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"Latar Belakang: Telah diketahui infeksi COVID-19 dapat menetap menjadi sindroma pasca COVID-19. Magnetic Resonance Imaging (MRI) kardiak memiliki nilai diagnostik tinggi untuk menilai karakteristik jaringan miokard. Belum diketahui secara pasti efek jangka panjang COVID-19 terhadap jaringan miokardium serta faktor-faktor admisi yang memiliki pengaruh terhadap prevalensi sindroma pasca-COVID-19 pada populasi dengan penyakit kardiovaskular. Tujuan: Mengevaluasi prevalensi fibrosis miokardium dengan MRI kardiak pada pasien dengan penyakit kardiovaskular dan riwayat COVID-19 1 tahun pascaperawatan, serta mengidentifikasi faktor admisi yang berpengaruh terhadap fibrosis miokardium. Metode: Kohort prospektif dengan menilai parameter MRI kardiak pada pasien terkonfirmasi COVID-19 dengan penyakit kardiovaskular 1 tahun pascaperawatan. Selanjutnya, dilakukan analisa temuan MRI kardiak terhadap kelompok kontrol tanpa riwayat COVID-19 yang telah di-matching berdasarkan umur, jenis kelamin, dan faktor resiko. Analisa multivariat dilakukan untuk mengetahui faktor admisi yang memiliki hubungan dengan kejadian fibrosis miokardium. Hasil: Total 32 subjek dengan penyakit KV dan riwayat COVID-19 1 tahun pascaperawatan dengan 49 subjek kontrol disertakan dalam studi ini. Terdapat peningkatan yang signifikan pada parameter MRI kardiak yaitu proporsi abnormal T1 relaxation time (65,5% vs 36,7%; p-value=0,011) serta late gadolinum enhancement (LGE) skar noniskemik 62,5% vs 29,8%;p-value=<0,001) pada kelompok dengan riwayat COVID-19 dibanding kontrol. Tidak ditemukan faktor admisi yang berpengaruh terhadap peningkatan LGE noniskemik/T1 abnormal. Kesimpulan: Terdapat peningkatan prevalensi fibrosis miokardium pada pasien dengan penyakit KV dan riwayat COVID-19 1 tahun pascaperawatan dibanding kontrol dinilai melalui MRI kardiak. Tidak terdapat hubungan antara faktor admisi dengan fibrosis miokardium 1 tahun pascaperawatan COVID-19.

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Background: Presently, it has been acknowledged that COVID-19 infection may persist longer as Post-acute COVID-19 Syndrome. Cardiac Magnetic Resonance Imaging (cMRI) possesses a high diagnostic value to evaluate myocardial tissue characteristics. Data are still limited regarding longer implications of COVID-19 infection towards myocardial tissues and predictive admission factors in patients with Cardiovascular Diseases (CVD).

Aim(s): To evaluate the prevalences of myocardial fibrosis using cMRI in patients with CVD and one year post-COVID-19 hospitalization and identifying admission factors in correlation with myocardial fibrosis. 

Method(s): Prospective cohort to assess cMRI parameters in patients with CVD and history of COVID-19 one year post-hospitalization. The results were then compared with the age-, sex-, risk factors-matched control group without prior of COVID-19 infection. Lastly, multivariat analysis was done to identify relations between admission factors and myocardial fibrosis. 

Result(s): A total of 32 subjects with CVD one year post-COVID-19 hospitalization and 49 controls were included in this study. Significant increases of cMRI parameters, namely abnormal T1 relaxation time (65.5% vs 36.7%; p-value=0.011) and non-ischemic late gadolinum enhancement (LGE) (62.5% vs 29.8%;p-value=<0.001) were observed in the population with prior COVID-19 infection compared to control. No admission factors were found to be related with the increases in nonischemic LGE/abnormal T1.

Conclusion: There is a significant increase of myocardial fibrosis prevalence in patients with CVD one year post-COVID-19 hospitalization compared to control assessed through cMRI parameters. No relationships were found between admission factors and myocardial fibrosis. "

