Hasil Pencarian  ::  Simpan CSV :: Kembali

"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.

---

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. "

"ABSTRAKSepsis adalah disfungsi organ yang mengancam jiwa akibat gangguan regulasi pejamu sebagai respons terhadap infeksi. Renjatan sepsis adalah subset sepsis dengan abnormalitas sirkulasi, selular, dan metabolisme yang berkaitan dengan risiko kematian. Penelitian ini bertujuan untuk menilai peran ekokardiografi, biomarker kardiovaskular, fungsi ginjal dan saturasi oksigen vena sebagai prediktor kematian pasien renjatan sepsis. Pada pemeriksaan ekokardiografi dinilai fungsi diastolik E/e rsquo;, Fraksi Ejeksi Bilik Kiri, Indeks Kardiak, TAPSE, sedangkan biomarker kardiovaskular dinilai Troponin I dan NT Pro BNP, dengan disain penelitian kohort prospektif. Tempat penelitian di Rumah Sakit Umum Kabupaten Tangerang, Banten. Selama periode 2 tahun penelitian ada 111 pasien masuk dalam kriteria renjatan sepsis yaitu adanya infeksi, hipotensi MAP < 65 mmHg dan Laktat darah > 2 mmol/L. Pada hari pertama dan kelima dilakukan pemeriksaan ekokardiografi dan laboratorium darah pada semua pasien renjatan sepsis. Pada pengamatan selama 10 hari diperoleh pasien yang meninggal 64 58 dan yang hidup 47 42 . Rerata umur pasien 48 18 tahun. Analisis bivariat ditemukan Fraksi Ejeksi Bilik Kiri abnormal memiliki risiko kematian 1,6 kali dibanding normal RR 1,6; p = 0,034 . Biomarker Troponin I abnormal menunjukkan risiko kematian 1,6 kali dibanding normal RR 1,6; p = 0,004 . Pasien dengan gangguan fungsi ginjal memiliki risiko kematian 1,5 kali RR 1,5; p = 0,024 . Pasien dengan Troponin I abnormal dengan atau tanpa gangguan fungsi ginjal menunjukkan peningkatan risiko kematian, demikian pula pada pasien dengan Troponin I normal yang disertai gangguan fungsi ginjal. Hasil analisis multivariat menunjukkan prediktor kematian pasien renjatan sepsis adalah kadar Troponin I dan Fraksi Ejeksi Bilik Kiri RR 1,83; IK95 1,049 ? 3,215; p = 0,043 dan RR 1,99; IK95 1,009 ? 3,956; p = 0,047 Simpulan: Troponin I dan Fraksi Ejeksi Bilik Kiri merupakan prediktor kematian pasien renjatan sepsis. Kata kunci :Ekokardiografi, Kematian, NT Pro BNP, Renjatan Sepsis, Troponin I.

---

ABSTRACTSepsis is a life threatening organ dysfunction caused by host regulation disorder in response to infections. Septic shock is a subset of sepsis with circulatory, cellular, and metabolic abnormalities associated with the risk of mortality. The aim of this study is to assess the role of echocardiography, cardiovascular biomarker, renal function and oxygen vein saturation as predictors of mortality in patients with septic shock. In this study, echocardiography examination including diastolic function E e 39 , Left Ventricle Ejection Fraction LVEF , Cardiac Index CI , and TAPSE, whereas cardiovascular biomarker Troponin I and NT Pro BNP were assessed. Research design of this study is cohort perspective. The study took place in Tangerang Regional General Hospital, Banten Province. During two years of research, there were 111 patients included in septic shock category, which indicated by the presence of infections, hypotension MAP 65 mmHg and serum lactate 2 mmol L. On the first and the fifth day, examinations on echocardiography and laboratory blood test were conducted on each patient of septic shock. During ten days of observation, 64 patients died 54 and 47 patients were survived 42 . The mean age of the patients was 48 18 years old. Bivariate analysis showed abnormal LVEF had 1.6 times higher mortality risk than normal RR 1.6 p 0.034 . Abnormal Troponin I biomarker showed 1.6 higher mortality risk, compared to normal RR 1.6 p 0.004 . The patients with kidney function disorder had 1.5 times higher mortality risk RR 1.5 p 0.024 . Patients with abnormal Troponin I with or without kidney function disorder showed increase in mortality risk. Normal Troponin I with kidney function disorder also increase in mortality risk. Multivariate analysis showed Troponin I and Left Ventricular Ejection Fraction as predictors of mortality in patients with septic shock RR 1.83 CI95 1.049 3.215 p 0.043 dan RR 1.99 CI95 1.009 3.956 p 0.047 In conclusion, Troponin I biomaker and Left Ventricular Ejection Fraction are predictors of mortality in patients with septic shock. Keyword Echocardiography, Death, NT Pro BNP, Septic Shock, Troponin I "

"Latar belakang: Gagal jantung kronik merupakan penyakit progresif lambat dengan morbiditas serta mortalitas yang tinggi. Penggunaan obat-obatan seringkali tidak berhasil, sehingga Enhanced External Counterpulsation (EECP) yang bersifat non-invasif dapat menjadi alternatif terapi dalam penanganan gagal jantung. Metode: Penelitian ini menggunakan desain uji klinik terkontrol secara randomisasi terbuka terhadap kelompok yang menjalani terapi EECP dan yang tidak menjalani terapi (non-EECP). Masing-masing kelompok terdiri dari 33 pasien. Pada semua pasien dilakukan pemeriksaan mieloperoksidase (MPO) sebagai penanda inflamasi pada awal dan setelah 6 bulan pengamatan untuk dinilai kelompok mana yang lebih banyak mengalami kejadian kardiovaskular. Hasil: Pengukuran kadar MPO awal (743,4 ± 232,9 pM) dan setelah 6 bulan pengamatan (534,8 ± 191,3 pM) pada kelompok EECP mengalami penurunan bermakna secara statistik (p < 0,001) tetapi pada kelompok non-EECP (679,4 ± 332,3 pM menjadi 517,6 ± 189,7 pM) secara statistik tidak bermakna (p = 0,110). Penurunan kadar MPO sangat bermakna secara statistik pada semua pasien kelompok EECP dibandingkan kelompok non-EECP (13 pasien). Hasil perhitungan risiko relatif (RR) menyatakan bahwa risiko penurunan MPO pada kelompok EECP 2,08 kali lebih baik daripada kelompok non-EECP. Pengamatan kejadian kardiovaskular setelah 6 bulan penelitian menunjukkan perbedaan bermakna antara kedua kelompok (p = 0,037). Kejadian kardiovaskular kelompok non-EECP ditemukan 15 pasien (45,5 %) sedangkan pada kelompok EECP hanya ditemukan 7 pasien (21,2 %). Kesimpulan: Terapi EECP menurunkan kadar MPO pasien GJK dan dapat menurunkan kejadian kardiovaskular dalam 6 bulan pengamatan. Makin tinggi kadar MPO berkorelasi dengan makin tingginya insiden kejadian kardiovaskular.

---

Background: Chronic heart failure (CHF) is a slowly progressive disease with high morbidity and mortality; the management using pharmacological treatments frequently fail. Therefore, Enhanced External Counterpulsation (EECP), a non-invasive treatment, may serve as alternative treatment for heart failure.

Methods: Our study was an open randomized controlled clinical trial. All subjects were categorized into two groups, i.e. the group who had EECP therapy and those who did not have EECP (non-EECP group). Each group consisted of 33 patients. Myeloperoxidase (MPO) as inflammatory marker was examined in all subjects at baseline and after 6 months of observation to assess which group had more cardiovascular events.

Results: Baseline MPO measurement (743.4 ± 232.9 pM) and after 6 months (534.8 ± 191.3 pM) in 32 patients in EECP group showed statistically significant reduction (p < 0.001); however in the non-EECP group, mean reduction value of MPO from 679.4 ± 332.3 pM to 517.6 ± 189.7 pM was not statistically significant (p = 0.110). MPO level reduction was statistically significant in all subjects of EECP group compared to non-EECP group (13 patients). Measured relative risk (RR) demonstrated that there was 2.08 fold risk of reduced MPO in EECP group compared to non-EECP group. Cardiovascular events observed after 6 months study showed that there was a significant difference between groups (p = 0.037).

Conclusion: EECP therapy can reduce MPO level in CHF patients. It may lower cardiovascular events in 6 months observation. Higher MPO level are associated with higher incidence of cardiovascular events."