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"Angka kematian pada pasien dengan infark miokardium akut (IMA) telah menurun secara signifikan oleh karena strategi terapi reperfusi saat ini. Terapi reperfusi dapat berakibat pada cedera reperfusi. Oleh karena itu, tatalaksana pada pasien ini menghadapi tantangan baru dalam hal diagnosis dan tatalaksana gagal jantung, identifikasi kondisi iskemia, estimasi keperluan antikoagulan, dan penilaian risiko kardiovaskular secara menyeluruh. Ilustrasi kasus ini akan menunjukkan pengaruh magnetic resonance imaging (MRI) kardiak dalam penilaian patofisiologi IMA pada era terapi reperfusi. MRI kardiak akan memberikan informasi berguna yang akan membantu para klinisi dalam tatalaksana dan pemilihan strategi terapi spesifik pada pasien IMA.

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AbstractMortality in patients with acute myocardial infarction (AMI) has decreased significantly and appears to be the result of current reperfusion therapeutic strategies. Reperfusion itself may develop into reperfusion injury. Therefore, management of these patients poses several challenges, such as diagnosing and managing heart failure, identifying persistent or inducible ischaemia, estimating the need for anticoagulation, and assessing overall cardiovascular risk. This case presentation will demonstrate the impact of cardiac magnetic resonance imaging (MRI) in the assessment of the pathophysiology of AMI inthe current reperfusion era. Cardiac MRI can provide a wide range of clinically useful information which will help clinicians to manage and choose specific therapeutic strategies for AMI patients."

"Infark miokard akut (IMA) telah menjadi sebab utama kematian di negara Barat maupun di Indonesia. Keterlambatan diagonis dan tatalaksana dini yang salah seringkali mengakibatkan kegagalan reperfusi dengan trombolitik. Dokter umum sebagai lini kesehatan pertama harus dibekali dengan ketrampilan mendiagnosis dan juga menangani IMA. Dalam tulisan ini dilaporkan kasus gagal terapi trombolitik pada pria usia 47 tahun setelah tujuh jam mengalami nyeri dada angina, yang telah sebelumnya ditangani oleh dokter umum. (Med J Indones 2005; 14:249-52)

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Acute myocardial infarction (AMI) has been the leading cause of death in Western countries, as well as in Indonesia. Delay in diagnosis and incorrect early management often result in failure of thrombolytic reperfusion. General practitioner (GP) as the primary care, needs to be equipped with the ability to diagnose and moreover to manage AMI. A case of fail thrombolytic management in a 47 years old man after seven hours of angina typical chest pain, after previously managed by GP, is being reported. (Med J Indones 2005; 14:249-52)"

"Evidence from epidemiologic studies suggests that periodontal diseases may exert a weak to moderate influence on the severity and course of coronary heart disease. The aim of this study was to investigate whether an association between chronic oral infections and the presence of an acute myocardial infarction (AMI) exists. A total of 248 patients after AMI and 249 healthy controls were recruited for this study. The oral assessment included caries frequency (DMFT indices), number of teeth, probing pocket depths, bleeding on probing, clinical attachment level, as well as radiographs to diagnose apical lesions. The medical examination included a blood analysis, e.g. the determination of the serum concentration of C-reactive protein (CRP). The data analysis showed statistically significant differences between AMI patients and the controls with regard to number of missing teeth (p = 0.001), DMFT index (p = 0.001) and presence of apical lesions of endodontic origin (p = 0.001). Logistic regression showed that the probability of having lesions of endodontic origin was with an odds ratio of 1.54 (95 % CI 1.10-2.16; p = 0.012) considerably higher in the AMI patient group. Likewise, the AMI patients had with an odds ratio of 1.21 (95 % CI 1.14-1.28; p < 0.001) a higher number of missing teeth. The data from the blood analysis, in particular the CRP values, showed no significant correlation with the number of apical lesions. The results of the present study underline that patients, who have experienced a myocardial infarction, had more missing teeth and a higher number of inflammatory processes, especially of endodontic origin, than healthy patients."

