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"Cardiac CT scanners are rapidly improving, each major vendor has introduced a state of the art scanner every 2–3 years. The basic applications, terminology and acquisition has not changed dramatically, however, improvements in hardware and software continue to reduce radiation exposure, scan times, artifacts and improve image quality. This chapter outlines the basic CT terminology, functions and background behind the current state of CT scan- ners for cardiac applications. It reviews spatial, temporal and contrast resolution limits of the CT scanners. An overview of common terms, radiation exposure and protocols are included. This acts as an introductory chapter to be expanded by subsequent chapters that will each go into more details on specific topics. Comparison to magnetic resonance for image quality and functionality, and dose comparisons to mammography, nuclear and fluoroscopy are included."

"Cardiovasculer Diseases (CVD) adalah penyakit jantung yang meliputi empat hal yaitu (1) coronary arterial diseases (CAD) atau penyakit jantung koroner (PJK); (2) cerebrovaskular diseases termasuk stroke dan ischemic transient attack (TIA); (3) penyakit arteri yaitu perifer arterial diseases (PAD) dan (4) aterosklerosis aorta. CVD menjadi salah satu pembunuh nomor satu di dunia, karena banyak faktor risiko yang mempengaruhi baik yang dapat dimodifikasi dan yang tidak bisa dimodifikasi sehingga sulit ditangani. Tujuan penelitian ini adalah menganalisis berbagai faktor yang berhubungan dengan kejadian CVD di PT. X. Untuk saat ini di PT. X faktor risiko yang bepotensi menyumbang kejadian CVD 10 tahun mendatang sudah mulai muncul berdasarkan data kesehatan pemeriksaan kesehatan rutin tahunan pekerja tahun 2021. Berdasarkan hasil pemeriksaan kesehatan tahunan 2021 terdapat peningkatan faktor risiko CVD meliputi angka obesitas 65,5%; kolesterol total tinggi 50,13%; diabetes mellitus 4,3 % dan hipertensi 5,79%. Studi ini merupakan studi cross sectional dengan pendekatan kuantitatif dengan menganalisis data primer dan sekunder untuk menggambarkan faktor risiko CVD termasuk prediksi 10 tahun mendatang bagi para responden menggunakan metode Framingham Risk Score (FRS), Skor Kardiovasar Jakarta (SKJ) dan WHO Chart serta menganalisis risiko CVD di PT X tahun 2022. Penelitian ini menemukan bahwa dengan metode Framingham Risk Score (FRS); Skor Kardiovaskuler Jakarta (SKJ) dan WHO Chart diperoleh persentase responden dengan risiko tinggi terjadinya CVD masing-masing adalah (10,2%); (18,7%) dan (1,7 %) dengan (n=235). Hasil penelitian juga menunjukan dari beberapa faktor risiko didapatkan bahwa (46,0%) responden berusia dibawah 40 tahun dan (77,0%) responden berjenis kelamin laki-laki., sedang untuk faktor risiko CVD merokok didapatkan (26,8%); BMI dengan obesitas (26%); HDL poor (34,5%); kolesterol total tinggi (37,9%); diabetes militus (10,6 %); tekanan darah tinggi (11,9%) dan mempunyai aktivitas rendah (93,2%). Faktor risiko dominan berupa merokok dari hasil analisis diperoleh pula nilai (OR=13,7), artinya seseorang yang merokok mempunyai peluang 13,7 kali berisiko lebih tinggi mengalami CVD dibandingkan dengan seseorang yang tidak merokok. Selain merokok adalah diabetes mellitus, dengan nilai (OR=7,6) artinya seseorang yang mengalami diabetes mempunyai peluang 7,6 kali berisiko lebih tinggi mengalami CVD dibandingkan dengan seseorang yang tidak diabetes mellitus. Juga HDL, dari hasil analisis diperoleh nilai (OR=7,7), artinya seseorang yang memiliki HDL rendah mempunyai peluang 7,7 kali berisiko lebih tinggi mengalami CVD dibandingkan dengan seseorang yang HDL tinggi. Secara garis besar masukan terhadap perusahaan adalah program pencegahan CVD agar dibuat continues dan serentak di berbagai Region atau Unit, serta meningkatkan pengetahuan dan kesadaran pekerja akan pentingnya menjaga kesehatan dan menerapkan reward dan konsekuensi secara lebih konsisten.

