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Sunu Budhi Raharjo, Sp.JP(K), Ph.D, FIHA) (Admin) Tue, 21 Aug 2018 08:37:13 +0000 OJS 60 Detailed Precision of Computed Tomography Angiography Compared to Invasive Angiography in Different Coronary Vessels: Overestimate, Underestimate, or Concordance? <p><strong>Background: </strong>Quantitative analysis of stenosis lesions by Computed Tomography angiography (CTA) show good correlation with Invasive Coronary Angiography (ICA) examination. However, detailed precision whether CTA overestimate or underestimate have not been explored thoroughly.</p> <p><strong>Objectives: </strong>This research is performed to analyze the precision of CTA compared to ICA.</p> <p><strong>Materials &amp; Methods: </strong>There are 195 patients examined by both CTA and ICA from October 2014 until December 2015 in our hospital. CTA was analyzed by a team of cardiovascular imaging cardiologists. Quantitative grading of stenosis was determined visually using 2014 Society of Cardiovascular Computed Tomography (SCCT) guidelines classification. Quantitative measurement of stenosis during ICA was classified with the same criteria so that it can be comparable. The final comparison of both tests was clas­sified as concordance, overestimate and underestimate.</p> <p><strong>Results: </strong>Lesion of stenosis was found in 573 coronary vessels. Coronary vessels are significantly associated with detailed precision of quantitative analysis comparison in CTA and ICA. LM coronary stenosis quantification from CTA is predominantly overestimate (concordance in 6% vessels and overestimate in 75.9% vessels), while stenosis analysis by CTA in other major coronary vessels is spread without conspicuous domination (p&lt;0.001). Sensitivity, specificity, PPV, and NPV of CTA to detect obstructive lesion (stenosis ≥ 50%) found by ICA is 81.4%, 80.4%, 73.9%, and 86.3%, respectively (780 vessels).</p> <p><strong>Conclusions: </strong>Degree of stenosis in LM is predominantly overestimate by CTA. The precision of stenosis grading in CTA in different coronary vessels is not the same.</p> <p>&nbsp;</p> <p><strong>Abstrak</strong></p> <p><strong>Latar Belakang: </strong>Analisis kuantitatif lesi stenosis pada pembuluh koroner menggunakan modalitas <em>Computed Tomography Angiography </em>(CTA) memiliki korelasi yang baik dengan pemeriksaan <em>Invasive Coronary Angiography </em>(ICA). Namun, presisi CTA terhadap ICA masih belum ter­eksplorasi dengan baik. Terutama dari sisi apakah CTA menunjukkan presisi yang overestimate atau underestimate.</p> <p><strong>Tujuan: </strong>Penelitian ini dilakukan untuk menganalisis presisi CTA terhadap ICA dalam mendeteksi lesi stenosis pada pembuluh koroner.</p> <p><strong>Metode Penelitian: </strong>Terdapat 195 pasien yang diperiksa menggunakan CTA dan ICA sejak Oktober 2014 hingga Desember 2015 di RS Jan­tung dan Pembuluh Darah Harapan Kita, Jakarta. Analisis kuantitatif CTA dilakukan oleh tim kardiolog pencitraan kardiovaskular. Klasifikasi derajat stenosis ditentukan secara visual menggunakan pedoman dari <em>Society of Cardiovascular Computed Tomography </em>(SCCT) 2014. Analisis kuantitatif lesi stenosis dari pemeriksaan ICA diklasifikasikan menggunakan pedoman yang sama sehingga keduanya dapat diperbandingkan. Data hasil perbandingan kedua modalitas diklasifikasikan sebagai <em>concordance</em>, <em>overestimate </em>dan <em>underestimate</em>.</p> <p><strong>Hasil Penelitian: </strong>Lesi stenosis ditemukan pada 573 pembuluh koroner. Pembuluh koroner yang berbeda secara signifikan berhubungan dengan perbandingan klasifikasi analisis semi-kuantitatif CTA dan ICA. Pembuluh koroner LM terutama menunjukkan lesi dengan kategori <em>overestimate </em>(75.9%). Sementara analisis stenosis pada pembuluh koroner lainnya tidak menunjukkan perbedaan yang mencolok (p &lt; 0,001). Sensitivitas, spesifisitas, PPV, dan NPV CTA dalam mendeteksi lesi koroner obstruktif (stenosis ≥50%) terhadap ICA adalah sebesar 81.4%, 80.4%, 73.9%, dan 86.3% (780 pembuluh kroner).