajat kompleksitas lesi koroner dianalisis dengan uji kesesuaian. Hasil: Sembilan puluh empat (54,6%) subjek terdapat gambaran fQRS. Pada analisis didapatkan hubungan antara fQRS dengan kategori skor Gensini ringan-sedang dan ringan-berat dengan kesesuaian baik (kappa 0,721 dan 0,820; p <0,001). Hubungan dengan kesesuaian yang baik juga didapatkan antara fQRS dan PJK signifikan (kappa 0,670; p <0,001) serta fQRS dan PJK multivessel (kappa 0,787; p <0,001). Simpulan: Terdapat hubungan fragmented QRS complexes dan derajat kompleksitas lesi koroner pada pasien penyakit jantung koroner.

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Background. The severity of coronary artery lesion is used as a predictor of mortality, major adverse cardiovascular event, and revascularization in coronary artery disease (CAD). Fragmented QRS complex (fQRS) as a novel marker of myocardial ischemia/scar in patients with coronary artery disease. The relationship between the two in Indonesia should be studied further.

Purpose. To determine the relationship between fQRS and the severity of coronary lesion in coronary artery disease.

Methods. A cross sectional study was conducted at Cipto Mangunkusumo Hospital. Secondary data were taken from 172 patients with CAD who underwent percutaneous coronary intervention (PCI) from January-June 2018 with total sampling. Patients were divided based on the existence of fQRS. Demographic, clinical, and severity of coronary artery lesion (Gensini score) characteristics were studied. Data were analysed using Cohens kappa agreement test.

Results. fQRS was present in 94 subjects (54.6%). Bivariate analysis showed a significant difference between fQRS with mild-moderate Gensini score as well as mild-severe Gensini score (kappa 0,721 and 0,820; p<0,001), fQRS with significant CAD (kappa 0.670; p<0,001), and fQRS with multivessel CAD (kappa 0.787; p<0,001).

Conclusion. There is a significant relationship between fQRS and the degree of severity of coronary lesion in coronary artery disease patients."

"Latar Belakang: Kadar hsCRP berhubungan dengan mayor adverse cardiac events. Pada PJK stabil, hubungan antara kadar hsCRP dengan skor SYNTAX sebagai gambaran derajat aterosklerosis koroner belum jelas. Tujuan: Mengetahui hubungan antara kadar hsCRP dengan skor SYNTAX pada penderita PJK stabil, dan mengetahui titik-potong kadar hsCRP yang dapat membedakan antara kelompok skor SYNTAX rendah dengan yang tinggi. Metode: Observasional potong-lintang pada consecutive 93 subjek penderita PJK stabil dewasa yang menjalani angiografi koroner di RSUPNCM pada bulan Mei sampai September 2018, untuk memperoleh skor SYNTAX. Diambil darah dari arteri perifer sebelum tindakan angiografi untuk pemeriksaan hsCRP dan laboratorium dasar. Dieksklusi penderita infeksi berat, trauma, PGK, sirosis hati, keganasan, pengobatan steroid. Selanjutnya data dikumpulkan dan dianalisis. Skor SYNTAX dikelompokkan tinggi bila > 27, dan rendah bila nilai < 27. Untuk menilai titikpotong kadar hsCRP dipakai uji Sperman karena distribusi data tidak normal. Hasil: Ditemukan rerata umur 60,23 tahun (SB 8,984), IMT 26,30 Kg/m2 (SB 3,903), kol-LDL 117,74 mg/dL (SB 36,31). Kadar hsCRP dan skor SYNTAX tidak dipengaruhi oleh IMT atau kol-LDL (hsCRP-IMT: r:0,032; p:0,772; skor SYNTAX-IMT: r:-0,021; p:0,849; hsCRP-kol LDL: r:-0,149; p:0,266; skor SYNTAX-kol LDL: r:0,159; p:0,234). Ditemukan korelasi positif lemah hsCRP dengan skorSYNTAX (r:0,270; p:0,009) dan Titik-potong pada kadar hsCRP 2,35 mg/L (sensitifitas 0,69; spesifisitas 0,53). Nilai AUC 0,554, IK 95%, p: 0,472, merupakan diskriminasi yang kurang baik. Simpulan: Pada penderita PJK stabil, kadar hsCRP berkorelasi positif lemah dengan skor SYNTAX sebagai gambaran derajat aterosklerosis. Kadar hsCRP dengan titik-potong > 2,35 mg/L dapat membedakan kelompok yang mempunyai skor SYNTAX rendah dengan kelompok skor SYNTAX tinggi, namun nilai prediksinya relatif rendah.

