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"Latar Belakang: Risiko aritmia pasta infark miokard akut 5-11%. Perlu adanya stratifikasi risiko tedadinya aritmia pasca infark miokard akin. Aritmia yang terjadi pasta infark miokard akut dapat disebabkan karena perubahan elektrofisiologi, milieu (transient factors) dan aritmia spontan. Penelitian menggunakan late potential sebagai salah satu modalitas untuk mendapat gambaran perubahan elektrofisiologi yang terjadi pasta infark miokard akin dan sebagai prediktor risiko terjadinya aritmia. Late potential didapatkan dengan pemeriksaan SA-ECG.Subyek: Dikurnpulkan 38 kasus infark miokard akut barn, sejak bulan Juni 2004 sampai dengan Februari 2005. Usia berkisar antara 35 - 65 tahun. Kriteria inklusi diagnosis infark miokard akut dengan menggunakan kriteria WHO. Kriteria eksklusi: infark sebeluinnya, blok cabang berkas, angina pektoris tak stabil, atrial fibrilasi dan fluter, infark miokard dengan strok iskemia, bedah pintas koroner dan riwayat angioplasti (sten atau balon).Metodologi: Penelitian ini menggunakan disain kohor, dilakukan pemeriksaan Signal Averaged ECG untuk mendapatkan late potential, kontrol internal late potential negatif Dilakukan uji hipotesis yang sesuai untuk mendapatkan nilai kemaknaan pada penelitian ink Pemeriksaan SA-ECG dilakukan pada hari 6-16 perawatan di RS Harapan Kita, late potential sesuai dua dari 3 kriteria WHO.Hasil : Laki-laki 30 (78,9%), wanita 8 (21,1%) dan usia rerata 52,34 tahun. Jens infark Q wave 18 (47,4%) dan non Q wave 20 (52,6%). Aritmia terutarna PVC 7 (18,4%), ventrikular takikardia (VT) 2 (5,3%) dan 29 (76,3%) normal. Lokasi infark terutama inferior 17 (44,7%) , non inferior 21 (55,3%).Rerata seat dilakukan pemeriksaan SA-ECG yaitu 9,6 hail dengan SB ± 2,6 hari. Parameter pemeriksaan SA-ECG yaitu 1. QRSD rerata 114,8 ins, SB ±15,8 ms, 2_ HFLA rerata 36,2 ms, SB ± 12,8 ms, 3, RMS rerata 30,2 u.V, SB ± 15,9 µV. Didapatkan late potential positif 13 (34,2%). Kadar kalium bulan pertarna dan bulan kedua dalann Batas normal. Aritmia terjadi pada bulan pertama 2 (5,3%) dan 9 (23.5%). Pada bulan pertama aritmia terjadi pada pasien dengan satu late potential positif dan satu dengan late potential negatif.Sedangkan pada bulan ke 2 didapatkan terjadi aritmia 7 (53,8%) dengan late potential positif dan 2 (8%) dengan late potential negatif, p < 0.003, IK 95% dan relatif risk (RR) 6.73.Tidak didapatkan hubungan bermakna lokasi infark, slat pemeriksaan SA-ECG dengan terbentuknya late potential. Tidak didapat hubungan bermakna antara kaliurn dan kejadian aritmia.Kesimpulan : Late potential dapat digunakan sebagai salah satu modalitas untuk stratifikasi risiko teijadinya aritmia, didapatkan aritmia dengan late potential positif pada bulan 2,.p < 0,003 dan risiko relatif sebesar 6,73. Perlu dilakukan penelitian dengan populasi yang lebih banyak, melibatkan beberapa seater, dilakukan menggunakan halter monitor untuk mengawasi terjadinya aritmia dan dalam waktu 1 tahun pasca infark miokard akut.

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Background: Risk of arrhythmias in post acute myocardial infarction in first 2 years was within range 5-i 1%. The stratification of arrhythmia event in post acute myocardial infarction was needed. There are several factors in arrhythmias mechanism, such as electrophysiology alteration, milieu (transient factors) and spontaneous arrhythmias. In this study, late potential as cardio electrophysiology state post infarction is used to be arrhythmias predictor. Late potential description was obtained used by Signal-Averaged ECG.

Subjects: Thirty eight consecutive patients admitted to coronary care unit in Dr. Cipto Mangunkusumo and Persahabatan hospitals with documented acute myocardial infarction, since Juny 2004 to February 2005. Their ages were ranging from 35 to 65 years: Patients were included according to WHO acute myocardial infarction criteria.

Methods: This is a cohort study. SA-ECG was performed to obtained late potential, negative late potential patients as internal control. Signal-Averaged ECG was done in 6 - 16 days post acute myocardial infarction in Harapan Kita hospital. An abnormal (positive) SA-ECG is considered if two or more of the following three criteria from WHO.

Results: Subjects consisted of 30 (78,9%) male patients and female of 8 (21,1%). The mean age was 52,34 years.The incidence Q wave and non Q wave of acute myocardial infarction were 18 (47,4%) and 20 (52,6%). Type of arrhytrnias were premature ventricle contraction (PVC) 7 (18,4%), ventricular tachycardia (VT) 2 (5,3%) and normal 29 (76,3%). The inferior and non inferior wall site of infarction were 17 (44,7%) and 21 (55,3%). The mean time (days) recording of SA-ECG was 9,6 days, SD 1 2,6 days. There were three parameters of SA ECG included L QRSD mean 114,8 ms, SD 115,8 ms, 2. HFLA mean 36,2 ms, SD ± 12,8 ms, 3, RMS mean 30,2 p.V, SD ± 15,9 IN. The incidence abnormal SA-ECG was 13 (34,2%), Kalium level in first and second month of following was within normal range. The arrhytmias event in first and second month were 2 (5,3%) and 9 (23,7%). in first month, arrhytmia event in one positive and one negative late potential. In second month, seven of 9 patients had positive late potential. There was significant relation between abnormal SA-ECG and arrhytmia event in second month, p < 0.003 (CI 95%: 1,63-27,89), relative risk (RR) 6,73. There was no significant relation in site of infarction, time recording of SA-ECG, and kalium level with arrhytmia event.

Conclusion: The late potential could be used as one of arrhytmia predictors of post acute myocardial infarction. There was significant relation between late potential and arrhytmia in second month, p < 0,003, relative risk (RR) 6,73. Furthere study is needed with greater samples size and appropriate instruments (eg. Holter monitor)."

"Latar belakang: Stenosis mitral SM akibat penyakit jantung reumatik PJR memiliki disfungsi sistolik ventrikel kiri VK secara subklinis bila menggunakan parameter global longitudinal strain GLS walaupun rata-rata pasien memiliki fraksi ejeksi FE baik. Pada PJR, inflamasi kronis menyebabkan terjadinya nekrosis fibrinoid, pada akhirnya menjadi fibrosis miokard. Berdasarkan teori ini, fibrosis miokard merupakan salah satu dasar teori yang mendasari disfungsi sistolik VK pada SM. Namun hingga kini penelitian yang menilai hubungan ini belum ditemukan.Tujuan: Mengetahui hubungan GLS sebagai parameter fungsi sistolik dengan volume fibrosis VK pada SM akibat PJR.Metode: Studi potong lintang melibatkan pasien SM akibat PJR akan menjalani pemeriksaan MRI jantung untuk mengevaluasi fibrosis miokard dengan metode LGE dan ekokardiografi untuk menilai GLS. Kedua data diolah menggunakan analisa korelasi.Hasil: Terdapat 36 pasien subjek penelitian. Volume fibrosis miokard rata-rata VK 4,9 2,7 . Walaupun FE baik median 62 , nilai GLS menurun dibandingkan nilai rujukan normal 13,5 3,9 . GLS memiliki korelasi sedang dengan volume fibrosis VK r = -0,432; p 0,009 . Tidak ada korelasi antara GLS dengan area katup mitral maupun gradien tekanan transmitral rata-rata. Tidak didapatkan juga korelasi antara FE dengan volume fibrosis.Kesimpulan: GLS memiliki korelasi sedang dengan volume fibrosis VK pada pasien SM akibat PJR.

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Abstract Background. The correlation between the extent of myocardial fibrosis and subclinical LV systolic dysfunction in rheumatic mitral stenosis MS has not been widely studied. We sought to evaluate the correlation between the extent of LV myocardial fibrosis quantified by Late Gadolinium Enhancement LGE CMR and Global Longitudinal Strain GLS by Speckle Tracking Echocardiography STE in these patients.Methods. We prospectively evaluated 36 consecutive rheumatic MS patients who were planing to undergo intervention in our center. Then we evaluate the correlation between the extent of LV myocardial fibrosis quantified by Late Gadolinium Enhancement LGE CMR and Global Longitudinal Strain GLS by Speckle Tracking Echocardiography STE Results. Thirty six patients showed mean of LGE was 4,9 2,7 . Despite good ejection fraction median 59.5 , IQR 28 68 , the LV GLS was reduced mean 13.5 3.9 compared to normal reference value. There was moderate correlation between GLS and LGE r 0,432 p 0,009 . There are no correlations between GLS with mitral valve area MVA and mean mitral valve gradient mean MVG . No significant correlation was found between ejection fraction and LGE.Conclusion. There was moderate correlation between LGE and GLS in patients with rheumatic MS. Keywords Myocardial fibrosis global longitudinal strain late gadolinium enhancement CMR rheumatic mitral stenosis "

"Indeks aterogenik Low Density Liporptein-Cholesterol/ High Density Lipoprotein-Cholesterol (LDL-C/HDL-C) dan indeks inflamasi Nilai Rasio Neutrofil/ imfosit (NLR) yang menggambarkan beban kolesterol dan beban inflamasi, merupakan pemain kunci pembentukan plak aterosklerosis. Pemahaman korelasi kedua indeks ini diharapkan dapat membantu tatakelola penyakit jantung koroner (PJK). Studi ini bertujuan mengetahui korelasi antara LDL-C/HDL-C dan NLR dengan beratnya stenosis, dan korelasi keduanya pada pasien PJK Infark Miokard Akut dengan Elevasi Segmen ST (IMA-EST) yang memiliki angka kematian yang tinggi. Penelitian ini dilakukan dengan desain potong lintang. Didapatkan 99 pasien yang memenuhi kriteria inklusi dan eksklusi dari data pasien IKP primer di RSUP Dr. Cipto Mangunkusumo dari tahun 2018-2023. Analisa korelasi menggunakan uji Spearman didapatkan tidak ada korelasi yang bermakna antara rasio LDL-C/HDL-C dan NLR dengan skor Gensini (r = -0.051, p = 0.617; r= -0.126, p = 0.241). Namun dijumpai korelasi negatif bermakna antara rasio LDL-C/HDL-C dengan NLR (r = -0.262, p = 0.009). Korelasi negatif kedua indeks ini tetap dijumpai pada tiap tertil meskipun yang bermakna secara statistik dijumpai pada tertil I yang memiliki indeks inflamasi yang paling tinggi (Tertil I: r = -0.445, p = 0.009, Tertil II: r = -0.035, p = 0.851, Tertil III: r = -0.290, p = 0.097).

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The LDL-C/HDL-C atherogenic index and the Neutrophil to Lymphocyte Ratio (NLR) inflammation index, which represent cholesterol burden and inflammation burden respectively, are key players in the formation of atherosclerotic plaques. Understanding the correlation between these two indices is expected to aid in the management of patients with coronary heart disease (CHD). This study aims to determine the correlation between LDL-C/HDL-C and NLR with the severity of stenosis, and the correlation between these two indices in patients with Acute ST-Elevation Myocardial Infarction (STEMI) who have a high mortality rate. The research was conducted using a cross-sectional design. 99 patients who met the inclusion and exclusion criteria were obtained from the primary IKP patients data at Dr. Cipto Mangunkusumo Hospital from 2018-2023. Spearman correlation analysis showed no significant correlation between the LDL-C/HDL-C ratio and NLR with the Gensini score (r = -0.051, p = 0.617; r= -0.126, p = 0.241). However, a significant negative correlation was found between the LDL-C/HDL-C ratio and NLR (r = -0.262, p = 0.009). This negative correlation between the two indices was consistently observed in each tertile, although statistically significant in tertile I, which had the highest inflammation index (Tertile I: r = -0.445, p = 0.009, Tertile II: r = -0.035, p = 0.851, Tertile III: r = -0.290, p = 0.097)."

"Aktivitas seksual merupakan bagian penting dalam kehidupan dan merupakan tuntutan dasar bagi manusia. Kondisi infark miokard itu sendiri dapat mempengaruhi kehidupan seksual pasien; namun, di Indonesia, belum banyak perhatian yang diberikan terhadap kondisi seksual pada pasien pasca-infark miokard, dan hanya sedikit penelitian yang dilakukan mengenai topik ini. Oleh karena itu, penelitian ini menggunakan pendekatan kualitatif untuk memahami pengalaman disfungsi seksual pasien setelah mengalami infark miokard tersebut, sehingga menjadi dasar bagi pengembangan pengukuran yang relevan. Wawancara semi terstruktur dilakukan terhadap 6 partisipan. Metode fenomenologi deskriptif digunakan untuk mengumpulkan data dan mengeksplorasi pengalaman seksual pasien pasca-infark miokard. Sebanyak 4 tema, yang ditemukan adalah (1) Perubahan aktivitas seksual pasca-IMA; (2) Dampak terkait disfungsi seksual pasca-IMA; (3) Kebutuhan akan edukasi dan dukungan pasangan; (4) Upaya untuk pulih. Keempat kelompok tema tersebut bersifat independen dan saling mempengaruhi. Dalam kelompok-kelompok ini, perubahan dalam pengalaman aktivitas seksual, termasuk perubahan fungsi seksual dan dampak emosi, dipengaruhi oleh kurangnya pengetahuan, penyakit, dan faktor-faktor lainnya. Lebih jauh, persepsi pasien tentang pasca perawatan IMA mempengaruhi upaya memperbaiki aktivitas seksual. Pengalaman disfungsi seksual pasien pasca-IMA dan faktor-faktor yang mempengaruhinya, seperti faktor penyakit, dan kurangnya pengetahuan terkait, dijelaskan. Temuan tersebut diharapkan dapat membantu dalam merumuskan tindakan intervensi yang ditargetkan.

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Sexual activity is an important part of life and is a basic requirement for humans. The condition of myocardial infarction itself can affect the patient's sexual life; However, in Indonesia, not much attention has been paid to sexual conditions in post-myocardial infarction patients, and little research has been done on this topic. Therefore, this study uses a qualitative approach to understand the patient's experience of sexual dysfunction after experiencing the myocardial infarction, thus becoming the basis for the development of relevant measurements. Semi-structured interviews were conducted on 6 participants. Descriptive phenomenological methods were used to collect data and explore the sexual experiences of post-myocardial infarction patients. A total of 4 themes, which were found were (1) Changes in sexual activity after IMA; (2) Impact related to post-IMA sexual dysfunction; (3) The need for education and support of the spouse; (4) Efforts to recover. The four theme groups are independent and mutually influential. In these groups, changes in the experience of sexual activity, including changes in sexual function and emotional impact, are influenced by lack of knowledge, disease, and other factors. Furthermore, patients' perceptions of post-IMA treatment affect efforts to improve sexual activity. The experience of post-IMA patients' sexual dysfunction and the factors that influence it, such as disease factors, and lack of related knowledge, are described. The findings are expected to help formulate targeted intervention actions."

"Level rekomendasi penggunaan rutin intra-arotic balloon pump (IABP) pada pasien dengan renjatan kardiogenik diturunkan menjadi level III. Manfaat penggunaan IABP sebelum revaskularisasi belum diinvestigasi secara uji klinis acak. Tujuan studi ini untuk menilai pengaruh penggunaan IABP sebelum revaskularisasi pada pasien infark miokard akut dengan komplikasi renjatan kardiogenik.Uji klinis acak pembanding terbuka dilakukan di Pusat Jantung Nasional Harapan Kita periode januari 2018 hingga Mei 2020. Randomisasi dilakukan pada 69 subjek infark miokard dengan renjatan kardiogenik. Alokasi kelompok kontrol 34 subjek dan perlakuan (IABP sebelum revaskularisasi) 35 subjek. Luaran primer adalah mortalitas rumah sakit dan pasca revaskularisasi hari ke_30. Luaran sekunder perfusi global (bersihan asam laktat jam ke_12), perfusi regional (kreatinin), performa jantung yang dinilai secara ekokardiografi (Global longitudinal strain) dan penanda biologis untuk regangan miokard (NT-proBNP dan ST2). Variabel hemodinamik ekokardiografi dan komplikasi tindakan juga dilaporkan.Setelah drop out, Analisis perprotokol dilakukan pada 18 subjek kelompok kontrol dan 16 subjek kelompok perlakuan. Mortalitas rumah sakit dan 30 hari pasca revaskularisasi, 12 (66,7%) subjek pada kelompok kontrol dan 9 (56,3%) subjek pada kelompok perlakuan, p 0,533. Pada luaran sekunder tidak ditemukan perbedaan bermakna pada kedua kelompok untuk bersihan laktat efektif jam ke-12; pemeriksaan kreatinin, global longitudinal strain, hemodinamik ekokardiografi dan nilai NT-proBNP dan ST2. Pada hari ke_3, kurva kaplan meier berpisah dan mortalitas RS dini pada kelompok kontrol 9 (50%) subjek dan pada kelompok perlakuan 1 (6,25%) subjek, hasil uji fisher p 0,013. Mortalitas RS lanjut berhubungan dengan IABP dan sepsis. Dua patomekanisme diusulkan untuk menerangkan patomekanisme kematian pada kelompok kontrol dan kelompok perlakuanSimpulan: Penggunaan IABP sebelum revaskularisasi pada subjek infark miokard akut dengan komplikasi renjatan kardiogenik tidak memperbaiki mortalitas rumah sakit dan pasca perawatan hari ke-30. Pada kelompok kontrol diusulkan patomekanime mortalitas serangan fisiologis kali satu. Kelompok perlakuan, patomekanime mortalitas diusulkan serangan fisiologis kali dua.

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The guideline recommendation on routine use of Intra Aortic balloon pump (IABP) in cardiogenic shock had been downgraded to level recommendation III. The role of IABP insertion before revascularization has never been investigated in randomized control trial. The aim of this study is to investigate the role of IABP insertion before revascularization in acute myocardial infarction complicated by cardiogenic shock.

Randomized control trial was performed in National Cardiac Center Harapan Kita at the period January 2018–April 2020. We randomly assigned 69 patients cardiogenic shock due to acute myocardial infarction. There are 34 patients assigned to control group (no IABP) and 35 patients assigned to intervention group (IABP before revascularization). Percutaneous Coronary Intervention and medical care were performed according to local protocol. The primary end points were in-hospital mortality and mortality at 30 days post revascularization. The secondary end points were perfusion (lactate clearance, creatinine), cardiac performance (global longitudinal strain), Biomarker for myocardial stretch (NT-proBNP & ST2). Echo hemodynamic and complication variables were also reported.

After drop out, a total of 18 patients in the control group and 16 patients in intervention group (IABP before revascularization were included in per protocol analysis for the primary and secondary end points. The primary end result of in hospital mortality and 30 days post revascularization mortality were identical in 12 patients in the control group (66.7%) and 9 patients in the intervention group (56.3%), p 0,533. There were no significant differences in secondary end points, effective lactate clearance at 12 hour, creatinine, Global Longitudinal Strain, NT-proBNP, ST2 including echo hemodynamic, dose of catecholamine therapy and sepsis. At the third day, Kaplan Meier curve demonstrated early separation with significant difference in mortality 9 patients in the control group (50%) and 1 patients in the intervention group (6,25%), p 0,013. Late in hospital was associated with IABP and sepsis. There was also a trend of greater elevation of NT-proBNP on day 3 in the intervention group. Therefore, pathomechanisms of death for control group and intervention group were proposed.

Conclusion: The use IABP before percutaneous intervention in patient shock cardiogenic due to acute myocardial infarction did not improve clinical outcome in hospital mortality or 30 days post Revascularization. One hit of physiological deterioration model for cardiogenic cardiogenic shock patient and two hit of physiological deterioration model for cardiogenic shock patient treated with IABP before revascularization were proposed. "