"Latar Belakang: Harapan hidup pasien thalasemia bergantung transfusi bertambah baik karena transfusi darah dan terapi kelasi besi yang sesuai. Penyakit jantung akibat toksisitas besi tetap menjadi penyebab utama kematian pada pasien thalasemia bergantung transfusi. MRI T2* jantung dapat mendeteksi dini toksisitas besi di jantung dan dapat mengevaluasi hasil pengobatan dengan membandingkan nilai T2* pra dan pasca terapi kelasi besi.Tujuan Penelitian: Penelitian ini bertujuan mendapatkan profil perbaikan toksisitas besi di jantung pada pasien thalasemia dewasa bergantung transfusi. Penelitian ini juga bertujuan untuk melihat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum dan saturasi transferin.Metode Penelitian: pre and post test dengan data sekunder retrospektif pada pasien dewasa thalasemia bergantung transfusi yang kontrol di poliklinik thalasemia Kiara dan poliklinik dewasa hematologi-onkologi medik RSUPN Cipto Mangukusumo. Penelitian dilakukan pada bulan Juli-Desember 2019. Data sekunder diperoleh dari rekam medis dan registri pasien thalasemia berupa riwayat medis, jenis obat kelasi besi, nilai T2* jantung satu tahun berturut-turut, kadar feritin serum dan saturasi transferin. Analisis data berupa data deskriptif dan uji marginal homogeneity serta uji kappa.Hasil: Sebanyak 115 pasien dilibatkan dalam penelitian ini. Terdapat perbaikan T2* jantung sebanyak 7,0% dan menetap baik (T2* jantung tetap >20 milidetik) sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum (nilai kappa = 0,044) dan perbaikan nilai T2* jantung dengan saturasi transferin ( nilai kappa = 0,011).Simpulan: Perbaikan toksisitas besi di jantung pasca terapi kelasi besi sebanyak 7,0% dan menetap baik sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan kadar feritin serum dan saturasi transferin.

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Background: Life expectancy of the transfusion dependent thalassemia patients is getting better because of blood transfusion and appropriate iron chelation therapy. Heart disease due to iron toxicity remains the leading cause of death in thalassemia patients who need transfusion. MRI T2* can allow to detect premature iron toxicity in the heart and can evaluate the results by comparing myocardial T2* pre and post iron chelation therapy.Objectives: This study aims to obtain a profile of improvement in cardiac iron toxicity in adult thalassemia patients who need transfusion. This study also supports to see aggrement between improvement in myocardial T2* with improved serum ferritin level and transferrin saturation.Methods: pre and post test with retrospective secondary data in adult thalassemia patients requiring controlled transfusions in Kiara thalassemia clinic and hematology-medical oncology clinic Cipto Mangukusumo General Hospital. The study was conducted in July-Desember 2019. Data were obtained from medical records and thalassemia registry, which consisted of medical history, type of chelation, myocardial T2* within one year, serum ferritin level and transferrin saturation. Data analysis was performed in descriptive data and marginal homogeneity test and Kappa test.Results: A total of 115 patients were included in this study. There was an improvement of a myocardial T2* in 7.0% patients and persistently good (myocardial T2* remains >20 milliseconds) in 72.2%. There was no agreement between improvement in myocardial T2* with improvement in serum ferritin level (kappa value 0.044) and improvement in myocardial T2* with transferrin saturation (kappa value 0.011).Conclusion: Improvement of cardiac iron toxicity after iron chelation therapy was 7.0% and persistently good in 72.2%. There was no agreement between the improvement in myocardial T2* with improvement in serum ferritin level and transferrin saturation."

"Latar Belakang: Harapan hidup pasien thalasemia bergantung transfusi bertambah baik karena transfusi darah dan terapi kelasi besi yang sesuai. Penyakit jantung akibat toksisitas besi tetap menjadi penyebab utama kematian pada pasien thalasemia bergantung transfusi. MRI T2* jantung dapat mendeteksi dini toksisitas besi di jantung dan dapat mengevaluasi hasil pengobatan dengan membandingkan nilai T2* pra dan pasca terapi kelasi besi.Tujuan Penelitian: Penelitian ini bertujuan mendapatkan profil perbaikan toksisitas besi di jantung pada pasien thalasemia dewasa bergantung transfusi. Penelitian ini juga bertujuan untuk melihat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum dan saturasi transferin.Metode Penelitian: pre and post test dengan data sekunder retrospektif pada pasien dewasa thalasemia bergantung transfusi yang kontrol di poliklinik thalasemia Kiara dan poliklinik dewasa hematologi-onkologi medik RSUPN Cipto Mangukusumo. Penelitian dilakukan pada bulan Juli-Desember 2019. Data sekunder diperoleh dari rekam medis dan registri pasien thalasemia berupa riwayat medis, jenis obat kelasi besi, nilai T2* jantung satu tahun berturut-turut, kadar feritin serum dan saturasi transferin. Analisis data berupa data deskriptif dan uji marginal homogeneity serta uji kappa.Hasil: Sebanyak 115 pasien dilibatkan dalam penelitian ini. Terdapat perbaikan T2* jantung sebanyak 7,0% dan menetap baik (T2* jantung tetap >20 milidetik) sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum (nilai kappa = 0,044) dan perbaikan nilai T2* jantung dengan saturasi transferin ( nilai kappa = 0,011).Simpulan: Perbaikan toksisitas besi di jantung pasca terapi kelasi besi sebanyak 7,0% dan menetap baik sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan kadar feritin serum dan saturasi transferin.

