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"[Latar belakang. Durasi AV delay (DAVD) pada pasien dengan pacu jantung dual chamber menentukan derajat sinkroni atrioventrikular (AV). Pengaturan DAVD yang optimal pada pasien dapat meningkatkan kualitas hidup dan memperbaiki parameter hemodinamik jika dibandingkan dengan pasien yang tidak dilakukan optimalisasi . Namun optimalisasi DAVD merupakan prosedur yang memakan waktu dan biaya. Perlu dicari faktor-faktor yang mempengaruhi nilai DAVD yang optimal.Metode. Penelitian ini merupakan studi potong lintang. Evaluasi dilakukan pada 35 pasien blok AV total dengan pacu jantung permanen dual chamber yang datang ke poliklinik RS Jantung Nasional Harapan Kita periode bulan Oktober sampai dengan pertengahan November 2014. Dilakukan pemeriksaan ekokardiografi terhadap parameter fungsi diastolik pada saat DAVD awal (DAVD pabrikan), lalu dicari DAVD optimal menggunakan VTI-LVOT terbesar.Hasil. Terdapat korelasi lemah antara paramater fungsi diastolik rasio E/A dan nilai DAVD optimal (r - 0,356 dengan p 0,036). Analisa regresi linear antara rasio E/A dengan nilai DAVD optimal (adjusted analysis sesuai usia, fraksi ejeksi, dan DAVD pabrikan) menunjukan nilai koefisien -0.477 dengan nilai p 0,007 (IK 95% - 84.4 s.d. -14.1). Analisa regresi linear antara nilai e' medial dengan DAVD optimal menunjukkan tingkat kemaknaan dengan nilai koefisien -0.390 dan nilai p 0.026 (IK 95% -16.3 s.d. -1.1). Terdapat perbedaan rerata DAVD optimal, 173.46 ±42.23 ms untuk pasien dengan rasio E/A ≥ 1, dan 128.89 ± 42.5 ms untuk rasio E/A <1 (p:0.01).Kesimpulan. Terdapat korelasi negatif yang bermakna antara parameter fungsi diastolik (E/A dan e' medial) dengan DAVD optimal pada pasien dengan pacu jantung permanen dual chamber.;Background. AV Delay Duration (AVD) in patient with dual chamber pacemaker defines atrioventricular synchrony. Optimazation of AVD could improve quality of life and hemodynamic parameters compared to factory setting. Despite that, AVD optimization is a time consuming procedure and not cost effective. factors that influence the optimal AVD should be sought.Methods. This is a cross sectional study on 35 total AV block patients that came to National Cardiovascular Center Harapan Kita from October to November 2014. Echocardiography on left ventricle diastolic indices was performed in factory setting AVD. The AVD that gives to the biggest LVOT VTI was set as the optimal AVD. Statistical analysis was done to correlate between diastolic indices and optial AVD.Results. Weak correlation was noted between diastolic indices (E/A ratio) and optimal AVD (r: - 0,356; p: 0,036). Linear regression analysis showed a negative correlation between E/A ratio {coefficient -0.477; p: 0,007 (CI 95% - 84.4 to -14.1)} and medial e' {coefficient -0.390; p: 0.026 (CI 95% -16.3 to -1.1)} with optimal AVD (adjusted with age, ejection fraction, and factory setting AVD). Different E/A ratio showed a different optimal AVD mean, 173.46 ±42.23 ms for E/A ≥ 1 vs. 128.89 ± 42.5 ms for E/A <1 (p:0.01).Conclusion. This paper shows a negative correlation between echocardiographic diastolic function indices (E/A ratio and medial e') with optimal AVD., Background. AV Delay Duration (AVD) in patient with dual chamber pacemaker defines atrioventricular synchrony. Optimazation of AVD could improve quality of life and hemodynamic parameters compared to factory setting. Despite that, AVD optimization is a time consuming procedure and not cost effective. factors that influence the optimal AVD should be sought.Methods. This is a cross sectional study on 35 total AV block patients that came to National Cardiovascular Center Harapan Kita from October to November 2014. Echocardiography on left ventricle diastolic indices was performed in factory setting AVD. The AVD that gives to the biggest LVOT VTI was set as the optimal AVD. Statistical analysis was done to correlate between diastolic indices and optial AVD.Results. Weak correlation was noted between diastolic indices (E/A ratio) and optimal AVD (r: - 0,356; p: 0,036). Linear regression analysis showed a negative correlation between E/A ratio {coefficient -0.477; p: 0,007 (CI 95% - 84.4 to -14.1)} and medial e' {coefficient -0.390; p: 0.026 (CI 95% -16.3 to -1.1)} with optimal AVD (adjusted with age, ejection fraction, and factory setting AVD). Different E/A ratio showed a different optimal AVD mean, 173.46 ±42.23 ms for E/A ≥ 1 vs. 128.89 ± 42.5 ms for E/A <1 (p:0.01).Conclusion. This paper shows a negative correlation between echocardiographic diastolic function indices (E/A ratio and medial e') with optimal AVD.]"