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Cardiovascular Diseases (CVD) is heart disease which includes four major diseases, namely (1) coronary arterial diseases (CAD) or coronary heart disease (CHD); (2) cerebrovascular diseases including stroke and ischemic transient attack (TIA); (3) arterial disease, namely peripheral arterial diseases (PAD) and (4) aortic atherosclerosis. CVD is one of the number one killer diseases in the world, because there are many modifiable and non-modifiable risk factors that affect it and making it difficult to treat. The purpose of this study was to analyse various factors related to be CVD at PT. X. Currently at PT. X risk factors that have the potential to contribute to be CVD in the next 10 years have started to appear based on the health data for the 2021 annual routine medical examination of workers. Based on the results of the 2021 annual health examination, there is an increase in CVD risk factors including an obesity rate of 65.5%; high total cholesterol 50.13%; diabetes mellitus 4.3% and hypertension 5.79%. This study is a cross-sectional study with a quantitative approach by analysing primary and secondary data to describe CVD risk factors including predictions for the next 10 years for respondents using the Framingham Risk Score (FRS) method, Jakarta Cardiovascular Score (SKJ) and WHO Chart as well as analysing CVD risk at PT X in 2022. This study found that using the Framingham Risk Score (FRS) method; The Jakarta Cardiovascular Score (SKJ) and the WHO Chart obtained the percentage of respondents with a high risk of developing CVD, respectively (10.2%); (18.7%) and (1.7%) with (n=235). The results of the study also showed that from several risk factors it was found that (46.0%) of respondents were under 40 years old and (77.0%) of respondents were male, while for CVD risk factors smoking was obtained (26.8%); BMI with obesity (26%); poor HDL (34.5%); high total cholesterol (37.9%); diabetes mellitus (10.6%); high blood pressure (11.9%) and have low activity (93.2%). The dominant risk factor in this study is smoking. From the results of the smoking analysis also obtained a value (OR = 13.7, meaning that someone who smokes has a 13.7 times higher risk of getting CVD compared to someone who does not smoke. Other dominant risk factor is diabetes mellitus, with a value (OR = 7.6) meaning that someone who has diabetes has a 7.6 times higher risk of getting CVD compared to someone who does not have diabetes mellitus. Also, HDL with the results of the analysis obtained a value (OR = 7.7), meaning that someone who has low HDL has a 7.7 times higher risk of getting CVD compared to someone with high HDL. Main input to the company is a CVD prevention program to be made continuously and simultaneously in various Regions or Units, as well as increasing employee knowledge and awareness of the importance of maintaining health and implementing rewards and consequences more consistently."

"Latar Belakang : Major Adverse Cardiac Events (MACE) adalah penyebab penting morbiditas dan mortalitas perioperatif pasien usia lanjut yang menjalani operasi non kardiak. Geriatric Sensitive Cardiac Risk Index diketahui memiliki akurasi yang baik dalam memprediksi kejadian henti jantung dan infark miokardium pada usia lanjut yang menjalani operasi non kardiak. Namun, belum pernah dilakukan uji performa index tersebut di Indonesia dengan perbedaan karakteristik usia dan komorbiditas yang berbeda.Tujuan: Mengetahui performa index GSCRI dalam memprediksi kejadian MACE (Major Adverse Cardiac Event) pada pasien usia lanjut yang menjalani operasi non kardiak dengan karakteristik usia lanjut pada populasi geriatri Indonesia.Metode : Studi retrospektif berbasis uji prognostik dengan data rekam medis pasien usia > 60 tahun yang menjalani operasi non kardiak di poliklinik perioperatif dan rawat Inap Gedung A yang menjalani operasi pada tahun 2021-2022 di RSCM dengan memasukkan data-data determinan sesuai kalkulator GSCRI dengan luaran berupa persentase kejadian dan dilihat luaran berupa henti jantung dan infark miokardium pasca operasi. Studi ini dianalisa dengan uji diskriminasi dengan Area Under the Curve (AUC).Hasil : Analisa dilakukan pada 225 subjek dengan median usia 65 tahun dengan proporsi MACE sebesar 3.1% (7 subjek) yang mengalami kejadian MACE pasca pembedahan non kardiak. Performa diskriminasi yang baik (AUC 0.888, IK95% 0.831-0.944).Kesimpulan : Index GSCRI memiliki performa diskriminasi baik dalam memprediksi kejadian MACE pasien usia lanjut yang menjalani pembedahan non kardiak.