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Background: High sensitivity C-reactive protein levels are associated with mayor adverse cardiac events. In stable CAD, the association of baseline hcCRP level with coronary atherosclerosis severity assessed by SYNTAX score were not clear.

Objective: To investigate the association between hsCRP level and SYNTAX score in patients with stable CAD, and to know cut-off point of hsCRP level which can differentiated between the group of low SYNTAX score and of high SYNTAX score.

Methods: Cross-sectional observation to the consecutive 93 subject adult patients of stable CAD, undergoing coronary angiography in Cipto Mangunkusumo General Hospital on May to September 2018 to obtain SYNTAX score. The blood tests were taking from pheripheral artery prior to carrying out of coronary angiography to obtain level of hsCRP and laboratory data base. The exclusion were severe infection, trauma, CKD, cirrhosis hepatis, malignancy, and steroid therapy. The SYNTAX score will be differentiated between the group of high if the value > 27, and the group of low if the value < 27. Sperman analysis will be used to evaluate hsCRP cut-off point.

Results: Average age was 60,23 year (SD 8,984), BMI 26,30 Kg/m2 (SD 3,903), and LDL-chol 117,74 (SD 36,31). The Level of hsCRP and SYNTAX score were not influenced by BMI or LDL-chol (hsCRP - BMI: r:0,032; p:0,772; SYNTAX score - BMI: r:-0,021; p:0,849; hsCRP- LDL-chol: r:-0,149; p:0,266; SYNTAX score - LDL-chol: r:0,159; p:0,234). We found positif corelation (weak) between hsCRP and SYNTAX Score (r:0,270; p:0,009). Cut-off point was found in the hsCRP level 2,35 mg/L (sensitivity 0,69; spesivisity 0,53). AUC 0,554, CI 95%, p: 0,472, were the poor discrimination.

Conclusions: There were positif (weak) correlation between hsCRP level and SYNTAX score in stable CAD patients. Cut-off point in the hsCRP level > 2,35 mg/L can differentiated between the group of low SYNTAX score and of high SYNTAX score, but the prediction value is low-grade."

"Latar Belakang: Keparahan stenosis pada penyakit jantung koroner (PJK) stabil berkaitan erat dengan prognosis. Dalam memprediksi keparahan stenosis dapat digunakan beberapa faktor klinis dan ekokardiografi. Akhir-akhir ini berkembang speckle tracking echocardiography yang mampu menilai strain miokardium dan baik untuk memprediksi stenosis. Penilaian faktor-faktor klinis dan ekokardiografi strain bersama-sama diharapkan mampu memprediksi lebih baik keparahan stenosis. Tujuan: Mengetahui apakah faktor-faktor klinis (usia, jenis kelamin, diabetes, angina tipikal, riwayat infark) dan global longitudinal strain (GLS) pada ekokardiografi strain dapat memprediksi keparahan stenosis pasien PJK stabil yang dinilai dengan skor Gensini. Membuat model prediktor dari parameter yang bermakna. Metode: Studi potong lintang dilakukan di RSCM pada periode Maret-Mei 2019. Pengambilan sampel secara konsekutif pada pasien PJK stabil yang menjalani angiografi koroner. Analisis bivariat dilakukan dengan chi-square, dilanjutkan analisis multivariat dengan regresi logistik metode baickward stepwise pada variabel yang bermakna. Hasil: Terdapat 93 subjek yang masuk dalam penelitian. Pada analisis bivariat faktor-faktor prediktor yang bermakna adalah diabetes melitus (OR 2,79; IK95%:1,08-7,23), riwayat infark (OR 4,04; IK95%:1,51-10,80), angina tipikal (OR 5,01; IK95%:1,91-13,14), dan GLS ≥-18,8 (OR 30,51; IK95%:10,38-89,72). Pada analisis multivariat faktor-faktor prediktor yang bermakna adalah angina tipikal (OR 4,48; IK95%:1,39-14,47) dan GLS ≥18,8 (OR 17,30; IK95%:5,38- 55,66). Tidak dilakukan pembuatan model prediktor karena hanya 2 faktor prediktor yang bermakna. Simpulan: Angina tipikal dan GLS merupakan faktor-faktor prediktor keparahan stenosis pada pasien PJK stabil, sedangkan faktor usia, jenis kelamin, diabetes, dan riwayat infark bukan merupakan prediktor keparahan stenosis pasien PJK stabil. Model skor prediktor tidak dikembangkan karena hanya 2 faktor prediktor yang bermakna.

