Papers by Trisulo Wasyanto
Majalah kardiologi Indonesia, Oct 22, 2023
Background: As the prevalence of heart failure (HF) kept rising each year, the burden caused by i... more Background: As the prevalence of heart failure (HF) kept rising each year, the burden caused by it also escalated, especially in terms of economic burden. This is urging the physician to quickly tackle the problem. Although HFrEF medications were developing vastly, the outcome of HF in the real world still varies. This indicates another approach is still needed to manage HFrEF/ HFmrEF comprehensively. This paper is aimed to give an overview of HFrEF and HFmrEF epidemiological data, based on CORE-HF real-world data. Methods: The CORE-HF is a single-center, prospective-cohort registry, which enrolls all patients with chronic HF, that were recruited consecutively from the outpatient Sebelas Maret HF Clinic. Both enrollment and followup have been performed since January 2018 until December 2022. Variables recorded consist of baseline characteristics, risk factors, subjective indicators, objective diagnostic assessments, therapies, and outcomes (readmission and mortality). Results: The population of this registry was younger (58.7 ± 12.14) compared to other HF registries, with more multi-comorbidities. The number of HFrEF patients was higher than HFmrEF (77.7% vs. 22.3%), with a clinically higher mortality rate (7.2% in the 1st year and 18.2% in the next year). Although triple therapy initiation and up-titration were excellent in number, the mortality rate during the second year of follow-up was higher than in other registries. We found medication and lifestyle recommendation non-adherence to be responsible for those results. Conclusion: Based on the CORE-HF sub-analysis of the HFrEF and HFmrEF groups, adherence to HF guidelines is the main but not the only key leading to lower mortality and rehospitalization. Our data provide satisfying low hard outcomes, but solving the non-adherence problem and optimizing the nonpharmacological approach should be done comprehensively by the HF team.
Indonesian journal of medicine, Oct 10, 2023
Background: Pulmonary Hypertension (PH) is a disease characterized by distressing symptoms and de... more Background: Pulmonary Hypertension (PH) is a disease characterized by distressing symptoms and decreased life expectancy due to the narrowing of the blood vessels of the lungs, which often leads to right heart failure. The prevalence of PH in women is 97 cases per million, with 64% of the main causes of PH in pregnancy congenital heart defects, resulting in a very high maternal and fetal mortality rate. Case Report: A 38-year-old G4P1A2 31-week gestational age complained of shortness of breath for 5 days. Physical examination revealed blood pressure was 107/62 mmHg, Heart Rate was 98 beats per minute, respiration 40x per minute, and SpO2 88% with NRM 10 Lpm. The heart examination obtained heart sound I-II regular and a systolic murmur was heard between the left 2nd ribs. Abdominal examination was single fetus, intrauterine, breech presentation, His (+), fetal heart rate 160 beats per minute. vaginal toucher 2 cm in labour. ultrasound examination singles fetal, transverse lies, with an estimated fetal weight of 1600 grams. Echocardiography finding: ASD II L to R shunt with LV EF 60%(T), 62% (S), dilated RA-RV, TR severe, MR mild, High Probability of Pulmonary Hypertension. The patient was diagnosed with Dyspnea, Pulmonary edema caused by cardiogenic, ASD II, High probability of PH, NYHA IV, and Breech presentation in labor. Decided to perform a caesarian section and sterilization. The Male baby was born with 1570 grams Apgar Score 3-5-7. post operation patient was admitted to ICU. Twelve hours after the operation the patient had decreased control and became a PH crisis then the patient was declared dead. Results: The death of the patient, in this case, was caused by cardiogenic shock due to Pulmonary Hypertension Crisis. Conclusion: Early diagnosis along with collaborative and comprehensive management of pulmonary hypertension is needed for good maternal and fetal outcomes.
