I Ketut Badjra Nadha
Division Of Cardiology, Department Of Internal Medicine, University Of Udayana/Sanglah General Hospital, Denpasar

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Respon Otonomik Jantung yang Buruk pada Pasien Diabetes Mellitus Paska Infark Miokard Akut Pranata, Gede Bagus Gita; Nadha, Ketut Badjra; Iswari, Ida Sri
WMJ (Warmadewa Medical Journal) Vol 1, No 1 (2016):
Publisher : Fakultas Kedokteran dan Ilmu Kesehatan Universitas Warmadewa

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Abstract

Diabetes mellitus (DM) dengan penyakit kardiovaskular sangat erat kaitannya. Pada beberapa penelitian telah dihubungkan antara diabetes mellitus dengan respon otonomik denyut jantung yang buruk, sedangkan hubungan diabetes mellitus dengan respon otonomik denyut jantung yang buruk pada pasien paska IMA masih belum ada. Pemulihan denyut jantung (HRR) dan denyut jantung istirahat (resting HR) merupakan alat investigasi yang baik,  terpercaya, dan mudah diukur dalam mengevaluasi pengaturan otonomik jantung dan sebagai faktor prediktor kuat untuk  semua kasus  mortalitas pada orang dewasa yang sehat maupun pada seseorang dengan penyakit kardiovaskular. Penelitian ini bertujuan untuk mengetahui bahwa diabetes mellitus tipe 2 sebagai faktor yang memperburuk denyut jantung saat istirahat,  terhadap pemulihan denyut jantung setelah uji latih treadmill pada pasien pasca infark miokard,  serta merupakan variabel penting sebagai faktor prediktor kejadian morbiditas dan mortalitas pada pasien dengan  paska infark miokard akut. Pada analisis bivariat ditemukan pasien dengan diabetes mellitus tipe 2 dan tanpa diabetes mellitus tipe 2 berbeda secara bermakna dalam memperburuk respon otonomik denyut jantung (denyut jantung saat istirahat dan denyut jantung pemulihan) pada pasien paska IMA (p<0,01). Pada analisis multivariat tidak ditemukan adanya pengaruh faktor umur, jenis kelamin, riwayat keluarga, dislipidemia, hipertensi, merokok, aktifitas fisik, dan penyekat beta terhadap respon otonomik denyut jantung yang buruk pada pasien DM paska IMA (p>0,05). Kata kunci: diabetes mellitus tipe 2, Infark miokard akut, denyut jantung saat istirahat, denyut jantung pemulihan, treadmill.   [Poor Autonomic Heart Response in Diabetes Mellitus Patients Post Acute Myocardial Infarction] Diabetes mellitus (DM) and cardiovascular disease are very closely related. Several studies have shown the link of diabetes with poor heart rate autonomic response, whereas data on the relationship of diabetes mellitus with poor heart rate autonomic response in post AMI patients are still not available. Heart rate recovery (HRR) and resting heart rate (resting HR) is an investigative tool that is both reliable and easy to measure in evaluating the cardiac autonomic regulation and as a strong predictor factor for all causes of mortality in healthy adults as well as in ones with cardiovascular disease. This study aimed to determine that type 2 diabetes mellitus is a factor that worsens heart rate at rest worsens recovery heart rate after treadmill exercise test in patients with post myocardial infarction, and that it is an important variable factor as predictor for incidence of morbidity and mortality. The bivariate analysis showed that patients with type 2 diabetes mellitus and those without type 2 diabetes mellitus differed significantly in worsening the autonomic response of the heart rate (heart rate at rest and recovery heart rate) in post-AMI patients (p<0.01). Multivariate analysis didn’t find any relationship of the other variables i.e. age, gender, family history, dyslipidemia, hypertension, smoking, physical activity, and beta blockers with poor heart rate autonomic response in post-AMI diabetic patients (p>0.05). Keywords: type 2 diabetes mellitus, acute myocardial infarction, heart rate at rest, heart rate recovery, treadmill.   
Positive Correlation between Degree of Liver Cirrhosis and N Terminal–Pro Brain Natriuretic Peptide (NT-pro-BNP) Steffanus, Mario; Wibawa, IDN; Nadha, I Ketut Badjra
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (450.874 KB) | DOI: 10.24871/162201573-77

