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"Adesi dan agregasi pletelet serta pembentukan trombin merupakan rangkaian proses pembentukan trombus yang mendasari sindrom koroner akut (SKA). Oleh karena itu terapi utama SKA adalah heparin dan anti agregasi platelet, disamping obat anti iskemia. Heparin berat molekul rendah (low molecular weight heparin LMWH) memiliki profil farmakokinetik yang lebih baik jika dibandingkan dengan heparin tak terfraksinasi (unfractionated heparin / UFH). Dari berbagai jenis LMWH, hanya enoxaparine yang memperlihatkan keuntungan jika dibandingkan dengan UFH dalam mencegah kematian, infark miokard dan angina berulang pada SKA. Manfaat tersebut mungkin bukan hanya disebabkan oleh efeknya terhadap pembentukan trombin tetapi juga oleh pengaruhnya terhadap adesi dan agregasi platelet melalui interaksi dengan faktor von Willebrand (vWF). Penelitian ini dilakukan untuk melihat efek UFH dan enoxaparine terhadap peningkatan nilai vWF pada akhir terapi dan 48 jam setelah penghentian terapi pada penderita APTS atau IMA non-Q. Pada penelitian ini nilai vWF diperiksa dengan menggunakan teknik double antibody sandwich ELISA Penelitian dilakukan terhadap 37 subyek yang terdiri dari 19 subyek yang diterapi UFH dengan target APTT 1,5 - 2 x kontrol dan 18 subyek diterapi enoxaparine 1 mg/kg BB subkutan, 2 x sehari. Dilakukan pemeriksaan nilai vWF pada awal terapi (vWF1), akhir terapi (vWF2) dan 48 jam setelah penghentian terapi (vWF3). Terdapat efek penekanan. terhadap peningkatan nilai vWF hingga saat penghentian terapi secara bermakna oleh enoxaparine (192,1 ± 57,5 % menjadi 172,8 ± 63,0 %, rerata lama terapi 4,8 ± 1,0 hari, p=0,23), tetapi tidak demikian halnya dengan UFH (165,4 ±42,1 % menjadi 216,1 ±66,5 % rerata lama terapi 52,0 hari, p= 0,009). Terdapat perbedaan bermakna peningkatan nilai vWF pada awal hingga saat penghentian terapi (A vWF2-1) antara kedua kelompok tersebut (p =0,01). Dengan menggunakan data yang dapat dilengkapi hingga pemeriksaan nilai vWF 48 jam setelah penghentian terapi (UFH n=9 dan Enoxaparine n-13) masih dijumpai efek penekanan oleh enoxaparine terhadap peningkatan nilai vWF. Efek tersebut tidak dijumpai pada subyek yang diterapi dengan UFH."

"ABSTRAKLatar Belakang. Depresi sering terjadi pada penderita sindroma koroner akut(SKA) dan berhubungan dengan peningkatan mortalitas penderita SKA. Obatselective serotonin reuptake inhibitor (SSRI) telah diketahui efikasinya padadepresi pasca SKA. Nitric oxide (NO) merupakan salah satu penanda fungsiendotel. Studi menunjukkan kemampuan SSRI citalopram dalam memperbaikifungsi endotel melalui peningkatan kadar nitric oxide (NO). Fluoxetinemerupakan obat SSRI yang tersedia dengan baik di Indonesia belum pernahditeliti pengaruhnya pada peningkatan kadar NO.Tujuan. Mengetahui pengaruh pemberian fluoxetine 20 mg/hari selama 8 mingguterhadap peningkatan kadar NO pasien depresi pasca SKA, serta Mengetahuikorelasi antara perbaikan simtom depresi dengan peningkatan kadar NO pasiendepresi pasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu.Metode. Penelitian uji klinik tersamar acak ganda yang dilakukan pada JanuariSeptember2015dipoklinikJantungRSUPDr.SardjitoYogyakarta.Subjekadalahpenderitapasca SKA usia 40-60 tahun yang memenuhi kriteria depresi. Subjekdirandomisasi untuk mendapatkan fluoxetine dosis 20 mg/hari selama 8 mingguatau plasebo. Simtom depresi yang diukur dengan kuesioner BDI dan kadar NOdiambil pada awal dan akhir minggu ke 8 penelitian. Hasil. Dari 44 subjek yang mengikuti penelitian, 24 subjek mendapatkanfluoxetine dan 20 subjek mendapatkan plasebo. Analisis dilakukan pada 19 subjekkelompok fluoxetine dan 19 subjek kelompok plasebo. Rerata kadar NO sebelumdan sesudah pemberian fluoxetine adalah berturut-turut 31,86(2,4) μm dan29,7(2,7) μm. Rerata kadar NO sebelum dan sesudah pemberian plasebo adalahberturut-turut 32,44(2,48) μm dan 30,09(2,87) μm. Tidak terdapat korelasi antara perbaikan simtom depresi dan peningkatan kadar NO pada pasien depresi pasca SKA yang mendapatkan fluoxetine dibandingkan kelompok plasebo (r -0,206; p0,215).Simpulan. Fluoxetine dosis 20 mg/hari selama 8 minggu pada pasien depresipasca SKA tidak meningkatkan kadar NO. Penurunan skor BDI pasien depresipasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu tidak berkorelasi dengan peningkatan kadar NO.

