Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKLatar Belakang: Lesi koroner kompleks berkaitan dengan prognosis buruk SKA. Pentingnya revaskularisasi awal untuk mengurangi angka morbiditas dan mortalitas. PLR berkaitan dengan kompleksitas lesi buruk dan diharapkan menjadi acuan dalam identifikasi dini lesi koroner kompleks.Tujuan: Mengetahui akurasi diagnostik dan nilai titik potong PLR sebagai penapis lesi koroner kompleks baik pada kelompok usia ≤45 tahun dan >45 tahun.Metode: Sebuah studi potong lintang secara retrospektif di ICCU RSUPN-CM. Data diambil dari rekam medis pasien SKA dewasa dan menjalani angiografi koroner dari Januari 2012 ? Juli 2015. Akurasi diagnositik dinilai dengan menghitung sensitivitas dan spesifisitas. Nilai titik potong ditentukan menggunakan kurva ROC.Hasil: Proporsi pasien SKA dengan lesi koroner kompleks 47,2%. Nilai titik potong optimal pada pasien usia ≤45 tahun adalah 111,06 dengan sensivitas 91,3% dan spesifisitas 91,9. Pada kelompok usia >45 tahun nilai titik potong optimal pada angka 104,78 dengan nilai sensivitas 91,7% dan spesifisitas 58,6.Simpulan: Nilai titik potong PLR optimal pada kelompok usia ≤45 adalah 111,06 dan kelompok usia >45 tahun adalah 104,78 dengan akurasi diagnositik masing-masing AUC 93,9% (p <0,001) dan AUC 77,3% (p <0,001).

---

ABSTRACT

Background: A Complex coronary lesion is related to poor prognosis in ACS patient. The importance of early revascularization is to decrease mortality and complications. Inflammatory marker such as PLR related to complex coronary lesions and expected to be a tool that can assist physicians and cardiologists to stratify patients who have high probability for having a complex coronary lesion.

Aim: Evaluate the diagnostic accuracy of PLR in identifying a complex coronary lesion in ACS patient. The other aim was to identify the proportion of complex coronary lesion and cut-off point of PLR between ≤45 years old group and >45 years old group subjects.

Method: This is a cross sectional retrospectively study in ACS patients hospitalized in ICCU of RSUPN-CM from January 2012 until July 2015. The inclusion are adult ACS patients and who underwent coronary. The diagnostic accuracy was determined by calculating the sensitivity, specificity, PPV, NPV, Positive LR, and Negative LR. The cut-off point was determined using ROC curve.

Results: The proportion of complex coronary lesion was 47,2%. The optimal cut-off point in ≤45 years old group was 111,06 with sensitivity and specificity respectively 91,3% and 91,9%. The optimal cut-off points in >45 years old groups was 104,78 with sensitivity and specificity respectively 91,7% and 58,6%.

Conclusion: The optimal cut-off point of ≤45 years old groups is 111,06 and for >45 years old group is 104,78. The diagnostic accuracy of PLR in ≤45 years old groups was very good (AUC 93,9%, p value <0,001), while in >45 years old group was moderate (AUC 77,3%, p value <0,001)."

