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"Saat ini penyakit jantung koroner merupakan salah satu penyebab kematian utama di dunia, termasuk di Indonesia. Penyakit jantung koroner adalah salah satu penyakit kardiovaskuler, yaitu masalah gangguan pada jantung dan pembuluh darah. Dampaknya peredaran darah menuju jantung menjadi tidak lancar dan hal ini mengakibatkan penurunan pasokan oksigen ke jantung. Seseorang dapat menderita penyakit jantung koroner karena beberapa faktor risiko antara lain merokok, diabetes dan hipertensi. Oleh karena itu, diperlukan prediksi akurat untuk menentukan apakah seseorang termasuk kategori menderita penyakit jantung koroner berdasarkan faktor – faktor risikonya. Dalam bidang asuransi jika prediksinya cukup akurat maka perusahaan asuransi dapat menyiapkan jenis polis yang tepat untuk calon pemilik polis, terutama bagi calon pemilik polis yang memiliki faktor risiko. Model Bayesian Neural Networks digunakan untuk memprediksi penyakit jantung koroner berdasarkan medical record yang terdiri atas faktor – faktor risiko. Tahap pertama adalah pemilihan model, yaitu membangun model neural networks yang optimal dengan inferensi Bayesian (Bayesian inference) dan metode aproksimasi inferensi variasi (variational inference). Tahap selanjutnya adalah evaluasi model dengan mengukur akurasi hasil prediksi menggunakan matriks confusion, tingkat akurasi (success rate), tingkat precision dan tingkat recall. Model yang diperoleh kemudian dapat digunakan untuk memprediksi penyakit jantung koroner.

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Coronary heart disease is one of the leading causes of death in the world currently, including in Indonesia. By the definition, coronary heart disease is a cardiovascular disease which is a problem of disorders of the heart and blood vessels. The impact is the flow of blood circulation to the heart is faltered. As the result, the supply of oxygen to the heart decreases. Someone can suffer from coronary heart disease due to several risk factors including smoking, diabetes and hypertension. Therefore, an accurate predictions is required to determine whether people are categorized as suffering from coronary heart disease according to their risk factors. In the insurance field if the predictions are accurate enough, the insurance company can prepare the right type of policy for prospective policyholders, particularly for those prospective policyholders who have those risk factors. The Bayesian Neural Networks model is used to predict coronary heart disease according to a medical record that consisting of risk factors. The first stage is model selection, which is building an optimal neural network model with Bayesian inference and the variational inference approximation method. Furthermore, the next stage is model evaluation by measuring the accuracy of the predicted results with the confusion matrix, the accuracy rate (success rate), the level of precision and the level of recall. Then the trained neural network model will be used to predict new data observation."

"Latar belakang: Mesin cardiopulmonary bypass (CPB) yang digunakan untuk operasi conventional coronary artery bypass graft (CCABG) meningkatkan risiko terjadinya gangguan fungsi ginjal pascaoperasi. Teknik operasi off-pump coronary artery bypass (OPCAB) tidak menggunakan mesin CPB, sehingga diharapkan dapat menurunkan kejadian acute kidney injury (AKI) pascaoperasi. Gangguan fungsi ginjal pascaoperasi dapat berkomplikasi menjadi penyakit ginjal kronik dan bahkan meningkatkan mortalitas.Tujuan: Membandingkan gangguan fungsi ginjal pascaoperasi OPCAB dan CCABG dengan menilai peningkatan kreatinin serum, derajat AKI, dan kebutuhan hemodialisis pascaoperasi.Metode: Penelitian ini menggunakan metode penelitian kohort retrospektif yang dilakukan dengan menganalisis data rekam medis pasien di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita tahun 2019 – 2021. Data kreatinin serum pascaoperasi diambil pada waktu 24 jam dan 48 jam pascaoperasi, kemudian hasilnya dibandingkan di antara kedua kelompok. Derajat AKI pascaoperasi dan kebutuhan hemodialisis pascaoperasi yang terjadi di antara kedua kelompok juga dibandingkan.Hasil: . Kelompok pasien OPCAB (n = 277) dan CCABG (n = 770) memiliki data demografis yang tidak berbeda bermakna. Kelompok OPCAB memiliki nilai median kreatinin serum pascaoperasi yang lebih rendah pada waktu 24 jam (1,04 mg/dL vs 1,20 mg/dL; p <0,05) dan 48 jam pascaoperasi (1,12 mg/dL vs 1,21 mg/dL; p<0,05). Kejadian AKI pascaoperasi pada semua stadium dan kebutuhan hemodialisis pascaoperasi juga lebih rendah secara bermakna pada kelompok OPCAB.Kesimpulan: Teknik operasi OPCAB menghasilkan kreatinin serum dan derajat AKI lebih rendah serta kebutuhan hemodialisis pascaoperasi yang lebih sedikit dibandingkan dengan CCABG.

