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Bhanu
Peran skor modified ACEF dalam memprediksi kompleksitas lesi koroner pada pasien penyakit ginjal kronik stadium 3 dan 4 dengan sindrom koroner akut = Role of modified ACEF score in predicting severity of coronary lesions in patients with chronic kidney disease stages 3 and 4 with acute coronary syndrome
"ABSTRAK
Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat
tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanya
lebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuah
perangkat yang memiliki peran penting dalam prognosis mortalitas PJK. Skor
mACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.
Informasi tersebut berguna dalam menentukan prioritas tindakan angiografi
koroner.
Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagai
prediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yang
mengalami sindrom koroner akut (SKA).
Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179
subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCM
tahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan dengan
menggunakan Receiver Operating Characteristic (ROC) curves dengan interval
kepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengan
cara menghitung sensitivitas, spesifisitas, RKP, dan RKN.
Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas
90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%.
Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGK
stadium 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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 mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, 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."
Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Astuti Giantini
Peran faktor genetik dan epigenetik terkait resistensi klopidogrel terhadap kejadian kardiovaskular mayor pada pasien sindrom koroner akut pasca intervensi koroner perkutan = The role of genetic and epigenetic factors related to clopidogrel resistance in major adverse cardiovascular events on acute coronary syndrome patients after percutaneous coronary intervention
"Sindrom koroner akut (SKA) merupakan masalah kesehatan nasional karena tingginya angka morbiditas dan mortalitas serta beban biaya yang dibutuhkan. Intervensi koroner perkutan (IKP) dan terapi antiplatelet seperti klopidogrel merupakan tata laksana yang direkomendasikan oleh organisasi kardiologi internasional. Meskipun demikian, pasien SKA masih dapat mengalami kejadian kardiovaskular mayor (KKM). Kemungkinan, resistensi klopidogrel berperan pada KKM sedangkan resistensi klopidogrel mungkin dipengaruhi oleh faktor genetik dan epigenetik. Penelitian ini bertujuan untuk mengetahui hubungan faktor genetik yaitu polimorfisme gen CYP2C19 dan P2Y12, serta epigenetik yaitu metilasi DNA gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dengan resistensi klopidogrel dan pengaruhnya terhadap KKM pada pasien SKA pasca IKP.
Untuk menganalisis hubungan faktor genetik dan epigenetik dengan resistensi klopidogrel, penelitian dilakukan dengan desain potong lintang, sedangkan untuk analisis hubungan faktor genetik dan epigenetik dengan KKM dilakukan dengan desain kohort prospektif. Subjek penelitian meliputi 201 pasien SKA pasca IKP dan mendapat terapi klopidogrel di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dari bulan September 2018 sampai dengan Juni 2020. Resistensi klopidogrel ditentukan dengan pemeriksaan light transmission aggregometry (LTA) apabila hasilnya lebih besar dari 59% dengan agonis ADP 20 mM. Deteksi polimorfisme gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dilakukan dengan metode qRT-PCR, sedangkan metilasi DNA gen CYP2C19 dan P2Y12 dikerjakan dengan metode konversi bisulfit. Pasien diobservasi selama satu tahun dan jika ada angina pektoris, infark miokard akut (IMA) rekuren, stroke, atau kematian, dicatat sebagai KKM.
Dari 201 subjek, terdapat 45,8% carrier mutant polimorfisme *2 dan *3 gen CYP2C19, 36,8% carrier mutant polimorfisme rs3679479 gen P2Y12, 10% hipometilasi DNA gen P2Y12, 80,1% hipometilasi DNA gen CYP2C19, dan 66,2% ekspresi miRNA-26a up regulated. Proporsi resisten klopidogrel adalah 49,8% dan proporsi KKM adalah 14,9% (kematian 7,5%). Terdapat hubungan antara merokok (p = 0,001; OR 0,37 [IK 95%; 0,20–0,68]), hipometilasi DNA gen CYP2C19 (p = 0,037; OR 2,13 [IK 95%; 1,04–4,37]), dan ekspresi miRNA-26a up regulated (p = 0,020; OR 2,03 [IK 95%; 1,12–3,68]) dengan resistensi klopidogrel. Terdapat hubungan antara jenis kelamin perempuan (p = 0,040; HR 2,73 [IK 95%; 1,05–7,14]), usia ≥ 60 tahun (p = 0,035; HR 2,17 [IK 95%; 1,06–4,48]), eGFR rendah (p = 0,001; HR 3,29 [IK 95%; 1,59–6,84]), dan polimorfisme *2 dan *3 gen CYP2C19 (p = 0,047; HR 2,12 [IK 95%; 1,01–4,46]) dengan KKM dalam satu tahun.
