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"Latar Belakang. Disfungsi endotel dan aterosklerosis merupakan kondisi yang terjadi secara sistemik. Bila ada aterosklerosis di aorta, maka kemungkinan juga terjadi aterosklerosis di arteri koroner. Kekakuan aorta akibat aterosklerosis tersebut dapat diketahui dari pulse wave velocity (PWV) aorta. Penelitian ini akan menilai hubungan antara PWV aorta dengan keberadaan penyakit arteri koroner (PAK) berdasarkan skor SYNTAX (Synergy between percutaneous coronary intervention with Taxus and cardiac surgery) angiografi koroner. Metode. Penelitian ini merupakan suatu penelitian observasional potong lintang. Evaluasi dilakukan pada 83 pasien yang menjalani angiografi koroner elektif di Pusat Jantung Nasional harapan Kita dan memenuhi kriteria inklusi sejak September hingga November 2013. Hubungan nilai PWV aorta dengan keberadaan PAK berdasarkan skor SYNTAX dinilai dengan analisis regresi logistik. Hasil. Setelah disesuaikan dengan usia, jenis kelamin, indeks massa tubuh, hipertensi, diabetes melitus, dislipidemia, penghambat enzim konverting angiotensin, penyekat reseptor angiotensin, penyekat kanal kalsium, diuretik, dan pasca infark miokard, tidak ditemukan hubungan antara PWV aorta dengan keberadaan PAK (Odds ratio 2,126; IK 95%: 0,744 – 6,072; p= 0,159). Pada kelompok PAK tidak ditemukan korelasi antara nilai PWV aorta dengan skor SYNTAX (r= -0,082; p= 0,539). Uji regresi logistik multinomial antara PWV aorta dengan skor pembuluh juga tidak menunjukkan hubungan yang bermakna. Kesimpulan. PWV aorta tidak memiliki hubungan yang bermakna dengan keberadaan dan beratnya stenosis PAK, tetapi pada kelompok PAK ada kecenderungan terjadi PWV aorta lebih tinggi.

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Background. Endothelial dysfunction and atherosclerosis are conditions that occurs systemically. If atherosclerosis occurred in the aorta, it may also occurred atherosclerosis in coronary artery. Aortic stiffness as a result of atherosclerosis can be known from the pulse wave velocity (PWV) of the aorta. This study will assess the relationship between aortic PWV with the presence of coronary artery disease (CAD) by SYNTAX (Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score from coronary angiography.

Method. This study is a cross-sectional observational study. The evaluation was done on 83 patients who undergoing elective coronary angiography at the Harapan Kita National Heart Centre and met the inclusion criteria since September to November 2013. The relationship between aortic PWV values with the presence of CAD by SYNTAX score was assessed by logistic regression analysis.

Results. After adjusting for age, sex, body mass index, hypertension, diabetes mellitus, dyslipidemia, angiotensin converting enzym inhibitor, angiotensin reseptor blocker, calcium channel blocker, diuretic, and post myocardial infarction, analyses revealed there is no associated between aortic PWV with the presence of CAD (Odds ratio 2,126; IK 95%: 0,744 – 6,072; p= 0,159). In CAD group, there was no associated between aortic PWV value with SYNTAX score. After multinomial logistic regression between aortic PWV with vessel score, there is also no significantly associated.

Conclusion. Aortic PWV has no relation with the presence and severity of CAD, but there is a trend toward high aortic PWV in CAD group."

"Latar Belakang : Pasien infark miokard akut dengan elevasi segmen ST IMAEST yang mengalami revaskularisasi dengan intervensi koroner perkutan primer IKPP dapat terjadi cedera reperfusi yang mempengaruhi prognosis. Penelitianpada model hewan menunjukkan ticagrelor melindungi jantung dari cederareperfusi, namun demikian belum ada penelitian pada manusia yang menguji halini. Tujuan : Membandingkan pengaruh antara ticagrelor dengan clopidogrelterhadap cedera reperfusi yang diukur melalui kadar puncak high sensitivetroponin T hs-cTnT pada pasien IMA-EST yang mengalami revaskularisasi. Metode : Penelitian ini merupakan penelitian eksperimental acak tersamar gandayang dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita padabulan Agustus 2016 sampai November 2016. Pasien IMA-EST yang akanmenjalani IKPP dirandomisasi ke dalam dua kelompok yaitu kelompok yangmendapatkan loading ticagrelor 180 mg dilanjutkan dosis rumatan 2x90 mg danyang mendapatkan loading clopidogrel 600 mg dilanjutkan dosis rumatan 1x75mg sebelum IKPP. Dilakukan pemeriksaan hs-cTnT 8 jam pasca dilatasi balonkateter pertama. Hasil Penelitian : Terdapat total 60 subyek, 30 subyek kelompok ticagrelor dan30 subyek kelompok clopidogrel. Tidak ditemukan perbedaan bermakna antaraticagrelor dengan clopidogrel terhadap kadar puncak hs-cTnT 9026 5026 ng/Lvs 9329 4664 ng/L, nilai p 0,809. Kesimpulan : Ticagrelor tidak menyebabkan kadar puncak high sensitivetroponin T yang lebih rendah bila dibandingkan dengan clopidogrel pada pasienIMA-EST yang mengalami revaskularisasi.