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ABSTRACTBackground. Depression was prevalent in post acute coronary syndrome (ACS)patients and this condition was related with increasing morbidity and mortality.selective serotonin reuptake inhibitor has established as a treatment choice fordepression in post ACS patients. Nitric oxide (NO) was a well known marker ofendothelial function. Study on SSRI Citalopram showed an increasing level of NOafter administration of citalopram. Fluoxetine was available in Indonesia, but itsfunction in improving endothelial function through the increasing of NO levelremains unknown.Purpose. To evaluate the influence of fluoxetine 20 mg daily for 8 weeks inincreasing NO level in patients post ACS with depression, and to evaluate thecorrelation between improvement in depressive symptoms and increment of NOlevel in post ACS depression patients who receive fluoxetine 20 mg daily for 8weeks.Method. It was a randomized double blind clinical trial counducted in JanuarySeptember2015 whic held in Sardjito General Hospital Yogyakarta. Eligiblesubjects were post ACS age 40-60 years who fulfilled depression criteria. Subjectswere randomized to receive fluoxetine 20 mg daily or plasebo for 8 weeks. Depressive symtoms were evaluate using BDI inventory. Nitric oxide level weretaken at baseline and the end of week 8.Results. From 44 subjects, 24 subjects received fluoxetine, while 20 subjectcsreceived placebo. Analysis was done in 19 subjects of fluoxetine group and 19subjects of plasebo group. Means of NO level before and after treatment influoxetine group were 31,86(2,4) μm and 29,7(2,7) μm respectively. We found nocorrelation between improvement of depressive symptoms and increment of NOlevel (r -0,206; p 0,215).Conclusions. The NO level was not increased in post ACS depression patientswho recieve fluoxetine 20 mg daily for 8 weeks. The improvement of depressivesymptoms was not correlated with increment of NO level in post ACS patients depression patients who recieve fluoxetine 20 mg daily for 8 weeks."

