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Abstrak :
Latar belakang: micro-RNA saat ini telah diketahui berperan dalam patofisiologi berbagai penyakit termasuk di bidang kardiovaskular. miR-26a platelet dikaitkan dengan aktifitas platelet tinggi.Resistensi klopidogrel telah diketahui memiliki prevalensi yang cukup tinggi di populasi Asia, yang mana dapat mempengaruhi mortalitas serta kejadian kardiovaskular mayor. Hubungan antara ekspresi miR-26a platelet dengan resistensi klopidogrel begitu pula dengan TIMI flow pasca IKPP pada IMA-EST di populasi Asia, belum pernah dilaporkan. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi miR-26a platelet terhadap reaktivitas platelet dan perfusi miokardium pasca IKPP. Metode: Pada pasien IMA-EST yang menjalani IKPP dan mendapatkan terapi dosis loadingklopidogrel 600 mg, dimasukkan kedalam populasi penelitian. Kami mengukur reaktivitas platelet dengan menggunakan VerifyNow P2Y12, aktifitas platelet tinggi didefiniskan jika memiliki nilai > 208 PRU. Metode RealtimePCR Taqman dilakukan untuk analisa ekspresi miR-26a platelet. Ekspresi miR-26a platelet dan reaktivitas platelet dikorelasikan dengan TIMI flowpasca IKPP pada pasien IMA-EST. Hasil: Terdapat 100 subyek yang direkrut pada studi ini. Diantaranya, 59% menunjukkan peningkatan ekspresi miR-26a. Reaktifitas platelet meningkat pada 27 % pasien studi ini dikategorikan non-responder terhadap klopidogrel. Terdapat hubungan antara ekspresi dengan penurunan fungsi penghambatan platelet (OR 4.2, p = 0.006). Indeks reaktivitas platelet >208 PRU meningkatkan risiko TIMI flow < 3 (OR 3.3, p= 0.015). Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIMI flow < 3. Kesimpulan: Pasien dengan peningkatan ekspresi miR-26a platelet memiliki risiko untuk mengalami menjadi non-responderklopidogrel. Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIM flowpasca IKPP. ......Background: micro-RNA has now been known to play a role in the pathophysiology of various diseases including cardiovascular disease. Clopidogrel resistance has been known prevalent in Asian population, that may affect mortality and major cardiovascular events. The relationship between the expression of platelet miR-26a and clopidogrel resistance as well as TIMI flow post primary PCI in STEMI among Asian populations, has never been done. Objective: the aim of this study is to define whether miR-26a platelet expression has a relation with platelet reactivity and myocardial perfusion after primary PCI. Methods: STEMI patients who underwent primary PCI and has received 600 mg loading dose of clopidogrel were recruited for the study. We measured platelet reactivity by VerifyNow P2Y12, high platelet reactivity was defined as > 208 PRU. Realtime PCR by taqman method were performed to asses the expression of miR-26a platelet. miRNA-26a platelet expression and platelet reactivity were correlated with TIMI flow post primary PCI in STEMI. Hasil: there were 100 patients recruited for this study. among them, 59% of patients with high expression of miR-26a platelet. Platelet reactivity showed 27% of the patients were clopidogrel non-responders. There was a relationship between high miR-26a expression and decreased function of platelet inhibition (OR 4.2, p = 0.006). Platelet reactivity index > 208 increased the risk of suboptimal reperfusion (OR 3.3, p = 0.015). There was no direct correlation between miR-26a expression and TIMI flow < 3. Conclusion: Patients with high miR-26a platelet expression had increased risk of being clopidogrel non responders. There is no direct relationship between miR-26a platelet expression and TIMI flow after primary PCI.

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ABSTRAK
Latar belakang: PCSK9 merupakan protein yang berperan dalam regulasi kadar kolesterol LDL darah. PCSK9 diketahui memiliki mekanisme kerja lain yang melibatkan proses inflamasi, peningkatan Lp(a), aktivasi jaras protrombotik dan platelet, metabolisme triglyceride-rich lipoprotein, serta modifikasi plak yang juga dapat berperan dalam patogenesis berbagai spektrum penyakit aterosklerotik, termasuk IMA-EST. Kemajuan dalam strategi penatalaksanaan IMA-EST telah berhasil meningkatkan kesintasan. Polimorfisme R46L gen PCSK9 diketahui memiliki efek proteksi terhadap risiko kardiovaskular. Pada pasien infark miokard, prevalensi pembawa karier mutan R46L sebesar 2,14%. Dalam observasi pasien infark miokard akut didapatkan proporsi pasien yang memiliki kesintasan yang panjang. Polimorfisme R46L gen PCSK9 dipikirkan dapat memiliki peranan dalam mempertahankan kesintasan pasien-pasien tersebut. Tujuan: Penelitian ini bertujuan untuk mempelajari hubungan antara polimorfisme R46L gen PCSK9 pada pasien IMA-EST yang menjalani IKPP dengan luaran kardioserebrovaskular mayor. Metode: Sebanyak 601 pasien dengan IMA-EST yang menjalani IKPP diperiksakan polimorfisme R46L gen PCSK9 pada saat admisi. Data luaran kardioserebrovaskular mayor dan data penunjang lain didapatkan dari rekam medik dan follow-up melalui telepon. Hasil: Tidak ditemukan varian mutan (GT dan TT) polimorfisme R46L gen PCSK9 pada pasien IMA-EST yang menjalani IKPP sehingga analisa hubungan polimorfisme R46L gen PCSK9 terhadap luaran kardioserebrovaskular mayor tidak dapat dilakukan. Kesimpulan: Pada pasien IMA-EST yang menjalani IKPP di RS Jantung Harapan Kita, tidak ditemukan varian mutan R46L gen PCSK9. Analisa hubungan polimorfisme R46L gen PCSK9 terhadap luaran kardioserebrovaskular mayor tidak dapat dilakukan.

