The Effect of Enhanced External Counterpulsation Therapy and Improvement of Functional Capacity in Chronic Heart Failure patients: a Randomized Clinical Trial

Aim: to investigate the efficacy of enhanced external counterpulsation (EECP) therapy to improve functional capacity in patients with chronic heart failure (CHF). Methods: a double-blind random clinical trial was performed in 99 patients with CHF who had received EECP therapy at Jade Cardiovascular Clinic, Manado, North Sulawesi, Indonesia between January 2014 and June 2015. Subjects were categorized into 2 groups, i.e. 49 subjects had sham EECP therapy and 50 subjects had EECP therapy. All subjects performed six-minute walking test (6MWT) before and after receiving EECP therapy. Results: there was no significant difference between both groups regarding the basic characteristics of patients with CHF. The 6MWT result before EECP therapy showed that there were 30 patients (61.2%) with walk distance of <300 meter in the sham EECP group; while in the group receiving EECP therapy, we found 34 patients (68%); p=0.24. Post-EECP therapy, there were 33 patients (67.3%) with walk distance of <300 meters in EECP sham group; while in the group receiving EECP alone, there was only 1 patient (2%); p <0.01.The 6MWT walk distance in sham group before EECP therapy was 252.65 (SD 97.55) meters and it was 243.65 (SD 86.96) meters following the EECP therapy; p=0.18. In EECP group, the 6MWT walk distance before therapy was 256.88 (SD 85.56) meters and after EECP therapy the walk distance was 449.46 (SD 92.08) meters; p<0.01. Conclusion: EECP therapy is effective to improve functional capacity in patients with CHF.Key words: chronic heart failure, six-minute walk test, enhanced external counterpulsation (EECP) therapy

ST2 Levels Before and After Treatment of NYHA III and IV Heart Failure

Aim: to find whether ST2 can be used to determine clinical improvement in patients with NYHA III and IV heart failure. Methods: this is a longitudinal, pre and post-test study without a control group. Study subjects are 23 NYHA III and IV heart failure patients. ST2 was tested at the start and end of hospital treatment. Results: of 23 heart failure patients, 70% were classified as NYHA III while 30% were NYHA IV. There were more male subjects than females (51.4% vs. 48.6%). Median age for NYHA III heart failure patients was 52 years and mean age for NYHA IV heart failure patients was 58 years. Heart failure was mostly caused by coronary artery disease (52%). ST2 levels did not correlate with age, length of care, sex and cause of heart failure. ST2 levels in NYHA IV heart failure patients (58.82±37.36 ng/mL) tended to be higher than the one in NYHA III group (30.75 [14.4-84.5] ng/mL), but the difference was statistically not insignificant (p=0.89). ST2 levels at the start of treatment was significantly higher than at the end (31.4 [14-129.2] ng/mL vs. 18.4 [7.6-77.8] ng/mL), p=0.001. This shows that clinical improvement is associated with significant reduction of ST2 levels. Conclusion: ST2 can be used as a marker to determine clinical improvement in NYHA III and IV heart failure.Key words: ST2, heart failure, NYHA III and I

Role of Glycated Albumin during Pregnancy

Objective: To determine the glycated albumin profile during pregnancy with normal glycemic status. Methods: We recruited 60 pregnant women between 21 and 36 weeks of gestation. We conducted several laboratory tests, such as glycated albumin, blood glucose, and albumin. These parameters were compared among four groups of gestational age (21-24 weeks, 25-28 weeks, 29-32 weeks, and 33-36 weeks) using ANOVA or Kruskal-Wallis test continued by Post-hoc test. Results: Glycated albumin was not statistically different among the groups. Albumin level of 33-36 weeks of gestation women (3.6 (SD 0.2) g/dl) was lower than 21-24 weeks of gestation women (3.8 (SD 0.2) g/dl). Conclusion: Glycated albumin level is not affected by gestational age. Therefore, glycated albumin may be used as glycemic status indicator during pregnancy from 21 to 36 weeks. [Indones J Obstet Gynecol 2017; 5-1: 16-18] Keywords: HbA1c, glycated albumin, glycemic status, pregnanc

Correlation Between Vitreous Advanced Glycation End Products, and D-dimer with Blood HbA1c Levels in Proliferative Diabetic Retinopathy