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Background : Reperfusion injury influence prognosis in ST elevation myocardialinfarction STEMI patients after primary percutaneous coronary intervention PPCI . Previous study on animal models showed that ticagrelor may haveprotective effect on the heart by reducing reperfusion injury. However, no studyon humans has ever been done to confirm this.

Aim : To compare the effect of ticagrelor with clopidogrel on reperfusion injurycalculated by peak high sensitive troponin T hs cTnT in STEMI patients whounderwent revascularization.

Methods : This was a randomized controlled trial done in NationalCardiovascular Center Harapan Kita from August 2016 to November 2016.STEMI patients who underwent PPCI was randomized to either ticagrelor loadingdose 180 mg with maintenance of 2x90 mg or clopidogrel loading dose 600 mgwith maintenance of 1x75mg group. Peak hs Troponin T was measured 8 hoursafter first balloon dilatation.

Results : Sixty subjects was included in the study, 30 subjects in the ticagrelorgroup and 30 subjects in the clopidogrel group. There were no difference betweenticagrelor vs clopidogrel on peak hs cTnT levels 9026 5026 ng L vs 9329 4664 ng L, p value 0,809.

Conclusion : Ticagrelor does not cause a lower peak high sensitive troponin Tlevel compared to clopidogrel in STEMI patients who underwentrevascularization."

"ABSTRAKLatar Belakang. Sindrom Brugada diketahui menjadi penyebab dari setidaknya 4 dari seluruh kematian mendadak dan 20 dari kematian mendadak pada struktur jantung normal. Saat ini, hanya pola EKG Sindrom Brugada tipe 1 yang bersifat diagnostik sedangkan pola tipe 2 dan 3 tidak diagnostik. Sudut > 580 memiliki nilai diagnosis yang baik pada populasi dengan EKG pola Brugada tipe 2 dan 3. Penelitian ini bertujuan untuk mengetahui apakah parameter tersebut mempunyai hubungan dengan kejadian aritmia pada pasien Sindrom Brugada tipe 2 dan 3.Metode. Studi kasus kontrol ini dilakukan terhadap 29 subjek dengan EKG pola Brugada tipe 2 dan 3 di RS Pusat Jantung dan Pembuluh Darah Harapan Kita RSPJDHK dari periode November 2013 - 2017. Tiga belas subjek dengan riwayat kejadian aritmia menjadi kelompok kasus dan 16 subjek tanpa kejadian aritmia menjadi kelompok kontrol. Data primer yang diambil antara lain riwayat henti jantung mendadak, TV/FV yang terdokumentasi, riwayat sinkop dengan kecurigaan etiologi aritmia dan riwayat pada keluarga serta interogasi data defibrillator kardioverter implan DKI pada subjek yang terpasang DKI. Data sekunder berupa data EKG yang kemudian dilakukan pengukuran sudut pada sadapan prekordial kanan oleh 2 penilai lalu dilakukan analisis statistik.Hasil. Pengukuran sudut oleh 2 penilai tidak terdapat perbedaan bermakna dengan nilai Cronbach rsquo;s Alpha 0,93. Analisa statistik menunjukkan tidak didapatkan perbedaan proporsi yang bermakna antara sudut > 58o terhadap kejadian aritmia pada kedua kelompok kasus dan kontrol. Dilakukan analisis korelasi, terlihat korelasi positif antara sudut r=0,50, p 58o dengan kejadian aritmia pada Sindrom Brugada. Terlihat korelasi positif antara sudut dengan kejadian aritmia namun hal ini masih diperlukan studi lebih lanjut.Kata kunci : sudut , sindrom Brugada.