"[, Penelitian ini bertujuan untuk mencari korelasi antarapola perubahan kadar Mg plasma dan K serum terhadaptimbulnya GIJ pada IMA. Jumlah sampel yang memenuhi kreteria penelitian sebanyak 28 orang yang terdiri dari 24 orang pria dan 4 orang wanita. Penderita IMA yang mengalami GIJ selama perawatan di ICCU RSCM sebesar 70%. GIJ yang terjadi dapat berupa gangguan konduktifitas (kelompok I) dan gangguan iritabilitas (kelompok II), sedang 30% irama sinus (kelompok III).

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This study aims to find a correlation between

pattern of changes in plasma Mg and K levels of serum to

the emergence of GIJ at IMA. The number of samples that met the research criteria was 28 people consisting of 24 men and 4 women. IMA patients who experience GIJ during treatment at ICCU RSCM is 70%. GIJ that occurs can be in the form of conductivity disorders (group I) and irritability disorders (group II), while 30% of sinus rhythms (group III).]"

"Telah dilakukan penelitian retrospektif terhadap pasien infark miokard akut (IMA) yang dirawat di ICCU RSUPN Dr Cipto Mangunkusumo, Jakarta antara Januari 1994 sampai Desember 1999. Dari 513 pasien yang dirawat dengan IMA, 227 pasien adalah usia lanjut, di mana 35,2 % dari mereka adalah wanita. Sebagian besar IMA usia lanjut mengeluh nyeri dada yang khas seperti pada pada kelompok usia muda. Pasien IMA usia lanjut cenderung terlambat datang ke rumah sakit dan lebih banyak menderita IMA gelombang Q. Faktor risiko diabetes melitus dan hipertensi lebih sering dijumpai pada usia lanjut. Prevalensi fibrilasi atrial dan mortalitas lebih tinggi pada usia lanjut. (Med J Indones 2003; 12: 229-35)

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A retrospective study were performed in patients with acute myocardial infarction (AMI) that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2%) were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non-Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients. (Med J Indones 2003; 12: 229-35)"

"Intervensi koroner perkutan primer (IKPP) merupakan pilihan utama terapi repefusi pada infark miokard akut dengan elevasi segmen ST (IMAEST) dan obstruksi mikrovaskular (OMV) merupakan salah satu komplikasi yang sering terjadi pada IKPP. Osteoprotegerin (OPG) merupakan tumor necrosis factor receptor yang konsentrasinya meningkat pada pasien IMA-EST. Studi yang menganalisis hubungan konsentrasi serum OPG dengan luasnya infark masih sangat terbatas. Metode. Tiga puluh enam pasien yang menjalani intervensi koroner perkutan primer (IKPP) pada bulan September hingga November 2013, direkrut secara konsekutif pada studi potong lintang ini. Dilakukan analisis hubungan antara konsentrasi serum OPG sebelum IKPP dengan hs-trop T 24 jam pasca IKPP. Hasil. Analisis bivariat menunjukkan hubungan antara konsentrasi serum OPG dengan hs-trop T (r = 0.41, p =0.015). Analisis multivariat konsentrasi serum OPG dan onset nyeri mempengaruhi luas infark (indeks kepercayaan 5.15 – 49.19, p =0.017 dan indeks kepercayaan 2.56 - 15.28, p = 0.005). Kesimpulan. Hasil penelitian ini menunjukkan hubungan antara konsentrasi serum osteoprotegerin saat masuk dengan luas infark miokard yang diukur dengan hs-trop T pada pasien IMA-EST yang menjalani IKPP.

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Primary percutaneous coronary intervention (PPCI ) is the preferred option for reperfusion therapy in acute ST-elevation myocardial infarction (STEMI) patients and microvascular obstruction (MVO) is one of the complication that might occurred during PPCI. Osteoprotegerin (OPG) is a tumor necrosis factor receptors that may increased in STEMI patients. Studies that analyze the relationship between serum concentrations of OPG with the extent of infarction are still very limited.

Method. Thirty six patients underwent PPCI were enrolled in this cross sectional study during September to November 2013. We analyzed the relationship between serum concentrations of OPG before PPCI with the level of hs-trop T measured 24 hours after PPCI.