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Background: Cardiopulmonary bypass (CPB) machine, that is used in conventional coronary artery bypass graft (CCABG), increases the risk of postoperative renal dysfunction. Off-pump coronary artery bypass technique does not utilize the CPB machine, therefore is expected to decrease postoperative acute kidney injury (AKI) incidents. Postoperative renal dysfunction can complicate into chronic kidney disease and even increases mortality risk.

Purpose: To compare the postoperative renal dysfunction after OPCAB and CCABG by evaluating the increase of creatinine serum, AKI, and postoperative hemodialysis.

Methods: For this retrospective cohort study, we analyzed the data from patient’s medical record in National Cardiovascular Center Harapan Kita from 2019 to 2021. The patients in OPCAB group (n=277) and CCABG group (n=770) had similar demographic characteristics. Postoperative creatinine serum was measured at 24 hours and 48 hours postoperative, then the results were compared between the two groups. Postoperative AKI and hemodialysis were also compared.

Results: The OPCAB group had lower median value of postoperative creatinine serum at 24 hours (1.04 mg/dL vs 1.20 mg/dL; p <0.05) and 48 hours postoperation. (1.12 mg/dL vs 1.21 mg/dL; p<0.05). All stages of postoperative AKI and hemodialysis were also lower significantly in the OPCAB group.

Conclusion: OPCAB technique resulted in lower postoperative creatinine serum, AKI rates, and less hemodialysis neeeds compared with CCABG technique ."

"Coronary artery bypass grafting (CABG) pada pasien Ejection Fraction (EF) <30% dikaitkan dengan risiko perioperatif yang tinggi. Oleh karena itu, penting untuk melakukan identifikasi pasien yang akan mendapat manfaat dari revaskularisasi. Single photon emission computed tomography (SPECT) digunakan untuk menilai viabilitas miokadium dan ischemic burden. Manfaat CABG pada pasien penyakit jantung koroner (PJK) EF <30% and ischemic burden <10% masih dalam perdebatan karena tingginya mortalitas dan morbiditas pascaoperasi. Teknik off-pump coronary artery bypass graft (OPCAB) diharapkan dapat mengurangi komplikasi pascaoperasi terkait penggunaan mesin cardiopulmonary bypass (CPB) dan dengan meminimalkan manipulasi aorta. Tujuan penelitian ini adalah untuk menganalisa mortalitas dan morbiditas pasien PJK dengan EF <30% and ischemic burden <10% yang menjalani OPCAB dibanding conventional CABG (CCABG). Dalam penelitian retrospektif ini, terdapat 109 pasien yang menjalani elektif CABG antara bulan Januari 2015 sampai November 2018 di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Indonesia. Terbagi dalam dua kelompok, 35 pasien kelompok OPCAB dan 74 pasien kelompok CCABG. Data demografi tidak terdapat perbedaan bermakna pada kedua kelompok. Aritmia yang terjadi pada kelompok OPCAB sebanyak 25,7% berbeda bermakna secara statistik lebih rendah dibandingkan kelompok CCABG sebanyak 51,4% (RR 3,55; IK 95% 1,40-8,91; p = 0,012). Hasil lain yang juga berbeda bermakna secara statistik adalah gagal ginjal akut 8,6% pada kelompok OPCAB dibandingkan 27% pada kelompok CCABG (RR 3,96; 95% CI 1,09-14,35; p = 0,027). Stroke pasca prosedur OPCAB sebesar 2,9% dibandingkan 17,6% pada kelompok CCABG (RR 7,25; IK 95% 1,91-57,81; p = 0,032). Sepsis pasca prosedur OPCAB 5,7% juga berbeda bermakna secara statistik lebih rendah dibandingkan CCABG 21,6% (RR 0,037; 95% CI 0,67-15,12; p = 0,037). Mortalitas pasca prosedur OPCAB lebih rendah dibandingkan CCABG namun tidak bermakna secara statistik, 5,7% dibandingkan 16,2% (RR 3,20; 95% CI 0,67-15,12; p = 0,126). Tidak terdapat perbedaan yang bermakna secara statistik pada low cardiac output syndrome (LCOS) dan operasi ulang pada kedua kelompok. Kami merekomendasikan OPCAB pada pasien PJK EF <30% and ischemic burden <10%.

