Trisulo Wasyanto

Background and Aims Echocardiographic pulmonary to left atrial ratio (ePLAR) is a new echocardiographic valuable parameter for distinguishing precapillary and postcapillary PH. This study aims to determine the association between ePLAR and PVR in patients with ACHD. Methods and Results A total of 42 patients with ACHD who underwent RHC at Dr Moewardi General Hospital between May 2019 to February 2021 were included in this retrospective observational study. Transthoracic echocardiography and RHC were performed in all patients. The ePLAR then compared between the patient with PVR <5 WU and PVR >5 WU. There were 15 patients (median age 37.00 (24.00 - 64.00) in PVR <5WU group and 10 patients (median age 29.00 (24.00 – 49.00) in PVR >5 WU group. Mean ePLAR in PVR <5 WU group was 0.28 ±0.13 and 0.52 ±0.23 in patients with PVR >5 WU group. Statistical analysis has shown significant difference of ePLAR between the PVR <5 WU group and the PVR >5 WU group, p < 0.003...

Background and Aims Growth Differentiation Factor-15 (GDF-15) is a systemic inflammation marker that has emerged as a biomarker that capable to predicting cardiovascular events. Recent studies suggest that GDF-15 is elevated in patients with acute myocardial infarction, but the prognostic remains incompletely defined. This study aimed to investigate the difference between high and low GDF-15 levels with major cardiac adverse events (MACE) in patients with acute myocardial infarction. Methods and Results This cohort study was conducted with total of 64 acute myocardial infarction patients. GDF-15 was measured at admission and clinical data and 3 months follow up events was registered. MACE at hospitalization occurred in 43.75% of patients, whereas MACE at three months of observation occurred in 18.6% of patients. After adjustment multivariate analysis, higher levels of GDF-15 was independently associated with risk of MACE at 3 months follow up (OR 1.501; p = 0.003). The cut-off point...

Background and aims In patients with acute myocardial infarction (AMI), global longitudinal strain (GLS) is a more sensitive marker than left ventricular ejection fraction (LVEF) in assessing left ventricular function, and the prognostic impact of marker of platelet distribution width (PDW) has also been reported in this setting. The aim of this study was to investigate the relationship between PDW and GLS in patients with AMI. Methods and results A total of 38 patients with AMI (31 males and 7 females), both with ST segment elevation (STEMI) and non ST segment elevation (NSTEMI) were included. Blood samples were drawn at presentation and echocardiography was performed within 24 hours of presentation. Median PDW levels was 16.0%, and median GLS was -9.9%. A positive correlation was found between PDW levels and GLS (r = 0.339, p = 0.037). Conclusion Among patients with AMI, elevated PDW levels were associated with poor left ventricular function. This finding suggests that determining...

Background The concept of 2:1 AV block remains poorly understood by many physicians even after so many years of advancement in the field of electrophysiology. It cannot be classified into type I or type II second-degree AV block because there is only one PR interval to examine before the blocked P wave. Case Illustration Case 1  . A 78-year-old male with asymptomatic bradycardia was referred to our hospital. Resting ECG revealed 2:1 conduction AV block. In order to define the site of block we performed the atropine challenge test, revealed improvement of AV block to Mobitz I and then 1st degree AV block, suggesting the suprahissian block. Case 2. A 74-year-old male with inferoposterior and right ventricular STEMI was referred to our hospital. His resting ECG revealed 2:1 conduction of P wave. The atropine challenge test revealed improvement of block to 1st degree AV block, suggesting the suprahissian block. Discussion It is often difficult to distinguish intranodal and infranodal bl...

Background: Myeloperoxidase (MPO) levels have been shown to have prognostic values for death events in acute myocardial infarction (AMI) patients. Increased levels of high sensitive troponin I (hs Trop I) are associated with poorer prognosis in AMI patients. This study aimed to determine the association between levels of MPO and hs troponin I at admisson on myocardial contractility in AMI patients. Subjects and Method: This was a prospective observational analytic study, conducted at Dr. Moewardi General Hospital, Surakarta, from November1, 2018 to January 31, 2019. The study subjects were patients who were diagnosed with AMI. A total of 23 patients were included in this study; 15 patients with ST elevation myocardial infarction (STEMI) and 8 with non ST elevation myocardial infarction (NSTEMI). The dependent variable was myocardial contractility. The inde­pendent variables were MPO and hs Trop I. Blood tests for MPO and hs Trop I was measured at admission and the left ventricular e...

