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"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."

"ABSTRAKLatar Belakang: Lesi koroner kompleks berkaitan dengan prognosis buruk SKA. Pentingnya revaskularisasi awal untuk mengurangi angka morbiditas dan mortalitas. PLR berkaitan dengan kompleksitas lesi buruk dan diharapkan menjadi acuan dalam identifikasi dini lesi koroner kompleks.Tujuan: Mengetahui akurasi diagnostik dan nilai titik potong PLR sebagai penapis lesi koroner kompleks baik pada kelompok usia ≤45 tahun dan >45 tahun.Metode: Sebuah studi potong lintang secara retrospektif di ICCU RSUPN-CM. Data diambil dari rekam medis pasien SKA dewasa dan menjalani angiografi koroner dari Januari 2012 ? Juli 2015. Akurasi diagnositik dinilai dengan menghitung sensitivitas dan spesifisitas. Nilai titik potong ditentukan menggunakan kurva ROC.Hasil: Proporsi pasien SKA dengan lesi koroner kompleks 47,2%. Nilai titik potong optimal pada pasien usia ≤45 tahun adalah 111,06 dengan sensivitas 91,3% dan spesifisitas 91,9. Pada kelompok usia >45 tahun nilai titik potong optimal pada angka 104,78 dengan nilai sensivitas 91,7% dan spesifisitas 58,6.Simpulan: Nilai titik potong PLR optimal pada kelompok usia ≤45 adalah 111,06 dan kelompok usia >45 tahun adalah 104,78 dengan akurasi diagnositik masing-masing AUC 93,9% (p <0,001) dan AUC 77,3% (p <0,001).

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ABSTRACT

Background: A Complex coronary lesion is related to poor prognosis in ACS patient. The importance of early revascularization is to decrease mortality and complications. Inflammatory marker such as PLR related to complex coronary lesions and expected to be a tool that can assist physicians and cardiologists to stratify patients who have high probability for having a complex coronary lesion.

Aim: Evaluate the diagnostic accuracy of PLR in identifying a complex coronary lesion in ACS patient. The other aim was to identify the proportion of complex coronary lesion and cut-off point of PLR between ≤45 years old group and >45 years old group subjects.

Method: This is a cross sectional retrospectively study in ACS patients hospitalized in ICCU of RSUPN-CM from January 2012 until July 2015. The inclusion are adult ACS patients and who underwent coronary. The diagnostic accuracy was determined by calculating the sensitivity, specificity, PPV, NPV, Positive LR, and Negative LR. The cut-off point was determined using ROC curve.

Results: The proportion of complex coronary lesion was 47,2%. The optimal cut-off point in ≤45 years old group was 111,06 with sensitivity and specificity respectively 91,3% and 91,9%. The optimal cut-off points in >45 years old groups was 104,78 with sensitivity and specificity respectively 91,7% and 58,6%.

Conclusion: The optimal cut-off point of ≤45 years old groups is 111,06 and for >45 years old group is 104,78. The diagnostic accuracy of PLR in ≤45 years old groups was very good (AUC 93,9%, p value <0,001), while in >45 years old group was moderate (AUC 77,3%, p value <0,001)."

"Latar Belakang: Sindrom koroner akut (SKA) adalah gangguan yang mengancam jiwa yang tetap menjadi sumber morbiditas dan mortalitas yang tinggi meskipun ada kemajuan dalam pengobatan. Hubungan antara asam urat serum dengan penyakit jantung iskemik masih kontroversial dan belum ditetapkan sebagai faktor risiko kardiovaskular. Interaksi kooperatif antara keduanya tidak sepenuhnya dipahami. Beberapa bukti epidemiologis hubungan kausal tersebut masih kontroversial. Sering sekali penelitian dengan kasus yang sama dan menggunakan metode yang sama tetapi hasilnya berbeda.Tujuan: Penelitian ini bertujuan untuk melakukan meta analisis untuk mensintesis hasil-hasil penelitian yang berbeda tersebut agar diperoleh data baru yang bersifat kuantitatif dan lebih akurat.Metode: Protokol penelitian didaftarkan di PROSPERO (CRD42020210948) dan telaah sistematis mengikuti pedoman preferred reporting items for systematic reviews and meta-analyses (PRISMA), dengan menelusuri studi yang dipublikasikan dalam rentan waktu dari Januari 2010 hingga Mei 2020. Cochrane Library, Ebsco, Medline/PubMed, ProQuest dan Sience Direct adalah sumber dari studi yang dipublikasikan. Meta analisis dilakukan untuk mensintesis korelasi antara kadar asam urat serum dan keparahan stenosis arteri koroner. Heterogenitas dinilai menggunakan I2, dan meta analisis menggunakan perangkat lunak Comprehensive Meta Analysis Version 3 (CMA3).Hasil: Lima studi (n = 601 pasien) diidentifikasi didapatkan korelasi antara kadar asam urat serum dan skor Gensini (r = 0,548; p <0,001) pada pasien SKA. Bias heterogenitas ditemukan dalam analisis.Simpulan: Keparahan stenosis arteri koroner pada pasien dengan SKA berkorelasi positif dengan kadar asam urat serum.