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Coronary artery bypass grafting (CABG) in patients with Ejection Fraction (EF) <30% is associated with high perioperative risk. Therefore, it is very important to identify patients who would benefit from revascularization. Single photon emission computed tomography (SPECT) is commonly performed to assess myocardial viability and ischemic burden. A benefit of CABG for coronary artery disease (CAD) patients with EF <30% and ischemic burden <10% is still on debate because of the high postoperative mortality and morbidity. The technique of offpump coronary artery bypass (OPCAB) might reduce postoperative complications related to cardiopulmonary bypass (CPB) machine and by minimizing aortic manipulation. The objective of this study is to analyze in hospital mortality and morbidity in patients with EF <30% and ischemic burden <10% undergoing OPCAB compared to conventional CABG (CCABG). In this retrospective study, we included 109 consecutive patients undergoing elective CABG between January 2015 and November 2018 at the National Cardiovascular Centre Harapan Kita, Indonesia. The patients were divided in two groups, 35 patients undergoing OPCAB and 74 patients undergoing CCABG. Demographically, there are no significant differences in preoperative and intraoperative data in comparisons between two groups. Arrhythmia in OPCAB group is statistically lower compared to CCABG group, 25.7% vs 51.4% (RR 3.55; IK 95% 1.40-8.91; p = 0.012). Acute kidney injury is 8.6% vs 27% in OPCAB group and CCABG group, respectively (RR 3.96; IK 95% 1.09-14.35; p = 0.027). Stroke is 2,9% vs 17,6% in OPCAB group and CCABG group, respectively (RR 7,25; IK 95% 1,91-57,81; p = 0,032). OPCAB surgery also shows a statistically significant reduction in perioperative sepsis (5.7% vs 21.6%, RR 0.037; IK 95% 0.67-15.12; p = 0.037). There is no statistically significant difference between OPCAB and CCABG in mortality, 57% vs 16.2% (RR 3.20; IK 95% 0.67-15.12; p = 0.126). There are also no statistically significant differences in perioperative low cardiac output syndrome, re-operation data in both groups. We recommend the OPCAB technique in patients EF <30% and <10% ischemic burden."