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Background: In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical and echocardiographic parameters can predict severity of stenosis. Recently a new method in echocardiography called speckle tracking echocardiography can be used to asses myocardial strain, which is a good predictor of stenosis severity. Assessment of clinical parameters together with strain echocardiography parameter is expected to make better prediction. Objective: To determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain, can predict severity of coronary artery stenosis measured with Gensini score. To further develop a prediction model based on significant parameters. Methods: This is a cross-sectional study taken at Cipto Mangunkusumo Hospital during period March-May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi- square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. Results: The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; CI95%:1.08-7.23), history of myocardial infartion (OR 4.04; CI95%:1.51-10.80), typical angina (OR 5.01; CI95%:1.91-13.14), and GLS ≥-18.8 (OR 30.51; CI95%:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; CI95%:1.39-14.47) and GLS ≥18.8 (OR 17.30; CI95%:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions: Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors."

"ABSTRAKPenyakit jantung koroner (PJK) adalah penyebab kematian utama dengan prevalensi di Indonesia 7,2%. Penelitian observasional memperlihatkan asupan kalsium yang rendah berkorelasi dengan peningkatan beberapa faktor risiko dan kejadian PJK, namun di lain pihak, didapatkan hubungan suplemen kalsium dengan peningkatan morbiditas dan mortalitas akibat PJK. Penelitian ini bertujuan untuk mengetahui hubungan antara asupan kalsium dengan derajat stenosis berdasarkan skor Gensini. Metode penelitian adalah studi potong lintang pada 49 pasien PJK laki-laki berusia 19 sampai 65 tahun yang pertama kali angiografi koroner di Pelayanan Jantung Terpadu (PJT) RSCM pada Juli sampai dengan November 2014. Asupan kalsium berdasarkan kuesioner FFQ dan kalsium dan albumin serum diperiksa sesaat sebelum dilakukan tindakan. Derajat stenosis dinyatakan dengan skor Gensini. Pada penelitian didapatkan median asupan kalsium 301,6 (93–1404) mg/hari dan tidak berkorelasi (r=0,13, p=0,37) dengan kadar kalsium terkoreksi (rerata=8,8+0,4 mg/dL). Rerata skor Gensini didapatkan sebesar 95,18 + 57,78. Asupan kalsium tidak berkorelasi dengan skor Gensini (r=- 0,04, p=0,77). Penelitian ini menyimpulkan tidak terdapat korelasi yang bermakna antara asupan kalsium dengan derajat stenosis pada pasien PJK laki-laki dewasa, dengan kecenderungan korelasi negatif.

