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"[ABSTRAKLatar belakang : Kekakuan arteri berkaitan dengan peningkatan risiko kejadian kardiovaskular. Variabilitas tekanan darah dengan menggunakan ambulatory blood pressure monitoring telah terbukti sebagai prediktor prognosis kardiovaskular dan dapat menggambarkan kekakuan arteri. Penelitian ini bertujuan untuk menyelidiki hubungan variasi tekanan darah dengan menggunakan home blood pressure monitoring dengan pemeriksaan pulse wave velocity sebagai penilaian kekakuan arteri.Metode : Penelitian potong-lintang dilakukan terhadap 57 subyek hipertensi yang belum terobati berusia 30-50 tahun. Subyek menjalani pemeriksaan PWV dan dilakukan monitoring tekanan darah menggunakan HBPM sebanyak 3 hari (setiap pagi dan malam, masing-masing dua kali pengukuran). Dilakukan juga penilaian terhadap variabel perancu (obesitas, diabetes, dislipidemia, penurunan fungsi ginjal).Hasil : Sebanyak 21% subyek obesitas, 8,7% mengidap diabetes melitus, 60% mengalami dislipedemia, 14% merokok, tidak ada yang mengalami perburukan fungsi ginjal. Tidak ada hubungan antara obesitas, dislipidemia, merokok, jenis kelamin, merokok dengan kekakuan arteri. Diabetes melitus memliki hubungan yang signifikan dengan kekakuan arteri (p=0,01). Ada perbedaan antar pengukuran tekanan sistolik berdasarkan pengelompokan hari dan waktu, sebaliknya tidak ada perbedaan antar pengukuran tekanan diastolik. Terdapat korelasi antara kekakuan arteri dengan rata-rata tekanan darah diastolik (p=0,028), rata-rata tekanan darah diastolik pagi (p=0,015), koefisien variasi diastolik (p=0,030), koefisien variasi diastolik pagi (p=0,015).Kesimpulan : Tidak terdapat hubungan variabilitas tekanan darah sistolik terhadap kekakuan arteri namun terdapat kecenderungan hubungan yang positif. Terdapat hubungan berbanding terbalik yang signifikan antara variabilitas tekanan darah diastolik dengan kekakuan arteri.

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ABSTRACTBackground : Arterial stiffness is related to higher risk of cardiovascular events. Blood pressure variability using ambulatory blood pressure monitoring has proven as a cardiovascular prognosis predictor and also serves as predictor of arterial stiffness. The study aims to prove the correlation between blood pressure variability measurement using home blood pressure monitoring and arterial stiffness measurement using pulse wave velocityMethods : A cross-sectional study was conducted to 57 subjects with native hypertension between 30-50 years old. Subjects underwent PWV measurement and was monitored for their blood pressure using HBPM for three consecutive days (morning and night BP each repeated two times). Subjects also screened for related confoundings i.e., diabetes, obesity, dyslipidemia, renal function disturbance. Results : As many as 21% subjects is obese, 8.7% had diabetes melitus, 60% had dyslipidemia, 14% is smoker. There is no subjects with renal function disturbance. There is no correlation between obesity, dyslipidemia, smoking habit, and sex to arterial stiffness, whereas diabetes melitus has a strong correlation to arterial stiffness (p=0,01). There was a significant difference between sytolic blood pressure measurement at each group of blood pressure based on day and time, but no difference found between diastolic blood pressure. There is significant correlation between arterial stiffness and mean diastolic pressure, mean morning diastolic pressure, variance coefficient of diastolic pressure, variance coefficient of morning blood pressure.Conclusion : We conclude that HBPM is reliable in measuring blood pressure variability. There is no significant relation of systolic blood pressure variability to arterial stiffness, but there is a tendency of positive correlation. While there is a significant negative correlation between diastolic pressure to arterial stiffness., Background : Arterial stiffness is related to higher risk of cardiovascular events.Blood pressure variability using ambulatory blood pressure monitoring has proven asa cardiovascular prognosis predictor and also serves as predictor of arterial stiffness.The study aims to prove the correlation between blood pressure variabilitymeasurement using home blood pressure monitoring and arterial stiffnessmeasurement using pulse wave velocity Methods : A cross-sectional study was conducted to 57 subjects with nativehypertension between 30-50 years old. Subjects underwent PWV measurement andwas monitored for their blood pressure using HBPM for three consecutive days(morning and night BP each repeated two times). Subjects also screened for relatedconfoundings i.e., diabetes, obesity, dyslipidemia, renal function disturbance. Results : As many as 21% subjects is obese, 8.7% had diabetes melitus, 60% haddyslipidemia, 14% is smoker. There is no subjects with renal function disturbance.There is no correlation between obesity, dyslipidemia, smoking habit, and sex toarterial stiffness, whereas diabetes melitus has a strong correlation to arterial stiffness(p=0,01). There was a significant difference between sytolic blood pressuremeasurement at each group of blood pressure based on day and time, but nodifference found between diastolic blood pressure. There is significant correlationbetween arterial stiffness and mean diastolic pressure, mean morning diastolicpressure, variance coefficient of diastolic pressure, variance coefficient of morningblood pressure.Conclusion : We conclude that HBPM is reliable in measuring blood pressurevariability. There is no significant relation of systolic blood pressure variability toarterial stiffness, but there is a tendency of positive correlation. While there is a significant negative correlation between diastolic pressure to arterial stiffness. ]"

