Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
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.

---

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 :
ABSTRAK
Latar Belakang. Sindrom Brugada diketahui menjadi penyebab dari setidaknya 4 dari seluruh kematian mendadak dan 20 dari kematian mendadak pada struktur jantung normal. Saat ini, hanya pola EKG Sindrom Brugada tipe 1 yang bersifat diagnostik sedangkan pola tipe 2 dan 3 tidak diagnostik. Sudut > 580 memiliki nilai diagnosis yang baik pada populasi dengan EKG pola Brugada tipe 2 dan 3. Penelitian ini bertujuan untuk mengetahui apakah parameter tersebut mempunyai hubungan dengan kejadian aritmia pada pasien Sindrom Brugada tipe 2 dan 3.Metode. Studi kasus kontrol ini dilakukan terhadap 29 subjek dengan EKG pola Brugada tipe 2 dan 3 di RS Pusat Jantung dan Pembuluh Darah Harapan Kita RSPJDHK dari periode November 2013 - 2017. Tiga belas subjek dengan riwayat kejadian aritmia menjadi kelompok kasus dan 16 subjek tanpa kejadian aritmia menjadi kelompok kontrol. Data primer yang diambil antara lain riwayat henti jantung mendadak, TV/FV yang terdokumentasi, riwayat sinkop dengan kecurigaan etiologi aritmia dan riwayat pada keluarga serta interogasi data defibrillator kardioverter implan DKI pada subjek yang terpasang DKI. Data sekunder berupa data EKG yang kemudian dilakukan pengukuran sudut pada sadapan prekordial kanan oleh 2 penilai lalu dilakukan analisis statistik.Hasil. Pengukuran sudut oleh 2 penilai tidak terdapat perbedaan bermakna dengan nilai Cronbach rsquo;s Alpha 0,93. Analisa statistik menunjukkan tidak didapatkan perbedaan proporsi yang bermakna antara sudut > 58o terhadap kejadian aritmia pada kedua kelompok kasus dan kontrol. Dilakukan analisis korelasi, terlihat korelasi positif antara sudut r=0,50, p 58o dengan kejadian aritmia pada Sindrom Brugada. Terlihat korelasi positif antara sudut dengan kejadian aritmia namun hal ini masih diperlukan studi lebih lanjut.Kata kunci : sudut , sindrom Brugada.

---

ABSTRACT
Brugada syndrome is known to be the cause of at least 4 of all sudden deaths and 20 of sudden deaths in structurally normal hearts. To this day, only type 1 Brugada Syndrome ECG pattern is diagnostic, while type 2 and 3 are not. A angle ge 58o has a good diagnostic value in population with Brugada ECG pattern type 2 and 3. This study aims to evaluate whether this parameter is associated with arrhythmic events in patients with Brugada Syndrome type 2 and 3.Methods. This case control study is carried out towards 29 subjects with Brugada ECG pattern type 2 and 3 in National Cardiovascular Center Harapan Kita NCCHK from November 2013 until November 2017. Thirteen subjects with history of arrhythmic events make up the case group while 16 subjects without arrhythmic events make up the control group. Primary data acquired was history of sudden cardiac arrest, documented VT VF, history of syncope suspected of arrhythmic origin and family history, and also interrogation data from implantable cardioverter defibrillator ICD in subjects with ICD. Secondary data were ECG data, from which angle was measured in the right precordial leads by two observers, and then statistical analysis was carried out.Results. From angle measurement by two observers, there was not a significant difference with Cronbach rsquo s Alpha of 0,93. Statistical analysis showed no significant association between a angle ge 58o and arrhythmic events. Correlation analysis was carried out, and a positive correlation was shown r 0,50, p

Abstrak :
ABSTRAK
Latar belakang: Hipertensi tak hanya berkaitan dengan disfungsi diastolik ventrikel kiri, namun juga disfungsi sistolik ventrikel kiri. Pemeriksaan speckle tracking echocardiography STE dapat digunakan untuk menilai disfungsi sistolik dan diastolik ventrikel kiri lebih awal. Tujuan: Mengetahui adanya perbedaan fungsi intrinsik ventrikel kiri pada populasi HT terkontrol dibandingkan populasi hipertensi yang tidak terkontrol Metode: Studi potong lintang dengan 119 subyek HT yang terdiri dari 59 subyek dengan HT tak terkontrol dan 60 subyek HT terkontrol, dilakukan pemeriksaan STE dengan parameter Global Longitudinal Strain GLS untuk menilai fungsi sistolik dan strain rate untuk menilai fungsi diastolik. Hasil: Terdapat perbedaan GLS yang bermakna pada kelompok HT tak terkontrol dibandingkan HT terkontrol -19,77 3,10 vs -23,85 2,25 , p.