"Diabetes mellitus (DM) is one of the public health problems worldwide, including in Indonesia. Cardiovascular disease was the main cause of death (75-80%) in DM, three-fourths of this death was caused by coronary heart disease (CHD). Approximately 34.2% of patients with acute coronary syndrome (ACS) receiving care at ICCU of Dr. Cipto Mangunkusumo General Hospital (RSCM) suffered from DM. Mortality rates of ACS in DM patients were still high and ACS prognosis in DM patients were still unfavorable. There are many factors playing a part in atherosclerosis and ACS incidence in DM patients, such as metabolic disorders due to hyperglycemia and the fomration of advanced glycation end product (AGE), oxidative stress, atherogenic dyslipidemia in DM in the form of high triglyceride level and low HDL cholesterol as well as an increase in small dense LDL, and insulin resistance. In addition, other risk factors of CHD frequently encountered with DM were hypertension, obesity, thrombocytc hyperaggregation and hypercoagulation. The management ofthis disease which was based on the control of risk factors was not yet satisfactory.Inflammatory response played an important role in pathogenesis of atherosclerosis, beginning with early lesion up to acute coronary syndrome. Increase in inflammatory responses (hsCRP) could predict cardiovascular event and predict post-ACS prognosis. Studies in DM population showed an increase in inflammation. ln-depth studies on inflammatory responses in ACS DM patients have not yet been reported. In normal condition, there was a balance of proinflammatory and antiinflammatory cytokines. The ratio of proinflammatory and antiinflammatory cytokines in ACS, particularly DM patients has not been studied. The relationship between metabolic factor (blood glucose, glyco Hb and lipid) and inflammatory response in ACS DM patients has not yet also been studied.Currently, the effort to decrease inflammatory response is made, among others, by aspirin, statin hypolipidemic medication and insulin sensitizer. Although aspirin and statin were used routinely in ACS patients and have proved to reduce inflammation, morbidity and mortality rates of ACS patients were still high. Thus, we would like to observe whether an addition of other medications in standard therapy could reduce inflammation better. Curcumin in experimental animals-and humans) showed -hypolipidemic effect (decrease 'in absorption and increase in catabolism) and hypoglycemia (effect on PPAR-7). Curcumin also demonstrated antiinflammatory effect. In this study we would like to observe the effects of curcumin on both metabolic factors and inflammatory responses in ACS patients.PROBLEM IDENTIFICATIONThe above elaboration showed a discrepancy associated with inflammatory response in DM ACS patients. Up to now, the relationship of metabolic factor and inflammatory response in DM ACS has not been clear yet. Likewise, the effects of curcumin on metabolic factor and inflammatory response in ACS have not yet been identified.OBJECTIVESTo evaluate inflammatory responses in DM ACS and its relationship with metabolic factors (glucose, blood; glyco Hb, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride); to evaluate the ratio of proinflammatory and antiinflammatory cytokines (IL-6/IL-10) in ACS DM patients, and to identify the effects of curcumin on metabolic factors and inflammatory responses in ACS patients.SETTINGThe study was conducted at ICCU of RSCM, ICCU of Persahabatan, ICCU of RS MMC and ICCU of Medistra Hospital, Cardiology Polyclinic, Department of Internal Medicine, Faculty of Medicine University of Indonesia! RSCM and Integrated Cardiac Service Poiyclinic of RSCM.STUDY SUBJECTSACS patients (DM and non-DM) and CHD (DM and non-DM).DESIGNThere were two studies: l. Observational design to observe inflammatory responses (hscRP, IL-6, IL-IO, VCAM and ICAM) in DM ACS, non-DM ACS, DM CI-ID, and non-DM CHD; to evaluate the relationship between metabolic factors (fasting blood glucose, blood glucose 2 hours PP, glyco Hb, total cholesterol, LDL cholesterol, HDI.. cholesterol and triglyceride) and inflammatory responses (hsCRP, IL-6, IL-10, VCAM and ICAM) in ACS DM. 2. Interventional study which was a double-blind randomized trial to evaluate the effects of curcumin at escalating doses (low dose 3:-:IS mglday, moderate dose 3x30 mg/day and high dose 3x60 mg/day on metabolic factors (fasting blood glucose. blood glucose 2 hours PP and glyco Hb) and the effects of curcumin at escalating doses on inflammatory responses (hsCRP, ll.-6, VCAM and ICAM) in ACS patients.RESULTSIn observational study, |46 subjects were analyzed, consisting of 84 ACS patients, (30 DM ACS patients and 54 non-DM ACS), and 62 CHD (25 DM CHD patients and 37 non-DM CHD patients). The results of the study in the four groups of patients showed: 1. Inflammatory response in DM ACS was higher than in DM CHD (hsCRP, p=0.00; II..-6, p=0.00; IL-10, p=0.00) and non-DM ACS (ICAM, P=0.03). 2. The ratio of proinflammatory and antiinflammatory cytokines (IL-6/II..-10) in DM ACS did not differ from that of DM CHD (p=0.2l) and non-DM ACS (p=0.5 l). 3. There was a relationship between metabolic factors and inflammatory responses in DM ACS: triglyceride and ll.-6 (r=O.39, p=0.03) and II..-I0 (r=0.37, p=o.o4).In interventional study we performed randomization in 75 ACS patients divided into four groups, consisting of low-dose curcumin group of 15 patients, moderate-dose curcumin group of 15 patients, high-dose curcumin group of IS patients, and placebo group of 30 patients. The results of the study in these four groups showed: l. Low-dose curcumin showed a decrease in hsCRP in one week ofthe first month after intervention, there was a significant difference liom that of placebo (p=0.04). Low-dose, moderate-dose, high-dose curcumin groups showed a decrease in IL-6, but was not significantly different from placebo. Low-dose, moderate-dose, high-dose curcumin did not show a decrease in VCAM and ICAM after intervention of 2 months. 2. Low-dose curcumin group tended to experience a decrease in glyco Hb level after intervention of 2 months (p=0.06); however, it was not significantly different from that of placebo. 3. There was a tendency that low-dose curcumin reduced total cholesterol and LDI. cholesterol; however, it was not significantly different from that of placebo. There was a tendency that low-dose curcumin increased HDL cholesterol; however, it was not significantly different from that of placebo. 4. There was a tendency that the pattern of escalating doses had some effects in inflammatory responses and metabolic factors, in which low-dose curcumin showed the best effects, followed by moderate-dose and finally high- dose curcumin.CONCLUSIONSIn this study, inflammatory responses in DM ACS patients were higher than those in DM CHD and non-DM ACS patients. There was no difference in the ratio of proinflammatory and antiinflammatory cytokines (IL-6fIL-IO) in DM ACS compared with DM CHD and non-DM ACS. ln addition, the present study identified some of the relationships between metabolic factors and inflammatory responses. Low-dose curcumin reduced hsCRP in one week of the first month after the intervention in ACS patients. There was a tendency that low-dose curcumin reduced glyco Hb level in ACS."