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ABSTRACTCoronary artery disease (CAD) is the leading cause of death, with its prevalence in Indonesia 7.2%. Observational evidence suggested that calcium intake was inversely associated with either some risks or event of CAD, but some others found association between calcium supplements with increasing trend in cardiovascular morbidity and mortality. This study proposed to investigate the association between calcium intake and severity of coronary artery disease (CAD) assessed by Gensini score. This cross sectional study enrolled 49 male patients from 19 to 65 years old who underwent their first angiography at Holistic Cardiac Care Centre Unit of Ciptomangunkusumo Hospital Indonesia from July to November 2014. Subjects were assessed using food frequency questionnaires to explore their historical intake of main food sources of calcium. Calcium and albumin level were performed immediately before angiography. Severity of CAD was assessed by Gensini Score. Association between calcium intake and Gensini Score were analyzed. From the study we found median calcium intake was 301,6 (93 – 1404) mg/day and did not have correlation (r=0,13, p=0,37) with corrected serum calcium (means=8,8+0,4 mg/dL). We found means of Gensini score was 95,18 + 57,78. We didn’t find any correlation between calcium intake with Gensini score (r=-0,04, p=0,77). We conclude that there was no correlation between calcium intake and severity of CAD, especially in male patients with CAD with negative tendency."

"Latar belakang. Kondisi iskemia pada penyakit jantung koroner (PJK) berkorelasi dengan disfungsi sistem saraf otonom. Revaskularisasi melalui percutaneous coronary intervention (PCI) dapat mengembalikan keseimbangan fungsi saraf otonom dan memperbaiki prognosis. Di sisi lain, perasaan cemas yang muncul menjelang prosedur PCI, dapat memicu hiperaktivitas simpatis. Tujuan penelitian ini adalah untuk mengetahui pengaruh ansietas terhadap perbaikan heart rate variability (HRV), sebuah teknik non-invasif untuk mengevaluasi aktivitas sistem saraf otonom; setelah tindakan PCI. Metode. Studi dengan desain potong lintang, korelasi pretest-posttest; melibatkan 44 subjek dengan PJK stabil yang menjalani PCI elektif di Pelayanan Jantung Terpadu, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Pengukuran HRV dilakukan sebelum PCI, kemudian diulang pasca tindakan PCI. Ansietas dinilai menggunakan kuesioner hospital anxiety depression score (HADS). Pengolahan data serta analisis statistik dilakukan dengan bantuan software SPSS 20.0. Hasil. Sebanyak 54,5% subjek mengalami ansietas saat akan menjalani PCI. Pada kelompok tanpa ansietas, ditemukan perbaikan signifikan pada parameter HRV sebelum-setelah PCI; yaitu SDNN [standard deviation of normal to normal intervals] (Median = 26,19 vs. Median = 39,60 ; Z = -3,621 ; p < 0,001) dan parameter RMSSD [root mean square of the successive differences] (Median = 21,90 vs. Median = 30,99; Z = -2,501; p = 0,012). Sementara itu, tidak didapatkan perbaikan bermakna parameter HRV sebelum-setelah PCI, pada kelompok ansietas. Terdapat perbedaan bermakna pada kenaikan nilai SDNN antara kelompok tanpa ansietas dibandingkan dengan kelompok ansietas ansietas (Median = 9,11 vs. Median = 2,83 ; U = 154,00 ; p = 0,043). Simpulan. Ansietas yang terjadi sebelum PCI elektif dapat menghambat perbaikan HRV pasca tindakan sehingga mempengaruhi prognosis penyakit. Diperlukan penelitian lanjutan mengenai peranan terapi ansietas menjelang PCI dihubungkan dengan luaran klinis serta prognosis pasca PCI.

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Background. Chronic ischemic condition in coronary artery disease (CAD) was associated with autonomic dysfunction. Percutaneous coronary intervention (PCI) could restore perfusion so that improving autonomic balance and disease prognosis. On the other hand, pre-PCI anxiety was known to produce sympathetic hyperactivity. The aim of this study was to determine whether pre-PCI anxiety may influence heart rate variability (HRV) improvement, a noninvasive technique for the evaluation of the autonomic nervous system activity; after successful PCI.