---

ABSTRACT
Hypertension HT is associated with left ventricle LV diastolic and systolic dysfunction, even in patient with normal ejection fraction. Speckle tracking echocardiography STE has a high sensitivity in evaluating LV systolic and diastolic dysfunction. Objective To asses the difference of intrinsic left ventricle function between controlled HT and controlled HT. Methods Cross sectional study with 119 subjects consisting of 59 uncontrolled HT subjects and 60 controlled HT subjects, underwent STE study with global longitudinal strain GLS as a parameter to asses LV systolic function and strain rate as a parameter to asses LV diastolic function. Results There is a significant difference of GLS between uncontrolled and controlled HT 19,77 3,10 vs 23,85 2,25 , p

Abstrak :
Penyakit Jantung Bawaaan (PJB) Tetralogy of Fallot (TOF) merupakan PJB sianotik (biru) terbanyak. Tatalaksana definitif operasi sedini mungkin. Hampir semua pembiayaan menggunakan BPJS Kesehatan berdasarkan tarif INA-CBG. Adanya selisih negatif tarif INA-CBG tahun 2016 dengan tagihan perawatan operasi TOF menyebabkan banyak rumah sakit tidak mengoperasi dan merujuk ke RSJPD Harapan Kita. Dengan adanya tarif INA-CBG terbaru tahun 2023 yang mengalami kenaikan, diperlukan penelitian apakah terdapat selisih negatif. Perlu dianalisa faktor yang berhubungan dengan tagihan perawatan serta kepatuhan Clinical Pathway (CP) TOF. Penelitian observasional deskriptif cross sectional mengambil sampel pasien perawatan operasi total koreksi TOF tahun 2022 sejumlah 82 pasien. Hasil penelitian didapatkan sebagian besar usia ≥1 tahun, perempuan, status gizi normal, ada diagnosa sekunder, severitas PPK I (ringan) dan INA-CBG II (sedang), tidak ada komplikasi, kelas III, median lama CPB 103,5 menit dan AoX 55 menit, lama rawat post operasi 6 hari dan total 8 hari. Faktor yang berhubungan dengan tagihan perawatan adalah komplikasi, kelas rawat dan lama rawat CP. Hal yang belum sesuai dengan CP TOF yaitu lama rawat, pemeriksaan laboratorium, radiologi, pemakaian obat, alkes dan BMHP. Masih terdapat selisih negatif antara total tagihan perawatan pasien operasi total koreksi TOF tahun 2022 dengan total tarif INA-CBG terbaru tahun 2023. ......Tetralogy of Fallot (TOF) is the most common cyanotic Congenital Heart Disease (CHD). Definitive management is surgery earliest as possible. Almost all financing uses BPJS Kesehatan based on INA-CBG rate. Negative difference between the 2016 INA-CBG rates and TOF surgery treatment bill make many hospitals not operating and refering to Harapan Kita Hospital. With increasing in the latest 2023 INA-CBG rates, research for negative difference is needed. Analyzing factors related to care bills and adherence to TOF Clinical Pathway (CP) is studied too. This cross-sectional descriptive observational study took a sample of 82 patients undergoing TOF total  correction in 2022. Results showed that most were aged ≥1 year, female, normal nutritional status, had secondary diagnoses, severity of PPK I (mild) and INA-CBG II (moderate), no complications, class III, median duration of CPB 103.5 minutes and AoX 55 minutes, length of postoperative care 6 days and total of 8 days. Factors related to treatment bills are complications, class of care and CP length of care. Things not in accordance with the TOF CP are length of stay, laboratory, radiology, drug, medical equipment and BMHP use. There is still negative difference between the 2022 TOF total correction treatment patient bills and the latest 2023 INA-CBG rate.