"[Latar Belakang: Komplikasi sirosis hati pada jantung masih sedikit diketahui. Mekanisme patofisiologi sirosis hati yang melibatkan hipertensi portal memungkinkan terjadinya disfungsi diastolik ventrikel kiri.Tujuan: Mengetahui proporsi disfungsi diastolik ventrikel kiri pada pasien sirosis hati dengan kriteria ASE-EAE 2009 dan konvensional, korelasi positif antara beratnya derajat disfungsi diastolik ventrikel kiri dengan beratnya derajat disfungsi hati melalui skor Child Turcotte Pugh ( CTP ) dan menilai hubungan parameter beratnya derajat disfungsi diastolik menurut kriteria ASE-EAE 2009 dengan skor CTP numerik.Metode: Potong lintang pada pasien yang berobat secara konsekutif di Unit Rawat Jalan Hepatologi dan Rawat Inap Departemen Ilmu Penyakit Dalam FKUI-RSCM. Penelitian dimulai di bulan November 2013 hingga tercapai 96 subjek sirosis hati berusia 18-60 tahun. Anamnesis, pemeriksaan fisik, rekam medik dan pemeriksaan penunjang dilakukan. Pemeriksaan dengan ekokardiografi dilakukan oleh dua pemeriksa. Uji kesesuaian Kappa dan uji beda rerata dilakukan antar pemeriksa. Data kemudian diolah untuk diperoleh nilai proporsi, uji normalitas sebaran data, analisis uji korelasi Spearman dan analisis multivariat regresi linier.Hasil: Sebanyak 54,17% pasien mengalami hipertrofi konsentrik ventrikel kiri. Proporsi disfungsi diastolik ventrikel kiri dengan kriteria ASE-EAE 2009 sebesar 34,3% namun 21,9% ditemukan fungsi diastolik normal dengan indeks volume atrium kiri meningkat, dengan kriteria disfungsi diastolik konvensional proporsi menjadi 68,8%. Seluruh parameter fungsi diastolik menunjukkan perubahan abnormal pada CTP B 8-10. Korelasi beratnya derajat disfungsi diastolik ventrikel kiri kriteria ASE-EAE 2009 dengan beratnya derajat disfungsi hati melalui skor CTP skala numerik adalah 0,42 ( p = 0,000 ). Bila penderita diabetes dan pengguna spironolakton dieksklusi, r menjadi 0,51 ( p = 0,000; ASE-EAE 2009 ). Parameter beratnya derajat disfungsi diastolik yang berhubungan dengan beratnya derajat disfungsi hati skor numerik CTP adalah selisih Ar-A, volume atrium kiri dan nilai lateral e’ ( p < 0,005 ).Kesimpulan: Semakin berat disfungsi diastolik ventrikel kiri maka semakin berat sirosis hati. Parameter disfungsi diastolik ventrikel kiri yang berhubungan dengan beratnya sirosis hati adalah tekanan pengisian diastol intraventrikel beserta kekakuan miokard, remodelling atrium kiri dan kecepatan alir balik vena pulmonalis dalam menghadapi tekanan pengisian. Deteksi dini disfungsi diastolik pada sirosis hati dapat dimulai pada CTP B 8., Background: Cardiovascular complication of liver cirrhosis is relatively obscure. Liver cirrhosis pathophysiology involving portal hypertension made the possibility of cirrhosis complication manifested as left ventricular diastolic dysfunction.Objective: To determine proportion of left ventricular diastolic dysfunction among liver cirrhotic patients according to American Society of Echocardiography-European Association of Echocardiography ( ASE-EAE ) 2009 and conventional approach, to determine any correlation between left ventricular diastolic dysfunction severity stages with severity stages of liver dysfunction in cirrhotic patients represented by Child Turcotte Pugh ( CTP ) score, also to asses relationship between severity stages of parameters of diastolic function according to ASE-EAE 2009 with liver cirrhosis severity evaluated by numerical CTP score.Methods: In this cross sectional design, we targeted 96 liver cirrhotic patients within age of 18-60 year old consecutively due to any cause who admitted to ambulatory unit of Hepatology and Internal Medicine Cipto Mangunkusumo General Hospital wards into intended sample. The study started in November 2013 until proper sample size wasobtained. Echocardiography examination was performed by 2 operators. Interobserver validity was assesed with level of Kappa aggrement and mean difference. Data was extracted to find prevalence, normality test, Spearman correlation test and multivariate linear regression test.Results: Left ventricular concentric hypertrophy was found in 54,2% of source population. Left ventricular diastolic dysfunction proportion among liver cirrhotic patients according to ASE-EAE 2009 is 34,3% and 21,9% of normal diastolic function subgroup has left atrial volume index ≥ 34 mL/m2. Conventional approach resulted in 68,8% of diastolic dysfuncation. All diastolic parameter showed abnormalities on CTP B 8-10. Spearman’s r values of stage of diastolic dysfunction severity according to ASE-EAE 2009 with severity of numerical CTP score is 0,42 ( p = 0,000 ). Exclusion of diabetic patients and spironolactone treated patients resulted in r 0,51 ( p = 0,000; ASE-EAE 2009 ). Parameters of diastolic function that have relation with liver dysfunction severity in cirrhosis measured by numerical CTP are Ar-A ( p = 0,004 ), left atrial volume index ( p = 0,005 ) and laterale e’ ( p = 0,026).Conclusion: Severity of left ventricular diastolic dysfunction with severity of liver cirrhosis is correlated positively. Diastolic parameters relate with severity of liver cirrhosis are diastolic ventricular filling pressure with left ventricular chamber stiffness, left atrial remodelling and regurgitant of pulmonary venous flow velocity to oppose filling pressure. Early detection for diastolic dysfunction can be started on CTP B 8.]"