"[ABSTRAKLatar belakang. Hipertensi adalah faktor risiko kardiovaskular yang penting. Kekakuan arteri meningkat seiring dengan peningkatan usia, hipertensi, diabetes mellitus, aterosklerosis, dan lainnya. Kekakuan arteri dapat diukur secara non-invasif dengan menggunakan alat carotid-femoral pulse wave velocity (CF-PWV), dimana alat ini mengukur kecepatan gelombang nadi yang berjalan dari arteri karotis komunis ke arteri femoralis. Obat antihipertensi telah diketahui memiliki kemampuan terhadap kekakuan arteri, namun berbeda efektifitasnya.Tujuan. Melihat perbandingan efek pemberian penghambat enzim pengubah angiotensin dan penyekat kanal kalsium terhadap kekakuan arteri pada pasien hipertensi yang belum pernah diobati sebelumnya.Metode. Uji klinis acak dengan tersamar ganda, dilakukan di RS Pusat Jantung dan Pembuluh Darah Harapan Kita (Maret-Mei 2015) terhadap 54 subyek usia 30-50 tahun. Subyek dibagi menjadi dua grup, grup lisinopril (n=27) dan amlodipin (n=27). Tekanan darah dan CF-PWV diukur sebelum dan setelah intervensi. Hasil. Terdapat penurunan tekanan darah dan sesudah terapi untuk kedua grup. Delta penurunan CF-PWV untuk kedua intervensi menujukkan hasil yang signifikan (P value <0.001). Lisinopril memiliki penurunan delta CF-PWV yang lebih signifikan dibandingkan amlodipin. (P value <0.001 IK 95% 0.2 - 0.5).Kesimpulan. Penelitian ini membuktikan adanya perbedaan bermakna terhadap CF-PWV pada grup yang diberikan lisinopril dan amlodipin, dimana lisinopril memiliki delta penurunan PWV yang lebih signifikan.

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ABSTRACTBackground. Hypertension is a well-recognized cardiovascular risk factors. Arterial stiffness increases with age, hypertension, diabetes mellitus, atherosclerosis, etc. Arterial stiffness can be assessed noninvasively by carotid-femoral pulse wave velocity (CF-PWV) measurement, that is, the velocity of the pulse wave to travel a given distance between carotid and femoral artery. Antihypertensive drugs have been implicated in arterial stiffness diminishment but vary in effectiveness.Objective. To examine the difference in arterial stiffness reduction in young native hypertensive subjects that was given ace-inhibitor or calcium channel blocker.Methods. A double blind randomized clinical trial was conducted in National Cardiovascular Centre Harapan Kita to 54 subjects (30-50 years old), from March to May 2015. Subjects were divided into lisinopril 5mg (n=27) and amlodipine 5mg (n=27) groups. Blood pressure and CF-PWV were measured before and 4 weeks post therapy.Results. Blood pressure reduction was found before and after treatment for both groups. CF-PWV for lisinopril and amlodipine showed significant reduction (p-value <0.001). Lisinopril had more significant decrease in CF-PWV (P value <0.001 CI 95% 0.2 - 0.5).Conclusion. There was a statistically significant difference in CF-PWV reduction between lisinopril and amlodipin administration to patients with native hypertension, with lisinopril having the larger effect., Background. Hypertension is a well-recognized cardiovascular risk factors.Arterial stiffness increases with agesubjects with diabetes mellitus, and hypertensionand is also enhanced in atherosclerosis,and end-stage renal disease.Arterial stiffness can be assessed noninvasively with the use of carotid-femoral pulse wave velocity (CF-PWV) measurement, that is, the velocity of the pulsewave to travel a given distance between carotid and femoral artery.Antihypertensive drugs have been implicated in arterial stiffness diminishmentbut vary in their degree of effect. The calcium channel blocker having its“destiffening” effect have been widely known to reduce arterial stiffness.However, the renin-angiotensin system inhibitors proved to be superior to allother antihypertensive drugs in reducing arterial stiffness. Objective. The aim of this study was to examine the difference in arterial stiffnessreduction in native hypertensive subjects that was given ace-inhibitor or calciumchannel blocker for four weeks, by measuring the CF-PWV. Methods. A double blind randomized clinical trial was conducted in NationalCardiovascular Centre Harapan Kita (NCCHK) to 54 subjects with nativehypertension between the age of 30-50 years old, from March to May 2015.Subjects were divided into two groups: lisinopril 5mg (n=27) and amlodipine 5mg(n=27). Blood pressure and CF-PWV were measured before and after 4 weeks oftherapy. Statistical analysis was done using bivariat and multivariat analisis todetermine the significance of arterial stiffness reduction. Results. There was a reduction in blood pressure (systole, diastole, mean arterialpressure) before and after the treatment for both groups. However although it wasclinicaly significant, statistically it was not (P value >0.05). Nonetheless, CFPWVforlisinoprilandamlodipinshowedsignificantreductionwithbothp-valuewere<0.001 (2.09±0.280, CI 95% 1.80-2.2 and 1.77±0.340, CI 95% 1.6-1.9).When both drugs were compared using multivariate analysis, lisinopril wasproved to have a more significant decrease in CF-PWV (P value <0.001 CI 95%0.2 - 0.5).Conclusion. This study proved that there was a statistically significant differencein CF-PWV reduction between lisinopril and amlodipin administration to patients with native hypertension, with lisinopril having the larger effect. ]"

