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"Hipertrofi ventrikel kiri atau Left ventricle hypertrophy (LVH) adalah faktor risiko independen terjadinya gagal jantung pada pasien hipertensi. Diagnosis dini LVH diperlukan untuk mencegah kerusakan lebih lanjut pada otot jantung. Cardiotropin-1 (CT-1) diproduksi oleh kardiomiosit dan fibroblas, yang kadarnya dilaporkan meningkat pada pasien hipertensi primer. Tujuan : Membuktikan manfaat CT-1 serum untuk mendeteksi LVH pada pasien hipertensi primer. Metode : Penelitian uji diagnostik dilaksanakan di RSCM Jakarta periode Februari s/d Maret 2013. Subyek penelitian adalah 75 pasien hipertensi primer dengan atau tanpa LVH. Diagnosis LVH dilakukan dengan ekokardiografi sebagai baku emas dan elektrokardiografi/EKG (kriteria Sokolow Lyon voltage, Cornell voltage dan Cornell product). Kadar CT-1 serum diperiksa dari sampel darah vena dengan metode ELISA. Hasil : Berdasarkan ekokardiografi 46 orang (61,3%) LVH dan 29 orang (38,7%) tidak LVH. Kadar CT-1 subyek LVH adalah 82,96 ± 351,843 pg/mL dan subyek tanpa LVH 4,55 ± 1,281 pg/mL (p=0,01). Korelasi CT-1 dengan LVMI adalah tidak bermakna (p=0,1). Luas area dibawah kurva ROC CT-1 untuk diagnosis LVH adalah 0,67 (p=0,01). Nilai cut-off CT-1 adalah 4,45 pg/mL. Uji diagnostik CT-1: Sensitifitas 54,4%, spesifisitas 75,9, NDP 78,1%, NDN 51,2 dan akurasi 61,3%. Uji diagnostik kombinasi CT-1 dan EKG (salah satu kriteria positif LVH): sensitifitas 67,4%, spesifisitas 72,4% , NDP 79,5%, NDN 58,3% dan akurasi 69,3%. Simpulan. CT-1 kurang sensitif namun cukup spesifik untuk diagnosis hipertrofi ventrikel kiri (LVH). Kombinasi CT-1 dengan EKG meningkatkan nilai diagnostik pemeriksaan untuk deteksi LVH pada pasien hipertensi primer.

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Left ventricle hypertrophy (LVH) is independent risk factor of heart failure on hypertension patients. Early detection of LVH is necessary to prevent extensive damage of heart muscle. Cardiotropin-1 (CT-1) is produce by cardiomyosite and fibroblast, that the level of CT-1 has been reported increase on primary hypertension patients.

Aim : To prove the benefit of CT-1 serum to detect LVH on primary hypertension patients.

Methods : A diagnostic study has been conducted on RSCM Jakarta on the periode of February to March 2013. Research subjects were 75 primary hypertension patients with and without LVH. LVH diagnosis was performed by echocardiography examination as gold standard and electrocardiography/ECG (Sokolow Lyon voltage, Cornell Voltage and Cornell product criterias). CT-1 level was measured by ELISA method from vein blood sample.

Results : Based on echocardiography examination 46 patients (61.3%) were diagnosed as LVH and 29 patients (38.7%) without LVH. The level of CT-1 of patients with LVH was 82.96 ± 351.843 pg/mL and 4.55 ± 1.,281 pg/mL on patients without LVH (p=0.01). Correlation between CT-1 and Left Ventricular Mass Index was not significant (p=0.1). Area under the ROC curve was 0.67 (p=0.01). The cut-off of CT-1 level for diagnosis of LVH was 4.45 pg/mL. Diagnostic test yield the sensitivity of CT-1 for diagnosis of LVH was 54.4%, specificity 75.9%, PPV 78.1%, NPV 51.2% and accuracy was 61.3%. Diagnostic test of combination CT-1 and ECG (positive LVH by one or more ECG’s criteria) yield sensitivity 67.4%, specificity 72.4% , PPV 79,5%, NPV 58.3% and accuracy 69.3%.

