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Association of Triglyceride/High Density Lipoprotein Cholesterol Ratio and Coronary Lesion Severity in Acute Myocardial Infarction Patients at Adam Malik Hospital, Medan Sinaga, Akbar; Hasan, Refli; Reynaldo, Abdul Halim; Hasan, Harris; Akbar, Nizam Zikri; Andra, Cut Aryfa
Journal of Society Medicine Vol. 2 No. 3 (2023): March
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i3.30

Introduction: Coronary heart disease is the leading cause of worldwide death. A number of markers have been identified in terms of the atherogenic potential of the lipid profile.The TG/HDL-C ratio is an easy and economical non-invasive examination method as a predictor of coronary heart disease severity. The aim of this study is to assess the relationship of the TG/HDL ratio with the severity of coronary lesions. Method: This cross-sectional study included 53 acute myocardial infarction patients undergoing coronary angiography. Exclusion criteria include (1)AMI patients receiving fibrinolytic therapy, (2) Patients who have routinely consumed lipid lowering drug for 6 weeks,(3) Incomplete coronary angiography and medical records. The TG/HDL ratio is the result of dividing the triglyceride value by HDL. The TG/HDL ratio was divided into 2 groups, namely the TG/HDL ratio <4 group and the TG/HDL ratio >4 group. The severity of coronary lesions was described by the SYNTAX score, which was divided into two: the low SYNTAX score group (≤22) and patients with a low SYNTAX score (≤22) and medium-high SYNTAX score (≥23). Bivariate analysis was performed to find the relationship between the TG/HDL ratio and the SYNTAX score. The value of p<0.05 was considered statistically significant. Results: From 53 patients, 26 patients (49.1%) had a SYNTAX score ≥ 23 and 27 patients (50.9%) had a SYNTAX score < 23. Patients with NSTEMI, DM risk factors, and obesity were higher in the SYNTAX score group ≥23. From the results of statistical analysis, there was a significant relationship between the TG/HDL ratio with coronary lesion severity (p = 0,004). Conclusion: Enhancement of TG/HDL ratio is correlated with coronary lesion severity in acute myocardial infarction patients using the SYNTAX score.

The Relationship Between Serum Apolipoprotein B Levels and Severity of Coronary Lesions Using The Syntax Score in Non-St Segment Elevation Acute Myocardial Infarction Patients at Haji Adam Malik General Hospital Medan Kesumawardani, Enggar Sari; Safri, Zainal; Hasan, Harris; Hasan, Refli; Andra, Cut Aryfa; Ardini, Tengku Winda
Journal of Society Medicine Vol. 2 No. 4 (2023): April
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i4.32

Introduction: Acute coronary syndrome mainly occurs as a result of plaque rupture of atherosclerosis. Apolipoprotein B (apoB) is a large glycoprotein, playing a role in lipoprotein metabolism and human lipid transport reflecting the number of circulating atherogenic particles. The purpose of this study was to assess the relationship of serum apoB levels with coronary lesion severity. Method: This is a cross-sectional study involving patients who was diagnosed with Non-ST Elevation Myocardial Infarction (NSTEMI) who underwent coronary angiography in November 2021 to July 2022. The NSTEMI criteria follow the Universal Definition of Myocardial Infarction and coronary severity is assessed using a SYNTAX score. Bivariate analysis was conducted looking for the relationship between apoB with SYNTAX scores with p<0.05 considered statistically significant. Results: The subjects of the study is 70 people, dominated by male 50 patients (71.4%). The median age of the subjects was 56 (38-77) years. Median levels of apoB was 107 (32-150) mg/dL. The average SYNTAX score was 25.66 ± 10.83. Using the Pearson correlation test, it was shown that there is a significant correlation between apoB and coronary lesion severity obtained r=0.442 (p<0.001). Conclusion: There is a significant correlation between apoB and coronary lesion severity using SYNTAX scores in NSTEMI patients.

The Relationship between Pre Discharge Left Ventricle Diastolic Dysfunction and 30 days And 6 Months Rehospitalization in Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) at Haji Adam Malik General Hospital Medan Khaidirman, Sophia Khairina; Mukhtar, Zulfikri; Sarastri, Yuke; Ketaren, Andre Pasha; Raynaldo, Abdul Halim; Andra, Cut Aryfa
Journal of Society Medicine Vol. 2 No. 5 (2023): May
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i5.33

Introduction: Heart failure (HF) is a complex clinal manifestation that cause abnormality of structural and/or functional of the heart. HF is due to diastolic dysfunction and systolic dysfunction of the left ventricle (LV). The aim of this study is to assess the relationship between grading of pre-discharge LV diastolic dysfunction and readmission at 30 days post discharge and 6 months post discharge. Method: This is a cohort retrospective study in HFrEF patients which are treated at Pusat Jantung Terpadu RSUP H. Adam Malik Medan on January 2021 until December 2021. Pre discharge echocardiography has been done to assess LV diastolic dysfunction and the we do the follow up of readmission at 30 days and 6 months by phone. Results: From 93 patients, there are 40 patients (43%) with grade I LV diastolic dysfunction, 22 patients (23,7%) with grade II LV diastolic dysfunction and 31 patients (33,3%) with grade III LV diastolic dysfunction. There are 34 patients (26,6%) with readmission at 30 days and 21 patients (26,6%) readmission at 6 months. There is a significant relationship between grading of pre-discharge LV diastolic dysfunction and readmission at 30 days post discharge (p value 0,000), but not at 6 months post discharge (p value 1,000). Conclusion: Grading of pre-discharge LV diastolic dysfunction on HFrEF patient is correlated with readmission at 30 days post discharge.

Prognostic Value of Tricuspid Annular Plane Systolic Excursion (TAPSE), Right Ventricular Fractional Area Changes (RV FAC) and Pulses Tissue Doppler S' Wave (PTD S') at 30 Days after Care of Acute Miocardial Infarction Patients in Haji Adam Malik Hospital Ilhami, Fadli; Nasution, Ali Nafiah; Andra, Cut Aryfa
Journal of Society Medicine Vol. 2 No. 5 (2023): May
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i5.65

Introduction: Echocardiography is a reliable and simple method of hemodynamic monitoring that can be used on every IMA patient. Tricuspid Annular Plane Systolic Excursion (TAPSE), Right Ventricular Fractional Aera Changes (RV FAC), and Pulses Tissue Doppler S' Wave (PTD S') are the three main parameters of ventricular electrocardiography. The purpose of this study is to understand the reliability of the right ventricle function prognostic indicators TAPSE, PTD S', and RV FAC with regard to the MACE at 30 days following the occurrence of the AMI in RSUP H. Adam Malik Medan Method: This study is an ambispective observational analytic study with sampling carried out at one time (cross-sectional study) on 88 AMI patients at the HAM Hospital who were treated from March 2022 to June 2022 and performed echocardiography in the first 24 hours and measured TAPSE, PTD S' and RV FAC. And followed for 30 days to see the MACE in patients. Bivariate test was conducted to assess the correlation between variables. To determine which independent variables were more effective at predicting MACE, a multivariate logistic regression test was then run. The effectiveness of the independent factors in predicting MACE was also assessed using ROC analysis. Results: The total subjects were 88 AMI patients consisting of 39 (44.3%) patients who experienced MACE and 49 (55.6%) patients who didn’t. The prognostic values of TAPSE, PTDS' and RV FAC on MACE at 30 days were related by bivariate analysis with P Value 0.001 but only PTD S’ showed logistic regression results that were consistent with P Value < 0.001. Based on ROC analysis obtained by PTD S' can predict MACE with AUC = 0.894 Conclusion: Echocardiographic measurement PTD S’ has a good prognostic value to predict MACE within 30 days in AMI patients.

The Relationship between Transient Ischemic Dilation (TID) and Severity of Coronary Artery Disease (CAD) in Patients with Chronic Coronary Syndrome (CCS) in Haji Adam Malik Medan, Indonesia Tamba, Ratna Mariana; Lubis, Hilfan Ade Putra; Mukhtar, Zulfikri; Sitepu, Andika; Habib, Faisal; Andra, Cut Aryfa; Haykal, T. Bob
Journal of Society Medicine Vol. 2 No. 9 (2023): September
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i9.88

Introduction: TID ratio derived from ratio of LV volume in stress and rest phase of MPS. It is said that this phenomenon has been a useful marker of severe CAD, that can be present with atypical angina. This occurs due to global myocardial hypoperfusion caused by severe and extensive CAD. Method: This study was an analytic observational study with a retrospective cohort design in CCS patients who underwent Myocardial Perfusion SPECT at Haji Adam Malik General Hospital from January 2022 to April 2023. All participants underwent MPS with Tc99m sestamibi with pharmacology Adenosine stress test and coronary angiography. The MPS could be performed before or after coronary angiography without any revascularization procedure between the two examination preocedures. An unpaired t-test analysis was performed to find the mean difference in TID values in the mild CAD and moderate-severe CAD groups. Results: The study subjects totaled 93 people with an average age of 55.87±7.44. It was found that the TID value was significantly different between the two groups of mild and moderate-severe CAD based on Syntax score, 0.906±0.13 vs 1.03±0.11 in the mild vs moderate-severe CAD group (p<0.001). Bivariate analysis showed that in this study, the ratio of TID was only associate with LV ESV and LV EDV in stress phase of MPS (p = 0.001). Conclusion: There is a relationship between TID and CAD severity based on Syntax score with higher TID values in patients with moderate-severe CAD compared to patients with mild CAD. TID ratio was only depends on severity od CAD and directly proportional to the volume of LV in the stress phase, suitable to the theory that said TID ratio comes from ratio of LV volume in stress and rest phase of MPS.

The Relationship between D-Dimer Levels and Coronary Lesion Severity in Patients with Acute Myocardial Infarction with ST-Segment Elevation at Haji Adam Malik Hospital Medan Rialdy, M. Isfan; Akbar, Nizam Zikri; Haykal, T. Bob; Ketaren, Andre Pasha; Andra, Cut Aryfa; Sarastri, Yuke
Journal of Society Medicine Vol. 2 No. 9 (2023): September
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v2i9.89

Introduction: Acute coronary syndrome results from rupture or erosion of an atherosclerotic plaque. D-dimer is a direct marker of fibronolysis events and an indirect marker of hypercoagulable state associated with atherosclerotic plaque formation and acute coronary syndrome. The purpose of this study was to determine the relationship between D-dimer levels and the severity of coronary lesions in ST Elevation Myocardial Infarction patients at H. Adam Malik Hospital Medan. Method: This study was conducted with a cross-sectional method on 72 ST Elevation Myocardial Infarction patients at H. Adam Malik Medan Hospital who underwent coronary angiography from December 2022 to May 2023. Definition of ST Elevation Myocardial Infarction followed the definition of Universal Definition of Myocardial Infarction and the severity of coronary lesions was calculated based on syntax score. Data were analyzed univariately and bivariately using SPSS to assess the association of D-dimer levels with syntax score with p<0.05 considered statistically significant. Results: The total study subjects were 72 people with an average age of 56,5410,84years. Most of the study samples were male 56 people (77.8%). The median D-dimer level was 605 and mean syntax score 22.027 + 14.61. There is a significant relationship between D-dimer levels and the severity of coronary lesions based on the syntax score (p: <0.001). Conclusion: There is a significant relationship between D-dimer and severity of coronary lesions in patients with acute myocardial infarction with ST segment elevation at H. Adam Malik General Hospital, Medan.

Relationship between QTc interval prolongation and mortality of acute ischaemic stroke patients during treatment and three months after treatment at Adam Malik Hospital Lubis, Al-Ma’ Arij Akbar; Andra, Cut Aryfa; Ketaren, Andre Pasha
Journal of Society Medicine Vol. 3 No. 3 (2024): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i3.135

Introduction: QTc interval prolongation is associated with an increased risk of mortality and incident cardiocerebrovascular disease in high-risk individuals and the general population. In addition, QTc interval prolongation in patients with acute stroke is associated with a significantly greater risk of death within 3 months. Based on the description in the background above, this study aims to determine how the relationship of QTc interval prolongation to mortality in acute ischaemic stroke patients during treatment and three months post-treatment at H. Adam Malik Hospital Medan. Method: This study was an analytical study with a case control research design to determine the relationship of QTc interval prolongation to mortality in acute ischaemic stroke patients during treatment and three months post-treatment at Adam Malik Hospital Medan. The research time was carried out in March 2023 by taking a sample of cases from January 2021 to December 2022. The association of QTc interval prolongation with mortality of acute ischaemic stroke patients during treatment and three months post-treatment was analysed by Chi-square test. The statistical significance threshold used was p < 0.05. Results: In patients who died, the mean QTc interval was 490 ms (453.0 - 547.0 ms). Comorbidities in this study included 27 (32.9%) patients with Type 2 DM, 42 (51.2%) patients with hypertension, 7 (16.6%) patients with chronic kidney disease, 13 (15.8%) patients with atrial fibrillation, 1 (1.21%) with pneumonia, and 1 (1.21%) with upper feeding tract bleeding (PSMBA). Conclusion: QTc interval prolongation is associated with mortality in acute ischaemic stroke patients during treatment and three months post-treatment at H. Adam Malik Hospital Medan

The Relationship between Heart Rate Recovery and Rate Pressure Product on Coronary Lesion Severity Using Syntax Score in Stable Angina Pectoris Patients at Haji Adam Malik Hospital Medan Adam, Faisal; Andra, Cut Aryfa; Lubis, Hilfan Ade Putra
Journal of Society Medicine Vol. 3 No. 7 (2024): July
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i7.158

Introduction: RPP is used as a marker of cardiac function. RPP reflects the function of the heart in fulfilling oxygen demand stably and continuously during activity. Slow decline of HRR is associated with risk factors for atherosclerosis, similar to hypertension and dyslipidaemia There has not been much research on HRR and RPP in coronary heart disease. The aim of this study is to examine the relationship between RPP and syntax score in stable coronary heart disease. Methods: This study is an observational analytic study with a cross sectional design to determine the relationship between HRR and RPP to the severity of coronary lesions using the syntax score in stable angina pectoris patients. Sampling was carried out at the Haji Adam Malik Hospital Medan from February. HRR and RPP scores were obtained from cardiac exercise testing and syntax scores were obtained from coronary angiography after validation by an interventionist. EF data were taken from echocardiography results validated by consultant echocardiographers. Statistical data analysis using computer statistical tools, p value <0.05 was considered statistically significant. Results: From angiographic data in samples with syntax score ≥ 23, there were 23 (100%) LAD, 21 (91.3%) LCx, and 22 (95.7%) RCA involvement. In samples with Syntax score < 23, there were single vessel lesions as many as 11 (40.07%), two vessels as many as 12 (44.4%), and three vessels as many as 4 (14.8%). From the test results, there was a significant relationship between HRR and RPP and SYNTAX score with a p value <0.05 (<0.001) in both variables. Conclusion: There was a significant association in HRR scores and RPP scores between groups with SYNTAX scores ≥ 23 and SYNTAX scores < 23.

Cardiometabolic Risk Assessment through Comprehensive Screening for Early Detection Andra, Cut Aryfa; Hasan, Refli; Khairul, Andi; Tamba, Ratna Mariana; Putra, Muhammad Hafiz Mahruzza
Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) Vol. 5 No. 3 (2023): Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI)
Publisher : TALENTA Publisher, Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/jetromi.v5i3.12818

Background: The development of cardiovascular disease (CVD) is influenced by many risk factors, such as tobacco use, an unhealthy diet, and physical inactivity, that could result in obesity, hypertension, dyslipidemia, and diabetes mellitus. Continuing exposure to these risk factors can be prevented by routine screening for populations without any clinical symptoms. This study was conducted to obtain data on cardiometabolic profiles of people who participated in the Community Service Program of the Department of Cardiology and Vascular Disease, University of Sumatera Utara. Method: This research was a descriptive study with a cross-sectional research design. The study aims to screen for the cardiometabolic profile in the people of Tebing Tinggi City. Cardiovascular risk factors were obtained from interviewing the participants and on-the-spot examination with validated measurement tools. All data were processed and analyzed statistically using SPSS ver.26. Categorical variables are presented with frequency (n) and percentage (%). Numeric variables are presented with mean and standard deviation (SD) values for normally distributed data. As for the normal non-distributed data numerical variables are presented with the middle value (median) and the interquartile range. Results: All subjects in this study (n= 102) are 39 male and 63 female. Most participants were in the 4th to 5th decade, with normal heart rates and normal sinus rhythm. Most female participants had a low risk for obstructive sleep apnea (OSA) and the male had intermediate risk. Most participants had normal random blood sugar and total cholesterol but mostly had obesity. Near 20-30% of participants were grade I and II systolic hypertensives but normally had diastolic blood pressure. Conclusion: In this study, most of the cardiometabolic risks of patients in the Community Service program were obesity, followed by hypertension.

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