Correlation between High-Sensitive C-Reactive Protein and HighSensitive Troponin I with 6-Minute Walk Distance in Acute Myocardial Infarction

Background: Biomarker has a role in diagnosis and risk stratification of ischemic heart disease patients. Troponin has become the reference biomarker for acute myocardial infarction (AMI). However, some other biomarkers have benefit on prognostic value, such as C-Reactive Protein (CRP). Six-minute walk test (6MWT) could be performed to assess functional capacity in patients with heart disease.Aim: To assess the correlation between hsCRP and hsTroponin I with 6-minute walk distance (6MWD) in AMI patients.Method: This is an observational analytic study with prospective cohort design, conducted in August-September 2018. The subjects were AMI patients at Dr. Moewardi district general hospital, Surakarta. The hsCRP and hsTroponin I sampling was carried out on admission. 6MWT was performed before discharge. Statistical analysis was performed to assess the correlation. Then the ROC curve was used to determine the cut-off point, sensitivity and specificity.Result: 6MWD of 40 subjects was divided into 2 groups based on the mean distance (<378 m and ≥378 m). There was a significant negative correlation between hsCRP and 6MWD (r =-0.475, p =0.002), but no significant correlation between hsTroponin I and 6MWD (r =-0.048, p = 0.244). However, hsCRP together with hsTroponin I have a significant correlation with 6MWD (r =0.491, p =0.006). Using the ROC curve, obtained AUC of 0.725 and a cut-off point of 0.555 mg/l, as well as a sensitivity of 69.6% and specificity of 88.2%Conclusion: There was a significant negative relationship between hsCRP and 6MWD, but no significant relationship between hsTroponin I with 6MWD.HsCRP together with hsTroponin I have a significant correlation with 6MWD in AM

Association Between Neutrophil to Lymphocyte Ratio and Left Ventricle Global Longitudinal Strain in Acute Myocardial Infarction

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% were performed.Results: As many as 57 patients were included in this study, 24 patients (mean age 56,21±9,43) in GLS ≤-13.8% group and 33 patients (mean age 56.67±8.24) in GLS >-13.8%. NLR was significantly higher in GLS>-13.8% group 6.06 (5.36-6.86) compare 4.20 (3.49-5.04),in GLS≤-13.8%, p=0.001. The cut-off value of NLR was 4.69. The bivariate analysis showed that NLR>4.69 associated with GLS>-13.8%, OR 2.70 (CI 95% 1.41-5.17, p=0.001). Multivariate analysis shown that higher NLR have more probability to develop GLS>-13.8%, OR 8.53 (CI 95% 2.38-30.60, p<0.001).Conclusion: There is an association between NLR and left ventricular GLS in AMI patients. AMI patients with high NLR are more likely to have worse GLS

Effect of Oral N-Acetylcystein on Galectin-3 in Acute Myocardial Infarction Patients

Background: The pathogenesis of heart failure after myocardial infarction is associated with the pathogenesis of cardiac remodeling. Galectin-3 (Gal-3) has a role in the pathophysiology of cardiac remodeling after acute myocardial infarction. N-Acetylcysteine (NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. The purpose of this study was to examine the effect of oral N-Acetylcysteine on Galectin-3 in acute myocardial infarction patients.Subjects and Methods: This was an experimental study with pre and post, single-blind, and randomization methods. The study was conducted at Dr.Moewardi General Hospital Surakarta, Central Java, from June to August 2018. A sample of 29 acute myocardial infarction patients with ST-segment elevation who received fibrinolytic therapy was selected for this study. 14 patients as a control group received standard therapy and 15 patients as intervention group received oral NAC supplementary therapy 600 mg three times daily for three days. The dependent variable was Gal-3 levels. The independent variable was NAC supplementary therapy. The data were analyzed by Mann Whitney test.Results : Gal-3 levels in intervention group (mean= 8.95; SD=1.76) were lowered than the control group (mean= 11.42; SD= 3.76) and it was statistically significant (p= 0.026). Conclusion: Supplementary therapy of NAC 600 mg orally 3 times a day for 3 days can reduce levels of Gal-3 in patients with acute myocardial infarction who receive fibrinolytic therapy.Keywords: galectin-3, n-acetylcysteine, acute myocardial infarction Correspondence: Akhmad Jalaludinsyah. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: [email protected]. Mobile: +6281393098987.Indonesian Journal of Medicine (2019), 4(1): 1-8https://doi.org/10.26911/theijmed.2019.04.01.0

Effect of Captopril Rapid Uptitration to Plasma Aldosterone Level in Patients with Acute Myocardial Infarction

Background: Acute myocardial infarction is a myocardial necrosis associated with acute myocardial ischemia of which the incidence keeps increasing over time. Appropriate management of acute myocardial infarction is very important in order to determine the efficacy of the therapy and also to prevent further complications due to acute myocardial infarction. Captopril is essential in the management of acute myocardial infarction to inhibit the renin-angiotensin-aldosterone system whereby aldosterone may increase the probability of heart failure and increase mortality up to approximately 10 times compared to patients with acute myocardial infarction without heart failure. The administration of captopril should be uptitrated the doses in order to obtain optimal results, however there is no such fixed standard on how fast the doses of captopril should be uptitrated in order to obtain a more optimal effect, especially in order to suppress the plasma aldosterone level. This study examined the effect of rapid uptitration of captopril in the first 3 days of treatment of patients with acute myocardial infarction on plasma aldosterone levels compared to the increase in the captopril standard uptitration.Subjects and Method: This is an experimental research with Randomized Controlled Trial (RCT). 28 patients with Acute Myocardial Infarction on Cardiovascular Intensive Care Unit (ICVCU) and Cardiovascular wards of RSUD Dr. Moewardi hospital Surakarta were sequentially involved as research subjects and then randomly divided into a control group who received standard captopril uptitration and treatment group who received captopril rapid uptitration. The blood plasma was taken on the first day before the administration of captopril and on the last day of treatment. The plasma aldosterone level was tested by ELISA. Independent t-tests were carried out for data that qualified the normality test and mann whitney test if not qualified in the normality test with kolmogorov smirnov. It was considered statistically significant if the value of p < 0.05.Results: Plasma Aldosterone levels in treatment group was lower than control group and statistically significant (1133.54 ± 748.81 pg/dl vs 512.16 ± 444.81 pg/dl; p = 0.013 )Conclusion: Treatment with captopril rapid uptitration can decrease aldosterone plasma levels lower than captopril with standard uptitration in patient with acute myocardial infarction.Keywords: Acute myocardial infarction, plasma aldosterone, captopril, captopril rapid uptitation.Correspondence: Verry Gunawan Sohan. Master Program of Family Medicine, Sebelas Maret University, Surakarta.Indonesian Journal of Medicine (2016), 1(3): 160-168https://doi.org/10.26911/theijmed.2016.01.03.0

Association Between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with Six-Minutes Walk Test in Patients After Acute Myocardial Infarction.

Background: The ischemia resulting from critical coronary narrowing or total occlusion first affects the subendocardialmyofibers. Thus, abnormalities in longitudinal function can be detected before reductions in LVEF and reflects infarct size. The 6MWT provides information that may be a better index of the patients ability to perform daily activities. This study was to assess the relationship between left ventricular (LV) global longitudinal strain (GLS) and functional capacity measured with 6 minute walk test (6MWT) after AMI.Subjects and Method: This is a cross sectional study of patients with STEMI and NSTEMI, at Moewardi Hospital, Surakarta. Eligible patients underwent echocardiography global longitudinal 2D-STE that performed within 48 hour of admission and 6MWT pre- discharge or at the first follow-up visits (day 4-9). Patients were divided into 2 groups according to the LV GLS value, patients with substantial infarction (LV GLS > -13.8%) and non-substantial infarction (LV GLS -13.8% (n=32) were more likely to be older (57.6 y.ovs 55 y.o), less in functional capacity (10.17 1.3 ml/kg/min vs 11.04 0.98 ml/kg/min; p= 0.018) and less in 6 MWT distance (347.97 65.49 m vs392.39 49.44 m; p=0.016). Using ROC curves, the 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8%, sensitivity of 72.2% and specificity 65.6%, respectively with AUC= 0.70 (CI 95%; 0.559-0.852; p= 0.017). However, LV GLS >-13.8% and age >60 y.o remained the independent predictor in a multivariate logistic regression analysis to identify 6 MWT distance -13.8%, (OR =7.967; CI 95%= 1.669-38.030; p=0.009) and age >60 y.o, (OR=10.898; CI95%= 2.201-53.971; p=0.003).Conclusions: In patients after AMI with substantial infarction (LV GLS >-13.8%) had less in functional capacity. The 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8% and could be used in rehabilitation program after AMI.Keywords: Acute Myocardial Infarction, LV Global longitudinal strain, functional capacity, 6 MWT.Correspondence:Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java.Indonesian Journal of Medicine (2017), 2(3): 192-206https://doi.org/10.26911/theijmed.2017.02.03.0

Association between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with Six-Minutes Walk Test in Patients after Acute Myocardial Infarction.

Background: The ischemia resulting from critical coronary narrowing or total occlusion first affects the subendocardialmyofibers. Thus, abnormalities in longitudinal function can be detected before reductions in LVEF and reflects infarct size. The 6MWT provides information that may be a better index of the patients ability to perform daily activities. This study was to assess the relationship between left ventricular (LV) global longitudinal strain (GLS) and functional capacity measured with 6 minute walk test (6MWT) after AMI.Subjects and Method: This is a cross sectional study of patients with STEMI and NSTEMI, at Moewardi Hospital, Surakarta. Eligible patients underwent echocardiography global longitudinal 2D-STE that performed within 48 hour of admission and 6MWT pre- discharge or at the first follow-up visits (day 4-9). Patients were divided into 2 groups according to the LV GLS value, patients with substantial infarction (LV GLS > -13.8%) and non-substantial infarction (LV GLS -13.8% (n=32) were more likely to be older (57.6 y.ovs 55 y.o), less in functional capacity (10.17 1.3 ml/kg/min vs 11.04 0.98 ml/kg/min; p= 0.018) and less in 6 MWT distance (347.97 65.49 m vs392.39 49.44 m; p=0.016). Using ROC curves, the 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8%, sensitivity of 72.2% and specificity 65.6%, respectively with AUC= 0.70 (CI 95%; 0.559-0.852; p= 0.017). However, LV GLS >-13.8% and age >60 y.o remained the independent predictor in a multivariate logistic regression analysis to identify 6 MWT distance -13.8%, (OR =7.967; CI 95%= 1.669-38.030; p=0.009) and age >60 y.o, (OR=10.898; CI95%= 2.201-53.971; p=0.003).Conclusions: In patients after AMI with substantial infarction (LV GLS >-13.8%) had less in functional capacity. The 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8% and could be used in rehabilitation program after AMI.Keywords: Acute Myocardial Infarction, LV Global longitudinal strain, functional capacity, 6 MWT.Correspondence:Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java.Indonesian Journal of Medicine (2017), 2(3): 192-206https://doi.org/10.26911/theijmed.2017.02.03.0

Effect of Captopril Rapid Uptitration to Plasma Aldosterone level in Patients with Acute Myocardial Infarction

Background: Acute myocardial infarction is a myocardial necrosis associated with acute myocardial ischemia of which the incidence keeps increasing over time. Appropriate management of acute myocardial infarction is very important in order to determine the efficacy of the therapy and also to prevent further complications due to acute myocardial infarction. Captopril is essential in the management of acute myocardial infarction to inhibit the renin-angiotensin-aldosterone system whereby aldosterone may increase the probability of heart failure and increase mortality up to approximately 10 times compared to patients with acute myocardial infarction without heart failure. The administration of captopril should be uptitrated the doses in order to obtain optimal results, however there is no such fixed standard on how fast the doses of captopril should be uptitrated in order to obtain a more optimal effect, especially in order to suppress the plasma aldosterone level. This study examined the effect of rapid uptitration of captopril in the first 3 days of treatment of patients with acute myocardial infarction on plasma aldosterone levels compared to the increase in the captopril standard uptitration.Subjects and Method: This is an experimental research with Randomized Controlled Trial (RCT). 28 patients with Acute Myocardial Infarction on Cardiovascular Intensive Care Unit (ICVCU) and Cardiovascular wards of RSUD Dr. Moewardi hospital Surakarta were sequentially involved as research subjects and then randomly divided into a control group who received standard captopril uptitration and treatment group who received captopril rapid uptitration. The blood plasma was taken on the first day before the administration of captopril and on the last day of treatment. The plasma aldosterone level was tested by ELISA. Independent t-tests were carried out for data that qualified the normality test and mann whitney test if not qualified in the normality test with kolmogorov smirnov. It was considered statistically significant if the value of p < 0.05.Results: Plasma Aldosterone levels in treatment group was lower than control group and statistically significant (1133.54 ± 748.81 pg/dl vs 512.16 ± 444.81 pg/dl; p = 0.013 )Conclusion: Treatment with captopril rapid uptitration can decrease aldosterone plasma levels lower than captopril with standard uptitration in patient with acute myocardial infarction.Keywords: Acute myocardial infarction, plasma aldosterone, captopril, captopril rapid uptitation.Correspondence: Verry Gunawan Sohan. Master Program of Family Medicine, Sebelas Maret University, Surakarta.Indonesian Journal of Medicine (2016), 1(3): 160-168https://doi.org/10.26911/theijmed.2016.01.03.0

PEMBERDAYAAN YAYASAN SEBAGAI PELOPOR GERAKAN MASYARAKAT HIDUP SEHAT DALAM UPAYA PENCEGAHAN PENYAKIT HIPERTENSI

ABSTRAKPenyakit Tidak Menular (PTM) merupakan penyebab kematian tertinggi di dunia, termasuk di Indonesia. Salah satu PTM yang cukup tinggi prevalensinya adalah hipertensi. Kabupaten Karanganyar merupakan salah satu kabupaten di provinsi Jawa Tengah dengan jumlah kasus hipertensi yang cukup tinggi dan prevalensinya terus meningkat dari tahun ke tahun. Pemerintah Indonesia dan pemerintah kabupaten setempat telah mencanangkan Gerakan Masyarakat Hidup Sehat (Germas) sebagai upaya pengendalian PTM. Yayasan Usaha Umat Karanganyar (YUUK), sebuah organisasi masyarakat yang berlokasi di Tasikmadu, Karanganyar, telah memiliki program kegiatan pendidikan dan pelatihan yang diperlukan oleh masyarakat setempat, namun program pendidikan dan pelatihan tersebut belum menjamah aspek kesehatan masyarakat. Untuk mengoptimalkan kesehatan masyarakat setempat melalui pemberdayaan organisasi kemasyarakatan, tim pengabdian masyarakat yang tergabung dalam grup riset Human Proteomics Fakultas Kedokteran Universitas Sebelas Maret (FK UNS) melakukan kegiatan penyuluhan dan konsultasi tentang hipertensi dan serta pelatihan penggunaan tensimeter digital dan oximeter. Kegiatan tersebut bertujuan untuk meningkatkan peran serta YUUK dalam pencegahan dan deteksi dini penyakit hipertensi. Sasaran kegiatan ini adalah para remaja di sekitar masjid Al Walidah Tasikmadu Karanganyar. Hasil dari kegiatan tersebut adalah meningkatnya pemahaman peserta mengenai hipertensi dan keterampilan memantau kesehatan kardiovaskuler melalui penggunaan tensimeter digital. Evaluasi kegiatan ini dilakukan dengan cara menghubungi pengurus YUUK untuk mendapatkan laporan tentang implementasi pemanfaatan 2 unit tensimeter digital dan 1 unit oximeter yang diberikan oleh tim pengabdi kepada pengelola Yayasan untuk dimanfaatkan sebaik-baiknya bagi masyarakat sekitar. Tim pengabdi juga terus memonitor prevalensi hipertensi dari tahun ke tahun di Kabupaten Karanganyar. Kata kunci: hipertensi; pemberdayaan masyarakat; penyakit tidak menular ABSTRACT Non-communicable diseases (NCD) are the major causes of mortality in the world, including in Indonesia. One of the most prevalent type of NCD is hypertension. Karanganyar is a district in Central Java province with high incidence of hypertension and its prevalence continues to rise over years. Both central and local governments have established "Gerakan Masyarakat Hidup Sehat (Germas)", a community-based movement to promote healthy lifestyle, to control NCD. "Yayasan Usaha Umat Karanganyar (YUUK)", a community organization located in Tasikmadu, Karanganyar, provides education and training for locals but their main focus has not reached health programs. To optimize the locals' health through empowerment of community organizations, we conducted education and counseling about hypertension as well as training on using digital sphygmomanometer and oxymeter. The activities aimed to increase YUUK's roles in the prevention and early detection of hypertension. The activities involved teenagers living in the catchment area of Al Walidah mosque, Tasikmadu, Karanganyar. The activites resulted in an increased understanding about hypertension and skills to monitor cardiovascular health by using a digital sphygmomanometer,  Evaluation was performed by contacting the YUUK manager who is responsible for reporting the use of 2 units of digital sphygmomanometers and 1 unit of oxymeter that were given during the occasion so that the equipment can be used by locals. We also continuosly monitor the annual prevalence of hypertension in Karanganyar district. Keywords:  hypertension; community empowerment; non-communicable disease

The diagnostic and prognostic value of right ventricle systolic and diastolic function in inferior myocardial infarction patients

Background: Inferior myocardial infarction (MI) with right ventricular (RV) involvement will increase mortality and morbidity. Data of systolic and diastolic RV function in inferior ST-segment elevation MI (STEMI) are useful to predict the RV involvement.  Aims: To evaluate the prognostic and diagnostic significance of RV systolic and diastolic function compared to RVMI diagnostic criteria by electrocardiography in inferior MI patients. Methods: Consecutive patients with first, acute, inferior STEMI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography was performed within 24 hours of the inferior STEMI symptoms. We assessed the RVMI diagnostic criteria in inferior MI patients using echocardiography. Results: Out of 31 patients (mean age 56.39 ± 9.02 years), RVMI by electrocardiography and echocardiography was found in 18 (37%). Moreover, multivariate analysis showed that two variables — RV systolic and diastolic function, were independent predictors of RVMI in inferior MI patients. Sensitivity and specificity of the RV systolic function were 94.4% and 69.2%, respectively, while RV diastolic functions were 44% and 76.9%, respectively. Conclusion: RV systolic function predict RVMI with relatively high sensitivity and specificity. RV diastolic function predicts RVMI with relatively low sensitivity but with high specificity

Pemberdayaan Yayasan Sebagai Pelopor Gerakan Masyarakat Hidup Sehat Dalam Upaya Pencegahan Penyakit Hipertensi

Penyakit Tidak Menular (PTM) merupakan penyebab kematian tertinggi di dunia, termasuk di Indonesia. Salah satu PTM yang cukup tinggi prevalensinya adalah hipertensi. Kabupaten Karanganyar merupakan salah satu kabupaten di provinsi Jawa Tengah dengan jumlah kasus hipertensi yang cukup tinggi dan prevalensinya terus meningkat dari tahun ke tahun. Pemerintah Indonesia dan pemerintah kabupaten setempat telah mencanangkan Gerakan Masyarakat Hidup Sehat (Germas) sebagai upaya pengendalian PTM. Yayasan Usaha Umat Karanganyar (YUUK), sebuah organisasi masyarakat yang berlokasi di Tasikmadu, Karanganyar, telah memiliki program kegiatan pendidikan dan pelatihan yang diperlukan oleh masyarakat setempat, namun program pendidikan dan pelatihan tersebut belum menjamah aspek kesehatan masyarakat. Untuk mengoptimalkan kesehatan masyarakat setempat melalui pemberdayaan organisasi kemasyarakatan, tim pengabdian masyarakat yang tergabung dalam grup riset Human Proteomics Fakultas Kedokteran Universitas Sebelas Maret (FK UNS) melakukan kegiatan penyuluhan dan konsultasi tentang hipertensi dan serta pelatihan penggunaan tensimeter digital dan oximeter. Kegiatan tersebut bertujuan untuk meningkatkan peran serta YUUK dalam pencegahan dan deteksi dini penyakit hipertensi. Sasaran kegiatan ini adalah para remaja di sekitar masjid Al Walidah Tasikmadu Karanganyar. Hasil dari kegiatan tersebut adalah meningkatnya pemahaman peserta mengenai hipertensi dan keterampilan memantau kesehatan kardiovaskuler melalui penggunaan tensimeter digital. Evaluasi kegiatan ini dilakukan dengan cara menghubungi pengurus YUUK untuk mendapatkan laporan tentang implementasi pemanfaatan 2 unit tensimeter digital dan 1 unit oximeter yang diberikan oleh tim pengabdi kepada pengelola Yayasan untuk dimanfaatkan sebaik-baiknya bagi masyarakat sekitar. Tim pengabdi juga terus memonitor prevalensi hipertensi dari tahun ke tahun di Kabupaten Karanganyar