"The major cause of mortalities in Indonesia shifs to Non Communicable risk faktors that related to physiological factors (intermediate risk factors) i.e. hypertension, obesity, and central obesity, diabetes...."

"[Latar belakang : Fibrilasi atrium merupakan aritmia yang paling sering terjadipasca bedah pintas arteri koroner. Peningkatan stress oksidatif, inflamasi, aktivitasneurohormonal memiliki peran terhadap kejadian fibrilasi atrium pasca bedahpintas arteri koroner. Berbagai strategi farmakologis seperti antiaritmia,antiinflamasi, dan antioksidan sudah dipelajari untuk menurun risiko kejadianfibrilasi atrium pasca bedah pintas arteri koroner namun kejadian fibrilasi atriummasih tinggi. Allopurinol memiliki efek antioksidan, namun belum ada uji klinisyang mempelajari efek allopurinol terhadap kejadian fibrilasi atrium. Penelitianini bertujuan untuk menilai efek allopurinol terhadap kejadian fibrilasi atriumpasca bedah pintas arteri koronerMetode : Uji klinis randomisasi tersamar ganda dilakukan di Rumah SakitPembuluh Darah Harapan Kita (RSJPDHK) pada periode April ? Mei 2015.Pasien BPAK on-pump elektif yang diseleksi secara consecutive samplingkemudian dibagi menjadi dua kelompok yaitu kelompok allopurinol dankelompok plasebo dengan randomisasi blok. Subyek diberikan allopurinol 600 mg/ plasebo dosis tunggal sejak 1 hari sebelum operasi sampai hari ke-5 pascaoperasi. Dilakukan pengamatan kejadian fibrilasi atrium pasca operasi sampaipasien pulang dari perawatan.Hasil : Sebanyak 90 subyek diikutsertakan dalam penelitian, 45 subyek padamasing-masing kelompok. Kejadiaan fibrilasi atrium lebih rendah secarabermakna pada kelompok allopurinol (12 (26,7%) vs 22 (48,9%) p 0,030). Kesimpulan : Pemberian allopurinol perioperatif menurunkan kejadian fibrilasi atrium pasca bedah pintas arteri koroner.;Background : Atrial fibrillation is the most common arrhythmias after coronaryartery bypass surgery. Increased oxidative stress, inflammation, neurohormonalactivity has a role on the incidence of atrial fibrillation after coronary arterybypass surgery. Various pharmacological strategies such as antiarrhythmias, antiinflammatory,and antioxidant have been studied to decrease atrial fibrillationincident after coronary artery bypass surgery, but the incidence of atrialfibrillation is still high. Allopurinol has antioxidant effects, but there was noclinical trials that studied the effect of allopurinol on atrial fibrillation incidence.The aim of this study to assess allopurinol effect on the atrial fibrillation incidenceafter coronary artery bypass surgery. Methods: A double-blind randomized clinical trial conducted at the NationalCardiovascular Center Harapan Kita in Jakarta from April to May 2015. Electiveon-pump CABG patients were selected by consecutive sampling then divided intotwo groups: allopurinol and placebo groups with block randomization. Subjectsgiven allopurinol 600 mg / placebo single dose since 1 day before surgery untilthe 5th day post-surgery. The incidence of atrial fibrillation was observedpostoperatively.Results: A total of 90 subjects were included in the study, 45 subjects in eachgroup. Occurrence of atrial fibrillation was significantly lower in the allopurinolgroup (12 (26.7%) vs 22 (48.9%) p 0,030). Conclusion: Perioperative allopurinol reduced the incidence of atrial fibrillation after coronary artery bypass surgery., Background : Atrial fibrillation is the most common arrhythmias after coronaryartery bypass surgery. Increased oxidative stress, inflammation, neurohormonalactivity has a role on the incidence of atrial fibrillation after coronary arterybypass surgery. Various pharmacological strategies such as antiarrhythmias, antiinflammatory,and antioxidant have been studied to decrease atrial fibrillationincident after coronary artery bypass surgery, but the incidence of atrialfibrillation is still high. Allopurinol has antioxidant effects, but there was noclinical trials that studied the effect of allopurinol on atrial fibrillation incidence.The aim of this study to assess allopurinol effect on the atrial fibrillation incidenceafter coronary artery bypass surgery. Methods: A double-blind randomized clinical trial conducted at the NationalCardiovascular Center Harapan Kita in Jakarta from April to May 2015. Electiveon-pump CABG patients were selected by consecutive sampling then divided intotwo groups: allopurinol and placebo groups with block randomization. Subjectsgiven allopurinol 600 mg / placebo single dose since 1 day before surgery untilthe 5th day post-surgery. The incidence of atrial fibrillation was observedpostoperatively.Results: A total of 90 subjects were included in the study, 45 subjects in eachgroup. Occurrence of atrial fibrillation was significantly lower in the allopurinolgroup (12 (26.7%) vs 22 (48.9%) p 0,030). Conclusion: Perioperative allopurinol reduced the incidence of atrial fibrillation after coronary artery bypass surgery.]"

