Clinical Effectiveness, Safety and Tolerability of Amlodipine/Valsartan in Hypertensive Patients: the Indonesian Subset of the EXCITE Study

Aim: to assess the effectiveness, safety and tolerability of amlodipine/valsartan (Aml/Val) single-pill combination (SPC) in hypertensive patients in a real-world setting. Methods: the Indonesian subset of the EXCITE (clinical EXperience of amlodIpine and valsarTan in hypErtension) study, which was a multinational, prospective, observational, open study in hypertensive patients treated with Aml/Val SPC for 26 weeks. Aml/Val SPCs (5/80, 5/160, 10/160 mg) were administered as monotherapy or as add-on therapy to other antihypertensive medications in patients not controlled by prior monotherapy. The effectiveness outcomes were (1) mean decrease in sitting systolic blood pressure and diastolic blood pressure (msSBP and msDBP) from baseline to week 26; (2) proportion of patients achieving BP goal (20/10 mmHg). The safety variables were the incidence of AEs and SAEs, and the incidence of edema. Results: a total of 500 patients from Indonesia received Aml/Val SPC, 487 patients were analyzed for efficacy (by LOCF), and 464 patients completed the study. At study end (week 26), the overall msSBP and msDBP(95% CI) reductions from baseline were -33.7(-35.2, -32.1) mmHg and -14.8 (-15.7, -13.8) mmHg, respectively. Among the 487 patients, 52.4% achieved BP goal and 80.5% were responders (LOCF). Among 464 patients who completed the study, 53.7% achieved BP goal and 84.5% were responders. Aml/Val SPC was effective in decreasing BP in Indonesian patients. AEs, including SAEs, were reported in 11.4% patients, with SAEs in 1% of patients, and death in 0.8% of patients. SAEs and deaths were considered unrelated to the study drug. Edema was reported by 9.4% of patients atbaseline, and in 3.7% patients at end of study. Effectiveness, tolerability and compliance were rated good and very good in 90.8%, 92.2%, and 89.2% of patients, respectively, according to the investigators. Conclusion: Aml/Val SPC was effective for BP reductions and well tolerated in hypertensive patients, not adequately controlled by monotherapy, in a daily clinical setting in Indonesia.Key words: Aml/Val, single-pill combination, daily clinical, EXCITE study

Quality of Life Evaluation After Coronary Artery Bypass Graft Surgery in Patient who Underwent Phase III Rehabilitation Program

Background. Coronary artery bypass graft surgery (CABG) is one of the management for coronary artery disease. Cardiovascular rehabilitation usually conducted for recovery and improved quality of life. Questionnaire was used to evaluate quality of life. One of the quality of life instrument most commonly used is Questionnaire SF-36. So far there isnt any study to evaluate quality of life in patients post CABG who wish to follow rehabilitation program phase III in Indonesia. Methods and results.This is a cross sectional study conducted in the National Cardiovascular Centre (NCC) - Rehabilitation Division to patients post CABG in phase III rehabilitation program during 2004-2005. Subject was taken in consecutive sampling manner. Questionnaire SF-36 was handed directly or via mail. Validity and reliability test was done for the questionnaire form in Indonesia language. There were 112 patients, 34 patients did rehabilitation program in hospital and 78 were home-based. The characteristics between two groups were similar. Validity test using r product moment from Pearson to every questions in SF-36 showed r = 0,53-0.83 > 0,51 (r table) and Cronbach a= 0,855. SF-36 scoring was not significantly different among the two groups (in hospital rehab vs home-based rehab) and also control group (healthy). Conclusions. There were no difference in quality of life and aerobic ca-pacity in patients who performed rehabilitation program phase III in hospi-tal and home-based

Correlation between NT-proBNP plasma levels with mitral annular Tissue Doppler Velocities in Heart Failure patients