</p> <p><strong>Kesimpulan: </strong>Analisis stenosis semi-kuantitatif pada LM terutama adalah <em>overestimate </em>berdasarkan pemeriksaan CTA. Presisi analisis perband­ingan derajat stenosis CT angiografi pada setiap pembuluh koroner tidak sama.</p> TM Haykal, Elen Elen, Celly A. Atmadikoesoemah, Abhirama N Putra, Andrew Parlautan, Wendy M Saragih, Manoefris Kasim ##submission.copyrightStatement## Tue, 21 Aug 2018 00:00:00 +0000 The Pulse Wave Velocity is Linearly Correlated with Resting Systolic and Diastolic Blood Pressure in Hypertensive Patients <p><strong>Introduction: </strong>Aortic stiffness is an independent predictor for cardiovascular event. If arteries lose their natural elasticity, systolic blood pressure become higher and dia­stolic blood pressure become lower. Method of evaluating arterial stiffness is aortic pulse wave velocity (PWV). Therefore, PWV has a potential application for screening vascular damage in large population.2 Recent reports have shown that PWV obtained by noninvasive automatic devices (i.e. tonometry, cuff pressure) is not only a marker of vascular damages, but also a prognostic predictor in patients with hypertension.3 The aim of this study is to investigate the correlation between PWV and systolic and diastolic blood pressure.</p> <p><strong>Methods : </strong>Male hypertensive patients, aged 40-60 years old who underwent Doppler Vascular were included in this study. The measurement of carotid-femoral PWV is made by dividing the distance (from the carotid point to the femoral point) by the so-called transit time (the time of travel of the foot of the wave over the distance). Hence, PWV = D (meters)/Dt (seconds). The correlation between PWV and systolic and diastolic blood pressure were analysed using linear regression test.</p> <p><strong>Results : </strong>A total 40 patients were included in this study. Those were significant correla­tion between PWV and systolic (R=0.473, p=0.002) and diastolic (R=0.454, p=0.003) blood pressure.</p> <p><strong>Conclusion : </strong>increasing PWV is linearly associated with systolic and diastolic blood pressure.</p> <p>&nbsp;</p> <p><strong>Abstrak</strong></p> <p><strong>Pendahuluan: </strong>Kekakuan aorta adalah prediktor independen untuk kejadian kardiovaskular. Jika elastisitas alami arteri hilang, tekanan darah sistolik menjadi lebih tinggi dan tekanan darah diastolik menjadi lebih rendah. Metode evaluasi kekakuan arteri adalah kecepatan gelombang pulsasi (<em>pulse wave velocity</em>/PWV). Oleh karena itu, PWV dapat diterapkan untuk skrining kerusakan vaskular pada populasi besar.2 Laporan terbaru menunjukkan bahwa PWV yang diperoleh dengan perangkat otomatis non-invasif (yaitu tonometri, tekanan manset) tidak hanya merupakan penanda kerusakan vaskular, tetapi juga prediktor prognostik pada pasien dengan hipertensi.3 Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara PWV dan tekanan darah sistolik dan diastolik.</p> <p><strong>Metode: </strong>Pasien pria dengan hipertensi, berusia 40-60 tahun yang menjalani Doppler Vascular dimasukkan dalam penelitian ini. Pengukuran PWV karotid-femoralis dilakukan dengan membagi jarak (dari titik karotid ke titik femoral) dengan waktu transit. Oleh karena itu, PWV = D (meter) / Dt (detik). Korelasi antara tekanan darah PWV dan sistolik dan diastolik dianalisis dengan menggunakan uji regresi linier.