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"Latar Belakang: Keparahan stenosis pada penyakit jantung koroner (PJK) stabil berkaitan erat dengan prognosis. Dalam memprediksi keparahan stenosis dapat digunakan beberapa faktor klinis dan ekokardiografi. Akhir-akhir ini berkembang speckle tracking echocardiography yang mampu menilai strain miokardium dan baik untuk memprediksi stenosis. Penilaian faktor-faktor klinis dan ekokardiografi strain bersama-sama diharapkan mampu memprediksi lebih baik keparahan stenosis. Tujuan: Mengetahui apakah faktor-faktor klinis (usia, jenis kelamin, diabetes, angina tipikal, riwayat infark) dan global longitudinal strain (GLS) pada ekokardiografi strain dapat memprediksi keparahan stenosis pasien PJK stabil yang dinilai dengan skor Gensini. Membuat model prediktor dari parameter yang bermakna. Metode: Studi potong lintang dilakukan di RSCM pada periode Maret-Mei 2019. Pengambilan sampel secara konsekutif pada pasien PJK stabil yang menjalani angiografi koroner. Analisis bivariat dilakukan dengan chi-square, dilanjutkan analisis multivariat dengan regresi logistik metode baickward stepwise pada variabel yang bermakna. Hasil: Terdapat 93 subjek yang masuk dalam penelitian. Pada analisis bivariat faktor-faktor prediktor yang bermakna adalah diabetes melitus (OR 2,79; IK95%:1,08-7,23), riwayat infark (OR 4,04; IK95%:1,51-10,80), angina tipikal (OR 5,01; IK95%:1,91-13,14), dan GLS ≥-18,8 (OR 30,51; IK95%:10,38-89,72). Pada analisis multivariat faktor-faktor prediktor yang bermakna adalah angina tipikal (OR 4,48; IK95%:1,39-14,47) dan GLS ≥18,8 (OR 17,30; IK95%:5,38- 55,66). Tidak dilakukan pembuatan model prediktor karena hanya 2 faktor prediktor yang bermakna. Simpulan: Angina tipikal dan GLS merupakan faktor-faktor prediktor keparahan stenosis pada pasien PJK stabil, sedangkan faktor usia, jenis kelamin, diabetes, dan riwayat infark bukan merupakan prediktor keparahan stenosis pasien PJK stabil. Model skor prediktor tidak dikembangkan karena hanya 2 faktor prediktor yang bermakna.

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Background: In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical and echocardiographic parameters can predict severity of stenosis. Recently a new method in echocardiography called speckle tracking echocardiography can be used to asses myocardial strain, which is a good predictor of stenosis severity. Assessment of clinical parameters together with strain echocardiography parameter is expected to make better prediction. Objective: To determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain, can predict severity of coronary artery stenosis measured with Gensini score. To further develop a prediction model based on significant parameters. Methods: This is a cross-sectional study taken at Cipto Mangunkusumo Hospital during period March-May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi- square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. Results: The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; CI95%:1.08-7.23), history of myocardial infartion (OR 4.04; CI95%:1.51-10.80), typical angina (OR 5.01; CI95%:1.91-13.14), and GLS ≥-18.8 (OR 30.51; CI95%:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; CI95%:1.39-14.47) and GLS ≥18.8 (OR 17.30; CI95%:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions: Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors."

"Latar Belakang: Jaringan adiposa epikardial (JAE) sebagai jaringan adiposa visera penting peranannya dalam proses aterosklerosis di arteri koroner. Studi sebelumnya menunjukkan ketebalan adiposa epikardial lebih besar pada pasien dengan penyakit jantung koroner (PJK) Tujuan Mengetahui korelasi antara ketebalan adiposa epikardial dengan derajat stenosis arteri koroner pada pasien PJK stabil. Metode: Dilakukan studi potong lintang pada tujuh puluh pasien PJK stabil yang menjalani angiografi koroner. Derajat stenosis arteri koroner dinilai dengan skor Gensini > 40 (berat) dan ≤ 40 (ringan-sedang). Ketebalan adiposa epikardial dinilai dengan ekokardiografi transtorakal pada fase sistolik akhir tampilan parasternal long axis. Hasil: Nilai rerata ketebalan adiposa epikardial adalah 5,96 mm (SB 1,76) dan nilai median skor Gensini adalah 35,0 (kisaran 2-126). Analisis bivariat menunjukkan korelasi positif kuat yang bermakna (r = 0,768, p < 0,001). Nilai titik potong terbaik dari ketebalan adiposa epikardial yang memiliki nilai klinis berkaitan dengan derajat stenosis arteri koroner berdasarkan skor Gensini adalah 6,15 mm dengan sensitivitas 85,29%, spesifisitas 83,33%, nilai duga positif 82%, nilai duga negatif 85% dengan AUC sebesar 0,893 (IK 95% 0,814-0,971, p < 0,001). Simpulan: Ketebalan adiposa epikardial berkorelasi signifikan dengan derajat stenosis arteri koroner berdasarkan skor Gensini. Ketebalan adiposa epikardial 6,15 mm memiliki kemampuan yang cukup baik untuk membedakan pasien PJK stabil ringan-sedang dan berat berdasarkan skor gensini.

