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"ABSTRAKLatar 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.

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ABSTRACTHypertension 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"

"Latar belakang: Hipertensi dan prediabetes adalah komponen mayor sindroma metabolik dan juga faktor risiko penyakit kardiovaskular. Variabilitas tekanan darah menjadi salah satu faktor untuk penyakit kardiovaskular, beberapa data menunjukan peningkatan variabilitas tekanan darah berhubungan dengan meningkatnya kejadian stroke, penyakit jantung koroner, dan semua penyebab kematian. Variabilitas tekanan darah pada populasi prediabetes memiliki variabilitas yang lebih tinggi dibandingkan populasi normal. Tujuan: Mengetahui efek pemberian metformin pada lisinopril selain sebagai obat oral antidiabetes memiliki efek antihipertensi dan pengaruh terhadap variabilitas tekanan darah pada populasi hipertensi dan prediabetes. Metode: Penelitian ini merupakan uji klinis acak yang dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) pada karyawan yang hipertensi dengan prediabetes. Dibagi 2 kelompok yang mendapat Lisinopril 5 mg (terbuka) dan Metformin 2 x 500 mg (tersamar) atau plasebo selama 8 minggu. Dilakukan pemeriksaaan Home Blood Pressure Monitoring (HBPM) sebelum dan setelah terapi diberikan. Hasil: Total terdapat 64 pasien menyelesaikan penelitian (31 kelompok plasebo, 33 kelompok metformin). Setelah 8 minggu follow up, variabilitas tekanan darah kelompok metformin memiliki variabilitas tekanan darah yang lebih rendah (3,8 ± 2,2 mmHg, p 0,03) dibandingkan kelompok plasebo. Perubahan rerata mean tekanan darah sistolik dan diastolik pagi kelompok metformin mengalami penurunan signifikan (p < 0,05 ) Kesimpulan: Penambahan metformin pada Subyek hipertensi dengan prediabetes yang mendapat lisinopril mengalami penurunan variabilitas tekanan darah pagi dan rerata tekanan darah pagi yang bermakna secara statistik.

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Background: Hypertension and prediabetes are major components of metabolic syndrome and also risk factors for cardiovascular disease. Variability of blood pressure is one factor for cardiovascular disease, some data show an increase in blood pressure variability associated with increased incidence of stroke, coronary heart disease, and all causes of death. Blood pressure variability in the prediabetes population has a higher variability than the normal population.

Objective: To determine the effect of adding metformin to lisinopril as well as an oral antidiabetic drug that has antihypertensive effects and influence on blood pressure variability in the hypertensive population and prediabetes.

Method: This study was a randomized clinical trial conducted at National Cardiac Center Harapan Kita Hospital (NCCHK) in hypertensive employees with prediabetes. Divided into 2 groups that received Lisinopril 5 mg (open) and Metformin 2x500 mg (disguised) or placebo for 8 weeks. Examination of Home Blood Pressure Monitoring (HBPM) is carried out before and after therapy is given.

Results: A total of 64 patients completed the study (31 placebo groups, 33 metformin groups). After 8 weeks of follow-up, the blood pressure variability of the metformin group had lower blood pressure variability (3.8±2.2 mmHg, p=0.03) than in the placebo group. The mean change in mean systolic and diastolic blood pressure in the metformin group decreased significantly (p<0.05)

Conclusion: Addition of metformin to hypertensive subjects with prediabetes who received lisinopril decreased morning blood pressure variability and morning mean blood pressure which was statistically significant."