Conclusion. CT-1 examination was not sensitive but specific for LVH diagnosis. Combination of CT-1 and ECG examination was improve diagnostic value of CT-1 for detection of LVH on primary hypertension patients."

"Latar Belakang. Penyakit kardiovaskular masih merupakan masalah kesehatan utama global. Banyak penelitian menghubungkan kondisi Penyakit Ginjal Kronik (PGK) pada pasien Sindrom Koroner Akut (SKA) dengan luaran klinis yang lebih buruk. Mengetahui peran faktor-faktor yang mempengaruhi Major Adverse Cardiovascular Event (MACE) pada pasien SKA dengan PGK penting dalam upaya pencegahan luaran yang buruk.Tujuan. Mengetahui hubungan skor Global Registry of Acute Coronary Events (GRACE), skor Gensini, Left Ventricular Hypertrophy (LVH), dan Rasio Netrofil Limfosit (RNL) terhadap kejadian MACE 30 hari pasien SKA yang mengalami PGK non-dialisis.Metode. Desain penelitian kohort retrospektif menggunakan data sekunder dari rekam medis117 pasien SKA yang menjalani PCI di Rumah Sakit Umum Pemerintah Cipto Mangunkusumo sejak Januari 2018 hingga Juni 2018. Pasien dibagi berdasarkan derajat PGK serta dinilai MACE 30 hari. Dilakukan pencatatan data skor GRACE, skor Gensini, LVH, dan RNL. Analisis hubungan faktor-faktor tersebut dilakukan menggunakan uji chi square.Hasil. Dari 117 pasien 62,3% ST Elevation Myocardial Infarction (STEMI), pada akhir perawatan 67,5% pasien termasuk dalam kelompok derajat 1-2 PGK, 17,1% dalam kelompok PGK derajat 3a-3b dan 15,4% dalam kelompok PGK derajat 4-5. MACE terjadi pada 47 (40,2%) pasien dengan 17 (14,5%) mengalami kematian.Terdapat hubungan bermakna antara skor GRACE dengan MACE (54,8% MACE pada skor GRACE tinggi vs 32% MACE padaskor GRACE rendah-sedang ( p = 0,016) (OR : 2,57 IK95% : 1,18-5,59), sedangkan pada skor Gensini,LVH dan RNL walaupun terdapat peningkatan proporsi MACE namun tidak didapatkan hubungan yang signifikan.Kesimpulan. Skor GRACE berhubungan dengan MACE 30 hari pasien SKA dengan PGK non dialisis.

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Background. Cardiovascular disease is still a major global health problem. Many studies have linked Chronic Kidney Disease (CKD) in Acute Coronary Syndrome (ACS) patients with worse clinical outcomes. Knowing the role of factors that influence MACE in ACS with CKD patients is important in preventing poor outcomes.

Objective. To determine the relationship between GRACE scores, Gensini scores, LVH, and NLR to the 30-day MACE incidence in ACS patients with CKD.

Method. This study is a retrospective cohort study using secondary data from the medical records of 117 ACS patients who underwent PCI at the Cipto Mangunkusumo Government General Hospital from January 2018 to June 2018. Patients were divided based on the degree of CKD and assessed for 30-day MACE. Data were recorded on GRACE scores, Gensini

scores, LVH, and RNL. Analysis of the relationship between these factors was carried out using the Chi Square test.

Results. Of the 117 patients 62.3% were STEMI, at the end of hospital treatment 67.5% were in the normal-grade 2 CKD group, 17.1% in the CKD grade 3a-3b group and 15.4% in the CKD grade 4-5 group. MACE occurred in 47 (40.2%) patients with 17 (14.5%) dying. There was a significant relationship between GRACE scores and MACE (54.8% MACE at high GRACE scores vs. 32% MACE at low-moderate GRACE scores (p = 0.016) (OR : 2,57

CI95% : 1,18-5,59)), while the Gensini score, LVH and NLR scores even though there was an increase in the proportion of MACE but no significant relationship was found.

Conclusion. The GRACE score correlates with the 30-day MACE of ACS with non- dialysis

CKD patients.

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