Background: proliferative diabetic retinopathy (DR) is an advanced form of DR that eventually could lead to blindness. Levels of vitreous advanced glycation end products (AGEs) and D-dimer may reflect the pathological changes in the retina, but only few studies have assessed their correlation with blood hemoglobin A1C (HbA1c) levels. This study aimed to find the association between blood HbA1c levels with vitreous AGEs and D-dimer levels in patients with proliferative DR. Methods: an analytical cross-sectional study was performed in subjects with proliferative DR who underwent vitrectomy. Subjects were divided into 2 subgroups, i.e. uncontrolled (HbA1c >7%) and controlled (HbA1c <7%) groups. Vitreous AGEs and D-dimer levels were assessed; the levels were compared between uncontrolled and controlled hyperglycemic patients. Statistic correlation tests were also performed for evaluating blood HbA1c, vitreous AGEs, and D-dimer levels. Results: a total of 47 patients were enrolled in this study and 32 (68.1%) of them were women. Median vitreous AGEs level was 11.0 (3.0 – 48.0) µg/mL; whereas median vitreous D-dimers level was 5,446.0 (44.0 – 37,394.0 ) ng/mL. The median vitreous AGEs levels was significantly higher in patients with uncontrolled vs. controlled hyperglycemia (14.0 vs. 4.0 mg/mL; p<0.001). There was a significant positive correlation with moderate strength between blood HbA1c level and vitreous AGEs level (r=0.524; r2=0.130; p=0.0001). Blood HbA1c level could be used to predict vitreous AGEs level by using the following calculation: vitreous AGEs = -1.442+ (1.740xblood HbA1c). Vitreous D-dimer levels were not significantly different between uncontrolled and controlled hyperglycemia (median 4607.5 vs. 5701.6 ng/mL; p = 0.458). There was a positive significant correlation between blood HbA1c and vitreous D-dimer levels (r = 0.342; p = 0.019); however the correlation was weak. Vitreous AGEs level had a positive significant correlation with vitreous D-dimer levels (r = 0.292; p = 0.046) and the correlation strength was also weak. Conclusion: median vitreous AGEs levels were significantly higher in proliferative DR patients with uncontrolled than those with controlled hyperglycemia. Blood HbA1c level can be used to assess vitreous AGEs level in patients with proliferative DR by using the following calculation: vitreous AGEs = -1.442+(1.740 x HbA1c). However, the blood HbA1c level can not be used to predict vitreous D-dimer level in patients with proliferative DR

ST2 Levels Before and After Treatment of NYHA III and IV Heart Failure

Aim: to find whether ST2 can be used to determine clinical improvement in patients with NYHA III and IV heart failure. Methods: this is a longitudinal, pre and post-test study without a control group. Study subjects are 23 NYHA III and IV heart failure patients. ST2 was tested at the start and end of hospital treatment. Results: of 23 heart failure patients, 70% were classified as NYHA III while 30% were NYHA IV. There were more male subjects than females (51.4% vs. 48.6%). Median age for NYHA III heart failure patients was 52 years and mean age for NYHA IV heart failure patients was 58 years. Heart failure was mostly caused by coronary artery disease (52%). ST2 levels did not correlate with age, length of care, sex and cause of heart failure. ST2 levels in NYHA IV heart failure patients (58.82±37.36 ng/mL) tended to be higher than the one in NYHA III group (30.75 [14.4-84.5] ng/mL), but the difference was statistically not insignificant (p=0.89). ST2 levels at the start of treatment was significantly higher than at the end (31.4 [14-129.2] ng/mL vs. 18.4 [7.6-77.8] ng/mL), p=0.001. This shows that clinical improvement is associated with significant reduction of ST2 levels. Conclusion: ST2 can be used as a marker to determine clinical improvement in NYHA III and IV heart failure. Key words: ST2, heart failure, NYHA III and I

The Association of b2-Microglobulin and Fibroblast Growth Factor 23 with Major Adverse Cardiac Event in Acute Coronary Syndrome Patients with Chronic Kidney Disease

Background: chronic kidney disease (CKD) increases the severity and risk of mortality in acute coronary syndrome (ACS) patients. The role of β2-M as a filtration and inflammation marker and FGF23 as a CKD-MBD process marker might be significant in the pathophysiology in ACS with CKD patients. This study aims to determine the association of β2-M and FGF23 with major adverse cardiac event (MACE) in ACS patients with CKD. Methods: we used cross sectional and retrospective cohort analysis for MACE. We collected ACS patients with CKD consecutively from January until October 2018 at Dr. Cipto Mangunkusumo General Hospital. Data were analyzed using logistic regression and Cox’s Proportional Hazard Regression. Results: a total of 117 patients were selected according to the study criteria. In bivariate analysis, β2-M, FGF23, and stage of CKD had significant association with MACE (p = 0.014, p = 0.026, p = 0.014, respectively). In multivariate analysis, β2-M - but not FGF 23- was significantly associated with MACE (adjusted HR 2.16; CI95% 1.15–4.05; p = 0.017). Conclusion: β2-M was significantly associated with MACE, while FGF23 was not so. This finding supports the role of inflammation in cardiovascular outcomes in ACS with CKD patient through acute on chronic effect

