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All Journal The Indonesian Biomedical Journal ACI (Acta Cardiologia Indonesiana) Heart Science Journal Eureka Herba Indonesia

Ardian Rizal

Department Of Cardiology And Vascular Medicine, Faculty Of Medicine, Universitas Brawijaya

Author-ID : 3606192

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Quantitative Assessment of Chronotropic Incompetence Using Time Domain Heart Rate Variability Derived from 24 – Hours Ambulatory Holter Monitoring Ardian Rizal; Fitranti Suciati Laitupa; Mohammad Saifur Rohman
Heart Science Journal Vol 1, No 2 (2020): The Assessment of Diagnostic and Treatment Modality in Heart Failure
Publisher : Universitas Brawijaya

Background : Chronotropic incompetence (CI) is defined as the failure of the heart to increase its heart rate along with activity and is an independent predictor of cardiovascular morbidity and mortality. The gold standard for CI is based on a treadmill test. However, up to now, there is no guideline to recommend whether CI could be concluded according to holter monitoring data.Objective : This study aimed to determine CI based on Holter monitoring, specifically using time-domain analysis of heart rate variability (HRV).Methods : This study used descriptive-analytic research with cross-sectional sampling. The population was patients that underwent treadmill and holter monitoring. The treadmill test was used as a gold standard of CI, and compare to holter monitoring using heart rate variability as a parameter. Data analysis used a comparative study (Independent T, Mann-Whitney, Chi-Square) and multivariate analysis logistic regression with a significance of p < 0,05.Results: The subjects of the study were 111 patients with male-dominant (59 men). Standard Deviation N-N interval (SDNN) and Standard Deviation of Average N-N Interval (SDANN) were found lower in the CI group compared to the normal one. Mean SDNN was 113,57 + 51,08 msec in CI group and 117,4 + 39,48 msec in normal group with p = 0.282. Mean SDANN was 94,77 (73,42-118,85) in CI and 104,16 (74,9–139) with p = 0.422. While the Proportion of RR interval with the difference > 50 ms (RR50) and Average of All N-N Intervals (AVNN) found to be higher in CI group, but not statistically significant (p = 0.681; p = 0.061 respectively). Other parameter extracted from holter result, delta HR showed significant correlation with CI (50.5 (43,25-61,5) vs. 56 (50-72) with p = 0.014).Conclusion: Time-domain HRV didn’t had a significant correlation with CI. However, delta HR from holter monitor could be used as a predictor of CI.

Clinical Management of Syncope in Emergency Department Based on Risk Stratification : A Review Literature Putri Annisa Kamila; Ardian Rizal; Novi Kurnianingsih; Sasmojo Widito
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.2020.001.04.03

Background: Background Syncope is a frequent problem among patients who present to the ED, accounts for 3% of emergency department admission and 1% of hospitalization. It is characterized by a comparatively short and self-limited loss of consciousness, which is caused by temporary cerebral hypoperfusion.Objective: Therefore, Risk stratification performed in the ED can guide triage decisions, and Risk-stratifying patients into low, moderate, and high-risk groups can assist medical decisions and determine the patient’s disposition.Discussion: The central point of syncope progression pathophysiology is the reduction of systemic blood pressure (BP) with a drop in global cerebral blood flow. Based on the European Society of Cardiology (ESC) syncope practice guidelines, syncope is classified into three categories, Neurally-mediated syncope (neural reflex syncope), Orthostatic hypotension, Cardiac syncope. Proper evaluation of syncope cases could in turn enable timely hospitalization and treatment by syncope experts. Assessment of a patient with syncope can be difficult, requiring a wide variety of medical testing with high health care costs. Sometimes, even after a careful examina- tion, it may not be possible to determine a definitive etiology for syncope. Given these uncertainties, about one-third of emergency room (ER) syncope/collapse patients are referred for assessment to the hospital, including non to low-risk patients. establish the urgency of any further work-up.Conclusion: Syncope assessment and treatment are very difficult, and syncope cases should be treated and dispositioned properly using proper risk stratification guidelines.