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ABSTRACT
Background: PCSK9 is a protein molecule that regulates serum LDL cholesterol level. Recent data suggest that PCSK9 activity may also work through other mechanisms, such as inflammation, increased Lp(a), triglyceride-rich lipoprotein metabolism, activation of prothrombotic pathways and platelets, and modification of atherosclerotic plaque, which may contribute to the pathogenesis of atherosclerotic diseases, including STEMI. Advances in the management of STEMI have succeeded in increasing survival. Polymorphism R46L of PCSK9 gene has been known to have protective effect on cardiovascular risks. In patients with myocardial infarction, the prevalence of R46L mutation carriers was 2.14%. In the longterm observation of acute coronary syndrome patients, a proportion of patients experienced longer survival. Polymorphism R46L of PCSK9 gene may play a role in longterm survival. Objective: The aim of this study is to evaluate the association between plasma polymorphism R46L of PCSK9 gene with MACCE in STEMI patients who underwent primary PCI. Methods: In total, 601 patients with STEMI who were treated with primary PCI had their plasma sample drawn during admission and evaluated for polymorphism R46L of PCSK9 gene. MACCE and other supportive data were taken from the medical records and telephone follow-up. Results: In this study, no polymorphism R46L of PCSK9 gene was detected. Therefore, its association with MACCE could not be further analysed. Conclusion: There was no polymorphism R46L of PCSK9 gene detected in STEMI patients treated with primary PCI. The analysis of its association with MACCE could not be conducted.

Abstrak :
Latar belakang: PCSK9 telah diketahui sebagai molekul yang berperan dalam regulasi kadar kolesterol LDL darah. Dua dekade ini, PCSK9 diketahui memiliki mekanisme kerja lain yang melibatkan proses inflamasi, peningkatan Lp(a), aktivasi jaras protrombotik dan platelet, metabolisme triglyceride-rich lipoprotein, serta modifikasi plak yang juga dapat berperan dalam patogenesis berbagai spektrum penyakit aterosklerotik, termasuk IMA-EST. Kemajuan dalam strategi penatalaksanaan IMA-EST telah berhasil meningkatkan kesintasan, akan tetapi sekelompok pasien masih mengalami luaran klinis buruk meski telah mendapatkan tatalaksana optimal. Adanya polimorfisme gain of function E670G PCSK9 dipikirkan dapat memiliki peranan dalam risiko residual pasien-pasien tersebut Tujuan: Penelitian ini bertujuan untuk mempelajari hubungan antara polimorfisme PCSK9 pada pasien IMA-EST yang menjalani IKPP dengan luaran kardioserebrovaskular mayor. Metode: Sebanyak 423 pasien dengan IMA-EST yang menjalani IKPP diperiksakan polimorfisme PCSK9 pada saat admisi. Pemeriksaan polimorfisme PCSK9 didapatkan dengan menggunakan Real Time PCR. Data luaran kardioserebrovaskular mayor dan data penunjang lain didapatkan dari rekam medik dan follow-up telepon. Hasil: Terdapat 2,1 % polimorfisme berupa alel mutan (AG). Terdapat 65 (15,4%) subjek penelitian yang mengalami luaran kardioserebrovaskular mayor dalam 180 hari. Didapatkan analisis kesintasan menunjukkan adanya hubungan yang bermakna secara statistik antara polimorfisme E670G PCSK9 dengan luaran kardioserebrovaskular mayor dalam 180 hari (HR 7,486; IK95% 3.57-15.697; P=0,0000). Kesimpulan: Pada pasien IMA-EST yang menjalani IKPP, terdapat hubungan yang bermakna antara polimorfisme E670G PCSK9 dengan luaran kardioserebrovaskular mayor dalam 180 hari. ......Background: PCSK9 is a molecule that regulates blood LDL cholesterol level. Recent evidences suggest that PCSK9 may also have other mechanisms, such as inflammation, increased Lp(a), triglyceride-rich lipoprotein metabolism, activation of prothrombotic pathways and platelets, and modification of atherosclerotic plaque, which all may play a role in the pathogenesis of atherosclerotic diseases, including STEMI. Previous advances in the management of STEMI had succeed in increasing survival. However, some STEMI patients still experienced adverse outcomes eventhough they already received optimal management in accordance with the guidelines. Polimorphysm gain of function PCSK9 may have a role in the residual risk that those patients have. However, our knowledge regarding this association between polymorphism gain of function E670G PCSK9 and MACCE in STEMI is still unknown. Objective: The aim of this study is to evaluate the association between polymorphism Gain of Function E670G PCSK9 with MACCE in STEMI patients who underwent primary PCI. Methods: In total, 423 patients with STEMI who were treated with primary PCI had their plasma sample drawn during admission and evaluated for Polymorphism PCSK9. PCSK9 Polymophism was measured with PCR RT. MACCE and other supportive data were taken from the medical records and telephone follow-up. Results: The prevalence of Poymorphisme E670G PCSK9 in STEMI patient who underwent PPCI is 2,1 %. There were 65 (15,4%) study participants who experienced MACCE in 180 days. Survival analysis shows a significant association between Polymorphsm Gain of Function E670G PCSK9 and MACCE in 180 days. (HR 7,486; IK95% 3.57-15.697; P=0,0000). Conclusion: There was significant association between Polymorphsm gain of function E670G PCSK9 and 180 days MACCE in STEMI patients treated with primary PCI.

