Djanggan Sargowo
Brawijaya Cardiovascular Research Center Department of Cardiology and Vascular Medicine Faculty of Medicine, Universitas Brawijaya Malang

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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
Management of Acute Uncomplicated Stanford B Aortic Dissection in The Era of Endovascular Repair: A Case Report Putri Annisa Kamila; Novi Kurnianingsih; Sasmojo Widito; Djanggan Sargowo; Budi Satrijo
Heart Science Journal Vol 1, No 3 (2020): Management of Coronary Artery Disease: From Risk Factors to The Better Long-Term
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.03.8

Abstract

Introduction:Uncomplicated type B aortic dissections have been traditionally treated with medication therapy. While it may provide good short-term results, longterm prognosis may be less favorable. With improvements in endovascular repair and the potential risk of disease progression, thoracic endovascular aortic repair (TEVAR) has been considered inpatients with uncomplicated type B aortic dissection. We present the case of 78-year-old gentleman who presented with acute uncomplicated type B aortic dissection managed by endovascular repair Case illustration:A 78 year-old hypertensive patient admitted to the hospital with persistent chest discomfort and cough for 2 weeks. The CT aortic angiogram showed type B dissection. Based on the recent guidelines, TEVAR should be considered in patients with uncomplicated type B aortic dissection, thus we prepared the patient for TEVAR procedure. First we established multidisciplinary vascular team for the pre-procedural preparation of the patient. We perform careful measurement through detailed CT angiography reconstruction from carotid to femoral arteries. We found proximal diameter was 30-35mm, distal diameter was 23mm and landing zone right after left brachial ostium, suitable for stent graft Valiant Captivia 36-32x150mm. The CT also showed that both femoral artery were normal, we decided to use right femoral artery as the access. We proceed to the procedure 2 days later, under general anaesthesia, digital subtraction angiography revealed dissection of descending aorta, and selected device was inserted. Subsequent contrast injection revealed total occlusion of the false lumen. Patient was transferred to ICU for postprocedural care, and extubated the day after. The hospital stay was uneventful, and one-month follow up CT shows no endoleak. Conclusion :Management of uncomplicated Stanford B dissections is very challenging. TEVAR has emerged as an alternative to surgery with lower morbidity and mortality rates that might offer good long-term results. 
Role of LAVi/A’ and E/’ as A Predictor of Major Adverse Cardiac Event on Patient with Acute Myocardial Infraction with ST Segment Elevation Undergo Through Percutaneous Coronary Intervention Aditya Reza Pratama; Budi Satrijo; Anna Fuji Rahimah; Djanggan Sargowo; Cholid Tri Tjahjono; Muhammad Rizki Rizki Fadlan
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.2021.002.01.05

Abstract

Introduction:STEMI is still a major health problem in industrialized and developing countries. The risk of adverse cardiovascular events remains substansial and may vary significantly across of STEMI patients. Echocardiography is recommended tool for diagnosis and predict outcomes. Increased LA volume index (LAVI) has been shown to be a powerfull predictor of mortality after AMI. The ratio of the  left atrial volume index (LAVI) and late diastolic mitral annular velocity (A’) is additional benefits in the assessment od advance diastolic dysfunction in ACS for predicting outcome.Methods:This study retrospective cohort was conducted in patient admitted to Saiful Anawar General Hospital with STEMI who undergo PCI from 2019-2020. All patient underwent echocardiography measurement within 24-48 hours and we follow-up patient for 6 months until 12 months. Echocardiography measurement that we conducted were LVEF, E/A, E/e’, LAVI/A’ and LV diastolic function were measured according to ASE guidelines. All of the patients were given standard medical therapy. Patients who did not adhere to medication were excluded. The study endpoints were hospitalisation and mortality because of cardiac problem. Result:We collected the data from 169 STEMI patients. However, about 39 STEMI patients were excluded because of incomplete data, lost follow-up, become atrial fibrillation, refused participation and death. Finally, a total of 130 patients were involved in the analysis process. The patients mean age was 61.48 ± 7 years, and 78% of them were male. The receiver operating characteristics curve indicated that LAVI/A’ ≥ 4.0 predicted these events (AUC 0.892, 95% CI 0.819-0.965) and E/e’  ≥ was 13.4 (AUC 0.874, 95% CI; 0.806-0.942). The MACE incident in 6 months with LAVI/A’ ≥ 4.0 was 40%, E/e’ ≥ 13.4 was 20% and LAVI/A’ ≥ 4.0 + E/e’ ≥ 13.4 was higher 60%. The incidence MACE incident was LAVI/A’ > 4.0 sensitivity 92% and specifity 88% (CI 95%), E/e’ > 13.4 sensitivity 80% and specifity 74% (CI 95%), LAVI/A’ > 4.0 + E/e’ > 13.4 sensitivity 92% and specifity 88% (CI 95%). Conlussion:The LAVI/A’ ratio is available as echo index which reflects LV chronic diastolic function in patient with STEMI. It can predict MACE, particularly in those with STEMI undergo PCI. Combined LAVI/A’ > 4.0 and E/e’ >13,4 ratio suggests MACE better than LAVI/A’ > 4.0 and E/e’ >13,4 alone.Keywords: ST-elevation Myocardial Infarction, Echocardiography, LAVI/A’, E/e’, Percutaneous Coronary Intervention