Abstrak :
Latar belakang: Aritmia ventrikular idiopatik, baik kompleks ventrikel prematur (KVP) maupun takikardia ventrikel (TV), dapat menyebabkan terjadinya penurunan fungsi sistolik ventrikel kiri (VKi) yang akan menimbulkan kardiomiopati dan meningkatkan mortalitas. Banyak faktor yang berkontribusi menyebabkan terjadinya kardiomiopati akibat KVP (KA-KVP) meskipun mekanisme terjadinya belum sepenuhnya dipahami. Variasi sirkadian KVP dilaporkan berhubungan dengan terjadinya penurunan fraksi ejeksi VKi. Deteksi dini adanya disfungsi sistolik intrinsik Vki dapat dilakukan melalui pemeriksaan speckle tracking ekokardiografi dengan mengukur nilai global longitudinal strain (GLS). Sampai saat ini belum diketahui apakah variasi sirkadian KVP berhubungan dengan penurunan fungsi sistolik intrinsik ventrikel kiri. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara variasi sirkadian aritmia ventrikular idiopatik dengan fungsi sistolik intrinsik ventrikel kiri melalui speckle tracking ekokardiografi. Metode: Penelitian ini adalah studi potong lintang dengan total subjek 67 pasien (17 laki-laki [25,4%]; usia rata-rata 46.5 + 9.8 tahun; fraksi ejeksi ventrikel kiri 63,2% + 7,5%) dengan KVP yang berasal dari jalur keluar ventrikel dari pemeriksaan elektrokardiogram 12 sadapan. Semua pasien menjalani pemeriksaan Holter monitoring 24 jam dan speckle tracking ekokardiografi. Dilakukan perhitungan variasi sirkadian beban KVP dan nilai global longitudinal global (GLS) kemudian dilakukan analisis statistik untuk menilai hubungan kedua variabel tersebut. Hasil: Sebanyak 31 pasien (46.3%) mengalami gangguan fungsi sistolik Vki (GLS lebih buruk dari -18%). Pasien dengan gangguan fungsi sistolik VKi memiliki GLS yang kurang negatif (-15.1% + 1.8% vs -21.3% + 2.0%; p=<0,001), beban KVP yang lebih tinggi (22.2% + 11.1% vs 13.9% + 8.3; p=0,001), variasi sirkadian beban KVP yang rendah (koefisien variasi beban KVP per 6 jam 26.8% + 15.6 vs 52.0 % + 28.2%; p=<0,001), dan episode TV non-sustained yang lebih sering (10 pasien [76.9%] vs 3 pasien [23.1%]; p=0,019). Sebanyak 70.6% pasien dengan jenis kelamin laki-laki mengalami gangguan disfungsi sistolik VKi (p=0,002). Pada analisis multivariat didapatkan beberapa prediktor terhadap gangguan fungsi sistolik Vki antara lain variasi sirkadian beban KVP yang rendah dengan [(koefisien variasi beban KVP per 6 jam < 35%), odds ratio (OR)=3.89 interal kepercayaan (IK)95%=1.09-13.80 p=0.036], episode TV non-sustained (OR=14.4, IK 95%=2.36-88.55, p=0.008), beban KVP > 9% (OR=6.81, IK 95%=1.35-34. Kesimpulan: Variasi sirkadian aritmia ventrikular idiopatik yang rendah berhubungan dengan penurunan fungsi sistolik intrinsik ventrikel kiri melalui speckle tracking ekokardiografi. Variasi sirkadian beban KVP per 6 jam < 35% memiliki risiko 3.89 kali lebih tinggi untuk terjadinya disfungsi sistolik ventrikel kiri ......Background: Idiopathic ventricular arrhythmias (AVI) including premature ventricular complex (PVC) or ventricular tachycardia (VT) can cause left ventricular (LV) dysfunction which may lead to cardiomiopathy. The mechanisms of this cardiomyopathy remain elusive, many factors are believed to contribute. PVC burden is influenced by circadian rhythmicity and lack of PVC circadian variability was proposed as one mechanism of LV dysfunction. Since early detection of LV systolic dysfunction can be done by speckle tracking echocardiography examination, further studies are needed to assess intrinsic left ventricular systolic function and its correlation with PVC circadian variation in patients with idiopathic ventricular arrhythmias. Objective: This study aimed to investigate the correlation between circadian variation of IVA and left ventricular intrinsic systolic function assessed by speckle tracking echocardiography. Methods: The subjects of this cross sectional study were 67 consecutive patients (17 men [25.4%]; mean age 46.5 + 9.8 years; left ventricular ejection fraction 63.2% + 7.5%) with PVC originated from ventricular outflow tract based on 12 lead electrocardiogram. All patients underwent 24-hour Holter monitoring and speckle tracking echocardiography examinations. The circadian variation of PVC burden and global longitudinal strain (GLS) were determined and statistical analysis was conducted to evaluate their correlation. Results: A total 31 patients (46.3%) had impaired LV systolic function by GLS ( worse than -18%). Patients with impaired LV systolic function had a less negative GLS (-15.1% + 1.8% vs -21.3% + 2.0%; p=<0.001), a higher PVC burden ((22.2% + 11.1% vs 13.9% + 8.3; p=0,001), less variation in circadian PVC distribution (coefficient of variation 6 hourly 26.8% + 15.6 vs 52.0 % + 28.2%; p=<0.001), and more frequent episode of non-sustained VT (10 patients [76.9%] vs 3 patients [23.1%]; p=0.019). Total 70.6% patient with male gender experienced impaired LV systolic function (p=0.002). Independent predictors for impaired systolic LV function were less variation in circadian PVC distribution [(coeficient of variation < 35%), odds ratio (OR)=3.89, 95% confidence interval (CI)= 1.09-13.80, p=0.036)], episode of non-sustained VT (OR=14.4, 95%CI=2.36-88.55, p=0.008), PVC burden > 9% (OR=6.81, CI 95%=1.35-34.41, p=0.020), and male gender (OR=14.4, CI 95%=2.02-101.1, p=0.004). Conclusion: Lack of circadian variation of IVA is associated with impaired LV systolic function by GLS. Coefficient of variation PVC burden < 35% has 3.89 times higher risk for development of left ventricular systolic dysfunction.