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Background: Life expectancy of the transfusion dependent thalassemia patients is getting better because of blood transfusion and appropriate iron chelation therapy. Heart disease due to iron toxicity remains the leading cause of death in thalassemia patients who need transfusion. MRI T2* can allow to detect premature iron toxicity in the heart and can evaluate the results by comparing myocardial T2* pre and post iron chelation therapy.Objectives: This study aims to obtain a profile of improvement in cardiac iron toxicity in adult thalassemia patients who need transfusion. This study also supports to see aggrement between improvement in myocardial T2* with improved serum ferritin level and transferrin saturation.Methods: pre and post test with retrospective secondary data in adult thalassemia patients requiring controlled transfusions in Kiara thalassemia clinic and hematology-medical oncology clinic Cipto Mangukusumo General Hospital. The study was conducted in July-Desember 2019. Data were obtained from medical records and thalassemia registry, which consisted of medical history, type of chelation, myocardial T2* within one year, serum ferritin level and transferrin saturation. Data analysis was performed in descriptive data and marginal homogeneity test and Kappa test.Results: A total of 115 patients were included in this study. There was an improvement of a myocardial T2* in 7.0% patients and persistently good (myocardial T2* remains >20 milliseconds) in 72.2%. There was no agreement between improvement in myocardial T2* with improvement in serum ferritin level (kappa value 0.044) and improvement in myocardial T2* with transferrin saturation (kappa value 0.011).Conclusion: Improvement of cardiac iron toxicity after iron chelation therapy was 7.0% and persistently good in 72.2%. There was no agreement between the improvement in myocardial T2* with improvement in serum ferritin level and transferrin saturation."

"Latar Belakang: Fibrosis ventrikel kanan merupakan respons adaptif sekaligus maladaptif terhadap kelebihan beban di ventrikel kanan. Peranan fibrosis ventrikel kanan pada populasi hipertensi pulmonal (HP) akibat defek septum atrial (DSA) sekundum belum banyak diketahui.Tujuan: Membandingkan derajat fibrosis ventrikel kanan pada pasien DSA sekundum yang sudah dan belum terjadi penyakit vaskular paru (PVP) serta menilai korelasi parameter fibrosis berdasarkan magnetic resonance imaging (MRI) dengan nilai pulmonary arterial resistance index (PARi), flow ratio (FR) dan rasio pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) dari kateterisasi jantung.Metode: Penelitian ini merupakan studi potong lintang pada pasien DSA sekundum dengan HP berusia 318 tahun yang menjalani kateterisasi jantung kanan dan pemeriksaan MRI untuk menilai fibrosis ventrikel kanan.Hasil: Terdapat total 63 pasien yang ikut serta dalam penelitian. Sebanyak 92.1% pasien memiliki gambaran late gadolinium enhancement (LGE) di regio right ventricular insertion point dan 66.7 % di septum interventrikular. Kelompok yang sudah mengalami PVP memiliki skor LGE, nilai native T1 dan extracellular volume (ECV) yang lebih tinggi dibanding kelompok yang belum (berturut-turut, 3 [1-4] vs. 2 [0-4]; p = 0.001, 1192 [1043-1407] ms vs. 1118 [1019-1191] ms; p <0.001, 43.7 ± 5.5% vs. 38.1 ± 4.6%; p <0.001). Skor LGE memiliki korelasi sedang terhadap PARi (r = 0.581, p <0.001), PVR/SVR (r = 0.561, p <0.001) dan FR (r = -0.490, p <0.001). Nilai native T1 memiliki korelasi kuat terhadap PARi (r = 0.679, p <0.001) dan PVR/SVR (r = 0.627, p <0.001) serta korelasi sedang terhadap FR (r = -0.589, p <0.001). Nilai ECV memiliki korelasi sedang terhadap FR (r = -0.440, p <0.001), serta korelasi lemah terhadap PARi (r = 0.398, p = 0.001) dan PVR/SVR (r = 0.382, p = 0.001).Kesimpulan: Pasien DSA sekundum yang sudah mengalami PVP memiliki derajat fibrosis ventrikel kanan yang lebih berat serta terdapat korelasi bermakna antara fibrosis ventrikel kanan dengan parameter kateterisasi jantung.

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Background : Right ventricular (RV) fibrosis is both adaptive and maladaptive response to the overloaded RV. Its role in pulmonary hypertension (PH) caused by secundum atrial septal defect (ASD) is not well known.

Aim(s): This study aims to compare RV fibrosis in patients with secundum ASD who have and have not experienced pulmonary vascular disease (PVD) and to determine the correlation of RV fibrosis with pulmonary arterial resistance index (PARi), flow ratio (FR), and pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) ratio.

Method(s): This is a cross-sectional study on patients aged ≥18 years with secundum ASD and PH, who underwent right heart catheterization (RHC) and cardiac magnetic resonance imaging (MRI) to assess RV fibrosis.

