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

Effect of a Weight Loss Program on Body Composition and Metabolic Syndrome Markers in Obese Weight Cyclers

Aim: to evaluate the effect of weight loss program on fat mass, visceral fat rating and metabolic syndrome markers in obese subjects with weight cycling. Methods: this was an 8-week open trial. The subjects were recruited consecutively from Balai Kota DKI Jaya. Subjects were classified into two groups according to the fluctuation of weight gain (weight cycling/WC and first encounter obesity/FEO group). Both groups were assigned to receive weight loss program consisted with following goals: a 1000 kcal energy intake reduction and 45 minutes mild-to-moderate intensity physical activity three times a week. Body composition (fat mass, visceral fat rating), and metabolic syndrome markers (waist circumference and triglyceride levels) were measured at baseline, week 4 and at the end of study. Results: seventy two subjects completed the study (34 subjects in WC group and 38 subjects in FEO group). Following weight loss program, a decrease in fat mass, visceral fat rating, and waist circumference was lower in WC group compared with FEO group but it was not statistically significant (p>0.05). Triglyceride levels were decreased in the FEO group while it was increased in WC group. However the difference was not significant (p=0.055). Conclusion: weight loss program may contribute to changes in body composition and metabolic syndrome markers in obese subjects, which the response appears to be worse in weight cyclers. Key words: weight loss program, weight cycling, fat mass, visceral fat rating, metabolic syndrome

QT Interval Prolongation Associated with Amiodarone Use in Cipto Mangunkusumo Hospital, Jakarta

Aim: to evaluate the incidence of QTc interval prolongation associated with the use of amiodarone, as well as factors that influence its occurrence. Methods: this was a descriptive retrospective study conducted from November 2010 until December 2011 using medical record of patients at ICCU Cipto Mangunkusumo Hospital from 2004-2011. Four groups of patients were included: (1) patients receiving amiodarone and other drugs causing which can cause QTc prolongation, (2) patients receiving amiodarone and other drug not causing QTc prolongation, (3) patients receiving drugs which can cause causing QTc prolongation, (4) patients not receiving amiodarone, nor other drugs which can cause causing QTc prolongation (served as control group). Difference of QTc interval within the same group was analyzed with paired t-test or Wilcoxon matched-pairs test. Between groups comparison were performed with Kruskal Wallis test. The influence of other factors (sex, age, heart failure, liver disorder, electrolyte imbalance) on QTc prolongation was analyzed using multiple regression. Results: QTc interval prolongation in groups 1, 2, and 3 were respectively 65.5%, 63.3%, 56.6%, which were significantly different from control group (24.4%); Hypernatremia and hypertension were revealed as significant risk factor for QTc prolongation. Mortality occurred in 3, 4, and 4 patients in group 1, 2, and 3 respectively, and none in group 4. Conclusion: QTc interval prolongation occurred in association with amiodarone and other drugs known to prolong QTc interval. Hypernatremia and hypertension were shown as significant influencing factor of QTc interval prolongation. Key words: amiodarone, antiarrhythmia, QTc interva

Prediction of Wound Healing in Diabetic Foot Ulcers: an Observational Study in Tertiary Hospital in Indonesia

Aim: to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. Methods: a cohort study (February – October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG). Results: median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. Conclusion: in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing

Validity of Simple Risk Index and Evaluation of Methods and Management of Acute Coronary Events to Predict Mortality in Acute Coronary Syndrome Patients in Intensive Coronary Care Unit Cipto Mangunkusumo Hospital

Introduction. Risk stratification is an important part in the management of patients with an Acute Coronary Syndrome (ACS) to avoid overtreatment or undertreatment. Although Simple Risk Index (SRI) and Evaluation of Methods and Management of Acute Coronary Events (EMMACE) have been validated in other countries, no study of its applicability has been performed in Indonesia with different patients’ characteristics. This study aims to obtain the calibration and discrimination performance of SRI and EMMACE to predict 30 days mortality in ACS patients in ICCU of Cipto Mangunkusumo Hospital. Methods. A retrospective cohort study with consecutive sampling was conducted in ACS patients hospitalized in the ICCU Cipto Mangunkusumo hospital between the period of 2003 up to 2010. Data analyzed performed by SPPS program for Windows Version 17. The discrimination performance was explained using a value of area under the receiver-operator curve (AUC) while calibration performance was evaluated using hosmer lemeshow and plot calibration. Results. A total of 922 patients were included in this study consisted of 453 STEMI patients, 234 NSTEMI patients and 235 UAP patients. Simple Risk Index (SRI) score for STEMI had presentable discrimination and calibration performance (AUC= 0,92; R2= 0,98; and p value= 0,01). Simple Risk Index (SRI) score for overall ACS also showed sufficient performance and calibration discrimination (AUC= 0,87; R2= 0,99; and p value= 0,52). Meanwhile, EMMACE score in ACS patients showed satisfactory performance discrimination (AUC= 0,87), but the calibration perfomance was not as satisfactory as the SRI score with the calibration plot (R2)= 0,54 (p value= 0,52). Conclusions. Simple Risk Index (SRI) score shows a satisfactory discrimination and calibration performance both in STEMI and overall ACS patients in predicting mortality of ACS patients in ICCU Cipto Mangunkusumo Hospital. Evaluation of Methods and Management of Acute Coronary Events (EMMACE) score, nonetheless, displays sufficient discrimination performance, but poor performance of calibration