"[ABSTRAKLatar Belakang : Endotelial glikokaliks merupakan bagian penting dalam barrier vaskular. Keadaan inflamasi, hiperglikemia, iskemia, dan hipervolemia dapat menyebabkan kerusakan glikokaliks. Kerusakan glikokaliks menyebabkan cairan terekstravasasi ke interstisial. Pada pasien pasca BPAK terjadi peningkatan syndecan-1 dalam plasma yang merupakan penanda terjadinya kerusakan endotelial glikokaliks. Hipervolemia pasca BPAK juga dapat memperburuk kerusakan glikokaliks dan hipervolemia sendiri berhubungan dengan kejadian komplikasi mayor pasca operasi. Pemilihan jenis cairan yang tepat diperlukan pada kondisi ini.Tujuan : Mengetahui apakah terdapat perbedaan efek pemberian koloid dan kristaloid terhadap endotelial glikokaliks pada pasien pasca bedah pintas arteri koroner.Metode Penelitian : Penelitian ini merupakan studi intervensi acak pada pasien pasca BPAK dengan pengambilan sampel secara konsekutif. Pasien yang tidak responsif terhadap pemberiaan cairan, memiliki fungsi pompa jantung pre oparasi yang turun, memiliki kelainan fungsi ginjal, atau menggunakan IABP saat operasi akan dieksklusi dari penelitian. Responsivitas terhadap cairan dinilai dengan pemeriksaan Doppler karotis. Pasien kemudian akan diberikan cairan koloid atau kristaloid secara acak. Sampel darah diambil pre dan pasca pemberian cairan. Kadar syndecan-1 diperiksa dengan metode ELISA.Hasil : Subyek penelitian sebanyak 54 orang dengan 27 orang mendapat cairan koloid dan 27 orang mendapat cairan kristaloid. Hasil pemeriksaan syndecan-1 pre pemberian cairan adalah 1,97 (0,29-14,03) ng/ml pada kelompok yang mendapat Gelofusine dan 2,14 (0,68-11,80) ng/ml pada kelompok Ringer?s lactate (p = 0,736). Syndecan-1 pasca pemberian cairan adalah 1,78 (0,23-10,98) ng/ml pada kelompok Gelofusine dan 2,08 (0,72-12,23) ng/ml pada kelompok Ringer?s lactate (p=0,276). Selisih antara syndecan-1 pre dan pasca pemberian cairan adalah 0,23 (-1,3 - 3,55) ng/ml pada kelompok Gelofusine dan 0,14 (-2,12 - 1,80) ng/ml pada kelompok Ringer?s lactate (p = 0,043). Syndecan-1 turun pada 23 pasien (85,5%) kelompok Gelofusine dan 15 pasien (55,6%) kelompok Ringer?s lactate (p = 0,017). Analisis bivariat pada beberapa faktor yang diduga mempengaruhi perubahan syndecan-1 menunjukkan bahwa jenis cairan merupakan satu-satunya faktor yang berpengaruh.Kesimpulan : Penelitian ini membuktikan bahwa terdapat perbedaan efek antara pemberian koloid (Gelofusine) dan kristaloid (Ringer?s lactate) terhadap endotelial glikokaliks pada pasien pasca BPAK. Pemberian koloid dapat lebih memperbaiki kerusakan endotelial glikokaliks yang terjadi pasca BPAK.