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[ABSTRAK
Latar belakang. Angka kejadian akut kardiovaskular diperkirakan akan semakin meningkat. Pasien dengan Angina APS dapat berkembang menjadi Sindroma Koroner Akut (SKA). Konsep proses inflamasi dan stress oksidatif berperan terhadap patogenesis atherosklerosis. Radikal bebas seperti reactive oxygen atau nitrogen species, dan HOCL (hypochlorous acid) dapat mengakibatkan kerapuhan plak. HOCL merupakan Reactive Oxygen Species (ROS) kuat yang menyebabkan ketidakstabilan plak sehingga mudah ruptur. Plak yang mudah ruptur disebut plak vulnerable. HOCL adalah substrat yang dihasilkan oleh myeloperoxidase (MPO). Studi histopatologi plak vulnerablemenilai ukuran pusat nekrotik adalah prediktor kuat terjadinya ruptur plak (OR 0.35; P <0.05), dan (OR 2.0; P <0.02).CT angiografi koroner adalah suatu modalitas pencitraan non invasif yang mampu memvisualisasi morfologi plak vulnerable salah satunya dengan mengidentifikasi adanya Napkin Ring Sign (NRS). NRS sangat spesifik untuk menilai pusat nekrotik. Studi ini bertujuan melihat hubungan MPO dengan plak vulnerableyang dinilai dengan Napkin Ring Sign pada pasien angina pektoris stabil. Metode. Penelitian ini adalah studi potong lintang yang dilakukan di Pusat Jantung Nasional Harapan Kita dari periode Juni ? November 2014. Studi dilakukan pada 41 subyek, pada pasien dengan angina pektoris stabil, jumlah laki ? laki sebanyak 32 orang ( 78%) dan perempuan 9 orang (22%), Pengambilan sampel secara konsekutif. Pengukuran kadar MPO dilakukan dengan menggunakan colorimetri assay. Pemeriksaan CT angiografi koroner dilakukan untuk mengidentifikasi NRS.Analisa statistik untuk mencari hubungan antara kadar MPO dengan plak vulnerable yang ditandai dengan NRSpada pemeriksaan CT angiografi koroner. Hasil.Kadar MPO (nmol) pada pasien dengan positif NRS lebih tinggi dibandingkan yang negatif 124,371 + 15,324 vs 105,206 + 18,335, aktivitas MPO (milliunit/mL) 829,136 + 102,157 vs701,371 + 122,235. Analisa bivariat erdapat hubungan yang bermakna antara kadar MPO dengan NRS p 0,002, IK 95%2.3,0 - 39,9. Dari multivariat regresi logistik didapatkan kadar MPO > 117,2 (median), memiliki OR 9,6 (IK 95% 2,3 -39) dengan p 0,002. Setelah dilakukan penyesuaian dengan faktor resiko, pada analisa multivariat regresi logistik, didapatkan OR 20,3 (IK 95% 3,1-31,7) dengan p 0,002. Kesimpulan. Kadar MPO memiliki hubungan yang bermakna dengan plak vulnerable yang ditandai dengan temuan NRS pada CT angiografi koroner pada pasien dengan APS. Kata kunci : atherosklerosis, plak vulnerable, myeloperoxidase, napkin ring sign.