Indonesian journal of medicine, Oct 10, 2023
Background: Patients with mechanical heart valves require lifelong oral anticoagulation. It will ... more Background: Patients with mechanical heart valves require lifelong oral anticoagulation. It will be a dilemma if a patient with a mechanical heart valve has surgery. This case report aims to discuss how to interrupt oral anticoagulants and bridging therapy in patients with mechanical heart valves who will be undergoing non-cardiac surgery. Case Report: A 26-year-old pregnant woman, G1P0A0, aterm with a mechanical mitral valve, will have elective Sectio Caesarian Transperitonealis (SCTP) surgery and Intra Uterine Device (IUD) insertion. The patient had a history of mitral valve replacement surgery (MVR) in 2014 and was routinely treated with 4 mg of warfarin at night. From the examination, blood pressure was 120/80 mmHg, heart rate was 90 beats per minute, and pulse rate was 90 beats per minute. The ECG examination found sinus rhythm with 1st-degree atrioventricular block, right axis deviation, 90 beats per minute, and left atrial enlargement. We decided to have oral anticoagulant interruption and bridging therapy by stopping warfarin three days before surgery. When the international normalized ratio (INR) falls <2, patients are given heparin injections (UFH) with an APTT target of 1.5-2.0 times from basic APTT. When the patient was about to be operated on, UFH was stopped 6 hours before surgery and resumed 12 hours after surgery. Warfarin was given one day postoperatively. Patients were adjusted to the dose of UFH according to the target. This patient had no thromboembolic events or bleeding before, during, or after surgery. The patient was allowed to be an outpatient and was given home therapy with Warfarin 5 mg at night. Results: We report a case of a 26-year-old female patient with a mechanical mitral valve who was going to undergo elective SCTP surgery and an IUD insertion. Patients at high risk of thromboembolism due to surgery with a high risk of bleeding. Bridging therapy was performed using UFH. In the perioperative period, the patient did not experience thromboembolic events, and bleeding before, during, and after surgery could be well controlled. Conclusion: Perioperative management of patients with mechanical heart valves must be done carefully. Interruption of oral anticoagulants should be carefully considered considering the risk of thromboembolism and bleeding during the perioperative period. Guidelines recommend that in patients with mechanical heart valves, anticoagulation interruption for minor surgeries is avoided. Whereas in patients with major surgery, it is necessary to do bridging therapy with fast-acting anticoagulants such as UFH or LMWH.
Journal of Hypertension, 2019
evidence, instead of fl uid overload, less aggressive anti-hypertensive approach and endothelial ... more evidence, instead of fl uid overload, less aggressive anti-hypertensive approach and endothelial dysfunction may be factor for causing IDH in hemodialysis unit Sumedang Regional Public Hospital.
International Journal of General Medicine
To prove that cystatin C is a predictor of major adverse cardiovascular events (MACE) after percu... more To prove that cystatin C is a predictor of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), either with ST-segment Elevation (AMI-EST) or without STsegment elevation (AMI-NEST), without cardiogenic shock or renal impairment. Patient and Methods: This was an observational cohort study. Samples were obtained from AMI patients who underwent PCI between February 2022 and March 2022 at the Intensive Cardiovascular Care Unit. Cystatin C levels were measured before PCI. MACE were observed within 6 months. Comparisons between normally distributed continuous data were performed using the t-test; Mann-Whitney test was used for non-normally distributed data. Categorical data were compared using the chi-squared test. The cutoff point of cystatin C levels to predict MACE was analyzed using Receiver Operating Characteristics (ROC). Results: The participants were 40 AMI patients, consisting of 32 patients (80%) with AMI-EST and eight patients (20%) diagnosed with AMI-NEST, who were evaluated for the occurrence of MACE within 6 months after PCI. Ten patients (25%) developed MACE during follow-up [(MACE (+)], and the rest were in the MACE (-) group. Cystatin C levels were significantly higher in the MACE (+) group (p=0.021). ROC analysis revealed a cystatin C level of 1.21 mg/dL; cystatin C > 1.21 is associated with MACE risk, showing a significant relationship with the odds ratio value reaching 26.00, with 95% CI (3.99-169.24). Conclusion: Cystatin C level is an independent predictor of MACE in patients with AMI without cardiogenic shock or renal impairment after PCI.
