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Setyasih Anjarwani
Brawijaya University
Health Professions Immunology & microbiology Medicine & Pharmacology

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The Effect of Bisoprolol on Heart Failure Preserved Ejection Fraction/HFpEF Patient’s Quality of Life Ayu Asri Devi Adityawati; Anna Fuji Rahimah; Mohammad Saifur Rohman; Setyasih Anjarwani; Djanggan Sargowo
Heart Science Journal Vol 2, No 4 (2021): Management of Thrombosis in Covid-19 Patient with Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.04.6

Abstract

Global Publich Health Burden of Heart Failure reported the growing prevalence of heart failure from 26 million people affected in 2017 to 64.3 million affected in 2020 worldwide with half of the case classified as heart failure preserved ejection fraction/HFpEF. It is well known that someone who have been diagnosed with heart failure will have a poorer quality of life/QoL. β-blocker is a heart rate lowering agent with a potency to improve the patient’s clinical outcome. One clinical outcome that should always be evaluated and become the main goal of the therapy is QoL of the patient. This study aimed to observe and evaluate the effect of Bisoprolol, a type of β-blocker, in the improvement of HFpEF patient’s QoL. This study is a retrospective cohort following HFpEF patients who received β-blocker and HFpEF patients who did not received β-blocker in a span of 6 months. The study participant selected by purposive sampling method. Our study found that from all HFpEF patients who received β-blocker 86 patients had a good QoL, 16 patients had a Mod QoL, and 2 patients had a poor QoL (p=0.000). Mean physical score in the patient who did not received β-blocker was 13.84±11.01 while the mean score of the patient who received β-blocker was 5.94±4.95 (p=0.000). Mean emotional score in the patient who did not received β-blocker was 6.02±6.61 while the mean score of patient who received β-blocker was 1.83±2.16 (p=0.000). We conclude that the use of Bisoprolol could improve the HFpEF patient’s QoL evaluated by total score, physical score, and emotional score.   
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

Abstract

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.
The Added Value of Bioimpedance Analysis to NT-proBNP in Predicting Short-term outcome in Acute Heart Failure Patients Putri Annisa Kamila; Mohammad Saifur Rohman; Setyasih Anjarwani; Djanggan Sargowo; Anna Fuji Rahimah; Indra Prasetya; Muhammad Rizki Fadlan; Salvatore Di Somma
Heart Science Journal Vol 2, No 1 (2021): How to Diagnose Heart Failure and Deal with The Treatment Complexity
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.01.06

Abstract

Background: Acute heart failure (AHF) is a significant clinical problem, which has a high prevalence, mortality, and rehospitalization. Congestion is critical in AHF's pathogenesis, which is also a predictor of mortality and rehospitalization in patients with AHF. Aim: Knowing the effect of adding a %Total body water (TBW) test detected by Bioimpedance Analysis to NT-proBNP as a short-term clinical outside predictor of patients with acute heart failure Method: This research is an analytical observational study using prospective cohort methods. The research was conducted at Dr. Saiful Anwar Malang Hospital in January 2018-July 2019, with research subjects taken consecutively against all AHF patients hospitalized at UD dr.UD dr. Saiful Anwar Malang. The data taken in the form of NT-proBNP value during mission and %TBW before the patient leaves the hospital detected with NICaS examination, then the outside seen is mortality rate and rehospitalization due to AHF within 90 days after exiting the hospital. Results:  This study involved 65 subjects who were 61 years old and the majority male. Non-survivor patients had a higher NYHA class, NT-proBNP, and %TBW predischarge than the survivor group. Based on statistical analysis, we found that NT-proBNP is a good predictor of mortality (HI: AUC 0.74; 95%CI 0.59-0.90) and rehospitalization (HI: AUC 0.88; 95%CI 0.78-0.97). Similarly , %TBW pre-discharge shows good predictors of mortality (HI: AUC 0.72, 95%CI 0.56-0.87) and rehospitalization (HI: AUC 0.83, 95%CI 0.73-0.94). The addition of the %TBW predischarge parameter to NT-proBNP results in the best predictor numbers among the three for both mortality (HI: AUC 0.84; 95%CI 0.72-0.96) and rehospitalization (HI: AUC 0.92; 95%CI 0.85-1.00). Conclusion: The addition of predischarge %TBW examination detected by bioimpedance analysis tool against NT-proBNP increases the predicted value of short-term clinical outpatient in the form of mortality and rehospitalization of acute heart failure patients.Keywords: acute heart failure, NT-proBNP, bioimpedance analysis, total body water
Percutaneous Coronary Intervention as Clinical Outcome Predictor for in-Hospital Adverse Events in STEMI Patients Anita Surya Santoso; Mohammad Saifur Rohman; Ardian Rizal; Setyasih Anjarwani; Heny Martini; 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.2022.003.02.3