Hanya faktor epigenetik berupa metilasi DNA gen CYP2C19 dan ekspresi miRNA-26a yang berhubungan dengan resistensi klopidogrel. Walaupun resistensi klopidogrel tidak berhubungan dengan KKM, terdapat hubungan antara faktor genetik polimorfisme *2 dan *3 gen CYP2C19 dengan KKM.
Acute coronary syndrome (ACS) is a national health problem due to high morbidity and mortality, and cost burden as well. Percutaneous coronary intervention (PCI) and antiplatelet therapy such as clopidogrel are recommended. However, ACS patients could still experience major adverse cardiovascular events (MACE). Clopidogrel resistance possibly plays a role in MACE whereas it may be affected by genetic and epigenetic factors. Therefore, the objective of this study was to determine the relationship between genetic factors which are CYP2C19 and P2Y12 polymorphisms, as well as epigenetic factors which are DNA methylation of CYP2C19 and P2Y12, and miRNA-26a expression and their effects on MACE in post-PCI patients.
To analyze the association between genetic and epigenetic factors and clopidogrel resistance, the study design was cross-sectional, while the study design of relationship between genetic and epigenetic factors and MACE was prospective cohort. The subjects were 201 post-PCI ACS patients who received clopidogrel therapy at Harapan Kita Hospital from September 2018 to June 2020. Clopidogrel resistance was determined by light transmission aggregometry (LTA) if the result was greater than 59% with agonist ADP 20 µM. The detection of CYP2C19 and P2Y12 gene polymorphisms and miRNA-26a expression were carried out by qRT-PCR method, while the DNA methylation of the CYP2C19 and P2Y12 genes were carried out by bisulfite conversion method. Patients were observed for one year and angina pectoris, recurrent acute myocardial infarction (AMI), stroke, or death, were recorded as MACE.
From 201 subjects, 45.8% were CYP2C19*2 and CYP2C19*3 polymorphism mutant carrier, 36.8% were rs3679479 P2Y12 polymorphism mutant carrier, 10% were hypomethylated of P2Y12, 80.1% were hypomethylated of CYP2C19, and 66.2% were up regulated in miRNA-26a expression. 49.8% of subjects were clopidogrel resistant and 14.9% of subjects experienced MACE (death was 7.5%). Smoking (p = 0.001; OR 0.37 [CI 95%; 0.20–0.68]), hypomethylated of CYP2C19 (p = 0.037; OR 2.13 [CI 95%; 1.04–4.37]), and up regulated miRNA-26a expression (p = 0.020; OR 2.03 [CI 95%; 1.12–3.68]) were associated with clopidogrel resistance. Female gender (p = 0.040; HR 2.73 [CI 95%; 1.05–7.14]), age over 60 years old (p = 0.035; HR 2.17 [CI 95%; 1.06–4.48]), low eGFR (p = 0.001; HR 3.29 [CI 95%; 1.59–6.84]), and CYP2C19*2 and CYP2C19*3 polymorphisms (p = 0.047; HR 2.12 [CI 95%; 1.01–4.46]) were associated with MACE in one year.
Only DNA methylation of CYP2C19 and miRNA-26a expression were associated with clopidogrel resistance. Although clopidogrel resistance was not associated with MACE, there was association between CYP2C19*2 and CYP2C19*3 polymorphisms and MACE."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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UI - Disertasi Membership  Universitas Indonesia Library
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Fahrani Imanina Putri Nurtyas
Peran rasio Neutrofil Limfosit sebagai Prediktor Major Adverse Cardiac Event serta Korelasinya dengan Derajat Keparahan Koroner pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik = The Role of Neutrophil Lymphocyte Ratio as Major Adverse Cardiac Event Predictor and Its Correlation with Coronary Severity in Acute Coronary Syndrome Patient with Chronic Kidney Disease
"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)."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Ahmad Fariz Malvi Zamzam Zein
Pengaruh hiperglikemia admisi terhadap kejadian aritmia selama perawatan pasien sindrom koroner akut = The influence of hyperglycemia at admission on in hospital arrhythmia in patients with acute coronary syndrome
"ABSTRAK
Latar Belakang: Aritmia selama perawatan merupakan komplikasi yang sering
terjadi pada pasien sindrom koroner akut (SKA) sehingga dibutuhkan identifikasi
risiko secara dini.