"Latar Belakang: Pasien dengan fraksi ejeksi (FE) rendah memiliki risiko apabila dilakukan BPAK dengan mesin PJP. Pengunaan mesin PJP memiliki risiko cedera miokard yang diakibatkan dari periode iskemia, reperfusi, dan inflamasi yang dapat mengakibatkan aritmia pascaoperasi. Aritmia pascaoperasi BPAK terjadi pada 5-40% dan meningkatkan mortalitas serta morbiditas. Glutamin merupakan asam amino yang memiliki efek anti inflamasi dengan menurunkan mediator inflamasi dan kerusakan oksidatif akibat radikal bebas sehingga menurunkan efek cedera miokard dan dihipotesiskan menurunkan kejadian aritmia pascaoperasi BPAK. Metodologi: Penelitian ini kohort retrospektif pada pasien penyakit jantung koroner dengan FE rendah yang menjalani BPAK menggunakan mesin PJP. Subjek dibagi menjadi kelompok yang mendapat dan tidak mendapat glutamin intravena praoperasi. Luaran yang dinilai adalah kejadian aritmia pascaoperasi secara keseluruhan, arimita ventrikel dan supraventrikel pascaoperasi BPAK. Hasil: Kejadian aritmia pascaoperasi lebh rendah secara bermakna pada kelompok yang mendapatkan glutamin intravena praoperasi, yaitu 16,7%dibandingkan 40% (p=0,045). Kejadian aritmia atrium pascaoperasi juga lebih rendah secara bermakna pada kelompok yang mendapat glutamin intravena praoperasi, yaitu 26,7% dibandingkan 73,3% (p=0,026), namun pada kejadian aritmia ventrikel pascaoperasi tidak ada perbedaan bermakna (p=0,74). Kesimpulan: Pada pasien dengan fraksi ejeksi rendah yang menjalani BPAK menggunakan mesin PJP, pemberian glutamin intravena praoperasi dapat menurunkan angka kejadian aritmia pascaoperasi.

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Background: Low ejection fraction (EF) increases the risk of morbidity and mortality in patients undergoing CABG. CABG with CPB induces myocardial injury caused from ischemia, reperfusion and inflammation, causing postoperative arrhythmias. Arrhyhtmias occur in 5-40% patients after CABG and increase postoperative mortality and morbidity. Glutamine is an amino acid that has antiinflammatory effect, decerasing inflammatory mediators and oxidative stress from free radicals. In turn, glutamin lower the effect of myocardial injury and hypothesized to lower postoperative arrhythmias after CABG.

Methods: This is a cohort retrospective study in patients with coronary artery disease with low EF undergoing CABG with CPB. The subjects were divided into two groups based on given or not given intravenous glutamin preoperative.The outcomes of the study is incidence of arrhythmias after CABG and the incidence of ventricular and supraventricular arrhythmias after CABG.

Results: The subjects in the intravenous glutamin group have lower incidence of postoperative arrhythmias compared to control (16.7% vs 40% respectively, p=0.045). Supraventricular arrhythmia incidence in intravenous glutamin group is also lower compard to control (26.7% vs 73.3% respectively, p=0,026). There are no significant differences of postoperative ventricular arrhythmias between two groups (p=0.74).

Conclussion: In patients with low EF undergoing CABG with CPB, intravenous glutamin administration can lower the incidence of postoperative arrhythmias."

"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. Fibrilasi atrium (FA) awitan dini pascabedah pintas arteri koroner (BPAK) merupakan salah satu komplikasi pascaoperasi yang sering terjadi. Aritmia ini merupakan fenomena sementara dan mayoritas pasien akan mengalami konversi ke irama sinus saat dipulangkan. Meskipun bersifat sementara, FA awitan baru pasca-BPAK berpotensi mengalami rekurensi sehingga dapat meningkatkan risiko mortalitas jangka panjang.Tujuan. Mengetahui peran FA awitan baru pasca-BPAK dalam mempengaruhi kesintasan tiga tahun.Metode. Studi dengan desain kohort retrospektif menggunakan analisis kesintasan yang meneliti 196 pasien yang menjalani BPAK di Rumah Sakit Cipto Mangunkusumo dalam rentang waktu Januari 2012 sampai Desember 2015. Eksklusi dilakukan pada pasien yang memiliki riwayat FA sebelum operasi, menjalani operasi tanpa mesin pintas jantung-paru, dan yang meninggal dalam 30 hari pascaoperasi. Subyek penelitian dibagi menjadi 2 kelompok berdasarkan ada tidaknya FA awitan baru pasca-BPAK, yang selanjutnya ditelusuri status kematiannya dalam tiga tahun sejak operasi. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia ≥60 tahun, penyakit paru obstruktif kronis, diabetes melitus, gangguan ginjal, dan fraksi ejeksi ventrikel kiri yang rendah) untuk mendapatkan nilai adjusted hazard ratio (HR).Hasil. Sebanyak 29,59% pasien mengalami FA awitan baru pasca-BPAK. Angka mortalitas tiga tahun pasien yang mengalami FA awitan baru pasca-BPAK baru lebih tinggi dibandingkan kelompok yang tidak mengalaminya (15,52% vs 3,62%). Fibrilasi atrium awitan baru pasca-BPAK secara signifikan menurunkan kesintasan tiga tahun (p=0,008; HR. Pada analisis multivariat, FA awitan dini pascaBPAK merupakan faktor independen terhadap penurunan kesintasan tiga tahun (adjusted HR 4,04; IK 95% 1,34-12,14).Simpulan. Fibrilasi atrium awitan baru pasca-BPAK secara independen menurunkan kesintasan tiga tahun.