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Background: Epicardial adipose tissue (EAT) as part of visceral adipose tissue, has an integral role in the atherosclerotic cardiovascular disease. Previous studies have shown that EAT is thicker in those with coronary heart disease.

Objective: To determine the correlation of epicardial adipose thickness with the severity of coronary artery stenosis in stable coronary heart disease (CHD) patient.

Method: A cross-sectional study was conducted on seventy stable CHD patient undergoing coronary angiography. Severity of coronary artery stenosis was evaluated using Gensini scoring system : > 40 (severe) and ≤ 40 (mild-moderate). Epicardial adipose tissue was measured using transthoracic echocardiography at end-systole from parasternal longaxis view.

Results: Mean value of epicardial adipose thickness was 5,96 mm (SD 1,76) and median value of Gensini score was 35,0 (range 2-126). The correlation test showed a significant strong-positive correlation (r = 0,768, p < 0,001). The best cut-off point of epicardial adipose thickness which has a clinical value correlating to severity of coronary artery stenosis based on Gensini scoring system was 6,15 mm with the sensitivity 85,29 %, specificity 83,33%, positive predictive value 82 %, negative predictive value 85 % and AUC of 0,893 (CI 0,814-0,971, p < 0,001).

Conclusion: Epicardial fat thickness is significantly correlated to the severity of coronary artery stenosis based on Gensini scoring system. The thickness cutoff point of 6,15 mm has a good capability in discriminating mild-moderate dan severe stable CHD patient based on Gensini scoring system."

"Latar Belakang: Sebesar 90% penderita DM merupakan DMT2. Komplikasi makrovaskular pada DM merupakan komplikasi ke tiga terbanyak setelah retinopati dan neuropati. Kematian pada DMT2 tujuh puluh lima persen disebabkan oleh PJK. Hal yang mendasari kejadian PJK adalah aterosklerosis yang didahului oleh proses disfungsi endotel. Disfungsi endotel ditandai oleh adanya peningkatan endotelin-1 (ET-1) dan penurunan NO akibat peningkatan inhibitor eNOS, asymmetrical dimethylarginine (ADMA). Tujuan: Mengetahui perbedaan kadar ADMA dan ET-1 dengan keparahan Penyakit Jantung Koroner (PJK) stabil dengan dan tanpa DMT2. Metode: Penelitian potong lintang, analitik pada pasien PJK stabil dengan dan tanpa DMT2 yang akan menjalani angiografi koroner pertama kali. Dilakukan pemeriksaan ADMA, ET-1, HbA1c dan evaluasi lesi koroner dengan sistim skoring berdasarkan syntax score (SS). Analisis untuk melihat 2 perbedaan median dilakukan dengan uji Mann Whitney dan perbedaan median lebih dari 2 kelompok dengan uji Kruskal Wallis pada distribusi data yang tidak normal. Hasil: Dari 28 orang pasien PJK stabil dengan DMT2 dan 30 pasien PJK stabil tanpa DMT2 didapatkan proporsi usia hampir sama, wanita lebih banyak pada kelompok DMT2. Kadar ADMA dan ET-1 pada DMT2 lebih tinggi dibanding tanpa DM (p 0,6; 2,1 dan p 0,3). Kadar ADMA dan ET-1 pada DMT2 dan HbA1c ≥ 7% lebih rendah dari HbA1c < 7% ( p 0,7 dan p 0,8).Kadar ADMA pada DMT2 dan SS tinggi lebih rendah dibanding SS rendah(p 0,7), sedangkan kadar ET-1 pada DMT2 dan SS tinggi, lebih tinggi dibanding SS rendah (p 0,9). Kadar ADMA dan ET-1 pada DMT2 dengan SS rendah dan HbA1c ≥ 7% lebih rendah dibanding HbA1c < 7% ( p 0,5 dan p 0,5). Simpulan: Tidak terdapat perbedaan bermakna kadar ADMA dan ET-1 pada pasien PJK stabil dengan dan tanpa DMT2. Tidak terdapat perbedaan bermakna kadar ADMA dan ET-1 dengan kontrol glukosa darah pada kelompok syntax score rendah.