Pulmonary Artery Wedge Pressure Formula Using Echocardiography Finding

This study aims to introduce a new formula for pulmonary artery wedge pressure (PAWP) derived from the pathophysiology of Velocity A (VA) waves. The current formula is the the Nagueh formula. Left ventricular (LV) filling is described as a velocity A (VA) wave. The VA wave represents the filling rate of the end-diastolic blood phase from the left atrium (LA) to the LV which can be determined on echocardiography. Left ventricular end diastolic pressure (LVEDP) is equivalent to LA pressure and is also equivalent to PAWP. The gold standard method for obtaining PAWP values is right heart catheterization. By measuring the VA waves in the bloodstream, a new PAWP formula is obtained, and the PAWP examination can be validated in research and can be compared with several other PAWP formulas that are currently the world’s standard formula for calculating pulmonary artery wedge pressure (PAWP).The new PAWP formula is obtained from the conversion of the VA wave. This formula could be validated further in research and used in clinical practice

Peran Tindakan Revaskularisasi terhadap Kesintasan Pasien Non ST Elevation Myocardial Infarction (NSTEMI)

Pendahuluan. Pengaruh revaskularisasi terhadap kesintasan pasien non ST elevation myocardial infarction (NSTEMI) masih belum jelas. Waktu revaskularisasi yang optimal pada pasien NSTEMI belum ditemukan. Penelitian ini bertujuan mengetahui pengaruh revaskularisasi terhadap kesintasan pasien NSTEMI, juga mengetahui pengaruh waktu revaskularisasi terhadap kesintasan pasien NSTEMI. Metode. Penelitian dengan disain kohort retrospektif dilakukan terhadap 300 pasien non ST elevation myocardial infarction yang dirawat di RSUPNCM pada kurun waktu Desember 2006-Maret 2011. Data klinis, laboratorium, elektrokardiografi (EKG), ekokardiografi, dan angiografi koroner dikumpulkan. Pasien yang telah terhitung enam bulan setelah onset kemudian dihubungi melalui telepon untuk melihat status mortalitasnya. Perbedaan kesintasan revaskularisasi ditampilkan dalam kurva Kaplan Meier dan perbedaan kesintasan diantara dua kelompok diuji dengan Log-rank test dengan batas kemaknaan <0,05, serta analisis multivariat dengan Cox proportional hazard regression untuk menghitung adjusted hazard ratio (dan interval kepercayaan 95%) antara pasien NSTEMI yang menjalani terapi medikamentosa dan revaskularisasi terhadap kelompok medikamentosa dengan memasukkan variabel perancu. Hasil. Terdapat perbedaan kesintasan yang bermakna pada uji log rank (p<0,001) antara pasien NSTEMI yang menjalani revaskularisasi dan terapi medikamentosa saja dengan crude HR 0,19 (IK95% 0,11-0,34) dan fully adjusted HR 0,33 (IK95% 0,17-0,64). Faktor perancu yang bermakna adalah penurunan fungsi ginjal dan syok kardiogenik. Pada analisis kesintasan berdasarkan waktu revaskularisasi tidak didapatkan perbedaan kesintasan antara pasien yang menjalani revaskularisasi < 1 minggu, 1-2 minggu, 2-3 minggu, 3-4 minggu, 4-5 minggu dengan p=0,853. Simpulan. Kesintasan enam bulan pasien NSTEMI yang menjalani terapi medikamentosa dan revaskularisasi lebih baik dibandingkan dengan terapi medikamentosa saja. Tidak terdapat perbedaan kesintasan enam bulan pasien NSTEMI berdasarkan waktu revaskularisasi

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