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"Pendahuluan, Obesitas merupakan masalah epidemic global diseluruh dunia. dan memperlihatkan kecendrungan yang meningkat secara tajam. Prevalensi nasional obesitas di Indonesia sebesar 19,1% dan 18,8% diantaranya adalah obesitas sentral. Obesitas sentral memiliki dampak yang lebih buruk terhadap penyakit degenartif dan kematian. Obesitas sentral dipengaruhi oleh berbagai faktor. Faktor risiko tersebut dapat berkembang sesuai dengan karakteristik masyarakat dan kondisi ekonomi setempat. Sampai saat ini, penelitian mengenai faktor risiko yang berpengaruh di kota maupun kabupaten masih tergolong langka. Metode penelitian, Disain studi yang digunakan dalam penelitian ini adalah cross sectional. Data penelitian adalah data sekunder Riset Kesehatan Dasar tahun 2007 yang diambil dari 440 kabupaten/kota seluruh Indonesia. Unit analisa yang digunakan adalah penduduk usia dewasa dengan rentang umur 20 sampai 64 tahun sebanyak 448.352 individu. Analisa data yang digunakan adalah analisa Regresi Logistik Ganda untuk mendapatkan model prediksi dan nilai OR dilanjutkan dengan uji interaksi multivariat terhadap variabel status kota berdasarkan pertimbangan logika substantif. Hasil penelitian, Prevalensi nasional obesitas sentral populasi dewasa sebesar 23,9%. Dengan prevalensi kota 29,5% dan kabupaten 20,5%. Faktor risiko yang berpengaruh terhadap obesitas sentral dalam model prediksi akhir adalah status kota (OR 1,519) umur (OR 3,314), jenis kelamin (4,480), pendidikan (OR 0,870), aktifitas fisik (OR 1,181), energy total (OR 1,960), Konsumsi karbohidrat (OR 0.860), konsumsi lemak (0,976), perokok (OR 0,616), mantan perokok (0,976) dan alcohol (OR 1,674). Setelah dilakukan uji interaksi terhadap status kota ditemukan bahwa lima variable memiliki interaksi yang bermakna yaitu umur, pendidikan, perokok, karbohidrat dan lemak terhadap status kota. Hal ini mengindikasikan bahwa adanya pengaruh yang berbeda dari kelima variable tersebut di kota dan kabupaten. Sehingga dapat disimpulkan factor risiko obesitas sentral dikota adalah umur diatas 40 tahun (OR 2,309), pendidikan tinggi (OR 1,107) dan karbohidrat berlebih (OR 1,29), sedangkan di kabupaten factor risiko obesitas sentral adalah umur diatas 40 tahun (OR 3,409).

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Introduction, the global epidemic of obesity is a problem worldwide. and showed a tendency to increase significantly. National prevalence of obesity in Indonesia amounted to 19.1% and 18.8% of which were abdominal obesity. Abdominal obesity has a worse impact on degenartif disease and death. Abdominal obesity is influenced by various factors. These risk factors can be developed in accordance with the characteristics of the community and local economic conditions. Until recently, research on risk factors that affect the Urban and district is still relatively rare. Research methods, study design used in this study is cross sectional. The research data is secondary data Health Research Association in 2007 which was taken from the 440 districts throughout Indonesia. Unit of analysis used was the adult population with a lifespan of 20 to 64 years were 448 352 individuals. Analysis of the data used is multiple logistic regression analysis to obtain the model prediction and the value of OR followed by a multivariant interaction test variable logic status of the Urban based on substantive considerations.

Results of research, the national prevalence of abdominal obesity 23.9% of the adult population. With a prevalence of 29.5% and 20.5% district. Factors influencing the risk of abdominal obesity in the final prediction model is the status of the Urban (OR 1.519), age (OR 3.314), gender (4.480), education (OR 0.870), physical activity (OR 1.181), total energy (OR 1.960), Consumption of carbohydrates (OR 0860), consumption of fat (0.976), smoking (OR 0.616), exsmokers (0.976) and alcohol (OR 1.674). After interaction test of the status of the Urban found that five variables had a significant interaction such as age, education, smoking, carbohydrate and fat on the status of the city. This indicates that the influence of five variables that are different from those in the cities and counties. It can be concluded in the city's abdominal obesity risk factors are age above 40 years (OR 2.309), higher education (OR 1.107) and an excess of carbohydrates (OR 1.29), while in districts of abdominal obesity risk factors are age above 40 years (OR 3.409)."