Abstrak :
ABSTRAK
Latar Belakang: Manuver vagal merupakan usaha lini pertama yang dilakukan pada pasien takikardia supraventrikel untuk mendapatkan konversi irama. Studi sebelumnya menunjukkan pemanjangan interval AH pada manuver Valsava. Mekanisme elektrofisiologi yang mendasari peningkatan efektifitas keberhasilan manuver Valsava termodifikasi belum diketahui dengan pasti. Tujuan: Mengetahui mekanisme elektrofisiologis yang mendasari keberhasilan peningkatan efektifitas manuver Valsava termodifikasi pada praktek klinis dibandingkan manuver Valsava standar. Metode: pasien takikarida supraventrikular TSV yang menjalani studi elektrofisiologi dan/atau ablasi radiofrekuensi di RS Jantung dan Pembuluh Darah Harapan Kita dengan irama sinus. Pasien dilakukan induksi TSV sebelum dimulai prosedur, kemudian dilakukan manuver Valsava standar dan manuver Valsava termodifikasi secara crossover dan dievaluasi data elektrofisiologi termasuk interval AH selama 1 menit Hasil: Dari 16 pasien TSV didapatkan rerata Dinterval AH fase 4 manuver Valsava standar sebesar 10,6 28,6 ms dan Dinterval AH fase 4 manuver Valsava termodifikasi sebesar 35 27,6 ms dibandingkan kondisi pre-manuver sehingga terdapat peningkatan yang bermakna pada Dinterval AH sebesar 24,4 27,6 ms p=0,003 pada manuver Valsava termodifikasi dibanding manuver Valsava standar. Kesimpulan : Terdapat peningkatan respon vagal pada manuver Valsava termodifikasi yang digambarkan oleh pemanjangan interval AH yang lebih besar pada manuver Valsava termodifikasi dibandingkan manuver Valsava standar.

---

ABSTRACT<>br> Background Vagal maneuver is a first line treatment for patient with stable supraventrikular tachycardia. Previous study showed prolongation of AH interval in Valsava maneuver. The electrophysiological mechanism of modified Valsava manuerver is not well understood. Objective To understand the electrophysiological mechanism of modified Valsava maneuver in SVT patient. Method Patient with supraventricular tachycardia SVT scheduled for electrophysiological study and or ablation procedure in National Cardiovascular Centre Harapan Kita NCCHK . SVT was induced in these patient and pre manuever data was collected, then standard Valsava and modified Valsava was performed with crossover design. Electrophysiological and hemodynamic data was then analyzed up to 1 minute after the maneuvers. Result From 16 SVT patients, DAH interval in phase 4 of standard Valsava maneuver was 10,6 28,6 ms dan DAH interval in phase 4 of modified Valsava maneuver was 35 27,6 ms compared to pre manuever data. Significant increase of 24,4 27,6 ms p 0,003 in DAH interval in phase 4 for modified Valsava maneuver was achieved compared to standar Valsava maneuver. Conclusion Increase vagal response in modified Valsava was shown by prolongation of AH interval compared to standar vaslsava maneuver.

Abstrak :
Latar belakang: Intervensi endovaskular aorta perkutan rutin dilakukan dan menjadi pilihan tatalaksana invasif aneurisma atau diseksi aorta serta penyakit katup aorta. Komplikasi vaskular pasca intervensi sering terjadi pada pasien dengan diameter arteri femoralis komunis yang lebih kecil. Namun terdapat perbedaan bermakna dari diameter arteri femoralis komunis antara populasi Kaukasia dan Asia terkait komplikasi vaskular. Pada populasi Indonesia belum ada data terkait diameter arteri femoralis komunis dengan komplikasi vaskular. Tujuan: Mengetahui diameter minimal arteri femoralis komunis sebagai prediktor komplikasi vaskular pasca intervensi endovaskular aorta perkutan pada populasi Indonesia. Metode: Pasien yang dilakukan intervensi endovaskular aorta perkutan, diukur diameter arteri femoralis komunis dengan CT scan. Pasien dievaluasi kejadian komplikasi vaskular selama perawatan pasca tindakan. Hasil: Terdapat 101 pasien dengan 135 arteri femoralis komunis yang menjadi sampel penelitian. Dibagi menjadi dua kelompok ukuran diameter arteri femoralis komunis berdasarkan median 7,6 mm, yaitu diameter ≥7,6 mm dan diameter <7,6 mm. Dari analisis multivariat, tidak terdapat hubungan bermakna antara kategori diameter arteri femoralis komunis dengan komplikasi vaskular pasca intervensi endovaskular aorta perkutan (p 0,38). Variabel lain yang berhubungan dengan kejadian komplikasi vaskular adalah jenis kelamin perempuan (p 0,03) dan RSAF ≥0,82 (p <0,001). Kesimpulan: Diameter arteri femoralis komunis tidak dapat menjadi prediktor kejadian komplikasi vaskular pasca intervensi endovaskular aorta perkutan pada populasi Indonesia karena berdasarkan analisis multivariat tidak ditemukan hubungan yang bermakna.