Result(s): There were a total of 63 patients participating in this study. The majority of patients showed late gadolinium enhancement (LGE) in the region of RV insertion point (92.1%) and interventricular septum (66.7%). The PVD group had higher LGE scores, native T1, and extracellular volume (ECV) (3 [1-4] vs. 2 [0-4]; p = 0.001, 1192 [1043- 1407] ms vs. 1118 [1019-1191] ms; p <0.001, 43.7 ± 5.5% vs. 38.1 ± 4.6%; p <0.001, respectively). LGE scores had a moderate correlation with PARi (r = 0.581, p <0.001), PVR/SVR ratio (r = 0.561, p <0.001), and FR (r = -0.490, p <0.001). RV native T1 showed a strong correlation with PARi (r = 0.679, p <0.001) and PVR/SVR (r = 0.627, p <0.001), and a moderate correlation with FR (r = -0.589, p <0.001). RV ECV had a moderate correlation with FR (r = -0.440, p <0.001), and weak correlations with PARi (r = 0.398, p = 0.001) and PVR/SVR (r = 0.382, p = 0.001).

Conclusion: Secundum ASD patients with PVD showed significantly higher degree of RV fibrosis. There is a significant correlation between RV fibrosis and hemodynamic parameters obtained from RHC."

"Latar belakang: Diabetes mellitus tipe 2 (DMT2) dan gagal jantung memiliki keterkaitan yang kuat dan luaran klinis yang satu mempengaruhi lainnya. Studi terakhir berhasil membuktikan manfaat empagliflozin, obat lini kedua pada DMT2, terhadap kardiovaskular. Mekanisme seluler yang diketahui berperan pada hewan adalah efek antifibrosis miokard, namunbelum ada studi pada manusia.Tujuan: Mengetahui efek pemberian empagliflozin terhadap fibrosis miokard pada pasien DMT2 dengan gagal jantung. Metode: Uji klinis acak tidak tersamar yang dilakukan di RS Jantung dan Pembuluh Darah Harapan Kita dari Februari 2019 sampai Mei 2019. Pasien DMT2 dan gagal jantung diberikan empagliflozin 10 mg selama tiga bulan. Perbedaan kadar suppression of tumorigenicity-2 (ST2) serum pada kelompok kontrol dan intervensi di awal dan akhir penelitian akan dianalisis. Hasil: Terdapat 58 pasien yang menjadi subjek penelitian dan 40 (69%) pasien menyelesaikan penelitian. Terdapat perbedaan kadar ST2 yang bermakna setelah pemberian empagliflozin selama tiga bulan (median ST2 kelompok empagliflozin sebelum dan sesudah empagliflozin masing-masing 23,5(12,5 - 130,7)ng/mL dan 18,9(12,5 - 29,4) ng/mL, p=0,02). Penurunan ST2 dan persentase penurunan ST2 kelompok empagliflozin kedua kelompok tidak berbeda secara statistik (masing-masing p=0,16 dan p=0,21). Kesimpulan: Pemberian empagliflozin selama tiga bulan dapat menurunkan fibrosis miokard yang tidak terlihat pada kelompok kontrol. Tidak terdapat perbedaan besaran penurunan fibrosis pada pemberian empagliflozin dibandingkan terapi standar.

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Background: Type 2 diabetes mellitus (T2DM) and heart failure have a strong relationship; one affects each other. Recent studies have proven some cardiovascular benefits of empagliflozin. Myocardial antifibrosis is proposed to be the mechanism in many animal studies, but in humans the data is lack. Objectives: To investigate the effect of empagliflozin on myocardial fibrosis in T2DM patients and heart failure. Methods: This was an open-labeled clinical trial in National Cardiovascular Center Harapan Kita, from February 2019 to May 2019. Patients with T2DM and heart failure received empagliflozin 10 mg for three months. Differences of serum suppression of tumorigenicity-2 (ST2) levels in both control and intervention groups at the beginning and end of the study were analyzed. Results: There were 58 patients enrolled in the study and total of 40 (69%) patients completed it. There were significant differences in ST2 levels after administration of empagliflozin (median for ST2 empagliflozin group before and after empagliflozin was 23.5 (12.5 - 130.7) ng / mL and 18.9 (12, 5 - 29.4) ng / mL respectively, p = 0.02). The ST2 value difference and percent different were not different (p=0,16 and p=0,21, respectively). Conclusion: Three months Empagliflozin might reduce myocard fibrosis which was not seen in control group. The total fibrosis reduction was not significantly different compared to standard therapy"

"Latar Belakang : Gagal jantung adalah salah satu kondisi dengan morbiditas dan mortalitas yang signifikan. Penyebab paling sering dari masalah gagal jantung adalah iskemia yang disebabkan oleh stenosis pada pembuluh darah koroner. Studi viabilitas adalah metode non-invasif untuk mengidentifikasi sel miokard yang mengalami kondisi stunning maupun hibernating yang mungkin memperoleh manfaat dari revaskularisasi. Studi sebelumnya mencoba melihat perananan viabilitas dengan kesintasan tidak menemukan kaitan antara adanya viabilitas miokard dan juga kesintasan.