Tujuan: Mengetahui insidens pasien SKA yang mengalami aritmia selama
perawatan dan mengetahui pengaruh hiperglikemia admisi terhadap kejadian
aritmia selama perawatan pasien SKA.
Metode: Studi kohort retrospektif ini menggunakan rekam medik pasien SKA yang
dirawat di ICCU RSPUN dr. Cipto Mangunkusumo dalam periode 1 Januari-31
Desember 2014. Hiperglikemia admisi didefinisikan sebagai kadar gula darah
admisi >140 mg/dL. Kejadian aritmia selama perawatan meliputi aritmia atrium,
takikardia supraventrikular, blok AV derajat tinggi, dan aritmia ventrikel, yang
diidentifikasi dalam tujuh hari pertama perawatan.
Hasil: Terdapat 232 subjek pada penelitian ini. Prevalensi hiperglikemia admisi
adalah 50,43%. Insidens pasien SKA yang mengalami aritmia selama perawatan
adalah 21,55% (IK 95% 16,26-26,84). Analisis bivariat menunjukkan
hiperglikemia admisi terkait dengan peningkatan risiko aritmia selama perawatan
(RR 1,747; IK 95% 1,042-2,930). Tidak terdapat hubungan yang bermakna antara
jenis SKA, diabetes melitus (DM), obesitas, dan hipertensi dengan kejadian aritmia
selama perawatan. Analisis multivariat menunjukkan OR hiperglikemia admisi
setelah penyesuaian adalah 2,852 (IK 95% 1,351-6,024), dengan variabel perancu
DM.
Simpulan: Insidens pasien SKA yang mengalami aritmia selama perawatan adalah
21,55%. Hiperglikemia admisi dapat meningkatkan risiko kejadian aritmia selama perawatan pasien SKA.ABSTRACT Background: The in-hospital arrhythmias complicating acute coronary syndrome
(ACS) is a common complication, and its ealy risk identification is urgently needed.
Aim: to determine the incidence of in-hospital arrhythmia complicating ACS and
to determine the influence of HA on in-hospital arrhythmia complicating ACS.
Methods: a retrospective cohort study was conducted using secondary data from
medical records of patients with ACS who were admitted to ICCU RSCM between
January 1st-Desember 31st, 2014. Hyperglycemia at admission was defined when
the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias
were observed during the first seven days of hospitalization.
Result: there were 232 subjects. The prevalence of HA WAS 50.43%. The
incidence of in-hospital arrhythmias was 21.55% (95% CI 16.26-26.84). In
bivariate analysis, there was significant association between HA and in-hospital
arrhythmia (RR 1.747; 95% CI 1.042-2.930). There were no significant relationship
among the type of ACS, diabetes mellitus (DM), obesity, and hypertension, with
the influence of HA on in-hospital arrhythmia. In multivariate analysis, the adjusted
OR of HA was 2.852 (95% CI 1.351-6.024), and DM was the confounding variable.
Conclusion: In-hospital arrhythmias is a common complication in patients with
ACS. Hyperglycemia at admission may increase the risk of in-hospital arrhythmia complicating ACS. ;Background: The in-hospital arrhythmias complicating acute coronary syndrome
(ACS) is a common complication, and its ealy risk identification is urgently needed.
Aim: to determine the incidence of in-hospital arrhythmia complicating ACS and
to determine the influence of HA on in-hospital arrhythmia complicating ACS.
Methods: a retrospective cohort study was conducted using secondary data from
medical records of patients with ACS who were admitted to ICCU RSCM between
January 1st-Desember 31st, 2014. Hyperglycemia at admission was defined when
the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias
were observed during the first seven days of hospitalization.
Result: there were 232 subjects. The prevalence of HA WAS 50.43%. The
incidence of in-hospital arrhythmias was 21.55% (95% CI 16.26-26.84). In
bivariate analysis, there was significant association between HA and in-hospital
arrhythmia (RR 1.747; 95% CI 1.042-2.930). There were no significant relationship
among the type of ACS, diabetes mellitus (DM), obesity, and hypertension, with
the influence of HA on in-hospital arrhythmia. In multivariate analysis, the adjusted
OR of HA was 2.852 (95% CI 1.351-6.024), and DM was the confounding variable.