Effect of Three and Six Months of Vitamin D Supplementation on Glycemic Control and Insulin Resistance in Type 2 Diabetes Mellitus: Randomized Placebo-controlled Trial

BACKGROUND: 25(OH)D level is correlated with insulin secretion and tissue sensitivity to insulin. Administration of vitamin D supplements may reduce tissue resistance to insulin in type 2 diabetes mellitus (T2DM), but a number of studies found conflicting results. The present study was to measure the results of administration of vitamin D supplements for 3 and 6 months regarding HbA1c, fasting blood glucose (FBG), insulin and tissue resistance to insulin in T2DM cases. METHODS: A randomized double-blind placebo-controlled trial was conducted in T2DM patients with ≤3 years duration. Subjects were randomly divided into two groups: 47 subjects received daily 5000 IU vitamin D supplementation and 47 subjects received daily placebo as control. After supplementation for 3 and 6 months, homeostatic model assessment for tissue resistance to insulin (HOMA-IR), insulin, HbA1c, and FBG were examined. RESULTS: Supplementation of daily 5000 IU vitamin D for 3 months increased 25(OH)D level in the vitamin D group from 12.50±5.28 to 43.57±17.14 ng/mL, and after 6 months the 25(OH)D level was 38.38±17.64 ng/mL. Both groups showed significant differences after 3 and 6 months regarding HOMA-IR (p=0.033 and p=0.031), insulin (p=0.034 and p=0.013), but not FBG (p=0.296) and HbA1c (p=0.360). In both groups, HOMA-IR and insulin increased although the increase in the control group was greater than in the vitamin D group. The difference between the control and vitamin D groups was significant. CONCLUSION: Vitamin D supplementation for 3 and 6 months may lead to improvement HOMA-IR but not for FBG and HbA1c in the vitamin D group as compared with the control group in T2DM cases. KEYWORDS: vitamin D, T2DM, HbA1c, blood glucose, insulin, tissue resistance to insuli

Correlation Between Vitreous Advanced Glycation End Products, and D-dimer with Blood HbA1c Levels in Proliferative Diabetic Retinopathy

Background: proliferative diabetic retinopathy (DR) is an advanced form of DR that eventually could lead to blindness. Levels of vitreous advanced glycation end products (AGEs) and D-dimer may reflect the pathological changes in the retina, but only few studies have assessed their correlation with blood hemoglobin A1C (HbA1c) levels. This study aimed to find the association between blood HbA1c levels with vitreous AGEs and D-dimer levels in patients with proliferative DR. Methods: an analytical cross-sectional study was performed in subjects with proliferative DR who underwent vitrectomy. Subjects were divided into 2 subgroups, i.e. uncontrolled (HbA1c >7%) and controlled (HbA1c <7%) groups. Vitreous AGEs and D-dimer levels were assessed; the levels were compared between uncontrolled and controlled hyperglycemic patients. Statistic correlation tests were also performed for evaluating blood HbA1c, vitreous AGEs, and D-dimer levels. Results: a total of 47 patients were enrolled in this study and 32 (68.1%) of them were women. Median vitreous AGEs level was 11.0 (3.0 – 48.0) µg/mL; whereas median vitreous D-dimers level was 5,446.0 (44.0 – 37,394.0 ) ng/mL. The median vitreous AGEs levels was significantly higher in patients with uncontrolled vs. controlled hyperglycemia (14.0 vs. 4.0 mg/mL; p<0.001). There was a significant positive correlation with moderate strength between blood HbA1c level and vitreous AGEs level (r=0.524; r2=0.130; p=0.0001). Blood HbA1c level could be used to predict vitreous AGEs level by using the following calculation: vitreous AGEs = -1.442+ (1.740xblood HbA1c). Vitreous D-dimer levels were not significantly different between uncontrolled and controlled hyperglycemia (median 4607.5 vs. 5701.6 ng/mL; p = 0.458). There was a positive significant correlation between blood HbA1c and vitreous D-dimer levels (r = 0.342; p = 0.019); however the correlation was weak. Vitreous AGEs level had a positive significant correlation with vitreous D-dimer levels (r = 0.292; p = 0.046) and the correlation strength was also weak. Conclusion: median vitreous AGEs levels were significantly higher in proliferative DR patients with uncontrolled than those with controlled hyperglycemia. Blood HbA1c level can be used to assess vitreous AGEs level in patients with proliferative DR by using the following calculation: vitreous AGEs = -1.442+(1.740 x HbA1c). However, the blood HbA1c level can not be used to predict vitreous D-dimer level in patients with proliferative DR