"The textbook will describe the relationship between human cardiopulmonary system and exercise in a format that is related to the mode of exercise, health status and aging. It will include data regarding exercise training principles and the adaptations of the cardiopulmonary following, anaerobic, resistance and aerobic training. A more in-depth presentation of the cardiopulmonary system adaptations in pressing environments such as: warm, cold and altitude. Therefore, students will experience a depth and extent of content balanced with unique and effective learning features: It will help students find the way by both the text and subject matter. Knowing cardiopulmonary exercise function in health and disease will allow understand new research and findings relevant to cardiovascular status as assessed by cardiopulmonary exercise indices. It will bring together investigational exercise physiologists, cardiologists and scientists who share a wealth of experience needed to judge the cardiovascular status and function, and the impairments of patients with a variety of cardiac dysfunction. This book will provide a comprehensive, updated presentation of the information of the cardiovascular system as a whole, and its individual components."

"For years heart disease prevelance have increased. results of basic health research (Known as riset kesehatan dasar riskesdas ) 2007. showed that heart disease is the second majoe cause of death after stroke in mortality cases in Indonesia...."

"Heart abnormalities in cirrhotic patients have been known for five decades, with atria and ventricular dilatation. Pozzi et al reported that in cirrhotic patients with or without ascites, the diastolic function was lower than control. Ascitic paracentesis improved diastolic function. The diameter of both atria was larger in cirrhotic patients with or without ascites. The diastolic diameter of left ventricle did not differ significantly in cirrhotic patients with or without ascites compared to control, but there was an increase after paracentesis. Eection fraction was lower in cirrhotic and increased after ascitic parancentesis although the increase was not significant.