</p> <p><strong>Hasil: </strong>Sebanyak 40 pasien dimasukkan dalam penelitian ini. Itu adalah korelasi yang signifikan antara tekanan darah PWV dan sistolik (R = 0,473, p = 0,002) dan diastolik (R = 0,454, p = 0,003).</p> <p><strong>Kesimpulan: </strong>Peningkatan PWV berhubungan linear dengan tekanan darah sistolik dan diastolik.</p> Kana Elka, Monique Rotty, Johan Winata, Janry Pangemanan, A. Lucia Panda ##submission.copyrightStatement## Tue, 21 Aug 2018 00:00:00 +0000 E-Point Septal Separation as a Surrogate Marker for Global Longitudinal Strain in Predicting MACE after ST Elevation Myocardial Infarction <p><strong>Background: </strong>Global Longitudinal Strain (GLS) is a sensitive measurement and has been studied as a parameter to assess myocardial deformity and had a prognostic value in STEMI patient, but this measurement is usually taken at echocardiography laboratory with software installed only, a simple parameter of systolic function that had been known is EPSS, the aim of this study is to determine the prognostic value of this simple parameter as a surrogate marker of myocardial deformity for mayor adverse cardiac event (MACE).</p> <p><strong>Methods: </strong>This is an analytic observational study using ambispective cohort study, basic and echocardiographic data were collected from 66 adult subjects of acute STEMI from July 2016 until April 2017. Each subjects were followed-up for MACE (mortality, heart failure, ventricular arrhytmia and cardiogenic shock) 30 days since admission. Cut off point were taken from ROC curve. Statistical analysis test were used to examine the association between two variables and obtained odds ratio (OR) for EPSS. To obtain the degree of relationship between EPSS and GLS we were using corelation test with the value of p&lt;0.05 was considered statistically significant.</p> <p><strong>Result: </strong>In this study the optimum cut off value for EPSS was 7 mm with sensitivity and specificity of 72% and 71%, respectively. Bivariate analysis showed among EPSS &gt;7 mm and GLS &gt;-10,6% were associated with MACE in 30 days after STEMI. In multivariate analysis, GLS &gt;-10,6% (OR 10,6 95%IK 2,5-44,7 p=0,001) and EPSS &gt;7 mm (OR 5, 95%IK 1,12-22,56 p=0,035) remained significantly associated and had 83% probability for MACE in 30-days after STEMI. Using the corelation test we found that EPSS had a stronger relationship with GLS (r=0,795, p&lt;0,001).</p> <p><strong>Conclusion: </strong>Our data show that EPSS &gt;7 mm had a strong relationship with myocardial deformity parameter and appears to be a strong predictor for MACE in 30-days after acute STEMI. Therefore, it can be taken earlier to help the cardiologist in emergency unit for futher appropriate management planning.</p> <p>&nbsp;</p> <p><strong>Abstrak</strong></p> <p><strong>Latar Belakang: </strong><em>Global Longitudinal Strain </em>(GLS) adalah parameter deformitas miokardium yang telah banyak diteliti untuk menilai fungsi sistolik ventrikel kiri serta kaitannya terhadap prognosis pasien IMA-EST, sayangnya pemeriksaannya cenderung terbatas dilakukan di laboratu­rium ekokardiografi dengan alat ekokardiografi tertentu. Parameter fungsi sistolik lainnya yang cukup dikenal karena tekniknya yang sederhana dan dapat dilakukan di Unit Gawat Darurat adalah <em>E-Point Septal Separation </em>(EPSS), tujuan dari penelitian ini adalah melihat nilai prognosis EPSS sebagai indikator tidak langsung deformitas ventrikel kiri terdahap Kejadian Kardiovaskular Mayor (KKvM).