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"Latar Belakang: Stenosis vena sentral adalah salah satu permasalahan utama yang dihadapi dalam penggunaan akses hemodialisis FAV. Kondisi ini dapat ditangani dengan tindakan single balloon angioplasty. Namun, tatalaksana ini memiliki angka patensi yang tidak memuaskan akibat respon pembuluh darah terhadap barotrauma. Mengetahui risiko yang mempengaruhi patensi pasca tindakan single baloon angioplasty pada penderita stenosis vena sentral penting untuk memprediksi prognosis pasien. Penelitian ini bertujuan untuk mengetahui faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Metode: Sebuah penelitian kohort retrospektif multicenter pada Januari 2018 – September 2022 di empat rumah sakit dilakukan untuk menilai faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Faktor yang diteliti mencakup derajat stenosis, panjang stenosis, jumlah stenosis, lokasi stenosis, residual stenosis, ukuran balon, dan tekanan balon. Hasil: Terdapat total 76 pasien pada penelitian ini. Pada penelitian ditemukan faktor yang berpengaruh pada patensi 6 bulan pasca single balloon angioplasty adalah jenis kelamin laki – laki (78.4% vs 46.2%; p 0.004), panjang stenosis ≥ 2 cm (85.7% vs 56.5%; p 0.042), lokasi stenosis pada vena innominata (75% vs 39.3%; p: 0.002),derajat stenosis ≥ 80% (83.3% vs 42.5%; p : 0.001), dan residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). Tidak ditemukan faktor yang berpengaruh pada patensi 12 bulan pasca single balloon angioplasty. Kesimpulan: Terdapat hubungan antara panjang stenosis, lokasi stenosis, derajat stenosis, dan residual stenosis terhadap patensi single balloon angioplasty

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Background: Central venous stenosis is one of the main problems encountered in AVF hemodialysis access. This condition can be treated with a single balloon angioplasty. However, this treatment has a low patency rates due to the response of the vessels to barotrauma. Knowing the risks that affect patency after single balloon angioplasty in patients with central venous stenosis is important to predict the patient's prognosis. This study aims to determine the factors influencing 6 and 12 months patency after single balloon angioplasty in central venous stenosis patient. Methods: A multicenter retrospective cohort study in January 2018 – September 2022 in four hospitals was conducted to assess factors that affect 6 and 12 months patency after single balloon angioplasty in patients with central venous stenosis. Factors studied included the degree of stenosis, length of stenosis, number of stenosis, location of stenosis, residual stenosis, balloon size, and balloon pressure. Results: There were a total of 76 patients in this study. In this study, it was found that the factors that affected the patency 6 months after single balloon angioplasty were male gender (78.4% vs 46.2%; p 0.004), stenosis length ≥ 2 cm (85.7% vs 56.5%; p 0.042),stenosis at the innominate vein (75% vs 39.3%; p: 0.002), stenosis degree ≥ 80% (83.3% vs 42.5%; p : 0.001), and residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). There were no factors that had an effect on patency 12 months after single balloon angioplasty. Conclusion: There is a relationship between the length of the stenosis, the location of the stenosis, the degree of stenosis, and the residual stenosis on the patency of single balloon angioplasty"

"Mitral stenosis merupakan kelainan katup yang paling sering ditemukan di bagian Kardiologi RS. M. Hoesin, Palembang, dan bukti kuat menunjukkan adanya tromboemboli pada mitral stenosis. Banyak studi melihat kontras ekho spontan (KES) yang dianggap sebagai awal kejadian tromboemboli, namun terdapat kontroversi mengenai bagaimana mencapai regresi KES ini. Uji klinik tersamar ganda dilakukan untuk membandingkan aspirin 100 mg dengan acenocoumarol (sintrom) 1 mg yang diberikan selama 4 minggu pada 22 penderita mitral stenosis. Pada akhir penelitian diperoleh regresi 100 % pada KES kelompok acenocoumarol, 40% diantaranya regresi dari KES berat menjadi ringan, sedangkan 60 % mengalami resolusi sempurna. Pada kelompok aspirin tidak satupun KES mengalami regresi. Pada kelompok acenocoumarol, 2 di antara 4 trombus menghilang, sedangkan 2 sisanya ukurannya mengecil, sedangkan pada kelompok aspirin pada akhir minggu keempat, pasien dengan thrombus bertambah dari 3 menjadi 4. Kesimpulan: Pemakaian acenocoumarol 1 mg selama 4 minggu dapat secara efektif dan aman meregresi kontras echo spontan dan thrombus pada mitral stenosis tanpa perubahan hemodinamik yang berarti. (Med J Indones 2002; 11: 202-7)

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Mitral stenosis is one of the most often valvular disease in Division of Cardiology, M. Hoesin hospital, Palembang, and there was strong evidence of thromboembolic phenomenon in mitral stenosis (MS) patients. Many studies evaluated the spontaneous echo contrast (SEC) that was regarded as a precursor of thrombo embolic phenomenon. So far there were controversies regarding how to regress spontaneous echo contrast. A randomized double blind controlled study was done on 22 MS patients with positive SEC, receiving either aspirin 100 mg or acenocoumarol 1 mg and followed up after 4 weeks. There was 100 % regression of SEC in acenocoumarol group that consisted of 40% regression from severe SEC to mild, and 60% complete resolution. In aspirin group there was no resolution of SEC. In acenocoumarol group, 2 of 4 thrombus totally disappeared while the rest was reduced in size. On the other hand, in aspirin group, after 4 weeks, the patients with thrombus was increased from 3 to 4 patients. In conclusion, four week therapy with acenocoumarol 1 mg is effective and save in regressing spontaneous echo contrast and thrombus in mitral stenosis patients without any significant change in hemodynamics. (Med J Indones 2002; 11: 202-7)"

"ABSTRAKPendahuluan Keputusan untuk melakukan tindakan operasi reparasi dan replace katup mitral pada stenosis mitral masih diperdebatkan. Tujuan penelitian ini adalah mencari hubunganantara Wilkin?s score dengan keputusan operasi reparasi dan replace katup mitralpada stenosis mitral, serta mencari titik potong nilai Wilkins? score pada operasireparasi dan replace katup mitralMetodePenelitian adalah deskriptif analitik dengan pendekatan cross sectional secararetrospektif mencakup seluruh pasien dari RS Harapan Kita Jakarta yang dilakukanoperasi stenosis mitral pada Januari 2010 ? September 2015 oleh satu orang dokterbedah Jantung. Hubungan Wilkins? score dengan keputusan operasi serta nilai titikpotong Wilkins? score pada operasi reparasi dan replace menjadi luaran yang akanditeliti.HasilSeratus dua puluh lima subjek dengan usia rata-rata kelompok reparasi 36,78 ± 9,37tahun dan replace 44,49 ± 9,29 tahun. Didapatkan nilai mean Wilkins? score padakelompok reparasi 6,5 (4-12) dan kelompok replace 8 (4-14) dengan nilai signifikansip<0,001. Dengan area under curve 0,786 dan p<0,001, dapat dinilai titik potongWilkins? score berada pada nilai 7. Dengan memerhatikan variabel lain yangmenunjukkan adanya hubungan signifikan pada analisis bivariat yaitu usia,regurgitasi mitral dan Euro score, dilakukan analisis multivariate dengan uji regresilogistic didapatkan area under curve 0,946 dan p<0,001, dapat dinilai titik potongWilkins? score berada pada 5. KesimpulanWilkins? score berhubungan dalam pengambilan keputusan tindakan operasi reparasidan replace katup pada subjek dengan stenosis mitral, dengan titik poin pada putusanoperasi reparasi dan replace yaitu Wilkins? score 7. Jika Wilkins? scoremempertimbangkan faktor usia, regurgitasi mitral dan Euro score titik poin padaputusan operasi reparasi dan replace yaitu Wilkins? score 5.

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ABSTRACTIntroductionDecision on the repair and replacement of mitral valve surgery in mitral stenosispatients is still being debated. The aim for this research is to find the relationshipbetween Wilkins? score and the decision between repair and replacing mitral valve inmitral stenosis cases, and to find the cut off point for Wilkins?score in the mitralvalve repair and replacement procedureMethodsThe research is an analytic descriptive study with restrospective cross sectionaldesign. This research covered all patients of Harapan Kita Hospital for Heart andBlood vessels that had mitral stenosis operations from January of 2010 untilSeptember 2015 that is conducted by one of the surgeon in that hospital. Therelationship between Wilkin?s score and the decision to operate and the cut of pointof the Wilkins? score on the repair and replacement decision is the outcome that weare going to study in this research.ResultsOne hundred and twenty five subjects with the mean age of repair 36,78 ± 9,37 yearsold and replacement age of 44,49 ± 9,29 years old. We found that the mean ofWilkins? score in the reparation group is 6,5 (4-12) and in the replacement group is 8(4-14) with the significance value is p <0,001. With area under the curve of 0,786 andp<0,001 we can see that the the cut off point for Wilkins? score is 7. By seeing othervariables to show the significance between all bivariates variable such as age, mitralregurgitation and Euro score, we conducted multivariate analysis of regression testwe found area under the curve 0,946 with p<0,001. We can assess that the cut offpoint of Wilkins? score is 5 ConclusionWilkins score is related with decision making of valve repair and replacmentprocedure in patients with mitral stenosis with poin between decision is 7. If Wilkinsscore consider other factors such as age, the presence of mitral regurgitation and EuroScore the point that determine the decision to repair and replace mitral valve isWilkins? score 5."

"Aliran darah koroner terjadi terutama pada fase diastolik. Stenosis arteri koronaria menimbulkan iskemia miokard. Iskemia miokard dapat menimbulkan gangguan diastolik. Gangguan diastolik mengakibatkan penurunan aliran darah koroner pada sepertiga awal diastolik, baik pada waktu istirahat maupun selama takikardia. Angina pektoris merupakan gejala iskemia miokard. Tujuan penelitian ini untuk membuktikan bahwa ditemukan gangguan diastolik ventrikel kiri, dan angina pektoris akan lebih berat bila disertai dengan gangguan diastolik ventrikel kiri pada pasien stenosis arteri koronaria. Pada penelitian ini dilakukan pemeriksaan variabeI diastolik ventrikel kiri, dengan ali ran mitral gelombang pulsa doppler ekokardiografi saat istirahat, pada pasien yang terbukti mengalami stenosis arteri koronaria dari pemeriksaan angiografi koroner. Pada penelitian ini, yang memenuhi kelima variabel diastolik dan diklasifikasikan sebagai fungsi diastolik normal adalah 3,3%, relaksasi abnormal 10%, sementara 86,7% menunjukkan perubahan beberapa variabel diastolik.

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Coronary blood flow occurs mainly in the diastolic phase. Arterial stenosis The coronary artery gives rise to myocardial ischemia. Myocardial ischemia can cause diastolic disorders. Diastolic disorders result in decreased blood flow coronary in the first third of diastolic, both at rest and during tachicardia. Angina pectoris is a symptom of myocardial ischemia. The purpose of this study to prove that diastolic disorders of the left ventricle, and angina were found Pectoris will be more severe when accompanied by diastolic disorders of the left ventricle in patients with coronary artery stenosis. In this study, a variabeI examination was carried out diastolic left ventricle, with ali ran mitral pulse wave Doppler echocardiography at rest, in patients who have been shown to have coronary artery stenosis of coronary angiography examination. In this study, a variabeI examination was carried out diastolic left ventricle, with ali ran mitral pulse wave Doppler echocardiography at rest, in patients who have been shown to have coronary artery stenosis of coronary angiography examination. In this study, which meets all five variables diastolic and classified as normal diastolic function is 3.3%, relaxation abnormal 10%, while 86.7% showed changes in several diastolic variables.

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"Latar belakang. Stenosis mitralis (SM) masih merupakan masalah kesehatan di Indonesia, dan fibrilasi atrium merupakan penyakit penyerta yang akan meningkatkan emboli sistemik, stroke dan mortalitas pasien. Diduga umpan balik mekano elektris dan remodeling elektris mempunyai peranan yang penting dalam mekanisme terjadinya tibrilasi atrium (FA) pada penyakit katup jantung. Untuk menguji hipotesis bahwa telah tejadi remodeling elektris intrinsik pada pasien SM, dan remodeling tersebut bersifat reversibel, malta telah dilakukan penelitian mengenai perubahan elektrotisiologis sesudah tindakan komisurotomi mitral transvena perkutan (KMTP). Bahan dan cara kerja. Tigapuluh satu pas ien SM yang dilakukan KMTP, 20 dengan irama sinus (IS) dan ll dengan FA persisten serta 10 pasien dengan jantung normal sebagai kelompok kelola dimasukkan dalam penelitian ini. Pemeriksaan hemodinamik dan elektrotisiologi dilakukan sebelum dan segera sesudah KMTP. Semua pasien FA, dilakukan kardioversi eksternal sinkron sebelum dilakukan KMTP. Sebelum pemeriksaan elektrofisiologis, diberikan propranolol iv, 0,2 mg/kgbb dan sulfas atropin 0,004 mg/kbb untuk mem-blok aktiiitas saraf autonom. Pemeriksaan elektrofisiologi meliputi pemeriksaan periode refrakter efektif (PRE) di 6 tempat di atrium, waktu koduksi (WK) di atrium kanan dan kiri dan pengukuran elektrogram atrium di I8 tempat atrium kanan dan kiri. Hasil. Tidak terdapat perbedaan umur, dan jenis kelamin antara kelompok pasien SM dan kelompok kelola. PRE keselunlhan pada kelompok SM dan kelola yang diperoleh pada pacuan 600 milidetik tidak menunjukkan perbedaan bermakna Demikian pula pada pacuan 400 milidetik, tidak menunjukkan kemaknaan statistik Secara regional, PRE atrium lcanan dan kiri tidak menunjukkan perbedaan yang bermakna pada kelompok pasien SM dan kelola. Tetapi kelompok pasien SM mempunyai dispersi PRE lebih lebar dibanding dengan kelompok kelola. WK atrium kanan dan kiri kelompok pasien SM menunj ukkan perlambatan yang bermaltna dibanding dengan kelompok kelola. Di sebagian besar tempat atrium kanan dan kiri, voltase elektrogram atrium juga menunjukkan penurunan yang sangat bermakna. Tidak ada perbedaan dalam durasi elektrogram pada kedua kelompok. Potensial ganda dan elektrogram yang terpecah-pecah tidak ditemukan pada kedua kelompok. Tidak Lerdapat perbedaan bermakna dalam variabel hemodinamik antara kelompok SM disertai IS dengan disertai FA, namun terdapat perbedaan bermakna dalam variabel elektroflsiologi (re-modeling elektris) PRE rerata Secara keseluruhan yang diukur pada interval pacuan 600 milidetik pada kelompok FAjauh lebih pendek dibanding dengan kelompok IS yang secara statistik berbeda bermakna. Demikian pula bila diukur pzlda interval pacuan 400 milidetik. Secara regional, PRE atrium kanan dan kiri kelompok FA lebih pendek dibanding dengan kelompok IS dan perbedaannya seeara statistik bermakna. Sedang dispersi PRE pada kedua kelompok tersebut tidak menunjukkan kemaknaan statislik. WK di atrium kanan dan kiri pada kelompok FA lebih lambat dibandingkan dengan kelompok IS, dan perbedaannya secara statistik bermalma. Sebagian besar tempat di atrium tidak menunjukkan perbedaan voltase elektogram antara kelompok IS dan FA. Remodeling elektris ini bersifat reversibel setelah dilakukan KMTP. PRE rerata secara keseluruhan yang diukur pada interval pacuan 600 milidetik sebelum dan sesudah dilakukan KMTP ialah 240,51-_39,2 milidetik vs 248,2i36,l mi1idetik(p=0,003). Demikian pula pada pengukuran dengan interval 400 mi1idetik(da.ri 228,2i35,3 milidetik vs 238,l i319 milidetik, p=0,000). Reversibilitas hanya terjadi terutama pada sebagian besar PRE atrium dan WK di atrium kiri, sedang besamya vol tase elektrogram lidak demikian halnya. Remodeling elektris atrium tersebut bersifat intrinsik, tidak dipengaruhi oleh susunan saraf autonom. Di samping pembuktian hipotesis di atas ditemukan pula variabel prediktor terhadap kejadian FA pada penderita SM yakni diameter atrium kanan medial-lateral yang diukur dengan ekokardiograti 2 dimensi (rasio odds 1,128 dengan KI 95% berkisar antara 1,012 sampai l,466), serta PRE atrium kanan bawah (rasio odds 0,952 dengan KI 95% anlara 0,907 - l,000). Kesimpulannya pada pasien SM telah terjadi remodeling elekuis yang mengarah texjadinya FA. Bilamana telah terjadi FA, maka remodeling elelctris akan makin memburuk. Walaupun demikian remodeling elektris yang terjadi bersifat reversibel dengan mengurangi regangan dinding atrium melalui KMTR Remodeling elektris dan reversibilitasnya bersifat intrinsik, tidak dipengaruhi oleh saraf autonom. Oleh karena itu intervensi dini dengan KMTP perlu dilakukan pada setiap pasien SM dengan keluhan, atau bilamana clijumpai pembesaran dimensi atrium kanan mediallateral.

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Background: Mitral stenosis (MS) is one of the major health problems in developing countries. In addition, atrial fibrillation (AF) is one of the MS complication and had a consequence of higher systemic embolic rate including stroke and mortality. Mechano-electrical feedback and electrical remodeling in patients with valvular heart disease might be play an important role in the mechanism of atrial fibrillation (AF). To test the hypothesis that there was an intrinsic electrical remodeling in MS and this remodeling might be reversible, we investigated electrophysiological changes after percutaneous transvenous mitral commissurotomy (PTMC). Material and methods. Eleven MS patients with persistentAF and 20 patients with sinus rhythm (SR) were undergoing PTMC included in this study. Ten patients who underwent electrophysiologic study or ablation involving left atrial study were as control group. Autonomic nervous system was blocked using propranolol 0.2 mg/kgbw and atropine 0.04 mgfkgbw. Atrial effective refractory period (AERP) was measured at 2 sites in the right and 4 sites in the left atrium. The conduction time (CT) was measured at the right and left atrium using decapolar catheter. Atrial electrogram was measured on its amplitude, duration and number of fragments of the electrogram at 18 sites of the atrium. Results. There were no statistically differences in age and sex among the MS group and the control group. No significant difference in the overall AERP between the MS group and control group, but the MS group had a higher AERP dispersion tha.n the control group. The MS group had a lower conduction time (CT) than the control group and its difference was statistically significant. Most of the sites in the MS group were smaller than the control group. The duration of electrogram of both groups were similar. No double potential and fractionated electrograms were found in both groups. There were no statistical difference in the hemodynamic variables between the MS patients with SR (SR group) and AF group. The AF group had shorter overall AERP than the IS group and the difference was statistically significant- In most sites of the atrium, the voltage of the an-ial electrogram was lower in the AF group compared with the IS group. There was no significant difference in CT between both groups. The voltage of the atrial electrogram in both groups were similar. The overal AERP and the AERP of most sites of the atrium was increased after PTMC. The CT in left atrium not the right was shortened after PTMC. And the voltage of atrial electrogram became higher after PTMC. In addition, beside the above hypothesis tested, there were 2 independent predictors for AF in patients with MS, i.e. the medial-lateral right atrial dimension (OR 1.128 and 95% Cl 1.012 - l.466) and AERP of the low right atrium (OR 0.952, 95% CI 0.907 - L000). Conclusion: Patients with MS have an electrical remodeling due to atrial stretch. Atrial remodeling also occurs when the patients are getting atrial fibrillation. But fortunately these electrophysiological changes will be reversible when PTMC is performed. The electrical remodeling and its reversibility is an intrinsic atrial property, not influenced by the autonomic nervous system. Earlier intervention should he performed to prevent AF for every symptomatic MS patient or asymptomatic with increased medial-lateral right atrial dimension."

"Latar Belakang : Stenosis mitral (SM) merupakan suatu lesi obstruksi katup mitral yang memerlukan terapi definitif suatu tindakan mekanik. Di Indonesia, prevalensinya masih cukup tinggi dengan penyebab yang multifaktorial; di antaranya waktu tunggu untuk antrian dari penjadwalan intervensi di era Jaminan Kesehatan Nasional. Kondisi pasien yang hadir terlambat dan waktu tunggu yang lama dapat memperburuk keadaan pasien. Pada SM, serangkaian neurohormonal teraktivasi. Penyekat enzim konversi angiotensin (EKA) dapat menghambat aktivasi renin-angiotensi-aldosteron (RAA), memperbaiki kondisi pasien selama menunggu jadwal operasi. Namun, pemberian penyekat EKA masih kontroversial. Tujuan : Untuk menilai keamanan dan pengaruh pemberian penyekat EKA dosis kecil pada pasien SM tanpa hipotensi terhadap six minute walk test (6MWT) dan N-Terminal pro B type natriuretic peptide (NT-proBNP). Metode : Penelitian ini merupakan studi eksperimental acak yang tersamar ganda. Sampel diambil secara konsekutif dan dilakukan randomisasi blok, untuk pemberian lisinopril 2,5 mg atau plasebo. Setiap subyek dilakukan ekokardiografi, 6MWT dan pemeriksaan laboratorium sebelum diberikan perlakuan. Evaluasi serupa dilakukan pada setiap subyek setelah 4 minggu. Hasil Penelitian : Terdapat 37 subyek yang berhasil dilakukan analisis; 19 pasien pada kelompok perlakuan dan 18 pasien pada kelompok kontrol. Tidak didapatkan perbedaan yang bermakna pada perubahan NT-proBNP dan 6MWT pada kedua kelompok (∆ NT proBNP 59 (-6747) - 2145) vs (-166) (-1495 - 1664) pg/mL; p = 0.443) dan (∆ 6 MWT 11.66 + 73 vs 21.37 + 47; p = 0.638). Tidak didapatkan pula perbedaan tekanan darah serta isi sekuncup yang bermakna antara kedua kelompok paska perlakukan, median isi sekuncup pada kelompok perlakuan 54 (34 - 74) vs 45 (34 - 94), p = 0.126.Kesimpulan : Pemberian penyekat EKA dosis kecil pada pasien SM tanpa keadaan hipotensi aman, namun tidak meningkatkan pencapaian 6MWT dan tidak meurunkan kadar NT-proBNP.

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Background : Mitral stenosis (MS) is an obstructive lesion in which the definitive therapy is mechanical intervention. The prevalence of MS in developed countries has been decreasing due to the development of mechanical intervention. In Indonesia the prevalence remains high especially in the era of national health coverage, there are too many patients queuing for mitral valve operation. By this situation, we want to know if the angiotensin converting enzyme (ACE) inhibitor could reduce the burden of symptoms and other neurohormonal activation such as NT-proBNP in MS patients. There are many controversies to the use of ace inhibitor in MS patients, questioning the benefit and safety of ace inhibitor to these patients.

Objective : To study the safety and efficacy of low dose ACE inhibitor towards six minute walk test (6MWT) and N-Terminal pro B type natriuretic peptide (NT-proBNP) in Mitral Stenosis Patients without Hypotension.

Methods : This study is a double blind randomized control trial. Sample was taken consecutively, and randomized to be given lisinopril 2.5mg or placebo. Every patient was assigned for echocardiography evaluation, 6MWT, and laboratory examination before and after intervention.

Result : 37 patients were included in the analysis; 19 was in the intervention group, 18 patient was in the placebo group. No significant difference were found between the two groups in terms of NT-proBNP and 6MWT, (∆ NT proBNP 59 (-6747) - 2145) vs (166) (-1495 - 1664) pg/mL; p=0.443) dan (∆ 6 MWT 11.66 + 73 vs 21.37 + 47; p = 0.638). In terms of blood pressure and stroke volume, there was also no significant difference between the two groups after intervention, median for stroke volume in intervention group and control group were 54 (34 - 74) vs45 (34 - 94), p = 0.126.

Conclusion : Low dose ACE inhibitor is safe to be given in MS patient without hypotension, however, it did not increase functional capacity measured by 6MWT, neither improve NT-proBNP. "

"ABSTRAK Latar belakang. Pada pasien SA fraksi ejeksi ventrikel kiri dapat normal bahkan supra normal untukjangka waktu yang lama walaupun proses remodeling ventrikel kiri sudah mulai terjadi..Ekokardiografi speckle tracking dua dimensi (EST) mempunyai kelebihan untukdigunakan dalam menilai penurunan fungsi kontraktilitas miokard subklinis, dimanakeadaan tersebut dapat mempengaruhi prognosis pasien SA. sST2 merupakan biomarkeryang relatif baru, dapat meningkat pada regangan otot jantung (myocardial stretch),fibrosis, inflamasi, dan injuri miokard, apakah berhubungan dengan disfungsi diniventrikel kiri masih belum diketahui.Tujuan. Mengetahui korelasi sST2 terhadap nilai GLS EST pada pasien SA berat denganFEVK normalMetode. Merupakan studi potong lintang. Evaluasi dilakukan pada 29 pasien stenosisaorta berat dengan fraksi ejeksi normal yang datang ke poliklinik RS Jantung HarapanKita periode Februari 2015 sampai November 2015. Dilakukan pengambilan figurekokardiografi untuk menilai severitas SA dan untuk perhitungan nilai global longitudinalstrain speckle tracking kemudian dilakukan pengambilan sampel darah di laboratoriumRS Jantung Harapan Kita untuk menilai sST2.Hasil Penelitian. Dua puluh sembilan subjek ikut dalam penelitian ini dengan rerata usiaadalah 59.7±12.1 tahun. Fungsi intrinsik ventrikel kiri pasien SA berat pada penelitian inimengalami penurunan dengan nilai rerata GLS -11±4.5%. Hasil uji korelasi menunjukanterdapat korelasi positif dengan kekuatan korelasi sedang yang bermakna (r=0.429,p=0.02). Analisis multivariat tetap menunjukkan adanya hubungan antara kadar sST2dengan nilai GLS EST (r=0,282 p=0.036). Kesimpulan. Terdapat korelasi sST2 dengan global longitudinal strain speckle trackingpada pasien SA berat dengan fraksi ejeksi normal.ABSTRACT Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. "

"Latar belakang. Stenosis mitralis (SM) masih merupakan masalah kesehatan di Indonesia, dan fibrilasi atrium merupakan penyakit penyerta yang akan meningkatkan emboli sistemik, stroke dan mortalitas pasien. Diduga umpan balik mekano elektris dan remodeling elektris mempunyai peranan yang penting dalam mekanisme terjadinya tibrilasi atrium (FA) pada penyakit katup jantung. Untuk menguji hipotesis bahwa telah tejadi remodeling elektris intrinsik pada pasien SM, dan remodeling tersebut bersifat reversibel, malta telah dilakukan penelitian mengenai perubahan elektrotisiologis sesudah tindakan komisurotomi mitral transvena perkutan (KMTP). Bahan dan cara kerja. Tigapuluh satu pas ien SM yang dilakukan KMTP, 20 dengan irama sinus (IS) dan ll dengan FA persisten serta 10 pasien dengan jantung normal sebagai kelompok kelola dimasukkan dalam penelitian ini. Pemeriksaan hemodinamik dan elektrotisiologi dilakukan sebelum dan segera sesudah KMTP. Semua pasien FA, dilakukan kardioversi eksternal sinkron sebelum dilakukan KMTP. Sebelum pemeriksaan elektrofisiologis, diberikan propranolol iv, 0,2 mg/kgbb dan sulfas atropin 0,004 mg/kbb untuk mem-blok aktiiitas saraf autonom. Pemeriksaan elektrofisiologi meliputi pemeriksaan periode refrakter efektif (PRE) di 6 tempat di atrium, waktu koduksi (WK) di atrium kanan dan kiri dan pengukuran elektrogram atrium di I8 tempat atrium kanan dan kiri. Hasil. Tidak terdapat perbedaan umur, dan jenis kelamin antara kelompok pasien SM dan kelompok kelola. PRE keselunlhan pada kelompok SM dan kelola yang diperoleh pada pacuan 600 milidetik tidak menunjukkan perbedaan bermakna Demikian pula pada pacuan 400 milidetik, tidak menunjukkan kemaknaan statistik Secara regional, PRE atrium lcanan dan kiri tidak menunjukkan perbedaan yang bermakna pada kelompok pasien SM dan kelola. Tetapi kelompok pasien SM mempunyai dispersi PRE lebih lebar dibanding dengan kelompok kelola. WK atrium kanan dan kiri kelompok pasien SM menunj ukkan perlambatan yang bermaltna dibanding dengan kelompok kelola. Di sebagian besar tempat atrium kanan dan kiri, voltase elektrogram atrium juga menunjukkan penurunan yang sangat bermakna. Tidak ada perbedaan dalam durasi elektrogram pada kedua kelompok. Potensial ganda dan elektrogram yang terpecah-pecah tidak ditemukan pada kedua kelompok. Tidak Lerdapat perbedaan bermakna dalam variabel hemodinamik antara kelompok SM disertai IS dengan disertai FA, namun terdapat perbedaan bermakna dalam variabel elektroflsiologi (re-modeling elektris) PRE rerata Secara keseluruhan yang diukur pada interval pacuan 600 milidetik pada kelompok FAjauh lebih pendek dibanding dengan kelompok IS yang secara statistik berbeda bermakna. Demikian pula bila diukur pzlda interval pacuan 400 milidetik. Secara regional, PRE atrium kanan dan kiri kelompok FA lebih pendek dibanding dengan kelompok IS dan perbedaannya seeara statistik bermakna. Sedang dispersi PRE pada kedua kelompok tersebut tidak menunjukkan kemaknaan statislik. WK di atrium kanan dan kiri pada kelompok FA1ebih lambat dibandingkan dengan kelompok IS, dan perbedaannya secara statistik bermalma. Sebagian besar tempat di atrium tidak menunjukkan perbedaan voltase elektogram antara kelompok IS dan FA. Remodeling elektris ini bersifat reversibel setelah dilakukan KMTP. PRE rerata secara keseluruhan yang diukur pada interval pacuan 600 milidetik sebelum dan sesudah dilakukan KMTP ialah 240,51-_39,2 milidetik vs 248,2i36,l mi1idetik(p=0,003)_ Demikian pula pada pengukuran dengan interval 400 mi1idetik(da.ri 228,2i35,3 milidetik vs 238,l i319 milidetik, p=0,000). Reversibilitas hanya terjadi terutama pada sebagian besar PRE atrium dan WK di atrium kiri, sedang besamya vol tase elektrogram lidak demikian halnya. Remodel ing elektris atrium tersebut bersifat intrinsik, tidak dipengaruhi oleh susunan saraf autonom. Di samping pembuktian hipotesis di atas ditemukan pula variabel prediktor terhadap kejadian FA pada penderita SM yakni diameter atrium kanan medial-lateral yang diukur dengan ekokardiograti 2 dimensi (rasio odds 1,128 dengan KI 95% berkisar antara 1,012 sampai l,466), serta PRE atrium kanan bawah (rasio odds 0,952 dengan KI 95% anlara 0,907 - l,000). Kesimpulannya pada pasien SM telah teijadi remodeling elekuis yang mengarah texjadinya FA. Bilamana telah terjadi FA, maka remodeling elelctris akan makin memburuk. Walaupun demikian remodeling elektris yang terjadi bersifat reversibel dengan mengurangi regangan dinding atrium melalui KMTR Remodeling elektris dan reversibilitasnya bersifat intrinsik, tidak dipengaruhi oleh saraf autonom. Oleh karena itu intervensi dini dengan KMTP perlu dilakukan pada setiap pasien SM dengan keluhan, atau bilamana clijumpai pembesaran dimensi atrium kanan mediallateral.

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Background: Mitral stenosis (MS) is one of the major health problems in developing countries. In addition, atrial fibrillation (AF) is one of the MS complication and had a consequence of higher systemic embolic rate including stroke and mortality. Mechano-electrical feedback and electrical remodeling in patients with valvular heart disease might be play an important role in the mechanism of atrial fibrillation (AF). To test the hypothesis that there was an intrinsic elec-trical remodeling in MS and this remodeling might be reversible, we investigated electrophysiological changes after percutaneous transvenous mitral commissurotomy (PTMC). Material and methods. Eleven MS patients with persistentAF and 20 patients with sinus rhythm (SR) were undergoing PTMC included in this study. Ten patients who underwent electrophysiologic study or ablation involving left atrial study were as control group. Autonomic nervous system was blocked using propranolol 0.2 mg/kgbw and atropine 0.04 mgfkgbw. Atrial effective refractory period (AERP) was measured at 2 sites in the right and 4 sites in the left atrium. The conduction time (CT) was measured at the right and left atrium using decapolar catheter. Atrial electrogram was measured on its amplitude, duration and number of fragments of the electrogram at 18 sites of the atrium. Results. There were no statistically differences in age and sex among the MS group and the control group. No significant difference in the overall AERP between the MS group and control group, but the MS group had a higher AERP dispersion tha.n the control group . The MS group had a lower conduction time (CT) than the control group and its difference was statistically significant. Most of the sites in the MS group were smaller than the control group. The duration of electrogram of both groups were similar. No double potential and fractionated electrograms were found in both groups. There were no statistical difference in the hemodynamic variables between the MS patients with SR (SR group) and AF group. The AF group had shorter overall AERP than the IS group and the difference was statistically significant- In most sites of the atrium, the voltage of the an-ial electrogram was lower in the AF group compared with the IS group. There was no significant difference in CT between both groups. The voltage of the atrial electrogram in both groups were similar. The overal AERP and the AERP of most sites of the atrium was increased after PTMC. The CT in left atrium not the right was shortened after PTMC. And the voltage of atrial electrogram became higher after PTMC. In addition, beside the above hypothesis tested, there were 2 independent predictors for AF in patients with MS, i.e. the medial-lateral right atrial dimension (OR 1.128 and 95% Cl 1.012 - l.466) and AERP of the low right atrium (OR 0.952, 95% CI 0.907 - L000). Conclusion: Patients with MS have an electrical remodeling due to atrial stretch. Atrial remodeling also occurs when the patients are getting atrial fibrillation. But fortunately these electrophysiological changes will be reversible when PTMC is performed. The electrical remodeling and its reversibility is an intrinsic atrial property, not influenced by the autonomic nervous system. Earlier intervention should he performed to prevent AF for every symptomatic MS patient or asymptomatic with increased medial-lateral right atrial dimension."

"Latar Belakang: Kondisi MS akan menyebabkan terjadinya peningkatan tekanan atrium kiri secara progresif dan menyebabkan remodelling serta dilatasi atrium kiri. Proses ini akan berakhir dengan penurunan komplians dari atrium kiri dan menyebabkan perubahan secara morfologis dan fungsional. Beberapa studi menunjukkan pengukuran Strain atrium kiri pada pasca tindakan balloon mitral valvuloplasty (BMV) menunjukkan perbaikan yang bermakna. Namun belum ada yang menilai hubungan antara perubahan Strain atrium kiri dengan perbaikan kapasitas fungsional pada pasien MS pasca tindakan BMV.Tujuan: Tujuan penelitian ini adalah untuk mengevaluasi hubungan antara perubahan Strain atrium kiri dengan perubahan kapasitas fungsional pada pasien MS pasca tindakan BMV.Metode: Desain penelitian yang digunakan adalah studi dengan one group pre-post design. Penelitian ini menggunakan data pemeriksaan ekokardiografi dan data kapasitas fungsional pasien mitral stenosis yang dilakukan tindakan BMV pada Maret 2019 hingga April 2020. Dilakukan pengukuran strain atrium kiri dengan metode speckle tracking echocardiography. Data sebelum dan sesudah BMV dianalisis untuk mencari hubungan variabel terhadap perubahan kapasitas fungsional.Hasil: Pasca tindakan BMV, terjadi perbaikan signifikan kapasitas fungsional yang ditandai dengan perbaikan median lama latihan (241 (18 – 1080) ke 606 (80 – 1900) detik, p <0.0001) dan perbaikan median nilai VO2max estimasi (18,8 (10,2 – 51,4) ke 33(12,6-83,2) mlO2/kg/menit, p <0.0001). Strain atrium kiri mengalami perubahan signifikan pasca tindakan BMV dari median 8(2-23)% ke 11(4-27)%. Dari uji korelasi didapatkan bahwa pre-MVG (r 0,23, adjusted R2 = 4,9%) berkorelasi terhadap perubahan kapasitas fungsional. Pada analisis bivariat dan multivariat didapatkan bahwa perubahan strain atrium kiri tidak berhubungan dengan perubahan kapasitas fungsional. Nilai pra MVA >1 cm2 (OR 7,37, IK 95% 1,0-54,35; p = 0,05) pra MVG > 10 mmHg (OR 6,6, IK 95% 1,71-25,5; p = 0,006) dan pra mPAP < 25 mmHg (OR 5,96, IK 95% 1,37-25,9; p = 0,017) berkorelasi terhadap perbaikan lama latihan pasca tindakan BMV.Kesimpulan: Perubahan strain atrium kiri tidak berhubungan dengan perubahan kapasitas fungsional pada pasien MS pasca tindakan BMV.

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Background: MS conditions will cause a progressive increase in left atrial pressure, remodelling and left atrial dilatation. This process will end with a decrease of left atrial compliance, causing morphological and functional changes. Several studies have shown that left atrial strain measurements after the BMV procedure showed significant improvement. However, no study has assessed the relationship between changes in left atrial strain and improvements in functional capacity in MS patients after the BMV procedure.

Objectives: This study aimed to evaluate the association between left atrial strain changes and functional capacity changes in MS patients after BMV procedures

Method: This is a one group pre-post design using retrospective data. This study used echocardiographic and functional capacity data of mitral stenosis patients who underwent BMV procedures from March 2019 to April 2020. Left atrial strain was measured using the speckle tracking echocardiography method. Data before and after BMV were analyzed to find the association of variables to changes in functional capacity.

Results: After the BMV procedure, there was a significant improvement in functional capacity as indicated by an improvement in the median length of exercise (241 (18 – 1080) to 606 (80 – 1900) seconds, p <0.0001) and an improvement in the median estimated VO2max value (18.8 (10.2). – 51.4) to 33(12.6-83.2) mlO2/kg/min, p < 0.0001). The left atrial strain underwent a significant change after the BMV procedure from a median of 8(2-23)% to 11(4-27)%. From the correlation test it was found that pre-MVG (r 0.23, adjusted R2 = 4.9%) correlated with changes in functional capacity. In bivariate and multivariate analysis, it was found that changes in left atrial strain were not associated with changes in functional capacity. Pre MVA value >1 cm2 (OR 7.37, CI 95% 1.0-54.35; p = 0.05) pre MVG > 10 mmHg (OR 6.6, CI 95% 1.71-25.5 ; p = 0.006) and pre mPAP < 25 mmHg (OR 5.96, CI 95% 1.37-25.9; p = 0.017) correlated with the improvement in duration of exercise after the BMV action.

Conclusion: Changes in left atrial strain are not associated with changes in functional capacity in MS patients after the BMV procedure."

"Perubahan tunika intima media (TIM) karotis dan flow mediated dilatation (FMD) dapat digunakan sebagai pemeriksaan untuk mengetahui aterosklerosis dini. Pada ODHA TIM karotis dan FMD dapat dipengaruhi oleh inflamasi kronik akibat infeksi HIV itu sendiri, efek samping terapi ARV, dan koinfeksi virus atau bakteri lain. Oleh karena itu, penelitian ini menelaah kinetika penanda inflamasi (CRP, ICAM-1 dan sTNFR), kondroitin sulfat (KS) serta antibodi CMV, mengorelasikannya dengan perubahan TIM karotis dan FMD pada ODHA yang memulai terapi ARV serta dibandingkan dengan kontrol sehat setelah 60 bulan terapi ARV.Desain penelitian kohort prospektif dan cross-sectional. Subjek penelitian didapatkan dengan consecutive sampling dari Januari 2013 sampai Desember 2014, diamati dalam 3 kurun waktu selama 60 bulan di RSUPN Dr. Cipto Mangunkusumo. Dilakukan pemeriksaan USG pembuluh darah karotis pada semua subjek, diamati perubahan ketebalan TIM karotis, FMD, kadar CD4, indeks massa tubuh, kadar CRP, ICAM-1, sTNFR, KS, dan antibodi CMV setiap periode pengamatan. Data dianalisis menggunakan uji Mann Whitney U, Wilcoxon, Spearman’s correlation, Pearson’s correlation dan multiple linear regression.Tidak didapatkan perubahan TIM karotis setelah dilakukan terapi ARV selama 12 bulan dan 60 bulan. Tidak ada perbedaan bermakna untuk TIM karotis dan FMD antara ODHA dengan kontrol sehat. ICAM-1 memiliki korelasi dengan TIM karotis pada kunjungan awal sebelum terapi dan KS memiliki korelasi dengan TIM karotis setelah 60 bulan terapi ARV. FMD memiliki korelasi negatif dengan KS dan antibodi CMV lysate pada ODHA, sedangkan pada kontrol sehat FMD memiliki korelasi negatif dengan sTNFR dan KS, namun memiliki korelasi kuat dengan antibodi CMV gB.Inflamasi kronik pada ODHA tidak menyebabkan perubahan TIM karoti. KS dan antibodi CMV lysate dapat memengaruhi nilai FMD pada ODHA. Pada kontrol sehat, KS dan sTNFR bisa memengaruhi nilai FMD, namun antibodi CMV gB bisa berfungsi sebagai faktor pelindung.

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Carotid intima-media thickness (CIMT) and flow mediated dilatation (FMD) used to detect early atherosclerosis. In people living with hiv/aids (PLWH), CIMT and FMD could be influenced by chronic inflammation affected HIV infection, ART and co-infection. We did the research to study the kinetic of inflammation biomarkers (CRP, ICAM-1 and sTNFR), chondroitine sulfate (CS) and CMV reactive antibodies, to find correlation for CIMT and FMD starting ART and compare to healthy control (HC) after 60 months.

This was a cohort prospective study and repeated cross sectional. The subjects were collected from January 2013 until December 2014, follow up to 60 months. Every visit we did USG for carotid artery and FMD at brachial artery, CD4, BMI, CRP, ICAM-1, sTNFR, CS and CMV antibodies level were also measured. Data were analyzed using Mann Whitney U, Wilcoxon, Spearman’s correlation, Pearson’s correlation and multiple linear regression.

There were no differences in CIMT changes in 60 years follow up. There were no differences of CIMT and FMD between PLWH and HC. ICAM-1 had a correlation with CIMT before starting ARV therapy and CS had a correlation with CIMT after 60 months of ARV therapy. FMD had a negative correlation with CS and CMV Lysate antibody for PLWH. FMD had negative correlation to CS and sTNFR but strong correlation to CMV gB antibody in HC.

Chronic inflammation in PLWH did not cause CIMT changes. CS and CMV Lysate antibody may influenced FMD in PLWH, but for HC, CS and sTNFR may influenced FMD, but CMV gB antibody could be a protective factor.

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