European Heart Journal Supplements
Aims Copeptin has been considered as a potential biomarker for AMI which also give information re... more Aims Copeptin has been considered as a potential biomarker for AMI which also give information regarding the prognostic of the Acute myocardial infarction (AMI). The aim of this study is to understand the role of copeptin as a predictor of major adverse cardiovascular events (MACE) during hospitalization in AMI patients. Methods and Results This was a cohort analytical study on AMI patient at Dr. Moewardi Hospital, whether with STEMI or NSTEMI. We observe the MACE during hospitalization and analyze the cut-off point value for optimal copeptin levels to predict the occurrence of MACE using the ROC curve. Linear multiple regression was conducted to predict determinants of MACE in hospitalization patients. 52 patients recruited in this research (44 males, 8 females). During hospitalization, MACE occurred in 52% of these subjects, with the respective proportions for acute heart failure, cardiogenic shock, arrhythmias, cardiopulmonary resuscitation, and mortality of 28%, 10%, 8%, 4%, and...
Medical Journal of Indonesia, Aug 9, 2019
BACKGROUND Releasing cytokine pro inflammation in patients with sepsis (tumor necrosis factor-alp... more BACKGROUND Releasing cytokine pro inflammation in patients with sepsis (tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β) and IL-6) with other factors (mid regional pro atrial natriuretic peptide [MR-proANP] and TNF-α) will cause left ventricular systolic dysfunction (LVSD). This research aimed to prove MR-proANP as a biomarker of LVSD in sepsis, area under the curve (AUC), sensitivity, specificity, cutoff point and probability of MR-proANP and TNF-α as a biomarker of LVSD. METHODS Non-experimental diagnostic test with cross sectional design and simple random sampling. Variable examined consisted of MR pro ANP, TNF-α and left ventricular ejection fraction (LVEF). LVSD if LVEF was ≤45%. Statistical analysis using 2 × 2 table and receiver operating characteristic curve using SPSS 22 for window. RESULTS There were examined 71 patients from November 2013 to March 2014 in tertiary ICU of Moewardi Hospital. There were 22 patients with mild sepsis (30.9%), 40 patients with severe sepsis (56.4%) and 9 patients with septic shock (12.7%). The AUC value of MR-proANP level was 0.84 (95% CI 0.73-0.95), p < 0.001. Optimal cut off point was ≥225.95 pmol/l and diagnostic odd ratio (DOR) was 12.11. The AUC value of TNF-α level was 0.73 (95% CI 0.60-0.86), p < 0.002. Optimal cutoff point was ≥7.36 pg/ ml and DOR was 5.03. Multivariate analysis was resulted that MR-proANP was the best predictor of LVSD (AUC 0.78), and TNF-α (0.69). CONCLUSIONS MR-proANP could be used as a biomarker and the best diagnostic predictor of LVSD.
PubMed, Oct 1, 2019
Background: inflammation, oxidative stress, and fibrosis play important roles after an acute myoc... more Background: inflammation, oxidative stress, and fibrosis play important roles after an acute myocardial infarction (AMI) event. The most studied inflammatory biomarker in cardiovascular disease is C-reactive protein (CRP). It has been demonstrated that myeloperoxidase (MPO) and Galectin-3 (Gal-3) have some essential roles on immune system when an AMI event occurs. We aimed to determine the effect of oral N-acetylcysteine (NAC) supplementation at the dose of 600 mg 3 times daily for 3 consecutive days on the immune system of AMI patients. Methods: our randomized single-blinded experimental study using pre- and post-treatment evaluations was performed at Dr. Moewardi Hospital, Indonesia, from May to August 2018. Thirty-two patients with AMI and ST segment elevation (STEMI) who received fibrinolytic therapy were included. There were 17 patients received standard therapy plus 600 mg oral NAC supplementation every 8 h for 3 days and 15 patients received standard therapy, which served as the control group. High-sensitivity C-reactive protein (HsCRP), MPO, and Gal-3 levels of both groups were evaluated at admission and after 72 h receiving treatment. Results: HsCRP, MPO, and Gal-3 levels between NAC and control groups at admission were not significantly different; while intergroup differences after 72 h of NAC supplementation were significant (p values of HsCRP, MPO, and Gal-3 levels were 0.0001, 0.001, and 0.017, respectively). Furthermore, in the NAC group, HsCRP, MPO, and Gal-3 levels at 72 h after treatment were significantly different from the corresponding levels at admission (p values: 0.0001, 0.0001, and 0.0001, respectively); the control group did not show these differences. There were also significant intergroup differences between the NAC and control groups regarding HsCRP, MPO, and Gal-3 levels (p values: 0.011, 0.022, and 0.014, respectively). Conclusion: oral supplementation of 600 mg NAC every 8 h for 72 h can reduce HsCRP, MPO, and Gal-3 levels in AMI patients receiving fibrinolytic therapy. Results of our study will provide more options for supplementation therapy to improve management of IMA patients.