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Background: Ninety percent of diabetes patients have type 2 diabetes mellitus (T2DM). Macrovascular complication was the third highest complication in diabetes after retinopathy and neuropathy. Coronary artery disease (CAD) resulting from diabetes is responsible for 75% of diabetes-related death. Underlying mechanism of CAD is atherosclerosis initiated by endothelial dysfunction. The endothelial dysfunction is marked by endothelin-1 (ET-1) levels raise and NO decrement, as a result of eNOS inhibition by increased asymmetrical dimethylarginine (ADMA).

Objective: To determine the difference of asymmetrical dimethylarginine (ADMA) and endotelin-1 (ET-1) levels to evaluate the severity and complexity of coronary lesion in stable coronary artery disease (SCAD) with and without T2DM.

Methods: This is an analytical cross-sectional study. We obtained serum sample and measured ADMA, ET-1, HbA1c levels and evaluated coronary lesion by syntax score (SS). Analysis of the ADMA and ET-1 correlation was evaluated by blood glucose control and SS. Mann-Whitney U test was used to compare two independent mean, Kruskal-Wallis test was used for differences among the groups median if variables were not normally distributed.

Results: We enrolled 28 stable CAD patients with T2DM and 30 stable CAD patients without T2DM. Baseline coroner angiography results with age proportion were similar in both groups. Women were predominant in T2DM group. ADMA and ET-1 levels in T2DM were higher than in without T2DM (58,0 and 50,5 with p 0,6 ; 2,1 and 1,8 with p 0,3). ADMA dan ET-1 levels in T2DM with HbA1c ≥ 7% were lower than in T2DM with HbA1c < 7% (51,7 and 65,3 with p 0,7 ; 2,08 and 2,14 with p 0,8). ADMA level in T2DM with high SS was lower than ones with low SS (44,5 and 58,4 with p 0,7), ET-1 level in T2DM with high SS was higher than in T2DM with low SS (2,72 and 2,08 with p 0,9). ADMA and ET-1 levels in T2DM with low SS and HbA1c ≥ 7% were lower than HbA1c < 7% (47,8 and 72,0 with p 0,5 ; 2,06 and 2,14 with p 0,5).

Conclusions: ADMA and ET-1 levels in patient SCAD with and without T2DM are insignificantly related. There is no significant difference of ADMA and ET-1 levels with blood glucose control and low syntax score."

"Latar Belakang: Penyakit kardiovaskular terutama penyakit jantung koroner (PJK) merupakan penyebab utama kematian pasien dengan penyakit perlemakan hati non-alkoholik (PPHNA). Pengukuran controlled attenuation parameter (CAP) menilai derajat steatosis hati secara non-invasif dan terukur, sementara skor SYNTAX dapat menggambarkan derajat aterosklerosis koroner dan membantu pemilihan modalitas revaskularisasi koroner (PCI atau CABG). Hingga saat ini, belum diketahui korelasi antara nilai CAP dengan skor SYNTAX pada pasien PJK signifikan. Tujuan: Mengetahui korelasi antara nilai CAP steatosis hati dengan skor SYNTAX lesi koroner pada pasien PJK signifikan. Metode: Studi potong lintang dengan populasi terjangkau adalah pasien dewasa yang menjalani tindakan angiografi koroner di ruang cathlab Rumah Sakit Cipto Mangunkusumo pada bulan Juli hingga Oktober 2023 dan terbukti menderita PJK signifikan. Selanjutnya dilakukan anamnesis, pemeriksaan fisik, pemeriksaan darah, penilaian CAP dengan elastografi transien, dan penghitungan skor SYNTAX. Analisis data dilakukan untuk mencari koefisien korelasi antara nilai CAP dengan skor SYNTAX. Hasil: Didapatkan 124 subjek penelitian dengan dengan rasio laki-laki berbanding perempuan 5:1 dan rerata usia 59,8 ± 11,1 tahun. Rerata IMT 25,6 ± 3,5 kg/m2, dengan 54,8% subjek tergolong obesitas. Sebanyak 94,4% dan 55,6% subjek menderita hipertensi dan DM, dengan tekanan darah dan parameter glikemik relatif terkontrol. Rerata HDL 38,8 ± 10,8 mg/dL dengan 55,6% subjek memiliki HDL rendah, dan median LDL 109,5 mg/dL dengan 89,5% subjek belum mencapai target LDL. Rerata nilai CAP 256,5 ± 47,3 dB/m, dengan 52,5% subjek (IK 95%: 43,3% - 61,5%) menderita steatosis signifikan (nilai CAP ≥ 248 dB/m), Median skor SYNTAX 22. Uji korelasi Spearman menunjukkan korelasi positif dan signifikan antara nilai CAP dengan skor SYNTAX (r = 0,245, p < 0,0001). Kesimpulan: Diantara pasien dengan PJK signifikan, 52,5% diantaranya memiliki steatosis hati non-alkoholik signifikan. Terdapat korelasi positif dan bermakna antara nilai CAP dengan skor SYNTAX pada pasien PJK signifika.