"[ABSTRAKLatar belakang. Angka kejadian akut kardiovaskular diperkirakan akan semakinmeningkat. Pasien dengan Angina APS dapat berkembang menjadi Sindroma Koroner Akut(SKA). Konsep proses inflamasi dan stress oksidatif berperan terhadap patogenesisatherosklerosis. Radikal bebas seperti reactive oxygen atau nitrogen species, dan HOCL(hypochlorous acid) dapat mengakibatkan kerapuhan plak. HOCL merupakan ReactiveOxygen Species (ROS) kuat yang menyebabkan ketidakstabilan plak sehingga mudah ruptur.Plak yang mudah ruptur disebut plak vulnerable. HOCL adalah substrat yang dihasilkan olehmyeloperoxidase (MPO). Studi histopatologi plak vulnerablemenilai ukuran pusat nekrotik adalahprediktor kuat terjadinya ruptur plak (OR 0.35; P <0.05), dan (OR 2.0; P <0.02).CT angiografikoroner adalah suatu modalitas pencitraan non invasif yang mampu memvisualisasimorfologi plak vulnerable salah satunya dengan mengidentifikasi adanya Napkin Ring Sign(NRS). NRS sangat spesifik untuk menilai pusat nekrotik. Studi ini bertujuan melihat hubunganMPO dengan plak vulnerableyang dinilai dengan Napkin Ring Sign pada pasien angina pektorisstabil.Metode. Penelitian ini adalah studi potong lintang yang dilakukan di Pusat Jantung NasionalHarapan Kita dari periode Juni ? November 2014. Studi dilakukan pada 41 subyek, padapasien dengan angina pektoris stabil, jumlah laki ? laki sebanyak 32 orang ( 78%) danperempuan 9 orang (22%), Pengambilan sampel secara konsekutif. Pengukuran kadar MPOdilakukan dengan menggunakan colorimetri assay. Pemeriksaan CT angiografi koronerdilakukan untuk mengidentifikasi NRS.Analisa statistik untuk mencari hubungan antarakadar MPO dengan plak vulnerable yang ditandai dengan NRSpada pemeriksaan CTangiografi koroner.Hasil.Kadar MPO (nmol) pada pasien dengan positif NRS lebih tinggi dibandingkan yangnegatif 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 antarakadar MPO dengan NRS p 0,002, IK 95%2.3,0 - 39,9. Dari multivariat regresi logistikdidapatkan kadar MPO > 117,2 (median), memiliki OR 9,6 (IK 95% 2,3 -39) dengan p0,002. Setelah dilakukan penyesuaian dengan faktor resiko, pada analisa multivariat regresilogistik, didapatkan OR 20,3 (IK 95% 3,1-31,7) dengan p 0,002.Kesimpulan. Kadar MPO memiliki hubungan yang bermakna dengan plak vulnerable yangditandai dengan temuan NRS pada CT angiografi koroner pada pasien dengan APS.Kata kunci : atherosklerosis, plak vulnerable, myeloperoxidase, napkin ring sign.

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ABSTRACTBackground.Coronary Heart Disease ( CHD) is still the major health problem in worldwide.Atherosclerosis is a chronic inflammatory process where oxidative damage play a role inatherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental andweaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactiveoxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaquevulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase(MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidantscontributes 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 subjectswas taken blood sample and underwent CCTA to evaluate NRS in National CardiovascularCenter Harapan Kita from June to November 2014. Statistical analysis is done to explore theassociation between MPO and vulnerable plaque marked with NRS in stable angina pectoris.Results. There was association between MPO level with vulnerable plaque marked withNapkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positifNRS 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 showedlevel of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. Afteradjustment 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 plaquemarked 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 inatherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental andweaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactiveoxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaquevulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase(MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidantscontributes 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 subjectswas taken blood sample and underwent CCTA to evaluate NRS in National CardiovascularCenter Harapan Kita from June to November 2014. Statistical analysis is done to explore theassociation between MPO and vulnerable plaque marked with NRS in stable angina pectoris.Results. There was association between MPO level with vulnerable plaque marked withNapkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positifNRS 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 showedlevel of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. Afteradjustment 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 plaquemarked 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 inatherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental andweaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactiveoxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaquevulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase(MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidantscontributes 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 subjectswas taken blood sample and underwent CCTA to evaluate NRS in National CardiovascularCenter Harapan Kita from June to November 2014. Statistical analysis is done to explore theassociation between MPO and vulnerable plaque marked with NRS in stable angina pectoris.Results. There was association between MPO level with vulnerable plaque marked withNapkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positifNRS 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 showedlevel of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. Afteradjustment 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 plaquemarked with Napkin Ring Sign]"

