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

"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.

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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. "

"Latar Belakang : Cedera reperfusi menyebabkan kerusakan dan kematian sel miokard dan memberikan kontribusi hingga 50% dari luas infark. Pengkondisian iskemia dari luar jantung (remote ischemic conditioning, RIC) dapat menjadi perlakuan non invasif, murah dan mudah untuk membatasi cedera reperfusi. Efek kardioprotektif yang didapatkan dari perlakuan ini antara lain penurunan luas infark dan peningkatan fungsi kontraktilitas ventrikel. 6 MWT merupakan salah satu penilaian luaran klinis dan NT pro BNP menjadi salah satu parameter dari penilaian fungsi miokard dari efek RIC. 6 MWT pada sejumlah studi telah menunjukkan hubungannya dengan luas infark. Dalam studi yang lain pemeriksan NT-pro BNP setelah IMA-EST berkorelasi dengan ukuran infark dan fungsi miokard setelah IMA. Tujuan : Menilai efek perlakuan pengkondisian iskemia ekstremitas pada pasien IMA EST yang menjalani IKPP terhadap 6 MWT dan kadar NT-ProBNP. Metode : Penelitian ini merupakan studi klinis acak tersamar dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Dilakukan perlakuan RIC pada kelompok studi sebelum tindakan IKPP. Pengukuran 6 MWT dan kadar NT-ProBNP dilakukan dalam masa perawatan pada kelompok studi dan kontrol. Hasil : Terdapat 87 subyek yang terbagi dalam 2 kelompok yakni 41 orang mendapat perlakuan RIC dan 46 orang sebagai kelompok kontrol. Didapatkan jarak 6 MWT lebih jauh pada kelompok studi dibandingkan dengan kelompok kontrol namun tidak bermakna secara statistik (316 (±46) vs 289 (±66) meter; p = 0.06). Didapatkan kadar NT-Pro BNP lebih rendah pada kelompok studi dibandingkan dengan kelompok kontrol yang bermakna secara statistik (1073 (328-3974) vs 1514 (205-10696) pg/mL; p = 0.05). Kesimpulan : Perlakuan RIC sebelum tindakan IKPP tidak meningkatkan kapasitas fungsional yang diukur dengan 6 MWT namun dapat menurunkan kadar NT-ProBNP.

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Background : Reperfusion injury has been recognized to cause cell damage and death. As consequence, it contributes about 50% of infarct size. Remote ischemic condiotioning (RIC) has been identified as a noninvasive, low-cost, and easy to performed method to prevent it, so cardioprotective effect such as reducing infarct size and ventricular contraction improvement could be achieved. Meanwhile, myocardial function can be clinically assessed by measuring 6 minutes walk test (6MWT) and serum NT-proBNP level. Many studies showed association and correlation among 6MWT, NT-proBNP, infarct size and myocardial function.

Objectives : To assess remote ischemic conditioning in ST-Elevation Myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) to their 6 MWT distance and serum NT-proBNP level.

Methods : Eighty seven subjects were randomly assigned into 2 groups, those receiving RIC intervention (4 to 5 minutes cycles of cuff inflation/deflation on lower extremity) or control (uninflated cuff for 40 minutes) protocols prior to primary PCI. Prior to hospital discharge, all subjects underwent 6MWT and NT-proBNP evaluation.

Results : RIC improve 6MWT distance in intervention group, but it was not significantly different compared to control group (316 ±46 meters vs. 289 ± 66 meters). Serum NT-ProBNP level was also lower in RIC group compared to control group (1073 (328-3974) pg/mL vs. 1514 (205-10696) pg/mL ) and the difference was statistically significant.

Conclusion : RIC intervention prior to primary PCI improved functional capacity measured by 6MWT but not statistically significant compared to control group, however it improved serum NT-ProBNP significantly."