"Rasio Netrofil-Limfosit (RNL) adalah pemeriksaan laboratorium murah dan mudah didapatkan dimanapun, dan saat ini berkembang menjadi penanda luaran pada berbagai kondisi, termasuk pada Sindrom Koroner Akut (SKA). RNL menggabungkan dua jalur inflamasi berbeda (netrofil dan limfosit) untuk memprediksi luarannya, dan beberapa studi telah menunjukkan manfaatnya dalam memprediksi Major Adverse Cardiac Events (MACE). Penelitian ini bertujuan untuk membuktikan manfaat RNL dalam stratifikasi risiko SKA pada populasi Indonesia, dan menentukan nilai titik potong RNL untuk peningkatan risiko MACE. Metode: 380 rekam medis pasien SKA dari Januari 2012-Agustus 2015 diikutkan dalam studi ini. Karakteristik, faktor risiko kardiovaskuler, dan hasil pemeriksaan laboratorium subjek dikumpulkan dan diikuti secara retrospektif untuk menilai kemunculan MACE (aritmia, infark ulang, in-stent restenosis, gagal jantung akut, syok kardiogenik, kematian) selama perawatan. Nilai RNL didapatkan dari pembagian hitung netrofil dan limfosit absolut. Analisis statistik untuk menentukan nilai titik potong RNL dan penyesuaian untuk faktor perancu dilakukan untuk memvalidasi hasil. Hasil: Subjek mayoritas merupakan laki-laki, dengan rerata usia 57,92 tahun. Hipertensi dan merokok merupakan faktor risiko yang paling sering ditemukan. Rerata RNL subjek adalah 4,72, dan MACE ditemukan pada 73 kasus (19,2%). Setelah analisis ROC, didapatkan nilai titik potong sebesar 3.55 (sensitivitas 72,6%, spesitifitas 60,6%, AUC 0.702). Ditemukan bahwa terdapat peningkatan insidens MACE pada kelompok RNL>3.55 (30.47% vs 9.71% pada ≤3.55, p<0.001). Setelah penyesuaian untuk faktor perancu, RNL>3.55 tetap signifikan dalam memprediksi MACE (p=0.02, adujsted OR 2,626 (IK95% 1,401-4,922)). Kesimpulan: RNL>3.55 adalah prediktor independen untuk kejadian MACE.

---

Background: Neutrophil-Lymphocyte Ratio (NLR) is a low-cost, readily available laboratory examination in various places, and is currently emerging as a prognostic marker for various conditions, including Acute Coronary Syndrome (ACS). NLR, which combines two different inflammatory pathways (neutrophil and lymphocyte), have been shown by several studies to be useful in predicting Major Adverse Cardiac Events (MACE). This study aims to prove NLR’s use in ACS risk stratification in Indonesians and determine a cutoff level for MACE risk increase.

Methods: 380 ACS patients’ medical records from January 2012 to August 2015 were included in this study. Subjects’ characteristics, cardiovascular risk factors and laboratory findings were collected, and retrospectively followed to evaluate for MACE (arrhythmia, reinfarction, in-stent restenosis, acute heart failure, cardiogenic shock, death) during hospitalization. NLR value was calculated from neutrophil and lymphocyte counts division. Statistical analysis to determine NLR cutoff point for MACE risks, and adjustment for confounding factors were done for results validation.

Results: Subjects were predominantly male, with average age of 57.92 years old. Hypertension and smoking were the most frequent risk factors found. Average NLR was 4.72, and MACE was found in 73 cases (19.2%). After ROC analysis, a cutoff of 3.55 was determined to be satisfactory (sensitivity 72.6%, spesitivity 60.6%, AUC 0.702). It was found that there is a significant increase in MACE incidence in NLR>3.55 (30.47% vs 9.71% in ≤3.55, p<0.001). After adjusting for confounding factors, NLR>3.55 was still significant in predicting MACE (p=0.02, adujsted OR 2,626 (CI95% 1,401-4,922)).

Conclusion: NLR>3.55 is an independent predictor of in-hospital MACE."

"ABSTRAK Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanyalebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuahperangkat yang memiliki peran penting dalam prognosis mortalitas PJK. SkormACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.Informasi tersebut berguna dalam menentukan prioritas tindakan angiografikoroner. Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagaiprediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yangmengalami sindrom koroner akut (SKA). Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCMtahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan denganmenggunakan Receiver Operating Characteristic (ROC) curves dengan intervalkepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengancara menghitung sensitivitas, spesifisitas, RKP, dan RKN. Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%. Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGKstadium 3 dan 4 yang mengalami SKA adalah 2,288. Akurasi diagnostik skor mACEF dinilai baik.ABSTRACT Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively."