Background.N-terminal pro brain natriuretic peptide (NT-proBNP) will release from myocite granules in a condition of increased cardiac wall-stress in heart failure (HF) patients, and its plasma level elevation had been widely used as a parameter of diagnosis, functional class, treatment monitoring and prognostication. Pulsed-wave tissue Doppler velocities of mitral annulus (Tissue Doppler Imaging/TDI) currently known had an ability to detect move-ment changes of cardiac wall in HF patients. But only few research to see the correlation between them, with various selection of patients and results. Aim. To determine whether plasma NT-proBNP levels correlate with mitral annulus velocities measured by TDI and to search which component had the strongest correlation. Methods.One hundred consecutive patients with HF who came for echocardiography examination in The National Cardiac Center Harapan Kita Jakarta underwent an additional TDI procedure (Sm, Emand E/Em component). Before or after echocardiography, venous blood sample was collected for plasma NT-proBNP examination. We determined the cor-relation between plasma NT-proBNP level and TDI results, and assessed which component had the strongest correlation. Results.There were 74 men and 26 women of HF patients with mean of age 54 y.o. Functional NYHA Class II were 28 patients, NYHA Class III 42 patients and NYHA Class IV 30 patients. The causes of HF were CAD 49 patients, HHD 19 patients, Valve Disease 23 patients, DCM 8 patients and other 1 patient. There were 64 patients with sinus rhythm and 36 patients with atrial fibrillation. There were 17 diastolic HF patients and 83 systolic HF patients. Fifty patients with significant MR and 50 patients without significant MR. We found the strongest significant negative correlation (r= -0,713, p0,000) between plasma NT-proBNP level and Emcomponent. Smalso had a significant negative correlation, but Emhad a stronger correlation than Sm. E/Emcomponent had a weak significant positive correlation. Conclusion.Elevated plasma NT-proBNP levels correlates strongly with declining velocities of TDI early diastolic Emcomponent in HF patients

Myeloperoxidase as a Predictor for Subsequent Cardio-vascular Events in Patients with Acute Myocardial Infarction

Background. Inflammation has been linked to all stages of the develop-ment of vulnerable plaque which not only causes platelet activation but also proceeded by activation of polymorphonuclear neutrophils (PMNs). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory prop-erties and may contribute directly to tissue injury. Among predictors of major adverse cardiovascular events (MACE) that we have been widely used and known, such as hs-CRP and Troponin T, it still unknown whether MPO also provides prognostic information in patients with acute myocar-dial infarction (AMI). Objectives. The aim of our study is to search predictive value of MPO and to compare MPO with hs-CRP and Troponin T as a predictor of MACE in patients with AMI. Methods.Cohort-prospective study was done, conducted from April to June 2006 in the emergency department of National Cardiovascular Cen-tre - Harapan Kita, (NCVC-HK), Jakarta. MPO, hs-CRP, and troponin T serum levels were assessed in 93 patients with AMI. It recorded death, re-infarctions, angina, revascularization, and heart failure during 6 months of follow-up. Results.Patients with MPO serum level > 204,9 g/l have increased risk of cardiovascular events (HR 6.76; 95% CI 3.37-13.56, P < 0.001). In statistical analysis, MPO (sensitivity 83.1%; specificity 82.4%) is a stronger independent predictor for subsequent cardiovascular events than Tropo-nin T (sensitivity 59.8%; specificity 71.6%) and hs-CRP (sensitivity 48.5%; specificity 46.1%). Conclusions.MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events in patients with acute myocardial infarction

Clinical Characteristics, Echocardiographic Feature, and Predictor of Embolic Events in Infective Endocarditis