---

Background: Percutaneus endovascular aorta repair has been routinely performed and become the primary choice of invasive therapy for aortic aneurism, aortic dissection and aortic valve disease. The occurrence of vascular complications resulting from intervention, often occurs in patients with smaller common femoral artery. However there is a significant difference in the diameter of common femoral artery between the Caucasian and Asian populations related to the incidence of vascular complications. Objectives: To investigate the minimal diameter of common femoral artery as a predictor of vascular complications after percutaneus endovascular aorta repair in the Indonesian population. Methods: Patients who performed percutaneus endovascular aorta repair, measured the diameter of the common femoral artery with a CT scan and than evaluated for the occurrence of vascular complications after procedure. Results: 101 patients with 135 common femoral arteries are divided into two groups based on median of common femoral arteries (7,6 mm), diameter ≥7,6 mm and diameter <7,6 mm. From multivariate analysis, there is no significant association between the common femoral artery diameter and vascular complications after percutaneous aortic endovascular repair (p 0,38). Other variables that related to the incidence of vascular complications were female (p 0.03) and RSAF ≥0.82 (p <0.001). Conclusion: Diameter of common femoral artery can not be used as predictor of vascular complications after percutaneus endovascular aorta repair in the Indonesian population because based on multivariate analysis there was no significant relationship.

Abstrak :
Latar belakang. Hipertensi pulmonal merupakan salah satu komplikasi jangka panjang pada stenosis mitral, dan meningkatkan morbiditas serta mortalitas. Peningkatan resistensi vaskular paru terjadi pada fase reaktif hipertensi pulmonal akibat stenosis mitral. Pada hipertensi pulmonal terjadi gangguan keseimbangan sistem otonom, yang berpengaruh pada perubahan laju jantung saat uji latih. Laju jantung pemulihan dihitung dari selisih laju jantung maksimal saat uji latih dengan laju jantung menit pertama fase pemulihan dipengaruhi oleh reaktivasi sistem parasimpatis saat akhir latihan, dan merupakan prediktor mortalitas jangka panjang. Metode. Penelitian ini dilakukan pada 20 pasien stenosis mitral bermakna dengan hipertensi pulmonal yang menjalani pembedahan katup mitral di Pusat Jantung Nasional Harapan Kita dari bulan Agustus hingga November 2014. Dilakukan pengukuran resistensi vaskular paru sebelum operasi dan sebelum pasien dipulangkan. Laju jantung pemulihan diambil dari uji treadmil pada akhir program rehabilitasi kardiak fase 2. Dilakukan analisa statistik untuk mencari hubungan antara resistensi vaskular paru dengan laju jantung pemulihan saat latihan pasca operasi katup mitral. Hasil. Laju jantung pemulihan yang diukur pada menit pertama fase pemulihan uji treadmill adalah 11,5 + 5,9 kali per menit, dan perubahan resistensi vaskular paru pre dan paska operasi sebesar 1,55 + 2,1 WU. Laju jantung pemulihan menit pertama memiliki korelasi sedang dengan perubahan resistensi vaskular paru (r 0,537; p 0,015) . Analisa regresi linier laju jantung pemulihan menit pertama dengan perubahan resistensi vaskular paru pre dan paska operasi mendapatkan nilai koefisien β 1,52 dengan IK 95% 0,338-2,706 dengan nilai p 0,015. Analisa bivariat menyimpulkan bahwa digoxin merupakan variabel perancu (p 0,048). Analisa regresi linier antara perubahanresistensi vaskular paru pasca operasidengan laju jantung pemulihan menit pertama(adjusted analysis sesuai variable perancu)menunjukkan nilai koefisien β 1,244 dengan IK 95% 0,032-2,457 dengan nilai p 0,045. Kesimpulan. Perubahan resistensi vaskular paru pada pasien stenosis mitral dengan hipertensi pulmonal yang menjalani pembedahan berhubungan dengan laju jantung pemulihan menit pertama saat uji latih jantung.