European Heart Journal Supplements, Nov 1, 2021
Aims Copeptin has been considered as a potential biomarker for AMI which also give information re... more Aims Copeptin has been considered as a potential biomarker for AMI which also give information regarding the prognostic of the Acute myocardial infarction (AMI). The aim of this study is to understand the role of copeptin as a predictor of major adverse cardiovascular events (MACE) during hospitalization in AMI patients. Methods and Results This was a cohort analytical study on AMI patient at Dr. Moewardi Hospital, whether with STEMI or NSTEMI. We observe the MACE during hospitalization and analyze the cut-off point value for optimal copeptin levels to predict the occurrence of MACE using the ROC curve. Linear multiple regression was conducted to predict determinants of MACE in hospitalization patients. 52 patients recruited in this research (44 males, 8 females). During hospitalization, MACE occurred in 52% of these subjects, with the respective proportions for acute heart failure, cardiogenic shock, arrhythmias, cardiopulmonary resuscitation, and mortality of 28%, 10%, 8%, 4%, and 2%. The ROC curve showed that the cut-off point of copeptin was 2,141.50 pg/mL and area under curve (AUC) value of 0.710 with sensitivity of 75.0%, specificity of 68.80% and accuracy of 71.15%. Hence, the AUC values and accuracy present fair results for predicting MACE during hospitalization in AMI patients. Conclusion Copeptin has a role as a predictor of MACE during hospitalization in AMI patients.
Indonesian journal of medicine, 2019
Background: Acute coronary syndrome (ACS) is one of the major causes of morbidity and mortality w... more Background: Acute coronary syndrome (ACS) is one of the major causes of morbidity and mortality worldwide. Thus, it is important to effectively diagnose and determine the prognosis and mortality risk. While criteria such as Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) score are clinically used to work out the prognosis of patients with ACS, the examination of Blood Urea Nitrogen (BUN) and creatinine alongside in predicting outcome may prove favorable as well. This study aimed to determine the efficacy of BUN and creatinine in mortality risk assessment of patients with ACS, and to find which one is better. Subjects and Method: This was an analytical study with a cohort retrospective design included 1463 ACS patients in Dr. Moewardi hospital from January 2014 to July 2018. The relationship between admission BUN, creatinine level, and in-hospital mortality were analyzed with chi-square and logistic regression. Receiver Operating Characteristic (ROC) curve to determine which one better as a predictor of in-hospital mortality. Results: The mean age of patients was 60 years old (mean= 60.08; SD= 11.04), which 72.9% were men. From all sample, 232 (15.9%) patients were died. In binary log regression models, elevated BUN (>50 mg/dL) at admission was an independent predictor of in-hospital mortality (OR= 4.01; 95% CI= 1.0 to 7.0; p= 0.001). Similar results were obtained for elevated creatinine (>1.3 mg/dL) at admission (OR= 3.6; 95% CI= 2.2 to 5.8; p= 0.031). ROC curves showed that area under the curve (AUC) of BUN (0.87) was higher than AUC of creatinine (0.61). Conclusion: Elevated BUN and creatinine are independent predictors of in-hospital mortality in ACS patients. A high level BUN at admission is a more accurate predictor of in-hospital mortality than creatinine.