Results. Bivariate analysis showed a significant correlation between serum osteoprotegerin concentration and hs-trop T (r=0.41, p=0.015). Multivariate analysis showed significant correlation between the extent of infarction with both onset of pain (confidence interval 2.56-15.28, p=0.005) and serum osteoprotegerin concentrations (confidence interval 5.15-49.19, p= 0.017).

Conclusion. This study showed that serum osteoprotegerin concentration have a significant relationship to the extent of infarction measured with hs-trop T in acute STEMI patients underwent PPCI."

"Infark miokard akut (IMA) merupakan salah satu masalah kesehatan utama di sebagian negara berkembang. Pasien IMA dengan penyakit ginjal kronis (PGK) mempunyai risiko tinggi terjadinya luaran major adverse cardiac events(MACE) dan mortalitas. Infark miokardium terjadi akibat erosi, maupun ruptur plak aterosklerotik, yang memicu oklusi arteri koroner. Sel yang nekrosis akan melepaskan komponen intraseluer seperti enzim creatine kinase(CK), maupun isoenzim CK-MB, serta protein struktural, seperti troponin ke dalam sirkulasi sistemik. Troponin sebagai baku emas penanda jantung dalam diagnosis IMA, mengalami penurunan spesifisitas, seiring dengan penurunan laju filtrasi glomerulus pada pasien PGK sehingga penelitian ini bertujuan untuk mendapatkan nilai diagnostik CK total dan aktivitas CK-MB sebagai penanda alternatif dalam diagnosis IMA, serta nilai prognostiknya terhadap kejadian MACE pada pasien sindrom koroner akut (SKA) dengan PGK. Penelitian ini menggunakan desain potong lintang untuk menilai peran pemeriksaan CK total dan aktivitas CK-MB dalam diagnosis IMA, serta desain nested case controluntuk memprediksi kejadian MACE dalam kurun waktu 30 hari. Sejumlah 109 pasien yang memenuhi kriteria, diikutsertakan ke dalam penelitian ini. Pemeriksaan CK total mempunyai luas area under curve(AUC) 81,9% dengan cut-offbatas atas nilai rujukan, yaitu 171 U/L untuk laki-laki, dan 145 U/L untuk perempuan (sensitivitas 76,3%; spesifisitas62,5%), sedangkan pemeriksaan aktivitas CK-MB mempunyai luas AUC 95,2% dengan cut-off14,55 U/L (sensitivitas 92,5%; spesifisitas 87,5%) dalam diagnosis IMA. Tidak ditemukan hubungan yang bermakna secara statistik antara nilai CK total [OR= 0,99; p= 0,98], dan aktivitas CK-MB [OR= 1,31; p= 0,58] dengan kejadian MACE pada pasien SKA dengan PGK. Berdasarkan hasil tersebut, maka pemeriksaan CK total pada batas atas nilai rujukan, dan aktivitas CK-MB pada titik potong 14,55 U/L dapat digunakan sebagai penanda biokimia jantung alternatif dalam diagnosis IMA pada pasien SKA dengan PGK, namun tidak dapat memprediksi luaran kejadian MACE.

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Acute myocardial infarction (AMI) is one of the major health problems in some developing countries. Acute myocardial infarction patients with chronic kidney disease (CKD) have a high risk of developing major adverse cardiac events (MACE) and high mortality. Myocardial infarction which results either from erosion or atherosclerotic plaque rupture may triggers coronary artery occlusion. The necrotic cells release intracellular components like creatine kinase (CK) enzyme and CK-MB isoenzyme as well as structural proteins like troponin into the systemic circulation. Troponin, as the gold standard for cardiac markers in the diagnosis of AMI, has decreased specificity along with the decrease in glomerular filtration rate in CKD patients. Therefore, this study aims to obtain a diagnostic value of total CK and CK-MB activity as an alternative marker in the diagnosis of AMI, and to obtain its prognostic value for the occurrence of MACE in acute cardiovascular disease (ACD) patients with CKD. This study uses a cross-sectional design to assess the role of total CK assay and CK-MB activity in AMI diagnosis, as well as a nested case control design to predict the occurrence of MACE within 30 days. A total of 109 patients who met the criteria were included in this study. The total CK assay has an area under the curve (AUC) of 81.9% with cut-off at the upper limit of the reference value at 171 U/L for men, and 145 U/L for women (sensitivity 76.3%; specificity 62.5%), while the assessment of CK-MB activity has an AUC of 95.2% with a cut-off of 14.55 U/L (sensitivity 92.5%; specificity 87.5%) in the diagnosis of AMI. Statistically, there was no significant relationship found between the total CK value [OR= 0.99; p= 0.98] and CK-MB activity [OR= 1.31; p= 0.58] with the occurrence of MACE in ACS patients with CKD. Based on these results, the total CK assay at the upper limit of the reference value, and CK-MB activity at the 14.55 U/L cut point can be used as an alternative biochemical cardiac markers in the diagnosis of AMI in ACS patients with CKD, but cannot predict the outcome of MACE."

