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Anna Fuji Rahimah
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
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