F1000Research, Mar 28, 2023
Background: Major adverse cardiovascular events (MACE) are predicted to be low in chronic coronar... more Background: Major adverse cardiovascular events (MACE) are predicted to be low in chronic coronary syndrome (CCS) patients who have undergone percutaneous coronary intervention (PCI). Endothelin-1 has been considered a pro inflammatory biomarker and suggested as a novel prognostic indicator in CCS. The objective of this research was to prove endothelin-1 as predictor of MACE within 1year evaluation in CCS patients undergoing PCI. Methods: This research was an analytic observational study with a cohort design. The participants were CCS patients who had undergone PCI. Endotelin-1 levels were checked before the patient underwent PCI. Occurrences of MACE were observed within 1 year. The comparison between normally distributed continuous data was performed with a T-test, and the Mann-Whitney test was used for not normally distributed data. A comparison between categorical data was performed with the Chi-square test. The cutoff point of endothelin-1 levels to predict MACE was analyzed by receiver operating characteristics (ROC). Results: Participants in this study were 63 patients. Six patients experienced MACE within 1 year (9.5%) and 57 patients were included in the non-MACE group (90.5%). Mann Whitney T test showed there were significance differences in endothelin-1 levels from the two groups (p=0.022). The ROC curve showed cut off point the endothelin-1 is 4.07 ng/dl with a sensitivity of 83.3%, specificity of 75.4% and accuracy of 76.2% for the occurrence of MACE. Based on the area under curve (AUC) value and the accuracy of this study, endothelin-1 was able to detect MACE within 1 year of follow-up. Conclusions: Endothelin-1 can be used as predictor of MACE within 1year evaluation in CCS patients undergoing coronary intervention.
European Heart Journal Supplements, Nov 1, 2021
Background The concept of 2:1 AV block remains poorly understood by many physicians even after so... more Background The concept of 2:1 AV block remains poorly understood by many physicians even after so many years of advancement in the field of electrophysiology. It cannot be classified into type I or type II second-degree AV block because there is only one PR interval to examine before the blocked P wave. Case Illustration Case 1 . A 78-year-old male with asymptomatic bradycardia was referred to our hospital. Resting ECG revealed 2:1 conduction AV block. In order to define the site of block we performed the atropine challenge test, revealed improvement of AV block to Mobitz I and then 1st degree AV block, suggesting the suprahissian block. Case 2. A 74-year-old male with inferoposterior and right ventricular STEMI was referred to our hospital. His resting ECG revealed 2:1 conduction of P wave. The atropine challenge test revealed improvement of block to 1st degree AV block, suggesting the suprahissian block. Discussion It is often difficult to distinguish intranodal and infranodal blocks when 2:1 conduction is present. Therefore, a careful search of a long ECG tracing for two consecutive P waves should be made. In addition, atropine can improve AV node conduction due to sympathetic and/or parasympatholytic stimulation. Therefore, it may increase AV node conduction but worsen infranodal block without affecting the refractory period of the infranodal. This case illustrates the importance of a noninvasive test for confirming the location of a 2:1 conduction AV block, as guide to diagnostic and therapeutic determinations.
Indonesian journal of medicine, 2020
Background: Nearly half of all patients with acute myocardial infarction (AMI) have left ventricu... more Background: Nearly half of all patients with acute myocardial infarction (AMI) have left ventricular systolic dysfunction and one-third have symptoms of heart failure (HF). In patients with AMI the resistin level correlated inversely with left ventricular ejection fraction (LVEF). Increased levels of high sensitive (hs) troponin I are associated with poorer prognosis. This study aimed to determine the association between levels of resistin and hs troponin I in ST elevation myocardial infarction (STEMI) patients with systolic HF. Subjects and Method: This was a crosssectional study was conducted at Dr. Moewardi General Hospital, Surakarta, from April 1 to May 31, 2018. A sample of 32 patients who admitted which diagnosed with STEMI was selected for this study. They were divided into two group according to result of LVEF measurement, LVEF < 40% and LVEF ≥ 40%. Blood examination and transthoracic echo-cardiography were performed to all patients. Correlation test using partial and multiple correlation test. To different 2 mean using Mann Whitney test. Results: Mean of patient age was 59.5 years old. Resistin decreased LVEF (r=-0.41; p= 0.009), and it was statistically significant. Hs troponin I decreased LVEF (r=-0.25; p= 0.081), but it was marginally significant. Resistin level and hs troponin I increased LVEF (r= 0.47; p= 0.025), and it statistically significant. Conclusion: There was an association between resistin and hs troponin I level together in STEMI patients with systolic HF. There was an association of resistin levels in STEM I patients with systolic HF. There was no association of hs troponin I levels in STEMI patients with systolic HF.