Accessory Pathway Ablation Located Just Below The Bundle of His: A Challenging Case Puspa Lestari; Ardian Rizal; Yoga Waranugraha
Heart Science Journal Vol 1, No 1 (2020): The Importance of Adherence to The Guidelines
Publisher : Universitas Brawijaya

We presented a case of Wolff-Parkinson-White (WPW) Syndrome. A 69-year-old man was admitted for evaluation of frequent episodes of palpitation. The diagnosis of WPW syndrome was established based on the 12-lead surface electrocardiogram (ECG) and electrophysiology (EP) study. We conducted the radiofrequency ablation (RFA) to the accessory pathway (AP). The challenging point of this case was the accessory pathway located just below to the bundle of His, which is related to the risk of complete atrioventricular (AV) block. In summary, we conclude that anatomical consideration, EP study, and the ablation strategy were important to improve the safety and success rate of RFA procedure.

Reperfusion Arrhythmia in Acute Myocardial Infarction: Clinical Implication and Management Harris Kristanto; Budi Satrijo; Sasmojo Widito; Ardian Rizal
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.2022.003.01.2

Reperfusion is a critical component of myocardium survival in acute myocardial infarction to minimize infarct size and improve clinical prognosis. Reperfusion, on the other hand, may result in increased and accelerated myocardial injury, a condition known as reperfusion injury. Following reperfusion, several arrhythmias are observed, and it is called reperfusion arrhythmia. Reperfusion arrhythmia is one manifestation of reperfusion injury. Numerous modest studies have evaluated what reperfusion arrhythmias are defined. It is described as an arrhythmia that occurs immediately or within the first minutes after coronary blood flow is restored. Traditionally, Accelerated Idioventricular Rhythm (AIVR) has been seen as a reperfusion arrhythmia. However, reperfusion may reveal any arrhythmia (or none at all); conversely, AIVR may occur in the absence of reperfusion. Calcium excess within the cells is thought to be a significant factor in the development of reperfusion arrhythmias. This may affect the significant delay following depolarization and the regional heterogeneity of regional blood flow restoration inside the ischemic zone, resulting in reperfusion arrhythmia. In some studies, it was mentioned that these arrhythmias may be due to ongoing myocardial cell damage and ischemia. Arrhythmias associated with reperfusion require special attention since hemodynamics can deteriorate quickly. In this review, clinical significance and management of reperfusion arrhythmia, as well as its link with reperfusion injury will be discussed.

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

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.

Prognostic Value of Residual Syntax Score Combined with Acef Score in Acute Coronary Syndrome Patient After Percutaneus Coronary Intervention in Saiful Anwar Hospital, Malang Adhika Prastya Wikananda; Mohammad Saifur Rohman; Novi Kurnianingsih; Sasmojo Widito; Ardian Rizal
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.2022.003.01.4

Background : Percutaneous coronary intervention (PCI) is one of the revascularization options in patients with clinical acute coronary syndrome (ACS) who often have multiple and complex vascular lesions. So, the decision to complete revascularization is still a topic that is widely explored to reduce the rate of rehospitalization and reinfarction. This study aims to determine the predictor value of rehospitalization and reinfarction events that can be used in ACS patients undergoing IKP using coronary angiography parameters with residual SYNTAX scores and clinical parameters using ACEF scores. Method : The study was cohort prospective with the inclusion criteria being all ACS patients who underwent PCI in RSUD Dr. Saiful Anwar Malang from January 2017 to July 2021. All patients underwent IKP and underwent coronary angiography evaluation after IKP with a residual SYNTAX score (rSS) and divided into categories into rSS≤8 and rSS>8. All patients underwent laboratory examination of serum creatinine and post-PCI echocardiography, and an ACEF score was obtained (ACEF score = age/left ventricular ejection fraction + 1 [if serum creatinine >2 mg/dl]). Research subjects will be followed up for at least 1 year related to the incidence of post-PCI rehospitalization and reinfarction. Results : From a total sample of 209 patients, it was found that the residual SYNTAX score data had the most significant predictive factor for the occurrence of rehospitalization at 1 year after PCI (OR 6.14 [95% CI, 1.92-1967]). At the value of rSS > 8, (AUC 0.750 [95% CI, 0.682-0.818], p 0.001) has a good predictive value for the occurrence of rehospitalization. However, combining with clinical parameters using the ACEF score provides a better predictive value. This study shows that the combination of rSS>8 and ACEF score>1.2 provides a better predictive value (AUC 0.884 [95%CI, 0.832-0.936) for the incidence of rehospitalization in post-PCI ACS patients. Conclusion : Acute coronary syndrome patients with residual SYNTAX scores > 8 and ACEF scores > 1.2 had a strong predictive value for rehospitalization events 1 year after PCI. The use of the combination of these two scores is expected to be a clinical guide to obtain the degree of completeness of revascularization in ACS patients.

