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Vidya Gilang Rejeki
Efek penyekat enzim konversi angiotensin dosis kecil terhadap six minute walk test dan kadar NT-proBNP pada pasien stenosis mitral tanpa hipotensi = Effect of low dose ace inhibitor towards six minute walk test and NT-proBNP in mitral stenosis patients without hypotension
"Latar Belakang : Stenosis mitral (SM) merupakan suatu lesi obstruksi katup mitral yang memerlukan terapi definitif suatu tindakan mekanik. Di Indonesia, prevalensinya masih cukup tinggi dengan penyebab yang multifaktorial; di antaranya waktu tunggu untuk antrian dari penjadwalan intervensi di era Jaminan Kesehatan Nasional. Kondisi pasien yang hadir terlambat dan waktu tunggu yang lama dapat memperburuk keadaan pasien. Pada SM, serangkaian neurohormonal teraktivasi. Penyekat enzim konversi angiotensin (EKA) dapat menghambat aktivasi renin-angiotensi-aldosteron (RAA), memperbaiki kondisi pasien selama menunggu jadwal operasi. Namun, pemberian penyekat EKA masih kontroversial.
Tujuan : Untuk menilai keamanan dan pengaruh pemberian penyekat EKA dosis kecil pada pasien SM tanpa hipotensi terhadap six minute walk test (6MWT) dan N-Terminal pro B type natriuretic peptide (NT-proBNP).
Metode : Penelitian ini merupakan studi eksperimental acak yang tersamar ganda. Sampel diambil secara konsekutif dan dilakukan randomisasi blok, untuk pemberian lisinopril 2,5 mg atau plasebo. Setiap subyek dilakukan ekokardiografi, 6MWT dan pemeriksaan laboratorium sebelum diberikan perlakuan. Evaluasi serupa dilakukan pada setiap subyek setelah 4 minggu.
Hasil Penelitian : Terdapat 37 subyek yang berhasil dilakukan analisis; 19 pasien pada kelompok perlakuan dan 18 pasien pada kelompok kontrol. Tidak didapatkan perbedaan yang bermakna pada perubahan NT-proBNP dan 6MWT pada kedua kelompok (∆ NT proBNP 59 (-6747) - 2145) vs (-166) (-1495 - 1664) pg/mL; p = 0.443) dan (∆ 6 MWT 11.66 + 73 vs 21.37 + 47; p = 0.638). Tidak didapatkan pula perbedaan tekanan darah serta isi sekuncup yang bermakna antara kedua kelompok paska perlakukan, median isi sekuncup pada kelompok perlakuan 54 (34 - 74) vs 45 (34 - 94), p = 0.126.
Kesimpulan : Pemberian penyekat EKA dosis kecil pada pasien SM tanpa keadaan hipotensi aman, namun tidak meningkatkan pencapaian 6MWT dan tidak meurunkan kadar NT-proBNP.
Background : Mitral stenosis (MS) is an obstructive lesion in which the definitive therapy is mechanical intervention. The prevalence of MS in developed countries has been decreasing due to the development of mechanical intervention. In Indonesia the prevalence remains high especially in the era of national health coverage, there are too many patients queuing for mitral valve operation. By this situation, we want to know if the angiotensin converting enzyme (ACE) inhibitor could reduce the burden of symptoms and other neurohormonal activation such as NT-proBNP in MS patients. There are many controversies to the use of ace inhibitor in MS patients, questioning the benefit and safety of ace inhibitor to these patients.
Objective : To study the safety and efficacy of low dose ACE inhibitor towards six minute walk test (6MWT) and N-Terminal pro B type natriuretic peptide (NT-proBNP) in Mitral Stenosis Patients without Hypotension.
Methods : This study is a double blind randomized control trial. Sample was taken consecutively, and randomized to be given lisinopril 2.5mg or placebo. Every patient was assigned for echocardiography evaluation, 6MWT, and laboratory examination before and after intervention.