</p> <p><strong>Metode: </strong>Penelitian ini merupakan studi kohort ambispektif, 66 orang subjek IMAEST yang memenuhi kriteria inklusi dan eksklusi yang dirawat di Rumah Sakit Haji Adam Malik mulai Juli 2016 sampai April 2017 diambil data dasar dan ekokardiografinya, kemudian pasien diikuti selama 30 hari untuk KKvM (kematian, gagal jantung, aritmia ventrikel dan syok kardiogenik). Nilai titik potong EPSS diambil dari kurva ROC. Uji statistik dilakukan untuk menilai hubungan antara variabel untuk mendapatkan nilai rasio odds (RO) EPSS, uji korelasi digunakan untuk menilai kekuatan hubungan antara EPSS dengan GLS, p&lt;0,05 dianggap bermakna.</p> <p><strong>Hasil: </strong>Nilai titik potong EPSS yang didapatkan adalah 7 mm dengan sensitivitas 72%, spesifisitas 71%. Analisis bivariat menunjukkan nilai EPSS &gt;7 mm dan GLS &gt;-10,6% berhubungan dengan KKvM. Pada analisis multivariat, GLS &gt;-10,6% (RO 10,6 95%IK 2,5-44,7 p=0,001) dan EPSS &gt;7 mm (RO 5, 95%IK 1,12-22,56 p=0,035) secara signifikan tetap berhubungan dan memiliki probabilitas sebesar 83% dalam memprediksi KKvM 30 hari setelah IMAEST. Adapun nilai EPSS dan nilai GLS memiliki hubungan yang kuat (r=0,795, p&lt;0,001).</p> <p><strong>Kesimpulan: </strong>Data menunjukkan bahwa nilai EPSS &gt;7 mm memiliki hubungan yang kuat dengan parameter deformitas ventrikel kiri dan suatu prediktor kuat pula terhadap KKvM dalam 30 hari setelah IMAEST. Hal ini menguntungkan kita sebagai klinisi karena dengan pemer­iksaan EPSS yang sederhana ini dapat menjadi indikator adanya deformitas miokardium ventrikel kiri yang bernilai prognosis sehingga dapat dilakukan lebih dini untuk dapat menentukan strategi tatalaksana pada pasien IMAEST.</p> Mustika Fadhilah Sarahazti, Harris Hasan, Andre Pasha Ketaren ##submission.copyrightStatement## Tue, 21 Aug 2018 00:00:00 +0000 Acute Pericarditis in Patient with Systemic Lupus Erythematosus: A Case Report <p>Acute pericarditis is a common disorder caused by inflammation of the pericardium and can occur as an isolated entity or as a manifestation of an underlying systemic disease. The diagnosis of acute pericarditis is established when a patient has at least two of the following symptoms or signs: chest pain consistent with pericarditis, pericardial friction rub, typical ECG changes, or a pericardial effusion of more than trivial size. Systemic Lupus Erythematosus (SLE) is a chronic autoimmune systemic disorder with unknown etio-pathogenesis. Upon the susceptible genetic, hormonal and abnormal immunologic background, the environmental factors may play role as trigger to permit disease development. Cardiovascular complications occur in more than half of the patients with SLE. Pericarditis is the most studied cardiovascular manifestation, although often not evident clinically, and it is included in the American College of Rheumatology (ACR) classification criteria for SLE. We report a clinical case of initially unremarkably findings which progressed to SLE complicated by full-blown acute pericarditis. A brief review of acute pericarditis, including etiology, clinical presentation, ECG criteria, echocardiographic manifestation, and treatment is presented.</p> <p>&nbsp;</p> <p><strong>Abstrak</strong></p> <p>Perikarditis akut adalah penyakit yang disebabkan oleh inflamasi dari perikard, dapat terjadi sebagai entitas penyakit primer maupun sekunder sebagai manifestasi dari penyakit sistemik yang mendasarinya. Diagnosis perikarditis akut ditegakkan saat pasien mengalami setidaknya dua dari tanda atau gejala berikut: nyeri dada spesifik perikarditis, pericardial friction rub, perubahan EKG tipikal, atau adanya efusi perikard dengan ukuran lebih dari trivial. Lupus Eritematosus Sistemik (LES) adalah penyakit autoimun sistemik kronis dengan etiopatogenesis yang belum diketahui. Adanya kepekaan genetik, latar belakang imunologis abnormal dan hormonal, serta faktor lingkungan memegang peran sebagai pemicu perkembangan penyakit. Komplikasi kardiovaskular terjadi pada lebih dari setengah pasien dengan SLE. Perikarditis merupakan manifestasi kardiovaskular yang paling sering dijumpai, meskipun jarang ditemukan patognomonis secara klinis, dan termasuk dalam kriteria klasifikasi LES menurut American College of Rheumatology (ACR). Berikut kami laporkan kasus dengan presentasi klinis febris dan takikardia yang kemudian mengarah pada LES dengan komplikasi perikarditis akut. Kami sertakan juga ulasan tentang perikarditis akut, termasuk etiologi, presentasi klinis, kriteria EKG, manifestasi ekokardiografis, dan terapi.