Abstract

Background : Limited resources and the concurrent COVID19 pandemic hinders the appropriate time to achieve reperfusion in Infarct-related artery (IRA). The number of patients receiving late primary PCI (PPCI) and without revascularization are steadily increase within 2 years into the pandemic. The impact of PCI timing in this setting has not been fully elucidated.Objective : This study was conducted to evaluate the effect of early PPCI vs late PPCI vs non revascularization groups towards in-hospital mortality and complications. This study also aimed to determine whether PPCI is the main predictor for in-hospital adverse events in STEMI patients.Method : Data of STEMI patients registered in Saiful Anwar General Hospiital ACS registry were collected between 2018-2021 Patients were subdivided into early PPCI if receiving PCI within the recommended time of the 2017 ESC STEMI management guideline, late PPCI if receiving PCI outside the timeframe provided by the guideline, and optimal medical therapy group if not receiving any means of revascularization. Patients undergoing thrombolysis were excluded. Afterwards, the incidence of in-hospital adverse event were calculated as primary endpoints, development of immediate complications during hospitalizations were analyzed as secondary endpoints. Stratification of baseline characteristics and PCI categorizations were performed using multivariate analysis to determine the main predictor of in-hospital mortality between STEMI patients.Results :  568 STEMI patients were included in the study with 387 in early PPCI, 107 in late PPCI, and 74 in optimal medical therapy group. Incidence of in-hospital mortality were significantly higher in optimal medical therapy group and lowest in early PPCI group (32.4% and 7.5% respectively, P 0.00). Mortality odds ratio between early PPCI group and optimal medical therapy group were significantly lowest (OR 0.17, 95% CI 0.13 – 0.41). Complications between each treatment groups were significantly different with early PPCI had the lowest incidence of in-hospital complications of cardiogenic shock, cardiac arrest, and VT/VF. Stratification of baseline characteristics and PCI category reveals that timing PPCI is the main predictor for in-hospital adverse events (HR 4.506, 95% CI 2.487-6.662, P 0.00). Conclusion : Percutaneous coronary intervention is the main predictor for the incidence of in hospital mortality and complications in STEMI patients.Keyword : STEMI, PCI, mortality, complications, in-hospital adverse events.
Male with Long Standing Heart Failure and Left Bundle Branch Block with Acute Chest Pain: Is It Needed for Urgent Revascularization? Fahmy Rusnanta; Mohammad Saifur Rohman; Setyasih Anjarwani; Ardian Rizal
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.08

Abstract

BACKGROUND: Patients with acute heart failure and left bundle branch block (LBBB) presenting acute chest pain have many clinical challenges to perform diagnostic and therapeutic process. Recent recommendations stated that the patients with LBBB (new or presumably new) should be performed early revascularization, many of clinical controversies occur due to scientific gaps between current evidence and recommendations. It has led to reviewing other approach to assess this setting.CASE SUMMARY: A 46-year-old man with previous history of dyspnea (long standing heart failure) came to our hospital with recurrent chest pain and acute heart failure. ECG showed LBBB suggesting acute myocardial infarction (excessive discordance in precordial lead). He had normal serial cardiac enzyme with on going ischemia symptom. He had been decided to not perform urgent reperfusion therapy. After five days hospitalization, he discharged home with medicines.DISCUSSION:  This case report provides an example of reviewing existing algorithm to assess acute chest pain in congestive heart failure, regardless of ST segmen deviation in LBBB. Further research is needed to establish the clinical outcome for these patients underwent reperfusion strategy. 
Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction with Acute Kidney injury caused by Cardiogenic Shock, Is it Really Safe?; A Case Report Oktafin Srywati Pamuna; Mohammad Saifur Rohman; Setyasih Anjarwani; Cholid Tri Tjahjono
Heart Science Journal Vol 2, No 3 (2021): The Science and Art of Myocardial Revascularization
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.03.8