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Background. New-onset atrial fibrillation after coronary artery bypass grafting (CABG) is a common postoperative complication. This arrhytmia considered as temporary phenomenon which the majority are converted back to sinus rhythm when the patients discharged from the hospital. Despite its transience, those arrhythmia can recur and increasing the long term mortality.

Objective. To determine the role of new-onset atrial fibrillation after CABG on three year survival.

Method. This is a retrospective cohort study using survival analysis of patients who underwent coronary artery bypass grafting since January 2012 to December 2015 at Cipto Mangunkusumo Hospital. Patients who had atrial fibrillation before surgery, who had surgery without cardiopulmonary bypass machine, and who died in 30 days after surgery were excluded. Subjects were divided into two category based of the presence of newonset atrial fibrillation after CABG and the mortality status was followed up until 3 years post-surgery. The Kaplan-Meier curve was used to determine the three-year survival of the patients who had new-onset atrial fibrillation after CABG and Cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Result. New-onset atrial fibrillation after CABG occurred in 29,59% patients. Patients with new-onset atrial fibrillation after CABG had higher three-year mortality (15,52% vs 3,62%). New-onset atrial fibrillation after CABG significantly decreased three-year survival (p=0,008; HR 4,42; 95% CI; 1,49-13,2). In multivariate analysis, it was concluded that new-onset atrial fibrillation after CABG was an independent factor of the three-year survival decline (adjusted HR 4,04; 95% CI; 1,34-12,14).

Conclusion. New-onset atrial fibrillation after CABG independently decreased the threeyear survival."