Conclusion: In-hospital arrhythmias is a common complication in patients with
ACS. Hyperglycemia at admission may increase the risk of in-hospital arrhythmia complicating ACS. "
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Irman Firmansyah
Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien pasca Sindroma Koroner Akut = Difference between Plasma Serotonin and Salivary Cortisol with Depressive Symptoms in Post-Acute Coronary Syndrome Patients
"Latar Belakang: Penyakit kardio-serebrovaskular dengan kematian tertinggi sebagian besar diakibatkan Sindroma Koroner Akut (SKA). Dalam perjalanan penyakit tersebut dapat timbul gangguan psikis berupa depresi. Dilaporkan bahwa depresi sering terjadi dan menetap, dengan prevalensi sekitar 20% pada pasien dengan penyakit jantung. Gangguan psikis memiliki hubungan yang erat dengan pengaruh hormonal seperti kortisol dan serotonin. Pada pasien SKA dapat terjadi disfungsi otonom dan disregulasi aksis HPA yang menyebabkan peningkatan kortisol yang dapat memperburuk prognosispasien SKA. Sehingga penting untuk mengetahui pengaruh hormonal yaitu kadar kortisoldan serotonin dalam mengurangi gejala depresi yang akan ditelaah pada penelitian ini. Metode: Penelitian ini merupakan penelitian cross sectional untuk mengetahui peran kortisol dan serotonin terhadap kejadian depresi pada pasien SKA pasca perawatan. Penelitian dilakukan di ICCU RSUPN dr. Cipto Mangunkusumo Jakarta Pusat, Divisi Kardiologi Departemen Ilmu Penyakit Dalam FKUI/RSCM dan Divisi Psikosomatik danPaliatif Departemen Ilmu Penyakit Dalam FKUI/RSCM pada 73 orang responden yang memenuhi kriteria inklusi dengan menggunakan wawancara, pengisian kuesioner HADS,pemeriksaan fisik, dan pemeriksaan laboratorium. Hasil: Sebanyak 15,1% pasien SKA mengalami depresi pasca perawatan. Hasil uji statistik antara serotonin plasma terhadapdepresi tidak bermakna secara statistik dengan p value 0,482, demikian pula dengan kortisol saliva dengan p value 0,275. Namun ditemukan bahwa, kadar rerata hormon serotonin pada pasien SKA dalam penelitian ini adalah 189 ng/ml dan kadar rerata kortisol pada pasien SKA pada penelitian ini adalah 2,19 ng/mL. Kesimpulan: Secara statistik, tidak ditemukan perbedaan signifikan antara kadar kortisol terhadap gejala depresi pada pasien paska sindrom koroner akut dengan nilai p-value 0,275. Namun, penelitian ini bermakna secara klinis dilihat dari kadar serotonin plasma yang lebih rendah pada pasien dengan depresi dan lebih tinggi pada pasien yang tidak depresi. Begitu pula dengan kadar kortisol saliva lebih tinggi pada pasien dengan depresi dan lebih rendah pada pasien yang tidak depresi.