Community-Based Cardiac Rehabilitation To Improves Medication Adherence in Stable Coronary Artery Disease Tonny Adriyanto; Cholid Tri Tjahjono; Mohammad Saifur Rohman; Sasmojo Widito; Ardian Rizal
Heart Science Journal Vol 1, No 1 (2020): The Importance of Adherence to The Guidelines
Publisher : Universitas Brawijaya

Cardiovascular disease contributes to 48% of deaths in the world. A cohort study at the Harapan Kita National Heart Center and 5 Indonesia hospitals in 2006 showed that the death rate due to heart disease in hospitals was around 6-12%. Rehospitalization rate reached 29% and the all-out expense of INA-CBG claimed for inpatient was Rp 42.4 trillion. The major problem causing rehospitalization was poor compliance to medication in coronary artery disease (CAD) patients. Education to improve compliance has been known not only reduced rehospitalization rate but also improve quality of life. In these review the author discussed the efficacy of community based cardiac rehabilitation for rehospitalisation reduction dan quality of life improvement.

Simple Clinical Predictors of Successful Fibrinolysis in Combined Assessment of ST-Segment Resolution, Myocardial Infraction Flow Grade, and Myocardial Perfusion Grade: Importance of Admission Blood Glucose and Ischemic Time Fahmy Rusnanta; Mohammad Saifur Rohman; Indra Prasetya; Ardian Rizal; Novi Kurnianingsih
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.2021.002.03.3

Background : Fibrinolytic therapy (FT) is the alternative recommendation in patients with ST-segment elevation myocardial infarction (STEMI) if primary percutaneous coronary intervention (PCI) could not be perfomed timely at initial presentation. Successful revascularization of occluded infarct-related coronary arteries depends on complex mechanisms of hemodynamic, clinical, biochemical, and mechanical parameters. The aim of study was to find outpredictors of patient characteristics to achieve complete reperfusion based on Thrombolysis in Myocardial Infarction(TIMI) 3 flow, Myocardial Blush Grade (MBG) 3, and ST-segment resolution. Method : This retrospective study was held in Saiful Anwar, Malang Hospital during 2017-2021, including total of 142 patients. All patients received FT and coronary angiographic evaluation post-FT. Those were divided into 3 groups, which included R0,1 (0/1 highest measure of reperfusion), R2 (2 highest measures of reperfusion), and R3 (3 highest measures of reperfusion). Results : Ischemic time (OR 0,82 [95%CI -0,39;-0,01]; p=0,04] and admission blood glucose (ABG) (OR 0,99 [95%CI -0,01;0]; p=0,046] were negatively correlated to the complete restoration of reperfusion (R3). This study revealed that ischemic time <5 hours (AUC 0,742 [95%CI 0,645-0,839]; p=0,000) and ABG <140 mg/dL (AUC 0,701 [95%CI 0,612-0,790]; p=0,000) were significant predictor for R≥2. Coronary characteristic was not related to measure of reperfusion (p=0,25). Conclusion : Ischemic time <5 hours and ABG <140 mg/dL are important predictors of successful reperfusion post FT (R≥2). Early assessment of patients who are likely to have low parameter reperfusion (R<2) would help promptly preparing for primary PCI.

The Effect of Garcinia Mangostana Linn Extract to The Levels of Circulating Endothelial Cells and Endothelial Progenitor Cells in Patients with High Framingham Score Aditha Satria Maulana; Djanggan Sargowo; Ardian Rizal; Heny Martini; Mohammad Saifur Rohman; Anna Fuji Rahimah; Jonny Karunia Fajar
Heart Science Journal Vol 1, No 2 (2020): The Assessment of Diagnostic and Treatment Modality in Heart Failure
Publisher : Universitas Brawijaya