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ABSTRACT
Background.Coronary Heart Disease ( CHD) is still the major health problem in worldwide. Atherosclerosis is a chronic inflammatory process where oxidative damage play a role in atherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental and weaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactive oxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaque vulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase (MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidants contributes to plaque vulnerability. Coronary Computed Tomography Angiography (CCTA) is a non invasive modality which able to identify morphology of vulnerable plaque. Napkin- Ring Sign (NRS) has been associated with high-risk plaques in several studies. Methods. A cross sectional study in 41 patients stable angina pectoris was done.The subjects was taken blood sample and underwent CCTA to evaluate NRS in National Cardiovascular Center Harapan Kita from June to November 2014. Statistical analysis is done to explore the association between MPO and vulnerable plaque marked with NRS in stable angina pectoris. Results. There was association between MPO level with vulnerable plaque marked with Napkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positif NRS vs non NRS (nmol) 124,371 + 15,324 vs 105,206 + 18,335, activity of MPO (milliunit/mL) 829,136 + 102,157 vs701,371 + 122,235. Logistic regression analysis showed level of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. After adjustment with confounding factor MPO level ≥ 117,2 nmol (median), OR 20,3 (IK 95% 3,1-31,7) , p value 0,002. Conclusion.There was association between Myeloperoxidase level with vulnerable plaque marked with Napkin Ring Sign;Background.Coronary Heart Disease ( CHD) is still the major health problem in worldwide. Atherosclerosis is a chronic inflammatory process where oxidative damage play a role in atherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental and weaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactive oxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaque vulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase (MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidants contributes to plaque vulnerability. Coronary Computed Tomography Angiography (CCTA) is a non invasive modality which able to identify morphology of vulnerable plaque. Napkin- Ring Sign (NRS) has been associated with high-risk plaques in several studies. Methods. A cross sectional study in 41 patients stable angina pectoris was done.The subjects was taken blood sample and underwent CCTA to evaluate NRS in National Cardiovascular Center Harapan Kita from June to November 2014. Statistical analysis is done to explore the association between MPO and vulnerable plaque marked with NRS in stable angina pectoris. Results. There was association between MPO level with vulnerable plaque marked with Napkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positif NRS vs non NRS (nmol) 124,371 + 15,324 vs 105,206 + 18,335, activity of MPO (milliunit/mL) 829,136 + 102,157 vs701,371 + 122,235. Logistic regression analysis showed level of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. After adjustment with confounding factor MPO level ≥ 117,2 nmol (median), OR 20,3 (IK 95% 3,1-31,7) , p value 0,002. Conclusion.There was association between Myeloperoxidase level with vulnerable plaque marked with Napkin Ring Sign, Background.Coronary Heart Disease ( CHD) is still the major health problem in worldwide. Atherosclerosis is a chronic inflammatory process where oxidative damage play a role in atherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental and weaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactive oxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaque vulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase (MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidants contributes to plaque vulnerability. Coronary Computed Tomography Angiography (CCTA) is a non invasive modality which able to identify morphology of vulnerable plaque. Napkin- Ring Sign (NRS) has been associated with high-risk plaques in several studies. Methods. A cross sectional study in 41 patients stable angina pectoris was done.The subjects was taken blood sample and underwent CCTA to evaluate NRS in National Cardiovascular Center Harapan Kita from June to November 2014. Statistical analysis is done to explore the association between MPO and vulnerable plaque marked with NRS in stable angina pectoris. Results. There was association between MPO level with vulnerable plaque marked with Napkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positif NRS vs non NRS (nmol) 124,371 + 15,324 vs 105,206 + 18,335, activity of MPO (milliunit/mL) 829,136 + 102,157 vs701,371 + 122,235. Logistic regression analysis showed level of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. After adjustment with confounding factor MPO level ≥ 117,2 nmol (median), OR 20,3 (IK 95% 3,1-31,7) , p value 0,002. Conclusion.There was association between Myeloperoxidase level with vulnerable plaque marked with Napkin Ring Sign]

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Latar Belakang : Morbiditas pasca operasi bedah pintas koroner BPAK masih cukuptinggi. Hal ini disebabkan karena adanya peningkatan inflamasi 48 ndash; 72 jam pasca BPAK danpeningkatan pada sistem renin angiotensin dan aldosteron RAAS. Penyekat EKA diketahuidapat menghambat RAAS dan inflamasi. Namun belum ada penelitian yang membuktikanbahwa penyekat EKA dapat menurunkan inflamasi pada pasien pasca BPAK Tujuan : Mengetahui efek captopril dalam menurunkan inflamasi yang diukur menggunakanhsCRP pada pasien yang menjalani BPAK elektif. Metode : Penelitian ini merupakan studi kohort prospektif. Dilakukan di Rumah SakitJantung dan Pembuluh Darah Harapan Kita RSJPDHK pada subyek yang menjalani BPAKelektif. Durasi penelitian dilakukan pada bulan Mei hingga Oktober 2016. Subyek dibagidalam dua kelompok yaitu kelompok yang mendapatkan captorpil pasca BPAK dan tanpacaptopril. Dilakukan pemeriksaan hsCRP serial sebanyak tiga kali yaitu sebelum operasi,hari ketiga pasca operasi dan sebelum pulang rawat. Hasil Penelitian : Terdapat total 85 subyek, 49 subyek pada kelompok mendapat captoprildan 36 subyek pada kelompok tanpa captopril. Pemeriksaan hsCRP sebelum operasi dan H 3pasca BPAK menunjukkan tidak ada perbedaan pada kedua kelompok. Pemeriksaan hsCRPH 6 pasca BPAK menunjukkan hsCRP pada kelompok yang mendapatkan captopril lebihrendah 31,4 mg/L 10,5 ndash; 154 vs 46,7 mg/L 10,3 ndash; 318 dengan nilai signifikansi P=0,018. Kesimpulan : Subyek yang mendapatkan captopril mempunyai tingkat inflamasi yang lebihrendah pada H 6 pasca BPAK yang dinilai dengan hsCRP dibandingkan kelompok yangtidak mendapat captopril. ......Background Postoperative morbidity of coronary artery bypass surgery CABG is fairlyhigh. This is due to increased of inflammatory response 48 ndash 72 hour after surgery andincreased of renin angiotensin aldosteron system RAAS. ACE inhibitors are known toinhibit inflammation and RAAS. However, no study has proved that ACE inhibitors canreduce inflammation in post operative CABG. Objective To determine the effect of captopril in reducing hsCRP post CABG surgery. Methods This is a cohort prospective study that was conducted in Harapan Kita Hospital, on post operative elective CABG subjects on May until October 2016. Subject divided intotwo groups, the group with captopril and the other is without captopril. High sensitive CRPwas measured 3 times day 0 before surgery, day 3 post CABG, day 6 post CABG. Results There are total 85 subjects, 49 subjects with captopril and 36 subjects withoutcaptopril. There was no difference in hsCRP results before surgery and day 3 post CABG. Inday 6 post CABG, hsCRP examination in captopril group is lower than the group withoutcaptopril 31,4 mg L 10,5 ndash 154 vs 46,7 mg L 10,3 ndash 318 with P 0,018. Conclusion Subjects with captopril has lower hsCRP at day 6 post CABG than the subjectswithout captopril.