"Latar belakang: Pasien pascabedah pintas arteri koroner (BPAK) mengalami penurunan fungsi paru akibat inflamasi perioperatif sehingga terjadi ketidakcocokan ventilasi/perfusi dan kelemahan otot pernapasan. Akibatnya saat beraktivitas, terjadi keterbatasan oksigen sehingga terjadi kelelahan otot lebih cepat dan kapasitas fungsional rendah. Latihan pernapasan diharapkan membantu memperbaiki kapasitas fungsional melalui perbaikan fungsi paru. Tujuan: Membuktikan manfaat latihan pernapasan terhadap kapasitas fungsional yang diukur dengan 6 Minutes walk test (6MWT) pada pasien pasca-BPAK yang menjalani rehabilitasi kardiovaskular fase II. Metode: Uji klinis dengan merandomisasi subjek pada kelompok perlakuan yang mendapat adjuvan latihan pernapasan atau menjalani program rehabilitasi standard. Diukur kapasitas inspirasi dan 6MWT pada awal dan akhir rehabilitasi fase II. Hasil: Dua puluh delapan subjek dirandomisasi menjadi 14 kelompok perlakuan dan 14 kelompok standard. Setelah menjalani program rehabilitasi, kelompok perlakuan dan standard mengalami peningkatan jarak 6MWT yang tidak berbeda bermakna (67 ± 62.9 meter VS. 53 ± 65.7 meter; p = 0.556 ) walau kelompok perlakuan mengalami peningkatan kapasitas inspirasi lebih baik daripada kelompok standard (1357 ± 691.4 mL VS 589 ± 411.5 mL; p = <0.001 ). Simpulan: Latihan pernapasan sebagai latihan adjuvan rehabilitasi kardiovaskular fase II pasca-BPAK tidak memperbaiki jarak 6MWT secara bermakna dibandingkan program rehabilitasi standard, hanya mempercepat perbaikan fungsi paru.

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Background : Patients undergoing coronary artery bypass graft (CABG) surgery develop pulmonary dysfunction due to inflammation and respiratory muscle weakness, hence ventilation/perfusion mismatch occurs then leads to low functional capacity. Respiratory training has been identified to improve functional capacity by recovering pulmonary function faster.

Objectives : To study respiratory training benefit as adjuvant training in 2 phase of cardiovascular rehabilitation program after CABG for improving functional capacity measured by 6 minutes walk test/6MWT distance.

Methods : This single blind clinical trial randomized subjects into intervention group or standard group. Intervention group received respiratory training up to 60% of maximum inspiratory volume (MIV) as an adjuvant to the standard program. Then MIV and 6MWT distance were evaluated.

Result : Twenty eight subjects participated, 14 subjects were in intervention group and others were in standard group. Six MWT distance improvement is not significantly different between groups (67 ± 62.9 VS. 53 ± 65.7 meters respectively; p = 0.556 ). However, intervention group experienced better MIV improvement compared to standard group (1357 ± 691.4 VS. 589 ± 411.5 mL; p = <0.001 ).

Conclusion : Respiratory training as adjuvant training did not improve 6MWT distance among patients undergoing CABG surgery significantly."