Tujuan : Studi ini mencoba membandingkan luaran kejadian kardiovaskular mayor (KKM), mortalitas, rehospitalisasi maupun perbaikan dari fraksi ejeksi pada pasien kardiomiopati iskemik yang akan menjalankan bedah pintas arteri koroner dengan atau tanpa studi viabilitas

Metode : Suatu studi kohort retrospektif dilakukan pada pasien Gagal Jantung dengan Fraksi Ejeksi Menurun yang diputuskan untuk dilakukan Bedah Pintas Arteri Koroner (BPAK) oleh Heart Team Meeting dari Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Pasien tersebut dikelompokan kedalam grup yang dilakukan studi viabilitas dan grup yang tidak dilakukan studi viabilitas. Dilakukan follow up pada pasien ini dan dilakukan pencatatan luaran seperti kematian, rehospitalisasi dan juga perbaikan dari fraksi ejeksi.

Hasil : Didapatkan adanya 216 pasien yang menjalankan BPAK dengan dilakukan pemeriksaan viabilitas dan 269 pasien yang menjalankan BPAK tanpa dilakukan pemeriksaan viabilitas. Tidak ada perbedaan yang signifikan secara statistik antara dilakukannya uji viabilitas dengan luaran KKM, mortalitas maupun rehospitalisasi paska dilakukan prospensity score adjustment. Namun, mereka yang dilakukan uji viabilitas lebih banyak yang mengalami perbaikan fraksi ejeksi dibandingkan dengan mereka yang tidak dilakukan uji viabilitas.

Kesimpulan : Tidak ada perbedaan dari KKM, kesintasan maupun rehospitalisasi pada pasien yang menjalankan BPAK dengan data viabilitas dibandingkan dengan mereka yang menjalankan BPAK tanpa data viabilitas. Namun, pasien yang menjalankan BPAK dengan data viabilitas lebih mungkin memiliki perbaikan dari fraksi ejeksi

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Backgrounds : Heart failure with reduced ejection fraction is one of the condition with significant morbidity and mortality. The most common etiology is ischemia caused by stenosis of coronary artery. Viability study is a non-invasive methods to identify which myocardial cells that may experienced stunning or hibernating conditions that may gain benefit from surgical revascularization using coronary artery bypass graft (CABG). Previous study failed to identify the benefit of viability study on major adverse cardiovascular events (MACE), mortality or rehospitalization.

Aim : This study aims to compare the outcome of major adverse cardiovascular events (MACE), mortality, rehospitalization and improvement of ejection fraction in patients with ischemic cardiomyopathy that had coronary artery bypass graft surgery with and without undergoing myocardial viability study.

Methods : A retrospective cohort study were done on patients with heart failure with reduced ejection fraction (HFrEF) that were decided to do coronary artery bypass graft by heart team meeting of National Cardiovascular Center Harapan Kita. The patients were grouped according to whether they undertook viability study or not. Follow up were done on these patients and outcome such as mortality, rehospitalization and improvement of ejection fraction were recorded.

Results : There are 216 patients that had CABG with viability study and 269 patients that had CABG without viability study. There are no statistically significant differences between those undergoing viability study and outcome of MACE, mortality or rehospitalization after prospensity score adjustment. However, those with viability study are more likely to have improvement of ejection fraction compared to those that do not have viability results.

Conclusion : There are no differences in either MACE, survival or rehospitalization in patients that did CABG procedure with viability data compared to those that do not have the data. However, those that have viability data are more likely to have improvement of ejection fraction."