"ABSTRAKSindrom Koroner Akut SKA merupakan kondisi kegawatdaruratan akibat ketidakseimbangan antara kebutuhan oksigen miokardium dengan suplai darah yang dapat berakibat pada kematian. Penanganan SKA dengan intervensi koroner perkutan dapat meningkatkan kualitas hidup. Pedoman American Heart Association AHA merekomendasikan standar waktu ? 120 menit dari awal mula munculnya gejala hingga pasien tiba di rumah sakit yaitu. Namun masih ditemukan terjadinya keterlambatan prehospital. Penelitian ini bertujuan untuk mengidentifikasi hubungan representasi gejala dengan keterlambatan prehospital pada pasien sindrom SKA. Desain penelitian menggunakan cross sectional dengan metode purposive sampling yang melibatkan sampel sebanyak 63 responden. Responden didominasi oleh lansia yang berusia 51-60 tahun, laki-laki, tingkat Pendidikan SMA. Hasil penelitian menunjukan ada hubungan antara representasi gejala yang meliputi tingkat nyeri p 0.001, kualitas nyeri p 0.01, dan lokasi nyeri p 0.032 dengan keterlambatan prehospital terkecuali gejala penyerta p 0.054. Perawat dianjurkan meningkatkan kompetensi dalam pengkajian gejala SKA dan pemberian edukasi. Sehingga dapat menurunkan angka keterlambatan prehospital.

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ABSTRACTAcute Coronary Syndrome ACS is an emergency condition due to an imbalance between the need for oxygen and the blood supply that can result in death. ACS with percutaneous coronary intervention may improve the quality of life. The American Heart Association ACCF AHA guidelines recommended is 120 minutes from onset symptoms until hospital arrived. for recording time standards when facing symptoms arrive at the hospital However, there is still a pre hospital delay. This study aimed to identify correlation of symptoms representation with pre hospital delay in patients with ACS symptoms. This crossectional study design is cross sectional of purposive sampling method involved 63 respondents. Respondents mostly 51 60 years old, men, and high school education level. The results showed there was a correlation symptoms factor representation including pain level p 0.001, pain quality p 0,01, and pain location p 0,032 except commorbid symptom p 0,054. Nurses recommended to improve their ability to assess ACS symptoms and provide proper health education to decrease educational the prehospital delays."