European Heart Journal Supplements, Nov 1, 2021
Background and aims In patients with acute myocardial infarction (AMI), global longitudinal strai... more Background and aims In patients with acute myocardial infarction (AMI), global longitudinal strain (GLS) is a more sensitive marker than left ventricular ejection fraction (LVEF) in assessing left ventricular function, and the prognostic impact of marker of platelet distribution width (PDW) has also been reported in this setting. The aim of this study was to investigate the relationship between PDW and GLS in patients with AMI. Methods and results A total of 38 patients with AMI (31 males and 7 females), both with ST segment elevation (STEMI) and non ST segment elevation (NSTEMI) were included. Blood samples were drawn at presentation and echocardiography was performed within 24 hours of presentation. Median PDW levels was 16.0%, and median GLS was -9.9%. A positive correlation was found between PDW levels and GLS (r = 0.339, p = 0.037). Conclusion Among patients with AMI, elevated PDW levels were associated with poor left ventricular function. This finding suggests that determining PDW levels within 24 hours following AMI may have beneficial prognostic value in predicting left ventricular function.
Indonesian journal of medicine, 2017
Background: The ischemia resulting from critical coronary narrowing or total occlusion first affe... more Background: The ischemia resulting from critical coronary narrowing or total occlusion first affects the subendocardialmyofibers. Thus, abnormalities in longitudinal function can be detected before reductions in LVEF and reflects infarct size. The 6MWT provides information that may be a better index of the patient's ability to perform daily activities. This study was to assess the relationship between left ventricular (LV) global longitudinal strain (GLS) and functional capacity measured with 6 minute walk test (6MWT) after AMI. Subjects and Method: This is a cross sectional study of patients with STEMI and NSTEMI, at Moewardi Hospital, Surakarta. Eligible patients underwent echocardiography global longitudinal 2D-STE that performed within 48 hour of admission and 6MWT pre-discharge or at the first follow-up visits (day 4-9). Patients were divided into 2 groups according to the LV GLS value, patients with substantial infarction (LV GLS >-13.8%) and non-substantial infarction (LV GLS <-13.8%). Results: There were 50 patients with 42 STEMI and 8 NSTEMI. Compared to patients in group LV GLS <-13.8% (n=18), patients in group LV GLS >-13.8% (n=32) were more likely to be older (57.6 y.ovs 55 y.o), less in functional capacity (10.17 ± 1.3 ml/kg/min vs 11.04 ± 0.98 ml/kg/min; p= 0.018) and less in 6 MWT distance (347.97± 65.49 m vs392.39 ± 49.44 m; p=0.016). Using ROC curves, the 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8%, sensitivity of 72.2% and specificity 65.6%, respectively with AUC= 0.70 (CI 95%; 0.559-0.852; p= 0.017). However, LV GLS >-13.8% and age >60 y.o remained the independent predictor in a multivariate logistic regression analysis to identify 6 MWT distance < 375 m in patients after AMI with GLS >-13.8%, (OR =7.967; CI 95%= 1.669-38.030; p=0.009) and age >60 y.o, (OR=10.898; CI95%= 2.201-53.971; p=0.003). Conclusions: In patients after AMI with substantial infarction (LV GLS >-13.8%) had less in functional capacity. The 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8% and could be used in rehabilitation program after AMI.