"Pasien sindrom koroner akut (SKA) dengan penyakit ginjal kronik (PGK) diketahui memiliki risiko mortalitas lebih tinggi dibandingkan dengan pasien SKA tanpa disertai PGK. Setiap tahunnya, dilaporkan 9% kematian akibat penyakit jantung koroner (PJK) yang disertai PGK, yaitu hampir 10 – 20 kali lebih tinggi dibanding populasi umum. Pada pasien SKA dengan PGK terjadi proses inflamasi kronik yang memainkan peranan penting dalam perubahan morfologi dan fungsional sel endotel yang mengakibatkan akselerasi proses aterosklerosis yang berkaitan dengan keparahan koroner pasien SKA dan berujung meningkatkan kejadian major adverse cardiac event (MACE). Penelitian ini bertujuan untuk mengetahui peran rasio neutrofil limfosit (RNL) sebagai prediktor MACE dan korelasinya dengan derajat keparahan koroner pada pasien SKA dengan PGK. Digunakan 2 desain pada penelitian ini, yaitu studi nested case control dengan 31 subjek yang mengalami MACE sebagai kelompok kasus dan 28 subjek yang tidak mengalami MACE sebagai kelompok kontrol dari total 59 pasien SKA dengan PGK, serta studi korelatif dengan pendekatan potong lintang. Pada penelitian ini didapatkan area under curve (AUC) sebesar 60,8% dengan nilai titik potong RNL terhadap kejadian MACE adalah 3,62 dengan sensitivitas 74,2% dan spesifisitas 42,9%. Tidak terdapat perbedaan dan hubungan yang bermakna antara nilai RNL dengan kejadian MACE (p>0,05; OR=2,16 [95%CI=0,63 – 7,51]) dan tidak terdapat korelasi antara nilai RNL dengan derajat keparahan koroner yang dinilai menggunakan skor Gensini (r=0,10; p=0,474).

---

Acute coronary syndrome (ACS) patients with chronic kidney disease (CKD) are known to have a higher risk of mortality compared to ACS patients without CKD. Every year, 9% of deaths due to coronary heart disease (CHD) accompanied by CKD reported, which is almost 10 – 20 times higher than the general population. In ACS patients with CKD, chronic inflammation play an important role in morphological and functional changes in endothelial cells that resulted in atherosclerosis acceleration associated with coronary severity in SKA patients, thus lead the increase in major adverse cardiac events (MACE). This study aims to determine the role of neutrophil lymphocyte ratio (NLR) as a predictor of MACE and its correlation with the degree of coronary severity in ACS patients with CKD. Two designs were used in this study, first using nested case control study with 31 subjects who experienced MACE as a case group and 28 subjects who did not experience MACE as a control group of a total of 59 ACS patients with CKD. Second using correlative study with a cross-sectional approach. Area under curve (AUC) of 60.8% was obtained with an NLR cutoff value for MACE is 3.62 with 74.2% sensitivity and 42.9% specificity. There is no significant difference and relationship between NLR and MACE (p>0.05; OR= 2.16 [95%CI=0.63 – 7.51]), also no correlation between NLR and coronary severity degree assessed using Gensini score (r = 0.10; p = 0.474)."

"Sindrom koroner akut (SKA) merupakan salah satu kegawatan kardiovaskular diInstalasi Gawat Darurat (IGD). Tatalaksana SKA yang ada saat ini membutuhkan waktuminimal 3 jam untuk menentukan apakah pasien dirawat atau dipulangkan, hal ini akanberdampak pada kepadatan IGD dan pemborosan biaya perawatan. European Society ofCardiology merekomendasikan algoritma 0/1 jam pada pasien dengan gambaran EKGnon elevasi segmen ST (NEST) dengan menggunakan high sensitive troponin T (hscTnT)dalam menegakkan atau penapisan infark miokard akut non elevasi segmen ST(IMA-NEST). Penelitian ini bertujuan untuk membandingkan nilai diagnostik hs-cTnTjam ke-1 dan jam ke-3 pada terduga SKA non elevasi segmen ST dengan awitan nyeridada kurang dari 6 jam. Desain penelitian potong lintang. Sebanyak 100 subjekpenelitian yang diambil secara konsekutif sampling. Sensitivitas, spesifisitas, nilaiprediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/1 jam secara berurutanadalah 93,75%, 98,81%, 93,75%, 98,81%, sementara sensitivitas, spesifisitas, nilaiprediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/3 jam secara berurutanadalah 87,50%, 96,81%, 93,33% 97,65%. Pemeriksaan hs-cTnT 0/1 jam dapatdipergunakan dalam rule in dan rule out terduga IMA-NEST dengan awitan nyeri dadakurang dari 6 jam.