Background: Copeptin has been considered as a potential biomarker for AMI which also give information regarding the prognostic of the Acute myocardial infarction (AMI). The aim of this study is to understand the role of copeptin as a predictor of major adverse cardio­vascular events (MACE) during hospitalization in AMI patients. Subjects and Method: This was a cohort analytical study conducted at Dr. Moewardi Hospital, Surakarta, from March to May 2021. The dependent variable was MACE. The inde­pendent variable was the copeptin level. We observe the MACE during hospitalization and analyze the cut-off point value for optimal copeptin levels to predict the occurrence of MACE using the receiver operating characteris­tic (ROC) curve. Linear multiple regression was conducted to predict determinants of MACE in hospitalization patients. Results: 52 patients recruited in this research (44 males, 8 females). During hospitalization, MACE occurred in 52% of these subjects, with the respective ...

Background: Pre-diabetes is a golden period to prevent and delay the development of diabetes. In coronary heart disease, there are more patients with impaired glucose tolerance than the patients without impaired glucose tolerance, so screening is needed in patients who have risk factors for cardiovascular disease. Assessment of insulin resistance is a "fundamental goal" that has a large value of prevention. Triglyceride Glucose (TyG) index is a surrogate marker of insulin resistance that can be applied to the community as a practical and efficient screening method. Aim: The purpose of this study was to assess TyG index for the severity of coronary arteries as assessed by SYNTAX score I in ACS patients. Methods: This study was an analytic cross-sectional study with a sample of 36 ACS patients who underwent coronary angiography (CAG) examinations in the catheterization laboratory of General Hospital Dr. Moewardi. The mean value of coronary artery severity was assessed using ...

Background: Pentraxin-3 (PTX3) was a useful marker for localized vascular inflammation and damage in the cardiovascular system. Recent studies have shown that plasma PTX3 is elevated in patients with myocardial infarction; however, its prognostic value still remains unclear. Aims: This study aimed to investigate the relationship between PTX3 and in-hospital and three months of a major adverse cardiac event (MACE) in acute ST-elevation and non-ST-elevation myocardial infarction patients. Methods: This cohort study conducted from September 1st, 2018 to October 31st, 2019 in Dr. Moewardi Hospital. A 144 patient were observed during hospitalization and 130 survived patient were follow up for three months. The admission PTX3 was compared between the patient with and without MACE. Higher levels of PTX3 were defined as concentrations greater than the optimal cut-off value derived from the Receiver Operating Characteristic (ROC) curve. Results: Among patients, 43.75% was anterior STEMI, 35....

Latar belakang: Sepsis merupakan masalah kesehatan karena angka kesakitan dan kematiannya yang tinggi. Pelepasan sitokin pro inflamasi bersama faktor lain akan mengakibatkan disfungsi sistolik ventrikel kiri/DSVK jantung. Pada sepsis terjadi pelepasan MR pro ANP, PCT dan TNF-α karena stimuli sitokin pro inflamasi. Tujuan penelitian: Membuktikan MR pro ANP sebagai biomarker DSVK pada sepsis; mencari nilai AUC, sensitivitas, spesifisitas, cut off point dan probabilitas MR pro ANP, PCT dan TNF-α sebagai biomarker DSVK dan membuktikan adanya korelasi kadar TNF-α dengan MR pro-ANP serta adanya korelasi kadar MR pro ANP dengan PCT dan mencari prediktor diagnostik DSVK jantung yang terbaik. Metoda penelitian: Uji diagnostik non eksperimental dengan desain cross sectional, dilakukan pada 71 pasien sepsis setelah simple random sampling. Variabel yang diteliti MR pro ANP, PCT dan TNF-α serta LVEF dengan metoda Simpson. DSVK bila LVEF ≤ 45%. Data di lakukan analisis tabel 2x2 dan kurva ROC sec...

Background— Myocardial infarct size is a major determinant of left ventricular (LV) remodeling after ST-segment–elevation myocardial infarction. We evaluated whether LV global longitudinal strain (GLS), proposed as a novel marker of infarct size, is associated with 3- and 6-month LV dilatation after ST-segment–elevation myocardial infarction. Methods and Results— In the first ST-segment–elevation myocardial infarction patients treated with primary percutaneous coronary intervention, baseline LVGLS was measured with 2-dimensional speckle-tracking echocardiography. Patients were dichotomized according to median value. The independent relationship between GLS groups and LV end-diastolic volume at 3 and 6 months (adjusted for clinical and echocardiographic variables) was assessed. The final study population comprised 1041 patients (60±12 years; 76% men). Median LVGLS was −15.0%. Patients with baseline LVGLS >−15.0% exhibited greater LV dilatation at 3 and 6 months compared with patie...