---

Background. Pulmonary hypertension is one of the long-term complication of mitral stenosis, resulting increase of morbidity and mortality. Pulmonary vascular resistance (PVR) is increase in reactive phase of pulmonary hypertension due to mitral stenosis. There is impaired autonom regulation following pulmonary hypertension, affecting heart rate changes during exercise test. Heart rate recovery (HRR) is defined as the difference between heart rate at peak exercise and 1 minute of recovery phase. It is affected by reactivation of parasympathetic system after cessation of exercise, and has been known as a long-term mortality predictor. Method. A study of 20 patients with significant mitral stenosis with pulmonary hypertension who underwent mitral valve surgery in National Cardiovascular Center Harapan Kita was done from August to November 2014. PVR data from echocardiography was measured before surgery and before the patients were discharged. HRR data was taken from the treadmill test at the end of phase 2 cardiac rehabilitation program. Statistical analysis is done to explore the correlation between pulmonary vascular resistance and heart rate recovery after exercise test. Result. Mean heart rate recovery after exercise test is 11,5 + 5,9 beat perminute, and changes of pulmonary vascular resistance after surgery is 1,55+2,1 WU. There was a correlation between change of PVR and heart rate recovery (r 0,537; p 0,015). Linear regression analysis of the change of PVR and heart rate recovery (unadjusted analysis) showed β coefficient 1,52 with 95% confidence interval 0,338-2,706 and p 0,015. Adjusted analysis to confounding variabel showed β coefficient 1,244 with 95% CI 0,032-2,457 and p 0,045. Conclusion. Changes of pulmonary vascular resistance after mitral valve surgery in mitral stenosis pastient is positively correlated with heart rate recovery during exercise test.

Abstrak :
Latar Belakang: Menurut Global and Regional Burden of Aortic Dissection and Aneurysm, laju kematian akibat patologi aorta torakalis di negara berkembang lebih tinggi dibandingkan negara maju, dengan median pertambahan percepatan +0,71 per 100.000 vs +0,22 per 100.000 pada tahun 1990 dibandingkan 2010. Asia Tenggara merupakan salah satu negara dengan penambahan laju kematian tertinggi yaitu 41%. Di Indonesia, pasien datang dalam kondisi penyakit lanjut karena keterlambatan diagnosis dan manajemen dan hal ini menjadikan pasien berada pada kondisi patologi aorta yang kompleks. Kondisi patologi aorta yang kompleks tentunya membutuhkan tindakan bedah aorta yang kompleks pula. Sejauh ini belum terdapat studi yang secara khusus meneliti luaran klinis bedah aorta torakalis kompleks dibandingkan dengan non-kompleks, terutama pada populasi di negara berkembang. Tujuan: Mengetahui hubungan kompleksitas pembedahan dengan mortalitas in-hospital dan kesintasan jangka menengah pasca bedah aorta torakalis serta faktor lain yang berhubungan. Metode: Studi kohort retrospektif ini menggunakan data sekunder. Dilakukan pengambilan data dasar melalui rekam medis dan registri terhadap pasien pasca bedah aorta torakalis (1 Januari 2018 – 31 Desember 2021) di PJNHK. Analisa kesintasan 1 dan 3 tahun dilakukan dengan follow up melalui telepon dan pesan digital. Kemudian dilakukan analisa statistik untuk mencari hubungan antara kompleksitas pembedahan sebagai prediktor utama serta variabel lainnya dengan luaran primer (mortalitas in-hospital) dan sekunder (kesintasan jangka menengah). Hasil: Total 208 pasien diinklusikan ke dalam analisis luaran primer; 157 (75,5%) menjalani bedah aorta torakalis kompleks dan 51 (24,5%) menjalani bedah aorta torakalis non-kompleks. Mortalitas in-hospital serupa pada kedua kelompok (23,6% vs 13,7%; p = 0,194). Pada analisa multivariat, sindrom malperfusi (OR 3,560; p = 0,002), durasi CPB > 180 menit (OR 4,331; p = 0,001), dan prioritas pembedahan (urgent OR 4,196; p = 0,003; emergency OR 10,879; p = 0,001) adalah prediktor independen mortalitas in-hospital. Follow-up kesintasan 1 dan 3 tahun pasca bedah aorta torakalis adalah 92,6% dan 80,3%, secara berurutan. Regresi Cox mengidentifikasi diabetes (HR 4,539; p = 0,025) dan status prosedur emergensi (HR 9,561; p = 0,015) sebagai prediktor independen mortalitas 1 tahun, dan diabetes (HR 3,609; p = 0,004), diseksi aorta (HR 2,795; p = 0,029) dan diameter aorta maksimum (HR 1,034; p = 0,003) sebagai prediktor independen mortalitas 3 tahun. Kompleksitas pembedahan tidak berhubungan dengan peningkatan mortalitas in-hospital maupun kesintasan jangka menengah. Kesimpulan: Pada pasien yang menjalani tindakan bedah aorta torakalis terbuka, kompleksitas pembedahan tidak berhubungan dengan mortalitas in-hospital maupun kesintasan jangka menengah. Kesintasan jangka pendek dan menengah lebih banyak dipengaruhi faktor komorbid maupun faktor durante pembedahan ......Background: According to Global and Regional Burden of Aortic Dissection and Aneurysm, a prominent increase of overall global death rate is seen on developing country compared to developed country, with relative change in median daeath rate of +0,71 per 100.000 vs +0,22 per 100.000 in 1990 vs 2010. South-east Asia is nation with highest increase of 41%. This is due to delayed in diagnosis and treatment and leads to late stage and complex aortic disease. The more complex the disease, the more complex the surgical procedure will be. Up until now, there is no data regarding the impact of surgical complexity on short and mid-term survival in patients underwent aortic surgery, especially in developing country. Objectives: This study aimed to investigate the impact of surgical complexity on short and mid-term mortality and other influencing factors. Methods: This retrospective cohort study used secondary data. Basic data was obtained through medical record and registry of patients underwent thoracic aortic surgery (January 1st, 2018 to December 31st, 2021) in National Cardiovascular Center Harapan Kita (NCCHK). One-year and 3-year survival analysis was obtained through phone calls and digital messages. Statistical analysis was done to investigate the impact of surgical complexity as the main predictor and other variables on primary (in-hospital mortality) and secondary (mid-term survival) outcome. Results: A total of 208 patients were included in the analysis; 157 (75,5%) underwent complex surgery, and 51 (24,5%) underwent non-complex surgery. In-hospital mortality was similar actoss 2 groups (23,6% vs 13,7%; p = 0,1240). On multivariable analysis, malperfusion syndrome (OR 3,560; p = 0,002), CPB duration > 180 minutes (OR 4,331; p = 0,001), and surgical priority (urgent OR 4,196; p = 0,003; emergency OR 10,879; p = 0,001) were identified as independent predictor of in-hospital mortality. One and 3-year survival were 92,6% and 80,3%, respectively. Cox regression identified diabetes (HR 4,539; p = 0,025) and emergency procedure (HR 9,561; p = 0,015) as independent predictors for 1-year mortality, and diabetes (HR 3,609; p = 0,004), aortic dissection (HR 2,795; p = 0,029), and maximum aortic diameter (HR 1,034; p = 0,003) for 3-year mortality. Surgical complexity was not associated with early and mid-term mortality. Conclusions: In patients undergoing thoracic aortic surgery, surgical complexity was not associated with early and mid-term survival. Short and mid-term survival was largely determined by patient comorbidities and intra-surgery factors.