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ABSTRACTBackground : Endothelial glycocalyx is an important part of vascular barrier. Inflammation, hyperglycemia, ischemia, and hypervolemia contribute to shedding of the glycocalyx. Damage to the glycocalyx can make fluid extravasation to interstitial. Increasing syndecan-1 value in plasma as marker of shedding the endothelial glycocalyx can occured in the post CABG patients. Hypervolemia is a worsening factor of the shedding in glycocalyx and hypervolemia contribute to major complication after operation. It is important to choose the appropriate fluid for this patient.Objective : The aim of this study is to examine the difference effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients.Methods : This is a randomized trial which recruits post CABG patients cosecutively. Non fluid responsive, reduced left ventricle ejection fraction, reduced renal function, or used of IABP during operation are excluded. Fluid responsiveness will be measured by carotis Doppler. Patients then given colloid or crytalloid randomly. Blood sample were taken before and after fluid loading. Syndecan-1 value examined using ELISA method.Result : The total of 54 subjects with 27 patients received colloid and 27 patients received crystalloid. Syndecan-1 pre loading are 1,97 (0,29-14,03) ng/ml in Gelofusine group vs 2,14 (0,68-11,80) ng/ml in Ringer?s lactate group (p = 0,736). Syndecan-1 post loading are 1,78 (0,23-10,98) ng/ml in Gelofusine group vs 2,08 (0,72-12,23) ng/ml in Ringer?s lactate group (p=0,276). The difference of syndecan-1 value in pre and post fluid loading are 0,23 (-1,3 - 3,55) ng/ml in Gelofusine group and 0,14 (-2,12 - 1,80) ng/ml in Ringer?s lactate group (p = 0,043). Lowering syndecan-1 occured in 23 patients (85,2%) in Gelofusine group and 15 (55,6%) in Ringer?s lactate group (p= 0,017). Bivariat analysis showed that kind of fluid is the only factor can influence the difference of syndecan-1. Conclusion : There is contrasting effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients. Colloid can reduce shedding of the endothelial glycocalyx after CABG., Background : Endothelial glycocalyx is an important part of vascular barrier. Inflammation, hyperglycemia, ischemia, and hypervolemia contribute to shedding of the glycocalyx. Damage to the glycocalyx can make fluid extravasation to interstitial. Increasing syndecan-1 value in plasma as marker of shedding the endothelial glycocalyx can occured in the post CABG patients. Hypervolemia is a worsening factor of the shedding in glycocalyx and hypervolemia contribute to major complication after operation. It is important to choose the appropriate fluid for this patient.Objective : The aim of this study is to examine the difference effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients.Methods : This is a randomized trial which recruits post CABG patients cosecutively. Non fluid responsive, reduced left ventricle ejection fraction, reduced renal function, or used of IABP during operation are excluded. Fluid responsiveness will be measured by carotis Doppler. Patients then given colloid or crytalloid randomly. Blood sample were taken before and after fluid loading. Syndecan-1 value examined using ELISA method.Result : The total of 54 subjects with 27 patients received colloid and 27 patients received crystalloid. Syndecan-1 pre loading are 1,97 (0,29-14,03) ng/ml in Gelofusine group vs 2,14 (0,68-11,80) ng/ml in Ringer’s lactate group (p = 0,736). Syndecan-1 post loading are 1,78 (0,23-10,98) ng/ml in Gelofusine group vs 2,08 (0,72-12,23) ng/ml in Ringer’s lactate group (p=0,276). The difference of syndecan-1 value in pre and post fluid loading are 0,23 (-1,3 - 3,55) ng/ml in Gelofusine group and 0,14 (-2,12 - 1,80) ng/ml in Ringer’s lactate group (p = 0,043). Lowering syndecan-1 occured in 23 patients (85,2%) in Gelofusine group and 15 (55,6%) in Ringer’s lactate group (p= 0,017). Bivariat analysis showed that kind of fluid is the only factor can influence the difference of syndecan-1. Conclusion : There is contrasting effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients. Colloid can reduce shedding of the endothelial glycocalyx after CABG.]"

"[ABSTRAKLatar belakang. Pada stenosis mitral sering timbul komplikasi hipertensi pulmoner dan disfungsi ventikel kanan. Belum ada penelitian yang menghubungkan antara resistensi vaskular paru sebelum operasi dengan fungsi jantung kanan saat pasca operasi serta perubahannya pasca operasi stenosis mitral rematik.Metode. Studi ini merupakan studi kohort prospektif pada 31 pasien stenosis mitral rematik yang menjalani operasi katup mitral di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita sejak April 2014 sampai Maret 2015. Pasien menjalani pemeriksaan ekokardiografi sebelum operasi, sebelum pulang perawatan pasca operasi serta saat follow up mid term di poliklinik. Dilakukan analisa statistik untuk melihat hubungan antara resistensi vaskular paru (RVP) pra operasi dengan strain longitudinal ventrikel kanan saat follow up mid term serta perubahan strain longitudinal ventrikel kanan pasca operasi (delta strain).Hasil. Tidak terdapat korelasi antara RVP pra operasi dengan strain longitudinal speckle tracking ventrikel kanan saat follow up mid term pasca operasi (r 0,199 p 0,264) serta dengan perubahan strain longitudinal ventrikel kanan pasca operasi atau delta strain (r 0,174 p 0,350).Kesimpulan. Resistensi vaskular paru pra operasi tidak berhubungan dengan strain longitudinal speckle tracking ventrikel kanan saat follow up mid term pasca operasi serta dengan perubahan strain longitudinal ventrikel kanan pasca operasi atau delta strain.