"Latar Belakang: Peningkatan serotonin plasma dan kortisol saliva yang terjadi pada sindrom koroner akut juga terjadi pada gejala ansietas. Dan kedua penanda biologis tersebut digunakan untuk mengetahui adanya gejala ansietas. Tujuan: Mengetahui perbedaan rerata serotonin plasma dan kortisol saliva pada sindrom koroner akut dengan gejala ansietas di RSUPN dr. Cipto Mangunkusumo. Metode: Dilakukan penelitian klinis poong lintang. Hasil: Kadar serotonin plasma dengan gejala ansietas dan tanpa gejala ansietas dibandingkan nilai normal yaitu 194,83 (142,00-892,04) ng/mL dan 167,16 (150,40-225,96) ng/ml. Kadar kortisol saliva pada subjek dengan gejala ansietas dan tanpa gejala ansietas adalah 2,75 (1,28-4,91) µg/dL dan 2,69 (0,91-7,09) µg/dL. Simpulan: Ada peningkatan kadar serotonin plasma dan kortisol saliva pada gejala ansietas walaupun tidak terdapat hubungan antara serotonin plasma dan kortisol saliva dengan gejala ansietas pada pasien SKA.

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Background: Increases in plasma serotonin and salivary cortisol that occur in acute coronary syndrome also occur in symptoms of anxiety. And the two biological markers are used to determine the presence of anxiety symptoms.

Objective: To determine the difference in mean plasma serotonin and salivary cortisol in acute coronary syndrome with anxiety symptoms at RSUPN dr. Cipto Mangunkusumo.

Methods: Poong Lintang clinical research was conducted.

Results: Compared to normal values, plasma serotonin levels with anxiety symptoms and without anxiety symptoms ​​were 194.83 (142.00-892.04) ng/mL and 167.16 (150.40-225.96) ng/ml. Salivary cortisol levels in subjects with anxiety symptoms and without anxiety symptoms were 2.75 (1.28-4.91) µg/dL and 2.69 (0.91-7.09) µg/dL.

Conclusion: There is an increase in plasma serotonin and salivary cortisol levels in anxiety symptoms although there is no relationship between plasma serotonin and salivary cortisol with anxiety symptoms in ACS patients."

"Latar Belakang: Respon antar-individu yang bervariasi terhadap obat antiplatelet (clopidogrel) telah dilaporkan. Perbedaan tingkat metabolisme clopidogrel untuk metabolit aktif tiol menggambarkan variabilitas antar-individu dalam penghambatan trombosit. Sitokrom P4502C19 (CYP2C19) memetabolisme zat metabolit aktif tiol. Carier polimorfisme yang menyebabkan hilangnya fungsi CYP2C19 * 2 dan * 3 alel pada terapi antiplatelet mengakibatkan berkurangnya penghambatan agregasi trombosit. Informasi mengenai hubungan antara CYP2C19 * 2 dan * 3 dengan inhibisi agregasi trombosit pada pasien Sindroma koroner akut di Indonesia masih terbatas. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara dua varian, CYP2C19 * 2 (6816>A) dan CYP2C19 * 3 (636G>A) terhadap penurunan fungsi inhibisi agregasi trombosit. Bahan dan Metode: Desain penelitian cross sectional. Jumlah responden adalah 114 orang (dipilih berdasarkan kriteria inklusi dan kriteria ekslusi). Pemeriksaan polimorfisme CYP2C19 dilakukan dengan menggunakan teknik Real Time-Polymerase Chain Reaction (RT-PCR) TaqMan SNP Genotyping Assays dengan alat dari applied Biosystems 7500 Fast/7900HT Fast Real Time PCR Systems (in standart or 9600 emulation mode). Inhibisi agregasi trombosit diperiksa dengan menggunakan metode Light Transmisi Aggregometry (LTA) dengan alat Helena AggGRAM Analyzer pada penambahan 5umol/L ADP sebagai agregator. Hasil: Distribusi inhibisi agregasi trombosit menunjukkan perbedaan rerata antara responden non carier polimorfisme dengan responden carier polimorfisme (16,9 CI95%: 12,1-21,6 vs 9,4 CI95%: 2,9 - 15,0). Analisis regresi linier menunjukkan bahwa responden carier polimorfisme memiliki inhibisi agregasi trombosit lebih rendah dibandingkan dengan responden non carier polimorfisme. Analisis regresi logistik menunjukkan bahwa responden carier polimorfisme mempunyai odds untuk merespon kurang baik terhadap clopidogrel sebesar 1,9 kali jika dibandingkan dengan responden yang non carier setelah dikontrol oleh variabel umur dan jenis kelamin, hal tersebut mengindikasikan bahwa carier polimorfisme mempunyai inhibisi yang rendah terhadap agregasi trombosit. Kesimpulan: Temuan kami membuktikan adanya hubungan antara CYP2C19 * 2 dan * 3 polimorfisme dengan inhibisi agregasi trombosit.