Background. There are many risk factors that are associated with embolic events in patients with Infective Endocarditis (IE) ranging from infecting organism, valve location, vegetation morphology, to age. Nevertheless, echocardiography role in predicting embolic events in patients with Infective Endocarditis remains controversial. Some studies reported an increased risk of embolism in patients with large and mobile vegetations, whereas other studies failed to demonstrate such a relationship. Objectives. The aim of this study is to assess the risk factors that are associated with embolic events and to evaluate the role of transthoracic echocardiography (TTE) in predicting embolic events (EEs) in a small group of patients with definite endocarditis according to the Duke criteria. Methods. Subjects more than 17 years of age, who were enrolled in National Cardiac Center Harapan Kita Infective Endocarditis Registry and who had complete TTE recording were selected for this study. Fourteenpatients with definite Infective Endocarditis according to the Duke Criteria who were hospitalised within 2010 2011 were examined with M-mode and two-dimension echocardiogram. The incidence of embolism was compared with the clinical and echocardiographic characteristics (localization and mobility) of the vegetations. Results. Among 14 patients, 5 (35,7%) had one or more EEs. There were no difference between patients with and without embolism in terms of infecting organism, gender and vegetation mobility. Five out of 9 patients (55%) with mitral valve involvement vegetation had EE. No patients with only aortic and tricuspid valve vegetations had EEs. And all of the patents with EE had mitral valve involvement. Thus, there was a significant higher incidence of embolism was present in patients with mitral valve involvement of vegetation (100%, p = 0,038). Conclusion. Our study shows that the involvement of mitral valve on TTE is predictive of embolism

Crash Course Sistem Kardiovaskular

xii, 265 hlm, : il. ; 12,5 x 20 cm

<em>Chlamydia pneumoniae</em> and cardiovascular disease: could we treat cardiovascular disease with antibiotics ?

[no abstract available

The risk factors profile of coronary heart disease in dyslipidemic patients : Results from a survey in 13 cities in Indonesia

<p>The incidence of coronary heart disease (CHD) has significantly increased and has been associated to the high mortality rate in Indonesia. One important CHD risk is the abnormal lipid profile or dyslipidemia, but there are other risk factors that has been associated with CHD in Western population. In Indonesia, data on CHD risk factors are very limited and usually only available as hospital-based data. The aim of this study is to analyze the CHD risk profile in the private clinical practice setting and to determine the factors affecting CHD in  dyslipidemic patients in Indonesia. This study is a cross-sectional survey which targeted physicians in 13 cities in Indonesia who regularly treat patients with dyslipidemia. The majority of dyslipidemic patients in clinical practice setting was the CHD high-risk group. Age, Iow HDL-C and hypertension were the most common risk factors. The prevalence of the risk factors and the proportion of dyslipidemic patients which belongs to the high risk group were comparable to the result of US (L-TAP) study.<em> <strong>(Med J Indones 2001; 10: 42-7)</strong></em></p><p><strong>Keywords :</strong> <em>Coronary Heart Disease, risk factors, dyslipidemia, clinical practice</em></p

Trigliseridemia Postprandial Sebagai Faktor Prediksi Kejadian Kardiak Sindroma Koroner Akut Berulang