"Latar belakang: Penyakit jantung koroner merupakan salah satu penyebab utama kematian di negara berkembang, termasuk Indonesia. Penyakit ini merupakan salah satu penyebab gagal jantung. Terapi yang selama ini dilakukan belum sepenuhnya mampu memperbaiki kerusakan otot jantung yang telah terjadi. Terapi sel punca baik injeksi maupun patch juga masih belum memperlihatkan hasil yang memuaskan. Penggunaan patch jantung dihadapkan pada masalah seperti rendahnya viabilitas sel yang dihasilkan. Hipotermia pada suhu 4°C yang digunakan untuk isolasi kardiomiosit selama ini dikaitkan dengan gangguan aktivitas sel yang menyebabkan penurunan jumlah sel viabel yang dihasilkan. Suhu 37°C yang merupakan suhu fisiologis tubuh dinilai mampu menghasilkan viabilitas sel lebih baik. Metode: Studi ekperimental in vitro dilakukan di Pelayanan Jantung Terpadu Rumah Sakit Cipto Mangunkusumo (PJT-RSCM) dan Indonesian Medical Education and Research Institute (IMERI) Fakultas Kedokteran Universitas Indonesia dalam periode Desember 2019 hingga November 2020 dengan mengikutsertakan subjek pasien yang menjalani operasi total koreksi tetralogy of Fallot. Jaringan reseksi otot infundibulum jantung diambil kemudian dilakukan isolasi untuk menilai viabilitas sel dan ekspresi genetik. Hasil: Delapan subjek ((n = 4) ± 95% C.I) kelompok suhu 37°C secara signifikan menghasilkan jumlah sel viabel yang lebih banyak (mean: 2675sel/mg) dibandingkan suhu 4°C (mean: 970 sel/mg) dengan (p <0,05). Ekspresi gen yang mengekspresikan sel kardiomiosit secara flowsitometer terlihat kelompok medium transpor 37°C secara bermakna lebih tinggi dibandingkan dengan suhu 4°C. Simpulan: Isolasi kardiomiosit menggunakan medium transpor suhu fisiologis (37⁰C) menghasilkan jumlah sel viable yang lebih banyak dibandingkan medium konvensional (4⁰C).

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Background: Coronary heart disease is one of the main causes of death in developing countries, including Indonesia. This disease is one of the causes of heart failure. The therapy that has been implemented has not able to repair the damage of the heart muscles that have occurred. Stem cell therapy, either injection or patch, has not succeeded satisfactorily. The use of the cardiac patch is exposed to many problems such as low viability of the cells produced. Hypothermia at 4°C, which is used for isolation of cardiomyocytes related with activity disturbance which causes a decrease in the number of viable cells produced. The temperature 37°C which is the body's physiological temperature considered can produce better cell viability.

Methods: An experimental invitro study was conducted in the Pelayanan Jantung Terpadu Cipto Mangunkusumo (PJT-RSCM) and the Indonesian Medical Education and Research Institute (IMERI) Faculty of Medicine, University of Indonesia from December 2019 to November 2020 by recruiting patient subjects who underwent total correction of tetralogy of Fallot. The resection of the cardiac infundibulum was taken and then isolated to assess cell viability and gene expression.

Results: A total of eight subjects ((n = 4) ± 95% CI) the 37°C group produced significantly more viable cells (mean: 2675 cells/mg) than at 4°C (mean: 970 cells/mg).)) with (p <0.05). The expression of genes expressing cardiomyocytes by flowcitometer showed that the physiological group (37°C) was significantly higher than the conventional group (4°C).