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Background: Inter-individual variability in response to antiplatelet drugs (clopidogrel) has been reported. The difference in the extent of metabolism of clopidogrel to its active metabolite tiol is the most plausible mechanism for the observed inter-individual variability in platelet inhibition. The cytochrome P4502C19 (CYP2C19) metabolizes the active metabolite tiol. The carrier polymorphisms of reduced - functions of CYP2C19*2 and *3 allele on antiplatelet therapy showed diminished platelet aggregation inhibition. There is limited information on the association between CYP2C19 *2 and *3 with platelet aggregation inhibition in ACS patients generally in Indonesia Population. The aim of this study was to determine the association between two variants, CYP2C19*2 (6816>A) and CYP2C19*3 (636G>A) reduced function with platelet aggregation inhibition.

Material & Method: a cross sectional study was done with 114 subjects (selected by inclusions and exclusions criteria). The CYP2C19 polymorphisms were genotype using the PCR method with TaqMan SNP Genotyping Assays from applied Bio systems 7500 Fast/7900HT Fast Real Time PCR Systems (in standard or 9600 emulation mode). The platelet aggregation inhibition was tested using Light Transmission Aggregometry (LTA) by Helena AggGRAM Analyzer with 5umol/L ADP as aggregator.

Results: The distribution of platelet inhibition aggregation showed difference between respondents with non-carrier polymorphisms and carrier polymorphisms (16,9 CI95%: 12,1 -21,6 vs 9,4 CI95%: 2,9 - 15,0). The linier regression analysist indicated that the carrier polymorphisms have lowest platelet aggregation inhibition compared with non-carrier polymorphisms. The logistic regression analysis indicated that carrier polymorphisms respondents has 1,9 odds to be low response to clopidogrel if compared with non-carrier polymorphisms respondents after adjusted with age and sex and it is indicated that it has low platelet aggregation inhibition.

Conclusion: Our present findings the evidence of an association between CYP2C19 *2 and *3 polymorphisms and platelet aggregation inhibition."