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ABSTRACTBackground. In MS right ventikel (RV) dysfunction and pulmonary hypertension often occur as complication. There is no research that connects the pulmonary vascular resistance before surgery with RV function and its changes in the case of rheumatic mitral stenosis who underwent mitral valve surgery.Methods. This study is a prospective cohort study which involves 31 patients with rheumatic mitral stenosis who underwent surgery at National Cardiovaskular Center Harapan Kita Hospital from April 2014 to March 2015. Patients underwent echocardiography before surgery, after surgery pre-hospital discharge and mid-term follow-up at clinic. Statistical analysis was performed to see the relationship between preoperative pulmonary vascular resistance (PVR) with RV function at mid term follow up, which is assessed using echocardiographic parameters right ventricular longitudinal speckle strain, and also with right ventricle longitudinal speckle strain postoperative changes (delta strain).Results. There is no correlation between pre operative PVR with RV longitudinal speckle strain at mid term follow-up (r 0,199 p 0,264), and post operative changes or delta strain (r 0.174 p 0.350).Conclusion. RVP before surgery is not associated with right ventricle longitudinal speckle strain at follow up mid term and post operative changes or delta strain., Background. Acute rheumatic fever and rheumatic heart disease is still regarded as animportant public health problem especially in developing countries. Mitral stenosis (MS) is asequale of rheumatic fever which are most commonly found. In MS right ventikel (RV)dysfunction and pulmonary hypertension often occur as complication. The right ventricle hasa smaller muscle mass so it is more sensitive to changes in pressure loads. There is noresearch that connects the pulmonary vaskular resistance before surgery with RV functionand also changes in the case of rheumatic mitral stenosis who underwent mitral valvesurgery.Methods. This study is a prospective cohort study which involves 31 patients with rheumaticmitral stenosis who underwent surgery at National Cardiovaskular Center Harapan Kita Hospital from April 2014 to March 2015. Patients underwent echocardiography before surgery, after surgery pre-hospital discharge and mid-term follow-up at clinic. Statisticalanalysis was performed to see changes in RV function with longitudinal speckle strain, aftersurgery pre-hospital discharge and mid-term follow-up at clinic. Analysis also performed tosee the relationship between preoperative pulmonary vascular resistance (PVR) with RVfunction at mid term follow up, which is assessed using echocardiographic parameters rightventricular longitudinal speckle strain, and also with right ventricle longitudinal specklestrain postoperative changes (delta strain). Results. Right ventricular function after surgery seen with longitudinal speckle strainimproved from -12.94 ± 3.63 preoperatively into -13.06 ± 3.63 after surgery pre hospitaldischarge, and -15.25 ± 3.75 at follow-up evaluation (p 0.007). There is no correlationbetween pre operative PVR with longitudinal speckle strain at mid term follow-up (r 0,199 p0,264), and RV longitudinal speckle strain post operative changes or delta strain (r 0.174 p0.350). Conclusion. After mitral valve surgery, right ventricle longitudinal speckle strain improves.RVP before surgery is not associated with right ventricle longitudinal speckle strain at follow up mid term and right ventricle longitudinal speckle strain post operative changes or deltastrain. ]"

"[ABSTRAKLatar Belakang. Perburukan fungsi ginjal berkaitan dengan luaran klinis yang lebih buruk pada pasien gagal jantung dekompensasi akut. Karakteristik klinis pada saat pasien masuk ke unit gawat darurat (UGD) dapat menolong untuk identifikasi pasien yang berisiko terhadap kejadian perburukan fungsi ginjal. Tujuan penelitian ini adalah membuat sistem skor untuk mempermudah identifikasi pasien yang berisiko terhadap perburukan fungsi ginjal pada gagal jantung dekompensasi akut.Metode. Studi kohort retrospektif dilakukan terhadap 614 pasien yang menjalani perawatan karenan gagal jantung dekompensasi akut. Perburukan fungsi ginjal didefinisikan sebagai peningkatan nilai kreatinin serum ≥ 0.3 mg/dL kapanpun selama perawatan atau ≥ 25% dari awal masuk perawatan.Hasil. Perburukan fungsi ginjal terjadi pada hampir 26% pasien. Prediktor independen terhadap kejadian perburukan fungsi ginjal yang didapat melalui analisis dengan logistik regresi backward selection adalah usia > 75 tahun (p < 0.0001); perempuan (p = 0.034); riwayat hipertensi (p = 0.001); anemia (p = 0.005); dan serum Creatinin saat masuk di UGD > 2.5 mg/dL (p = 0.013). Sistem skor dibuat dari model akhir tersebut. Dilakukan validasi internal dengan metode bootstrap didapatkan hasil optimisme yang baik (0.01088808).Kesimpulan. Sistem skor baru dapat memprediksi kejadian perburukan fungsi ginjal pada pasien gagal jantung dekompensasi akut yang menjalani rawat inap.