"Latar Belakang: Penyakit arteri koroner dapat di tata laksana dengan bedah pintas arteri koroner (BPAK) menggunakan mesin pintas jantung paru (PJP) dan fraksi ejeksi (FE) yang rendah berhubungan dengan peningkatan mortalitas jangka pendek dan jangka panjang. Kejadian AKI pascaoperasi BPAK dengan mesin PJP merupakan kejadian yang cukup sering dengan prevalensi bervariasi antara 7,6-48,5%. Patogenesis acute kidney injury(AKI) pascaoperasi jantung bersifat kompleks dan multifaktorial, dengan beberapa mekanismenya melibatkan proses inflamasi, iskemia-cedera reperfusi, dan stres oksidatif. Hingga saat ini belum ada pedoman strategi proteksi ginjal pada operasi BPAK. Glutamin, sebuah asam amino esensial-kondisional memiliki efek anti inflamasi dan anti oksidena melalui induksi heat shock protein (HSP) dan produksi antioksidan glutathione (GSH). Sehingga, dihipotesiskan pemberian glutamin dapat menurunkan kejadian AKI menurunkan gangguan fungsi ginjal pascaoperasi BPAK.Metodologi: Penelitian ini merupakan penelitian kohort retrospektif pada pasien yang menjalani operasi BPAK menggunakan mesin PJP dengan FE rendah. Subjek dibagi menjadi kelompok yang mendapat glutamin intravena praoperasi dan kelompok yang tidak mendapat glutamin. Kejadian AKI 24 jam pascaoperasi, kadar kreatinin serum 24 jam pascaoperasi dan estimated glomerular filtration rate(eGFR) 24 jam pascaoperasi merupakan luaran yang dinilai pada penelitian ini.Hasil: Dari hasil penelitian didapatkan kejadian AKI 24 jam pascoperasi pada kelompok glutamin sebesar 3,3% dan kelompok kontrol 10%. Namun, tidak didapatkan hubungan bermakan kejadian AKI 24 jam pascaoperasi terhadap pemberian glutamin intravena praoperasi (p=0,612). Dari hasil pemeriksaan eGFR 24 jam pascaoperasi, didapatkan rerata kelompok kontrol 57,67 ± 18,86 mL/min/1,73m2dan kelompok glutamin 64,43 ± 17,56 mL/min/1,73m2, namun tidak berbeda bermakna (p=0,156). Dari hasil pemeriksaann kreatinin serum 24 jam pascaoperasi, didapatkan median kelompok kontrol 1,3 (0,87 – 2,68) mg/dL dan kelompok glutamin 1,2 (0,78 – 2,35), namun hasil ini juga tidak berbeda bermakna (p=0,258)Kesimpulan: Pemberian glutamin intravena praoperasi pada pasien dengan fraksi ejeksi rendah yang menjalani BPAK menggunakan mesin PJP, tidak memiliki hubunga bermakna terhadap kejadian AKI dan eGFR serta kadar kreatinin serum 24 jam pascaoperasi.

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Background: Coronary artery disease can be managed by coronary artery bypass graft surgery (CABG) using a cardiopulmonary machine (CPB) and low ejection fraction (FE) is associated with increased short-term and long-term mortality. The incidence of postoperative acute kidney injury (AKI) after CABG using a CPB machine is quite common with a prevalence varying between 7.6-48.5%. The pathogenesis AKI after cardiac surgery is complex and multifactorial, with several mechanisms involving inflammation, ischemia-reperfusion injury, and oxidative stress. Until now, there are no guidelines for kidney protection strategies in CABG surgery. Glutamine, a conditionally essential amino acid has anti-inflammatory and anti-oxidant effects through the induction of heat shock protein (HSP) and the production of the antioxidant glutathione (GSH). Thus, it is hypothesized that the administration of glutamine can reduce the incidence of AKI and decrease renal function impairment after CABG surgery.

Methods: This study is a retrospective cohort study in patients who underwent CPA surgery using a PJP machine with low FE. Subjects were divided into groups that received preoperative intravenous glutamine and groups that did not receive glutamine. The incidence of AKI 24 hours postoperatively, serum creatinine levels 24 hours postoperatively and the estimated glomerular filtration rate (eGFR) 24 hours postoperatively were the outcomes assessed in this study.

Results:From this study, the incidence of AKI 24 hours postoperatively in the glutamine group was 3.3% and the control group was 10%. However, there was no significant relationship between the incidence of AKI 24 hours postoperatively with preoperative intravenous glutamine administration (p=0.612). From the results of the 24-hour postoperative eGFR examination, the mean of the control group was 57.67 ± 18.86 mL/min/1.73m2 and the glutamine group was 64.43 ± 17.56 mL/min/1.73m2, but not significantly different (p= 0.156). From the results of serum creatinine examination 24 hours postoperatively, the median control group was 1.3 (0.87 – 2.68) mg/dL and the glutamine group 1.2 (0.78 – 2.35) mg/dL, but these results also did not differ significantly (p=0,258)"