---

Acute coronary syndrome (ACS) is one of the cardiovascular events in an EmergencyInstallation (ED). The patients management of ACS required at least 3 hours todetermined whether the patient hospitalized or outpatient, these would increased EDscrowded and high cost treatment. The European Society of Cardiology recommended a0/1 hour algorithm in patients with ECG showed non ST segment elevationusing highsensitive troponin T (hs-cTnT) parameter to rule in or rule out non ST segmentelevation myocard infarct (NSTEMI).We aimed to compare diagnostic values of hscTnTat the 1st and 3rd hour in NSTEMI with chest pain onset less than 6 hours. Studydesign was cross sectional. A total of 100 subjects enrolled by consecutive samplingmethod. Sensitivity, specificity, positive predictive value, and negative predictive valueof hs-cTnT 0/1 hours were 93.75%, 98.81%, 93.75%, 98.81%, while sensitivity,specificity, positive predictive value, and the negative predictive value of hs-cTnT 0/3hours were 87.50%, 96.81%, 93.33%, 97.65%. Hs-cTnT 0/1 hour test can be used inrule in and rule out suspect NSTEMI with the chest pain onset less than 6 hours."

"ABSTRAKLatar belakang Major adverse cardiovascular events (MACE) masih menjadi target yang dicegah dalam tata laksana sindroma koroner akut (SKA). Rasio netrofil-limfosit (RNL) terkait dengan dampak atau prognosis pada pasien dengan penyakit ini. Kondisi psikologis berperan sebelum, selama dan setelah infark. Psikoterapi suportif singkat (PSS) ditujukan untuk membangun kepercayaan diri, mengurangi cemas dan memperbaiki mekanisme koping terhadap penyakit ini.Tujuan Penelitian ini bertujuan membandingkan pengaruh PSS terhadap MACE, RNL dan gejala psikis pada pasien SKA yang dirawat di Intensive Cardiac Care Unit (ICCU).Metode Penelitian ini merupakan uji klinis random tidak tersamar ganda untuk membandingkan kelompok yang mendapat intervensi PSS dengan kontrol pada pasien SKA yang dirawat di ICCU RSUPN Cipto Mangunkusumo mulai 18 April hingga 30 Juli 2019 terhadap MACE, RNL dan gejala psikis. Intervensi PSS berlangsung 5 sesi selama rawatan di ICCU, kelompok PSS dan kontrol akan difollow-up pada saat sebelum pulang rawatan terhadap MACE (fatal aritmia, infark miokard rekuren, syok kardiogenik dan kematian), RNL dan gejala psikis yang diukur menggunakan inventori Hospital Anxiety Depression Scale (HADS). Data dianalisis menggunakan uji Chi square dan t tidak berpasangan untuk distribusi normal dan uji Fisher dan Mann-Whitney untuk yang tidak terdistribusi normal.Hasil Hasil menunjukkan kelompok PSS terdapat 32 pasien, dan kontrol sejumlah 35 pasien. Median usia sebesar 55 (32-86) tahun. Proporsi lelaki sebesar 74,6%. Rerata lama rawatan ICCU yaitu 5 (2-13) hari. Tidak ada kejadian MACE, namun insiden major adverse event lain (stroke) 3,13% pada PSS dan 5,71% pada kontrol. Rerata RNL kelompok PSS sebesar 3,35(2,26) dan kontrol 3,63(1,79), p 0,346 (95% KI -1,27-0,71). Delta rerata RNL 1,49, p 0,098 (95% KI -0,69 - 3,67); tanpa CHF 3,87(5,48), 0,33(2,54) pada kontrol, p 0,007 d 0,79; tanpa CAD 3,88(4,55), 0,84(2,51) pada kontrol, p 0,014, d 0,77. Rerata skor HAD-Ansietas kelompok PSS sebesar 4,63(3,52) dan kontrol 4,31(2,62), p 0,874 (95% KI -1,19 - 1,82). Delta rerata skor HAD-Ansietas sebesar -0,01, p 0,988 (95% KI -1,74-1,71). Rerata skor HAD-Depresi kelompok PSS sebesar 4,91 (2,63) dan kontrol 4,37 (3,05), p 0,447 (95% KI -0,86 - 1,93). Delta rerata skor HAD-Depresi sebesar 1,62, p 0,149 (95% KI -0,17 -3,41); dengan CHF 1,73(3,58), -1,27(2,8) pada kontrol, p 0,041, d 0,86; dengan CAD 2,08(3,4), -0,8(3,3) pada kontrol, p 0,035, d 0,80.

