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Ambari AM, Radi B, Dwiputra B, Arityanti D, Rikl T, Inggriani MP, Qhabibi FR, Susilowati E, Makes IK, Rudiktyo E, Cramer MJ, Doevendans P, Setianto B, Santoso A. Adherence to penicillin treatment is essential for effective secondary prevention of rheumatic heart disease: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:2116-2123. [PMID: 38576943 PMCID: PMC10990302 DOI: 10.1097/ms9.0000000000001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/04/2024] [Indexed: 04/06/2024] Open
Abstract
Background Penicillin is essential for secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). However, the incidences of ARF recurrence and RHD progression remain high, particularly in endemic countries. This meta-analysis evaluated the effectiveness of penicillin adherence in secondary prevention of ARF recurrence and RHD progression. Methods The authors included original articles employing an observational study design in which the study population included patients with ARF or RHD and documented adherence to secondary prophylaxis with penicillin for secondary prevention. Systematic searches of the PubMed, Scopus, and Cochrane databases were performed. Moreover, the authors also conducted a snowballing literature search from Europe PMC to expand the included studies. The quality of each study was assessed using the National Institute of Health Quality Assessment Tool. The statistical analyses were conducted using Review Manager 5.4.1 software developed by Cochrane. In addition, the authors utilized pooled odds ratios (ORs) to compare the adherence techniques. Results A total of 310 studies were identified, of which 57 full-text articles were assessed for eligibility. The authors included six studies with 1364 patients for the qualitative synthesis and meta-analysis. Good adherence to penicillin for the secondary prophylaxis of ARF and RHD, significantly reduced the odds of ARF recurrence or RHD progression by up to 71% compared to that associated with poor adherence [pooled OR 0.29 (0.21-0.40); I²=0% (p=0.56); Z=7.64 (p <0.00001)]. Conclusion Good adherence to penicillin for secondary prophylaxis in patients with ARF or RHD is essential for reducing the risk of ARF recurrence or RHD progression.
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Affiliation(s)
- Ade M. Ambari
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dean Arityanti
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Thomas Rikl
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Maria P. Inggriani
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Faqrizal Ria Qhabibi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Eliana Susilowati
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Indira Kalyana Makes
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Estu Rudiktyo
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Pieter Doevendans
- Department of Cardiology, University Medical Centre Utrecht
- Central Military Hospital, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Budhi Setianto
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Dwiputra B, Santoso A, Purwowiyoto BS, Radi B, Pandhita BAW, Fatrin S, Ambari AM. Current Evidence and Future Directions of Omega-3 Supplementation and Cardiovascular Disease Risk. Int J Angiol 2024; 33:1-7. [PMID: 38352637 PMCID: PMC10861298 DOI: 10.1055/s-0043-1777258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Omega-3 supplementation has a controversial role in the secondary prevention of cardiovascular diseases. Despite large clinical trials published over the years, the evidence of omega-3 in preventing cardiovascular diseases, especially coronary heart disease, is still inconclusive. However, recent clinical trials using higher dose of omega-3 or highly purified esters of omega-3 shows promising result, with reduction in cardiovascular death and incidence of cardiovascular disease. This review aims to summarize the possible mechanism of omega-3 in preventing cardiovascular disease and future directions of research regarding the benefit of omega-3 in cardiovascular disease.
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Affiliation(s)
- Bambang Dwiputra
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Anwar Santoso
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Budhi Setianto Purwowiyoto
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Basuni Radi
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Bashar Adi Wahyu Pandhita
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Serlie Fatrin
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Ade Meidian Ambari
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
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Allo IJT, Findyartini A, Santoso A, Iqbal M. Cardiology residents' attitudes towards clinical supervision: a multi-centered study. Korean J Med Educ 2023; 35:407-416. [PMID: 38062686 PMCID: PMC10704050 DOI: 10.3946/kjme.2023.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/20/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Residents' gender, residency level, and hospital types might influence their attitudes towards clinical supervision (CS); however, reports of its impact on cardiology residency are nonexistent. We explore the effect of gender, residency level, and hospital location's effect on Indonesian cardiology trainees' attitudes towards CS. METHODS A multi-centered, cross-sectional study was conducted. We invited 490 Indonesian cardiology residents in September- October 2019 to complete the Cardiology CS Scale. Residents' attitudes, gender, university, and residency year were expressed using descriptive statistics. A Mann-Whitney test analyzed the gender and university location effect on residents' attitudes. Training year and university's impact were subjected to the Kruskal-Wallis test; a p-value of <0.05 reflected a significant result. RESULTS A total of 388 residents agreed to participate (response rate=79.18%). Most of them were male (n=229 [59,02%]), attended universities in Java Island (n=262 [67,52%]), and were in their 2nd-3rd year of training (n=95 [24.48%], each). There were no significant differences in residents' attitudes between genders (U [Nmale=229, Nfemale=159]=17,908.50, z=-0.27, p=0.78). Generally, their attitudes were significantly affected by the university (H(7)=47.38, p<0.01). However, the university location (located in Java Island or outside Java Island) does not affect residents' attitude towards CS (U [NJava=262, Nnon-Java=126]=15,237.00, z=-1.23, p=0.22). In addition, the residents' training year also affected the residents' response (H(2)=14.278, p<0.01). CONCLUSION Cardiology residents' attitudes towards CS are significantly influenced by training year and university but not gender or university location. The results might provide insightful information for further improvement of CS in cardiology training and guide further evaluation.