Abstract

Background: Liver cirrhosis (LC) is a chronic disease characterized by damage of liver parenchyme with wide fibrosis and nodules formation. One of LC complications is cirrhotic cardiomyopathy (CC). CC is diagnosed when there are more than one of the following signs: diastolic dysfunction (DD), systolic dysfunction (SD), enlargement of the cardiac chamber, electrophysiology dysfunction, and increasing of natriuretic peptide such as N Terminal–Pro Brain Natriuretic Peptide (NT-proBNP). The aim of this study was to determine the correlation between degree of liver cirrhosis and increasing of the NT-proBNP.Method: Cross-sectional analytic study was performed with 72 LC patients from May 2014 to May 2015 in Sanglah General Hospital, Denpasar. Degree of liver cirrhosis was determined by child turcotte pugh (CTP) criteria and NT-proBNP was examined by electro chemiluminescence immunoassay (ECLIA) method. LC patients with other disorders which can cause the increase of NT-proBNP were excluded.  Statistical analysis used was Spearman’s correlation test.  Results: Of 72 LC patients, 79.2% were male. Patients with CTP A were 9 (12,5%), CTP B 19 (26,4%) and CTP C 44 (61,19%). Median of NT-proBNP in CTP A was 112 pg/mL, CTP B 130 pg/mL, and CTP C 315 pg/ml. There was a strong possitive correlation between degree of liver cirrhosis and NT-proBNP (r = 0.686; p = 0.000). In this study, there was also significant comparison between NT-proBNP and CTP A,B, and C (p = 0,000) and there was no significant relation between NT-proBNP and those cofounding variables (p > 0.05).Conclusion: there was a strong possitive correlation between degree of LC and NT-proBNP. 
Respon Otonomik Jantung yang Buruk pada Pasien Diabetes Melitus Paska Infark Miokard Akut Gede Bagus Gita Pranata; Ketut Badjra Nadha; Ida Sri Iswari
WMJ (Warmadewa Medical Journal) Vol 1 No 1 (2016): Mei 2016
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.1.1.8.30-41