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Background: Cardiovascular diseases, particularly coronary artery disease (CAD), is the leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD). The controlled attenuation parameter (CAP) measurement assesses the degree of liver steatosis in a non-invasive and measurable manner, while the SYNTAX score depicts the degree of coronary atherosclerosis and aids in the selection of coronary revascularization modalities (PCI or CABG). To date, the correlation between CAP values and SYNTAX scores in patients with significant CAD remains unknown. Objective: To determine the correlation between controlled attenuation parameter (CAP) value of liver steatosis and SYNTAX score of coronary lesions in patients with significant CAD. Methods: This cross-sectional study was conducted on an accessible population of adult patients who underwent coronary angiography at Cipto Mangunkusumo Hospital catheterization laboratory from July to October 2023, and were proven to have significant CAD. Anamnesis, physical examination, blood tests, CAP assessment with transient elastography, and SYNTAX score calculation were performed. Data analysis was conducted to find the correlation coefficient between CAP values and SYNTAX scores. Results: A total of 124 patients were included in this study, with a mean age of 59.8 ± 11.1 years and 5:1 of male to female ratio. The mean BMI was 25.6 ± 3.5 kg/m2, with 54.8% subjects classified as obese. A total of 94.4% and 55.6% subjects were hypertensive and diabetic with relatively controlled blood pressure and glycemic parameters. The mean HDL was 38.8 ± 10.8 mg/dL with 55.6% of the subjects having low HDL, and a median LDL of 109.5 mg/dL, with 89.5% of the subjects yet to achieve the optimal LDL target. The mean CAP value was 256.5 ± 47.3 dB/m, with 52.5% of the subjects having significant steatosis (CAP value ≥ 248 dB/m). The median SYNTAX score was 22. The Spearman correlation test showed a positive and significant correlation between CAP values and SYNTAX score (r = 0.245, p < 0.0001). Conclusion: Among patients with significant CAD, 52.5% have significant non-alcoholic hepatic steatosis. There is a positive and significant correlation between CAP values and SYNTAX scores in patients with significant CAD."

"Latar Belakang Uji latih jantung beban (ULJB) merupakan modalitas diagnostik PJKO yang telah lama digunakan. Meskipun demikian, perannya semakin semakin tergantikan oleh karena tingginya angka positif palsu, khususnya pada respons iskemik sugestif positif. Tujuan studi ini adalah untuk menyusun sebuah model algoritme prediksi menggunakan kecerdasan buatan untuk mendeteksi PJKO pada populasi respons iskemik sugestif positif.Metode Pasien yang menjalani ULJB dengan hasil respons iskemik sugestif positif dan angiografi koroner invasif dalam rentang 1 tahun pasca ULJB diikutsertakan dalam studi ini. Populasi studi dibagi secara acak menjadi kelompok latihan (80%) dan uji (20%) untuk membuat algoritme prediktif. Total 16 dari 122 fitur yang digunakan, meliputi informasi klinis, faktor risiko dan EKG saat ULJB. Algoritme yang digunakan meliputi support vector machine, logistic regression, random forest, k-nearest neighbor, naive Bayesian, Adaboost, decision tree dan extreme gradient boosting. Hasil Sebanyak 124 dari 513 pasien dengan respons iskemik sugestif positif ikutserta dalam studi ini. Algoritme random forest memiliki nilai akurasi yang paling tinggi 0,75±0,05 dengan indeks Youden 0,37 serta AUC 0,7±0,14. Sebanyak 86(69,35%) populasi terbukti memiliki stenosis signifikan.Kesimpulan ULJB dengan bantuan kecerdasan buatan dapat mendeteksi adanya PJKO pada pasien dengan sindroma koroner kronik dengan respons iskemik sugestif positif.

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Background Treadmill stress testing (TST) used to be an established diagnostic modalities in diagnosing obstructive coronary artery disease (OCAD) among patients with chronic coronary syndrome (CCS). Nevertheless, it has high false positive rate especially especially those with suggestive positive ischemic response (SPIR). We aim to develop an predictive model based on machine learning to detect OCAD among those with SPIR.