Methods. A cross sectional studies, pretest-posttest correlation; enclose 44 patients with stable CAD undergoing PCI in Integrated Heart Service, Cipto Mangunkusumo National Hospital. HRV measurement was done before and after PCI. Anxiety symptoms was collected using hospital anxiety depression score (HADS) questionnaires. Data input and statistical analysis was carried out using SPSS 20.0 for Windows.

Results. As many as 54.5% stable CAD patients undergoing elective PCI experienced anxiety symptoms. In the anxiety group, there were significant post-PCI improvement of SDNN [standard deviation of normal to normal intervals] (Median = 26.19 vs. Median = 39.60; Z = -3.621; p < 0.001) and RMSSD [root mean square of the successive differences] (Median = 21.90 vs. Median = 30.99; Z = -2.501; p = 0.012). Post-procedure HRV improvement was not significant in patients with anxiety symptoms. There was significant difference of the SDNN improvement between non-anxiety and anxiety patients (Median = 9.11 vs. Median = 2.83; U = 154.00; p = 0.043).

Conclusions. Pre-PCI anxiety may affect HRV improvement after revascularization thus influence disease prognosis. Further studies are needed to determine the impact of pre-PCI anxiety treatment on cardiac outcomes."

"Latar Belakang: Jaringan adiposa epikardial (JAE) sebagai jaringan adiposa visera penting peranannya dalam proses aterosklerosis di arteri koroner. Studi sebelumnya menunjukkan ketebalan adiposa epikardial lebih besar pada pasien dengan penyakit jantung koroner (PJK) Tujuan Mengetahui korelasi antara ketebalan adiposa epikardial dengan derajat stenosis arteri koroner pada pasien PJK stabil. Metode: Dilakukan studi potong lintang pada tujuh puluh pasien PJK stabil yang menjalani angiografi koroner. Derajat stenosis arteri koroner dinilai dengan skor Gensini > 40 (berat) dan ≤ 40 (ringan-sedang). Ketebalan adiposa epikardial dinilai dengan ekokardiografi transtorakal pada fase sistolik akhir tampilan parasternal long axis. Hasil: Nilai rerata ketebalan adiposa epikardial adalah 5,96 mm (SB 1,76) dan nilai median skor Gensini adalah 35,0 (kisaran 2-126). Analisis bivariat menunjukkan korelasi positif kuat yang bermakna (r = 0,768, p < 0,001). Nilai titik potong terbaik dari ketebalan adiposa epikardial yang memiliki nilai klinis berkaitan dengan derajat stenosis arteri koroner berdasarkan skor Gensini adalah 6,15 mm dengan sensitivitas 85,29%, spesifisitas 83,33%, nilai duga positif 82%, nilai duga negatif 85% dengan AUC sebesar 0,893 (IK 95% 0,814-0,971, p < 0,001). Simpulan: Ketebalan adiposa epikardial berkorelasi signifikan dengan derajat stenosis arteri koroner berdasarkan skor Gensini. Ketebalan adiposa epikardial 6,15 mm memiliki kemampuan yang cukup baik untuk membedakan pasien PJK stabil ringan-sedang dan berat berdasarkan skor gensini.

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Background: Epicardial adipose tissue (EAT) as part of visceral adipose tissue, has an integral role in the atherosclerotic cardiovascular disease. Previous studies have shown that EAT is thicker in those with coronary heart disease.

Objective: To determine the correlation of epicardial adipose thickness with the severity of coronary artery stenosis in stable coronary heart disease (CHD) patient.

Method: A cross-sectional study was conducted on seventy stable CHD patient undergoing coronary angiography. Severity of coronary artery stenosis was evaluated using Gensini scoring system : > 40 (severe) and ≤ 40 (mild-moderate). Epicardial adipose tissue was measured using transthoracic echocardiography at end-systole from parasternal longaxis view.