"Latar Belakang. Fibrilasi atrium (AF) adalah komplikasi aritmia yang paling sering ditemukan pada pasien yang menjalani operasi bedah pintas arteri koroner (BPAK) dengan insidens yang bervariasi antara 20-50%. Walaupun diketahui sebagai gangguan yang bersifat sementara, namun AF pasca operasi dapat mengancam jiwa serta dikaitkan juga dengan peningkatan angka kesakitan dan kematian yang bermakna, sehingga perlu diketahui faktor-faktor yang dapat menjadi prediktor terhadap kejadian AF pasca BPAK. Penelitian ini menilai interval elektromekanikal atrium yang diukur dengan menggunakan ekokardiografi Doppler jaringan dan dispersi interval elektromekanikal sebagai prediktor kejadian AF pasca BPAK. Metode. Seratus delapan pasien diambil secara konsekutif untuk studi potong lintang ini, mulai bulan Mei hingga September 2012 dari pasien penyakit jantung koroner yang menjalani operasi BPAK di Pusat Jantung Nasional Harapan Kita, Jakarta. Pasien menjalani pemeriksaan ekokardiografi sebelum operasi BPAK. Dilakukan penilaian terhadap interval elektromekanikal dengan Doppler jaringan pada lateral atrium kiri serta dispersi interval interatrial. Pasien dimonitor selama perawatan terhadap kejadian AF.Hasil. Dalam studi kami, 27 dari 108 (25%) pasien mengalami AF pasca operasi BPAK. Dari analisa terlihat perbedaan interval elektromekanikal di atrium kiri sebesar 18.04 ms dan terdapat perbedaan dispersi interval interatrial 10.25 ms antara kelompok pasien yang mengalami AF pasca BPAK dan yang tidak mengalami AF. Dari hasil analisa didapatkan nilai titik potong interval elektromekanikal di lateral atrium kiri sebesar 77,75 ms dan dispersi interval elektromekanikal sebesar 38,95 ms sebagai prediktor terhadap kejadian AF pasca BPAK.Kesimpulan. Interval elektromekanikal pada lateral atrium kiri dan dispersi interval interatrial dengan menggunakan Doppler jaringan merupakan potensial prediktor terhadap kejadian AF pasca BPAK.

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Background. Atrial fibrillation (AF) is the most common arrhythmia complication in patient undergone coronary artery bypass grafting (CABG) with the incidence of 20- 50% according to different studies. Although this complication is temporary but can be life threathening, and increased the number of mortality and morbidity. Thus, it is very important to identified factors that can predict the occurance of AF post CABG. This study use atrial electromechanical interval and interval dispertion measured by tissue Doppler echocardiography as predictor of AF post CABG.

Methods. One hundred and eight patients were included in this cross sectional study. Samples were taken consecutively from May to September 2012 among patients with coronary artery disease undergoing CABG at the National Cardiovascular Center Harapan Kita Jakarta. The patients underwent a preoperative transthoracic echocardiography with tissue Doppler evaluation. We measured the atrial electromechanical interval in the lateral of left atrium and interatrial interval dispertion. Patients was monitored thorugh out hospitalization for the occurance of AF.

Result. In our study, 27 out of 108 (25%) patients developed AF post CABG. There are 18.04 ms electromechanical interval difference in the lateral of left atrium and 10.25 ms interatrial dispersion difference between patients who suffer from post operative AF and non AF. From this study we have 77,75 ms as the cutoff point for interval electromechanical in the left atrium and 38.95 ms as the cutoff point for dispersion of interatrial interval as the predictor for AF post CABG.

Conclusion. The interval of Electromechanical in the lateral left atrium and interatrial interval dispersion using tissue dopper echocardiography are potensial predictor the occurrence of AF post CABG."