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Latar Belakang : Telah banyak dipublikasikan berbagai macam algoritme untukmenentukan lokasi jaras tambahan pada pasien dengan sindroma Wolff-ParkinsonWhite.Algoritme-algoritme tersebut memiliki akurasi yang baik meskipunmemiliki alur yang komplek dan sulit untuk diingat. Berbagai macam algoritmeyang berkembang menggunakan morfologi delta wave dan polaritas komplek QRSdalam penyusunannya. Dengan adanya teknologi kateter ablasi yang ada saat inialgoritme yang komplek tidak diperlukan lagi. Diperlukan suatu algoritme yangsederhana, memiliki akurasi yang baik dan mudah diingat. Penelitian ini bertujuan untuk menilai akurasi algoritme sederhana untuk memprediksi lokasi jarastambahan. Metode : Penelitian ini merupakan studi potong lintang yang dilakukan diDepartemen Kardiologi dan Kedokteran Vaskuler FKUI/ Pusat Jantung NasionalHarapan Kita PJNHK. Data yang diambil berupa elektrokardiografi EKG pada67 pasien dengan sindroma Wolff-Parkinson-White yang menjalani tindakan ablasiperiode Januari 2014 - Oktober 2016. Data EKG yang terkumpul dibacaberdasarkan algoritme baru oleh dua orang penilai independen kemudiandibandingkan dengan hasil ablasi pada tabel 2x2. Hasil Penelitian : sampel akhir sebanyak 47 data hasil bacaan EKG observerterpercaya dihitung berdasarkan tabel 2x2 dengan hasil ablasi. Hasil menunjukkanalgoritme ini memiliki sensitivitas left free wall 45, septal 80, right free wall92, spesifisitas left free wall 96, septal 69, right free wall 85. Nilai dugapositif NDP left free wall 90, septal 55, dan right free wall 67. Nilai duganegatif NDN left free wall 70, septal 88, dan right free wall 97. Akurasialgoritme bervariasi dari 73 -87. Didapatkan perhitungan kesepahaman antarpenilai dengan nilai kappa 0,74-0,93. Perhitungan likelihood ratio menunjukkanlikelihood ratio positif left free wall 11,23, septal 2,23, dan right free wall 6,57.Likelihood ratio negatif left free wall 0,57, septa 0,28, dan right free wall 0,09. Kesimpulan : Algoritme baru yang lebih sederhana ini memiliki akurasi yang baikdengan angka kesepahaman antar penilai yang baik sehingga dapat digunakansecara umum.

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Background : A lot of algorithms in localizing accessory pathway AP in patientswith Wolff Parkinson White Syndrome have been published. Although many ofthose methods have high accuracy, they are complicated and difficult to memorize.Most of the established algorithm use delta wave morphology and QRS polarity todetermine the location. With the technology of catheter ablation nowadays suchcomplex algorithms are not really needed. This study aim to investigate theaccuracy of a simple algorithm to predict the location of accessory pathways. Methods : This was a cross sectional study conducted in the NationalCardiovascular Center Harapan Kita RSJPDHK Department Cardiology andVascular Medicine, FMUI. The electrocardiography ECG findings of 67 patientswith Wolff Parkinson White syndrome underwent ablations from January 2014until October 2016 were used in the current study. Those ECGs were analyzed usingthe new algorithm and were evaluated by two independent observers and comparedwith ablation results in a 2x2 table. Results : The final number of samples was 47 ECGs. The algorithm showed it hada sensitivity of 45 on left free wall, 80 on septal, 92 on right free wall APs inaddition to the specificity of 96 on left free wall, 69 on septal, 85 on right freewall APs. Positive predictive value PPV were 90 on left free wall, 55 on septaland 67 on right free wall APs. Negative predictive value NPV were 70 on leftfree wall, 88 on septal and 97 on right free wall APs. Algorithm accuracy variedfrom 73 to 87. Inter observer agreement calculation was a kappa of 0.74 mdash 0.93.Likelihood ratio calculation identified the positive likelihood ratio of 11.23 on leftfree wall, 2.23 on septal and 6.57 on right free wall APs and negative likelihoodratio of 0.57 on left free wall, 0.28 on septal and 0.09 on right free wall APs. Conclusion : This new and simple algorithm provide a remarkable accuracy with agood inter observer agreements. Therefore this algorithm is potential to beimplemented in general practice.