Result : 37 patients were included in the analysis; 19 was in the intervention group, 18 patient was in the placebo group. No significant difference were found between the two groups in terms of NT-proBNP and 6MWT, (∆ NT proBNP 59 (-6747) - 2145) vs (166) (-1495 - 1664) pg/mL; p=0.443) dan (∆ 6 MWT 11.66 + 73 vs 21.37 + 47; p = 0.638). In terms of blood pressure and stroke volume, there was also no significant difference between the two groups after intervention, median for stroke volume in intervention group and control group were 54 (34 - 74) vs45 (34 - 94), p = 0.126.
Conclusion : Low dose ACE inhibitor is safe to be given in MS patient without hypotension, however, it did not increase functional capacity measured by 6MWT, neither improve NT-proBNP. "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Hervin Ramadhani
Korelasi kadar ST2 terlarut (sST2) dengan miokardial longitudinal strain speckle tracking dua dimensi untuk menilai disfungsi ventrikel kiri subklinis pada subjek stenosis aorta berat = Asscociation of the biomarkers soluble ST2 and subclinical left ventricular systolic dysfunction assessed by myocardial global longitudinal strain in patients severe aortic stenosis
"ABSTRAK
Latar belakang.
Pada pasien SA fraksi ejeksi ventrikel kiri dapat normal bahkan supra normal untuk
jangka waktu yang lama walaupun proses remodeling ventrikel kiri sudah mulai terjadi..
Ekokardiografi speckle tracking dua dimensi (EST) mempunyai kelebihan untuk
digunakan dalam menilai penurunan fungsi kontraktilitas miokard subklinis, dimana
keadaan tersebut dapat mempengaruhi prognosis pasien SA. sST2 merupakan biomarker
yang relatif baru, dapat meningkat pada regangan otot jantung (myocardial stretch),
fibrosis, inflamasi, dan injuri miokard, apakah berhubungan dengan disfungsi dini
ventrikel kiri masih belum diketahui.
Tujuan. Mengetahui korelasi sST2 terhadap nilai GLS EST pada pasien SA berat dengan
FEVK normal
Metode. Merupakan studi potong lintang. Evaluasi dilakukan pada 29 pasien stenosis
aorta berat dengan fraksi ejeksi normal yang datang ke poliklinik RS Jantung Harapan
Kita periode Februari 2015 sampai November 2015. Dilakukan pengambilan figur
ekokardiografi untuk menilai severitas SA dan untuk perhitungan nilai global longitudinal
strain speckle tracking kemudian dilakukan pengambilan sampel darah di laboratorium
RS Jantung Harapan Kita untuk menilai sST2.
Hasil Penelitian. Dua puluh sembilan subjek ikut dalam penelitian ini dengan rerata usia
adalah 59.7±12.1 tahun. Fungsi intrinsik ventrikel kiri pasien SA berat pada penelitian ini
mengalami penurunan dengan nilai rerata GLS -11±4.5%. Hasil uji korelasi menunjukan
terdapat korelasi positif dengan kekuatan korelasi sedang yang bermakna (r=0.429,
p=0.02). Analisis multivariat tetap menunjukkan adanya hubungan antara kadar sST2
dengan nilai GLS EST (r=0,282 p=0.036).