The aim of the Study: To compare the function and structure o fthe heart before and afler ascitic paracentesis in cirrhotic patients.

Methods: This study tool: place from February 2000 to April 2001 in dr. Pringadi Hospital/H.Adam Malik Hospital. There were 18 samples (12 men and 6 women), 15 of which were cirrhotic patients with tense ascites and 3 cirrhotic patients with refractory ascites. The mean age was 51,8 + 8,28 years, the youngest being 29 years and the oldest 65 years. The mean ascitic fluid removed by paracentesis was 7,20 liters with a range of 5 to 9 liters. Immediately following paracentesis, Dextran 40 % was administered at a dose of 8g lL ascilic fluid aspirated.

Results: The diameter of the four heart chambers decreased after paracentesis, but the decrease was not statistically significant. There was increase in E/A ratio after ascitic paracentesis, from 0,93 + 0,3 70 to 1,06 + 0,383 (significant, p<0, 05), meaning that there was an improvement in diastolic function after ascitic paracentesis. There was also an increase in ejection fraction from 68,99 + 13,26 % to 72,10 + 11,10 %, bitt this was not significant (p>0,05).

Conclusion: after paracentesis, there was a significant inmprovement in diastolic function while diameter of the four heart chambers decreased and the ejection fraction increased insignificantly"

"Latar BelakangDaya tahan jantung paru sebagai komponen kebugaran jasmani mempunyai peranan penting dalam meningkatkan kualitas dan produktivitas pegawai sipil. Di era otonomi daerah, peranan Pemerintah Daerah dan Dinas Otonom dalam pembangunan semakin penting. Untuk itu perlu diketahui sebaran daya tahan jantung paru dan faktor yang berhubungan antara pegawai negeri sipil di kedua instansi tersebut.MetodeDisain cross sectional dengan deskripsi analisis. Didapatkan sample penelitian Pegawai Negeri Sipil umur 30-50 tahun Dinas Kesehatan dan Pemerintah Daerah Tk.I di 4 Provinsi sebanyak 654 orang. Pengumpulan data dilakukan dengan wawancara, pemeriksaan fisik dan daya tahan jantung paru di nilai dengan tes lari 2,4 km.HasilTingkat daya tahan jantung paru yang baik ditemukan hanya pada 27 % dari total responder. Proporsi tingkat daya tahan jantung paru yang baik di Pemerintah Daerah lebih besar dari Dinas Kesehatan Tingkat I. Faktor yang paling berpengaruh adalah tidak berminum alkohol (OR sesuai 2,39), berolahraga (OR sesuai 2,1) dan golongan kepegawaian ( OR = 1,51 ).Kesimpulan SaranDaya tahan jantung paru pada Pegawai sipil pada umumnya masih rendah. Daya tahan jantung pare mempunyai hubungan bermakna dengan golongan, unit kerja, tidak minum alkohol, dan olah raga. Disarankan untuk diteliti lebih lanjut tentang hemoglobin, aktifitas fisik dan pola makan. Perlu penyuluhan mengenai gaya hidup sehat bagi pegawai negeri sipil.

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Background

Cardiorespiratory endurance as a component of physical healthy is playing an important role in improving quality and productivity of government officials. In the decentralization era, the role of the provincial government and health office in coordinating the implementation and controlling developments has become more important. Therefore, there is a need to find out the status of cardiorespiratory endurance and its related factors among the government officials of provincial health and government office in four provinces.

Methods

This study is using cross-sectional design with descriptive analysis. A total of 645 samples of government officials, age 30-50 years, working at provincial health office and government office in four provinces were recruited. The data was collected by interview and physical examination; the cardiorespiratory endurance was measured by performing the running test for 2.4km (Cooper Test).

Results

The level of good cardiorespiratory endurance among the subjects was 27.6% out of 645 total respondents. It was better in government office's staff than in the health office (31.6%, 24%). The most affecting factors were; not taking alcoholic drinks (adjusted OR 2.39), sports (adjusted OR 2.1), and grade of government official (adjusted OR 1,51),

Conclusion and Recommendation

The level of cardiorespiratory endurance among the government officials is still low. The provincial government office's staffs have better cardiorespiratory endurance than the provincial health office's staffs. The cardiorespiratory endurance correlated with the grade of government official, working unit, not taking alcoholic drinks, and sports. The health education on healthy life style should be given to government officials. For further research, it is recommended to assess the relations of the haemoglobin, physical activity, and dietary pattern, with the cardiorespiratory endurance."