Method Patients who underwent TST and coronary angiography (CAG) within 1 year interval were enrolled into the study. They were randomly splitted into training (80%) and testing (20%) dataset for model development. Sixteen out of 122 features were used, including clinical information, risk factor and ECG parameter during TST. Several algorithm were used in model development including support vector machine, logistic regression, random forest, k-nearest neighbor, naive Bayesian, Adaboost, decision tree dan extreme gradient boosting.

Result 124 out of 513 patients with SPIR were enrolled in this study. Random forest algorithm achieved the highest accuracy (0,75±0,05) with Youden index of 0,37 and AUC 0,7±0,14. A total of 86(69,35%) patients had OCAD based on CAG.

Conclusion Machine learning based predictive model can diagnosed OCAD among CCS patients with SPIR."

"Latar Belakang: Angka harapan hidup yang meningkat menyebabkan peningkatan populasi usia lanjut termasuk populasi usia lanjut dengan penyakit jantung koroner. Frailty sering ditemukan pada pasien usia lanjut dengan penyakit kardiovaskular dan keberadaan frailty sangat mempengaruhi prognosis penyakit jantung koroner pada pasien usia lanjut termasuk luaran terhadap intervensi revaskularisasi. Percutaneous Coronary Intervention (PCI) adalah salah satu metode revaskularisasi dan belum banyak penelitian yang dilakukan terkait pengaruh frailty terhadap luaran pasien usia lanjut yang menjalani PCI elektif. Tujuan: Penelitian ini dilakukan untuk mendapatkan proporsi frailty, insidensi Major Adverse Cardiovascular Events (MACE) 30 hari dan mengkaji peran frailty terhadap prognosis pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif. Metode: Secara prospektif dilakukan penilaian terhadap kondisi frailty pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif di RS Cipto Mangunkusumo dengan menggunakan kriteria Frailty Phenotipe. Pasien kemudian di follow-up selama 30 hari setelah tindakan PCI elektif untuk melihat apakah MACE terjadi atau tidak. Hasil: Terdapat 100 pasien usia lanjut dengan penyakit jantung koroner yang menjalani PCI elektif dari bulan September 2014 - Juni 2015. Usia rata-rata pasien adalah 66.95 tahun (SD = 4.875) dengan pasien terbanyak adalah laki-laki (69%). Sebanyak 61% pasien termasuk ke dalam kelompok frail. MACE terjadi pada 8.19% pasien pada kelompok frail dan 5.12% pada kelompok non-frail. Hubungan frailty terhadap MACE dapat dilihat dari hasil crude Hazard Ratio (HR) 1.6 (IK 95% 0.31-8.24). Pada penelitian ini, kesintasan 30 hari 95% pada kelompok frail, sementara pada kelompok non-frail kesintasan 30 hari adalah sebesar 98%. Kesimpulan: Terdapat peningkatan risiko 1.6 kali untuk terjadinya MACE 30 hari pada subyek usia lanjut frail yang menjalani PCI elektif namun belum bermakna secara statistik.

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Background: The increase in life expectancy caused the increase in elderly population including the population of elderly with Coronary Artery Disease. Frailty is commonly found in elderly patients with cardiovascular disease and frailty had a major influence in determining the prognosis of cardiovascular disease in elderly including the outcome of revascularization intervention. PCI (Percutaneous Coronary Intervention) is one method of revascularization. However, frailty research on the effect on the outcome of elderly patients with coronary artery disease undergoing PCI is still limited.

Aim: To get the proportion of frailty and 30 days Major Adverse Cardiovascular Events (MACE) incidence, and to review impact of frailty in elderly patients with coronary heart disease who underwent elective PCI.

Method: The frailty condition of the elderly patients with coronary artery disease that underwent elective PCI in Cipto Mangunkusumo Hospital was assessed with the Frailty Phenotype criteria. After the patients underwent the elective PCI, they were followed for 30 days to see whether MACE occurred or not.

Result: There are 100 elderly patients with coronary artery disease that underwent elective PCI from September, 2014 until June, 2015. The mean age of patients is 66.95 ± 4.875 years and 69% of the patients were males. Frail was present in 61% of the patients. MACE were occurred in 8.19% of frail patients and 5.12% were occurred in non-frail patients. The correlation between frailty and MACE could be seen in the result of crude HR 1.6 (CI 95% 0.31-8.24). In this research, the 30 days survival rate is 95% in frail patients and 98% in non-frail patients.

Conclusion: There is a 1.6 fold increased risk of 30 days MACE in elderly frail patients that underwent elective PCI but it is not statistically significant."