"Coronary Artery Disease (CAD) atau Penyakit Jantung Koroner (PJK) merupakan suatu gangguan fungsi jantung yang disebabkan karena otot miokard kekurangan suplai darah akibat adanya penyempitan dan tersumbatnya pembuluh darah jantung. Kondisi ini dapat mengakibatkan perubahan pada berbagai aspek, baik fisik, psikologis, maupun sosial yang berakibat pada penurunan kapasitas fungsional dan kenyamanan. Rehabilitasi jantung merupakan program pencegahan, pengobatan, pemulihan yang aman serta efektif untuk menilai kapasitas fungsional jantung, hemat biaya, mudah diterapkan pada kelompok besar, dan dapat ditoleransi dengan baik. Tujuan dari penelitian ini adalah mengidentifikasi pengaruh 6-MWT terhadap kapasitas fungsional jantung dan kenyamanan pada pasien PJK. Penelitian ini merupakan penelitian quasi experiment, dengan desain pre-post with control group. Teknik consecutive sampling digunakan untuk merekrut 57 responden yang terbagi menjadi 29 responden kelompok kontrol dan 28 responden kelompok intervensi. Pengumpulan data kapasitas fungsional jantung dilakukan dengan VO2 max dan kenyamanan menggunakan Short General Comfort Questionnaire (SGCQ). Hasil pengukuran menunjukkan terdapat perbedaan yang signifikan kapasitas fungsional dan kenyamanan sebelum dan setelah perlakuan pada kedua kelompok dengan p-value < 0,001. Berdasarkan hasil penelitian tersebut, 6-MWT dapat digunakan sebagai modalitas keperawatan bagi pasien PJK. 6-MWT hendaknya dijadikan bagian integral dari manajemen rehabilitasi fase 3 pada pasien PJK.

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Coronary Heart Disease (CHD) is a disorder of cardiac function caused a deficiency of blood supply to a myocardial muscle. This condition may result in changes various aspects of physical, psychological, and social that will a decrease of functional capacity of the heart and patients comfort. Heart rehabilitation is a safe, effective and effective prevention, treatment, recovery program to assess cardiac functional capacity, cost-effective, easy to apply to large groups, and well tolerated.

The purpose of this study was to identify the impact of 6-MWT on the heart functional capacity and comfort of CHD patients. This study was a quasiexperiment, with a pre and post with control group design. The consecutive sampling technique was used recruited 57 respondent divided into 29 respondent in the control group and 28 respondent in the intervention group. A VO2 max of functional capacity and Short General Comfort Questionnaire (SGCQ).

There were significant differences in functional capacity and comfort before and after treatment in control and intervention groups with the p-value < 0,001. This study suggests that the 6-MWT can be used as a nursing modality for patients with CHD Post. 6-MWT should be made an integral part of phase 3 rehabilitation management in CHD patients. "

"[ABSTRAKLatar Belakang : Pasien gagal jantung mengalami penurunan kapasitas fungsional akibat timbulnya sesak dan kelelahan saat aktifitas. Kondisi ini juga memberikan dampak psikologis berupa depresi dan kecemasan. Masalah fisik dan mental tersebut dapat menurunkan kualitas hidup. Short Form-36 merupakan instrumen yang dapat digunakan untuk menilai kualitas hidup dari aspek fisik dan mental dan bersifat generik.Tujuan: Mengetahui hubungan kapasitas fungsional melalui uji jalan 6 menit dengan kualitas hidup yang dinilai dengan SF-36Metode : Responden penelitian adalah pasien gagal jantung kronis stabil klasifikasi NYHA fungsional kelas II dan III. Setiap responden dianamnesis,dan dilakukan pemeriksaan fisik, kemudian mengisi kuesioner SF-36. Untuk menilai kapasitas fungsional, responden melakukan uji jalan 6 menit pada lintasan sepanjang 30 m.Hasil : Responden pada penelitian ini berjumlah 36 orang. Nilai tengah jarak tempuh pasien gagal jantung klasifikasi NYHA fungsional kelas II dan III masing-masing 333.65m, dan 123.72 m. Jarak tempuh uji jalan 6 menit memiliki hubungan dengan kualitas hidup yang dinilai dengan SF-36 pada domain Fungsi Fisik (r=0.527), Peran Fisik (r=0.459) dan Peran Emosi (r = 0.35).Kesimpulan : Terdapat korelasi sedang antara kapasitas fungsional pasien gagal jantung kronis stabil klasifikasi NYHA fungsional kelas II dan III dengan kualitas hidup pada domain Fungsi Fisik, Peran Fisik dan Peran Emosi.