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Latar Belakang : Dari berbagai penelitian, dijumpai hasil yang beragam mengenai efek jangka panjang pemacuan ventrikel kanan non apeks terhadap fungsi sistolik ventrikel kiri pada pasien dengan alat pacu jantung permanen (APJP) serta faktor-faktor yang mempengaruhinya. 

Tujuan:Menilai hubungan beban pemacuan ventrikel kanan non apeks, durasi QRS pacu (pQRSd) dan durasi pemasangan dengan disfungsi sistolik ventrikel kiri pada pasien dengan APJP 

Metode: Studi potong lintang terhadap pasien yang menjalani pemeriksaan APJP di Poliklinik Kardiologi Pelayanan Jantung Terpadu RSCM-FKUI. Dilakukan pemeriksaan program APJP, EKG, NT-proBNP dan ekokardiografi terhadap keseluruhan subyek. Disfungsi sistolik ventrikel kiri didefinisikan sebagai penurunan fraksi ejeksi ventrikel kiri dibawah 50% dan atau NT-proBNP diatas 300 pg/ml.  

Hasil:Dari 46 pasien yang ikut serta dalam penelitian ini, dijumpai 21 (45,65%) pasien dengan disfungsi sistolik ventrikel kiri. Terdapat 17 pasien dengan pQRSd ³150 ms yang mengalami disfungsi sistolik ventrikel kiri sementara hanya dijumpai 4 pasien dengan pQRSd < 150 ms yang mengalami disfungsi sistolik ventrikel kiri. pQRSd signifikan berhubungan dengan disfungsi sistolik ventrikel kiri (p = 0,016). Rerata pQRSd yang lebih lebar dijumpai pada kelompok dengan disfungsi sistolik ventrikel kiri (171,14 ms ±40,62 vs 147,04 ms ±29,99, p = 0,026). Beban pemacuan ventrikel kanan dan durasi pemasangan APJP tidak berhubungan dengan disfungsi sistolik ventrikel kiri ( p = 0,710 dan p = 0,079). 

Simpulan: Durasi QRS pacu berhubungan dengan disfungsi sistolik ventrikel kiri pada pasien dengan APJP.  

 

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Background : The recent studies have suggested that impact of right ventricular non apical pacing on left ventricular systolic function and factors predispose to its development are still conflicting

Objective : To clarify the clinical significance of non apical right ventricle burden, paced QRS duration (pQRSd) and length of permanent pacemaker usage on left ventricle systolic dysfunction

Methods : This is a cross sectional study of 46 patients who underwent routine pacemaker programming evaluation at Poliklinik Kardiologi Pelayanan Jantung Terpadu, RSCM – FK UI. All subjects went through pacemaker programming, ECG, NT-proBNP, and echocardiography examination. Left ventricle systolic dysfunction was defined as ejection fraction < 50 % and or NT-proBNP > 300 pg/ml.  

Results :Out of fourty six patients who enrolled in this study, twenty one (45,65%) patients have left ventricle systolic dysfunction. Seventeen (60,7%) patients with wider pQRSd (³150 ms)have left ventricle systolic dysfunction. pQRSd has association with left ventricle systolic dysfunction (p = 0,016). Wider mean of pQRSd found in left ventricle systolic dysfunction group (171,14 ms ±40,62 vs 147,04 ms ±29,99, p = 0,026). While burden of right ventricle pacing and duration of pacemaker usage have no association with left ventricle systolic dysfunction (p = 0,710 and p = 0,079).

Conclusion: Paced QRS duration has association with left ventricle systolic dysfunction in patients with permanent pacemaker. 