---

ABSTRACTBackground Major adverse cardiovascular events (MACE) is still the preventive target in management acute coronary syndrome (ACS). Neutrophil-lymphocyte ratio (NLR) is regarded to the impact or prognosis in this patients. Psychological conditions play a role before, during and after infarction. Brief supportive psychotherapy (BSP) is stressed in terms of building confidence, reduce anxiety and improve coping mechanisms of this illness.Aim The present study aims to compare influence of BSP on MACE, NLR, and psychological symptom in ACS patients to control one in ICCU.Method The study is a double opened clinical randomized study which was compared with controls before and after intervention to observe the influence of BSP on the patients with ACS who were treated in ICCU of RSUPN Cipto Mangunkusumo - Jakarta in April, 18th to July, 30th 2019 on MACE, NLR and psychological symptom. The BSP intervention was about 5 sessions as long as inpatient in ICCU, the BSP group and the control ones would be followed by the end of the day in ICCU for the MACE (fatal arrhythmias, recurrent myocardial infarction, cardiogenic shock, and death), NLR, and psychological symptom which it was measured with hospital anxiety depression scale (HADS) inventory. Data were analyzed with Chi square and independent t-test for normally distributed data and Fisher and Mann-Whitney test for abnormally ones.Results The study results showed 32 patients in brief supportive psychotherapy group and 35 patients in control one. The median age was 55(32 - 86) years old. The male proportion was 74,6%. The median length of stay in ICCU was 5(2-13) days. There was no MACE, but incident of other major adverse event (stroke) 3,13% in BSP and 5,71% in control. The mean NLR was 3,35(2,26) in BSP group and 3,63(1,79) in control one, p 0,346 (95% CI -1,27 - 0,71). The mean delta of NLR was 1,49, p 0,098 (95% CI -0,69 - 3,67); without CHF 3,87(5,48), 0,33(2,54) in control group, p 0,007 d 0,79; without CAD 3,88(4,55), 0,84(2,51) in control one, p 0,014, d 0,77. The mean of HAD-Anxiety score was 4,63(3,52) in BSP group and 4,31(2,62) in control one, p 0,874 (95% CI -1,19 -1,82). The mean delta of HAD-Anxiety score was -0,01, p 0,988 (95% CI -1,74 - 1,71). The mean of HAD-Depression score was 4,91(2,63) in BSP group and 4,37(3,05) in control one, p 0,447 (95% CI -0,86 - 1,93). The mean delta of HAD-Depression score was 1,62, p 0,149 (95% CI -0,17 - 3,41); with CHF 1,73(3,58), -1,27(2,8) in control group, p 0,041, d 0,86; with CAD 2,08(3,4), -0,8(3,3) in control one, p 0,035, d 0,80. Conclusions There was no MACE, but stroke incident lower in BSP than control one. There was influence of BSP on NLR in ACS patients without CHF or CAD, and psychological symptom in ACS ones with CHF or CAD."