"[ABSTRAKLatar belakang dan tujuan: Menentukan korelasi nilai Ejection Fraction (EF) ventrikel kiri pada echo 2D dan DSCT jantung pada pasien Penyakit Jantung Koroner (PJK) stabil di RSUPN Cipto Mangunkusumo, sehingga nilai EF ventrikel kiri DSCT jantung dapat dijadikan acuan untuk evaluasi, penatalaksanaan dan prognosis pada PJK stabil yang mempunyai indikasi dilakukan CT jantung.Metode: Analisa retrospektif dari 30 pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak waktu ≤ 3 bulan, meliputi penilaian EF ventrikel kiri. Berdasarkan nomor rekam medis yang ada, dilakukan pengambilan data EF ventrikel kiri echo 2D serta data tambahan lainnya. Nilai EF ventrikel kiri secara DSCT di evaluasi kembali pada cardiac workstation (Siemens, Leonardo), kemudian ditentukan bagaimana korelasinya dengan nilai EF ventrikel kiri secara echo 2D. Analisis statistik penelitian ini menggunakan uji SpearmanHasil: Terdapat perbedaan nilai EF ventrikel kiri sebanyak 4% antara echo 2D dengan DSCT jantung. Perbedaan sebanyak 4% ini tidak bermakna signifikan secara klinis namun bermakna secara statistik. Nilai R Spearman yang didapat adalah 0,17 sementara nilai p 0,364 (p > 0,005), artinya tidak terdapat korelasi antara nilai EF ventrikel kiri secara echo 2D dengan DSCT jantung pada pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak ≤ 3 bulan di RSUPN Cipto Mangunkusumo.Kesimpulan: Walaupun pada penelitian ini secara statistik tidak berkorelasi, namun pada keadaan hasil echo yang borderlineatau pada pasien PJK stabil yang mempunyai indikasi dilakukan CT jantung, nilai EF ventrikel kiri pada CT dapat menjadi acuan untuk penatalaksanaan selanjutnya.

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ABSTRACTBackground and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.;Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management., Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.]"

"Latar belakang: Mesin cardiopulmonary bypass (CPB) yang digunakan untuk operasi conventional coronary artery bypass graft (CCABG) meningkatkan risiko terjadinya gangguan fungsi ginjal pascaoperasi. Teknik operasi off-pump coronary artery bypass (OPCAB) tidak menggunakan mesin CPB, sehingga diharapkan dapat menurunkan kejadian acute kidney injury (AKI) pascaoperasi. Gangguan fungsi ginjal pascaoperasi dapat berkomplikasi menjadi penyakit ginjal kronik dan bahkan meningkatkan mortalitas.Tujuan: Membandingkan gangguan fungsi ginjal pascaoperasi OPCAB dan CCABG dengan menilai peningkatan kreatinin serum, derajat AKI, dan kebutuhan hemodialisis pascaoperasi.Metode: Penelitian ini menggunakan metode penelitian kohort retrospektif yang dilakukan dengan menganalisis data rekam medis pasien di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita tahun 2019 – 2021. Data kreatinin serum pascaoperasi diambil pada waktu 24 jam dan 48 jam pascaoperasi, kemudian hasilnya dibandingkan di antara kedua kelompok. Derajat AKI pascaoperasi dan kebutuhan hemodialisis pascaoperasi yang terjadi di antara kedua kelompok juga dibandingkan.Hasil: . Kelompok pasien OPCAB (n = 277) dan CCABG (n = 770) memiliki data demografis yang tidak berbeda bermakna. Kelompok OPCAB memiliki nilai median kreatinin serum pascaoperasi yang lebih rendah pada waktu 24 jam (1,04 mg/dL vs 1,20 mg/dL; p <0,05) dan 48 jam pascaoperasi (1,12 mg/dL vs 1,21 mg/dL; p<0,05). Kejadian AKI pascaoperasi pada semua stadium dan kebutuhan hemodialisis pascaoperasi juga lebih rendah secara bermakna pada kelompok OPCAB.Kesimpulan: Teknik operasi OPCAB menghasilkan kreatinin serum dan derajat AKI lebih rendah serta kebutuhan hemodialisis pascaoperasi yang lebih sedikit dibandingkan dengan CCABG.

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Background: Cardiopulmonary bypass (CPB) machine, that is used in conventional coronary artery bypass graft (CCABG), increases the risk of postoperative renal dysfunction. Off-pump coronary artery bypass technique does not utilize the CPB machine, therefore is expected to decrease postoperative acute kidney injury (AKI) incidents. Postoperative renal dysfunction can complicate into chronic kidney disease and even increases mortality risk.