 

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"ABSTRAKLatar Belakang : Infark miokard masih menyisakan banyak masalah morbiditaspasca infark. Upaya regenerasi miokard pasca infark mendorong berbagaipenelitian tentang terapi sel punca sumsum tulang. Endothelial Progenitor Cellsebagai bagian dari Bone Marrow Mononuclear Cell merupakan komponen selpunca yang berperan dalam proses neovaskularisasi. Fungsi sistolik merupakansebagai salah satu pertimbangan dalam pemilihan kandidat terapi sel puncasumsum tulang. Hingga saat ini belum diketahui pengaruh penurunan fungsisistolik ventrikel kiri terhadap jumlah absolut Endothelial Progenitor Cell dalamBone Marrow Mononuclear Cell.Tujuan : Mengetahui apakah terdapat hubungan antara fungsi sistolik ventrikelkiri serta faktor klinis dan demografis lain, dengan jumlah absolut EPC dalamBMMC sumsum tulang terhadap jumlah absolut EPC dalam BMMCMetode : Penelitian ini merupakan studi potong lintang yang dilakukan di PusatJantung Nasiona Harapan Kita dengan subyek pasien yang menjalani terapi selpunca pasca infark. Penelitian dilakukan pada bulan Oktober 2016. Dilakukanpencatatan karakteristik pasien, faktor resiko penyakit jantung koroner,pengukuran fungsi sistolik ventrikel kiri dan pengambilan serta analisa aspirasisumsum tulang.Hasil : Total sampel penelitian ini adalah 21 sampel, yang menjalani terapi selpunca pasca infark miokard selama periode Oktober 2015-September 2016.Faktor-faktor yang dianalisa hubungannya dengan kadar EPC dalam BMMCadalah fungsi sistolik ventrikel kiri, usia, indeks massa tubuh serta faktor resikopenyakit jantung koroner yaitu hipertensi, diabetes dan merokok. Hasil analisastatistik menunjukkan tidak terdapat korelasi antara fungsi sistolik ventrikel kiridengan jumlah absolut EPC. Fungsi sistolik ventrikel kiri, indeks massa tubuh danhipertensi berpengaruh secara signifikan terhadap jumlah absolut BMMC Kesimpulan : Fungsi sistolik ventrikel kiri tidak menunjukkan korelasi yangsignifikan dengan jumlah absolut Endothelial Progenitor Cell dalam sumsumtulang pasien dengan penyakit jantung iskemik

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ABSTRACTBackground Myocardial infarct still carries significant morbidity in postinfarction patients. This condition trigger many study in stem cell therapy formyocardial regeneration after infarctio. Endothelial Progenitor Cell as thecomponent of Bone Marrow Mononuclear Cell was one of determinant factor inmigration capacity of Bone Marrow Mononuclear Stemcell. Left Ventriclesystolic function has becoming one of determinant factor in selection of stem cellpatient. No previous study has evaluate the influence of decreased LV systolicfunction to the numbers of Endothelial Progenitor Cell in Bone MarrowMononuclear CellObjective Evaluating correlation of LV systolic function and other risk factorsof coronary heart disease to the numbers of Endothelial Progenitor Cell in BoneMarrow Mononuclear Cell from Ischemic Heart Disease patients with stem celltherapyMethods This is a cross sectional study that was conducted in NationalCardiovascular Centre Harapan Kita on october 2016. Patients from 2 previousstem cell study in NCCHK enrolled to this studyResults There were 21 patients in this study that undergo stem cell therapy fromOctober 2015 until September 2016. Factors that being analyzed in this studywere LV systolic function and risk factors of coronary heart disease includinghypertension, diabetes melitus and history of cigarrete smoke. Statistical analysisshowed no significant correlation between LV systolic function and absolutnumbers of Endothelial Progenitor Cell in Bone Marrow Mononuclear Cell frompatients with ischemic heart disease. Significant result showed by correlation ofBone Marrow Mononuclear Cell with LV systolic function, body mass index andhypertensionConclusion LV systolic function has no significant correlation with absolutnumbers of Endothelial Progenitor Cell in Bone Marrow Mononuclear Cells frompatients with Ischemic Heart Disease."

"Aimed specifically at undergraduate clinical medical students, this text provides the necessary factual information for medical finals. It covers the history and examination of the cardiovascular system, cardiac investigations and the common disorders."