Abstrak :
ABSTRAK
Latar Belakang. Perempuan dengan preeklampsia memiliki resiko tinggi terhadap penyakit kardiovaskuler 5-15 tahun pasca kehamilan. Disfungsi endotel diperkirakan menjadi patogenesis manifestasi klinik preeklampsia dan penghubung antara preeklampsia dan kejadian kardivaskular setelah kehamilan. Nilai flow mediated vasodilation (FMD) dari arteri brakhialis pada sebagian subset preeklampsia tetap rendah 3-10 tahun pasca-melahirkan. Proteinuria pada preeklampsia secara etiologi juga berhubungan dengan disfungsi endotel glomerulus. Namun, tidak seperti pada populasi hipertensi dan diabetes mellitus, sampai saat ini belum diketahui bagaimana korelasi antara nilai proteinuria dengan nilai FMD pada populasi preeklampsia. Tujuan : Untuk mengetahui hubungan/korelasi antara proteinuria terhadap nilai FMD pada preeklampsia sebelum dan sesudah melahirkan Metode. Studi prospektif dilakukan di tiga rumah sakit. Subyek preeklampsia yang akan diterminasi dan sesuai kriteria inklusi dan eksklusi diperiksa nilai FMD dan rasio protein-kreatinin urinnya (RPKU) sebelum melahirkan, 48-72 jam setelah melahirkan dan pasca-nifas. Data kemudian diolah dengan analisis bivariat dan multivariat untuk mengetahui korelasi antara rasio protein-kreatinin urin dengan nilai FMD dan perubahannya sebelum dan setelah melahirkan. Hasil Penelitian. Sebanyak 30 perempuan preeklampsia diikutsertakan dalam penelitian ini. Rerata nilai FMD sebelum melahirkan, 48-72 jam pasca-melahirkan dan follow up pasca-nifas adalah 5.46 ± 0.27 ,, 6.10 ± 0.35 dan 8.14 ± 2.48 ( p <0.001). Ditemukan 40 % subyek masih dengan FMD < 7 saat pemeriksaan pasca-nifas (40-60 hari). Uji korelasi bivariat menunjukkan korelasi dengan arah negatif yang kuat antara proteinuria (RPKU) pasca-nifas dengan nilai FMD pascanifas (r= -0.73, p <0.001) , dan nilai RPKU sebelum melahirkan berhubungan dengan rendahnya FMD pasca-nifas dan perubahan (delta) FMD sebelum-sesudah melahirkan. Tidak diperoleh korelasi bermakna antara proteinuria dan nilai FMD sebelum melahirkan. Analisis multivariat dengan regresi linier membuktikan korelasi yang independen antara proteinuria dan nilai FMD pasca-nifas dan delta FMD. Kesimpulan. Studi ini menegaskan korelasi yang kuat yang arahnya negatif antara nilai proteinuria pasca-melahirkan dengan nilai flow mediated dilation pasca melahirkan pada subyek preeklampsi dan semakin tinggi nilai proteinuria sebelum melahirkan berhubungan dengan rendahnya perubahan FMD sebelum dan sesudah melahirkan.