Purpose: To compare the postoperative renal dysfunction after OPCAB and CCABG by evaluating the increase of creatinine serum, AKI, and postoperative hemodialysis.

Methods: For this retrospective cohort study, we analyzed the data from patient’s medical record in National Cardiovascular Center Harapan Kita from 2019 to 2021. The patients in OPCAB group (n=277) and CCABG group (n=770) had similar demographic characteristics. Postoperative creatinine serum was measured at 24 hours and 48 hours postoperative, then the results were compared between the two groups. Postoperative AKI and hemodialysis were also compared.

Results: The OPCAB group had lower median value of postoperative creatinine serum at 24 hours (1.04 mg/dL vs 1.20 mg/dL; p <0.05) and 48 hours postoperation. (1.12 mg/dL vs 1.21 mg/dL; p<0.05). All stages of postoperative AKI and hemodialysis were also lower significantly in the OPCAB group.

Conclusion: OPCAB technique resulted in lower postoperative creatinine serum, AKI rates, and less hemodialysis neeeds compared with CCABG technique ."

"Coronary artery bypass grafting (CABG) pada pasien Ejection Fraction (EF) <30% dikaitkan dengan risiko perioperatif yang tinggi. Oleh karena itu, penting untuk melakukan identifikasi pasien yang akan mendapat manfaat dari revaskularisasi. Single photon emission computed tomography (SPECT) digunakan untuk menilai viabilitas miokadium dan ischemic burden. Manfaat CABG pada pasien penyakit jantung koroner (PJK) EF <30% and ischemic burden <10% masih dalam perdebatan karena tingginya mortalitas dan morbiditas pascaoperasi. Teknik off-pump coronary artery bypass graft (OPCAB) diharapkan dapat mengurangi komplikasi pascaoperasi terkait penggunaan mesin cardiopulmonary bypass (CPB) dan dengan meminimalkan manipulasi aorta. Tujuan penelitian ini adalah untuk menganalisa mortalitas dan morbiditas pasien PJK dengan EF <30% and ischemic burden <10% yang menjalani OPCAB dibanding conventional CABG (CCABG). Dalam penelitian retrospektif ini, terdapat 109 pasien yang menjalani elektif CABG antara bulan Januari 2015 sampai November 2018 di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Indonesia. Terbagi dalam dua kelompok, 35 pasien kelompok OPCAB dan 74 pasien kelompok CCABG. Data demografi tidak terdapat perbedaan bermakna pada kedua kelompok. Aritmia yang terjadi pada kelompok OPCAB sebanyak 25,7% berbeda bermakna secara statistik lebih rendah dibandingkan kelompok CCABG sebanyak 51,4% (RR 3,55; IK 95% 1,40-8,91; p = 0,012). Hasil lain yang juga berbeda bermakna secara statistik adalah gagal ginjal akut 8,6% pada kelompok OPCAB dibandingkan 27% pada kelompok CCABG (RR 3,96; 95% CI 1,09-14,35; p = 0,027). Stroke pasca prosedur OPCAB sebesar 2,9% dibandingkan 17,6% pada kelompok CCABG (RR 7,25; IK 95% 1,91-57,81; p = 0,032). Sepsis pasca prosedur OPCAB 5,7% juga berbeda bermakna secara statistik lebih rendah dibandingkan CCABG 21,6% (RR 0,037; 95% CI 0,67-15,12; p = 0,037). Mortalitas pasca prosedur OPCAB lebih rendah dibandingkan CCABG namun tidak bermakna secara statistik, 5,7% dibandingkan 16,2% (RR 3,20; 95% CI 0,67-15,12; p = 0,126). Tidak terdapat perbedaan yang bermakna secara statistik pada low cardiac output syndrome (LCOS) dan operasi ulang pada kedua kelompok. Kami merekomendasikan OPCAB pada pasien PJK EF <30% and ischemic burden <10%.