BACKGROUND: Type 2 Diabetes Mellitus (T2DM) represents one of the most important risk factors for... more BACKGROUND: Type 2 Diabetes Mellitus (T2DM) represents one of the most important risk factors for atrial fibrillation (AF). Numerous studies have shown that T2DM and poor glycemic control reflected by glycated hemoglobin A1c (HbA1c) levels are independently associated with AF onset. Recent experimental studies reported that the increased susceptibility to AF in the diabetic patients was presumably due to the slowing conduction associated with increased interstitial fibrosis. Systemic inflamemation can play role in the development of atrial fibrillation. Highsensitivity C-reactive protein (HsCRP) is an inflammatory biomarker that independently predicts the cardiovascular risk. This study aimed to analyze the association between HsCRP level, glycemic control, and total interatrial conduction time in T2DM patients. SUBJECT AND METHODS: This was an analytic cross sectional study. A total of 41 patients with T2DM were evaluated. HsCRP and HbA1c were measured from peripheral venous blood samples taken from these patients. The total interatrial conduction time was measured by tissue Doppler echocardiography. Multiple regression analysis was use to analyzed the data. RESULTS: The high-sensitivity C-reactive protein level was higher in the T2DM patients with HbA1c≥7% (0.44±0.30) than in the T2DM patients with HbA1c<7% (0.32±0.22), although statistically non-significant (p=0.183). The total atrial conduction time (milliseconds) was longer in the T2DM patients with HbA1c≥7% (100.29±28.53) than in T2DM patients with HbA1c<7% (94.88±16.50), although statistically non-significant (p=0.449). Multiple regression analysis showed that HsCRP level (b=38.78; 95%CI=14.01 to 63.54; p=0.003) and glycemic control (b=14.04; 95%CI=0.09 to 27.98; p=0.048) had positive association with total interatrial conduction time in T2DM patients. CONCLUSION: HsCRP level and glycemic control had significant positive association with total interatrial conduction time in T2DM patients.
Indonesian journal of medicine, 2018
Background: Patients with coronary heart disease (CHD) who have received standard therapy to the ... more Background: Patients with coronary heart disease (CHD) who have received standard therapy to the fullest, are still at risk for further cardiovascular events. This is likely because the standard therapy fails to inhibit some inflammatory pathways and platelet aggregation which implies the disease. This study aimed to determine the effect of colchicine on reducing levels of high sensitive c-reactive protein (HsCRP) and mean platelet volume (MPV) in patients with Acute Myocardial Infarction (IMA) in the Intensive Cardiovascular Unit (ICVCU) Dr. Moewardi Hospital, Surakarta. Subjects and Method: Experimental study was conducted with pre and post design. The study was conducted from November 1 to December 31, 2016. A sample of 32 patients with Acute Myocardial Infarction was divided into two groups. The control group was given a placebo and the treatment group was given colchicine 0.5 mg orally for 5 days. Statistical analysis was done using two mean different tests with dependent t-test or Mann-Whitney and two mean analysis paired using independent t test or Wilcoxon. Results: The HsCRP delta level in colchicine group (mean = 3.82; SD = 2.20) was higher than control group (mean = 0.57; SD = 3.12) and it was statistically significant (p<0.001). The delta MPV levels in colchicine group (mean = 2.01; SD = 1.16) were higher than control group (mean = 0.64; SD = 0.83) and it was statistically significant (p = 0.001). Conclusions: The administration of 0.5 mg colchicine by oral for 5 days was associated with levels of HsCRP and MPV among IMA patients.
Indonesian Journal of Cardiology, Sep 11, 2019
Background: Worldwide, coronary heart disease (CHD) is a leading cause of death. Inflammation in ... more Background: Worldwide, coronary heart disease (CHD) is a leading cause of death. Inflammation in CHD and acute myocardial infarction (AMI) is a trigger due to the formation of atheroma plaques in the coronary arteries. N-Acetylcysteine (NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. To determine the effect of NAC on hsCRP levels in patients with acute myocardial infarction who received fibrinolytic therapy. Methods: This study was an experimental study with pre and post, single blind and randomization methods on the effect of NAC on hsCRP levels compared to controls carried out in July-August 2018 on the incidence of ST Elevation Myocardial Infarction (STEMI) came to Dr Moewardi Hospital and get fibrinolytic therapy. Results: A total of 33 patients were included in this study, there were 15 patients (mean age 58.80 ± 8.54 years) of the control group and 18 patients (mean age 55.45 ± 9.92 years) the treatment group receiving additional therapy of NAC evervescent 600 mg three times a day for three days. This study showed that hsCRP levels after intervention in the control and treatment groups were significantly different with p = 0.001. The level of hsCRP in the control group after administration of NAC had a median of 114.50 mg / L (18.60-300.00) while in the treatment group had a median of 18.75 mg / L (5.50-102.90). Conclusion: The addition of NAC 600 mg of therapy three times daily for 3 days can reduce hsCRP levels in patients with STEMI receiving fibrinolytic therapy compared to patients with acute myocardial infarction with ST segment elevation who did not receive additional NAC therapy.
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Papers by Trisulo Wasyanto