"[ABSTRAKLatar Belakang: Major adverse cardiac events (MACE) merupakan komplikasi serius pada pasien pasca sindrom koroner akut (SKA) sehingga perlu suatu metode yang andal dalam memprediksi kejadiannya. Heart rate variability (HRV) yang menggambarkan ketidakseimbangan sistem otonom pasca SKA dan dapat dilakukan dengan cara yang lebih cepat, mudah, dan praktis berpotensi dapat digunakan sebagai alat stratifikasi risiko MACE.Tujuan: Mengetahui kemampuan HRV awal perawatan yang diukur melalui metode pulse photoplethysmograph (PPG) dalam memprediksi MACE pada pasien pasca SKA yang dirawat di intensive cardiac care unit (ICCU).Metode: Studi ini adalah studi kohort prospektif dengan subjek pasien SKA yang menjalani perawatan di ICCU. Pemeriksaan HRV dilakukan dengan metode PPG dalam 48 jam pasca diagnosis SKA dan adanya MACE dideteksi selama perawatan di ICCU. Komplikasi yang digolongkan sebagai MACE adalah kematian, aritmia fatal, gagal jantung, syok kardiogenik, re-infark, dan komplikasi mekanik. Kemampuan HRV dalam memprediksi MACE dinyatakan melalui AUC (+IK95%) dan untuk parameter yang memiliki kemampuan prediksi baik akan dihitung nilai prediksi positif (PPV) dan nilai prediksi negatif (NPV) beserta IK95% parameter tersebut.Hasil: Sebanyak 75 subjek SKA menjalani pengukuran HRV < 48 jam pasca diagnosis dan sebanyak 18,7% di antaranya mengalami MACE. Parameter LF dengan AUC 0,697 (0,543-0,850) dan rasio LF/HF dengan AUC 0,851 (0,741-0,962) memiliki kemampuan diskriminasi MACE yang paling baik. Parameter LF pada titik potong 89,673 memiliki PPV dan NPV sebesar 13% dan 71%, sedangkan rasio LF/HF pada titik potong 1,718 sebesar 6% dan 50%.Kesimpulan: Variabel LF dan rasio LF/HF merupakan parameter HRV yang dinilai memiliki kemampuan diskriminasi cukup baik terhadap MACE. Kedua variabel tersebut memiliki nilai prediksi negatif sehingga dapat digunakan untuk menyingkirkan kemungkinan terjadinya MACE pada mereka dengan nilai LF > 89,673 dan rasio LF/HR > 1,718.

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ABSTRACTIntroduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.;Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718., Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.]"

"Latar Belakang : Indonesia memiliki angka kematian karena penyakit kardiovaskular yang semakin meningkat, dengan angka kematian diperkirakan sebanyak 17,3 juta kematian. Mengingat tingkat mortalitas yang sangat tinggi pada pasien dengan sindrom koroner akut SKA, maka diperlukan sebuah prediktor Major Adverse Cardiac Event MACE yang objektif dan terukur untuk manajemen pasien SKA dalam jangka panjang. Pada SKA dapat ditemukan heterogenitas repolarisasi ventrikel yang dapat dilihat pada elektrokardiografi EKG sebagai QTmax-QTmin, atau dapat disebut sebagai QTD.QTD disinyalir dapat dijadikan penanda untuk risiko MACE pada pasien SKA. Tujuan : Mengetahui peran dispersi QT dan QTcD sebagai prediktor MACE pada pasien sindrom koroner akut SKA. Metode : Penelitian ini merupakan studi kohort retrospektif pada 230 rekam medis pasien SKA yang dirawat di ICCU RSCM dalam rentang waktu Januari 2016 hingga November 2017. EKG standar 12 sadapan saat serangan dianalisis dan dilakukan pengukuran interval QTmax dan QTmin yang kemudian dihitung QTd. Selanjutnya dikoreksi dengan frekuensi nadi menggunakan rumus Bazett QTcD. Hasil : Pemanjangan QTD lebih dari 100mdet dapat menjadi prediktor MACE pada pasien dengan SKA OR 1,25 IK95 0,17 ndash; 2,71 . Setelah dikoreksi dengan frekuensi nadi menggunakan rumus Bazett, pemanjangan QTcD juga dapat menjadi prediktor MACE pada pasien SKA 1,89 IK95 0,05 ndash; 67,37. Kesimpulan : Pemanjangan QTD lebih dari 100mdet atau QTcD lebih dari 12,72mdet dapat menjadi prediktor MACE.

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Background: In Indonesia, the number of death due to cardiovascular disease is rapidly rising and it was approximated to have resulted in 17,3 million deaths. Due to this steadily increasing cases, it is necessary to find a predictor for Major Adverse Cardiac Event MACE that is objective and standardized for long term care of patients with acute coronary syndrome ACS. In ACS, one of the underlying mechanisms is the presence of heterogeneity in ventricle repolarization that is seen on ECG machine as QTmax ndash QTmin, or what is identified as QTD. QTD is hypothesized to have role as marker in patients with MACE in ACS.

Aim: Identify the role of QTD and QTcD as MACE predictor in patients with acute coronary syndrome.