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ABSTRACTBackground : Heart failure patients experience reduced functional capicity due to dyspnea and fatigue during activity. The condition also cause psychological problems such as depression and anxiety. Both the mental and physical ailments results in decreased quality of life. The Short Form-36 (SF-36) is a generic assessment tool that can be utilized to measure quality of life from both the physical and mental aspect.Objective : To measure the correlation between the functional capacity measured using the 6-minute walk test and the quality of life measured using the SF-36Methods : The study subjects are chronic stable heart failure patients with New York Heart Association (NYHA) functional class II and III. Each subjects were interviewed, examined, and asked to fill the SF-36 questionnaire. The 6-minute walk test was performed on a 30m long track to measure the finctional capacity.Results : A total of 36 subjects were included in the study. The median for the total distance walked of heart failure patient with NYHA functional class II and III are 333.65m and 123.72 m. The total distance walked in 6-minute walk test and the quality of life measured using the SF-36 have correlation in the domain of Physical Function (r = 0.527), Role-Physical (r = 0.459) and Role-Emotional (r = 0.35)Conclusion : There is a moderate positive correlation between the functional capacity of chronic stable heart failure patient with NYHA functional class II and III with the quality of life in the domain of Physcial Function, Role-Physical and Role-Emotional.;Background : Heart failure patients experience reduced functional capicity due to dyspnea and fatigue during activity. The condition also cause psychological problems such as depression and anxiety. Both the mental and physical ailments results in decreased quality of life. The Short Form-36 (SF-36) is a generic assessment tool that can be utilized to measure quality of life from both the physical and mental aspect.Objective : To measure the correlation between the functional capacity measured using the 6-minute walk test and the quality of life measured using the SF-36Methods : The study subjects are chronic stable heart failure patients with New York Heart Association (NYHA) functional class II and III. Each subjects were interviewed, examined, and asked to fill the SF-36 questionnaire. The 6-minute walk test was performed on a 30m long track to measure the finctional capacity.Results : A total of 36 subjects were included in the study. The median for the total distance walked of heart failure patient with NYHA functional class II and III are 333.65m and 123.72 m. The total distance walked in 6-minute walk test and the quality of life measured using the SF-36 have correlation in the domain of Physical Function (r = 0.527), Role-Physical (r = 0.459) and Role-Emotional (r = 0.35)Conclusion : There is a moderate positive correlation between the functional capacity of chronic stable heart failure patient with NYHA functional class II and III with the quality of life in the domain of Physcial Function, Role-Physical and Role-Emotional., Background : Heart failure patients experience reduced functional capicity due to dyspnea and fatigue during activity. The condition also cause psychological problems such as depression and anxiety. Both the mental and physical ailments results in decreased quality of life. The Short Form-36 (SF-36) is a generic assessment tool that can be utilized to measure quality of life from both the physical and mental aspect.Objective : To measure the correlation between the functional capacity measured using the 6-minute walk test and the quality of life measured using the SF-36Methods : The study subjects are chronic stable heart failure patients with New York Heart Association (NYHA) functional class II and III. Each subjects were interviewed, examined, and asked to fill the SF-36 questionnaire. The 6-minute walk test was performed on a 30m long track to measure the finctional capacity.Results : A total of 36 subjects were included in the study. The median for the total distance walked of heart failure patient with NYHA functional class II and III are 333.65m and 123.72 m. The total distance walked in 6-minute walk test and the quality of life measured using the SF-36 have correlation in the domain of Physical Function (r = 0.527), Role-Physical (r = 0.459) and Role-Emotional (r = 0.35)Conclusion : There is a moderate positive correlation between the functional capacity of chronic stable heart failure patient with NYHA functional class II and III with the quality of life in the domain of Physcial Function, Role-Physical and Role-Emotional.]"