</p> Anudya Kartika Ratri, Mochamad Yusuf Alsagaff, Tri Pudy Asmarawati ##submission.copyrightStatement## Tue, 21 Aug 2018 00:00:00 +0000 Role of Highly Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease <p>Cardiac troponins (cTn) are the preferred biomarkers of myocardial necrosis, usually used for diagnosis and risk stratification in acute coronary syndromes. Highly sensitive troponin T (hs-cTnT) may be elevated in stable coronary artery disease (SCAD), in which subclinical plaque erosion or rupture and distal embolization and subclinical ischemic episode. hs-cTnT may be used as a prognostic marker in SCAD and can predict cardiovascular events and patient’s mortality rate. In this article, plaque characteristic that is linked to hs-cTnT, it’s used as prognostic biomarker and comparison to other indicators are the focus of discussion.</p> <p>&nbsp;</p> <p><strong>Abstrak</strong></p> <p>Troponin adalah biomarker yang paling disukai untuk mendeteksi nekrosis miokardium dan untuk mendiagnosis dan stratifikasi risiko pada sindrom koroner akut. Highly sensitive troponin T (hs-cTnT) dapat meningkat pada penyakit jantung koroner stabil dimana terjadi ruptur plak atau erosi dan embolisasi distal sublklinis, dan episode iskemik subklinis. Sehingga biomarker tersebut dapat digunakan sebagai marker prognostik pada penyakit jantung koroner stabil dan dapat memprediksi angka kejadian kardiovaskular dan tingkat mortalitas pasien. Pada artikel ini akan dibahas mengenai karakteristik plak yang dihubungkan dengan peningkatan hs-cTnT, pengunaan sebagai biomarker prognostik dan serta perbandingan dengan indikator lainnya.</p> Raymond Pranata, Nico Kusuma, Rachel Vania, Bambang Budi Siswanto ##submission.copyrightStatement## Tue, 21 Aug 2018 00:00:00 +0000 CT-FFR: Clinical Application <p>Invasive fractional flow reserve (FFR) is the gold standard for guiding decision making to identify patients who would benefit from revascularization. Now, computed tomography can also do that by using computational fluid dynamics to calculate fractional flow reserve values from coronary CT angiography image data sets, known as CT-FFR. CT-FFR as an alternative method beside invasive FFR enables the identification of lesion-specific in coronary tree noninvasively. CT-FFR has showed significant improvement in specificity and positive predictive value and decreasing the frequency of using invasive coronary angiography.</p> <p>&nbsp;</p> <p><strong>Abstrak</strong></p> <p>Pemeriksaan invasif fractional flow reserve (FFR) adalah standar emas untuk memandu pengambilan keputusan dalam mengidentifikasi pasien apakah yang mendapat manfaat dari revaskularisasi. Sekarang, computed tomography juga dapat melakukannya dengan menggunakan dinamika cairan terkomputasi untuk menghitung fractional flow reserve dari kumpulan data gambar angiografi koroner CT, yang dikenal sebagai CT-FFR. CT-FFR sebagai metode alternatif selain FFR invasif memungkinkan identifikasi spesifik lesi pada koroner secara non-invasif. CT-FFR telah menunjukkan peningkatan yang signifikan pada spesifisitas dan nilai prediksi positif dan penurunan frekuensi penggunaan angiografi koroner invasif.</p> Sidhi Laksono Purwowiyoto ##submission.copyrightStatement## Tue, 21 Aug 2018 00:00:00 +0000