Background: Cardio-cerebrovascular disease with the highest mortality is mostly due toAcute Coronary Syndrome (ACS). During the course of the disease, psychological disorders such as depression may happen. It has been reported that depression is commonand persistent, with a prevalence of approximately 20% in patients with heart disease. Psychological disorders have a close relationship with hormones such as cortisol and serotonin. In ACS patients, autonomic dysfunction and dysregulation ofthe HPA axis canoccur and cause an increase in cortisol which can worsen the prognosis of ACS patients. So it is important to know the how hormones, namely cortisol and serotonin in reducing depressive symptoms which will be examined in this study. Methods: This study is a cross-sectional study to determine the impact of cortisol and serotonin in the incidence ofdepression in post-treatment ACS patients. The research was conducted at the ICCU RSUPN dr. Cipto Mangunkusumo Central Jakarta, Division of Cardiology Department ofInternal Medicine FKUI/RSCM and Division of Psychosomatics and Palliative Department of Internal Medicine FKUI/RSCM in 73 respondents who met the inclusion criteria by using interviews, filling out HADS questionnaires, physical examinations andlaboratory tests. Results: A total of 15.1% of ACS patients experienced post-treatment depression. The statistical test results between plasma serotonin and depression were notstatistically significant with a p value of0.482, as well as salivary cortisol with a p valueof 0.275. However, it was found that the average serotonin level in ACS patients in this study was 189 ng/ml and the average cortisol level in ACS patients in this study was 2.19 ng/mL. Conclusion: Statistically, there was no significant relationship between cortisol levels and depressive symptoms in post-acute coronary syndrome patients with a p-valueof 0.275. However, this study is clinically significant in view of the lower plasma serotonin levels in patients with depression and higher in patients who are not depressed.Likewise, salivary cortisol levels were higher in patients with depression and lower in patients who were not depressed."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Joshua Eldad Frederich Lasanudin
Association between admission serum aspartate aminotransferase and alanine aminotransferase levels with TIMI risk score in acute coronary syndrome patients = Asosiasi antara tingkat transaminase aspartat dan transaminase alanina serum saat admisi dengan TIMI risk score pada pasien dengan sindrom koroner akut
"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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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Diding Heri Prasetyo
Korelasi kadar asam urat serum dengan keparahan stenosis arteri koroner pasien sindrom koroner akut (Studi Meta Analisis) = Correlation of serum uric acid levels with the severity of coronary artery stenosis in patients with acute coronary syndrome (Meta Analysis Study)
"Latar Belakang: Sindrom koroner akut (SKA) adalah gangguan yang mengancam jiwa yang tetap menjadi sumber morbiditas dan mortalitas yang tinggi meskipun ada kemajuan dalam pengobatan. Hubungan antara asam urat serum dengan penyakit jantung iskemik masih kontroversial dan belum ditetapkan sebagai faktor risiko kardiovaskular. Interaksi kooperatif antara keduanya tidak sepenuhnya dipahami. Beberapa bukti epidemiologis hubungan kausal tersebut masih kontroversial. Sering sekali penelitian dengan kasus yang sama dan menggunakan metode yang sama tetapi hasilnya berbeda.
Tujuan: Penelitian ini bertujuan untuk melakukan meta analisis untuk mensintesis hasil-hasil penelitian yang berbeda tersebut agar diperoleh data baru yang bersifat kuantitatif dan lebih akurat.
Metode: Protokol penelitian didaftarkan di PROSPERO (CRD42020210948) dan telaah sistematis mengikuti pedoman preferred reporting items for systematic reviews and meta-analyses (PRISMA), dengan menelusuri studi yang dipublikasikan dalam rentan waktu dari Januari 2010 hingga Mei 2020. Cochrane Library, Ebsco, Medline/PubMed, ProQuest dan Sience Direct adalah sumber dari studi yang dipublikasikan. Meta analisis dilakukan untuk mensintesis korelasi antara kadar asam urat serum dan keparahan stenosis arteri koroner. Heterogenitas dinilai menggunakan I2, dan meta analisis menggunakan perangkat lunak Comprehensive Meta Analysis Version 3 (CMA3).
Hasil: Lima studi (n = 601 pasien) diidentifikasi didapatkan korelasi antara kadar asam urat serum dan skor Gensini (r = 0,548; p <0,001) pada pasien SKA. Bias heterogenitas ditemukan dalam analisis.
Simpulan: Keparahan stenosis arteri koroner pada pasien dengan SKA berkorelasi positif dengan kadar asam urat serum.
Background: Acute coronary syndrome (ACS) is a life-threatening disease which remains a source of high morbidity and mortality despite advances in treatment. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different.
Objective: This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately.
Methods: The study protocol was registered in PROSPERO (CRD42020210948) and systematic study follows the guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA), tracing studies published in January 2010 to May 2020. Sources of database using Cochrane Library, Ebsco, Medline/PubMed, ProQuest and Science Direct. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis. Heterogeneity was assessed using I2, and the meta-analysis was performed using Comprehensive Meta Analysis Version 3 (CMA3) software.
Results: Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis.