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ABSTRACTBrugada syndrome is known to be the cause of at least 4 of all sudden deaths and 20 of sudden deaths in structurally normal hearts. To this day, only type 1 Brugada Syndrome ECG pattern is diagnostic, while type 2 and 3 are not. A angle ge 58o has a good diagnostic value in population with Brugada ECG pattern type 2 and 3. This study aims to evaluate whether this parameter is associated with arrhythmic events in patients with Brugada Syndrome type 2 and 3.Methods. This case control study is carried out towards 29 subjects with Brugada ECG pattern type 2 and 3 in National Cardiovascular Center Harapan Kita NCCHK from November 2013 until November 2017. Thirteen subjects with history of arrhythmic events make up the case group while 16 subjects without arrhythmic events make up the control group. Primary data acquired was history of sudden cardiac arrest, documented VT VF, history of syncope suspected of arrhythmic origin and family history, and also interrogation data from implantable cardioverter defibrillator ICD in subjects with ICD. Secondary data were ECG data, from which angle was measured in the right precordial leads by two observers, and then statistical analysis was carried out.Results. From angle measurement by two observers, there was not a significant difference with Cronbach rsquo s Alpha of 0,93. Statistical analysis showed no significant association between a angle ge 58o and arrhythmic events. Correlation analysis was carried out, and a positive correlation was shown r 0,50, p"

"Latar Belakang : Infeksi COVID-19 telah diketahui masih dapat menyebabkan gejala sampai 90 hari dan bahkan lebih, meski infeksi akutnya telah berlalu. Hal ini disebabkan karena adanya fenomena sindroma pasca COVID-19. Mekanisme kejadian tersebut sampai saat ini masih belum diketahui pasti. Hal tersebut diduga kuat akibat adanya fibrosis di beberapa organ, terutama jantung dan paru. Sementara itu, beberapa studi telah menyebutkan bahwa sST2 merupakan penanda fibrosis jantung. Meskipun demikian, sampai saat ini belum ada penelitian yang mencoba mengetahui faktor-faktor apa saja yang memiliki hubungan dengan kejadian fibrosis pasca infeksi COVID-19. Kadar sST2 pada pasien komorbid kardiovaskular tanpa COVID-19 dan populasi orang sehat, khususnya di Indonesia juga belum diketahui.Tujuan : Mengetahui perbandingan kadar sST2 pada pasien komorbid kardiovaskular 12 minggu pasca infeksi COVID-19 dengan pasien komorbid kardiovaskular tanpa COVID-19 dan populasi orang sehat, serta hubungannya dengan faktor-faktor admisi.Metode : Penelitian ini merupakan studi observasional potong lintang. Kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19 dibandingkan dengan komorbid kardiovaskular akan dibandingkan dengan kelompok kontrol, yaitu kontrol 1 yang merupakan pasien komorbid kardiovaskular tanpa COVID-19 dan kontrol 2 yang merupakan populasi orang sehat. Kelompok kontrol dipilih menggunakan metode matching. Hubungan faktor klinis dan laboratoris saat dengan kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19 dianalisis menggunakan analisis multivariat.Hasil : Terdapat 162 subjek yang menyelesaikan rangkaian penelitian yang terdiri atas 100 subjek dengan penyintas COVID-19 disertai komorbiditas kardiovaskular (kelompok kasus), 31 subjek dengan komorbiditas kardiovaskular tanpa COVID-19 (kelompok kontrol 1), dan 31 subjek sehat tanpa riwayat COVID-19 dan komorbiditas kardiovaskular (kelompok kontrol 2). Ketiga kelompok memiliki karakteristik yang sama. Terdapat perbedaan signifikan rerata nilai sST2 antara kelompok kasus dibandingkan kontrol 1 dan kontrol 2 (2786 ± 73 vs 2666 ± 162 pg/l, p <0.001 dan 2786 ± 73 vs 2517.15 ± 321 pg/l, p < 0.001), serta kontrol 1 dibandingkan kontrol 2 (2666 ± 162 pg/l vs 2517.15 ± 321 pg/l, p < 0.001). Analisis multivariat menunjukkan PaO2 (p < 0.001) dan nilai CT (p = 0.04) memiliki hubungan dengan kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19.Kesimpulan : Terdapat perbedaan signifikan antara kadar sST2 sebagai penanda fibrosis jantung pada ketiga kelompok subjek penelitian, dengan kadar sST2 lebih tinggi pada subjek dengan penyintas COVID-19 disertai komorbiditas kardiovaskular. Terdapat hubungan PaO2 dan nilai CT saat admisi dengan kadar sST2.