Kesimpulan. Terdapat korelasi sST2 dengan global longitudinal strain speckle tracking
pada pasien SA berat dengan fraksi ejeksi normal.ABSTRACT
Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Geis Alaztha
Hubungan antara ekspresi miRNA-26a platelet, reaktivitas platelet, dan TIMI flow pada pasien infark miokard akut disertai elevasi segmen ST yang menjalani intervensi koroner perkutan primer = Association between miRNA-26a platelet, platelet reactivity, and TIMI-flow of patients with Acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
"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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T58704
UI - Tesis Membership  Universitas Indonesia Library
cover
Evans Tofano Bobian
Hubungan Polimorfisme Gly972Arg Gen Insulin Receptor Substrate-1 dengan Nilai Ankle-brachial Index pada Populasi Rural di Indonesia = Association between Gly972Arg Polymorphism of Insulin Receptor Substrate-1 Gene and Ankle-brachial Index Values on Rural Population in Indonesia
"Penyakit Arteri Perifer (PAP) merupakan obstruksi total atau parsial dari arteri perifer yang terutama disebabkan oleh proses aterosklerosis. Disfungsi endotel telah dikenal sebagai penanda dini dari aterosklerosis. Dari penelitian sebelumnya, diketahui polimorfisme Gly972Arg gen IRS-1 berhubungan dengan disfungsi endotel. Hingga saat ini belum ada penelitian yang menghubungkan secara langsung antara polimorfisme IRS-1 dengan penyakit arteri perifer. Penelitian ini bertujuan untuk mengetahui hubungan antara polimorfisme Gly972Arg dengan nilai Ankle-Brachial Index (ABI) sebagai penanda penyakit arteri perifer. Studi observasional (potong lintang) ini dilakukan pada 104 subjek populasi Desa Gunung Sari Kecamatan Pamijahan. Dilakukan pemeriksaan lab untuk polimorfisme Gly972Arg gen IRS-1 dengan metode Taqman Assay. Data pemeriksaan ABI diambil dari data retrospektif di Desa Gunung Sari, Kecamatan Pamijahan, Jawa Barat yang diambil pada tahun 2017. Terdapat 104 subjek yang diikutsertakan dalam penelitian ini, yaitu grup wildtype/CC (6,7%), heterozigot/CT (82,7%), dan homozigot mutan/TT (10,6%). Tidak terdapat hubungan yang bermakna antara polimorfisme Gly972Arg gen IRS-1 dengan nilai ABI (p= 0,7). Setelah dilakukan penyesuaian terhadap merokok, hipertensi, diabetes melitus dan indeks massa tubuh, dapat disimpulkan bahwa hasil hubungan tidak bermakna antara polimorfisme Gly972Arg gen IRS-1 dengan ABI tidak dipengaruhi oleh faktor lain.
Peripheral Artery Disease (PAD) is defined as a total or partial obstruction of peripheral arteries, which mainly caused by an atherosclerotic process. Endothelial dysfunction is widely known as an early predictor of atherosclerosis. From previous studies, Gly972Arg polymorphism of IRS-1 gene is associated with endothelial dysfunction. To date, there is still very limited study about the association between Gly972Arg polymorphism of IRS-1 gene with Ankle-Brachial Index (ABI) as a marker of atherosclerosis in peripheral arteries. Therefore, we attempt to perform a study of association between Gly972Arg polymorphism of IRS-1 gene with ABI values. We performed a cross sectional study on 104 subjects from a rural population in Gunung Sari Village, Pamijahan District, West Java, Indonesia. Laboratory examinations for polymorphism detection uses Taqman Assay Method. Demographic, risk factors, and ABI data were obtained from a retrospective data in 2017. There were 104 subjects in this study. The prevalence of genotypes are as follows: Wildtype (6,7%), heterozygous carrier/CT (82,7%), and homozygous mutant/TT (10,6%). We found no significant association between Gly972Arg of IRS-1 gene with ABI values (p=0,7). After the adjustments for smoking, hypertension, diabetes, and body mass index, we concluded that none of those risk factors affected the results of our study."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T59133
UI - Tesis Membership  Universitas Indonesia Library
cover
Maha Fitra Nd