"Sindrom koroner akut (SKA) berkaitan erat dengan aspek nutrisi. Pencegahan primer dan sekunder dimulai saat diketahui pasien memiliki risiko atau telah mengalami gejala. Permasalahan nutrisi pada SKA dapat menurunkan asupan selama perawatan intensif, terutama pada pasien usia lanjut karena terdapat berbagai komorbid yang dapat menjadi kendala pemberian nutrisi. Risiko malnutrisi selama perawatan di rumah sakit juga dapat terjadi dan akan mempengaruhi luaran klinis. Terapi medik gizi bertujuan mengurangi respons inflamasi, mempertahankan imbang energi dan nitrogen positif, mencegah katabolisme, serta mencegah komplikasi. Serial kasus ini melaporkan empat orang pasien SKA yang dirawat di ruang rawat intensif. Usia pasien antara 51–64 tahun. Status gizi pasien saat admisi berkisar dari berat badan normal hingga obes morbid. Terapi medik gizi yang diberikan menggunakan panduan pada perawatan jantung intensif, sakit kritis, dan panduan lain sesuai kondisi klinis pasien. Pemberian nutrisi ditingkatkan bertahap sesuai kondisi klinis dan toleransi saluran cerna dengan target kebutuhan energi total dan protein tercapai saat persiapan pulang rawat. Mikronutrien yang diberikan adalah vitamin B kompleks dan asam folat. Seluruh pasien pulang dengan perbaikan kondisi klinis. Terapi medik gizi yang adekuat mendukung kesembuhan pasien.

---

Acute Coronary Syndrome (ACS) is closely related to nutritional aspects. Primary and secondary prevention should be started when the patients are known to be at risk or have experienced the symptoms. Patients with ACS have nutritional problems that can reduce intake during intensive care, particularly in elderly patients, because of various comorbidities that can be nutritional challenges. The risk of malnutrition during hospitalized may also occur and will affect clinical outcomes. Medical therapy in nutrition aims to reduce the inflammatory response, maintain energy and positive nitrogen balance, and prevent catabolism and complications. The patients were 51–64 years old. The nutritional status of patients at admission ranges from normal weight to morbid obesity. Medical therapy in nutrition was given using the guidelines for cardiac intensive care, critical illness, and other guidelines according to the patient's clinical condition. Provision of nutrition was gradually increased according to the clinical and gastrointestinal tolerance with the goal of achieving total energy requirements during discharge planning. The micronutrients given were B-complex vitamins and folic acid. All patients discharged with improvements in clinical conditions. Adequate medical therapy in nutrition supports the patients recovery."

"Latar belakang: Penyakit jantung koroner (PJK) masih menjadi masalah di Indonesia bahkan di dunia. Berdasarkan patofisiologinya, PJK dibagi menjadi sindrom koroner akut (SKA) dan kronik (SKK). Salah satu tatalaksana PJK adalah revaskularisasi otot jantung. Namun sangat penting untuk mengetahui viabilitas miokardium untuk kepentingan pengembalian fungsi kontraktilitas miokardium. Saat ini, magnetic resonance imaging (MRI) jantung adalah baku emas yang digunakan untuk mengevaluasi viabilitas miokardium. Namun ketersediaan modalitas ini sangat terbatas. Dobutamine stress echocardiography (DSE) juga dapat mengevaluasi viabilitas miokardium dan memiliki ketersediaan yang lebih luas di Indonesia. Tujuan: Meta analisis ini bertujuan membandingkan sensitivitas dan spesifisitas DSE terhadap MRI kardiak pada pasien dengan SKK. Metode: Meta analisis ini mencari literatur dari empat database yaitu Pubmed, Embase, Cochrane dan Scopus. Meta analisis ini mengacu pada Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 dan Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Forest plot menampilkan sensitivitas dan spesifisitas DSE dan MRI kardiak. Hasil: Terdapat tiga belas studi yang diinklusi. Dari penyusunan forest plot didapatkan DSE memiliki sensitivitas 75% (CI 0,61 – 0,86) dan spesifisitas 87% (CI 0,82 –0,91), dimana MRI kardiak memiliki sensitivitas 93% (CI 0,88 – 0,96) dan spesifisitas 77% (CI 0,61 – 0,87). Walaupun demikian, perlu diperhatikan beberapa faktor yang dapat menyebabkan overestimation pada sensitivitas dan spesifisitas DSE dan underestimation pada sensitivitas dan spesifisitas MRI kardiak. Kesimpulan: DSE memiliki sensitivitas yang lebih rendah dan spesifistas yang lebih tinggi dibandingkan MRI kardiak. Dengan mempertimbangkan overestimation dan underestimation kedua modalitas tersebut, MRI kardiak memiliki akurasi yang lebih baik dibandingkan DSE. Kata kunci: Sindrom koroner kronik, viabilitas miokardium, dobutamine stress echocardiography, magnetic resonance imaging kardiak.