"Latar Belakang: COVID-19 di Indonesia menyebabkan kematian hingga lebih dari 150.000 orang. Salah satu populasi yang mengalami dampak dengan risiko kematian yang tinggi adalah populasi penyakit kardiovaskular. Severitas COVID-19 sering dikaitkan dengan rendahnya rasio PaO2/FiO2 dan tingginya kadar D-dimer. COVID-19 varian Omicron diketahui memiliki angka penyebaran yang lebih tinggi dengan severitas infeksi yang lebih rendah dibandingkan varian sebelumnya. Namun dampak jangka panjang pada pasien COVID-19 varian Omicron, khususnya pada populasi pasien dengan penyakit kardiovaskular masih menjadi pertanyaan. Penelitian ini ingin mengetahui dampak pasca COVID-19 varian Omicron dengan melihat kadar ST2 terlarut dan adanya gangguan paru yang dinilai dengan pemeriksaan spirometri.Tujuan: Penelitian ini dilakukan untuk mengetahui hubungan Rasio PaO2/FiO2 dan Kadar D-dimer pada saat admisi terhadap kadar ST2 terlarut dan gambaran spirometri pada pasien pasca COVID-19 varian Omicron dengan penyakit kardiovaskular. Metode: Penelitian berupa studi potong lintang terhadap pasien COVID-19 varian Omicron dengan riwayat komorbid penyakit kardiovaskular yang dirawat di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Diagnosis COVID-19 varian Omicron dilakukan dengan menggunakan metode WGS/SGTF. Pasien dengan kriteria inklusi menjalani pemeriksaan spirometri dan pengukuran kadar ST2 terlarut pada 6 bulan pasca perawatan.Hasil dan Pembahasan: Penelitian ini menunjukkan rasio PaO2/FiO2 dengan median 454 dan kadar D-dimer 790ng/mL. Mayoritas pasien menunjukkan gambaran gangguan resktriktif. Kadar ST2 terlarut pasca perawatan memiliki median 2716,8pg/mL. Tidak ditemukan adanya hubungan yang signifikan antara rasio PaO2/FiO2 dan kadar D-Dimer terhadap kadar ST2 terlarut maupun gambaran spirometri pada 6 bulan pasca COVID-19. Hal ini dapat dikaitkan dengan severitas COVID-19 yang lebih rendah sehingga tidak terdapat hubungan bermakna terhadap parameter admisi serta hubungan pengukuran 6 bulan pasca COVID-19 dengan kemungkinan adanya perbaikan fibrosis.Kesimpulan: Tidak ada hubungan yang signifikan antara rasio PaO2/FiO2 dan kadar D- Dimer terhadap kadar ST2 terlarut ataupun gambaran spirometri pada 6 bulan pasca COVID-19 varian Omicron.

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Introduction: COVID-19 in Indonesia has caused more than 150,000 deaths. One of the affected populations with a high risk of death is the cardiovascular disease population. The severity of COVID-19 is associated with a low of PaO2/FiO2 ratio and the increased levels of D-dimer. Omicron variant is known to have higher transmission with less severe infection than the previous variant. However, research related to long term effect post COVID-19 with Omicron variant in cardiovascular population is not yet known.

Aim: This study was conducted to determine the relationship of PaO2/FiO2 ratio and D- dimer levels at admission to sST2 levels and spirometry profile in post COVID-19 variant Omicron patient with cardiovascular disease.

Method: Research in the form of a cross-sectional study was conducted on Omicron variant COVID-19 patients with a history of comorbid cardiovascular disease who were treated at the Harapan Kita Heart and Blood Vessel Hospital (RSJPDHK). The diagnosis of COVID-19 is carried out using the WGS/SGTF method. Patients undergo spirometry examination and measurement of sST2 levels at 6 month after hospitalization.

Results and Discussion: This study shows a PaO2/FiO2 ratio with a median of 454 with D-dimer levels 790 ng/mL. The majority of patients have a restrictive patterns. The median sST2 value in Omicron variant COVID-19 patients at 2716.8 pg/mL. There was no significant relationship between the ratio of PaO2/FiO2 and D-Dimer levels to sST2 levels and spirometry profile at 6 months after COVID-19 infection. This can be associated with lower COVID-19 severity so that there is no significant association with inflammatory parameters such as PaO2/FiO2 ratio and D-dimer levels, as well as the relationship between measurements 6 months post COVID-19 and the possibility of fibrosis improvement.

Conclusion: There was no significant relationship between the ratio of PaO2/FiO2 and D-Dimer levels to sST2 levels and spirometry abnormality at 6 months post COVID-19 variant Omicron."