Efek empagliflozin terhadap fibrosis miokard pada pasien diabetes melitus tipe 2 dengan gagal jantung = Effects of empagliflozin on myocardial fibrosis in patients with type 2 diabetes mellitus and heart failure
"Latar belakang: Diabetes mellitus tipe 2 (DMT2) dan gagal jantung memiliki keterkaitan yang kuat dan luaran klinis yang satu mempengaruhi lainnya. Studi terakhir berhasil membuktikan manfaat empagliflozin, obat lini kedua pada DMT2, terhadap kardiovaskular. Mekanisme seluler yang diketahui berperan pada hewan adalah efek antifibrosis miokard, namunbelum ada studi pada manusia.Tujuan: Mengetahui efek pemberian empagliflozin terhadap fibrosis miokard pada pasien DMT2 dengan gagal jantung. Metode: Uji klinis acak tidak tersamar yang dilakukan di RS Jantung dan Pembuluh Darah Harapan Kita dari Februari 2019 sampai Mei 2019. Pasien DMT2 dan gagal jantung diberikan empagliflozin 10 mg selama tiga bulan. Perbedaan kadar suppression of tumorigenicity-2 (ST2) serum pada kelompok kontrol dan intervensi di awal dan akhir penelitian akan dianalisis. Hasil: Terdapat 58 pasien yang menjadi subjek penelitian dan 40 (69%) pasien menyelesaikan penelitian. Terdapat perbedaan kadar ST2 yang bermakna setelah pemberian empagliflozin selama tiga bulan (median ST2 kelompok empagliflozin sebelum dan sesudah empagliflozin masing-masing 23,5(12,5 - 130,7)ng/mL dan 18,9(12,5 - 29,4) ng/mL, p=0,02). Penurunan ST2 dan persentase penurunan ST2 kelompok empagliflozin kedua kelompok tidak berbeda secara statistik (masing-masing p=0,16 dan p=0,21). Kesimpulan: Pemberian empagliflozin selama tiga bulan dapat menurunkan fibrosis miokard yang tidak terlihat pada kelompok kontrol. Tidak terdapat perbedaan besaran penurunan fibrosis pada pemberian empagliflozin dibandingkan terapi standar.
Background: Type 2 diabetes mellitus (T2DM) and heart failure have a strong relationship; one affects each other. Recent studies have proven some cardiovascular benefits of empagliflozin. Myocardial antifibrosis is proposed to be the mechanism in many animal studies, but in humans the data is lack. Objectives: To investigate the effect of empagliflozin on myocardial fibrosis in T2DM patients and heart failure. Methods: This was an open-labeled clinical trial in National Cardiovascular Center Harapan Kita, from February 2019 to May 2019. Patients with T2DM and heart failure received empagliflozin 10 mg for three months. Differences of serum suppression of tumorigenicity-2 (ST2) levels in both control and intervention groups at the beginning and end of the study were analyzed. Results: There were 58 patients enrolled in the study and total of 40 (69%) patients completed it. There were significant differences in ST2 levels after administration of empagliflozin (median for ST2 empagliflozin group before and after empagliflozin was 23.5 (12.5 - 130.7) ng / mL and 18.9 (12, 5 - 29.4) ng / mL respectively, p = 0.02). The ST2 value difference and percent different were not different (p=0,16 and p=0,21, respectively). Conclusion: Three months Empagliflozin might reduce myocard fibrosis which was not seen in control group. The total fibrosis reduction was not significantly different compared to standard therapy"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T59208
UI - Tesis Membership  Universitas Indonesia Library
cover
M. Hadi Utama Syam
Hubungan antara pola metilasi DNA gen reseptor klopidogrel P2y12 dan penghambatan fungsi platelet dengan timi flow pada pasien infark miokard akut disertai elevasi segmen ST yang menjalani intervensi koroner perkutan primer = The Association between DNA Methylation of P2Y12 gene with platelet reactivity and TIMI-flow after primary percutaneous coronary intervention in patients with acute ST-segment
"ABSTRAK