"ABSTRAKPendahuluan: Gagal jantung akut merupakan penyebab paling sering untuk perawatan rumah sakit pada pasien usia >65 tahun, yang juga berkaitan dengan prognosis buruk. N-terminal pro brain natriuretic peptide (NT-proBNP) merupakan suatu petanda peregangan miokardium yang dapat digunakan sebagai petanda prognostik pada pasien gagal jantung akut. Penambahan parameter kadar NT-proBNP pada model prognostik yang sudah ada akan memberikan nilai klinis yang lebih baik dan akurat dalam menetapkan prognosis untuk kejadian major adverse cardiac events (MACE) pasien gagal jantung akut.Metode: Desain penelitian kohort prosfektif. Subjek penelitian terdiri dari 77 penderita gagal jantung akut dan dilakukan pemeriksaan kadar NT-proBNP saat admisi, selanjutnya ditetapkan faktor risiko klinis dan laboratoris yang terdiri dari jenis kelamin laki-laki, kelompok usia >65 tahun, riwayat penyakit jantung koroner, tekanan darah sistolik <115 mmHg, kadar Hb <11,3 g/dL, serta kadar natrium 135 mEq/L. Luaran klinis berupa MACE dan mortalitas pasien gagal jantung akut dilakukan pemantauan selama 30 hari.Hasil: Insiden MACE jangka pendek pada penderita gagal jantung akut sebesar 61% dengan angka mortalitas sebesar 7,8%. Riwayat penyakit jantung koroner dan kadar NT-proBNP >1000 pg/mL berhubungan dengan terjadinya MACE. Model prognostik yang didapat adalah penderita gagal jantung akut dengan riwayat penyakit jantung koroner dan kadar NT-proBNP >1000 pg/mL. Nilai cut off kadar NT-proBNP untuk terjadinya MACE adalah 859,1 pg/mL dengan nilai AUC sebesar 77,3%, sensitivitas 72,3% dan spesifisitas 63,3%. Nilai cut off kadar NT-proBNP untuk terjadinya kematian adalah 4374,5 pg/mL dengan nilai AUC sebesar 83,1%, sensitivitas 83,3%, dan spesifisitas 77,5%.Kesimpulan: Kadar NT-proBNP >1000 pg/mL dapat menilai prognosis untuk terjadinya MACE selama perawatan rumah sakit.

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ABSTRACT

Introduction. Acute heart failure is the most frequent cause of hospitalization in patients aged >65 years, which is also associated with poor prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker stretching of the myocardium that can be used as a prognostic marker in patients with acute heart failure. Addition of parameter levels of NT-proBNP on existing prognostic models will provide better clinical value and accurate in determining the prognosis for the incidence of major adverse cardiac events (MACE) patients with acute heart failure.

Methods. Prospective cohort study design. Subjects consisted of 77 patients with acute heart failure and examine the levels of NT-proBNP at the time of admission, the next set of clinical risk factors and laboratory consisting of a type of male sex, age group >65 years, history of coronary heart disease, systolic blood pressure <115 mmHg, Hb <11,3 g/dL, as well as levels of sodium 135 mEq/L. The clinical outcomes such as MACE and mortality of patients with acute heart failure monitoring within 30 days.

Results. Incidence of acute heart failure patients with short-term MACE was 61% with a mortality rate of 7,8%. A history of coronary heart disease and levels of NTproBNP >1000 pg/mL associated with the occurrence of MACE. Prognostic models obtained is acute heart failure patients with a history of coronary heart disease and levels of NT-proBNP is >1000 pg/mL. The cut off levels of NT-proBNP for the occurrence of MACE was 859,1 pg/mL with an AUC of 77,3%, 72,3% sensitivity and 63,3% specificity. The cut off levels of NT-proBNP for the occurrence of death was 4374,5 pg/mL with an AUC of 83,1%, 83,3% sensitivity and 77,5% specificity.