Abstract

BackgroundST-elevation myocardial infarction (STEMI) is a life-threatening condition. Timely treatment with Percutaneous Coronary Intervention (PCI) is a recommended management of STEMI. However, in STEMI condition accompanied by complications such as prolonged shock condition and become  Acute Kidney Injury (AKI), it is still a question of whether to be treated conservatively or invasively. If PPCI was an option, how to prevent the worsening outcome is still an issueCase IllustrationA 53 years old, woman, was referred from a private hospital with STEMI inferior Killip IV onset 5 hours with typical chest pain and azotemia with creatinine serum was 3.4 mg/dl; eGFR 15 ml/m/1.73m2. In the emergency room, she got hydration, inotropic, and planned for PPCI.  After the PPCI procedure, she was fallen into the altered mental status and then referred to our hospital. The GCS was E4V4M6; blood pressure was 118/62 mmHg (on dobutamine 10 mcg/kg BW/minutes and NE 0.3 mcg/kg BW/minutes), heart rate was 130 bpm, respiration rate was 20 times per minute, peripheral saturation was 98% on NRBM 10 liters per minute. The laboratorium result in our hospital showed a creatinine level was 1.6 mg/dl. We treated this patient for 9 days, with optimal medicamentosa and fluid therapy. There is an improvement in clinical presentation and physical examination on the last day of treatment, with urine output 1900 cc/24 hours, creatinin serum 0.8 mg/dl, and eGFR  84 ml/min/1.73m2.Conclusion Acute renal failure is a frequent complication in STEMI, leading to higher mortality, morbidity, and intrahospital complications. PPCI is a reperfusion strategy recommended by the guideline in the setting of myocardial infarction with cardiogenic shock. Proper management to prevent worsening of renal function in this condition is very important.    Keyword: acute kidney injury, cardiogenic shock, ST-elevation myocardial infarction
In-hospital Mortality Reduction among Heart Failure Patients Treated with Optimal Dose of Angiotensin-Converting Enzyme Inhibitors Yoseph Budi Utomo; Mohammad Saifur Rohman; Yoga Waranugraha; Djanggan Sargowo; Sasmojo Widito; Budi Satrijo; Setyasih Anjarwani
Heart Science Journal Vol 1, No 1 (2020): The Importance of Adherence to The Guidelines
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (27.846 KB) | DOI: 10.21776/ub.hsj.2020.001.01.3

Abstract

Background : Angiotensin-converting enzyme inhibitors (ACEI) should be titrated to the optimal dose for adequate inhibition of the Renin-Angiotensin-Aldosterone system (RAAS). The up-titration of ACEI to the optimal doses during in-hospital treatment is challenging.Objectives : This study aimed to investigate whether the use of optimal dose of ACEI during in-hospital treatment could give more benefit to the outcome of heart failure (HF) patients.Methods : We involved 171 HF patients in this prospective cohort study. 29 and 142 HF patients were treated with optimal dose and suboptimal dose of ACEI during in-hospital treatment, respectively. The primary endpoint was in-hospital and 30 days post-discharge mortality. The secondary endpoint was 30 days post-discharge rehospitalization due to worsening of HF.Results: Only 17% of HF patients treated with optimal dose of ACEI during in-hospital treatment. In-hospital mortality in optimal dose of ACEI group was lower than in suboptimal dose of ACEI group (0% vs. 19.7%; p = 0.009). The 30 days post-discharge mortality (0% vs 2.7%; p = 0.375) and rehospitalization (6.9% vs 16.7%; p = 0.184) between both groups were not significantly different.Conclusion: The use of optimal dose of ACEI during in-hospital treatment reduced in-hospital mortality in HF patients.
Leukocytosis as The Short-Term Predictor for Mortality in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention Setyasih Anjarwani; Krishna Ari Nugraha; Muhammad Rizki Fadlan
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.04

Abstract

AbstractBackground: In daily clinical practice, leukocyte count is the most common and simple inflammation parameter. Moreover, its role in predicting acute coronary syndrome (ACS) patients' clinical outcomes and prognosis is still conflicting. This study aimed to assess the role of leukocytosis as the predictor of mortality in ACS patients undergoing percutaneous coronary intervention (PCI).Method: This single-center retrospective cohort study used the STEMI registry data in Saiful Anwar General Hospital, Malang, Indonesia, from January to July 2019. The exposure was the leucocyte count during hospital admission and the outcome was the 30-day mortality following PCI procedure. The receiver-operating characteristic (ROC) curve was used to determine leucocyte count cut-off pint, sensitivity, and specificity.Result: The best leukocyte count cut-off value was 12300/µL, with the area under the curve (AUC) of 0.702 (95% CI 0.575 - 0.83), sensitivity of 71.4%, and specificity of 61.3%. Leukocytosis increased the risk of 30-day mortality (74.5% vs 42.4%; OR = 3.958; 95% CI = 1.518-10.25; p = 0.014). Survival rate within 30-day after PCI was lowered in leukocytosis group (the Log-Rank p = 0.002). The difference became apparent after day five post-PCI. Conclusion: Leukocytosis during hospital admission is associated with increased mortality in ACS patients undergoing PCI. Leucocytosis is a good predictor of mortality within 30 days after PCI in this population. Keywords: leukocytosis, acute coronary syndrome, percutaneous coronary intervention, mortality
Mortality Prevention in Pregnancy With Pulmonary Arterial Hypertension Olivia Handayani; Mohammad Saifur Rohman; Ardian Rizal; Setyasih Anjarwani
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.07