Latar belakang: Salah satu faktor yang dicurigai berperan dalam mekanisme resisensi klopidogrel adalah faktor epigenetik seperti metilasi DNA. Individu dengan resistensi klopidogrel ini memiliki kecenderungan untuk mengalami luaran kardiovaskular yang lebih buruk. Nilai TIMI flow pasca IKPP telah diketahui berkaitan dengan luaran klinis pada pasien IMA-EST. Sampai saat ini belum ada penelitian yang menghubungan antara metilasi gen P2Y12 dengan penghambatan fungsi platelet dan nilai TIMI flow pasca IKPP pada pasien IMA EST. Tujuan: Untuk mengetahui hubungan antara metilasi gen reseptor P2Y12 terhadap fungsi penghambatan platelet dan nilai TIMI flow pasca IKPP pada pasien IMA EST. Metode: Sebanyak 118 pasien IMA-EST yang menjalani IKPP dan mendapatkan terapi klopidogrel dimasukkan kedalam populasi penelitian. Dilakukan pemeriksaan VerifyNow P2Y12 dan pemeriksaan metilasi P2Y12. Selanjutnya dilakukan analisis hubungan antara metilasi P2Y12 dengan nilai Verifynow P2Y12 dan TIMI flow pasca IKPP. Hasil: Dari seluruh subyek, 22% diantaranya termasuk klopidogrel nonresponder dan 30% memiliki nilai TIMI flow kurang dari 3. Terdapat 48% subyek yang tidak mengalami metilasi dan 19% subyek mengalami metilasi sempurna pada gen P2Y12. Tidak terdapat hubungan bermakna antara metilasi P2Y12 dengan nilai Verifynow P2Y12 dan TIMI flow pasca IKPP. Nilai Verifynow P2Y12 yang tinggi berhubungan dengan TIMI flow kurang dari 3 pasca IKPP (p=0,043). Kesimpulan: Tidak terdapat hubungan bermakna antara pola metilasi gen P2Y12 dengan penghambatan fungsi platelet dan nilai TIMI flow pasca IKPP. Pasien yangnon-responder terhadap klopidogrel berisiko untuk mendapatkan reperfusi miokard yang suboptimal.
ABSTRACT
Background: Mechanism of clopidogrel resistance is not well understood yet. In the other hand, epigenetic modifications such as DNA methylation, are suspected to play role in clopidogrel resistence. Subject with high on treatment clopidogrel reactivity show worsen cardiovascular outcome. Meanwhile, TIMI flow after reperfusion are known to be related with poor outcome. Study that evaluate the relationship between methylation of P2Y12 gene with Platelet Reactivity and TIMI-flow after Primary Percutaneous Coronary Intervention (PPCI) in Patients With Acute ST-segment Elevation Myocardial Infarction in South East Asia Population has never been done. Objectives: to define whether methylation of P2Y12 gene and platelet reactivity may affect the myocardial perfusion after PPCI. Methods: There were 118 of STEMI patients who underwent PPCI and had received clopidogrel were recruited for the study. We measured platelet reactivity using Verifynow P2Y12 and Methylation of P2Y12 gene. The relationship among variables are assessed using statistic method. Results: Among 118 subject, 22% are clopidogrel nonresponder and 30% had TIMI flow less than 3. Median of Methylation degree was 15% with 48% subject were unmethylated, 19% subject had 100% methylation. There are no relationship between methylation of P2Y12 gene with platelet reactivity and TIMI flow after PPCI among subjects. The value of Verifynow P2Y12 more than 208 were related TIMI flow less than 3 after PPCI (p=0,043). Conclusion: There are no relationship between methylation of P2Y12 gene with platelet reactivity and TIMI flow after PPCI among subjects. Clopidogel nonresponder subjects were more likely to have suboptimal reperfusion after PPCI"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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Harry Mahathir Akip
Hubungan Polimorfisme Gly972Arg Gen Insulin Receptor Substrate 1 (IRS1) dengan TIMI Flow Pasca Intervensi Koroner Perkutan Primer (IKPP) dan Jumlah Kelainan Pembuluh Koroner pada Infark Miokard Akut Elevasi Segmen ST (IMA-EST) = The Association between Gly972Arg Polymorphism of Insulin Receptor Substance 1 Gene and TIMI Flow After Primary Percutaneous Coronary Intervention and Coronary Multivessel Involvement in Patients with Acute ST-Segment Elevation Myocardial Infarction
"Latar belakang: Polimorfisme Gly972Arg pada gen IRS1 dapat mengganggu
fungsi normal endotel dan menyebabkan disfungsi endotel. TIMI flow pasca
prosedur IKPP dan jumlah pembuluh darah yang terlibat pada pasien IMA-EST
merupakan prediktor mortalitas dan morbiditas selama perawatan. Mekanisme
yang menyebabkan adanya perbedaan profil angiografi ini salah satunya
dipengaruhi oleh difungsi endotel di tingkat mikrovaskular dan makrovaskular.