"Latar belakang: Berdasarkan pilot study di divisi Bedah Jantung Dewasa Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita, SIRS lebih sering terjadi pada OPCAB dibandingkan dengan on-pump CABG, 67% vs 33% (30 sampel, 2017). Berangkat dari hal tersebut, peneliti melakukan uji klinis memberikan deksametason pada pasien yang menjalani operasi OPCAB. Metode: Pengumpulan sampel dilakukan secara konsekutif di divisi Bedah Jantung Dewasa Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita antara Agustus 2018 - Januari 2019. Sampel yang memenuhi kriteria inklusi dan eksklusi dirandomisasi menjadi grup deksametason (n=30) dan grup plasebo (n=30). Intervensi deksametason intravena dosis 1 mg/KgBB (maksimal 100 mg) atau plasebo menggunakan normal salin (NaCl 0,9%). Analisis statistik digunakan independent t-test, Mann-Whitney test, fisher exact test dan AUC. Hasil: Insiden MACE pada grup deksametason dibandingkan grup plasebo (RR 0,385, CI 95%: 0,157-0,945, p = 0,024). Keluaran klinis lebih baik ditemukan pada grup deksametason dibandingkan grup plasebo untuk durasi ventilasi mekanik (6 (5-16) jam vs 8 (5-72) jam, p = 0,029), lama rawat ICU (17,5 (12-32) jam vs 19 (13-168) jam, p = 0,028), lama rawat rumah sakit (5 (5-8) hari vs 6,5 (5-30) hari, p = 0,04) dan VIS (0 (0-15) vs 5 (0-100), p = 0,045). Hasil penanda inflamasi, terdapat perbedaan rata-rata yang bermakna antara grup deksametason dibandingkan grup plasebo pada IL-6 (217,4 pg/mL, CI 95%: 107,9-326,8, p = 0,0001), PCT (3,41 µg/L, CI 95%: 2,1-4,71, p = 0,0001) dan CRP (52,3 mg/L, CI 95%: 28.8-75,8, p = 0,0001). Pada analisis AUC terdapat hubungan signifikan antara penanda inflamasi dengan insiden MACE pada IL-6 (AUC 0,728, CI 95%: 0,585-0,871, p = 0,005) dan PCT (AUC 0,723, CI 95%: 0,578-0,868, p = 0,007). Kesimpulan: Pemberian deksametason praoperasi OPCAB, efektif memperbaiki keluaran klinis dan mengendalikan reaksi inflamasi pascaoperasi dibandingkan plasebo.

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Background: Based on a pilot study in the Adult Heart Surgery division of Harapan Kita Heart and Vascular Center Hospital, SIRS is more common in OPCAB compared to on-pump CABG, 67% vs 33% (30 samples, 2017). Based from this result, this research conducted a clinical trial to provide dexamethasone in patients undergoing OPCAB surgery. Methods: Samples were collected consecutively in the Adult Heart Surgery division of Harapan Kita Heart and Vascular Center Hospital between August 2018 - January 2019. Samples that fulfill inclusion and exclusion criteria were randomized to dexamethasone group (n=30) and placebo group (n=30). Intervention using intravenous dexamethasone dose of 1 mg/KgBB (maximum 100 mg) or placebo using normal saline (0.9% NaCl). Statistical analysis were used independent t-test, Mann-Whitney test, fisher exact test and AUC. Results: MACE incidence in dexamethasone group compared to placebo group (RR 0.385, 95% CI: 0.157-0.945, p = 0.024). Clinical output of dexamethasone group was better than placebo group in duration of mechanical ventilation (6 (5-16) hours vs 8 (5-72 ) hours, p = 0.029), ICU length of stay (17.5 (12-32) hours vs 19 (13-168) hours, p = 0.028), hospital length of stay (5 (5-8) days vs 6.5 (5-30) days, p = 0.04) and VIS (0 (0-15) vs 5 (0-100), p = 0.045). As a result of the inflammatory markers, there was a significant average difference between dexamethasone group compared to the placebo group in IL-6 (217.4 pg/mL, 95% CI: 107.9-326.8, p = 0,0001), PCT ( 3.41 µg/L, 95% CI: 2.1-4.71, p = 0.0001) and CRP (52.3 mg/L, 95% CI: 28.8-75.8, p = 0.0001 ) In the AUC analysis there was a significant association between inflammatory markers with the incidence of MACE in IL-6 (AUC 0.728, 95% CI: 0.585-0.871, p = 0.005) and PCT (AUC 0.723, 95% CI: 0.578-0.868, p = 0.007). Conclusion: Preoperative dexamethasone OPCAB is effective to improving clinical output and controlling postoperative inflammatory reactions compared to placebo."

"[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.]"