Conclusions: The severity of coronary artery stenosis in patients with ACS is positively correlated with serum uric acid levels"
Depok: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tesis Membership  Universitas Indonesia Library
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Anastasia Asylia Dinakrisma
Peran fragmented QRS FQRS sebagai prediktor major adverse cardiac event dalam 30 hari pada pasien sindrom koroner akut = The role of fragmented QRS FQRS as a predictor of major adverse cardiac event within 30 days in acute coronary syndrome patients
"Latar Belakang: Kematian kardiak dan reinfark merupakan MACE yang sering terjadi pada pasien SKA. Gelombang fragmented QRS fQRS merupakan penanda iskemia atau jejas miokardium dini pada pasien sindrom koroner akut SKA. Peran fQRS terhadap MACE 30 hari perlu diteliti lebih lanjut pada pasien SKA.
Tujuan: Mengetahui peran fQRS sebagai prediktor MACE berupa reinfark dan kematian kardiak pada pasien SKA di ICCU selama 30 hari.
Metode: Studi dengan desain kohort retrospektif untuk meneliti peran gelombang fragmented QRS sebagai prediktor MACE selama 30 hari pasien SKA, dengan menggunakan data rekam medis pasien SKA yang menjalani perawatan di ICCU RSCM pada bulan Juli 2015 - Oktober 2017. Analisis bivariat dan multivariat dengan logistik regresi dilakukan untuk menghitung crude risk ratio RR dan adjusted RR terjadinya MACE dalam 30 hari antara kelompok fQRS terhadap kelompok non-fQRS dengan menggunakan SPSS.
Hasil: Dalam 2 tahun, didapatkan jumlah subyek yang memenuhi kriteria inklusi dan eksklusi sebanyak 353 orang. Fragmented QRS didapatkan pada 60,9 subyek, dengan lokasi terbanyak di inferior 48,8 dan rerata onset 34 jam. Proporsi kejadian MACE 30 hari lebih tinggi pada grup fQRS vs non fQRS 15,8 vs 5,8. Pada analisis bivariat didapatkan fQRS meningkatkan probabilitas terjadinya MACE selama 30 hari pada pasien SKA, dengan risiko relatif RR sebesar 2,72 IK 95 1,3 -5,71. Sedangkan pada analisis multivariat, didapatkan adjusted RR 2,79 IK 95 1,29 - 4,43, setelah memperhitungkan 6 faktor perancu, yakni skor GRACE risiko sedang-berat, eGFR kurang dari 60 ml/menit, LVEF kurang dari 40, riwayat diabetes melitus, usia lebih dari 45 tahun dan hipertensi. Laju eGFR merupakan faktor perancu yang memberikan perubahan paling besar, yakni 12,4.
Kesimpulan: Proporsi fQRS pada SKA selama perawatan di ICCU RSCM sebesar 60,9. Fragmented QRS yang muncul pada fase akut pada pasien SKA yang dirawat di ICCU merupakan prediktor independen terjadinya MACE dalam 30 hari dan meningkatkan probabiltas terjadinya MACE 30 hari berupa kematian kardiak dan reinfark pada pasien SKA.
Background: Cardiac death and reinfarction are most common major adverse cardiac events in acute coronay syndrome. Fragmented QRS fQRS in 12 leads ECG is associated with myocardial injury and ischaemia in coronary artery disease. The role of fQRS as predictor of 30 days MACE cardiac death and reinfarction needs to be evaluated in acute coronary syndrome patients in Indonesia.
Objectives: To identify proportion and role of fQRS as a predictor 30 days MACE in acute coronary syndrome patients.
Methods: A cohort retrospective study was conducted by using secondary data acute coronary syndrome patients in Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 ndash October 2017. Analysis was done by using SPSS statistic for univariate, bivariate and multivariate logistic regression to obtain crude risk ratio and adjusted risk ratio of probability 30 days MACE patient with fQRS.
Result: Three hundred and fifty three subjects during 2 years were included in this study. Fragmented QRS was found in 60,9 subjects, more frequent in inferior leads 48,8, with mean onset 34 hours. Major adverse cardiac events were higher in fQRS vs non fQRS group 15,8 vs 5,8. Bivariate analysis showed higher probability of 30 days MACE in ACS patient RR 2,72, 95 CI 1,3 5,71. Multivariate analysis were done by using logistic regression with GRACE score moderate and high risk, low eGFR 60 ml min, low LVEF 40, diabetes melitus, age more than 45 years and hypertension as confounding factors, revealed adjusted RR was 2,79 95 CI 1,29 ndash 4,43. Low eGFR was a potential confounder in this study.