Results: Mean value of epicardial adipose thickness was 5,96 mm (SD 1,76) and median value of Gensini score was 35,0 (range 2-126). The correlation test showed a significant strong-positive correlation (r = 0,768, p < 0,001). The best cut-off point of epicardial adipose thickness which has a clinical value correlating to severity of coronary artery stenosis based on Gensini scoring system was 6,15 mm with the sensitivity 85,29 %, specificity 83,33%, positive predictive value 82 %, negative predictive value 85 % and AUC of 0,893 (CI 0,814-0,971, p < 0,001).

Conclusion: Epicardial fat thickness is significantly correlated to the severity of coronary artery stenosis based on Gensini scoring system. The thickness cutoff point of 6,15 mm has a good capability in discriminating mild-moderate dan severe stable CHD patient based on Gensini scoring system."

"Latar Belakang: Sebesar 90% penderita DM merupakan DMT2. Komplikasi makrovaskular pada DM merupakan komplikasi ke tiga terbanyak setelah retinopati dan neuropati. Kematian pada DMT2 tujuh puluh lima persen disebabkan oleh PJK. Hal yang mendasari kejadian PJK adalah aterosklerosis yang didahului oleh proses disfungsi endotel. Disfungsi endotel ditandai oleh adanya peningkatan endotelin-1 (ET-1) dan penurunan NO akibat peningkatan inhibitor eNOS, asymmetrical dimethylarginine (ADMA). Tujuan: Mengetahui perbedaan kadar ADMA dan ET-1 dengan keparahan Penyakit Jantung Koroner (PJK) stabil dengan dan tanpa DMT2. Metode: Penelitian potong lintang, analitik pada pasien PJK stabil dengan dan tanpa DMT2 yang akan menjalani angiografi koroner pertama kali. Dilakukan pemeriksaan ADMA, ET-1, HbA1c dan evaluasi lesi koroner dengan sistim skoring berdasarkan syntax score (SS). Analisis untuk melihat 2 perbedaan median dilakukan dengan uji Mann Whitney dan perbedaan median lebih dari 2 kelompok dengan uji Kruskal Wallis pada distribusi data yang tidak normal. Hasil: Dari 28 orang pasien PJK stabil dengan DMT2 dan 30 pasien PJK stabil tanpa DMT2 didapatkan proporsi usia hampir sama, wanita lebih banyak pada kelompok DMT2. Kadar ADMA dan ET-1 pada DMT2 lebih tinggi dibanding tanpa DM (p 0,6; 2,1 dan p 0,3). Kadar ADMA dan ET-1 pada DMT2 dan HbA1c ≥ 7% lebih rendah dari HbA1c < 7% ( p 0,7 dan p 0,8).Kadar ADMA pada DMT2 dan SS tinggi lebih rendah dibanding SS rendah(p 0,7), sedangkan kadar ET-1 pada DMT2 dan SS tinggi, lebih tinggi dibanding SS rendah (p 0,9). Kadar ADMA dan ET-1 pada DMT2 dengan SS rendah dan HbA1c ≥ 7% lebih rendah dibanding HbA1c < 7% ( p 0,5 dan p 0,5). Simpulan: Tidak terdapat perbedaan bermakna kadar ADMA dan ET-1 pada pasien PJK stabil dengan dan tanpa DMT2. Tidak terdapat perbedaan bermakna kadar ADMA dan ET-1 dengan kontrol glukosa darah pada kelompok syntax score rendah.

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Background: Ninety percent of diabetes patients have type 2 diabetes mellitus (T2DM). Macrovascular complication was the third highest complication in diabetes after retinopathy and neuropathy. Coronary artery disease (CAD) resulting from diabetes is responsible for 75% of diabetes-related death. Underlying mechanism of CAD is atherosclerosis initiated by endothelial dysfunction. The endothelial dysfunction is marked by endothelin-1 (ET-1) levels raise and NO decrement, as a result of eNOS inhibition by increased asymmetrical dimethylarginine (ADMA).