Background. Plasminogen Activator Inhibitor-1 (PAI-1) is an important hemostatic factor of thrombosis that inhibits fibrinolysis mechanism by tissue-Plasminogen Activator (t-PA). PAI-1 is a predictor for recurrentacute coronary syndrome (ACS). PAI-1 is also associated with Insulin Resistance syndrome that manifest as increase level of Triglyceride (Tg), decrease of HDL cholesterol, hypertension and glucose intolerance. Acute or chronic hypertriglyceridemia is often associated with high PAI-1 plasma activity. Objective. To know the relationship between postprandial Tg (ppTg) and increasing PAI-1 plasma levels in patients with ACS that may cause recur-rent cardiac events.MethodsThis is a case-control study, that included 54 ACS patients (aged 54-63 years), with or without ST segment elevation, without diabetes mel-litus, who were admitted to Emergency Department of National Cardiac Center Harapan Kita, Jakarta. All patients were followed up during hos-pitalization and one month after discharged. Subjects were divided into 2 groups based on ppTg level and compared it to age group, sex, body mass index, smoking habit, systolic blood pressure, pulse, ST segment deviation, CKMB, total cholesterol, low density lipoprotein (LDL), HDL and PAI-1 levels, as haemostatic factor. Patients with ppTg level &lt; 153.5 mg/dL is a control case. Results.There was an increasing PAI-1 levels (mean 28.9 ± 25.81 ng/dL) as predictor of post ACS events in the study subjects. The level of PAI-1 plasma increased in patients with hypertriglyceridemia (p=0.004). Despite no significant association between pp hipertriglicerydemia and MACE, the overall results showed a significant association between postprandial hipertriglicerydemia and obesity (p=0.037) as well as HDL cholesterol as components of metabolic syndrome. Conclusions. The postprandial hipertriglicerydemia is a condition that can be found in metabolic disturbances and may influence coagulation status. There are association between pp hipertriglicerydemia and obesity. PAI-1 level is predictor for recurrent cardiac events post ACS.Latar Belakang. Plasminogen Activator Inhibitor-1 (PAI-1) merupakan faktor hemostatik penting dalam kejadian trombosis, karena menghambat mekanisme fibrinolisis oleh tissue-Plasminogen Activator (t-PA). Beberapa penelitian membuktikan bahwa PAI-1 merupakan prediktor kejadian kardiak berulang pasca Sindroma Koroner Akut (SKA). Disamping itu, PAI-1 juga berhubungan dengan Sindroma Resistensi Insulin yang bermanifestasi : peningkatan kadar Trigliserid (Tg), penurunan kadar High Density Lipoprotein (HDL) kolesterol, hipertensi dan Glukosa Intolerans. Peningkatan kadar Tg baik akut maupun kronik berhubungan dengan peningkatan aktifitas PAI-1. Objektif. Studi ini untuk mengetahui hubungan antara Tg postprandial dengan peningkatan PAI-1 pada pasien SKA, yang dapat berakibat kejadian kardiak berulang.Metoda. Suatu studi kontrol kasus dilakukan pada 54 pasien SKA usia 54-63 tahun dengan atau tanpa elevasi segmen ST, tanpa diabetes mellitus (DM). Pasien dibagi dalam 2 kelompok berdasarkan kadar Tg postprandial dan dibandingkan dengan umur, jenis kelamin, indek massa tubuh, merokok, tekanan darah sistolik, nadi, deviasi segmen ST, kadar CKMB, total kolesterol, low density lipoprotein (LDL), HDL dan PAI-1. Pasien dengan kadar Tg postprandial &lt; 153.5 mg/dL dipakai sebagai control. Pasien diamati selama perawatan dan 1 bulan setelah perawatan. Analisis statistik dilakukan untuk melihat kemaknaan antara variabel-variabel pada kedua kelompok tersebut, dan hubungannya dengan faktor hemostatik serta kejadian utama perburukan kardiak (Major Adverse Cardiac Event/MACE).Hasil. Terdapat peningkatan kadar PAI-1 pada populasi studi (28.89 ± 25.81 ng/dL) dan pada kelompok pasien dengan postprandial hipertrigliseridemia (p=0.004). Namun secara keseluruhan meskipun tidak dijumpai hubungan yang bermakna antara postprandial hipertrigliseridemia dengan MACE didapatkan kebersamaan dan hubungan yang bermakna antara postprandial hipertrigliseridemia dengan obesitas (p=0.037) serta HDL kolesterol yang merupakan komponen Sindroma Metabolik.Kesimpulan:Postprandial hipertrigliseridemia merupakan suatu keadaan yang dapat dijumpai pada gangguan metabolik yang mempengaruhi status koagulasi dan dijumpai suatu korelasi antara postprandial hipertrigliseridemia dengan obesitas PAI-1 merupakan prediktor kejadian berulang pasca Sindroma Koroner Akut namun tidak dijumpai hubungan antara postprandial hipertrigliseridemia dengan kejadian berulang pasca Sindroma Koroner Akut