Background: Type 2 Diabetes Mellitus (T2DM) represents one of the most important risk factors for atrial fibrillation (AF). Numerous studies have shown that T2DM and poor glycemic control reflected by glycated hemoglobin A1c (HbA1c) levels are independently associated with new onset AF. Recent experimental studies reported that the increased susceptibility to AF in the diabetic patients was presumably due to the slowing of conduction associated with increased interstitial fibrosis. Systemic inflammation cam play role in the development of atrial fibrillation. High-sensitivity C-reactive protein (hsCRP) is an inflammatory biomarker that independently predicts the cardiovascular risk. This study aimed to determine the association between hsCRP level and glycemic control with total interatrial conduction time in T2DM patients.Subjects and Methods: This was an analytic study with cross-sectional design. A total of samples were 41 patients with T2DM. Peripheral venous blood samples to mea...

Atherothrombosis is the leading cause of cardiovascular morbidity and mortality around the globe. To date, no single international database has characterized the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis. To determine whether atherosclerosis risk factor prevalence and treatment would demonstrate comparable patterns in many countries around the world. The Reduction of Atherothrombosis for Continued Health (REACH) Registry collected data on atherosclerosis risk factors and treatment. A total of 67,888 patients aged 45 years or older from 5473 physician practices in 44 countries had either established arterial disease (coronary artery disease [CAD], n = 40,258; cerebrovascular disease, n = 18,843; peripheral arterial disease, n = 8273) or 3 or more risk factors for atherothrombosis (n = 12,389) between 2003 and 2004. Baseline prevalence of atherosclerosis risk factors, medication use, and degree of risk factor control. Atherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8%), hypercholesterolemia (72.4%), and diabetes (44.3%). The prevalence of overweight (39.8%), obesity (26.6%), and morbid obesity (3.6%) were similar in most geographic locales, but was highest in North America (overweight: 37.1%, obese: 36.5%, and morbidly obese: 5.8%; P<.001 vs other regions). Patients were generally undertreated with statins (69.4% overall; range: 56.4% for cerebrovascular disease to 76.2% for CAD), antiplatelet agents (78.6% overall; range: 53.9% for > or =3 risk factors to 85.6% for CAD), and other evidence-based risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4%). Undertreated hypertension (50.0% with elevated blood pressure at baseline), undiagnosed hyperglycemia (4.9%), and impaired fasting glucose (36.5% in those not known to be diabetic) were common. Among those with symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease. This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely…

EFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL  INFARCTION  PATIENTS RECEIVING FIBRINOLYTIC THERAPY   Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia   Background: Worldwide, coronary heart disease (CHD) is a leading cause of death. Inflammation in CHD and acute myocardial infarction (AMI) is a trigger due to the formation of atheroma plaques in the coronary arteries. N-Acetylcysteine ​​(NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. Objective: To determine the effect of NAC on hsCRP levels in patients with acute myocardial infarction who received fibrinolytic therapy. Methods: This study was an experimental study with pre and post, single blind and randomization methods on the effect of NAC on hsCRP levels compared to controls carried out in July - August 201...

Background: High neutrophil to lymphocyte ratio (NLR) is independently associated with lower EF, in hospital complications, and higher mortality rates in acute myocardial infarction (AMI). Global longitudinal strain (GLS) measurement after AMI demonstrated specific benefit compared with LVEF in evaluation of the extent of post MI left ventricular myocardial injury. The aim of this study was to determine the association between NLR and left ventricular GLS in AMI patients.Methods: An analytic observational study was conducted on August-December 2017 to patients who admited to Dr. Moewardi General Hospital which diagnosed STEMI or NSTEMI. Blood examination and transthoracic echocardiography were performed. They were divided into two groups according to GLS measurement result, GLS>-13.8% and GLS≤-13.8%. The cut-off value of NLR to predict GLS>-13.8%was determined by ROC curve analysis. Bivariate and multivariate analysis to assess whether high NLR was associated with GLS>-13.8...

In the present study, we investigated the prognostic value of MR-proANP (mid-regional pro-atrial natriuretic peptide). We consecutively evaluated a catheterization laboratory cohort of 2700 patients with symptomatic CAD (coronary artery disease) [74.1% male; ACS (acute coronary syndrome), n=1316; SAP (stable angina pectoris), n=1384] presenting to the Cardiology Department of a large primary care hospital, all of whom underwent coronary angiography. Serum MR-proANP and other laboratory markers were sampled at the time of presentation or in the catheterization laboratory. Clinical outcome was assessed by hospital chart analysis and telephone interviews. The primary end point was all-cause death at 3 months after enrolment. Follow-up data were complete in 2621 patients (97.1%). Using ROC (receiver operating characteristic) curves, the AUC (area under the curve) of 0.73 [95% CI (confidence interval), 0.67–0.79] for MR-proANP was significantly higher compared with 0.58 (95% CI, 0.55–0.6...