Objective: To determine the difference of asymmetrical dimethylarginine (ADMA) and endotelin-1 (ET-1) levels to evaluate the severity and complexity of coronary lesion in stable coronary artery disease (SCAD) with and without T2DM.

Methods: This is an analytical cross-sectional study. We obtained serum sample and measured ADMA, ET-1, HbA1c levels and evaluated coronary lesion by syntax score (SS). Analysis of the ADMA and ET-1 correlation was evaluated by blood glucose control and SS. Mann-Whitney U test was used to compare two independent mean, Kruskal-Wallis test was used for differences among the groups median if variables were not normally distributed.

Results: We enrolled 28 stable CAD patients with T2DM and 30 stable CAD patients without T2DM. Baseline coroner angiography results with age proportion were similar in both groups. Women were predominant in T2DM group. ADMA and ET-1 levels in T2DM were higher than in without T2DM (58,0 and 50,5 with p 0,6 ; 2,1 and 1,8 with p 0,3). ADMA dan ET-1 levels in T2DM with HbA1c ≥ 7% were lower than in T2DM with HbA1c < 7% (51,7 and 65,3 with p 0,7 ; 2,08 and 2,14 with p 0,8). ADMA level in T2DM with high SS was lower than ones with low SS (44,5 and 58,4 with p 0,7), ET-1 level in T2DM with high SS was higher than in T2DM with low SS (2,72 and 2,08 with p 0,9). ADMA and ET-1 levels in T2DM with low SS and HbA1c ≥ 7% were lower than HbA1c < 7% (47,8 and 72,0 with p 0,5 ; 2,06 and 2,14 with p 0,5).

Conclusions: ADMA and ET-1 levels in patient SCAD with and without T2DM are insignificantly related. There is no significant difference of ADMA and ET-1 levels with blood glucose control and low syntax score."

"Latar Belakang : PJK disebabkan adanya stenosis pembuluh koroner akibat adanya proses aterosklerosis. Aterosklerosis berhubungan dengan penebalan tunika intima media arteri karotis komunis. Penebalan tunika intima media terjadi akibat kondisi inflamasi sebagai konsekuensi peningkatan sekresi sitokin proinflamasi.Tujuan : Mengetahui gambaran ketebalan tunika intima media pada pasien PJK stabil dan korelasinya dengan derajat stenosis arteri koroner.Metode : Dilakukan studi potong lintang pada lima puluh enam pasien PJK stabil yang telah menjalani angiografi koroner. Derajat stenosis arteri koroner dinilai dengan skor Gensini > 40 berat dan le; 40 ringan-sedang . Ketebalan tunika intima media arteri karotis komunis dinilai menggunakan alat USG dan dinyatakan tidak normal jika rerata ketebalannya ge;1mm. Dilakukan analisa statistik untuk melihat korelasi antara tebal tunika intima arteri karotis komunis dengan skor Gensini arteri koroner.Hasil : Didapatkan rerata Tebal Tunika Intima-Media Arteri Karotis Komunis TTIM AKK gabungan sebesar 0,95 mm SB 0,18 . Nilai median skor gensini adalah 71 kisaran 0-256 . Uji spearman correlation menunjukan hasil korelasi bermakna antara derajat beratnya skor Gensini dan TTIM AKK dengan p.

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Background Coronary heart disease CHD is caused by stenosis of coronary artery as the effect of atherosclerosis. Atherosclerosis has a correlation with the thicken of intimal media of common carotid artery. The thicken of intimal media of common carotid artery happened because of inflammatory process which is a consequencies of increased proinflammatory cytokines.Objective To determine the correlation between Intimal media thickness IMT with the severity of coronary artery stenosis in patient with stable CHDMethod A cross sectional study was conducted on fifty six stable CHD patient undergoing coronary angiography. Severity of coronary artery stenosis was evaluated using Gensini scoring system 40 severe and le 40 mild moderate. IMT was measured using USG and determined as abnormal if the mean of IMT ge 1mm. Statistical analytic was perform to determine the correlation between CCA IMT with Gensini score of coronary artery.Results Mean value of combined IMT of common carotid artery IMT CCA was 0.95mm SD 0,18. The median value of Gensini score was 71 range 0 256. The Spearman correlation Test showed a significant correlation between Gensini score severity with IMT CCA p."