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Background : Recent findings showed that symptoms associated with COVID-19 infection may persist up to 90 days even after the acute disease period has passed. This condition is now termed as post COVID-19 syndrome. Several pathophysiologic mechanisms of this event had been proposed, all of which still needed further elaboration. One of the proposed mechanisms involves fibrotic processes in several organs, especially heart and the lungs. SST2 has been suggested as a novel biomarker for cardiac fibrosis. However data are still needed to further elucidate the factors which are associated with the incidence of fibrosis post COVID-19 infection. Furthermore, data regarding sST2 levels in patients with cardiovascular comorbidities and in healthy subjects are still limited.

Objective : Knowing the differences on sST2 levels between subjects with cardiovascular comorbidities 12 weeks post COVID-19 infection, those without history of COVID-19 but with cardiovascular comorbidities, and healthy population, as well as knowing its relationship with admission factors.

Methods : This study is a cross-sectional observational study on patients 3 months after COVID-19 infection presented with cardiovascular comorbidities. Age and sex-matched control groups were used as comparison. The results were compared with a group without history of COVID-19 and healthy populations. Relationship between admission factors was assessed using multivariate analysis

Results : 162 subjects completed the study series, consisting of 100 subjects with COVID-19 survivors with cardiovascular comorbidities (case group), 31 subjects with cardiovascular comorbidities without COVID-19 (control group 1), and 31 healthy subjects without a history of COVID-19 and cardiovascular comorbidities (control group 2). All three groups had similar characteristics. There was a significant difference in the mean sST2 value between the case groups compared to control 1 and control 2 (2786 ± 73 vs 2666 ± 162 pg/l, p < 0.001 and 2786 ± 73 vs 2517.15 ± 321 pg/l, p < 0.001 respectively), and control 1 compared to control 2 (2666 ± 162 pg/l vs 2517.15 ± 321 pg/l, p < 0.001). Multivariate analysis revealed PaO2 (p < 0.001 and CT values (p = 0.04) as admission factor associated with increased sST2 3 months after initial COVID-19 infection.

Conclusion : SST2 levels were found to be significantly different between the three groups, with the highest level on the case group (subjects with history of COVID-19 and cardiovascular comorbidities). Factors upon admissions which include Arterial oxygen partial pressure (PaO2) (p < 0.001) and CT value (p = 0.04) were found to be associated with increased sST2 levels."

"ABSTRAKLatar Belakang : Pada era sebelum tindakan reperfusi, kadar fibrinogen merupakan faktorindependen terhadap mortalitas pada pasien-pasien dengan infark miokard akut dengan elevasisegmen-ST (IMA-EST) dibandingkan dengan kadar fibrinogen yang normal. Dan kemudian erareperfusi dikatakan obstruksi mikrovaskular merupakan salah satu faktor menyebabkan kejadianmayor kardiovaskular. Dengan kemajuan teknologi dibidang kardiologi kejadian dan besaranMVO dapat di ketahui secara akurat dan pada fase akut. Dari studi terbaru dikatakan bahwaindeks resistensi mikrovaskular memiliki hubungan positif terhadap MVO dibandingkan denganmagnetic resonance imaging. Dan diduga faktor hemostasis terutama kadar fibrinogen didugamemiliki peran yang penting terhadap kejadian obstruksi mikrovaskuler melalui mekanismehiperkoagulasi dan embolisasi distal.Metode: Sebanyak 55 subjek IMA–EST yang menjalani IKPP dipilih secara konsekutif yangmemenuhi kriteria inklusi dan ekslusi sejak 15 Oktober 2013 – 31 Maret 2014. Fibrinogendiambil saat masuk UGD, penilaian indeks resisten mikrosirkulasi (IMR) diambil segera pascaIKPP. Perhitungan statistik menggunakan SPSS 17.Hasil: Dari lima puluh lima pasien yang masuk dalam penelitian didapatkan proporsi laki-laki87,3%, dengan rerata umur pasien adalah 53,1+8,9 tahun. Faktor risiko penyakit jantung koroneryang paling besar adalah merokok yaitu 76,36. Semua pasien menjalani IKPP dengan waktuperfusi 89.04+37.114 menit dan waktu Iskemia 458,69+170,709. Nilai rerata IMR 55,2 + 47,454dengan nilai rerata fibrinogen 350,80+103,190. Melalui diagram scattered plot didapatkan kadarfibrinogen memilliki kecenderungan yang terbalik terhadap IMR, dengan kekuatan hubunganyang lemah dan secara statistik tidak bermakna. ( r = - 0,137 ; p = 0,319 ).Kesimpulan: Kadar fibrinogen saat admisi tidak memiliki hubungan terhadap IMR pada pasienpasien IMA-EST yang menjalani IKPP.