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Latar Belakang: Proprotein convertase subtilisin kexin-9 PCSK-9 merupakan protein yang menghancurkan reseptor low density lipoprotein LDL sehingga penurunan kadarnya dapat menurunkan kadar LDL. Sebagai bagian dari pencegahan sekunder, latihan resistensi direkomendasikan pada pasien pasca bedah pintas arteri koroner BPAK. Tujuan: Mengetahui efek tambahan latihan resistensi terhadap kadar PCSK-9 pada pasien pasca bedah pintas arteri koroner yang menjalani rehabilitasi fase II. Metode: Studi eksperimental randomisasi acak tersamar tunggal membagi 87 pasien pasca BPAK menjadi dua kelompok. Kelompok kontrol n=43 adalah pasien yang menjalani rehabilitasi fase II standar sementara kelompok intervensi n=44 adalah pasien yang menjalani rehabilitasi fase II ditambah dengan latihan resistensi tersupervisi. Kadar PCSK-9 diperiksa sebelum dan sesudah rehabilitasi fase II pada kedua kelompok. Hasil: Setelah menyelesaikan rehabilitasi fase II, didapatkan perbedaan kadar PCSK-9 yang bermakna antara kelompok kontrol dan intervensi 377,1 SD 125 vs 316,6 111,1 ng/ml, ?= -60,5 ng/ml, 95 CI -7,5 -113,4, p=0.026. Tidak didapatkan perbedaan bermakna pada kadar LDL p=0,07, kolesterol total p=0,99, high density lipoprotein HDL p=0,44, dan trigliserid p=0,56 antara kedua kelompok pada akhir rehabilitasi fase II. Kesimpulan: Tambahan latihan resistensi dapat menurunkan kadar PCSK-9 secara bermakna pada pasien pasca bedah pintas arteri koroner yang menjalani rehabilitasi fase II. ......Background: Pro protein Convertase Subtilisin Kexin 9 PCSK 9 is a protein degrading low density lipoprotein LDL receptor that lower LDL. As secondary prevention, resistance training is recommended after coronary artery bypass surgery CABG as a complement to aerobic exercise. Objective: To determine the effects of additional resistance training on PCSK 9 levels and lipid profile in post CABG patients who undergo phase II cardiac rehabilitation. Methods: A single blinded randomized clinical trial of 87 post CABG patients was devided into two groups. The control group n 43 consisted of patients who received standard phase II cardiac rehabilitation while intervention group n 44 received standard program and supervised resistance training. PCSK 9 level and lipid profile examination were performed pre and post training. Results: After completion of phase II cardiac rehabilitation, mean PCSK9 levels in intervention group decrease significantly compared to control group control vs intervention, 377,1 SD 125 vs 316,6 111,1 ng ml, 60,5 ng ml, 95 CI 7,5 113,4 , p 0.026 . Nonetheless, there are still no significant changes in terms of LDL level p 0,07 , total cholesterol p 0,99 , high density lipoprotein p 0,44 and triglyseride levels p 0,56 pre and post intervention between two groups. Conclusion: The additional resistance training can reduce significantly PCSK 9 levels in patients after CABG surgery who underwent phase II cardiac rehabilitation.

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Latar belakang: Gagal jantung dekompensasi akut (GJDA) termasuk penyakit kardiovaskular dengan mortalitas serta tingkat readmisi yang tinggi. Resistensi insulin saat ini merupakan salah satu faktor yang dapat menjadi prediktor terhadap prognosis pasien GJDA. Indeks trigliserida glukosa (ITG) telah dilaporkan sebagai salah satu prediktor risiko kardiovaskular dan petanda resistensi insulin yang sederhana. Namun, hubungan ITG terhadap kejadian readmisi 30-hari dan kematian dalam 6 bulan pascarawat pasien GJDA masih belum diteliti. Tujuan: Mengetahui hubungan ITG dengan kejadian readmisi 30-hari dan kematian dalam 6 bulan pascarawat pasien GJDA yang dirawat pertama kali. Metode: Studi dilakukan dengan desain kohort retrospektif. Data subjek diambil dari rekam medis berdasarkan admisi pasien yang memenuhi kriteria inklusi dari Januari 2018 – November 2021. Luaran klinis yang dinilai adalah readmisi 30 hari dan kematian dalam 6 bulan pascarawat. Data tersebut diolah dengan analisis multivariat dan laju kesintasan pada subjek. Hasil: Total subjek dalam penelitian ini adalah 467 orang, dengan 158 subjek mengalami luaran klinis readmisi 30-hari dan kematian dalam 6 bulan pascarawat. Proporsi readmisi sebesar 29% (135 subjek) dan kematian dalam 6 bulan pascarawat sebesar 5% (23 subjek). Analisis multivariat menunjukkan bahwa faktor yang berhubungan dengan luaran klinis readmisi 30- hari adalah hipertensi (p 0.05, HR 1.493, 95% IK 1.019 – 2.187), usia (p 0.013, HR 0.98, 95% IK 0.964 – 0.996), fraksi ejeksi <50% (p 0.016, HR 1.888, 95% IK 1.124 – 3.172), tekanan darah sistolik saat admisi (p 0.012, HR 1.010, 95% IK 1.001–1.017), denyut nadi sebelum pulang (p 0.017, HR 0.989, 95% IK 0.979 – 0.998), gula darah puasa (p 0.017, OR 0.992, 95% IK 0.986 – 0.999), dan nilai ITG ( p <0.001, OR 28.9, 95% IK 10.112 – 83.068). Sedangkan faktor independen terhadap luaran kematian dalam 6 bulan pascarawat adalah tanpa penggunaan diuretik (p 0.02, HR 6.89, 95% IK 2.022 – 23) dan gula darah puasa (p 0.017, OR 0.992, 95% IK 0.986 – 0.999). Kesimpulan: Nilai ITG dapat menjadi prediktor readmisi 30-hari, namun tidak berhubungan dengan luaran kematian dalam 6 bulan pasarawat pada pasien GJDA ......Background: Acute decompensated heart failure (ADHF) is a cardiovascular disease with high mortality and readmission rates. Currently, insulin resistance has been reported to predict prognosis of ADHF