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ABSTRACTBackground. Worsening renal function (WRF) is associated with worse outcomes among patients who are hospitalized with acute decompensated heart failure (ADHF). Clinical characteristics at admission may help identify patients at increased risk of WRF. The aim of this study was to create in admission scoring system to simplify identification patients at risk of WRF in ADHF setting.Methods. A retrospective data of 614 patients admitted with ADHF was analyzed. By the definition WRF occurred when serum Creatinin increased at anytime during hospitalization by ≥ 0.3 mg/dL or by ≥ 25% from admission.Results. Worsening renal function developed in near 26% patients. The independent predictors of WRF analyzed with backward selection logistic regression were: age > 75 years old (p < 0.0001), female (p = 0.034); history of hypertension (p = 0.001); anemia (p = 0.005); and in admission serum Creatinin (p = 0.013). A scoring system was generated from this final model. An internal validation with bootstrap method showed good optimism (0.01088808).Conclusion. A new scoring system could predict in-hospital worsening renal function among patients hospitalized with acute decompensated heart failure., Background. Worsening renal function (WRF) is associated with worse outcomesamong patients who are hospitalized with acute decompensated heart failure(ADHF). Clinical characteristics at admission may help identify patients at incresedrisk of WRF. The aim of this study was to create in admission scoring system tosimplify identification patients at risk of WRF in ADHF setting.Methods. A retrospective data of 614 patients admitted with ADHF was analyzed.By the definition WRF occurred when serum Creatinin increased at anytime duringhospitalization by ≥ 0.3 mg/dL or by ≥ 25% from admission.Results. Worsening renal function developed in near 26% patients. Theindependent predictors of WRF analyzed with backward selection logisticregression were: age > 75 years old (p < 0.0001), female (p = 0.034); history ofhypertension (p = 0.001); anemia (p = 0.005); and in admission serum Creatinin (p= 0.013). A scoring system was generated from this final model. An internalvalidation with bootstrap method showed good optimism (0.01088808).Conclusion. A new scoring system could predict in-hospital worsening renal function among patients hospitalized with acute decompensated heart failure.]"

"Lima puluh persen penderita gagal jantung merupakan gagal jantung dengan fraksi ejeksi yang normal (HFPEF). Morbiditas dan mortalitas HFPEF belumlah jelas. Latihan olahraga telah menjadi rekomendasi pertama dalam beberapa panduan klinis, namun belum pada HFPEF. Strain longitudinal apikal 4 ruangan dapat digunakan sebagai nilai prognostik. Perbaikan fungsi longitudinal intrinsik ventrikel kiri menggunakan strain longitudinal apikal empat ruangan akibat latihan olahraga belumlah diketahui. Kuasi eksperimental menggunakan 30 sampel konsekutif HFPEF, dilakukan program latihan olahraga tersupervisi. Program latihan olahraga dilakukan selama satu bulan. Dilakukan pemeriksaan ekokardiografi, 6MWT, kuesioner MLWHF dan WHO. Terdapat perbedaan yang signifikan dalam 6MWT, nilai skoring MLWHF dan WHO5 sebelum dan sesudah latihan olahraga. Didapatkan nilai strain longitudinal sebesar -16,20% (-10,7% sampai dengan -17,81%). Strain longitudinal apikal 4 ruangan mengalami perbaikan pada minggu ke 2 dan ke 4 latihan olahraga (sebelum latihan olahraga LS = -16,20 [-10,70 to -17,81]; minggu ke dua latihan olah raga LS = -18,00±2,69 dan minggu ke 4 latihan olahraga LS = -21,86±1,79) dan terdapat perbedaan yang signifikan (p < 0,001). Terdapat perbaikan fungsi intrinsik longitudinal ventrikel kiri sebelum dengan sesudah diberikan program latihan olahraga pada penderita gagal jantung dengan fraksi ejeksi yang normal.

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Fifty percent of patients with heart failure are heart failure with preserved ejection fraction (HFPEF). Morbidity and mortality of HFPEF is unclear. Exercise has become the first recommendation in several clinical guidelines, but not yet in HFPEF. Apical 4 chamber longitudinal strain can be used as a prognostic value. But the improvement of longitudinal intrinsic left ventricular function using apical 4 chamber longitudinal strain due to exercise training is not yet known. Quasi- experimental study using thirty consecutive sample of HFPEF. Exercise training program was conducted for a month. Echocardiography, 6MWT, MLWHF and WHO questionnaire was performed before and after exercise. There was significant differences in the 6MWT, the value of MLWHF and WHO5 score before and after exercise. Longitudinal strain values obtained by -16.20 % (-10.7% to -17.81%). Four chamber longitudinal strain was improved at weeks 2 and 4 of exercise (before exercise LS = -16.20[-10.70 to -17.81]; the second week of exercise training LS = -18.00±2,69 and week 4 exercise LS = -21.86 ± 1.79) and there were significant differences (p < 0.001). There was an improvement in the longitudinal intrinsic left ventricular function before and after exercise training in patients with heart failure with preserved ejection fraction."