Penelitian mengenai hubungan antara polimorfisme Gly972Arg pada gen IRS1
dengan TIMI flow pasca prosedur dan jumlah keterlibatan pembuluh darah belum
pernah dilakukan.
Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara polimorfisme
Gly972Arg pada IRS1 dengan TIMI flow pasca IKPP dan jumlah keterlibatan
pembuluh darah pada pasien IMA-EST.
Metode: Studi potong lintang pada 104 pasien IMA-EST RSJPDHK yang
menjalani IKPP yang masuk pada registri 2018. Pemeriksaan polimorfisme
Gly972Arg pada IRS1 dengan menggunakan metode Taqman.
Hasil: Terdapat 104 subjek yang diikutsertakan dalam penelitian ini. Subjek dibagi
dalam 3 kelompok, yakni grup wildtype/CC (42,3%), heterozigot/CT (49,0%), dan
homozigot mutan/TT (8,7%). Tidak terdapat hubungan yang bermakna antara
kelompok mutan (TT) dengan TIMI flow pasca IKPP (OR 0,8; p = 1,000) dan
jumlah keterlibatan pembuluh darah (OR 0,3; p = 0,163).
Kesimpulan: Tidak terdapat hubungan antara polimorfisme Gly972Arg gen IRS1
dengan TIMI flow pasca IKPP dan jumlah keterlibatan pembuluh darah pasien IMA
EST.
Background: Gly972Arg polymorphism of IRS1 gene can interfere with normal
endothelial function and cause endothelial dysfunction. TIMI flow after the primary
percutaneous intervention procedure and the number of coronary vessels involved
in STEMI patients are predictors that determine mortality and morbidity during
treatment. The mechanism that causes this difference in angiographic profile is
influenced by endothelial dysfunction at the microvascular and macrovascular
levels. Research on the relationship between Gly972Arg polymorphisms of IRS1
gene with TIMI flow post procedure and the amount of blood vessel involvement
has not been carried out.
Objective: We sought to define whether Gly972Arg polymorphisms of IRS1 gene
may affect TIMI flow after primary percutaneous intervention and number of
coronary vessel involved.
Methods: Cross-sectional study design of 104 STEMI patients who underwent
primary PCI at National Cardiovascular Center Harapan Kita Hospital at year 2018.
Examination of Gly972Arg polymorphism on IRS1 is using the Taqman method
PCR.
Results: There were 104 of STEMI patients who underwent primary PCI and
recruited for the study. The subjects then divided into 3 categories, which are
wildtype/CC (42,3%), carrier/CT (49,0%) and mutant/TT (8,7%). There were no
significant relationship between the mutant group (TT) with TIMI flow after
primary PCI (OR 0.8; p = 1,000) and the number of coronary vessel involvement
(OR 0.3; p = 0.163).