---

Background: Coronary heart disease (CHD) still becomes a health problem in Indonesia, even in the world. Based on its pathophysiology, CHD is classified to acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). One of the treatment of CHD is myocardial revascularization, however it’s important to know the myocardial viability in prior in order to reverse the contractility function of the myocardium. Nowadays, cardiac magnetic resonance imaging (MRI) is the gold standard for evaluating myocardial viability. Nevertheless, the availibility of MRI is limited. Dobutamine stress echocardiography (DSE) is also able to evaluate myocardial viaiblity and widely available across Indonesia. Purpose: This meta analysis compares the sensitivity and specificity of DSE and cardiac MRI in patients with CCS. Method: This meta analysis searches literatures from four database: Pubmed, Embase, Cochrane and Scopus. We used Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 dan Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy as references. Forest plot is constructed to show the sensitivity and specificity of DSE and cardiac MRI. Result: Thirteen studies were included. The Forest plot shows that DSE has sensitivity of 75% (CI 0,61 – 0,86) and specificity of 87% (CI 0,82 – 0,91), while cardiac MRI has sensitivity of 93% (CI 0,88 –0,96) and specificity of 77% (CI 0,61 – 0,87). Conclusion: DSE has lower sensitivity yet higher specificity than cardiac MRI. Considering the overestimation and underestimation of these modalities, cardiac MRI has higher diagnostic accuracy than DSE."

"Latar Belakang Sindrom koroner akut (SKA) merupakan suatu penyakit yang disebabkan oleh penyumbatan pada arteri koroner jantung. Gejala utamanya adalah nyeri dada, yang disebut juga sebagai angina pektoris. TIMI risk score adalah suatu sarana penilaian risiko yang mengevaluasi berbagai faktor untuk menentukan prognosis pasien SKA. Namun, TIMI risk score tidak memperhitungkan tingkat transaminase aspartat serum dan transaminase alanina serum saat admisi pasien. Penelitian ini bertujuan untuk melihat apabila terdapat hubungan antara enzim tersebut dengan hasil TIMI risk score.Metode Penelitian ini merupakan suatu studi cross-sectional analitik yang dilaksanakan melalui pengumpulan data rekam medik Rumah Sakit Cipto Mangunkusumo, yang meliputi TIMI risk score, tingkat transaminase aspartat serum saat admisi pasien, dan tingkat transaminase alanina serum saat admisi pasien. Terdapat 111 sampel dan data yang telah diperoleh dianalisis menggunakan program SPSS.Hasil Tingkat transaminase aspartate serum pada saat admisi tidak berhubungan dengan hasil TIMI risk score pasien (p=,183). Tidak ditemukan hubungan statistik yang bermakna antara tingkat transaminase alanina serum pada saat admisi dengan hasil TIMI risk score pasien (p=,835).

---

Background Acute coronary syndrome (ACS) is a disease caused by blockage in the coronary arteries. Its characteristic symptom is chest pain, also called as angina pectoris. TIMI risk score is a risk assessment method that evaluate various factors to determine the prognosis of ACS patients. However, it does not take into account admission serum AST and ALT levels of the patient. This research aims to see whether the said liver enzymes are associated with TIMI risk score results.