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Background : Major Adverse Cardiac Events (MACEs) is an important cause of perioperative morbidity and mortality in elderly patients undergoing non-cardiac surgery. The Geriatric Sensitive Cardiac Risk Index is known to have good accuracy in predicting cardiac arrest and myocardial infarction in the elderly undergoing non-cardiac surgery. However, this performance index has never been tested in Indonesia with different age characteristics and different comorbidities.

Objective: We aimed to determine the performance of the GSCRI index predicting the incidence of MACE (Major Adverse Cardiac Event) in elderly patients undergoing non-cardiac surgery with elderly characteristics in the Indonesian geriatric population.

Methods : Retrospective study based on prognostic test with medical record data of patients aged > 60 years who underwent non-cardiac surgery at the perioperative outpatient and inpatient who underwent surgery in 2021-2022 at RSCM by entering determinant data according to the GSCRI calculator with outcomes form of cardiac arrest and myocardial infarction postoperative. This study was analyzed by discrimination test with Area Under the Curve (AUC).

Results : The analysis was carried out on 225 subjects with an median age of 65 years with a proportion of MACE of 3.1% (7 subjects) who experienced MACE events after non-cardiac surgery. GSCRI had good discrimination performance (AUC 0.888, CI95% 0.831-0.944).

Conclusion: GSCRI index has good discriminatory performance in predicting the incidence of MACE in elderly patients undergoing non-cardiac surgery."

"Penyakit kardiovaskular merupakan salah satu masalah kesehatan utama di negara maju maupun berkembang. Tahun 2008 sebanyak 17,3 juta kematian disebabkan penyakit kardiovaskular. Lebih dari 3 juta kematian tersebut terjadi sebelum usia 60 tahun. Di PT Harmoni Panca Utama, dalam medical check up tahun 2016 menunjukkan tingkat overweight sebesar 38,75, obesitas 7,50, hipertensi stadium 1 3,75, kolesterol 32,50, gula darah puasa terganggu 10, diabetes 7,5, kelainan pada pemeriksaan elektrokardiogram EKG 2,86 yang termasuk dalam faktor risiko penyakit kardiovaskular. Tujuan dari penelitian ini menjelaskan faktor risiko penyakit kardiovaskular pada karyawan head office di PT Harmoni Panca Utama tahun 2017. Desain penelitian yang digunakan adalah deskriptif dengan pendekatan kuantitatif dan kualitatif. Pendekatan kuantitatif untuk mendapatkan tingkat risiko dan distribusi penyakit kardiovaskular dari medical check up tahun 2016 menggunakan Skor Kardiovaskular Jakarta dan Framingham Risk Score. Pendekatan kualitatif untuk mengetahui kesadaran dan pengetahuan mengenai penyakit kardiovaskular, pola hidup sehat untuk mengurangi penyakit tersebut, dan upaya preventif perusahaan melalui wawancara mendalam. Hasil penelitian menunjukkan tingkat risiko penyakit kardiovaskular menggunakan Skor Kardiovaskular Jakarta adalah 49 orang risiko rendah, 21 orang risiko sedang, dan 10 orang risiko tinggi serta dengan menggunakan Framingham risk score adalah 26 orang kategori low risk dan 8 orang kategori intermediate risk. Sebagian besar karyawan mengetahui apa itu penyakit kardiovaskular, tetapi sebagian kecil karyawan tidak mencegah faktor risiko yang dapat menyebabkan penyakit kardiovaskular tersebut. Sebagian besar karyawan sudah mengetahui bagaimana pola hidup sehat, tetapi sebagian kecil karyawan masih mengabaikan pola hidup sehat. Upaya perusahaan yang telah dilakukan diantaranya program Medical Check Up, weekly sharing, BMI challenge, dan pemberian makan pada saat makan siang.

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Cardiovascular disease is one of the major health problems in both developed and developing countries. In 2008 as many as 17,3 million deaths caused by cardiovascular disease. More than 3 million of these deaths occured before the age of 60 years. At PT Harmoni Panca Utama, medical check up result in 2016 showed overweight rate of 38,75, obesity 7,50, hypertension stage 1 3,75, cholesterol 32,50, fasting blood glucose disorders 10, diabetes 7,5, abnormalities in electrocardiogram examination ECG 2,86 and those are included in risk factors for cardiovascular disease. The purpose of this study is to explain the risk factors of cardiovascular disease of head office rsquo s employees at PT Harmoni Panca Utama in 2017.