patients. Triglyceride glucose index (TyG) has now been proposed as an independent predictor of cardiovascular risk and a simple marker of insulin resistance. However, the association between TyG and 30-days readmission and 6 months mortality after hospitalization remains unclear. Objective: To investigate TyG as a predictor of 30-day readmission and 6 months mortality after hospitalization in ADHF patients. Methods: The study was conducted in a retrospective cohort. Data were taken from medical records based on the admission of patients who met the inclusion criteria from January 2018 – November 2021. The clinical outcomes were 30-days readmission and 6 months mortality. The data were analyzed by multivariate analysis and the survival rate of the subjects. Results: This study included 467 subjects, with 158 subjects have clinical outcomes. The readmission rate is 29% (135 subjects), and 6 month mortality after hospitalization is 5%. Multivariate analysis showed that the factors associated with 30-days readmission were hypertension (p 0.05, HR 1.493, CI 95% 1.019 – 2.187), age (p 0.013, HR 0.98, CI 95% 0.964 – 0.996), ejection fraction <50% (p 0.016, HR 1.888, CI 95% 1.124 – 3.172), systolic blood pressure on admission (p 0.012, HR 1.010, 95% CI 1.001 – 1.017), heart rate predischarge (p 0.017, HR 0.989, CI 95% 0.979 – 0.998), gfsting blood glucose (p 0.017, OR 0.992, CI 95% 0.986 – 0.999), dan TyG (p <0.001, OR 28.9, 95% IK 10.112 – 83.068). Independent factors for 6 months mortality were no diuretic medication (p 0.02, HR 6.89, 95% IK 2.022 – 23) and fasting blood glucose (p 0.017, OR 0.992, 95% IK 0.986 – 0.999). Conclusion: Triglyceride glucose index can predict 30-days readmission, but does not associated with 6-months mortality in ADHF patients.

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ABSTRAK
Latar Belakang. Disfungsi miokardiak subklinis merupakan salah satu konsekuensi berbahaya dari sindrom metabolik, dimana diduga disebabkan oleh resistensi insulin. Kelainan tersebut merupakan kondisi patologis awal, yang berisiko menimbulkan gagal jantung ke depannya. Melalui Two Dimensional-Speckle Tracking Echocardiography 2D-STE dengan parameter Global Longitudinal Strain GLS yang memiliki sensitivitas dan spesifisitas tinggi, disfungsi miokardiak tersebut dapat dideteksi lebih dini. Tujuan Mengetahui hubungan antara resistensi insulin pada sindrom metabolik terhadap disfungsi sistolik VKi subklinis.Metode. Studi ini merupakan studi potong lintang, dengan menggunakan 483 datasekunder dari pegawai RS Jantung Harapan Kita. Dari total data, 119 subjek masuk dalam kriteria inklusi dan eksklusi, yang kemudian dilakukan pemeriksaan GLS.Subjek tersebut terbagi menjadi dua kelompok non resistensi insulin dan resistensi insulin berdasarkan nilai Homeostasis Model Assessment of Insulin Resistance HOMA-IR dengan nilai cut-off 2.0.Hasil. Terdapat perbedaan nilai GLS yang bermakna antara kelompok resistensi insulin dan non resistensi insulin rerata -18.3 SD 3.05 vs -19.7 2.2 , 95 IK -2.39 ndash; -0.37 , p=0.008 . Variabel resistensi insulin memiliki risiko terbesar diikuti variabel trigliserida adjusted OR 2.8, p=0.009 dan 2.4, p=0.03 secara berurutan terhadap disfungsi sistolik VKi subklinis pada sindrom metabolik. Kesimpulan. Resistensi insulin menunjukkan fungsi sistolik VKi yang lebihrendah secara signifikan yang dinyatakan dengan nilai GLS dibandingkan nonresistensi insulin pada sindrom metabolik. Resistensi insulin dan trigliserida adalah petanda independen disfungsi sistolik VKi subklinis diantara komponen sindrom metabolik lain.Kata kunci. resistensi insulin, HOMA-IR, disfungsi sistolik VKi subklinis, GLS,sindrom metabolik, trigliseridaABSTRACT
Background. Subclinical myocardial dysfunction is a dangerous consequence ofthe metabolic syndrome, which is thought to be caused by insulin resistance. Thedisorder is an early pathological condition, which poses a risk of heart failure in thefuture. Through Two Dimensional Speckle Tracking Echocardiography 2D STE with the Global Longitudinal Strain GLS parameters that have high sensitivityand specificity, these myocardial dysfunctions can be detected earlier.Objective. To determine the relationship between insulin resistance in metabolicsyndrome to subclinical left ventricle systolic dysfunction.Methods. A cross sectional study, using 483 secondary data from employees of theNational Heart Center of Harapan Kita. 119 subjects were included in the inclusionand exclusion criteria, which were performed 2D STE with GLS parameter. Thesubjects were divided into two groups of non insulin resistance and insulinresistance based on the value of Homeostasis Model Assessment of InsulinResistance HOMA IR with a cut off value of 2.0.Results. There were significant differences in GLS values between the insulinresistance group and non insulin resistance mean 18.3 SD 3.05 vs 19.7 2.2 ,95 CI 2.39 0.37 , p 0.008 . Insulin resistance have the greatest risk followedby triglyceride levels adjusted OR 2.8, p 0.009 and 2.4, p 0.03 respectively tosubclinical left ventricle systolic dysfunction in the metabolic syndrome.Conclusion. Insulin resistance showed a lower left ventricle systolic function asexpressed by GLS score significantly than non insulin resistance in the metabolicsyndrome. Insulin resistance and triglycerides are an independent marker ofsubclinical left ventricle systolic dysfunction among other components of themetabolic syndrome.