Conclusion. Levels of NT-proBNP >1000 pg/mL can assess the prognosis for the occurrence of MACE during hospitalization."

"ABSTRAKPenyakit jantung bawaan asianotik yang merupakan sebagian besar dari penyakit jantung bawaan memerlukan operasi bedah jantung terbuka untuk memperbaiki kelainannya. Sindrom curah jantung rendah masih merupakan masalah yang dihadapi pada pasien pediatrik pascabedah jantung terbuka. Deteksi sindrom curah jantung rendah yang ada sekarang menggunakan kriteria klinis dan indikator laboratorik masih belum dirasa cukup, yang terbukti dengan masih adanya angka morbiditas dan mortalitas. Peranan penanda biologis NT-proBNP telah berkembang di gagal jantung dewasa diharapkan dapat digunakan untuk dapat mendeteksi sindrom curah jantung rendah pada pediatrik.Penelitian cross sectional observasional dengan jumlah 38 subjek yang memenuhi kriteria inklusi dan eksklusi yang menjalani operasi jantung bawaan asianotik bulan Oktober-November 2018 di Rumah Sakit Jantung dan Pembuluh darah Nasional Harapan Kita, Indonesia. Data prabedah, intrabedah dan pascabedah termasuk kejadian sindrom curah jantung rendah dicatat. Kadar NT-proBNP akan diambil prabedah, 4 jam, 24 jam dan 72 jam pascabedah. Analisis data menggunakan uji Mann-Whitney.Kadar NT-proBNP prabedah, 4 jam pascabedah dan 24 jam pascabedah berbeda bermakna dengan kejadian sindrom curah jantung rendah (nilai p <0,05). Kadar NT-proBNP prabedah memiliki perbedaan rerata lebih rendah dibandingkan dengan kadar NT-proBNP 4 jam pascabedah yang juga lebih rendah dibandingkan kadar NT-proBNP 24 jam pascabedah dan hal ini berbeda bermakna (p <0,001). Sedangkan kadar NT-proBNP 72 jam pascabedah memiliki rerata lebih rendah dibandingkan dengan kadar NT-proBNP 24 jam pascabedah yang juga berbeda bermakna (p <0,001). Analisis kadar NT-proBNP dengan variabel lainnya mendapatkan hasil berbeda bermakna dengan variabel usia, jenis kelamin, berat badan, diagnosis PJB, durasi ventilasi mekanik dan durasi ICU.Kadar NT-proBNP berhubungan dengan kejadian sindrom curah jantung rendah. Kadar NT-proBNP yang tinggi menunjukkan adanya kejadian sindrom curah jantung rendah (pada kadar NT-proBNP prabedah, 4 jam dan 24 jam pascabedah).

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ABSTRACT"

"Peran NT-proBNP sebagai penanda biologis untuk mengetahui terjadinya sindrom curah jantung rendah pada pasien pediatrik dengan penyakit jantung bawaan sianotik pascabedah jantung terbuka belumlah diketahui. NT-proBNP diharapkan dapat menjadi penanda sindrom curah jantung rendah sehingga dapat mengurangi morbiditas dan mortalitas. Penelitian cross sectional ini melibatkan 40 pasien pediatrik dengan penyakit jantung bawaan sianotik yang menjalani pembedahan jantung terbuka di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, selama bulan Maret 2019-April 2019. Terdapat perbedaan bermakna antara kadar NT-proBNP prabedah, 4 jam pascabedah, 24 jam pascabedah dan 72 jam pascabedah terhadap kejadian sindrom curah jantung rendah (p<0,001). Kadar NT-proBNP tertinggi pada 24 jam pasca bedah dengan perbedaan bermakna terhadap kadar NT-proBNP prabedah (p<0,001), 4 jam pascabedah dan 72 jam pascabedah (p<0,001). Diperoleh pula variabel lain yang berhubungan secara bermakna dengan NT-proBNP yaitu usia, berat badan, jenis penyakit jantung bawaan sianotik, lama aortic cross clamp, lama cardiopulmonary bypass, lama ventilasi mekanik dan lama rawat PICU. Dapat disimpulkan bahwa kadar NT-proBNP yang tinggi sebagai penanda kejadian sindrom curah jantung rendah.