"Hiperlipidemia salah satu faktor resiko penyakit jantung koroner yang meningkatkan viskositas darah. Umbi kucai (Allium schoenoprasum L.) mengandung allisin yang berefek antihiperlipidemia. Penelitian bertujuan mengetahui pengaruh pemberian ekstrak etanol umbi kucai sebagai antihiperlipidemia pada tekanan darah tikus yang diinduksi diit tinggi kolesterol dan lemak. Tikus galur Sprague-Dawley sebanyak 36 ekor dibagi menjadi 6 kelompok. Semua kelompok kecuali kelompok normal diberikan diit tinggi kolesterol dan lemak. Kelompok normal, induksi, simvastatin, dosis 1, 2, dan 3 berturut-turut diberikan CMC 0,5%, CMC 0,5%, simvastatin, ekstrak umbi kucai 4,79 mg, 9,58 mg dan 19,16 mg/200g bb selama 56 hari. Tekanan darah sistol, diastol, dan tekanan arteri rata-rata diukur dengan alat pengukur tekanan darah non-invasif CODA® pada hari ke-0, ke-29 dan ke-57. Hasil analisis menunjukkan ekstrak etanol 80% umbi kucai pada dosis 9,58 mg/200g bb dapat mempengaruhi tekanan darah secara bermakna (p<0,05).

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Hyperlipidemia is one of risk factors for coronary heart disease that increased blood viscosity. Bulb chives (Allium schoenoprasum L.) contains allicin as antihyperlipidemia. The study aimed to determine the effect of ethanol extract of blub chives as antyhiperlipidemia on rats blood pressure induced with a high dietary cholesterol and fat. Thirty six Sprague-Dawley rats were divided into 6 groups. All groups except the normal group was given a high dietary cholesterol and fat. Normal group, induction, simvastatin, dose 1, 2, and 3 respectively was given 0.5% CMC, CMC 0.5%, simvastatin, bulb chives extract 4,79 mg, 9,58 mg and 19,16 mg/200 g mm during 56 day. Systole, diastole, and mean blood pressure was measured with a non-invasive blood pressure tools from CODA® on days 0, 29th and 57th. The analysis showed the extract of bulb chives at a dose of 9,58 mg/200 g mm influence blood pressure significantly (p <0,05)."

"ABSTRAKTujuan:Untuk mengetahui hubungan antara kadar kromium serum dengan kadar insulin, gula darah, HbAlc, profit lipid dan tingkat oklusi koroner pada penderita baru penyakit jantung koroner.Tempat : Bagian Cath-Lab RS Jantung Harapan Kita.Bahan dan Cara: Penelitian dilakukan pada laki-laki di atas usia 35 tahun yang memenuhi kriteria dikumpulkan data mengenai sosio-ekonomi, keadaan kesehatan, gaya-hidup, aktivitas, IMT, asupan makanan, proporsi zat dan pemeriksaan tekanan darah, kadar kromium serum, insulin, gula darah, HbAlc, profil lipid dan tingkat oklusi koroner.Karakteristik subyek disajikan secara deskriptif, sedangkan analisis dilakukan dengan uji statistik chi kuadrat, t, Mann Whitney, dan uji korelasi Spearman.Hasil: Dari 65 subyek penelitian yang diteliti, umur rata-rata 51.17 + 7.44 tahun, terbanyak (60 %) antara 40 - 55 tahun, 73.9% golongan ekonomi menengah atas, prevalensi DM 13.8%, Hipertensi 16.9%, Merokok 69.2%, olahraga 28%, Obese dan gemuk 52.3%, aktivitas ringan 100%. Asupan nutrisi secara kualitatif sesuai dengan anjuran diit Konsensus Nasional Pengelolaan Dislipidemia di Indonesia, secara kuantitatif subyek dengan tingkat oklusi > 50%, mempunyai asupan protein hewani dan kolesterol yang lebih besar secara bermakna (p<0,05) dibandingkan dengan subyek dengan tingkat oklusi < 50%, dan telah jauh di atas AKG. Nilai rata-rata kromium serum 8.08 ug/L. Nilai ini 431 lebih rendah dari nilai normal. Nilai insulin, gula darah puasa dan trigliserida masih berada dalam batas normal. Nilai HbAlc, LDL, HDL dan Total kolesterol berada dalam batas yang diwaspadai. Berdasarkan Triad Lipid 98.5% menderita Dislipidemia.Berdasarkan tingkat oklusi koroner, didapatkan 44 orang subyek dengan tingkat oklusi >50%, dan 21 orang dengan tingkat oklusi <50% . Subyek dengan tingkat oklusi >50% mempunyai kadar LDL dan total kolesterol yang lebih besar secara bermakna. Kadar kroaium, insulin, gula puasa, HbAlc, trigliserida dan HDL kolesterol tidak berbeda secara bermakna. Pada tingkat oklusi koroner <50%, tidak ada korelasi yang bermakna antara kromium serum dengan faktor-faktor resiko. Pada tingkat oklusi koroner >50% ada korelasi yang bermakna kromium serum dengan gula puasa, trigliserida dan HDL kolesterol.Kesimpulan: Tidak ada hubungan antara kromium serum dengan kadar gula puasa, profil lipid dan tingkat oklusi koroner. Pada tingkat oklusi > 50% ada korelasi yang bermakna antara kroaium serum dengan gula puasa, trigliserida dan HDL kolesterol."