Abstract

Background : Pulmonary hypertension (PH) is a global disease that affects all age groups and progresses in later years. Pregnancy with PH has a poor prognosis, and it is because of delayed diagnosis or even undiagnosed. PH gives high-risk to the mother and fetus; therefore, arranging a multidisciplinary team for pregnancy and delivery management is required.Objective : This case report was structured to emphasize mortality prevention in pregnancy with PH.Case : A 23-year-old female was admitted to the hospital with a chief complaint of dyspnea at rest. She was 34-week pregnant pregnancy and previously had a history of abortion with similar symptoms. After conducting some examinations, the patient was diagnosed with pulmonary hypertension. We planned for lung maturation for the fetus, scheduled termination, delivery method, and post-delivery care. The fetus was dead intra-uterine on day 5 of care, and the mother passed away 24 hours later.Conclusion : In summary, pregnancy was not advised in women with pulmonary hypertension. The collaboration and management by a multidisciplinary team are essential to improve outcomes if the pregnancy was still wanted.
The Relationship of Heart Rate Recovery Post Exercise Stress Test To Syntax Values In Patients With Stable Coronary Artery Disease Iskandar Iskandar; Setyasih Anjarwani; Cholid Tri Tjahjono; Budi Satrijo; Valerinna Yogibuana Swastika Putri
Heart Science Journal Vol 3, No 4 (2022): Prevention, Screening dan Rehabilitation : The Back Bone of Quality Care Improve
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.04.4

Abstract

Background:The prognostic usefulness of abnormal heart rate recovery (HRR) as a predictor of death has been discovered. Abnormal HRR results from inadequate vagal activation after exercise. The association between HRR and angiography in CAD (coronary artery disease) has been studied, however the conclusions are still being contested due to a lack of data. The purpose of this study is to see if HRR after an EST (exercise stress test) may predict the severity of syntax values in individuals with stable CAD at Saiful Anwar Hospital Malang (RSSA). Methods:This study is an analytic observational study with a retrospective cross sectional design. It was held in Saful anwar, Malang Hospital during January 2017–December 2019, including 366 patients. All patients underwent exercise stress test for CAD screening and coroner angiography. Those were divided into two groups, which included syntax score  < 23 (n=148) and syntax score ≥ 23 (n= 218). Result: Chi-square analysis was used to analyze the relationship correlation between HRR1, HRR2 and Syntax Score, and was used to compared between HRR1 (heart rate recovery first minutes), HRR2 (heart rate recovery second minute) and Syntax Score group. The confounding factor was adjusted with multivariate logistic regression analysis and AUC curve. There was a significant negatif correlation between abnormal HRR1 and HRR2 after exercise and Syntax score, with strong correlation (HRR1 ; OR = -2.11, p = 0.00 AUC :90,8%, HRR2 ; OR = -1,6, p = 0,48, AUC : 70,4%).  Conclusion: Abnormal first and second minutes of HRR after exercise stress test in stable CAD patient have a higher incidence of high Syntax Score (>1) than stable CAD patient with normal HRR. Keywords: Coronary artery disease (CAD), Heart rate recovery (HRR), Syntax. 
Co-Authors Andi Wahjono Adi Anita Surya Santoso Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Ardian Rizal Ardian Rizal Ayu Asri Devi Adityawati Bayu Aji Budi satrijo Budi Satrijo Budi Satrijo Budi Satrijo Cholid Tri Tjahjono Dea Arie Kurniawan Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Evit Ruspiono Fahmy Rusnanta Fahreza Caesario Heny Martini Imelda Krisnasari Indra Prasetya Indra Prasetya Indra Prasetya Indra Prasetya Iskandar Iskandar Krishna Ari Nugraha Krishna Ari Nugraha Lina Haryati Lutfi Hafiz Zunardi Lutfi hafiz zunardi Mohammad Saifur Rohman Mohammad Saifur Rohman Muhammad Rizki Fadlan Muhammad Rizki Fadlan Novi Kurnianingsih Oktafin Srywati Pamuna Olivia Handayani Putri Annisa Kamila Salvatore Di Somma Sasmojo Widito Tri Astiawati Valerinna Yogibuana Valerinna Yogibuana Swastika Putri Yoga Waranugraha Yoseph Budi Utomo Yudha Tria Nugraha