Conclusion: The fQRS proportion in ACS patients during ICCU admission was 60,9. Acute and persistent fQRS developed in ACS during hospitalization was an independent predictor of 30 days MACE cardiac death and reinfarction.Keywords fQRS, acute coronary syndrome, Major adverse cardiac event."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Tugas Akhir  Universitas Indonesia Library
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Anditha Ratnadhiyani
Pengalaman wanita pasca sindrom koroner akut dalam adaptasi terhadap perubahan kemampuan fungsional = The experiences of women after acute coronary syndrome in adaptation to functional ability changes / Anditha Ratnadhiyani
"ABSTRAK
Nama : Anditha RatnadhiyaniProgram Studi : Magister Ilmu KeperawatanJudul : Pengalaman Wanita Pasca Sindrom Koroner Akut dalam Adaptasi terhadap Perubahan Kemampuan Fungsional Pemulihan pasca sindrom koroner akut mencakup proses adaptasi individu terhadap perubahan kemampuan fungsional. Perkembangan dalam penelitian di bidang kardiovaskular menunjukkan dampak dan prognosis sindrom koroner akut yang lebih buruk pada wanita jika dibanding pria, yang dikaitkan dengan perbedaan dalam persepsi, prediktor klinis, dan status sosioekonomi. Penelitian ini bertujuan untuk mengeksplorasi pengalaman wanita pasca sindrom koroner akut dalam adaptasi terhadap perubahan kemampuan fungsional. Metode kualitatif dengan desain fenomenologi deskriptif digunakan untuk memperoleh gambaran pengalaman sepuluh partisipan dalam penelitian ini. Pengambilan data dilakukan dengan wawancara mendalam, kemudian dilakukan content analysis dengan metode Colaizzi. Teridentifikasi enam tema utama dari penelitian ini yaitu respon ketidaknyamanan setelah mengalami sindrom koroner akut, penurunan kemandirian dan kemampuan melakukan aktivitas sebagai dampak perubahan kondisi fisik, self-adjustment sebagai koping terhadap perubahan kemampuan fisik, revaskularisasi memberikan harapan kesembuhan, pengaruh dukungan terhadap psikologis, dan self-effort untuk memulihkan kemampuan fungsional. Hasil penelitian menunjukkan peran penting faktor psikologis dalam proses adaptasi wanita selama pemulihan, sehingga direkomendasikan peningkatan intervensi yang mendukung psikologis dalam tatalaksana pasien wanita dengan sindrom koroner akut. Kata kunci: adaptasi, kemampuan fungsional, sindrom koroner akut, wanita
ABSTRACT
Name Anditha RatnadhiyaniStudy Program Master of NursingTitle The Experiences of Women after Acute Coronary Syndrome in Adaptation to Functional Ability Changes Adaptation to functional ability changes is part of recovery after Acute Coronary Syndrome ACS . Earlier studies have indicated that women with ACS have worse impact and prognosis. It is associated with perception differences, clinical predictors and socio economy status. The aim of this study is to explore experiences of women after ACS in adaptation to functional ability changes. A qualitative study using phenomenological description design was conducted. Ten women after ACS participated in individual in depth interview. Data were analysed using Colaizzi rsquo s procedural approach. Women rsquo s experiences in adaptation were formulated into six main themes 1 inconvenience response to ACS 2 decrease in autonomy and ability to perform activities as a result of physical changes 3 self adjustment as a mechanism to cope with physical ability changes 4 being recovered by revascularization 5 social support promotes psychological improvement and 6 self efforts to improve functional abilities. This research denotes a major role of psychological factors in women rsquo s adaptation during recovery process. Therefore, developing a psychological based intervention for women after ACS is an important strategy to improve outcomes. Keywords acute coronary syndrome, adaptation, functional ability, women"
2016
T47065
UI - Tesis Membership  Universitas Indonesia Library
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Vera Abdullah
Pengaruh psikoterapi suportif singkat terhadap major adverse cardiovascular events, nilai rasio netrofil-limfosit dan gejala psikis pada pasien sindroma koroner akut yang dirawat di Intensive Cardiac Care Unit. = Influence of brief supportive psychotherapy in major adverse cardiovascular events, neutrophil-lymphocyte ratio and psychological symptoms in acute coronary syndrome patients in Intensive Cardiac Care Unit
"ABSTRAK
Latar 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.
ABSTRACT
Background 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."
Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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