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ABSTRAK Background: In no coronary reperfusion era, fibrinogen is known as an indepndent risk factorfor cardiac mortality in acute myocard infract patient. And in revascularization era,microvascular obstruction (MVO) is associated with adverse ventricular remodelling and patientprognosis. With the advanced technology in cardiology, MVO can be detected accurately in theacute phase. In recent study index microcirculatory resistance (IMR) show a positive correlationwith magnetic resonance imaging while detecting and counting severity of MVO. It is suspectedthat hemostatic factor mainly fibrinogen play an important role in MVO due to hypercoagulablestate and distal embolization.Methode: 55 STEMI patients undergoing primary PCI were consecutively recruited fromOctober 15th, 2013 to march 31th, 2014. The fibrinogen was withdraw at admission. We evaluatethe IMR immediately after PCI done. Statistical analysis was done by SPSS 17.Results: From fifty-five patients included in the study, there were 87,3% men, with mean age53,1±8.9 years old, and smoker show the biggest proportion compare with risk factor forcoronary artery disease. All the patient undergo primary percutaneus coronary intervention withmean door to ballon time 89.04+37.114 minute and ischemia time 458,69+170,709 minute.Mean IMR was 55,2 + 47,454 and mean fibrinogen level was 350,8+103,19. From the scaterredplot fibrinogen prone to had a weak negatif correlation with IMR and statistically non significant(r = - 0,137 ; p = 0,319)Conclusion: There is no correlation between fibrinogen level and IMR value in STEMI patientsthat undergoing PPCI"

"[ABSTRAKLatar belakang. Abnormalitas fungsi vena terkait inflamasi dan hipertensi vena merupakan dasar patofisiologi insufisiensi vena kronik. Pembuktian hubungan faktor inflamasi lokal pada jaringan vena dengan fungsional vena menjadi penting ketika vena yang diteliti akan menjadi konduit vena pada Bedah Pintas Arteri Koroner (BPAK) dan evaluasi patensinya berpengaruh pada mortalitas dan morbiditas pasien Penyakit Jantung Koroner (PJK).Metode. Penelitian ini merupakan studi potong lintang dari 35 sampel jaringan vena saphena magna pasien PJK yang diambil untuk konduit vena pada BPAK dan telah diperiksa IVK menggunakan Duplex Ultrasound (DUS) dengan parameter time refluks, periode bulan September sampai November 2014 di Pusat Jantung Nasional Harapan Kita. Untuk analisa hitung jumlah leukosit dilakukan pewarnaan Hematoxyllin eosin pada jaringan vena oleh ahli patologi anatomi. Analisis statistik dilakukan untuk mencari hubungan antara hitung jumlah leukosit jaringan vena dengan time refluks vena saphena magna.Hasil. Analisa statistik dengan Chi square didapatkan perbedaan bermakna peningkatan jumlah leukosit jaringan vena pada pasien insufisiensi vena kronik dibandingkan normal (52,63 % vs 18,755) dengan nilai P 0,039. Analisa lebih lanjut dengan rasio odd, dimana pasien dengan peningkatan jumlah leukosit jaringan vena memiliki 4 kali lipat kemungkinan menderita insufisiensi vena kronik (Crude OR 4,81; CI 95% 1.02 - 22.57; P value 0.046), dan setelah dianalisa menggunakan variabel perancu usia, jenis kelamin, Diabetes mellitus, Hipertensi, Perokok, Dislipidemia, adjusted OR bertambah menjadi 6 kali lipat (Adjusted OR 6,66; CI 95% 1.16 - 38.31; P value 0.033)Kesimpulan. Terdapat hubungan antara nilai inflamasi lokal dengan parameter hitung jumlah lekosit jaringan vena dengan fungsi vena pada pasien insufisiensi vena kronik dengan parameter time refluks yang diperiksa dengan DUS.

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ABSTRACTBackground: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients.;Background: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients., Background: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients.]"

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

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

"[ABSTRAKLatar belakang. Patogenesis dari pre-diabetes terhadap vascular sudah terjadi sejak awal sebelum ada manifestasi klinis sehingga sudah seharusnya ditatalaksana sejak awal untuk mencegah komplikasi lanjut. Metformin sebagai terapi antihiperglikemik oral memiliki efek pleiotropik yang dapat memperbaiki disfungsi endotel pada keadaan resistensi insulin. Metode. Penelitian ini merupakan suatu studi longitudinal observasi-intervensi non randomisasi. Observasi dilakukan pada 62 pasien hipertensi dan IGT di Pusat Jantung Nasional Harapan Kita dari bulan Agustus 2014 hingga bulan Januari 2015. Pasien dibagi menjadi tiga kelompok yaitu plasebo (n=18 orang), kelompok metformin 1x500 mg (n=21 orang) dan kelompok metformin 2x500 mg (n=23 orang). Pemeriksaan FMD diambil dua kali (0 dan 3 bulan). Dilakukan analisis statistik untuk menilai efek pemberian Metformin yang dinilai dengan delta FMD dan melihat perbandingan efektifitas dosis 1x500 mg dibandingkan dengan dosis 2x500 mg.Hasil. Tidak terdapat perbedaan bermakna pada data dasar ketiga kelompok dalam hal umur, jenis kelamin dan terapi hipertensi yang diberikan. Nilai delta FMD menunjukkan peningkatan yang signifikan pada kelompok Metformin 2x500 mg (p <0,001). Analisa regresi linear (adjusted analysis; sesuai usia, jenis kelamin, riwayat merokok dan BMI) menunjukkan koefisiensi 0,89 dengan nilai p 0,394 pada kelompok metformin 1x500 mg dan koefisien 7,88 dengan nilai p <0,001 pada kelompok metformin 2x500 mg.Kesimpulan. Pemberian Metformin 2x500 mg pada subjek pre-diabetes dengan hipertensi dapat memperbaiki fungsi endothel pembuluh darah yang ditandai dengan perbaikan nilai FMD setelah 3 bulan.

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ABSTRACTBackground : The vascular effect of insulin resistance had been known to cause serious damage on endothelial function, especially nitric oxide (NO) system, that may cause an earlier onset of cardiovascular disease.Objective : To explore the pleiotropic effect of Metformin on improving endothelial function.Method and Results : A quasi experimental study of 62 hypertensive and pre-diabetic (IGT) patients showed a significant improvement of Flow Mediated Dilatation (FMD) within 3 months in those who received added theraphy of Metformin 500 mg twice daily (n=23) on their routine anti-hypertensive drugs (p<0,001). It also showed a moderate correlation between improvement of FMD that reflects the endothelial function with good achivement of targeted blood pressure (R 0,421). Linear regression analysis (adjusted analysis to confounder factors such as age, sex, BMI, history of smoking, aspilet added therapy, anti-hypertensive drugs) showed Metformin as the only factor that influenced the improvement FMD (OR 7,88; p<0,001).Conclusion : This study showed that Metformin 2x500 mg as an add-on therapy in hypertensive pre-diabetic subject plays a positive role in improving the endothelial function as seen on the FMD measurement, Background : The vascular effect of insulin resistance had been known to cause serious damage on endothelial function, especially nitric oxide (NO) system, that may cause an earlier onset of cardiovascular disease.Objective : To explore the pleiotropic effect of Metformin on improving endothelial function.Method and Results : A quasi experimental study of 62 hypertensive and pre-diabetic (IGT) patients showed a significant improvement of Flow Mediated Dilatation (FMD) within 3 months in those who received added theraphy of Metformin 500 mg twice daily (n=23) on their routine anti-hypertensive drugs (p<0,001). It also showed a moderate correlation between improvement of FMD that reflects the endothelial function with good achivement of targeted blood pressure (R 0,421). Linear regression analysis (adjusted analysis to confounder factors such as age, sex, BMI, history of smoking, aspilet added therapy, anti-hypertensive drugs) showed Metformin as the only factor that influenced the improvement FMD (OR 7,88; p<0,001).Conclusion : This study showed that Metformin 2x500 mg as an add-on therapy in hypertensive pre-diabetic subject plays a positive role in improving the endothelial function as seen on the FMD measurement]"