"ABSTRAKLatar Belakang. Salah satu penyakit jantung bawaan (PJB) yang kompleks adalah terdapatnya satu ventrikel yang fungsional. Tatalaksana yang dilakukan untuk kelainanini adalah dengan operasi Fontan. Efusi pleura merupakan salah satu komplikasi yang sering terjadi setelah operasi Fontan. Peningkatan tekanan akhir diastolik ventrikelsistemik (TADVS) sebelum operasi diduga turut berperan dalam terjadinya efusi pleura paska operasi Fontan.Metode. Studi potong lintang dilakukan terhadap populasi yang sudah dilakukan operasi Fontan dengan ekstrakardiak konduit dan fenestrasi di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) periode April 2006 sampai dengan April 2016. Durasi efusi pleura berdasarkan pada lama terpasangnya selang (drain) intrapleurasetelah operasi Fontan. Lama rawat adalah lama rawat setelah operasi Fontan. Data studi diambil dari rekam medik.Hasil. Populasi studi penelitian sebanyak 63 pasien dengan nilai rerata TADVS adalah 9,7 mmHg dengan standar deviasi ± 2,8 mmHg. Efusi pleura terjadi pada semua pasien dengan nilai tengah 9 hari (2-54 hari), dengan 43 pasien (68,3%) yang > 7 hari. Nilai tengah lama rawat adalah 20 hari (8-58 hari). Uji korelasi Spearman menunjukkan tidak terdapat korelasi bermakna antara TADVS dengan lama efusi pleura sesudah operasi (p = 0,548, r = -0,077) dan lama rawat (p = 0,843, r = -0,025). Analisis bivariat menunjukkan 2 variabel yang mempunyai korelasi bermakna terhadap lama efusi pleura yaitu dominanventrikel kanan (p = 0,014) dan waktu CPB (p = 0,003), kemudian terdapat 5 variabel berkorelasi bermakna terhadap lama rawat yaitu waktu CPB (p = 0,023), aritmia sesudah operasi (p = 0,021), lama aritmia sesudah operasi (p = 0,009), infeksi sesudah operasi (p = 0,000), kadar albumin sesudah operasi (p = 0,005) dan lama efusi pleura sesudah operasi (p = 0,000).Kesimpulan. Tidak terdapat korelasi bermakna antara TADVS sebelum operasi Fontan dengan lama efusi pleura sesudah operasi dan lama rawat.

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ABSTRACT

Background: Congenital Heart Disease (CHD) is a major congenital disease. One of the most common is a CHD that only have single functional ventricle. Management for this disease is Fontan operation. Pleural effusion is one of the most common complication after operation. Elevated systemic ventricle end diastolic pressure (SVEDP) will increase pulmonary vein pressure, pulmonary artery pressure, and pleural vein pressure consecutively that leads to pleural effusion.

Goals: To correlate between SVEDP before Fontan operation with post operative pleural effusion duration and length of stay.

Methods: Cross sectional study was performed to patients who underwent Fontan operation extra cardiac conduit and fenestration at National Cardiac Centre Harapan Kita

(NCCHK) from April 2006 to April 2016. Pleural effusion duration was based on chest tube indwelling time after operation. Length of stay was days the patient hospitalized after operation. Baseline characteristic of the patients were obtained from medical records.

Results: Subjects were 63 patients who fulfilled the criteria. Mean SVEDP was 9.7 mmHg with standard deviation of ± 2.8 mmHg. Pleural effusion occurred to all subjects

ranged 2-54 days (median 9 days), in which 43 patients (68.9%) more than 7 days. Length of stay after operation ranged 8-58 days (median 20 days). Spearman correlation

test showed no correlation between SVEDP with post operative pleural effusion duration (p = 0.548, r = -0.077) and length of stay (p = 0.843, r = -0.025). Bivariate analysis showed correlation between right ventricle domination and CPB time to pleural effusion

duration with p = 0.014 and p = 0.003 respectively, whereas factors that correlate to length of stay after operation were CPB time (p = 0.023), post operative arrhythmia (p = 0.021), post operative arrhythmia duration (p = 0.009), post operative infection (p =

0.000), post operative albumin level (p = 0.005) and post operative pleural effusion duration (p = 0.000).

Conclusions: There is no correlation between SVEDP before Fontan operation with post operative pleural effusion duration and length of stay."

"Latar Belakang : Pasien infark miokard akut dengan elevasi segmen ST IMAEST yang mengalami revaskularisasi dengan intervensi koroner perkutan primer IKPP dapat terjadi cedera reperfusi yang mempengaruhi prognosis. Penelitianpada model hewan menunjukkan ticagrelor melindungi jantung dari cederareperfusi, namun demikian belum ada penelitian pada manusia yang menguji halini. Tujuan : Membandingkan pengaruh antara ticagrelor dengan clopidogrelterhadap cedera reperfusi yang diukur melalui kadar puncak high sensitivetroponin T hs-cTnT pada pasien IMA-EST yang mengalami revaskularisasi. Metode : Penelitian ini merupakan penelitian eksperimental acak tersamar gandayang dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita padabulan Agustus 2016 sampai November 2016. Pasien IMA-EST yang akanmenjalani IKPP dirandomisasi ke dalam dua kelompok yaitu kelompok yangmendapatkan loading ticagrelor 180 mg dilanjutkan dosis rumatan 2x90 mg danyang mendapatkan loading clopidogrel 600 mg dilanjutkan dosis rumatan 1x75mg sebelum IKPP. Dilakukan pemeriksaan hs-cTnT 8 jam pasca dilatasi balonkateter pertama. Hasil Penelitian : Terdapat total 60 subyek, 30 subyek kelompok ticagrelor dan30 subyek kelompok clopidogrel. Tidak ditemukan perbedaan bermakna antaraticagrelor dengan clopidogrel terhadap kadar puncak hs-cTnT 9026 5026 ng/Lvs 9329 4664 ng/L, nilai p 0,809. Kesimpulan : Ticagrelor tidak menyebabkan kadar puncak high sensitivetroponin T yang lebih rendah bila dibandingkan dengan clopidogrel pada pasienIMA-EST yang mengalami revaskularisasi.

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Background : Reperfusion injury influence prognosis in ST elevation myocardialinfarction STEMI patients after primary percutaneous coronary intervention PPCI . Previous study on animal models showed that ticagrelor may haveprotective effect on the heart by reducing reperfusion injury. However, no studyon humans has ever been done to confirm this.

Aim : To compare the effect of ticagrelor with clopidogrel on reperfusion injurycalculated by peak high sensitive troponin T hs cTnT in STEMI patients whounderwent revascularization.

Methods : This was a randomized controlled trial done in NationalCardiovascular Center Harapan Kita from August 2016 to November 2016.STEMI patients who underwent PPCI was randomized to either ticagrelor loadingdose 180 mg with maintenance of 2x90 mg or clopidogrel loading dose 600 mgwith maintenance of 1x75mg group. Peak hs Troponin T was measured 8 hoursafter first balloon dilatation.

Results : Sixty subjects was included in the study, 30 subjects in the ticagrelorgroup and 30 subjects in the clopidogrel group. There were no difference betweenticagrelor vs clopidogrel on peak hs cTnT levels 9026 5026 ng L vs 9329 4664 ng L, p value 0,809.

Conclusion : Ticagrelor does not cause a lower peak high sensitive troponin Tlevel compared to clopidogrel in STEMI patients who underwentrevascularization."

"Latar belakang: Program rehabilitasi jantung pada pasien pasca bedah pintas arterikoroner BPAK dapat dilaksanakan baik di rumah sakit maupun di luar rumah sakit,dimana hambatan utama pada program rehabilitasi di rumah sakit adalah jarak tempattinggal yang jauh. Mengingat kesulitan ini, untuk meningkatkan jangkauan pelayananprogram rehabilitasi jantung perlu dikembangkan ke arah program latihan mandiri dirumahdengan menggunakan pemantauan jarak jauh / telemonitor elektrokardiografi Tele-EKG .Pemantauan ini diharapkan dapat meningkatkan kepatuhan pasien terhadap programlatihan mandiri dirumah. Tujuan: Menilai efek pemantauan jarak jauh untuk meningkatkan kepatuhan pasien pascaBPAK yang menjalani program latihan mandiri. Metode: Pasien BPAK yang masuk kriteria inklusi dirandomisasi dan dibagi dua kelompok dengan dan tanpa alat pemantauan jarak jauh . Dilakukan dua kali uji latih treadmilldengan metode bruce, yaitu setelah kedua kelompok menyelesaikan program rehabilitasifase II dirumah sakit sebagai baseline, dan setelah latihan dirumah selama 12 minggupasca-intervensi sebagai evaluasi akhir program. Selanjutnya dilakukan analisis statistikantara kedua kelompok untuk melihat pengaruh pemantauan jarak jauh terhadap kepatuhanprogram latihan mandiri. Hasil penelitian: Sebanyak 44 pasien diikut sertakan pada penelitian ini. Dari hasilevaluasi, tidak didapatkan tingkat kepatuhan yang lebih baik antara kelompok intervensi n= 20 dan kontrol n = 24 95 vs 70,8 ; p = 0,054 , demikian pula peningkatan durasidan kapasitas aerobik uji latih [ 57,90 81,14 detik vs 21,67 61,22 detik; p = 0,099 , dan 0,77 1,19 METs vs 0,33 1,05 METs; p = 0,193 ]. Kesimpulan: Pasien pasca bedah pintas arteri koroner yang menjalani program latihanmandiri dengan pemantauan jarak jauh tidak mempunyai kepatuhan yang lebih baikterhadap program latihan mandiri.

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Background: Cardiac rehabilitation CR program in patient who had coronary artery bypass surgery CABG surgery could be institution based or home based, but there were many barriers for home based CR program that influence the patient's adherence to the program. As an effort to overcome the barrier of distance, confidence, and safe feeling, electrocardiography telemonitoring ECGTM could be used But there wes no data regarding the effect of the electrocardiography telemonitoring to the adherence to the home based CR program in Indonesia.

Aim: To assess the effect of electrocardiography telemonitoring to the adherence to homebased CR program for the patients who have had CABG surgery.

Methods: Patients after having CABG surgery in National Cardiovascular Center Harapan Kita Jakarta who have finished phase II CR program were recruited consecutively and were radomized to the intervention group which used ECGTM and to the control group which did not use ECGTM for 3 months home based CR program. Home based exercise was based on the result of exercise stress testing using Bruce Protocol. Adherence was defined as compliance to the minimum of 3 sessions per week for 12 weeks CR program.

Results: A total of 44 patients completed the study, The adherence to the CR program of the intervention group n 20 and control group n 24 was not different 95 vs 70,8 p 0.054 , and neither was the exercise testing duration 57.9 81.1 vs 21.7 61.2 seconds, p 0.099 , and the improvement of functional capacity 0.77 1.2 vs 0.33 1.05 METS, p 0.193.

Conclusion: The aplication of electrocardiography telemonitoring did not increase the patients adherence to home based CR program."

"Latar Belakang: Hipertrofi ventrikel kiri VKi merupakan adaptasi kardiak pada hipertensi dan meningkatkan risiko gagal jantung diastolik. Hipertrofi VKi sering ditemui pada gagal jantung diastolik, namun hubungan hipertrofi VKi dengan kapasitas fungsional dan parameter disfungsi diastolik masih kontroversi. Tujuan: Menilai korelasi IMVKi dengan kapasitas fungsional, perubahan parameter diastolik, dan global longitudinal strain GLS pada pasien hipertensi laki-laki asimptomatik dengan hipertrofi VKi. Metode: Pasien hipertensi laki-laki asimptomatik dengan IMVKi>115 gr/m2 tanpa masalah koroner, aritmia, penyakit jantung bawaan, dan penyakit jantung katup masuk kriteria studi. Uji latih ergocycle menggunakan protokol ramp. Akuisisi IMVKi pada awal uji dan pengukuran parameter diastolik E/A, E/e rsquo;, IVRT dan GLS pre dan puncak uji. Hasil: Terdapat 41 subjek dengan usia 55 32-64 tahun. Median nilai IMVKi subjek 129 116-319 gr/m2, dengan rerata kapasitas fungsional 5,7 1 METs. parameter diastolik pre dan puncak uji latih beban tidak berbeda bermakna. Rerata GLS pre uji rendah namun berbeda bermakna pada puncak uji latih pre vs puncak: -15,4 vs 18,5 ; p

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Backgrounds: Left Ventricular Hypertrophy LVH is an adaptation on hypertension and increases diastolic heart failure risk. LVH are common in diastolic heart failure. Prior studies showed various results on correlation Left ventricular mass index LVMI, with functional capacity and diastolic parameters.

Objectives: To assess correlations of LVMI with functional capacity, diastolic parameters changes, and global longitudinal strain GLS in male asymptomatic hypertensive patients with LVH.

Methods: Male asymptomatic hypertensive patients with LVMI 115 gr m2 without history of CAD, arrhythmia, congenital, and valvular heart disease are recruited. Stress test use ramp protocol. Initial LVMI is acquired, and diastolic parameters E A, E e, IVRT and GLS are acquired at pre and peak stress test.

Results: Forty one patients were recruited aged 55 32 64 years old. The median of LVMI was 129 gr m2 and mean functional capacity was 5,7 METs. Pre and peak stress test diastolic parameter values were insignificant. Pre stress test GLS mean was low but increased at peak pre vs peak 15,4 vs 18,5 p"

"Latar Belakang : Deteksi adanya penyakit jantung koroner PJK pada pasien bradikardi simptomatik yang memerlukan pemasangan pacu jantung permanen perlu diketahui secara dini. Saat ini penggunaan modalitas canggih seperti kateterisasi jantung dan CT kardiak menjadi pilihan utama dalam deteksi adanya PJK pada pasien blok nodus atrioventrikular AV total namun dengan risiko dan biaya yang masih relatif mahal. Gambaran fragmentasi kompleks QRS fQRS pada elektrokardiografi berkaitan dengan adanya jaringan parut atau iskemia pada miokard, namun belum ada studi sebelumnya yang menghubungkan fQRS dengan PJK pada pasien blok nodus AV total yang akan dilakukan pemasangan pacu jantung permanen. Tujuan : Mengetahui hubungan antara fragmentasi kompleks QRS dengan penyakit jantung koroner pada pasien dengan blok nodus AV total yang memerlukan pemasangan pacu jantung permanen. Metode : Penelitian ini merupakan studi analitik kasus kontrol dengan menggunakan data sekunder rekam medis pasien blok nodus AV total yang sudah dilakukan tindakan pemasangan pacu jantung permanen dan angiografi koroner di Rumah Sakit PJN Harapan Kita. Penelitian dilakukan pada bulan April-Agustus 2017. Dilakukan pencatatan karakteristik pasien, faktor-faktor yang diketahui mempengaruhi kejadian PJK serta hasil pemeriksaan ekokardiografi dan angiografi koroner. Pembacaan ekg dilakukan oleh dua orang spesialis jantung dan pembuluh darah konsultan di divisi aritmia. Hasil : Total sampel penelitian ini adalah 46 sampel yang terdiri atas 23 kasus dan 23 kontrol. Gambaran fQRS pada pasien blok nodus AV total menunjukkan kecenderungan 2,4 kali mengalami PJK dibandingkan dengan yang tanpa fQRS, walaupun secara statistik memperlihatkan hasil yang tidak bermakna OR = 2,4; p = 0,236 . Hasil uji Kappa menunjukkan kesepakatan yang baik kedua observer dengan nilai Kappa inter-observer 0,487 serta intra-observer 0,737 dan 0,783. Kesimpulan : Fragmentasi kompleks QRS pada pasien blok nodus AV total memiliki kecenderungan 2,4 kali untuk prediksi PJK namun tidak bermakna secara statistik.Kata Kunci : Fragmentasi kompleks QRS, penyakit jantung koroner, blok nodus AV total, pacu jantung permanen

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Background Detection of coronary artery disease CAD in symptomatic bradycardia patients requiring permanent pacemaker implantation should be known early. Currently the use of advanced modalities such as cardiac catheterization and cardiac CT are the primary choice in detection of CAD in total atrioventricular blok patients with relatively high cost and risk. The description of fragmented QRS complex fQRS in electrocardiography associated with the presence of ischemia or scar in the myocardium that can be an alternative detection of CAD in patients with total AV block requiring permanent pacemaker implantation. Objectives To determine the relationship between fragmented QRS complex and coronary artery disease in patients with complete atrioventricular AV nodal block requiring permanent pacemaker implantion. Methods This study is an analytic study of case control using secondary data of medical record of complete AV block patients who have performed permanent pacemaker and coronary angiography at PJN Harapan Kita hospital. The study was conducted in April Agustus 2017. Recorded patient characteristics, factors known to influence CAD events as well as results of echocardiography and coronary angiography. The EKG readings were performed by two cardiologist consultants in the arrhythmia division. Results The total sample of this study was 46 consisting of 23 case and 23 control. The description of Fqrs in patients with total AV nodal block showed a trend of 2.4 times for CAD prediction compared with those without Fqrs, although statistically showed a non significant OR 2.4 p 0.236 . Kappa test results showed good agrreement both observers with Kappa inter observer value 0.487 and intra observer 0.737 and 0.783. Conclusion Fragmented QRS complex in patients with complete AV nodal block had a tendency of 2.4 times for CAD prediction but statistically not significant. "

"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. "