"ABSTRAK Latar belakang: disglikemia adalah keadaan intoleransi glukosa berupa peningkatan kadar gula darah yang berhubungan dengan risiko penyakit kardiovaskular. Seiring dengan waktu, pada akhirnya diabetes akan menimbulkan kerusakan pada target organ, salah satu yang penting adalah pada sistem organ kardiovaskular, dapat berupa penyakit jantung koroner, kardiomiopati diabetes, penyakit serebrovaskuler, dan penyakit arteri perifer. Diabetes juga meningkatkan risiko terjadinya gagal jantung. Pada kardiomiopati diabetes, proses fibrosis yang masih reversibel sudah mulai terjadi bahkan ketika penderita masih asimtomatik. Pemeriksaan baku emas untuk mendeteksi terjadinya fibrosis miokard secara dini adalah pemeriksaan histopatologi jaringan miokardium melalui biopsi. Akan tetapi pemeriksaan ini sangat invasif dan tidak nyaman bagi subjek. Pemeriksaan yang kemudian berkembang adalah pencitraan menggunakan Cardiac Magnetic Resonance Imaging (CMRI). Akan tetapi pemeriksaan ini cukup mahal, dan tidak tersedia pada semua fasilitas kesehatan. Sementara itu, ST2 adalah penanda enzim jantung yang menggambarkan derajat proses fibrosis yang sedang terjadi pada miokard, terutama pada keadaan gagal jantung. Pemeriksaan menggunakan penanda enzim dapat menjadi alternatif dengan keuntungan lebih murah, dapat terjangkau luas dan mudah tersedia. Tujuan: Mengetahui hubungan antara kadar ST2 serum dengan fibrosis miokard interstisial pada penderita disglikemia. Metode: Pasien disglikemia yang lolos kriteria eksklusi berupa komorbid kardiovaskular akan menjalani pemeriksaan kadar ST2 serum dan T1 relaxation time menggunakan Cardiac MRI. Selanjutnya dilakukan analisis hubungan antara kadar ST2 serum dan T1 relaxation time. Hasil penelitian: Sebanyak 34 pasien diikutsertakan ke dalam penelitian ini. Didapatkan kisaran nilai kadar ST2 serum antara 12.40-53.22 ng/dL (median 19.95 ng/dL). Rerata nilai T1 relaxation time didapatkan sebesar 443.39 ± 113.35 ms. Terdapat korelasi bermakna antara kadar ST2 serum dengan fibrosis diffuse miokardium (Spearman correlation r = -0,547, p < 0.01). Pada analisa multivariat hubungan antara kadar ST2 serum dan T1 relaxation time tidak dipengaruhi oleh faktor perancu yang telah ditetapkan (r = -0,44, p = 0,033). Kesimpulan: Hasil penelitian ini menunjukkan kadar ST2 serum berkolerasi dengan fibrosis diffuse miokardium pada populasi disglikemia.ABSTRACT Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population."

"Latar belakang: Penyakit jantung koroner (PJK) masih menjadi masalah di Indonesia bahkan di dunia. Berdasarkan patofisiologinya, PJK dibagi menjadi sindrom koroner akut (SKA) dan kronik (SKK). Salah satu tatalaksana PJK adalah revaskularisasi otot jantung. Namun sangat penting untuk mengetahui viabilitas miokardium untuk kepentingan pengembalian fungsi kontraktilitas miokardium. Saat ini, magnetic resonance imaging (MRI) jantung adalah baku emas yang digunakan untuk mengevaluasi viabilitas miokardium. Namun ketersediaan modalitas ini sangat terbatas. Dobutamine stress echocardiography (DSE) juga dapat mengevaluasi viabilitas miokardium dan memiliki ketersediaan yang lebih luas di Indonesia. Tujuan: Meta analisis ini bertujuan membandingkan sensitivitas dan spesifisitas DSE terhadap MRI kardiak pada pasien dengan SKK. Metode: Meta analisis ini mencari literatur dari empat database yaitu Pubmed, Embase, Cochrane dan Scopus. Meta analisis ini mengacu pada Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 dan Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Forest plot menampilkan sensitivitas dan spesifisitas DSE dan MRI kardiak. Hasil: Terdapat tiga belas studi yang diinklusi. Dari penyusunan forest plot didapatkan DSE memiliki sensitivitas 75% (CI 0,61 – 0,86) dan spesifisitas 87% (CI 0,82 –0,91), dimana MRI kardiak memiliki sensitivitas 93% (CI 0,88 – 0,96) dan spesifisitas 77% (CI 0,61 – 0,87). Walaupun demikian, perlu diperhatikan beberapa faktor yang dapat menyebabkan overestimation pada sensitivitas dan spesifisitas DSE dan underestimation pada sensitivitas dan spesifisitas MRI kardiak. Kesimpulan: DSE memiliki sensitivitas yang lebih rendah dan spesifistas yang lebih tinggi dibandingkan MRI kardiak. Dengan mempertimbangkan overestimation dan underestimation kedua modalitas tersebut, MRI kardiak memiliki akurasi yang lebih baik dibandingkan DSE. Kata kunci: Sindrom koroner kronik, viabilitas miokardium, dobutamine stress echocardiography, magnetic resonance imaging kardiak.

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Background: Coronary heart disease (CHD) still becomes a health problem in Indonesia, even in the world. Based on its pathophysiology, CHD is classified to acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). One of the treatment of CHD is myocardial revascularization, however it’s important to know the myocardial viability in prior in order to reverse the contractility function of the myocardium. Nowadays, cardiac magnetic resonance imaging (MRI) is the gold standard for evaluating myocardial viability. Nevertheless, the availibility of MRI is limited. Dobutamine stress echocardiography (DSE) is also able to evaluate myocardial viaiblity and widely available across Indonesia. Purpose: This meta analysis compares the sensitivity and specificity of DSE and cardiac MRI in patients with CCS. Method: This meta analysis searches literatures from four database: Pubmed, Embase, Cochrane and Scopus. We used Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 dan Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy as references. Forest plot is constructed to show the sensitivity and specificity of DSE and cardiac MRI. Result: Thirteen studies were included. The Forest plot shows that DSE has sensitivity of 75% (CI 0,61 – 0,86) and specificity of 87% (CI 0,82 – 0,91), while cardiac MRI has sensitivity of 93% (CI 0,88 –0,96) and specificity of 77% (CI 0,61 – 0,87). Conclusion: DSE has lower sensitivity yet higher specificity than cardiac MRI. Considering the overestimation and underestimation of these modalities, cardiac MRI has higher diagnostic accuracy than DSE."