Conclusion: There were no relationship between the Gly972Arg polymorphism of
IRS1 gene with TIMI flow after primary PCI and the number of coronary vessel
involvement of STEMI patients."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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Muhammad Andi Yassiin
Rasio Volume Kontras dengan Laju Filtrasi Glomerolus untuk Memprediksi Kejadian Contrast Induced Nephropathy pada Pasien Risiko Rendah yang menjalani Angiografi atau Intervensi Koroner Perkutan = Contrast volume to creatinine clearance ratio for the prediction of contrast induced nephropathy in low risk patients undergoing angiography or percutaneous coronary intervention
"ABSTRAK
Latar Belakang. Media kontras dapat memberikan efek toksik pada sel tubulus ginjal, menyebabkan suatu kondisi dinamakan contrast induced nephropathy (CIN), yang berhubungan dengan peningkatan morbiditas dan mortalitas, dan memiliki efek yang sama pada pasien dengan gagal ginjal kronik maupun pasien risiko rendah (Laju Filtrasi Glomerolus (LFG) ≥ 60, skor Mehran sebelum tindakan ≤ 5). Dari beberapa penelitian mengenai rasio volume kontras dengan laju filtrasi glomerulus (V/LFG) untuk memprediksi CIN belum ada yang dikhususkan untuk pasien risiko rendah.
Metodologi. Penelitian ini merupakan studi potong lintang yang dilakukan di Departemen Kardiologi dan Kedokteran Vaskular FKUI/Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) dengan mengambil data dari rekam medis dan ruang kateterisasi. Durasi data yang diambil adalah Agustus 2015 - April 2016. Hasil penelitian dianalisis dengan prosedur Receiver Operating Characteristic (ROC) dari rasio V/LFG. Akan dianalisis nilai Area Under Curve dan mencari titik potong yang direkomendasikan sebagai nilai prediktor optimal dengan sensitivitas dan spesifisitas yang terukur.
Hasil. Dari 223 data yang terkumpul lengkap dan sesuai dengan kriteria inklusi dan eksklusi didapatkan jumlah pasien yang mengalami CIN adalah sebesar 11 pasien (4,9%). Didapatkan perbedaan bermakna pada kedua jenis kelompok yaitu pada variabel jenis tindakan (P = 0,04), volume kontras (P = 0,02), dan rasio V/LFG (P = 0,032). Dari kurva ROC didapatkan bahwa rasio V/LFG mempunyai nilai AUC 0,69 (IK 95% 0,53 - 0,86). Dari kurva ROC ditentukan nilai potong yang bermakna dari rasio V/LFG ≥ 1,0 (Sensitifitas 55%, Spesifisitas 78%, Akurasi 77%, Nilai Prediksi Positif 12%, Nilai Prediksi Negatif 97%, P = 0,022). Dengan menggunakan rasio V/LFG ≥ 1 didapatkan insidensi CIN adalah 12% dibandingkan 3% pada pasien dengan V/LFG < 1 (OR 4,33; IK 95% 1,27 - 14, 83); P = 0,022).
Kesimpulan. Rasio V/LFG ≥ 1,0 dapat memprediksi kejadian CIN pada pasien risiko rendah yang menjalani tindakan angiografi atau intervensi koroner perkutan elektif
ABSTRACT
Background: Contrast media could give toxic effect to renal tubulus, creatining a condition named contrast induced nephropathy (CIN) and is associated with increased morbidity and mortality, and has the same effect in patient with chronic kidney disease or in low risk patients (estimated Glomerolus Filtration Rate (eGFR) ≥ 60, Mehran Score before procedure ≤ 5). From several studies concerning ratio of contrast volume to creatinine clearance (V/CrCl) to predict CIN, there were not any study yet focusing in low risk patients.
Methods: This is a cross-sectional study conducted in Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita (NCCHK). The data were retrieved from medical records and catheterization room, since August 2015 -- April 2016. Receiver Operating Characteristic (ROC) is used to analyze the data, and by using Area Under Curve will gives the optimal cut-off for contrast volume to creatinine clearance ratio with measured sensitivity and specificity.
