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Correlation of Ischemic Time with Diastolic Dysfunction and Correlation of Diastolic Dysfunction with 6 Minute Walk Test Distance in STEMI Patients Receiving Percutaneus Coronary Intervention Imelda Krisnasari; Anna Fuji Rahimah; Mohammad Saifur Rohman; Setyasih Anjarwani; Indra Prasetya
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.5

Background: Minimizing the time between ischemia and reperfusion in STEMI patients is critical for salvaging ischemic myocardium and limiting residual injury. One of the methods for determining the impact of ischemic time on the myocardium and correlating the findings to the outcomes is by using echocardiography.Objectives: To evaluate the correlation of ischemic time to diastolic dysfunction and also the correlation of diastolic dysfunction to functional capacity by 6-minute walk distance in STEMI patients. Methods: The study was a retrospective cohort, with all STEMI patients who underwent PCI at RSUD Dr. Saiful Anwar Malang between January 2018 and November 2021 being eligible. All patients underwent PCI, echocardiography, and a 6-minute walk test before being discharged. We defined significant diastolic dysfunction as grade 2 or 3 diastolic dysfunction, according to the 2016 American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines. The distance of 6-minute walk test was divided into three categories: less than 300m, 300-400m, and more than 400m.Results: From total 258 patients, 92 patients (35.7%) had significant diastolic dysfunction. The significant diastolic dysfunction was correlated with ischemic time > 12 hours (r = 0.51, p = 0.000), Killip class (r= 0.46, p = 0.000), culprit artery (r= 0.203, p=0,001), and peak toponin I levels (r=0.35, p=0.000). We identified that the ischemic time (odds ratio / OR 6.78; 95% Confidence Interval / CI 3.27 – 14.09; p = 0.000), Killip class (odds ratio 4.62, 95% CI 2.53 to 8.48, p = 0.000), and infarct size by peak troponin I levels (OR 1.12, 95% CI 1.06 to 1.18, p = 0.000) as independent predictors of significant diastolic dysfunction. There was inversely correlation of diastolic dysfunction with 6-minute walk test distance. (r = -0,422 dan p=0,000), with E/e’ as independent predictors of level of 6 minute walk distance (OR -1.126, 95% CI -1.78 to -0.48, p = 0.001).Conclusion: Ischemic time is one of the independent predictors of significant diastolic dysfunction. LV diastolic dysfunction was inversely correlated with 6-minute walk test distance in STEMI patient.

Diastolic Dysfunction Following Acute Myocardial Infarction with ST Segment Elevation Imelda Krisnasari; Anna Fuji Rahimah; Sasmojo Widito; Cholid Tri Tjahjono
Heart Science Journal Vol 3, No 2 (2022): Improving ST-Elevation Myocardial Infraction Patients Prognosis
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.02.2

ST segment elevation myocardial infarction (STEMI) caused by atherosclerotic vulnerable plaque rupture or plaque erosion, resulting in activation of the coagulation cascade. It causes a temporal sequence known as the “ischemic cascade,” which first involves the metabolic process, the diastolic dysfunction, and then systolic dysfunction. Diastolic dysfunction in STEMI patient is an independent predictor for long-term outcome. Rapid and early restoration of blood flow is critical to ensure cell recovery and prevent additional damage.

Premature Coronary Artery Disease in Young Male Patient with Strong Family History Dea Arie Kurniawan; Mohammad Saifur Rohman; Anna Fuji Rahimah; Budi Satrijo
Heart Science Journal Vol 3, No 1 (2022): Assesment and Outcome of Coronary Artery Disease in the Reperfusion Era
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.01.8

BACKGROUND: Coronary artery disease (CAD) occurring in less than 45 years of age is termed as premature CAD (PCAD). Recent studies showed a prevalence of 4-10 % of PCAD. PCAD is associated with unfavorable outcomes for the patients and had a greater impact on the quality of life. Family History is the best method to explained complex interaction between shared risk factor.CASE ILLUSTRATION: A 37-years old male admitted to Saiful Anwar Hospital for further evaluation of anginal pain. The patient complains of recurrent chest pain since 5 months ago but still relieved by rest. The electrocardiogram showed Wellens Type B which is specific for critical stenosis of the left anterior descending artery (LAD). Then the patient undergoing DCA Ad Hoc. The implantation of a 46 mm DES at proximal until distal LAD was performed. The patient discharged after a day observation.DISCUSSION: The challenging point, in this case, was it happen at a young age with strong family history. There was positive family history of PCAD in 1st degree relative on her brother and mother, despite several risk factors were identified in this case consist of smoking, and dyslipidemia, which make CAD risk higher. Despite adequate control of risk factors, family screening is important to reveal subclinical atherosclerosis.CONCLUSION: Approach to a patient with PCAD comprises of management of traditional risk factors and careful investigation of Family History. Individual with positive family history of PCAD should be treated more cautiously