Background : Recently, studies have concerned on the use of xanthones for treating patients with cardiovascular diseases. In our country, xanthones were found in Garcinia Mangostana Linn.Objectives : To assess the effect of Garcinia Mangostana Linn Extract (GMLE) to the levels of Circulating Endothelial Cells (CEC) and Endothelial Progenitor Cells (EPC) in patients with high framingham score.Methods : A prospective cohort study was conducted from November 2018 to January 2019. The patients were divided into two groups. The first group was given 2520 mg/day of GMLE for 90 days and the second group was given placebo. In sub group analyses, patients were divided based on previous medication, including statin, statin and angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), statin and oral antidiabetic drugs (OAD), and statin and ACEI or ARB and OAD. The outcome measures were CEC and EPC levels, measured at baseline and after 90 days of treatment. We used multiple linear regression to analyze the correlation and effect estimates.Results: A total of 72 patients was included in our study. All of the patients baseline characteristics were distributed homogeneously (p>0.05). Our findings confirmed that GMLE administration was associated with decreased CEC level compared to placebo. On other hands, increased EPC level compared to placebo was observed after GMLE administration. In sub-group analyses, our study found that the combination of GMLE with statin and ACEI or ARB and the combination of GMLE with statin and ACEI or ARB and OAD were associated with decreased level of CEC compared to placebo, with the odd ratios were 0.12 and 0.18, respectively. Conversely, increased level of EPC was observed in subjects receiving the combination of GMLE with statin and ACEI or ARB and the combination of GMLE with statin.Conclusion: Administration of GMLE as adjuvant therapy is associated with the improvement of CEC and EPC levels in patients with high framingham scores.

Cardiac Implantable Electronic Device (CIEDs) for Heart Failure in Indonesia: We Have to be More Selective Ardian Rizal
Heart Science Journal Vol 1, No 2 (2020): The Assessment of Diagnostic and Treatment Modality in Heart Failure
Publisher : Universitas Brawijaya

Cardiac Implantable Electronic Device (CIEDs) had been recommended as an integral part of heart failure management. Despite clear benefits on CIEDs itself, the rate of therapy penetration in Indonesia is still very low. Many contributing factors had been identified, they are lack of physician awareness, lack of referral, and mismatch between national insurance reimbursement and the cost of therapy. We focussed on talking about selective patient selection as one of the most feasible solutions to this problem.

Co-Authors Achmad Guntur Hermawan Suryo Adji Adhika Prastya Wikananda Aditha Satria Maulana Adriyawan Widya Nugraha Al Mazida Fauzil Aishaqeena Aloysius Yuwono Suprapta Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Aris Munandar ZI Aris Munandar Zulkifli Ismail Budi Satrijo Budi Satrijo Bunga Bella Pratiwi Cholid Tri Tjahjono Cik Kahadi Dea Arie Kurniawan Diah Ivana Sari Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Estyka Ratu Fahmy Rusnanta Fahmy Rusnanta Fahriza Abid Sonia Fajar, Jonny Karunia Fandy Hazzy Alfata Faris Wahyu Nugroho Ferry Sandra Ferry Sandra Fitranti Suciati Laitupa Harris Kristanto Heny Martini Heny Martini Heny Martini Icmi Dian Rochmawati Indra Prasetya Indra Prasetya Intan Masyfufah Hanim Khilmi Ainun Nadliroh Mohammad Rizki Fadlan Mohammad Saifur Rohman Mohammad Saifur Rohman Mohammad Saifur Rohman Mohammad Saifur Rohman Muhamad Rizki Fadlan Muhammad Saifur Rohman Novi Kurnianingsih Novi Kurnianingsih Novi Kurnianingsih Novi Kurnianingsih Novi Kurnianingsih Novi Kurnianingsih Olivia Handayani Olivia Handayani Peter Sugita Puspa Lestari Putri Annisa Kamila Putri Annisa Kamila Rizkia Milladina Hidayatulloh Sasmojo Widito Sasmojo Widito Sasmojo Widito Sasmojo Widito Sasmojo Widito Sasmojo Widito Sasmojo Widito Seprian Widasmara Setyasih Anjarwani Setyasih Anjarwani Setyasih Anjarwani Sri Winarsih Susanti Lara Dewi Syanindita Puspa Wardhani Taufieq Ridlo Makhmud Tonny Adriyanto Valerinna Yogibuana Veny Kurniawati Wiwit Nurwidyaningtyas Yoga Waranugraha Yuke Fawziah Kemala

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