Results: From 223 patients the incidence of CIN is 11 patients (4,9%). There is a significant difference from both groups in types of procedure (P = 0,04), contrast volume (P = 0,02), and V/CrCl ratio (P = 0,032). From ROC curve we found that V/CrCl ratio have an AUC 0,69 (CI 95% 0,53 - 0,86). From ROC curve the significant cut-off ratio of V/CrCl is ≥ 1,0 (Sensitifity 55%, Specificity 78%, Accuracy 77%, Positive Predictive Value 12%, Negative Predictive Value 97%, P = 0,022). Using V/CrCl ratio ≥ 1,0 the incidence of CIN is 12%, compared to 3% in patients with V/LFG < 1,0 (odds ratio 4,33; CI 95% 1,27 - 14, 83); P = 0,022).
Conclusions: V/CrCl ratio ≥ 1,0 could predict CIN in low risk patients undergoing angiography or percutaneous coronary intervention."
2016
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Rony Mario Candrasatria
Hubungan antara polimorfisme C677T pada gen methylenetetrahydrofolate reductase (MTHFR) dengan hipertensi pada masyarakat rural di Desa Gunung Sari, Bogor-Indonesia = The association between methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism and hypertension in rural population of Gunung Sari Village Bogor Indonesia
"Polimorfisme gen Methylenetetrahydrofolate Reductase MTHFR C677T dihubungkan dengan kejadian hipertensi dan bergantung dengan etnis dan daerah geografis. Stratifikasi risiko dan potensi terapeutik menjadi alasan dilakukannya sejumlah studi pada gen MTHFR ini. Hingga saat ini belum ada studi yang menghubungkan polimorfisme MTHFR C677T dengan hipertensi di Indonesia. Penelitian ini bertujuan untuk menentukan hubungan antara polimorfisme C677T pada gen MTHFR dengan hipertensi pada masyarakat rural di desa Gunung Sari, Bogor-Indonesia. Total sebanyak 415 subyek yang terdiri dari 213 subyek dengan hipertensi dan 202 subyek normotensif sebagai kontrol, menjalani pemeriksaan polimorfisme MTHFR C677T dengan menggunakan metode Taqman. Terdapat perbedaan polimorfisme MTHFR C677T yang bermakna antara kelompok hipertensi dengan kelompok kontrol 62,9 CC; 34,3 CT; 2,8 TT vs 77,7 CC; 20,8 CT; 1,5 TT . Setelah disesuaikan dengan usia, indeks massa tubuh, lingkar pinggang, dan status diabetes mellitus, didapatkan hubungan antara polimorfisme MTHFR C677T dengan kejadian hipertensi OR 2,1; 95 IK 1,3-3,5 . Sebagai kesimpulan, terdapat hubungan antara polimorfisme MTHFR C677T dengan kejadian hipertensi pada populasi desa Gunung Sari, Kabupaten Bogor, Indonesia.
Methylenetetrahydrofolate Reductase MTHFR C677T gene polymorphism is associated with hypertension depending on ethnic and geographic region. Risk stratification and therapeutic potential has become the common reason of recent studies on this gene. No study of MTHFR C677T polymorphism on hypertension is available in Indonesia. This study sought to determine the association of MTHFR C677T gene polymorphism and hypertension in rural population of Gunung Sari Village, Bogor Indonesia. A total of 415 subjects consisting of 213 hypertensive subjects and 202 normotensive subjects as a control group, underwent MTHFR C677T polymorphism examination using Taqman method. There was a significant difference of MTHFR C677T polymorphism between hypertensive group and control group 62,9 CC 34,3 CT 2,8 TT vs 77,7 CC 20,8 CT 1,5 TT . After adjustment of age, body mass index, waist circumference, and diabetes mellitus, there was an association between MTHFR C677T polymorphism with hypertension OR 2,1 95 CI 1,3 3,5 . As conclusion, there is an association between MTHFR C677T gene polymorphism and hypertension in rural population of Gunung Sari Village, Bogor Indonesia"
Depok: Fakultas Kedokteran Universitas Indonesia, 2017
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Aprivita Gayatri
Peran resistensi insulin terhadap disfungsi sistolik vki subklinis pada sindrom metabolik = The role of insulin resistance to subclinical left ventricle systolic dysfunction in metabolic syndrome
"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. "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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