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The role of NT-proBNP as a biological marker to determined the occurrence of low cardiac output syndromes in pediatric patients with cyanotic congenital heart disease after open heart surgery was unknown. NT-proBNP was expected to be a marker of low cardiac output syndrome so that it can reduce morbidity and mortality. This cross-sectional study involved 40 pediatric patients with cyanotic congenital heart disease who underwent open heart surgery at National Cardiovascular Centre Harapan Kita, during March 2019-April 2019. There were significant differences between pre-operative levels of NT-proBNP, 4 hours postoperatively, 24 hours postoperatively and 72 hours postoperatively with the incidence of low cardiac output syndrome (p <0.001). The highest NT-proBNP level was 24 hours postoperatively with a significant difference in preoperative levels of NT-proBNP (p <0.001), 4 hours postoperatively and 72 hours postoperatively (p <0.001). Other variables that were significantly associated with NT-proBNP were age, body weight, type of cyanotic congenital heart disease, duration of aortic cross clamp, duration of cardiopulmonary bypass, duration of mechanical ventilation and length of stay of PICU. It can be concluded that high NT-proBNP level as a marker of low cardiac output syndrome."

"Tesis ini disusun untuk mengetahui korelasi kelelahan dan kadar asam laktat darah dengan uji jalan enam menit (6MWT) pada pasien penyakit jantung koroner (PJK). Penelitian  ini menggunakan desain potong lintang, dengan pengambilan sampel secara konsekutif. Sebanyak 20 subjek penelitian yang merupakan pasien PJK pasca percutaneous coronary intervention (PCI) dan coronary arterial bypass grafting (CABG) yang memenuhi kriteria inklusi dan eksklusi. Kelelahan pasien PJK akan diukur menggunakan kuesioner fatigue severity scale (FSS) versi Bahasa Indonesia, dan dilanjutkan dengan pengukuran kadar asam laktat darah menggunakan alat accutrend plus sebanyak dua kali yaitu pada saat istirahat dan setelah dilakukan 6MWT. 6MWT dilakukan sesuai protokol standar pada lintasan 30 meter, untuk mengukur kebugaran kardiorespirasi. Jarak yang ditempuh pasien dikonversi menjadi VO2max menggunakan rumus Cahalin. Analisis statistik dilakukan untuk melihat korelasi antara nilai FSS dan kadar laktat darah dengan VO2max. Hasil penelitian menunjukkan korelasi negative yang tidak bermakna secara statistik antara FSS dan VO2max (r = -0,258; p > 0,05), serta pada kadar laktat darah dan VO2max (r = -0.18; p > 0,05). Namun didapatkan korelasi positif yang bermakna secara statistik antara FSS dan kadar asam laktat darah (r = 0,58; p < 0,05). Dapat disimpulkan tidak terdapat korelasi antara kelelahan dan kadar asam laktat darah dengan 6MWT pada pasien PJK. Namun terdapat korelasi sedang antara kelelahan dan kadar asam laktar darah pada pasien PJK. Diperlukan penelitian lebih lanjut untuk menilai faktor-faktor yang mempengaruhi kelelahan dan kadar asam laktat darah pasien PJK.

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This thesis was prepared to determine the correlation of fatigue and blood lactate levels with a six-minute walk test (6MWT) in patients with coronary artery disease (CAD). This study used a cross-sectional design, with consecutive sampling. A total of 20 research subjects were CAD patients underwent percutaneous coronary intervention (PCI) and coronary arterial bypass grafting (CABG) who met the inclusion and exclusion criteria. The fatigue of CAD patients will be measured using the Indonesian version Fatigue Severity Scale (FSS) questionnaire, followed by measuring blood lactate using the accutrend plus device twice, at rest and after 6MWT. 6MWT was performed according to a standard protocol on a 30 meter track, to measure cardiorespiratory fitness. The distance traveled by the patient was converted to VO2max using the Cahalin formula. Statistical analysis was performed to see the correlation between FSS values and blood lactate levels with VO2max. The results showed a statistically insignificant negative correlation between FSS and VO2max (r = -0.258; p > 0.05), as well as on blood lactate levels and VO2max (r = -0.18; p > 0.05). However, there was a statistically significant positive correlation between FSS and blood lactate (r = 0.58; p < 0.05). It can be concluded that there is no correlation between fatigue and blood lactate with 6MWT in CAD patients. However, there is a moderate correlation between fatigue and blood lactic acid levels in CAD patients. Further research is needed to assess the factors that influence fatigue and blood lactic acid levels in CAD patients."