This research uses descriptive with quantitative and qualitative approach for the reseaech design. Quantitative approach is used to obtain the level of risk and distribution of cardiovascular disease from medical check up in 2016 using Jakarta Cardiovascular Score and Framingham Risk Score. Qualitative approach is used to find out about the awareness and knowledge of cardiovascular disease, the healthy life style that prevent the disease, and also corporate preventive efforts through in depth interview.

The results showed that the risk of cardiovascular disease using the Jakarta Cardiovascular Scores are 49 low risk people, 21 moderate risk and 10 high risk people, and by using the Framingham Risk Score are 26 low risk and 8 intermediate risk categories. Most of the employees are well educated about cardiovascular disease,but only a few of them don rsquo t prevent the risk factors which caused cardiovascular diseases. Most of them have already known how healthy life style are, but some of them avoid it. The company has Medical Check Up program, weekly sharing, BMI challenge, and free lunch."

"Intracoronary thrombosis plays an important role in the pathogenesis of acute coronary syndrome. It occurs due to a rupture of an atherosclerotic plaque, which may be spontaneous, as in the case of acute coronary syndrome, or due to procedures such as percutaneous intervention (PCI). Atherosclerotic plaque rupture causes exposure of thrombogenic subendothelial components and initiates platelet aggregation, which then initiates the coagulation cascade. In stable angina, the formation of platelet thrombus is the most important tiling to occur on plaque progressiveness as a result of rupture and episodic formation of thrombi.' Arterial thrombi contain many platelets. Anti-platelet agents are greatly beneficial in acute and chronic coronary heart disease. This paper discusses the use of anti-platelet agents in coronary heart disease."

"Kuantifikasi standar lemak jantung menggunakan citra nonkontras dapat menjadi suatu nilai prognostik tambahan dalam mengevaluasi penyakit jantung koroner. Metode otomatis berbasis deep learning memiliki kelebihan dari metode manual yaitu mengurangi waktu kuantifikasi, beban kerja dan user dependence. Pada penelitian ini, lemak jantung epikardial dan mediastinal dari dataset open source dan dari Rumah Sakit Mayapada Tangerang disegmentasi menggunakan segmentasi semantik berbasis CNN DeepV3+ Resnet18 dan dievaluasi. Volume dari lemak jantung diestimasikan menggunakan fitur regionprops Matlab 2021a. Sistem dapat segmentasi lemak jantung pada keakurasian tertinggi sebesar 98,8 % dan dice score sebesar 0,76 untuk lemak epikardial dan keakurasian 96,8% dan dice score sebesar 0,69 untuk lemak mediastinal dataset open source. Namun, pada data uji yaitu data CT jantung yang diambil dari rumah sakit menghasilan keakurasian tertinggi pada 28% untuk lemak epikardial. Secara kualitatif, struktur seperti lemak abdomen, otot jantung dan tulang belakang masih ikut tersegmen. Setelah melakukan penyesuaian citra antara data uji dengan data pelatihan, akurasi tertinggi pada lemak epikardial sebesar 97%. Namun, lemak epikardial dan mediastinal belum berhasil untuk dipisahkan. Volume lemak jantung untuk kedua dataset berhasil diestimasikan. Metode volume manual dengan metode otomatis menunjukkan korelasi yang kuat (R2= 0,9843) dengan standard error sebesar 3,86 namun terlihat bahwa terjadi eror sistematik.

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Standard quantification of cardiac fat using non-contrast images can be additional prognostic value in evaluating coronary heart disease. Automatic methods based on deep learning have advantages over manual methods, namely reducing quantification time, workload and user dependence. In this study, epicardial and mediastinal cardiac fat from open source dataset and Mayapada Hospital Tangerang were segmented using CNN DeepV3+ Resnet18-based semantic segmentation and evaluated. The volume of cardiac fat was estimated using the regionprops feature of Matlab 2021a. The system can segment cardiac fat at the highest accuracy of 98.8% and a dice score of 0.76 for epicardial fat and 96.8% accuracy and a dice score of 0.69 for mediastinal fat of the open source dataset. However, the test dataset, namely cardiac CT data taken from the hospital, yielded the highest accuracy at 28% for epicardial fat. Qualitatively, structures such as abdominal fat, cardiac muscle and spine are still segmented. After adjusting the image between the test data and the training data, the highest accuracy in epicardial fat was 97%. However, epicardial and mediastinal fat have not been successfully separated. Heart fat volumes for both datasets were successfully estimated. The manual volume method in respect to the automatic method showed a strong correlation (R2= 0.9843) with a standard error of 3.86, but it was seen that there was a systematic error."