"Latar Belakang: Reaktivitas platelet yang tinggi terutama pada kondisi Infark Miokard Akut dengan Elevasi Segmen ST (IMA-EST) memerlukan antiplatelet untuk menginhibisi aktivasi dan agregasi platelet sehingga mencegah kejadian trombosis lebih hebat. Eptifibatide, suatu penghambat glikoprotein (Gp) IIb/IIIa diberikan sebagai terapi tambahan pada terapi reperfusi Intervensi Koroner Perkutan Primer (IKPP). Reaktivitas platelet yang tetap tinggi ditemukan pada pasien-pasien yang mengalami kejadian aterotrombosis yang berulang. Tujuan: Menilai inhibisi agregasi platelet sebagai respon terapi Eptifibatide dan menilai adanya hubungan antara respon inhibisi agregasi platelet terhadap Kejadian Kardiovaskular Mayor (KKM) pada pasien IMA-EST yang menjalani IKPP. Metode: Pasien IMA-EST yang diberikan Eptifibatide dan dilakukan IKPP dilakukan pemeriksaan fungsi platelet pada menit ke-10 setelah bolus Eptifibatide dengan alat Multiplate analizer. Pasien akan diikuti selama perawatan rumah sakit untuk melihat KKM. Hasil: Dari 99 subyek penelitian, sekitar 55% subyek merupakan non-responder. Didapatkan 18 pasien mengalami KKM, terbanyak adalah gagal jantung (8 orang), aritmia maligna (3 orang), angina berulang (2 orang), stroke (2 orang) dan reinfark, infeksi dan perdarahan mayor masing-masing 1 orang. Dua belas orang subyek yang mengalami KKM merupakan kelompok subyek non-responder dan 8 subyek berasal kelompok responder. Dari analisa statistik didapatkan bahwa respon inhibisi agregasi platelet yang kurang yaitu pasien non-responder terhadap Eptifibatide tidak meningkatkan risiko terjadinya KKM. Kesimpulan: Angka subyek IMA-EST dan menjalani IKPP yang non-responder terhadap Eptifibatide sebanyak 55% dengan nilai agregasi yang amat bervariasi yaitu 1 AU hingga 131 AU. Tidak terdapat adanya hubungan respon inhibisi agregasi platelet dalam terapi Eptifibatide dengan KKM pada pasien IMA-EST yang menjalani IKPP.

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Background: Eptifibatide, an inhibitor of glycoprotein IIb/IIIa administered as adjunctive therapy to reperfusion therapy Primary PCI in ST-Elevation Myocardial Infarction (STEMI) patients. Persistently high platelet reactivity was found in patients who experienced recurrent atherothrombotic events during antiplatelet therapy.

Objective: To evaluate the level of platelet inhibition after Eptifibatide therapy and to assess the relation between level of platelet inhibition and Major Cardiaovascular event (MACE).

Methods: Platelet function test by Multiplate analyzer was performed in STEMI Patients who undergone Primary-PCI, Ten minutes after a bolus of Eptifibatide. MACE were prospectively monitored during hospitalization and the incidence of MACE correlated with the measured level of platelet inhibition.

Results: From 99 subjects, approximately 55% of the subjects were non-responders (high platelet reactivity). 18 patients experienced MACE, most were heart failure (8 people), malignant arrhythmias (3 people), recurrent angina (2 people), stroke (2 people) and reinfark, infections and major bleeding each 1 person. 12 subjects experienced MACE was from the non-responder group and 8 subjects from the responder grup. The study was found that the level of platelet inhibition wasn’t an independent predictor for the risk of MACE.

Conclusion: Less achieved therapeutic effects of platelet Inhibition (non-responders) to Eptifibatide in STEMI undergo Primary PCI patient was found in the majority (55%) subjects. Different level of platelet inhibition wasn’t an independent predictor for the risk of MACE."

"Latar Belakang. Kondisi hipoksia kronik pada pasien dengan penyakit jantung bawaan sianotik akan menurunkan oksigenasi jaringan sehingga terjadilah mekanisme adaptasi yaitu eritrositosis sekunder. Besi merupakan substrat yang penting dalam produksi hemoglobin dan cadangan besi untuk menjaga kadar hemoglobin yang adekuat. Namun 50% pasien dengan kelainan penyakit jantung bawaan sianotik mengalami defisiensi besi dan kondisi ini dikaitkan dengan gangguan kapasitas fungsional akibat berkurangnya pengiriman oksigen dan efeknya terhadap metabolisme pada otot rangka. Kadar feritin serum merupakan pemeriksaan yang paling awal dan akurat untuk menilai defisiensi besi. Studi ini bertujuan untuk mengetahui hubungan antara kadar feritin serum dengan kapasitas fungsional pada pasien Tetralogi Fallot (TF). Metode. Studi potong lintang dilakukan di Departemen Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Jakarta pada pasien TF usia 4-8 tahun yang belum menjalani operasi paliatif dan atau operasi definitif. Dilakukan pengumpulan karakteristik dasar, kadar feritin serum, ekokardiografi, serta uji jalan 6 menit. Dilakukan uji korelasi dan analisis multivariat menggunakan uji regresi. Hasil. Diteliti sebanyak 20 pasien TF dengan rentang usia 51 hingga 98 bulan. Nilai tengah kadar feritin serum adalah 39.75 g/L (kadar terendah 5g/L, kadar tertinggi 246g/L). Nilai tengah kadar hemoglobin adalah 16.4 g/dL, kadar terendah 12 g/dL dan kadar tertinggi 20 g/dL. Limapuluh persen pasien memiliki kadar feritin serum di bawah normal (< 40 g/L). Pada uji korelasi antara kadar feritin serum dengan jarak uji jalan 6 menit didapatkan nilai r = 0.23 dengan nilai p = 0.34. Pada uji regresi linear pada 2 kelompok, ditemukan perbedaan rerata jarak uji jalan 6 menit pada kelompok dengan kadar feritin lebih tinggi (> 40 g/L, n = 10) sebesar 46,83 m dibandingkan dengan kelompok feritin rendah (< 40 g/L, n = 10) dengan koefisien β = 46,83; IK 95 -47,81- 141,47 p = 0,307. Kesimpulan. Secara klinis terdapat kecenderungan pasien TF dengan kadar feritin serum yang lebih tinggi mampu menempuh jarak uji jalan 6 menit yang lebih jauh walaupun secara satistik tidak bermakna.

