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Significance of Six Minute Walking Distance in Predicting Functional Capacity Status of Patients with Pulmonary Hypertension Complicating an Atrial Septal Defect Anggia Endah Satuti; Dyah Wulan Anggrahini; Lucia Krisdinarti
ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17789

Background: Six minute walk test (6 MWT) is a sub-maximal exercise test that measures an integrated response of all systems responsible during exercise. Pulmonary arterial hypertension (PAH) is a problem encountered by patients with atrial septal defect (ASD). Assessment of functional capacity in patients with PAH based on the WHO functional classifi cation remains a powerfulpredictor of survival in these patients. The World Health Organization functional classifi cation is a subjective tool because it is based on anamnesis of ordinary activity. On the contrary, 6 MWT is an objective tool to measure functional capacity of patients with pulmonary hypertension. Objective: To determine the walking distance obtained using 6 MWT as a measurement of functionalcapacity in ASD patients with PAH. Methods: A cross sectional study was used to determine the walking distance as a measurement of functional capacity in ASD patient with PAH. This study was a sub-study of an Atrial Septal DefectRegistry done in RSUP Dr. Sardijto, Yogyakarta, since 2012. Pulmonary arterial pressure was measured using Pulmonary Arterial Systolic Pressure (PASP) obtained from echocardiography. Pulmonary hypertension was divided into three categories based on PASP, mild with PASP of less than 45 mmHg, moderate with PASP of 45-59 mmHg and severe with PASP of more than 60 mmHg. All patients did 6 MWT to measure their functional capacity. The relationship between 6 MWT distance and severity of PAH was measured using Pearson correlation analysis. Results: Forty-three patients were included in this study with 32 female patients (74%) and 11 male patients (26%) with an age range of 17-70 years old. Forty-four patients (44%) with ASD had severe PAH. The mean of 6 MWT distance was 337 m. There were signifi cant differences between mild, moderate and severe PAH in correlation with the 6 MWT distance (p= 0.001). The patients with severe PAH had only 278 m walking distance compared to those with mild PAH who had 394 m walking distance. There was a significant relationship between the 6 MWT distance and severity of PAH (p=0.01). This study showed that 6 MWT correlates negatively with the severity of PAH. We found that the higher pulmonary arterial pressure, the shorter walking distance (p=0.01, r -0,506). Conclusion: ASD defect patients with severe PAH had shorter walking distance compared to those with mild PAH. The 6 MWT is a reliable and objective measurement of functional capacity for ASD patients with PAH.

The Incidence of Mitral Valve Prolapse and Mitral Valve Regurgitation in Patient with Secundum Atrial Septal Defect Ni Made Elva Mayasari; Dyah Wulan Anggrahini; Hasanah Mumpuni; Lucia Krisdinarti
ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17790

Background: Association between secundum atrial septal defect (ASD) and mitral valve disease has been recognized for many years. Noninvasive studies indicate a high incidence of mitral valve prolapse (37-70 percent) in these patients. Change of left ventricular geometry in atrial septal defect had been showed were associated with degree of mitral valve prolapse. This study delineates the incidence of mitral valve prolaps and mitral regurgitation in adult patients with secundum atrial septal defect and association with age at onset and size defect. Method: This study was a substudy from ASD registry in Dr. Sardjito General Hospital. The records of 103 adult patients ranged in age from 17 to 76 years old, with an average of 36 years old, and consisted of 16 men and 87 women who had secundum atrial septal defects demonstrated by crosssectional echocardiography between july 2012 until july 2013. Echocardiographic examinations were performed with the patient in the supine position. The echocardiograph was a Vivid 7. The mitral valve apparatus and mitral regurgitation was examined with long axis images, short axis image and apical four chamber view. Result: Mitral valve prolapse was observed in 76% patients with secundum atrial septal defect. Prolaps of anterior mitral leafl et (AML) in age group younger than 35 years and older than 36 years are 38,6% and 61,4% respectively. The incidence of mitral regurgitation was 43%. Severity varianceof mitral regurgitation were 31,7% mild, 7,7% moderate and 2,9% severe. Mitral regurgitation in patient with prolapse AML was 56.4%. None of the patients without mitral valve prolapse had mitral regurgitation.In patient with size defect more than 2 cm, the proportion of prolapse of AML and mitral regurgitation was higher as compared with patient with size defect less than 2 cm. Conclusion: Incidence of mitral valve prolaps and mitral regurgitation are high in patient with atrial septal defect and increase with onset of age. Patients with larger size defect had a greater likelihood of mitral prolapse and mitral regurgitation. Onset of age and size defect might be associated with magnitude of the shunt and abnormal ventricular geometry.Keywords: secundum atrial septal defect, mitral valve prolaps, mitral regurgitation

29-Years Old Woman Presenting with ST Elevation Myocardial Infarction Dyah Wulan Anggrahini; Budi Yuli Setianto
ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17795

Myocardial infarction in young female is rare condition, but carries significant morbidity and mortality. The recognition management for MI in young female is challenging due to its unspecific clinical presentation and lack of guidance in the current guidelines. We reported a 29-years old woman presenting with infarction type chest pain, showing ST- elevation in the inferior leads with total AVblock as complication. The risk factors in this patient were smoking, family history, cardiomyopathy, and preeclampsia history. The cause for myocardial infarction in this patient was atherosclerotic plaque rupture, but we did not manage to performed coronary intervention due to her low ventricular function and unavailability data for myocardial viability at the time of hospitalization.

Clopidogrel Resistance in Patients with Coronary Stent Thrombosis Dyah Wulan Anggrahini; Bambang Irawan
ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17796

Antiplatelet drugs plays important role in the therapy of atherothrombosis. Dual antiplatelet therapy is recommended as a strategy for the prevention of stent thrombosis in patients who underwent Percutaneus Coronary Intervention (PCI). In combination with aspirin, tienoperidine is currently the drug of choice to prevent stent thrombosis. The issue of the high inter-individual variability ofresponse is clinically relevant, since poor responders are not adequately protected from major adverse cardiac events (MACE). We reported a 62-years old woman underwent primary PCI with implantation of BAS. She was later known to have in-stent thrombosis in the LAD after repeated angiography. The probable cause for the later cardiac event in this patient were overlapped stent, small vessel diameter, diabetes mellitus, and the patients also shown a persistent platelet reactivity despite clopidogrel therapy. We administered this patient with pasugrel as antiplatelet replacing clopidogrel and the patient was managed without ischemic symptoms afterwards.

Correlation Between Right Ventricular Function Using Myocardial Performance Index (Tei Index) with Pulmonary Arterial Hypertension Severity in Patient with Atrial Septal Defect Hendry Purnasidha Bagaswoto; Dyah Wulan Anggrahini; Hasanah Mumpuni; Lucia Krisdinarti
ACI (Acta Cardiologia Indonesiana) Vol 2, No 1 (2016)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Background: Right ventricular (RV) volume overload that occurs in patients with atrial septal defect (ASD) could lead to the development of pulmonary arterial hypertension (PAH). RV function has been found depressed in some patients with PAH. Myocardial performance index (MPI) is one of methods to assess RV function. The aim of this study was to assess correlation between RVfunction using RV-MPI with PAH severity in patients with ASD. Methods: We conducted a cross sectional study between July 2012-July 2013. We enrolled 67patients with secundum type ASD. RV-MPI, defi ned as the sum of isovolumic relaxation time and isovolumic contraction time derived by ejection time, was measured from tricuspid infl ow and RV outflow. The normal range is 0.28-0.32. Pulmonary artery systolic pressure (PASP) was measured from echocardiography. Results: There were 67 patients (54 women) with mean age was 38.01±14.29 years (11.9% with no PAH, 11.9% mild PAH, 26.9% moderate PAH and 49.3% severe PAH). The mean PASP was 67.16±32.33 mmHg and mean MPI was 0.44±0.25. We found signifi cant correlation between PASP and MPI (r=0.73; p=0.000). In addition, we classifi ed the PAH severity based on PASP and there was signifi cant differences of MPI between groups (no PAH, MPI 0.25±0.07; mild PAH 0.24±0.05; moderate PAH 0.24±0.12; severe PAH 0.63±0.21; p=0.000). Furthermore, in severe PAH group, the correlation between PASP and MPI remain signifi cant (r=0.42; p<0.05). Conclusion: These result demonstrate a correlation between PAH severity and MPI in patientswith ASD. Specifi cally, RV function found decreased in ASD patients with severe PAH.Keyword: myocardial performance index (Tei index), pulmonary arterial hypertension, right ventricular function, atrial septal defect

Surgical and Non Surgical Interventions in Adult Congenital Heart Disease: Our Experience from COHARD registry Budi Yuli Setianto; Dyah Wulan Anggrahini
ACI (Acta Cardiologia Indonesiana) Vol 3, No 2(S) (2017): Supplement, Abstracts of Jogja INternational CARdiovascular TOpic Series (JIN
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.28012

Surgical and Non Surgical Interventions in Adult Congenital Heart Disease:Our Experience from COHARD registry

LIPOPROTEIN(a) DAN KEBAHAYAAN SINDROM KORONER AKUT Ira Puspitawati; Setyawati Setyawati; Dyah Wulan Anggrahini; Diah Saraswati; Aisyah Ratna Yuniarti
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 21, No 2 (2015)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v21i2.1104

One of the risk factors of Acute Coronary Syndrome (ACS) still controversial is Lipoprotein(a). Lp(a) is one of the lipid componentshighly homologous to plasminogen and which may compete with it in the fibrinolytic pathway and has an atherogenic effect. Prior to thestudy many variaties in results have been shown. These variations are related to different population and ethnics, thus, the researcherswere triggered to investigate the role of Lp(a) on the ACS in the Indonesian population. This case control study was conducted at theSardjito General Hospital, Yogyakarta, Indonesia consisting of 40 participants in ACS as the case group and other 40 persons sufferingfrom Stable Angina Pectoris (SAP) as a control group. This study lasted from May−December 2011. The Lp(a) was measured usingturbidimetric immunoassay method while other laboratory results were obtained from the medical records. The results of this studyshowed that high Lp(a) level (more than 30 mg/dL) was the risk factor of ACS (RR=2.818, CI: 1.069–7.426). There was no difference ofthe baseline characteristics such as: the history of hypertension, diabetes mellitus, smoking, as well as in other laboratory parameters suchas: lipid profile, hemoglobine and uric acid level in the case as well as the control group. Significant differences were found in leucocytenumber, creatinine and blood glucose level. The median level of those parameters was found higher in the case group.

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