Pengaruh Teh Hijau Terhadap Fungsi Endotel Dinilai dari Flow Mediated Dilatation pada Pasien Penyakit Jantung Koroner

Background. Endothelial dysfunction begins when atherosclerosis developed as what go through on hypertension, diabetes, hyper-homocysteinemia, and also what go through among smoker who hasn’t have CAD until end phase of atherosclerosis. Impairment of endothelial function depends on vasodilatation due to the decreasing of eNOS activity. Green tea has been proved to have positive effect in reversing endothelial dysfunction among healthy smoker. This study aim to prove that the short term green tea consumption improved flow mediated dilatation among coronary artery disease patients, thus reversed endothelial dysfunction. Methods and results.Twenty three coronary artery disease patients which had been confirmed by coronary angiography joined the study. The sample was divided into two groups, first was the group who took green tea, and the second was the group who took placebo (mineral water). Before treatment, the FMD of both two groups were measured and one hour and half after treatment. After 3-7 days of treatment, both groups were crossover. FMD among healthy group of age less than 25 years old was also measured as control group. There was no significant differences in baseline characteristic between the first and the second group (both received green tea but in different time). FMD after treatment was increased among group who took green tea (4.80±5.37 vs 8.68±6.00, p=0.026), while FMD among placebo group was decreased (5.87±3.89 vs 3.34±3.66 p=0.026). There was significant differences of FMD after treatment with green tea and after treatment with placebo (8.68±6.00 vs 3.35±3.66 p = 0.002). There was no differences of brachial artery diameter in both groups (4.60±0.36 vs 4.57±0.41, p=0.8 and 4.57±0.41 vs 4.61±0.36, p=0.601). There was no significant differences on systolic and diastolic blood pressure as well as heart rate in both groups. Conclusions. Green tea had positive effect in reversing endothelial dysfunction among coronary artery disease patient by assessing flow mediated dilatation in short time. The group who took placebo showed the paradoxical effect.Latar Belakang.Disfungsi endotel terjadi sejak fase awal dari aterosklerosis yaitu pada pasien-pasien hipertensi, diabetes, hiperhomosisteinemia, perokok maupun pada fase lanjut dari aterosklerosis. Disfungsi endotel terjadi karena gangguan respons dilatasi, akibat penurunan aktifitas eNOS. Teh hijau terbukti mampu memperbaiki disfungsi endotel dinilai dari perbaikan aliran darah lengan pada perokok sehat yang belum mengalami PJK. Penelitian ini bertujuan untuk membuktikan bahwa pemberian teh hijau sekali asupan, dapat memperbaiki flow mediated dilatation (FMD) pada pasien-pasien penyakit jantung koroner, yang berarti ada perbaikan disfungsi endotel.Metode dan hasil.Penelitian dilakukan pada 23 pasien yang terbukti penyakit jantung koroner dari hasil kateterisasi, baik yang sudah menjalani revaskularisasi maupun yang belum. Sampel dibagi menjadi dua kelompok, kelompok pertama mendapatkan teh hijau dahulu, setelah sebelumnya diperiksa FMD dasar, kemudian FMD diukur satu setengah jam pasca pemberian teh; kelompok kedua mendapatkan placebo (air putih) dahulu. Kemudian dilakukan crossover setelah 3-7 hari periode washout,kelompok pertama ganti mendapatkan placebo dengan diperiksa FMD sebelum dan sesudah perlakuan, dan kelompok kedua mendapatkan teh hijau. Dilakukan pemeriksaan FMD pada orang-orang yang sehat usia kurang dari 25 tahun sebagai kontrol populasi sehat. Tidak ada perbedaan bermakna pada karakteristik dasar antara kelompok yang mendapatkan teh hijau dahulu dibandingkan yang mendapatkan placebo dahulu. FMD dasar sebelum mendapat teh 4,80±5,37 berbeda bermakna dibandingkan kontrol sehat 9,15±3,65 (p=0,047), tetapi FMD dasar sebelum mendapatkan air 5,87±3,89 tidak berbeda bermakna dibandingkan FMD dasar sebelum mendapat teh hijau (p=0,398) maupun kelompok kontrol sehat (p=0,082). FMD pasca mendapat teh meningkat bermakna dibanding sebelum mendapat teh (4,80±5,37 vs 8,68±6,00; p=0.026). Sedangkan kelompok placebo menunjukan penurunan FMD bila dibandingkan pre dan pasca perlakuan (5,87±3,89 vs 3,34±3,66 p=0,026). FMD pasca teh hijau berbeda bermakna bila dibandingkan pasca placebo (8,68±6,00 vs 3,35±3,66 p=0,002). Tidak ada perubahan diameter arteri brachialis kelompok teh hijau maupun placebo (4,60±0,36 vs 4,57±0,41 ; p=0,800 dan 4,57±0,41 vs 4,61±0,36 p=0,601). Demikian hanya tekanan darah sistolik, diastolik maupun frekuensi nadi pada kedua kelompok, tidak memperlihatkan perubahan yang bermakna.Kesimpulan.Teh hijau mampu memperbaiki fungsi endotel dinilai dari perbaikan flow mediated dilatationjangka pendek pada pasien-pasien penyakit jantung koroner, efek yang berlawanan justru diperlihatkan pada pemberian air putih

Ablasi Radiofrekuensi pada Kepak Atrium Tipikal Setelah Pemasangan Amplatzer Septal Occluder : Suatu Laporan Kasus

We report a case of a 48-year old female with secundum atrial septal defect (ASD), already undergone device closure with an Amplatzar Septal Occluder (ASO). The patient subsequently underwent radiofrequency catheter ablation for typical atrial flutter, three months after ASD closure with good results. During follow up the patient remained in sinus rhythm and the complaints of dyspnoe and palpitation subsided.Seorang pasien wanita berusia 48 tahun dengan Defek Septum Atrium (DSA) sekundum yang telah menjalani penutupan DSA menggunakan Amplatzer Septal Occluder(ASO) datang dengan kepak atrium tipikal. Tindakan ablasi kateter menggunakan radiofrekuensi kemudian dilakukan pada pasien ini tiga bulan setelah penutupan DSA. Selama pengamatan lebih lanjut keluhan sesak nafas dan berdebar menghilang, dan pemantauan terhadap irama pasien menunjukkan irama sinus yang menetap

Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry

Objective: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. Design: Retrospective cohort study. Setting: Emergency department of 56 health centres. Participants: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure: Characteristics of reperfusion therapy. Results: The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than nonreperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of nonreperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intraaortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to doorout (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions: In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres. Trial registration number: NCT02319473

Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry

OBJECTIVE: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. DESIGN: Retrospective cohort study. SETTING: Emergency department of 56 health centres. PARTICIPANTS: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. MAIN OUTCOME MEASURE: Characteristics of reperfusion therapy. RESULTS: The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). CONCLUSIONS: In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres. TRIAL REGISTRATION NUMBER: NCT02319473