The Impact of Successful Percutaneous Coronary Intervention on the Reduction of Major Cardiovascular Events in Patients with Chronic Total Coronary Occlusion In dr. Saiful Anwar's Malang Hospital Ratna Pancasari; Mohammad Saifur Rohman; Ardian Rizal; Novi Kurnianingsih; Anna Fuji Rahimah
Heart Science Journal Vol 3, No 3 (2022): Cardiovascular Disease in Young Adulthood: Who, When, and How to Screen?
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.03.5

Background: Chronic total coronary occlusion (CTOs) is associated with an increased risk of adverse clinical outcomes. The benefits of percutaneous coronary intervention (PCI) in CTO are still being debated due to the limited data available. This study aims to determine the relationship between the success of PCI in CTOs and the reduction of major cardiovascular events compared to those who failed or did not perform revascularization in patients with chronic coronary total occlusion in RSUD by Dr. Saiful Anwar Malang. Methods:This study is an analytic observational study with a retrospective cohort design. Of a total of 2165 patients who underwent angiography at Saiful Anwar Hospital, Malang, for the period August 2017–September 2020, consecutively, 578 patients with lesions of at least one CTO were found. There were 68 patients who were excluded, so 510 patients were analyzed in this study. They were divided into two groups, the CTO group that was successfully revascularized with PCI (n = 141) and the group that was not revascularized (n = 369). The outcome of this study was major cardiovascular events (MACE), which included cardiac mortality , all cause mortality, and rehospitalization events. Result: Patients with CTO who were not revascularized compared to those with revascularized CTO had a higher history of heart failure, involvement of LM disease, multivessel disease, and three vessel disease (41.2% vs 18.4%, p = 0.041; 16.5% vs 1.8%, p < 0.001; 69.4% vs 22.7%, p < 0.001; 56.5% vs 14.1%, p < 0.001) with a lower mean LVEF (0.49 ± 0.06 vs 0.51 ± 0.07, p=0.045) and older age (60±9 vs 57±8 years ; p=0.007).. At a 12-month follow-up, in the CTO group that was successfully revascularized by PCI, there was a better prognosis than the non-revascularized CTO group in terms of major cardiovascular events (19.9% vs 33.1% Plog-rank = 0.002). These results were consistent for all-cause mortality (5.5% vs 20.6%, Plog-rank =0.027), cardiac mortality (3.7% vs 20.6%, Plog-rank < 0.001) and rehospitalization events. (7.5% vs 32.2%, Plog-rank = 0.001). Conclusion: Successful revascularization of CTO by PCI may provide clinical benefits in patients with CTO in association with major cardiovascular events.

Management of Pregnant Women with Atrial Septal Defect and Pulmonary Hypertension: A Case Report Arif Wicaksono; Heny Martini; Ardian Rizal; Anna Fuji Rahimah
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.13

Backgrounds:Pulmonary Hypertension (PH) is a condition where there is an increase in Pulmonary Vascular Resistance (PVR) and an increase in the mean Pulmonary Arterial Pressure (mPAP) to more than 20 mmHg. PH can occur in someone with Congenital Heart Disease (CHD). PH conditions can aggravate pregnancy in women with CHD. So that women with PH are recommended not to undergo pregnancy. However, it is possible for women with CHD with PH conditions to undergo pregnancy. In these conditions, optimizing PH therapy is important so that pregnant women with PH do not experience a worsening of the condition and can carry out their pregnancy well until delivery. Case Presentations:A 38-year-old female patient with a history of Atrial Septal Defect-Pulmonary Hypertension came for routine control to the cardiac clinic with the condition of pregnancy of her 4th child who was just discovered when she was 6 months pregnant. Since giving birth to her third child, the patient began to complain of being easily tired when doing activities accompanied by swollen legs that disappeared with rest. At that time, the patient went to a cardiologist for an echocardiography examination and was diagnosed as Atrial Septal Defect (ASD)-Pulmonary Hypertension (PH). Since then, the patient has been routinely treated at a cardiologist with Pulmonary Hypertension drugs, including Phospodiesterase5 (PDE5) inhibitors (Sildenafil) and Prostacyclin Analogue (Dorner). The patient had done Transesophageal Echocardiography (TEE) with the results of ASD secundum suitable for closure by device. Patients with Right Heart Catheterization (RHC) results, ASD secundum with PH High Flow High Resistance reactive to Vasoreactivity Test. Since the patient was found to be pregnant, the patient continued to use Sildenafil and discontinued the use of Dorner. The patient then continued treatment in a multidisciplinary team. Conclusion :Management of pregnant women with CHD and PH is important because the condition of PH itself further aggravates the condition of pregnancy. Medical management for PH in pregnant women follows the guidelines for the safety of drugs in pregnancy. So that the choice of therapy is crucial related to the goal of treatment to control the PH condition in the patient but still pay attention to safety in pregnancy conditions.

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