Method The research is an analytical cross-sectional research that is performed through data collection, which includes TIMI risk scores, admission serum AST levels, and admission serum ALT levels, from the medical records of Rumah Sakit Cipto Mangunkusumo. There are 111 samples collected and the data that has been gathered is analysed using the SPSS program.

Results Admission serum AST levels are not associated with patients’ TIMI risk score results (p=.183). There is also no statistical significance between the patient’s admission serum ALT and his/her TIMI risk score result (p=.835).

Conclusion Data analysis show that there are no significant association between patients’ admission serum AST and ALT with their TIMI risk score. Thus, the use of admission serum AST and ALT are not able to assess prognosis of ACS patients."

"Latar Belakang: Keparahan stenosis pada penyakit jantung koroner (PJK) stabil berkaitan erat dengan prognosis. Dalam memprediksi keparahan stenosis dapat digunakan beberapa faktor klinis dan ekokardiografi. Akhir-akhir ini berkembang speckle tracking echocardiography yang mampu menilai strain miokardium dan baik untuk memprediksi stenosis. Penilaian faktor-faktor klinis dan ekokardiografi strain bersama-sama diharapkan mampu memprediksi lebih baik keparahan stenosis. Tujuan: Mengetahui apakah faktor-faktor klinis (usia, jenis kelamin, diabetes, angina tipikal, riwayat infark) dan global longitudinal strain (GLS) pada ekokardiografi strain dapat memprediksi keparahan stenosis pasien PJK stabil yang dinilai dengan skor Gensini. Membuat model prediktor dari parameter yang bermakna. Metode: Studi potong lintang dilakukan di RSCM pada periode Maret-Mei 2019. Pengambilan sampel secara konsekutif pada pasien PJK stabil yang menjalani angiografi koroner. Analisis bivariat dilakukan dengan chi-square, dilanjutkan analisis multivariat dengan regresi logistik metode baickward stepwise pada variabel yang bermakna. Hasil: Terdapat 93 subjek yang masuk dalam penelitian. Pada analisis bivariat faktor-faktor prediktor yang bermakna adalah diabetes melitus (OR 2,79; IK95%:1,08-7,23), riwayat infark (OR 4,04; IK95%:1,51-10,80), angina tipikal (OR 5,01; IK95%:1,91-13,14), dan GLS ≥-18,8 (OR 30,51; IK95%:10,38-89,72). Pada analisis multivariat faktor-faktor prediktor yang bermakna adalah angina tipikal (OR 4,48; IK95%:1,39-14,47) dan GLS ≥18,8 (OR 17,30; IK95%:5,38- 55,66). Tidak dilakukan pembuatan model prediktor karena hanya 2 faktor prediktor yang bermakna. Simpulan: Angina tipikal dan GLS merupakan faktor-faktor prediktor keparahan stenosis pada pasien PJK stabil, sedangkan faktor usia, jenis kelamin, diabetes, dan riwayat infark bukan merupakan prediktor keparahan stenosis pasien PJK stabil. Model skor prediktor tidak dikembangkan karena hanya 2 faktor prediktor yang bermakna.

---

Background: In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical and echocardiographic parameters can predict severity of stenosis. Recently a new method in echocardiography called speckle tracking echocardiography can be used to asses myocardial strain, which is a good predictor of stenosis severity. Assessment of clinical parameters together with strain echocardiography parameter is expected to make better prediction. Objective: To determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain, can predict severity of coronary artery stenosis measured with Gensini score. To further develop a prediction model based on significant parameters. Methods: This is a cross-sectional study taken at Cipto Mangunkusumo Hospital during period March-May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi- square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. Results: The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; CI95%:1.08-7.23), history of myocardial infartion (OR 4.04; CI95%:1.51-10.80), typical angina (OR 5.01; CI95%:1.91-13.14), and GLS ≥-18.8 (OR 30.51; CI95%:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; CI95%:1.39-14.47) and GLS ≥18.8 (OR 17.30; CI95%:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions: Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors."