MID REGIONAL PRO ATRIAL NATRIURETIK PEPTIDE (MR PRO ANP) SEBAGAI BIOMARKER DISFUNGSI SISTOLIK VENTRIKEL KIRI JANTUNG PADA SEPSIS STUDI HUBUNGAN TNF- α – PROCALCITONIN – MR PRO ANP – DISFUNGSI JANTUNG

Latar belakang: Sepsis merupakan masalah kesehatan karena angka kesakitan dan kematiannya yang tinggi. Pelepasan sitokin pro inflamasi bersama faktor lain akan mengakibatkan disfungsi sistolik ventrikel kiri/DSVK jantung. Pada sepsis terjadi pelepasan MR pro ANP, PCT dan TNF-α karena stimuli sitokin pro inflamasi. Tujuan penelitian: Membuktikan MR pro ANP sebagai biomarker DSVK pada sepsis; mencari nilai AUC, sensitivitas, spesifisitas, cut off point dan probabilitas MR pro ANP, PCT dan TNF-α sebagai biomarker DSVK dan membuktikan adanya korelasi kadar TNF-α dengan MR pro-ANP serta adanya korelasi kadar MR pro ANP dengan PCT dan mencari prediktor diagnostik DSVK jantung yang terbaik. Metoda penelitian: Uji diagnostik non eksperimental dengan desain cross sectional, dilakukan pada 71 pasien sepsis setelah simple random sampling. Variabel yang diteliti MR pro ANP, PCT dan TNF-α serta LVEF dengan metoda Simpson. DSVK bila LVEF ≤ 45%. Data di lakukan analisis tabel 2x2 dan kurva ROC secara statistik menggunakan SPSS 22 for window. Hasil penelitian: Nilai AUC kadar MR pro ANP 0,84 (95% CI 0,73-0,95), p<0,001. Titik potong optimal pada ≥ 225,95 pmol/L dengan DOR sebesar 12,11. Nilai AUC kadar PCT 0,81 (95% CI 0,71 -0,91), p<0,001. Titik potong optimal PCT pada ≥ 7,875 ng/mL dengan DOR sebesar 5,55. Nilai AUC kadar TNF-α 0,73 (95% CI 0,60- 0,86), p<0,002. Titik potong optimal TNF-α pada ≥ 7,36 pg/mL dengan DOR sebesar 5,03. MR pro ANP berkorelasi positif lemah dengan TNF-α (r=0,197, p=0,100). MR pro ANP berkorelasi positif dengan PCT (r=0,309, p=0,009). Analisis multivariat didapatkan MR pro ANP sebagai predikor DSVK yang terbaik (AUC 0,78), kemudian PCT (AUC 0,70) dan TNF-α (AUC 0,69). Penggabungan MR pro ANP+PCT akan meningkatkan nilai diagnostik dengan AUC sebesar 0,87. Kesimpulan: MR proANP dapat digunakan sebagai biomarker DSVK. AUC MR pro ANP sebesar 0,84 (95% CI 0,73-0,95), p<0,001. Nilai cut off point pada ≥ 225,95 pmol/L dengan DOR 12,11. AUC PCT sebesar 0,81 (95% CI 0,71 -0,91), p<0,001 . Nilai cut off point pada ≥ 7,875 ng/mL dengan DOR 5,55 AUC TNF-α sebesar 0,71 (95% CI 0,60- 0,86), p<0,002. Nilai cut off point pada ≥ 7,36 pg/mL dengan DOR 5,03. TNF-α berkorelasi positif lemah dengan peningkatan kadar MR pro ANP. MR pro ANP berkorelasi positif dengan peningkatan kadar PCT. MR pro ANP prediktor diagnostik DSVK jantung yang terbaik. Penggabungan MR pro ANP + PCT merupakan prediktor diagnostik DSVK yang terbaik dan efisien. Kata kunci: biomarker, disfungsi sistolik ventrikel kiri, MR pro ANP, PCT, TNF-

Association between Resistin and High Sensitive Troponin I in St Elevation Myocardial Infarction and Systolic Heart Failure

Background: Nearly half of all patients with acute myocardial infarction (AMI) have left ventri­cular systolic dysfunction and one-third have symptoms of heart failure (HF). In patients with AMI the resistin level correlated inversely with left ventricular ejection fraction (LVEF). Increased levels of high sensitive (hs) troponin I are associated with poorer prog­nosis. This study aimed to deter­mine the association between levels of resistin and hs troponin I in ST elevation myocardial infarc­tion (STEMI) patients with systolic HF.Subjects and Method: This was a cross-sectional study was conducted at Dr. Moewardi Gene­ral Hospital, Surakarta, from April 1 to May 31, 2018. A sample of 32 patients who admitted which diagnosed with STEMI was selected for this study. They were divided into two group according to result of LVEF mea­sure­ment, LVEF < 40% and LVEF ≥ 40%. Blood examination and transthoracic echo-car­diography were performed to all patients. Cor­re­lation test using partial and multiple cor­relation test. To different 2 mean using Mann Whitney test.Results: Mean of patient age was 59.5 years old. Resistin decreased LVEF (r= -0.41; p= 0.009), and it was statistically significant. Hs troponin I decreased LVEF (r= -0.25; p= 0.081), but it was marginally significant. Resis-tin level and hs troponin I increased LVEF (r= 0.47; p= 0.025), and it statistically significant.Conclusion: There was an association between resistin and hs troponin I level together in STEMI patients with systolic HF. There was an association of resistin levels in STEM I patients with systolic HF. There was no association of hs troponin I levels in STEMI patients with systolic HF.Keywords: Resistin, hs troponin I, STEMI, systolic heart failure.Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hos-pital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: [email protected] Journal of Medicine (2020), 5(1): 1-9https://doi.org/10.26911/theijmed.2020.05.01.0

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 Early Spironolactone on the ST2 Level and Clinical Changes in Acute Decompensated Heart Failure Patients

Background: In spite ofmajor advances in therapy, morbidity, and mortality due to acute decom­pen­sated heart failure (ADHF) remain poor. Early initiation of mineralocorticoid antagonist (spironolactone) may increase the suppression of negative effect of renin-angiotensin-aldosterone system (RAAS) activation, even though it already uses ACEI/ARB accompanying ADHF and give a better outcome. This study aims to determine the effect of early spironolactone 100 mg a day for 3 consecutive days on the suppression of tumorigenicity 2 (ST2) level and clinical changes in patients with ADHF.Subjects and Method: This was a randomized single blind controlled trial. Thirty eight conse­cutive patients with ADHF hospitalized at Dr. Moewardi Hospital, Surakarta were randomized into two groups: spironolactone group (standard therapy plus spironolactone 100 mg per day for 3 day, n=19) and control group (standard therapy, n=19). Clinical sign and simptom of ADHF was monitored everyday and the difference of clinical changes was evaluated at the day-3. Venous blood samples were collected from all patients at the first day prior therapy and day-4 after therapy. The dependent variable was ST2 level. The independent variable wasSpironolacton therapy. The data were analyzed by independent t-test.Results: Decreased levels of ST2 in the spironolactone group (mean= 36.96; SD= 21.29) was higher than the control group (mean= 19.73; SD= 16.48) and it was statistically significant (p= 0.008). Spironolacton therapy 100 mg once daily at the first 3 day in patient with ADHF was safe, no hiperkalemia, or worsening renal function. There was decreasing risk of hipokalemia up to 33% (RR= 0.33; 95% CI= 0.1 to 1.0; p= 0.036) and greater proportion patient with improvement clinical simptom and sign of ADHF at day-3 in the spironolactone group vs control group.Conclusion: Administration of spironolactone 100 mg at the first 3 day plus standard therapy decreases levels of ST2, safe, decreases risk of hipokalemia and give greater proportion of clinical improvement patients ADHF.Keywords: Spironolactone, ADHF, ST2Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Uni­versitas Sebelas Maret/Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126. Indonesia. Email: [email protected]. Indonesian Journal of Medicine (2019), 4(3): 232-240https://doi.org/10.26911/theijmed.2019.04.03.0

Blood Urea Nitrogen as a Predictor of In-Hospital Mortality in Acute Coronary Syndrome Patients

Background: Acute coronary syndrome (ACS) is one of the major causes of morbidity and mortality worldwide. Thus, it is important to effectively diagnose and determine prognosis and mortality risk. While criteria such as Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) score are clinically used to work out the prognosis of patients with ACS, the examination of Blood Urea Nitrogen (BUN) and creatinine alongside in predicting outcome may prove favorable as well. This study aimed to determine the efficacy of BUN and creatinine in mortality risk assessment of patients with ACS and to find which one is better.Subjects and Method: This was an analytical study with a cohort retrospective design included 1463 ACS patients in Dr. Moewardi hospital from January 2014 to July 2018. The relationship between admission BUN, creatinine level, and in-hospital mortality was analyzed with chi-square and logistic regression. Receiver Operating Characteristic (ROC) curve to determine which one better as a predictor of in-hospital mortality.Results: The mean age of patients was 60 years old (mean= 60.08; SD= 11.04), which 72.9% were men. From all sample, 232 (15.9%) patients were died. In binary log regression models, elevated BUN (>50 mg/dL) at admission was an independent predictor of in-hospital mortality (OR= 4.01; 95% CI= 1.0 to 7.0; p= 0.001). Similar results were obtained for elevated creatinine (>1.3 mg/dL) at admission (OR= 3.6; 95% CI= 2.2 to 5.8; p= 0.031). ROC curves showed that area under the curve (AUC) of BUN (0.87) was higher than AUC of creatinine (0.61).Conclusion: Elevated BUN and creatinine are independent predictors of in-hospital mortality in ACS patients. A high-level of BUN at admission is a more accurate predictor of in-hospital mortality than creatinine.Keywords: blood urea nitrogen, creatinine, acute coronary syndromeCorrespondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126. Indonesia. Email: [email protected] Journal of Medicine (2019), 4(3): 241-251https://doi.org/10.26911/theijmed.2019.04.03.0

EFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL INFARCTION PATIENTS RECEIVING FIBRINOLYTIC THERAPY

EFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL&nbsp; INFARCTION&nbsp; PATIENTS RECEIVING FIBRINOLYTIC THERAPY &nbsp; Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia &nbsp; Background: Worldwide, coronary heart disease (CHD) is a leading cause of death. Inflammation in CHD and acute myocardial infarction (AMI) is a trigger due to the formation of atheroma plaques in the coronary arteries. N-Acetylcysteine ​​(NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. Objective: To determine the effect of NAC on hsCRP levels in patients with acute myocardial infarction who received fibrinolytic therapy. Methods: This study was an experimental study with pre and post, single blind and randomization methods on the effect of NAC on hsCRP levels compared to controls carried out in July - August 2018 on the incidence of ST Elevation Myocardial Infarction (STEMI) came to Dr Moewardi Hospital and get fibrinolytic therapy. Results: A total of 33 patients were included in this study, there were 15 patients (mean age 58.80 ± 8.54 years) of the control group and 18 patients (mean age 55.45 ± 9.92 years) the treatment group receiving additional therapy of NAC evervescent 600 mg three times a day for three days . This study showed that hsCRP levels after intervention in the control and treatment groups were significantly different with p = 0.001. The level of hsCRP in the control group after administration of NAC had a median of 114.50 mg / L (18.60 - 300.00) while in the treatment group had a median of 18.75 mg / L (5.50 - 102.90). Conclusion: The addition of NAC 600 mg of therapy three times daily for 3 days can reduce hsCRP levels in patients with STEMI receiving fibrinolytic therapy compared to patients with acute myocardial infarction with ST segment elevation who did not receive additional NAC therapy. Keywords: hsCRP, N-Acetylcysteine, acute myocardial infarction . &nbsp; PENGARUH N-ACETYLCYSTEIN TERHADAP HSCRP PADA PASIEN INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN ST YANG MENDAPAT TERAPI FIBRINOLITIK &nbsp; Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1 Departemen Ilmu Penyakit Jantung dan Pembuluh Darah, Fakultas Kedokteran Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia &nbsp; Latar Belakang: Di seluruh dunia, penyakit jantung koroner (PJK) merupakan penyebab utama kematian. Inflamasi pada PJK dan infark miokard akut (IMA) merupakan pemicu akibat terbentuknya plak ateroma pada arteri koroner. N-Acetylcysteine (NAC) dapat mencegah inflamasi, remodeling dan disfungsi ventrikel kiri, fibrosis interstisial, dan meningkatkan survival. Tujuan: Untuk mengetahui pengaruh&nbsp; NAC terhadap kadar hsCRP pada pasien infark miokard akut yang mendapatkan terapi fibrinolitik. Metode:&nbsp; Penelitian ini merupakan penelitian eksperimental dengan metode pre dan post, single blind dan randomisasi&nbsp; mengenai pengaruh NAC terhadap kadar hsCRP dibandingkan dengan kontrol yang dilakukan pada bulan Juli - Agustus 2018 terhadap paien Infark Miokard Akut dengan Elevasi Segmen ST (IMA-EST) yang datang ke&nbsp; Rumah Sakit Dr Moewardi dan mendapat terapi fibrinolitik. Hasil: Sebanyak 33 pasien diikutsertakan pada penelitian ini, terdapat 15 pasien (rerata usia 58.80±8.54 tahun) kelompok kontrol dan 18 pasien (rerata usia 55.45±9.92 tahun) kelompok perlakuan yang mendapat terapi tambahan NAC evervescent 600 mg tiga kali sehari selama tiga hari.&nbsp; Penelitian ini menunjukkan bahwa kadar hsCRP sesudah dilakukan intervensi pada kelompok kontrol dan perlakuan berbeda bermakna dengan nilai p = 0.001. Kadar hsCRP pada kelompok kontrol&nbsp; sesudah pemberian NAC memiliki median 114.50 mg/L(18.60 – 300.00) sedangkan pada kelompok perlakuan memiliki median 18.75 mg/L(5.50 – 102.90). Kesimpulan: Pemberian terapi tambahan NAC 600 mg tiga kali sehari selama 3 hari dapat menurunkan kadar hsCRP pada pasien infark miokard akut dengan elevasi segmen ST yang mendapat terapi fibrinolitik dibanding pasien infark miokard akut dengan elevasi segmen ST yang tidak mendapat terapi tambahan NAC. Kata Kunci: hsCRP, &nbsp;N-Acetylcysteine, infark miokard aku

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

The Effect of Colchicine Administration on HsCRP Level and Mean Platelet Volume in Patients with Miocard Acute Infark

Background: Patients with coronary heart disease (CHD) who have received standard therapy to the fullest, are still at risk for further cardiovascular events. This is likely because the standard therapy fails to inhibit some inflammatory pathways and platelet aggregation which implies the disease. This study aimed to determine the effect of colchicine on reducing levels of high sensitive c-reactive protein (HsCRP) and mean platelet volume (MPV) in patients with Acute Myocardial Infarction (IMA) in the Intensive Cardiovascular Unit (ICVCU) Dr. Moewardi Hospital, Surakarta.Subjects and Method: Experimental study was conducted with pre and post design. The study was conducted from November 1 to December 31, 2016. A sample of 32 patients with Acute Myocardial Infarction was divided into two groups. The control group was given a placebo and the treatment group was given colchicine 0.5 mg orally for 5 days. Statistical analysis was done using two mean different tests with dependent t-test or Mann-Whitney and two mean analysis paired using independent t-test or Wilcoxon.Results: The HsCRP delta level in colchicine group (mean = 3.82; SD = 2.20) was higher than control group (mean = 0.57; SD = 3.12) and it was statistically significant (p<0.001). The delta MPV levels in colchicine group (mean = 2.01; SD = 1.16) were higher than control group (mean = 0.64; SD = 0.83) and it was statistically significant (p = 0.001).Conclusion: The administration of 0.5 mg colchicine by oral for 5 days was associated with levels of HsCRP and MPV among IMA patients. Keywords: Colchicine, HsCRP, MPV, Acute Myocardial InfarctionCorrespondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta57126, Central Java, Indonesia. Email: [email protected] Journal of Medicine (2018), 152-157https://doi.org/10.26911/theijmed.2018.03.03.0

Association between Hscrp Levels and Glycemic Control with Total Interatrial Conduction Time in Type 2 Diabetes Mellitus Patients

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) represents one of the most important risk factors for atrial fibrillation (AF). Numerous studies have shown that T2DM and poor glycemic control reflected by glycated hemoglobin A1c (HbA1c) levels are independently associated with AF onset. Recent experimental studies reported that the increased susceptibi-lity to AF in the diabetic patients was presumably due to the slowing con-duction associated with increased interstitial fibrosis. Systemic inflame-mation can play role in the development of atrial fibrillation. High-sensitivity C-reactive protein (HsCRP) is an inflammatory biomarker that independently predicts the cardiovascular risk. This study aimed to analy-ze the association between HsCRP level, glycemic control, and total intera-trial conduction time in T2DM patients. SUBJECT AND METHODS: This was an analytic cross sectional study. A total of 41 patients with T2DM were evaluated. HsCRP and HbA1c were measured from peripheral venous blood samples taken from these patients. The total interatrial conduction time was measured by tissue Doppler echocardiography. Multiple regression analysis was use to analyzed the data. RESULTS: The high-sensitivity C-reactive protein level was higher in the T2DM patients with HbA1c≥7% (0.44±0.30) than in the T2DM patients with HbA1c<7% (0.32±0.22), although statistically non-significant (p=0.183). The total atrial conduction time (milliseconds) was longer in the T2DM patients with HbA1c≥7% (100.29±28.53) than in T2DM patients with HbA1c<7% (94.88±16.50), although statistically non-signifi-cant (p=0.449). Multiple regression analysis showed that HsCRP level (b=38.78; 95%CI=14.01 to 63.54; p=0.003) and glycemic control (b=14.04; 95%CI=0.09 to 27.98; p=0.048) had positive association with total interatrial conduction time in T2DM patients. CONCLUSION: HsCRP level and glycemic control had significant positive association with total interatrial conduction time in T2DM patients. Keywords: HsCRP, glycemic control, HbA1c, total interatrial conduction time