"Latar belakang: Hubungan antara HbA1c dengan kejadian mortalitas dan morbiditas pada pasien diabetes yang menjalani CABG telah dijelaskan dalam banyak penelitian sebelumnya. Namun, peran HbA1c pada populasi pasien non-diabetes dengan PJK yang menjalani BPAK belum pernah dilakukan, khususnya di Indonesia. Penelitian ini bertujuan untuk mengetahui apakah kadar HbA1c praoperasi memiliki hubungan dan dapat memprediksi keluaran awal pascaoperasi setelah BPAK pada pasien non-diabetes dengan penyakit arteri koroner. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien non-diabetes dengan penyakit jantung koroner yang menjalani BPAK sejak Januari 2022 hingga Desember 2023 di Pusat Jantung Nasional Harapan Kita. Kemudian, data kadar HbA1c praoperasi serta keluaran pascaoperasi yaitu mortalitas intrahospital dan morbiditas pascaoperasi seperti durasi penggunaan ventilator mekanik, lama rawat inap di ICU, lama rawat inap di rumah sakit, Major Adverse Cardiovascular Event (MACE), dan infeksi luka operasi diambil dari rekam medis pasien. Data variabel kontinu dinilai dengan menggunakan uji T atau uji Mann-Whitney U, sedangkan data nominal dinilai menggunakan uji Chi square atau Fischer. Analisis multivariat akan dilakukan lebih lanjut untuk hasil yang signifikan. Hasil: Sebanyak 391 subjek memenuhi kriteria dalam penelitian ini. Usia rata-rata subjek adalah 58,69 ± 8,29 tahun. Subjek dengan prediabetes (n = 268) memiliki perbedaan yang signifikan  secara statistik dalam median durasi ventilator dibandingkan dengan kelompok HbA1c normal (p = 0,009). Namun, tidak didapatkan hubungan yang signifikan antara HbA1c praoperasi dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Simpulan: Tidak terdapat hubungan antara HbA1c praoperasi pada pasien non-diabetes dengan PJK yang telah menjalani BPAK dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Pasien HbA1c normal praoperasi diasosiasikan signifikan secara statistik mempunyai durasi ventilasi mekanik yang lebih pendek dibandingkan pada pasien prediabetes dengan PJK yang telah menjalani BPAK.

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Background: The association between HbA1c with mortality and morbidity events in diabetic patients undergoing CABG have been explained in many previous studies. However, the predictive value of this in the non-diabetic patient population has not received sufficient attention, especially in Indonesia. This study investigated whether the pre-operative HbA1c level had an association and could predict early post-operative outcomes after CABG in non-diabetic patients with coronary artery disease. Methods: This retrospective cohort study involved non-diabetic patients with coronary artery disease who underwent CABG from January 2022 until December 2023 at National Cardiovascular Center Harapan Kita. Pre-operative HbA1c level and post-operative incidence of intrahospital mortality and morbidities such as mechanical ventilator duration, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections were collected. Continuous variable is assessed using T test or Mann- Whitney U test. Nominal data are assessed using Chi square or Fischer test. Multivariate analysis will be conducted further for significant results. Results: Three hundred-ninety-one subjects were involved in this study. The mean age of all subjects was 58.69 ± 8.29 years. Subjects with pre-diabetes (n = 268) have statistically significant difference in median ventilator duration compared to normal HbA1c group (p = 0.009). However, there was no significant association between pre-operative HbA1c and early post-operative intrahospital mortality, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections in this population. Conclusion: Pre-operative glycated hemoglobin level is not associated with early mortality, length of ICU stay, length of hospital stay and MACE. However, there is statistically significant lower mechanical ventilator duration in normal HbA1c compared to pre-diabetic patients with CAD who have undergone CABG."