"Latar belakang: Sindrom curah jantung rendah (low cardiac output syndrome, LCOS) merupakan salah satu morbiditas yang terjadi pascaoperasi jantung terbuka. Angka kejadian LCOS pada pasien pascaoperasi sebanyak 25–65%, sehingga diperlukannya suatu penanda biologis praoperatif untuk menilai keadaan pembedahan yang optimal. NT-proBNP merupakan suatu biomarker yang berpotensi digunakan dalam diagnosis, tata laksana dan prognosis pada populasi pediatrik. Penelitian ini bertujuan untuk mengevaluasi peran NT-proBNP sebagai faktor prediktor terhadap kejadian LCOS pascabedah jantung terbuka.Metode: Studi longitudinal dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dalam periode November 2018 hingga Maret 2020 dengan merekrut subjek di bawah usia 18 tahun yang menjalani operasi korektif kelainan jantung bawaan. Kadar NT-proBNP prabedah diambil dan dianalisis terhadap kejadian LCOS pascaoperasi.Hasil: Terdapat 159 subjek dilibatkan sebagai subjek penelitian. Angka kejadian LCOS pascaoperasi sebanyak 23,9%. Median NT-proBNP prabedah berbeda bermakna antara pasien yang mengalami LCOS dengan pasien yang tidak mengalami LCOS (1592 pg/mL vs. 227 pg/mL; p = 0,001). Nilai cut-off NT-proBNP prabedah terhadap kejadian LCOS pascaoperasi adalah 400 pg/mL, dengan sensitivitas 78,95%, spesifisitas 64,46%, positive predictive value 41,10%, negative predictive value 90,70% dan diagnostic accuracy 67,92%.Simpulan: NT-proBNP prabedah dapat dijadikan faktor prediktor terhadap kejadian LCOS pascaoperasi jantung terbuka. Nilai cut-off NT-proBNP prabedah terhadap luaran LCOS pascaoperasi adalah 400 pg/mL.

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Background: Low cardiac output syndrome (LCOS) is a common morbidity following open heart surgery in pediatric population. The incidence of postoperative LCOS range from 25 to 65%, indicating the needs for preoperative tool to evaluate optimum condition prior to surgery. NT-proBNP is a biomarker that has potential in diagnosis, management, and prognosis in pediatric population. This study aims to evaluate the role of NT-proBNP as predictive factor for LCOS following cardiac surgery.

Methods: A longitudinal study was conducted in Harapan Kita National Heart Center between November 2018 and March 2020. We recruited subjects below 18 years old who underwent corrective cardiac surgery. NT-proBNP was obtained preoperatively and analyzed for postoperative LCOS.

Results: A total of 159 subjects were enrolled. The incidence of postoperative LCOS was 23.9%. The median of preoperative NT-proBNP was found to be significantly higher in patients experiencing LCOS compared to that of patients without LCOS (1592 pg/mL vs. 227 pg/mL; p = 0.001). The cut-off value for preoperative NT-proBNP to determine postoperative LCOS was 400 pg/mL with sensitivity of 78.95%, specificity of 64.46%, positive predictive value of 41.10%, negative predictive value of 90.70% and diagnostic accuracy of 67.92%.

Conclusions: Preoperative NT-proBNP can be used as predictor for postoperative LCOS following cardiac surgery. The cut-off value of preoperative NT-proBNP in determining postoperative LCOS was found to be 400 pg/mL."