Conclusion: Isolation of cardiomyocytes using a physiological temperature transport medium (37⁰C) resulted in a higher number of cells than conventional medium (4⁰C)."

"Latar belakang: PCSK9 telah diketahui sebagai molekul yang berperan dalam regulasi kadar kolesterol LDL darah. Dua dekade ini, PCSK9 diketahui memiliki mekanisme kerja lain yang melibatkan proses inflamasi, peningkatan Lp(a), aktivasi jaras protrombotik dan platelet, metabolisme triglyceride-rich lipoprotein, serta modifikasi plak yang juga dapat berperan dalam patogenesis berbagai spektrum penyakit aterosklerotik, termasuk IMA-EST. Kemajuan dalam strategi penatalaksanaan IMA-EST telah berhasil meningkatkan kesintasan, akan tetapi sekelompok pasien masih mengalami luaran klinis buruk meski telah mendapatkan tatalaksana optimal. Adanya polimorfisme gain of function E670G PCSK9 dipikirkan dapat memiliki peranan dalam risiko residual pasien-pasien tersebut Tujuan: Penelitian ini bertujuan untuk mempelajari hubungan antara polimorfisme PCSK9 pada pasien IMA-EST yang menjalani IKPP dengan luaran kardioserebrovaskular mayor. Metode: Sebanyak 423 pasien dengan IMA-EST yang menjalani IKPP diperiksakan polimorfisme PCSK9 pada saat admisi. Pemeriksaan polimorfisme PCSK9 didapatkan dengan menggunakan Real Time PCR. Data luaran kardioserebrovaskular mayor dan data penunjang lain didapatkan dari rekam medik dan follow-up telepon. Hasil: Terdapat 2,1 % polimorfisme berupa alel mutan (AG). Terdapat 65 (15,4%) subjek penelitian yang mengalami luaran kardioserebrovaskular mayor dalam 180 hari. Didapatkan analisis kesintasan menunjukkan adanya hubungan yang bermakna secara statistik antara polimorfisme E670G PCSK9 dengan luaran kardioserebrovaskular mayor dalam 180 hari (HR 7,486; IK95% 3.57-15.697; P=0,0000). Kesimpulan: Pada pasien IMA-EST yang menjalani IKPP, terdapat hubungan yang bermakna antara polimorfisme E670G PCSK9 dengan luaran kardioserebrovaskular mayor dalam 180 hari.

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Background: PCSK9 is a molecule that regulates blood LDL cholesterol level. Recent evidences suggest that PCSK9 may also have other mechanisms, such as inflammation, increased Lp(a), triglyceride-rich lipoprotein metabolism, activation of prothrombotic pathways and platelets, and modification of atherosclerotic plaque, which all may play a role in the pathogenesis of atherosclerotic diseases, including STEMI. Previous advances in the management of STEMI had succeed in increasing survival. However, some STEMI patients still experienced adverse outcomes eventhough they already received optimal management in accordance with the guidelines. Polimorphysm gain of function PCSK9 may have a role in the residual risk that those patients have. However, our knowledge regarding this association between polymorphism gain of function E670G PCSK9 and MACCE in STEMI is still unknown. Objective: The aim of this study is to evaluate the association between polymorphism Gain of Function E670G PCSK9 with MACCE in STEMI patients who underwent primary PCI. Methods: In total, 423 patients with STEMI who were treated with primary PCI had their plasma sample drawn during admission and evaluated for Polymorphism PCSK9. PCSK9 Polymophism was measured with PCR RT. MACCE and other supportive data were taken from the medical records and telephone follow-up. Results: The prevalence of Poymorphisme E670G PCSK9 in STEMI patient who underwent PPCI is 2,1 %. There were 65 (15,4%) study participants who experienced MACCE in 180 days. Survival analysis shows a significant association between Polymorphsm Gain of Function E670G PCSK9 and MACCE in 180 days. (HR 7,486; IK95% 3.57-15.697; P=0,0000). Conclusion: There was significant association between Polymorphsm gain of function E670G PCSK9 and 180 days MACCE in STEMI patients treated with primary PCI."