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Latar Belakang : External counterpulsation (ECP) ditunjukkan dapat mengurangi gejala angina dan memperbaiki kualitas hidup pasien penyakit jantung koroner (PJK) dengan angina refrakter. Efek protektif jangka panjang ini dipikirkan merupakan efek dari peningkatan pulsatile shear stress pada endotel vaskular sehingga terjadi perbaikan pada fungsi endotel. Dalam proses ini, sekelompok miRNA berfungsi meregulasi ekspresi gen dan dipengaruhi oleh shear stress, diantaranya adalah miR-92a yang bersifat proatherosklerosis. Tujuan : Mengetahui pengaruh ECP terhadap kadar miR-92a di plasma pada pasien PJK dengan angina refrakter. Metode : Sebanyak 50 pasien PJK dan angina refrakter direkrut dan diacak ke salah satu dari kelompok terapi ECP atau sham (1:1), dan menjalani 35 sesi yang berdurasi 1 jam tiap sesi. Terapi sham serupa dengan terapi ECP namun memberikan tekanan yang jauh lebih rendah. Level miR-92a di sirkulasi diukur di plasma darah sebelum dan sesudah selesai seluruh terapi, kemudian besar perubahan pada kedua kelompok dibandingkan. Hubungan antara keluaran klinis seperti keluhan angina, kapasitas fisik dan ejection fraction (EF) ventrikel kiri dengan kadar miR-92a juga dinilai. Hasil : miR-92a di plasma meningkat bermakna pada kelompok ECP [+5.1 (+4.2 s.d +6.4) menjadi +5.9 (+4.8 s.d +6.4), p value <0.001] dan sham [+5.2 (+4.1 s.d +9.4) menjadi +5.6 (+4.8 s.d +6.3), p value 0.008]. Besar perubahan dan fold changes cenderung lebih besar pada kelompok ECP namun tidak berbeda bermakna secara statistik dibandingkan kelompok sham. Kadar miR-92a post intervensi berkorelasi signifikan dengan rasio diastolik/sistolik selama terapi dan perbaikan EF pasca intervensi. Selain itu, perubahan miR-92a berkorelasi positif dengan perbaikan kapasitas fisik. ......Background : Noninvasive modality External counterpulsation (ECP) can improve angina frequency and exercise capacity in refractory angina (RA) patients. The long term benefit is thought to be the result of increase in shear stress on vascular endothelial cells resulting in improvement of endothelial dysfunction. In this process, a group of miRNA regulating gene expression in relation to shear stress is called flow-sensitive miRNA, among them is miR-92a. Aim : To evaluate ECP effect on plasma miR-92a level in RA patients. Method : Fifty subjects with RA were enrolled and randomized to either one of ECP or sham therapy (1:1 randomization). Each therapy session was one hour, for a total of 35 sessions. As a control, sham gave same sensation as ECP but with lower pressure. Plasma miR-92a level was measured before and after therapy and delta changes was compared between group. Secondary clinical outcome such as angina class, physical capacity and left ventricle Ejection Fraction (EF) were also measured and correlated with miR-92a level. Result : Plasma miR-92a level increased in both treatment groups [in ECP group +5.1 (+4.2 to +6.4) to +5.9 (+4.8 to +6.4), p value <0.001, in sham group +5.2 (4.+1 to 9.4) to +5.6 (+4.8 to +6.3), p value =0.008]. There was higher delta increase and fold changes in ECP group, however the difference did not reach statistically significant. miR-92a level post intervention correlated significantly with Diastolic/Systolic ratio during intervention and improvement in ejection fraction (EF) post intervention. Moreover, changes in miR- 92a correlated positively with improvement in physical capacity. Conclusion : ECP did not cause significant different increase of miR-92a compared to sham.