"Latar Belakang: Pada pasien dengan penyakit jantung, gangguan pada fungsi paru dapat memperburuk kondisi jantung dengan menyebabkan terjadinya dekompensasi. Infeksi virus SARS-CoV-2 berpotensi mengakibatkan terjadinya fibrosis paru dan gangguan fungsi paru lainnya yang dapat dinilai dengan pemeriksaan spirometri dan kadar ST2 terlarut dalam darah. Infeksi COVID-19 varian Omicron mengakibatkan luaran yang relatif lebih baik dibandingkan varian Delta namun jumlah kasusnya lebih banyak dan tetap dapat mengakibatkan komplikasi tersebut. Oleh sebab itu, penelitian ini akan membandingkan kedua parameter tersebut pada pasien pasca infeksi COVID-19 varian Omicron dan Delta.Tujuan: Mengetahui hubungan kadar ST2 terlarut dan luaran spirometri pada pasien pasca COVID-19 varian Omicron dibandingkan varian Delta pada pasien dengan penyakit kardiovaskular serta perbedaan pada kedua populasi.Metode: Studi observasional potong lintang pada 76 pasien dengan penyakit jantung yang terinfeksi COVID-19 varian Omicron dan Delta dilakukan pemeriksaan spirometri dan kadar ST terlarut 12 minggu pasca konfirmasi negatif. Analisis statistik dilakukan untuk mengetahui hubungan antara kadar ST2 terlarut pada varian Omicron dibandingkan dengan Delta terhadap gangguan fungsi paru menggunakan spirometri dan perbedaan luaran kedua varian.Hasil: Dari 76 subjek penelitian, proporsi pasien dengan varian Omicron lebih banyak dibandingkan Delta (53 orang berbanding 23 orang), dengan perbedaan pada proporsi pasien dengan gagal jantung, penyakit jantung koroner, penerima vaksin dan distres pernafasan akut pada admisi. Kadar ST2 terlarut (p=0.026, OR 1.01 (95% CI 1.00-1.01)) dan kondisi gagal jantung (p=0.019, OR 6.07 (95% CI 1.34-27.47)) memiliki hubungan terhadap kejadian luaran gambaran spirometri abnormal khususnya gambaran restriksi terutama pada varian Omicron, namun hubungan ini lemah dan kemaknaan klinis tidak signifikan.Hasil studi ini mengindikasikan bahwa kadar ST2 terlarut, meskipun lemah, mungkin memiliki asosiasi terhadap kelainan spirometri pada penyintas COVID-19, namun temuan ini terbatasi oleh perbedaan pada masing-masing populasi dari studi ini.

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Background: In patients with heart disease, impaired lung function can exacerbate cardiac conditions due to decompensation. Infection by the SARS-CoV-2 virus has the potential to cause pulmonary fibrosis and other lung impairment which could be assessed by spirometry and measurement of soluble ST2 levels. Omicron infection resulted in a relatively better outcome than the Delta variant but higher number of cases and it could still cause these complications. Therefore, this study aims to compare these two parameters in survivors of COVID-19 infected by Omicron and Delta variant.

Objective: To determine the relationship between soluble ST2 levels and spirometry outcomes in patients with cardiovascular disease after COVID-19 infection by Omicron variant as compared to the Delta variant and the differences in the two populations.

Methods: A cross-sectional observational study on 76 patients with heart disease who were infected by Omicron and Delta variant of COVID-19 underwent spirometry and blood sampling for soluble ST levels at the Outpatient clinic in 12 weeks after confirmed negative. Statistical analysis will be performed to find out the association between soluble ST2 levels in the Omicron variant compared to Delta and impairment of lung function using spirometry and the difference in the outcomes of the two variants.

 

Results: From 76 study subjects, the proportion of survivor of Omicron variant was higher than Delta (53 versus 23), with differences in the proportion of patients with heart failure, coronary artery disease, recipients of vaccine and acute respiratory distress syndrome on admission. Soluble ST2 levels (p=0.026, OR 1.01 (95% CI 1.00-1.01)) and heart failure (p=0.019, OR 6.07 (95% CI 1.34-27.47)) have a significant association to abnormal spirometry pattern, especially the restrictive pattern in the Omicron variant, however this relationship may be weak and the clinical implication might be insignificant.

Conclusion: The results of this study indicate that soluble ST2 levels, although weak, may have an association with spirometry abnormalities in COVID-19 survivors, but these findings may be limited by differences in each population and study design."