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Background: Acute coronary syndrome (ACS) is a life-threatening disease which remains a source of high morbidity and mortality despite advances in treatment. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different.Objective: This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately.Methods: The study protocol was registered in PROSPERO (CRD42020210948) and systematic study follows the guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA), tracing studies published in January 2010 to May 2020. Sources of database using Cochrane Library, Ebsco, Medline/PubMed, ProQuest and Science Direct. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis. Heterogeneity was assessed using I2, and the meta-analysis was performed using Comprehensive Meta Analysis Version 3 (CMA3) software.Results: Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis.Conclusions: The severity of coronary artery stenosis in patients with ACS is positively correlated with serum uric acid levels"

"ABSTRACTBackground: with the increasing number of patients with acute coronary syndrome (ACS) with complex coronary lesion and the increasing needs of coronary artery bypass grafting (CABG) procedures, there is an increasing need for a tool to perform early stratification in high-risk patients, which can be used in daily clinical practice, even at first-line health care facilities setting in Indonesia. It is expected that early stratification of highrisk patients can reduce morbidity and mortality rate in patients with ACS. This study aimed to identify diagnostic accuracy of platelet/lymphocyte ratio (PLR) and the optimum cut-off point of PLR as a screening tool for identifying a complex coronary lesion in patients ≤45 and >45 years old. Methods: this was a retrospective cross-sectional study, conducted at the ICCU of Cipto Mangunkusumo Hospital. Data was obtained from medical records of adult patients with ACS who underwent coronary angiography between January 2012 - July 2015. The inclusion criteria were adult ACS patients (aged ≥18 years old), diagnosed with ACS and underwent coronary angiography during hospitalization. Diagnostic accuracy was determined by calculating sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-). The cut-off point was determined using ROC curve. Results: the proportion of ACS patients with complex coronary lesion in our study was 47.2%. The optimum cut-off point in patients aged ≤45 years was 111.06 with sensitivity, specificity, LR+ and LR of 91.3%, 91.9%, 11.27 and 0.09, respectively. The optimum cut-off points in patients aged >45 years was 104.78 with sensitivity, specificity, LR+ and LR of 91.7%, 58.6%, 2.21 and 0.14, respectively. Conclusion: the optimum cut-off point for PLR in patients aged ≤ 45 years is 111.06 and for patients with age >45 years is 104.78 with diagnostic accuracy, represented by AUC of 93.9% (p<0.001) and 77.3% (p<0.001), respectively for both age groups."

"Latar Belakang: Pasien diabetes melitus tipe 2 menunjukkan peningkatan risiko penyakit jantung koroner dengan kondisi aterosklerosis arteri koroner yang lebih berat. Ketebalan lemak epikardial diperkirakan berhubungan dengan kondisi inflamasi dan derajat stenosis arteri koroner pada pasien DM tipe 2 dengan chronic coronary syndrome (CCS), dimana kadar HsCRP dapat digunakan sebagai penanda inflamasi dan skor Gensini digunakan untuk menilai derajat stenosis arteri koroner.Tujuan: Penelitian ini bertujuan untuk mengetahui korelasi antara ketebalan lemak epikardial dengan kadar dan HsCRP derajat stenosis arteri koroner pada pasien DM tipe 2 dengan CCS.Metode: Studi potong lintang pada 47 pasien DM tipe 2 dengan CCS yang berusia antara 35 sampai 87 tahun dan menjalani angiografi koroner di Laboratorium Kateterisasi Jantung PJT-RSCM. Nilai ketebalan lemak epikardial diperoleh dari hasil pemeriksaan ekokardiografi, skor Gensini dihitung berdasarkan hasil pemeriksaan angiografi koroner, dan kadar HsCRP diperiksa menggunakan metode Imunoturbidimetri.Hasil: Diperoleh median kadar HsCRP sebesar 1,9 mg/L (RIK 0,8–3,30 mg/L), rerata ketebalan lemak epikardial sebesar 6,06 ± 2,14 mm, dan median skor Gensini sebesar 34 (RIK 14–84). Didapatkan korelasi positif sedang antara ketebalan lemak epikardial dan HsCRP (p<0,05; r = 0,500, namun tidak menemukan adanya korelasi yang bermakna antara ketebalan lemak epikardial dan skor Gensini (p > 0,05).Kesimpulan: Ketebalan lemak epikardial hanya menunjukkan adanya korelasi yang bermakna dengan kadar HsCRP pada pasien DM tipe 2 dengan CCS, namun tidak dengan derajat stenosis arteri koroner yang dinilai berdasarkan skor Gensini. Jadi dengan memeriksa ketebalan lemak epikardial dengan ekokardiografi kita dapat memperkirakan tingkat inflamasi pada pasien DM tipe 2 dengan CCS

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Background: T2DM patients showed an increased risk of CAD with more severe coronary artery atherosclerosis. Epicardial fat thickness (EFT) was presumed to be associated with inflammatory conditions and the severity of coronary artery stenosis in patients with T2DM and CCS, wherein HsCRP levels can be used as an inflammatory marker and Gensini score to quantify the severity of coronary artery stenosis.

Objective: To determine the correlation between EFT and HsCRP levels and the severity of coronary artery stenosis in patients with T2DM and CCS.

Methods: A cross sectional study conducted among 47 patients with T2DM and CCS between the age of 35 to 87 that had underwent coronary angiography at the Heart Catheterization Laboratory of PJT-RSCM. Results of echocardiography was evaluated to determine EFT, while the Gensini score was calculated based on the results of coronary angiography, and HsCRP levels was evaluated using a commercial Immunoturbidimetry kit.

Results: Median HsCRP levels was 1.9 mg/L (IQR 0.8–3.30 mg/L), mean EFT was 6.06 ± 2.14 mm, and median Gensini score was 34 (IQR 14–84). There was a moderate positive correlation between EFT and HsCRP (p < 0.05, r = 0.500), but found no significant correlation between EFT and Gensini score (p > 0.05).

Conclusion: EFT only showed significant correlation with HsCRP levels in patients with T2DM and CCS, but showed no correlation with the severity of coronary artery stenosis that was quantified by Gensini score. So, by echocardiography evaluation of epicardial fat thickness, we could have an estimation of inflamation degree in patients with T2DM and CCS."

"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."

"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: 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."