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"Latar belakang : Coronary Artery Disease (CAD) merupakan masalah yang masih menjadi penyebab utama morbiditas dan mortalitas di dunia, dengan angka prevalensi yang semakin meningkat. Uji treadmill merupakan suatu modalitas diagnostik yang tersedia secara luas di Indonesia untuk menilai kemungkinan stenosis pembuluh darah koroner dan menjadi referensi perlu tidaknya corangiografi. Keterbatasan dalam ketepatan diagnostik uji treadmill, perlu ditingkatkan performanya, yang dimana dalam penelitian ini menggunakan Duke Treadmill Score (DTS) sebagai prediktor Coronary Artery Disease yang signifikan dengan corangiografi sebagai pemeriksaan baku emas.Tujuan : Mengetahui nilai DTS dalam mendiagnosis CAD signifikan pada pasien dengan uji treadmill positif.Metode : Penelitian potong lintang pada pasien dengan CAD stabil berusia 18-75 tahun yang menjalani uji treadmill dengan hasil positive ischemic response dan sudah dilakukan corangiografi di Poliklinik Pelayanan Jantung Terpadu RSCM dalam kurun waktu Januari 2011 hingga Desember 2013. DTS akan ditetapkan titik potongnya (cut-off point) dengan Receiver Operator Curve (ROC) kemudian ditentukan nilai sensitivitas dan spesifisitas. Setelah ditetapkan titik potong, dibuat tabel 2x2 yang nantinya didapatkan nilai duga positif dan negatif beserta rasio kemungkinan positif dan negatif dengan rentangan nilainya menurut batas 95 % interval kepercayaan (IK).Hasil : Terdapat 103 subyek dalam penelitian ini, dengan 37,9 % diagnosis CAD signifikan dari corangiografi. Rerata usia subyek penelitian 54,71 tahun yang dimana sebagian besar adalah wanita (53,4 %) dengan rentang usia 26-75 tahun. Faktor risiko CAD yang paling banyak ditemukan adalah hipertensi (51,5%). Didapatkan rerata DTS -3.53, yang sebagian besar termasuk dalam kelompok intermediate risk (89,3 %). Dari ROC ditentukan titik potong -8,85. Didapatkan hasil sensitivitas DTS adalah 28 % (IK 95 %: 17 % sampai 44 %), spesifisitas 95 % (IK 95 %: 87 % sampai 98 %), nilai duga positif (NDP) 79 % (IK 95 %: 52 % sampai 92 %), nilai duga negatif (NDN) 69 % (IK 95 %: 58 % sampai 77 %), dan rasio kemungkinan positif (RKP) 6,02 beserta rasio kemungkinan negatif (RKN) 0,75.Simpulan : DTS dapat memprediksi CAD yang signifikan pada titik potong -8,85 untuk pasien uji treadmill positif dengan nilai duga positif yang cukup baik.

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Background: Coronary Artery Disease (CAD) is one of the disease entity that leading cause of morbidity and mortality in worldwide. Treadmill test is part of the diagnostic modality which readily available to assess possibility of narrowing coronary artery and guiding us whether we need for the further investigation. Despite of that, treadmill test has limitation in diagnostic accuracy. Duke Treadmill Score (DTS) was also tested as a diagnostic score, and shown to predict significant CAD better than the ST-segment response alone.Objectives : To determine the potential of DTS as a predictor significant CAD in patients who showed positive ischemic response during treadmill test, comparing with coronary angiography as a gold standard.Methods : This is a cross-sectional study performed in adult patients with stable CAD that underwent treadmill test and coronary angiography in outward patient clinic of the Integrated Cardiac Service in Cipto Mangunkusumo Hospital between January 2011 and December 2013.Results : A total of 103 patients in this study, thirty nine patients (37,9 %) had significant CAD in coronary angiography. Briefly, mean age was 54,71 years and 55 patients (53,4 %) were females. The most common CAD risk factor was hypertension (51,5 %). A mean of DTS score was -3.53, which mostly categorized as intermediate risk (89,3 %). Based on DTS results, cut-off point was determined by using Receiver Operator Curve (ROC) method, in which value of -8,85 considering as a cut-off point. Sensitivity and specificity value of DTS were 28 % (CI 95 %: 17 % to 44 %), and 95 % (CI 95 %: 87 % to 98 %). Positive and negative predictive value were 79 % (CI 95 %: 52 % to 92 %) and 69 % (CI 95 %: 58 % to 77 %). Positive and negative likelihood ratio were 6.02 and 0.75.Conclusion : DTS has a good performance in predicting significant CAD at cut-off point -8,85 in patients with positive treadmill test."

"Angka kematian mendadak semakin meningkat setiap tahunnya. Kebanyakan diperkirakan akibat serangan jantung atau penyakit jantung koroner. Frekuensi nadi pemulihan dan kapasitas fungsional merupakan prediktor risiko kematian akibat gangguan jantung. Penelitian dilakukan untuk mengetahui gambaran frekuensi nadi pemulihan dan kapasitas fungsional pada pasien dengan penyakit jantung koroner. Metode Penelitian ini adalah deskriptif dilakukan dengan melakukan pemantauan terhadap 100 pasien penyakit jantung koroner yang menjalani pemeriksaan treadmill.Frekuensi nadi pemulihan diukur pada menit pertama setelah selesai pemeriksaan lalu dilakukan analisis kategori kapasitas fungsional. Hasil penelitian dari 53 laki-laki dan 47 perempuan yang mengikuti penelitian dengan rentang usia 40-78 tahun, hanya 31% yang mengalami gangguan frekuensi nadi pemulihan dan 44% yang mengalami gangguan kapasitas fungsional. Penelitian ini merekomendasikan pengkajian frekuensi nadi pemulihan dan kapasitas fungsional perlu dilakukan sebagai dasar dalam memberikan edukasi.

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Sudden death rate is increasing every year. Most expected cause is heart attack or coronary artery disease. Heart rate recovery and functional capacity as predictor of risk of death from cardiac event. The study was conducted to reveal the heart rate recovery and functional capacity in patients with coronary artery disease.

The method of study is descriptive, it was done by monitoring 100 coronary artery disease patients who underwent treadmill test. Heart rate recovery measured in the first minute after the treadmill test is completed and then the analysis of functional capacity categories was done.

The results of 53 men and 47 women who followed the study with age range 40-78 years, only 31% of patients were susceptible to abnormal heart rate recovery and 44% of patients were impaired functional capacity. The study recommend that ssessment of heart rate recovery and functional capacity needs to be done as a basis for providing education."

"Background:Cardiac rehabilitation in patients with Coronary Artery Bypass Surgery (CABG) is an effective way in reducing mortality in patients with coronary heart disease (CHD). The presence of impaired cardiac autonomic function is increase the risk of arrhythmias and sudden death. Exercise training as one component of cardiac rehabilitation can improve autonomic function that can be measured indirectly with Heart Rate Recovery (HRR). The aim of this study is to assess the effect of the frequency of physical exercise on improved of HRR.Metod:The data used for this analysis include 100 patients who underwent second phase of cardiac rehabilitation after CABG at Pusat Jantung Nasional Harapan Kita, Jakarta between July and October 2013. Patients were categorized into group I (exercise 3 times a week) : 40 people and group II (5 times a week exercise) : 60 people. Heart rate recovery was measured with a 6 minute walk test (6MWT). Measurements were performed 2 times, in the early phase and the evaluation phase after 12 times. Increased HRR from both groups were analyzed by linear regression analysis.Result :In our study, age, gender, diabetes mellitus, psychological, smoking, coronary artery bypass surgery and the duration of aortic cross clamp did not affect the increase of HRR. Five times a week exercise training gives significant increase of HRR compare to 3 times a week exercise training after analyzed multivariate linear regression ( RR 2.9, 95% KI 1.53 to 4.40, p <0.001 ).Conclusion:Frequency of physical exercise 5 times a week give a better response to the increase in HRR than exercise 3 times a week.

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Latar Belakang:Rehabilitasi jantung pada pasien Bedah Pintas Arteri Koroner (BPAK) merupakan tindakan efektif dalam menurunkan mortalitas pada pasien dengan Penyakit Jantung Koroner (PJK). Adanya gangguan fungsi otonom jantung dikatakan meningkatkan risiko aritmia dan kematian mendadak. Latihan fisik sebagai salah satu komponen rehabilitasi jantung dapat meningkatkan fungsi otonom yang dapat diukur secara tidak langsung dengan Heart Rate Recovery (HRR). Penelitian ini bertujuan untuk menilai pengaruh frekuensi latihan fisik terhadap peningkatan HRR.Metode:Sebanyak 100 pasien pasca BPAK yang melakukan rehabilitasi jantung fase II dipilih secara konsekutif sejak 1 Juli ? 15 Oktober 2013 di Pusat Jantung nasional Harapan Kita, Jakarta. Pasien dikelompokkan menjadi kelompok I (3 kali latihan seminggu) sebanyak 40 orang dan kelompok II (5 kali latihan seminggu) sebanyak 60 orang. Heart rate recovery satu menit diukur dengan uji jalan 6 menit/6 minute walk test (6MWT). Pengukuran dilakukan 2 kali, pada fase awal dan fase evaluasi setelah 12 kali. Peningkatan HRR dari kedua kelompok dianalisa dengan analisa regresi linier.Hasil:Pada studi kami, usia, gender, diabetes melitus, psikologis, merokok, bedah pintas arteri koroner dan lamanya aortic cross clamp setelah dianalisa tidak mempengaruhi peningkatan HRR secara bermakna. Frekuensi latihan 5 kali seminggu memberikan peningkatan HRR yang bermakna secara statistik dibandingkan 3 kali seminggu setelah dianalisa dengan regresi linier multivariate (RR 2,9; 95 % IK 1,53-4,40, p<0,001)Kesimpulan: Frekuensi latihan fisik 5 kali seminggu memberikan respon yang lebih baik terhadap peningkatan HRR dibandingkan latihan 5 kali seminggu."

"In the classic movie, The Breakfast Club this dialog among three adolescents is reflective of how teenagers often regard school and academics. In this example, Brian, clearly in the minority because he enjoys the physics club, is referred to as “a dork.” His schoolmate further goes on to characterize such clubs as, “demented and sad, but social …” Though a fictitious satire, the film reflects the unfortunate reality of how teenagers often regard school and students who are enthusiastic members of learning. This scorn and ridicule directed at Brian illustrates how students who value school are often subject to criticism and low social status; a claim which has been supported in the literature.Evaluating and promoting positive school attitude in adolescents goes beyond these traditional measurements and explores less psychologically focused indicators, including ecological factors and observable behaviors. This study provides school psychologists with a new, comprehensive, and ecologically based approach with which to evaluate the school attitude of high school students.​"

"Latar Belakang Uji latih jantung beban (ULJB) merupakan modalitas diagnostik PJKO yang telah lama digunakan. Meskipun demikian, perannya semakin semakin tergantikan oleh karena tingginya angka positif palsu, khususnya pada respons iskemik sugestif positif. Tujuan studi ini adalah untuk menyusun sebuah model algoritme prediksi menggunakan kecerdasan buatan untuk mendeteksi PJKO pada populasi respons iskemik sugestif positif.Metode Pasien yang menjalani ULJB dengan hasil respons iskemik sugestif positif dan angiografi koroner invasif dalam rentang 1 tahun pasca ULJB diikutsertakan dalam studi ini. Populasi studi dibagi secara acak menjadi kelompok latihan (80%) dan uji (20%) untuk membuat algoritme prediktif. Total 16 dari 122 fitur yang digunakan, meliputi informasi klinis, faktor risiko dan EKG saat ULJB. Algoritme yang digunakan meliputi support vector machine, logistic regression, random forest, k-nearest neighbor, naive Bayesian, Adaboost, decision tree dan extreme gradient boosting. Hasil Sebanyak 124 dari 513 pasien dengan respons iskemik sugestif positif ikutserta dalam studi ini. Algoritme random forest memiliki nilai akurasi yang paling tinggi 0,75±0,05 dengan indeks Youden 0,37 serta AUC 0,7±0,14. Sebanyak 86(69,35%) populasi terbukti memiliki stenosis signifikan.Kesimpulan ULJB dengan bantuan kecerdasan buatan dapat mendeteksi adanya PJKO pada pasien dengan sindroma koroner kronik dengan respons iskemik sugestif positif.

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Background Treadmill stress testing (TST) used to be an established diagnostic modalities in diagnosing obstructive coronary artery disease (OCAD) among patients with chronic coronary syndrome (CCS). Nevertheless, it has high false positive rate especially especially those with suggestive positive ischemic response (SPIR). We aim to develop an predictive model based on machine learning to detect OCAD among those with SPIR.

Method Patients who underwent TST and coronary angiography (CAG) within 1 year interval were enrolled into the study. They were randomly splitted into training (80%) and testing (20%) dataset for model development. Sixteen out of 122 features were used, including clinical information, risk factor and ECG parameter during TST. Several algorithm were used in model development including support vector machine, logistic regression, random forest, k-nearest neighbor, naive Bayesian, Adaboost, decision tree dan extreme gradient boosting.

Result 124 out of 513 patients with SPIR were enrolled in this study. Random forest algorithm achieved the highest accuracy (0,75±0,05) with Youden index of 0,37 and AUC 0,7±0,14. A total of 86(69,35%) patients had OCAD based on CAG.

Conclusion Machine learning based predictive model can diagnosed OCAD among CCS patients with SPIR."

"AbstrakPhysical excercises are hoped to improve functional capacity and quality of life of patients with chronic obstructive pulmonary disease (COPD). This study is aimed to assess the differences between treadmill and ergocycle exercise on changes in functional capacity and quality of life in patients with stable COPD.This is an experimental study with complete randomization and repeated pre and post-intervention observation. The study was conducted on 44 subjects with COPD who were presented at Persahabatan Hospital, Medical Rehabilitation Clinic, consisting of 22 subjects undergoing ergocycle exercise and 22 subjects undergoing treadmill exercise test. Functional capacity was assessed by using the 6 minutes walking test (6 MWT) performed at week I, V and IX. Quality of life was measured using the St. George Respiratory Questionnaire (SGRQ) at week I and IX. Training program was conducted for 8 weeks with exercise dosage based on the results of exercise test on week I. Treadmill and ergocycle exercise produce significant improvement in both the 6 MWT and SGRQ test since week I to IX. But in comparison, treadmill exercise improves 6 MWT distance better than ergocycle consistently at week I-V, V-IX and I-IX (p < 0.001). For the SGRQ score, both exercises did not differ significantly.Conclusion: Treadmill exercise is associated with significantly better improvement in functional capacity compared to ergocycle exercise in stable COPD subjects. Concerning quality of life, both exercises gave an equivalent improvement in stable COPD subjects."

"Latar belakang: DSV (Defek Septum Ventrikel) adalah satu dari banyak kasus penyakit jantung bawaan dengan angka 2,6 per 1000 kelahiran di Dunia. Salah satu komplikasi DSV yang sering ditemukan adalah DSV dengan hipertensi pulmonal. Diagnosis intervensi terhadap hipertensi arteri pulmonal menjadi perhatian pada 2-10% kasus DSV, sehingga pasien DSV yang bermanifestasi hipertensi pulmonal dilakukan pemeriksaan kateterisasi. Pasien usia 6 bulan menjadi pedoman batas usia untuk dilakukan kateterisasi di RSPJDNHK (Rumahsakit Pusat Jantung dan Pembuluh darah Nasional Harapan Kita). Sehingga antrean operasi menjadi lebih lama. Penelitian ini bertujuan untuk melihat pengaruh usia terhadap nilai PARi pascates oksigen dan mencari kelompok usia yang tidak memiliki hasil nonreaktif terhadap tes oksigen. Metode: Dilakukan studi Observasional retrospektif pada pasien DSV usia di bawah 5 tahun di RSPJDNHK tahun 2015 - 2020. Pengumpulan data melalui rekam medis pasien di divisi bedah jantung pediatrik RSPJDNHK. Pengambilan sampel dilakukan secara acak dengan perhitungan besar sampel mengikuti perhitungan besar sampel untuk uji komparatif numerik lebih dari dua kelompok dengan satu kali pengukuran. Analisis deskriptif dan analisis bivariat dilakukan dengan bantuan SPSS v 20.0. Hasil: Terdapat 178 sampel penelitian pada penelitian ini. Dari hasil penelitian diketahui bahwa usia berpengaruh atau berhubungan dengan nilai PARi pascates oksigen (p<0,05) pada pasien DSV usia di bawah 5 tahun. Simpulan: Terdapat hubungan usia dengan nilai PARi pascates oksigen dan usia ≤2 tahun memiliki nilai mutlak reaktif terhadap tes oksigen.

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Background: Ventricular Septal Defect (VSD) is one of the many cases of congenital heart disease with a rate of 2.6 per 1000 births in the world. One of the complications of VSD is pulmonary hypertension, with the prevalence of interventional diagnosis of pulmonary hypertension is about 2 – 10 % of VSD. Those who manifest pulmonary hypertension are undergone right heart catheterization. Patients aged six months are the limit for catheterization in National Cardiovascular Center Harapan Kita Hospital leads to a long waiting list. The study aimed to determine the effect on the PARi value of oxygen delivery and find age groups that have reactive results on oxygen tests.

Methods: A retrospective crossectional study was carried out in the pediatric cardiac surgery division of the National Cardiovascular Center Harapan Kita Hospital. Data were taken from the medical record, enrolling those treated from January 2015 to December 2020 with subjects under five years old with VSD pulmonary hypertension who underwent cardiac catheterization. Samples were taken randomly by calculating the sample size following the sample size calculation for the comparative numerical test of more than two groups with one measurement. Descriptive analysis and bivariate analysis were carried out using SPSS v 20.0.

Results: There were 178 subjects enrolled in this study. The age correlated to the post-oxygen test PARi value (p<0.05) on VSD patients under five years of age.

Conclusions: This study showed that age correlated to the PARi value after oxygen test, and age ≤2 years old has absolute reactive value to oxygen test."

"Tesis ini disusun untuk mengetahui korelasi kelelahan dan kadar asam laktat darah dengan uji jalan enam menit (6MWT) pada pasien penyakit jantung koroner (PJK). Penelitian  ini menggunakan desain potong lintang, dengan pengambilan sampel secara konsekutif. Sebanyak 20 subjek penelitian yang merupakan pasien PJK pasca percutaneous coronary intervention (PCI) dan coronary arterial bypass grafting (CABG) yang memenuhi kriteria inklusi dan eksklusi. Kelelahan pasien PJK akan diukur menggunakan kuesioner fatigue severity scale (FSS) versi Bahasa Indonesia, dan dilanjutkan dengan pengukuran kadar asam laktat darah menggunakan alat accutrend plus sebanyak dua kali yaitu pada saat istirahat dan setelah dilakukan 6MWT. 6MWT dilakukan sesuai protokol standar pada lintasan 30 meter, untuk mengukur kebugaran kardiorespirasi. Jarak yang ditempuh pasien dikonversi menjadi VO2max menggunakan rumus Cahalin. Analisis statistik dilakukan untuk melihat korelasi antara nilai FSS dan kadar laktat darah dengan VO2max. Hasil penelitian menunjukkan korelasi negative yang tidak bermakna secara statistik antara FSS dan VO2max (r = -0,258; p > 0,05), serta pada kadar laktat darah dan VO2max (r = -0.18; p > 0,05). Namun didapatkan korelasi positif yang bermakna secara statistik antara FSS dan kadar asam laktat darah (r = 0,58; p < 0,05). Dapat disimpulkan tidak terdapat korelasi antara kelelahan dan kadar asam laktat darah dengan 6MWT pada pasien PJK. Namun terdapat korelasi sedang antara kelelahan dan kadar asam laktar darah pada pasien PJK. Diperlukan penelitian lebih lanjut untuk menilai faktor-faktor yang mempengaruhi kelelahan dan kadar asam laktat darah pasien PJK.

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This thesis was prepared to determine the correlation of fatigue and blood lactate levels with a six-minute walk test (6MWT) in patients with coronary artery disease (CAD). This study used a cross-sectional design, with consecutive sampling. A total of 20 research subjects were CAD patients underwent percutaneous coronary intervention (PCI) and coronary arterial bypass grafting (CABG) who met the inclusion and exclusion criteria. The fatigue of CAD patients will be measured using the Indonesian version Fatigue Severity Scale (FSS) questionnaire, followed by measuring blood lactate using the accutrend plus device twice, at rest and after 6MWT. 6MWT was performed according to a standard protocol on a 30 meter track, to measure cardiorespiratory fitness. The distance traveled by the patient was converted to VO2max using the Cahalin formula. Statistical analysis was performed to see the correlation between FSS values and blood lactate levels with VO2max. The results showed a statistically insignificant negative correlation between FSS and VO2max (r = -0.258; p > 0.05), as well as on blood lactate levels and VO2max (r = -0.18; p > 0.05). However, there was a statistically significant positive correlation between FSS and blood lactate (r = 0.58; p < 0.05). It can be concluded that there is no correlation between fatigue and blood lactate with 6MWT in CAD patients. However, there is a moderate correlation between fatigue and blood lactic acid levels in CAD patients. Further research is needed to assess the factors that influence fatigue and blood lactic acid levels in CAD patients."