---

ABSTRACT
Background. Endothelial dysfunction was associated with both of the predisposition of preeclampsia and the later development of vascular disease. Flow mediated dilation (FMD) was reduced in preeclamptic women and persist after delivery in several cases. Proteinuria in preeclampsia was also a manifestation of endothelial dysfunction in kidney, but there was no data untill now showing the correlation of FMD and the level of proteinuria in preeclamptic woman Objectives. To asses the correlation between urine protein-creatinine ratio and flow mediated dilation (FMD) before and after delivery in preeclamptic women. Methods. Women with a diagnosis of preeclampsia and planned for termination were enrolled for the study. History of hypertension before 20 weeks of gestation, diabetes mellitus, chronic kidney disease became exclusion criterias. The FMD was studied through the use of high resolution vascular ultrasound examination of brachial artery for 3 times; before delivery, 48-72 hours after delivery and 40-60 days after delivery. Urine protein-creatinine ratio (UPCR) was measured twice; prior to delivery and 40-60 days after delivery. Correlation between them was then evaluated. Results. Thirty patients were enrolled in this study. The mean ages was 29.5±6,4 years old. FMD was improved after delivery, 5.46 ± 0.27 % (before delivery) & 8.14 ± 2.48 % ( p <0.001) 40-60 days after delivery. Bivariates analysis showed that after delivery, there was an inverse correlation between UPCR with FMD (r=0,735 p< 0,0001). UPCR prior to delivery also has inverse correlation with FMD after delivery (r= -0.55.p=0.002) and with the change of FMD before and after delivery (r= -0.45 with p =0.01). Multivariate analysis showed that correlation between UPCR after delivery with FMD after delivery was independent. Conclusion. This study demonstrated there was a moderate-strong correlation between urinary protein prior and after delivery with flow mediated vasodilatation of brachial artery after delivery. ;Background. Endothelial dysfunction was associated with both of the predisposition of preeclampsia and the later development of vascular disease. Flow mediated dilation (FMD) was reduced in preeclamptic women and persist after delivery in several cases. Proteinuria in preeclampsia was also a manifestation of endothelial dysfunction in kidney, but there was no data untill now showing the correlation of FMD and the level of proteinuria in preeclamptic woman Objectives. To asses the correlation between urine protein-creatinine ratio and flow mediated dilation (FMD) before and after delivery in preeclamptic women. Methods. Women with a diagnosis of preeclampsia and planned for termination were enrolled for the study. History of hypertension before 20 weeks of gestation, diabetes mellitus, chronic kidney disease became exclusion criterias. The FMD was studied through the use of high resolution vascular ultrasound examination of brachial artery for 3 times; before delivery, 48-72 hours after delivery and 40-60 days after delivery. Urine protein-creatinine ratio (UPCR) was measured twice; prior to delivery and 40-60 days after delivery. Correlation between them was then evaluated. Results. Thirty patients were enrolled in this study. The mean ages was 29.5±6,4 years old. FMD was improved after delivery, 5.46 ± 0.27 % (before delivery) & 8.14 ± 2.48 % ( p <0.001) 40-60 days after delivery. Bivariates analysis showed that after delivery, there was an inverse correlation between UPCR with FMD (r=0,735 p< 0,0001). UPCR prior to delivery also has inverse correlation with FMD after delivery (r= -0.55.p=0.002) and with the change of FMD before and after delivery (r= -0.45 with p =0.01). Multivariate analysis showed that correlation between UPCR after delivery with FMD after delivery was independent. Conclusion. This study demonstrated there was a moderate-strong correlation between urinary protein prior and after delivery with flow mediated vasodilatation of brachial artery after delivery.