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Background. Chronic hypoxia in cyanotic congenital heart disease (CCHD) result in reduced of tissue oxygenation, therefore stimulates adaptive mechanism of secondary erythrocytosis. Iron is a vital substrate for hemoglobin production and sufficient iron stores are necessary to achieve and maintain adequate levels of hemoglobin. Unfortunately, 50% of patients with cyanotic CHD are iron-deficient and this condition is associated with exercise intolerance through reduced oxygen delivery and its effect on skeletal muscle cell metabolism Ferritin serum level is the most accurate test to determine iron deficiency. Aim of this study is to evaluate the association between ferritin serum level and functional capacity in patient with Tetralogy of Fallot (TOF).

Methods. A cross-sectional study was done in Department Cardiology and Vascular Medicine, Faculty Medicine Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta in patients with TOF aged 4-8 years old before the palliatif and or definite operation. The data collected from patients including basic characteristic, ferritin serum level and erythocyte index and six minute walk test result. Statistical analysis was done using correlation test and multivariat analysis using regression test.

Result. Twenty subjects of TF aged 51 to 98 months was collected. Median level of ferritin serum level was 39.75 g/L (the lowest level 5g/L, the highest level 246g/L). Median level of hemoglobin level was (the lowest level 12 g/dL, the highest level 20 g/dL). Fifty percent of patients had abnormal feritin serum level (< 40 g/dL). There was a correlation coefficient (r) of 0,23 with p value of 0,34 found on the correlation between ferritin serum level and six minute walk test distance. However, on linear regression test between 2 groups of ferritin serum, 46,83 m mean difference of six minute walk test distance found between higher level of ferritin serum group (> 40 g/d, n = 10), and lower level of ferritin serum group (< 40 g/d, n = 10) with β = 46,83; IK 95 -47,81- 141,47 p = 0,307.

Conclusion. Clinically in patients with higher level of feritin serum there is a tendency able to walk farther on six minute walk test, although statitically not significant."

"Background: Iron deficiency anemia IDA is commonly found and is associated with worse functional capacity in heart failure HF . Ferrous Sulfate FS tablets are cheap and widely available in Indonesia, but there has not been much research conducted to prove its efficacy in improving iron stores and functional capacity in HF patients with IDA. Aim: To determine the efficacy of FS tablets in improving iron stores and functional capacity in HF patients with IDA. Methods: We conducted a randomized double blind controlled trial RCT enrolling 54 HF patients LVEF 50 with IDA Ferritin 100 ng mL or 100 300 ng mL with Tsat 20 at outpatient clinic of National Cardiovascular Center Harapan Kita from January to July 2016. Patients were randomized 1 1 to received FS or placebo for 90 days, we then evaluated the change in 6MWT distance as primary end point and changes on NT proBNP and post 6MWT serum lactate levels as secondary end points. Results: 41 patients had completed the study Treated Group,n 22 Control Group,n 19. We found not only improvement on Tsat 14,13 9,66 p 0,000, ferritin 114,42 20,52 ng mL p 0,000 and Hb 1,085 0,365 gr dL p 0,005 levels, but also significant improvement in 6MWT distance in treated group 46,23 35,93 meter from baseline p 0,000. As for the secondary end points, there were reductions on NT ProBNP 2236,00 492,00 16476,00 vs. 1439,50 29,00 5027,00 pg mL p 0,011 and serum lactate 1,30 0,70 3,60 to 1,20 0,50 2,30 mmol L p 0,3 levels compared to baseline. Conclusion: Oral administration of FS for 90 days not only improves iron stores but also functional capacity in HF patients with IDA, without significant reductions on NT ProBNP and post 6MWT serum lactate levels."