"Latar belakang: Gagal jantung kronik merupakan penyakit progresif lambat dengan morbiditas serta mortalitas yang tinggi. Penggunaan obat-obatan seringkali tidak berhasil, sehingga Enhanced External Counterpulsation (EECP) yang bersifat non-invasif dapat menjadi alternatif terapi dalam penanganan gagal jantung. Metode: Penelitian ini menggunakan desain uji klinik terkontrol secara randomisasi terbuka terhadap kelompok yang menjalani terapi EECP dan yang tidak menjalani terapi (non-EECP). Masing-masing kelompok terdiri dari 33 pasien. Pada semua pasien dilakukan pemeriksaan mieloperoksidase (MPO) sebagai penanda inflamasi pada awal dan setelah 6 bulan pengamatan untuk dinilai kelompok mana yang lebih banyak mengalami kejadian kardiovaskular. Hasil: Pengukuran kadar MPO awal (743,4 ± 232,9 pM) dan setelah 6 bulan pengamatan (534,8 ± 191,3 pM) pada kelompok EECP mengalami penurunan bermakna secara statistik (p < 0,001) tetapi pada kelompok non-EECP (679,4 ± 332,3 pM menjadi 517,6 ± 189,7 pM) secara statistik tidak bermakna (p = 0,110). Penurunan kadar MPO sangat bermakna secara statistik pada semua pasien kelompok EECP dibandingkan kelompok non-EECP (13 pasien). Hasil perhitungan risiko relatif (RR) menyatakan bahwa risiko penurunan MPO pada kelompok EECP 2,08 kali lebih baik daripada kelompok non-EECP. Pengamatan kejadian kardiovaskular setelah 6 bulan penelitian menunjukkan perbedaan bermakna antara kedua kelompok (p = 0,037). Kejadian kardiovaskular kelompok non-EECP ditemukan 15 pasien (45,5 %) sedangkan pada kelompok EECP hanya ditemukan 7 pasien (21,2 %). Kesimpulan: Terapi EECP menurunkan kadar MPO pasien GJK dan dapat menurunkan kejadian kardiovaskular dalam 6 bulan pengamatan. Makin tinggi kadar MPO berkorelasi dengan makin tingginya insiden kejadian kardiovaskular.

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Background: Chronic heart failure (CHF) is a slowly progressive disease with high morbidity and mortality; the management using pharmacological treatments frequently fail. Therefore, Enhanced External Counterpulsation (EECP), a non-invasive treatment, may serve as alternative treatment for heart failure.

Methods: Our study was an open randomized controlled clinical trial. All subjects were categorized into two groups, i.e. the group who had EECP therapy and those who did not have EECP (non-EECP group). Each group consisted of 33 patients. Myeloperoxidase (MPO) as inflammatory marker was examined in all subjects at baseline and after 6 months of observation to assess which group had more cardiovascular events.

Results: Baseline MPO measurement (743.4 ± 232.9 pM) and after 6 months (534.8 ± 191.3 pM) in 32 patients in EECP group showed statistically significant reduction (p < 0.001); however in the non-EECP group, mean reduction value of MPO from 679.4 ± 332.3 pM to 517.6 ± 189.7 pM was not statistically significant (p = 0.110). MPO level reduction was statistically significant in all subjects of EECP group compared to non-EECP group (13 patients). Measured relative risk (RR) demonstrated that there was 2.08 fold risk of reduced MPO in EECP group compared to non-EECP group. Cardiovascular events observed after 6 months study showed that there was a significant difference between groups (p = 0.037).

Conclusion: EECP therapy can reduce MPO level in CHF patients. It may lower cardiovascular events in 6 months observation. Higher MPO level are associated with higher incidence of cardiovascular events."