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Coronary artery bypass grafting (CABG) in patients with Ejection Fraction (EF) <30% is associated with high perioperative risk. Therefore, it is very important to identify patients who would benefit from revascularization. Single photon emission computed tomography (SPECT) is commonly performed to assess myocardial viability and ischemic burden. A benefit of CABG for coronary artery disease (CAD) patients with EF <30% and ischemic burden <10% is still on debate because of the high postoperative mortality and morbidity. The technique of offpump coronary artery bypass (OPCAB) might reduce postoperative complications related to cardiopulmonary bypass (CPB) machine and by minimizing aortic manipulation. The objective of this study is to analyze in hospital mortality and morbidity in patients with EF <30% and ischemic burden <10% undergoing OPCAB compared to conventional CABG (CCABG). In this retrospective study, we included 109 consecutive patients undergoing elective CABG between January 2015 and November 2018 at the National Cardiovascular Centre Harapan Kita, Indonesia. The patients were divided in two groups, 35 patients undergoing OPCAB and 74 patients undergoing CCABG. Demographically, there are no significant differences in preoperative and intraoperative data in comparisons between two groups. Arrhythmia in OPCAB group is statistically lower compared to CCABG group, 25.7% vs 51.4% (RR 3.55; IK 95% 1.40-8.91; p = 0.012). Acute kidney injury is 8.6% vs 27% in OPCAB group and CCABG group, respectively (RR 3.96; IK 95% 1.09-14.35; p = 0.027). Stroke is 2,9% vs 17,6% in OPCAB group and CCABG group, respectively (RR 7,25; IK 95% 1,91-57,81; p = 0,032). OPCAB surgery also shows a statistically significant reduction in perioperative sepsis (5.7% vs 21.6%, RR 0.037; IK 95% 0.67-15.12; p = 0.037). There is no statistically significant difference between OPCAB and CCABG in mortality, 57% vs 16.2% (RR 3.20; IK 95% 0.67-15.12; p = 0.126). There are also no statistically significant differences in perioperative low cardiac output syndrome, re-operation data in both groups. We recommend the OPCAB technique in patients EF <30% and <10% ischemic burden."

"Latar Belakang : Peningkatan kadar homosistein merupakan faktor risiko terjadinya aterosklerosis dan trombogenesis. Baik faktor genetik maupun lingkungan mempunyai pengaruh terhadap kadar plasma homosistein. Pada penelitian ini, kami meneliti gambaran dari homosistein pada populasi PJK di Jakarta dan Malang serta hubungannya dengan enzim MTHFR, Vit. B6, Vil. B12, dan asam folat.Metode dan Hasil : Penelitian deskriptif ini melibatkan 30 pasien PJK di Jakarta dan 12 pasien di Malang. Subyek yang direkrut di Malang lebih muda, tetapi tidak ada perbedaan dalam jenis kelamin, 1MT, diabetes, dan merokok. Tidak ada perbedaan pada profil lipid diantara dua populasi. Subyek di Malang mempunyai kadar homosistein lebih tinggi (median 18 mmol/dL vs 9,1 mmol/dL; p < 0,001), kadar MTHFR yang lebih rendah (median 0,105 IU vs 0,157 IU; p = 0,019) kadar asam folat yang lebih rendah (median 7,1 vs 11,2 ng/mL; p = 0,005), kadar vit. B12 yang lebih rendah (median 273 ng/mL vs 429,5 ng/mL; p = 0,032). Tidak ada perbedaan pada kadar vit B6. Analisis dari hubungan menunjukkan hubungan yang terbalik antara homosistein dan pit. B12 (r = - 0,43, p = 0,004) dan asam folat (r = -0,39,p = 0,01).Kesimpulan : Tidak ada perbedaan kadar homosistein, MTHFR, asam folat, dan vitamin B12 pada populasi PJK (Jakarta dan Malang). Terdapat hubungan yang terbalik antara homosistein dan vit. B12 serta asam folat.

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Background : Increased homocysleine level is a risk factor for atherosclerosis and thrombogenesis_ Both genetic and environmental factors influence plasma level of homocysteine. In this study, we examine the distribution of homocysteine in population of CAD in Malang and Jakarta and the association between homocysteine, enzyme MTHFR, Vit. B6, Vii. B12, and folic acid.Methods and Results : This is a descriptive study including 30 CAD patients in Jakarta and 12 in Malang. Subjects recruited in Malang is younger, but no difference in gender, BMI, smoking and diabetes. No difference in lipid profile between both populations. Subjects in Malang have higher level of homocysteine (median 18 mmol/dL vs 9.1 mmol/dL; p <0.001), lower level of MTHFR (median 0.105 IU vs 0.157 IU; p = 0.019), lower level of Folic acid (median 7.1 vs 11.2 ng/mL; p = 0.005), lower level of Vit. B12 (median 273 ng/mL vs 429.5 ng/mL; p = 0.032). There is no difference in level of Vit. B6. Analysis of association showed inverse relationship between homocysteine and vit B12(r - -0.43, p = 0.004) and folic acid (r = -0.39,p =0.01).Conclusion : There is difference in level of homocysteine, MTHFR, folic acid and vii. B12 between populations coronary artery disease ( Jakarta and Malang). There is inverse relationship between homocysteine and vit B12 and folic acid."