Methods: This study is a retrospective cohort with the subject of 230 ACS patients that was hospitalised on RSCM ICCU among January 2016 to November 2017. Data was taken from medical record and 12 lead ECG during attack were taken and analysed manually to calculate QTmax and QTmin and substraction of both into QTD. Followed by correction using the heart rate with Bazett formula QTcD.

Result: QTD prolongation of more than 100ms in patients with ACS may lead to MACE OR 1,25 IK95 0,17 ndash 2,71 . Following correction with Bazett formula, QTcD prolongation is also predictor 1,89 IK95 0,05 ndash 67,37.

Conclusion: QTD prolongation of more than 100ms or QTcD of more than 12.72ms might lead to MACE "

"Latar Belakang. Salah satu penyebab kematian pada sindrom koroner akut adalah terjadinya komplikasi yang dikenal dengan major adverse cardiac event MACE . Terdapat beberapa prediktor terjadinya MACE pada pasien SKA, diantaranya adalah faktor psikologis yaitu depresi dan ansietas. Saat ini, depresi dan ansietas belum mendapat banyak perhatian padahal memiliki peran penting dalam pengobatan SKA dan prognosisnya. Tujuan. Mengetahui hubungan antara depresi dan ansietas dengan major adverse cardiac event dalam 7 hari pada pasien SKA. Metode. Studi dengan desain kohort prospektif untuk meneliti hubungan antara depresi dan ansietas dengan MACE dalam 7 hari pasien SKA, dengan menggunakan kuisioner HADS pada pasien SKA yang menjalani perawatan di ICCU, Rawat Inap Gedung A RSCM pada bulan Januari ndash; Mei 2018. Analisis bivariat dilakukan untuk menghitung risk ratio RR terjadinya MACE dalam 7 hari pada kelompok depresi dan ansietas dengan menggunakan SPSS. Hasil. Didapatkan jumlah subjek yang memenuhi kriteria inklusi sebanyak 114 orang. depresi didapatkan pada 7 subjek, ansietas didapatkan pada 28,95 subjek, dan MACE didapatkan pada 9,6 subjek. Pada kelompok depesi, MACE 7 hari terjadi pada 12,5 subjek. Pada kelompok Ansietas, MACE 7 hari terjadi pada 21,2 subjek. Pada analisis bivariat didapatkan ansietas meningkatkan risiko terjadinya MACE dalam 7 hari pada pasien SKA, dengan risiko relatif RR sebesar 4,2 IK 1,34 ndash; 13,7. Kesimpulan. Proporsi depresi pada pasien SKA di RSCM sebesar 7 dan proporsi ansietas pada pasien SKA di RSCM sebesar 28,95 . Ansietas pada pasien SKA merupakan prediktor independen terjadinya MACE dalam 7 hari dan meningkatkan risiko terjadinya MACE 7 hari.

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Background. One of the causes of death in acute coronary syndrome is the occurrence of a complication known as major adverse cardiac event MACE. There are several predictors of the occurrence of MACE in patients with ACS, including psychological factors such as depression and anxiety. Currently, depression and anxiety have not received much attention when it has an important role in the treatment of ACS and its prognosis.

Objective. To determine the association between depression and anxiety with major adverse cardiac event within 7 days in patients with acute coronary syndrome.

Method. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in January May 2018. Bivariate analysis was performed to calculate the risk ratio RR of MACE occurrence within 7 days in the depression and anxiety group using SPSS.

Results. Obtained number of subjects who meet the inclusion criteria of 114 people. depression was obtained in 7 of subjects, Anxiety was obtained in 28,95 of subjects, and MACE was obtained in 9.6 of subjects. In the depression group, MACE 7 days occurred in 12.5 of subjects. In the Anxiety group, MACE 7 days occurred in 21,2 of subjects. In bivariate analysis, anxiety increased the risk of MACE within 7 days in patients with ACS, with relative risk RR of 4,2 IK 1,34 ndash 13,7.

Conclusion. The proportion of depression in patients with SKA in RSCM was 7 and the proportion of anxiety in ACS patients in RSCM was 28,95. Anxiety in patients with ACS is an independent predictor of MACE within 7 days and increases the risk of a 7 day MACE. "