Abstract

Diabetes mellitus (DM) dengan penyakit kardiovaskular sangat erat kaitannya. Pada beberapa penelitian telah dihubungkan antara diabetes mellitus dengan respon otonomik denyut jantung yang buruk, sedangkan hubungan diabetes mellitus dengan respon otonomik denyut jantung yang buruk pada pasien paska IMA masih belum ada. Pemulihan denyut jantung (HRR) dan denyut jantung istirahat (resting HR) merupakan alat investigasi yang baik,  terpercaya, dan mudah diukur dalam mengevaluasi pengaturan otonomik jantung dan sebagai faktor prediktor kuat untuk  semua kasus  mortalitas pada orang dewasa yang sehat maupun pada seseorang dengan penyakit kardiovaskular. Penelitian ini bertujuan untuk mengetahui bahwa diabetes mellitus tipe 2 sebagai faktor yang memperburuk denyut jantung saat istirahat,  terhadap pemulihan denyut jantung setelah uji latih treadmill pada pasien pasca infark miokard,  serta merupakan variabel penting sebagai faktor prediktor kejadian morbiditas dan mortalitas pada pasien dengan  paska infark miokard akut. Pada analisis bivariat ditemukan pasien dengan diabetes mellitus tipe 2 dan tanpa diabetes mellitus tipe 2 berbeda secara bermakna dalam memperburuk respon otonomik denyut jantung (denyut jantung saat istirahat dan denyut jantung pemulihan) pada pasien paska IMA (p<0,01). Pada analisis multivariat tidak ditemukan adanya pengaruh faktor umur, jenis kelamin, riwayat keluarga, dislipidemia, hipertensi, merokok, aktifitas fisik, dan penyekat beta terhadap respon otonomik denyut jantung yang buruk pada pasien DM paska IMA (p>0,05).Kata kunci: Diabetes mellitus tipe 2, Infark miokard akut, denyut jantung saat istirahat, denyut jantung pemulihan, treadmill. [Relationship Between Type 2 Diabetes Mellitus and Poor Heart Rate Autonomic Response In Post IMI Patients]. Diabetes mellitus (DM) and cardiovascular disease are very closely related. Several studies have shown the link of diabetes with poor heart rate autonomic response, whereas data on the relationship of diabetes mellitus with poor heart rate autonomic response in post AMI patients are still not available. Heart rate recovery (HRR) and resting heart rate (resting HR) is an investigative tool that is both reliable and easy to measure in evaluating the cardiac autonomic regulation and as a strong predictor factor for allcauses of mortality in healthy adults as well as in ones with cardiovascular disease. This study aimed to determine that type 2 diabetes mellitus is a factor that worsens heart rate at rest worsens recovery heart rate after treadmill exercise test in patients with post myocardial infarction, and that it is an important variable factor as predictor for incidence of morbidity and mortality. The bivariate analysis showed that patients with type 2 diabetes mellitus and those without type 2 diabetes mellitus differed significantly in worsening the autonomic response of the heart rate (heart rate at rest and recovery heart rate) in post-AMI patients (p<0.01). Multivariate analysis didn’t find any relationship of the other variables i.e. age, gender, family history, dyslipidemia, hypertension, smoking, physical activity, and beta blockers with poor heart rate autonomic response in post-AMI diabetic patients (p>0.05).Keywords: Type 2 diabetes mellitus, acute myocardial infarction, heart rate at rest, heart rate recovery, treadmill.
Positive Correlation between Degree of Liver Cirrhosis and N Terminal–Pro Brain Natriuretic Peptide (NT-pro-BNP) Mario Steffanus; IDN Wibawa; I Ketut Badjra Nadha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (450.874 KB) | DOI: 10.24871/162201573-77

Abstract

Background: Liver cirrhosis (LC) is a chronic disease characterized by damage of liver parenchyme with wide fibrosis and nodules formation. One of LC complications is cirrhotic cardiomyopathy (CC). CC is diagnosed when there are more than one of the following signs: diastolic dysfunction (DD), systolic dysfunction (SD), enlargement of the cardiac chamber, electrophysiology dysfunction, and increasing of natriuretic peptide such as N Terminal–Pro Brain Natriuretic Peptide (NT-proBNP). The aim of this study was to determine the correlation between degree of liver cirrhosis and increasing of the NT-proBNP.Method: Cross-sectional analytic study was performed with 72 LC patients from May 2014 to May 2015 in Sanglah General Hospital, Denpasar. Degree of liver cirrhosis was determined by child turcotte pugh (CTP) criteria and NT-proBNP was examined by electro chemiluminescence immunoassay (ECLIA) method. LC patients with other disorders which can cause the increase of NT-proBNP were excluded.  Statistical analysis used was Spearman’s correlation test.  Results: Of 72 LC patients, 79.2% were male. Patients with CTP A were 9 (12,5%), CTP B 19 (26,4%) and CTP C 44 (61,19%). Median of NT-proBNP in CTP A was 112 pg/mL, CTP B 130 pg/mL, and CTP C 315 pg/ml. There was a strong possitive correlation between degree of liver cirrhosis and NT-proBNP (r = 0.686; p = 0.000). In this study, there was also significant comparison between NT-proBNP and CTP A,B, and C (p = 0,000) and there was no significant relation between NT-proBNP and those cofounding variables (p 0.05).Conclusion: there was a strong possitive correlation between degree of LC and NT-proBNP.