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Affiliation(s)
- Iswandy Janetputra Turu’ Allo
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Cardiology and Vascular Medicine, Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Medical Education Unit, Faculty of Medicine, Universitas Pendidikan Indonesia, Bandung, Indonesia
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Medical Education Cluster, Indonesia Medical Education and Research Institute, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology- Vascular Medicine, National Cardiovascular Centre-Harapan Kita Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Dwiputra B, Santoso A, Purwowiyoto BS, Radi B, Ambari AM. The effect of resistance training on PCSK9 levels in patients undergoing cardiac rehabilitation after coronary artery bypass grafting: a randomized study. BMC Cardiovasc Disord 2023; 23:549. [PMID: 37946122 PMCID: PMC10636968 DOI: 10.1186/s12872-023-03571-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Resistance training is commonly recommended as part of secondary prevention for post-coronary artery bypass graft (CABG) patients in conjunction with aerobic exercise. Despite its potential benefits, there is currently a lack of studies investigating the impact of resistance training on proprotein convertase subtilisin kexin 9 (PCSK9). AIM To evaluate the effect of intensive resistance training on proprotein convertase subtilisin kexin 9 (PCSK9) levels among post-CABG patients undergoing cardiac rehabilitation (CR). METHODS In this prospective, open-label, randomized trial, 87 post-coronary artery bypass graft (CABG) patients were randomly assigned into two groups: moderate to high intensity resistance training and aerobic training (n = 44) or aerobic training alone (n = 43) for a total of 12 sessions. Changes in PCSK9 levels was determined as a primary endpoint, while secondary endpoints included changes in the six-minute walk test (6-MWT) results, aerobic capacity, WHO-5 well-being index, fasting blood glucose, and lipid profile. Both groups underwent intention-to-treat analysis. RESULTS Following completion of cardiac rehabilitation program, the intervention group demonstrated a significant decrease in mean PCSK9 levels when compared to the control group (β = -55 ng/ml, 95% CI -6.7 to -103.3, p = 0.026), as well as significant improvements in the 6-MWT result (β = 28.2 m, 95% CI 2.4-53.9, p = 0.033), aerobic capacity (β = 0.9 Mets, 95% CI 0.1-1.7, p = 0.021), and WHO-5 well-being index (β = 8.1, 95% CI 2.0-14.4, p = 0.011) in patients who received resistance and aerobic training. No statistically significant changes were observed in fasting blood glucose, cholesterol, LDL-C, HDL-C, and triglyceride levels. CONCLUSION Resistance training in CR significantly reduced PCSK-9 levels and increases patient's functional capacity and quality of life. (NCT02674659 04/02/2016).
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Affiliation(s)
- Bambang Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia.
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
| | - Budhi Setianto Purwowiyoto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
| | - Basuni Radi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
| | - Ade Meidian Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
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Ardiana M, Santoso A, Hermawan HO, Nugraha RA, Pikir BS, Suryawan IGR. Acute effects of cigarette smoke on Endothelial Nitric Oxide synthase, vascular cell adhesion molecule 1 and aortic intima media thickness. F1000Res 2023; 10:396. [PMID: 38046985 PMCID: PMC10690037 DOI: 10.12688/f1000research.28375.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 12/05/2023] Open
Abstract
Background. Cigarette smoking could induce endothelial dysfunction and the increase of circulating markers of inflammation by activation of monocytes. This can lead to increased intima media thickness (IMT) of entire blood vessels and result in acceleration of the atherosclerosis process. However, to our knowledge, little is known about the role of cigarette smoking in this atherosclerotic inflammatory process. The aim of this study is to explore the link between cigarette smoking and its effect on endothelial nitric oxide synthase (e-NOS) and vascular cell adhesion molecule 1 (VCAM-1). Methods. An experimental study with a post-test only controlled group design was used. We used 18 Wistar rats ( Rattus norvegicus) randomly subdivided into two groups: group K (-) were not exposed to tobacco smoke, whereas group K (+) were exposed to smoke equivalent of more than 40 cigarettes for 28 days daily. After 28 days, samples were analyzed for e-NOS, VCAM-1 and aortic IMT. Results . Our results indicate that tobacco smoke can enhance the expression of VCAM-1 on rat cardiac vascular endothelial cells, resulting in a decreased expression of e-NOS level and increase of aortic IMT. Linear regression model found that eNOS level negatively correlated wiith aortic IMT ( r 2 = 0.584, β = -0.764, p < 0.001), whereas VCAM-1 expression did not correlate with aortic IMT ( r 2 = 0.197, p = 0.065). Conclusion. Low e-NOS level and high VCAM-1 level observed after cigarette smoke exposure which may increase aortic IMT.
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Affiliation(s)
- Meity Ardiana
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia - National Cardiovascular Centre Harapan Kita Hospital, Jakarta, DKI Jakarta, 11420, Indonesia
| | - Hanestya Oky Hermawan
- Department of Biomedicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
| | - Budi Susetyo Pikir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
| | - I. Gde Rurus Suryawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
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Adiarto S, Nurachman LA, Dewangga R, Indriani S, Taofan T, Alkatiri AA, Firman D, Santoso A. Predicting multi-vascular diseases in patients with coronary artery disease. F1000Res 2023; 12:750. [PMID: 37744767 PMCID: PMC10517298 DOI: 10.12688/f1000research.134648.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background: Because of its systemic nature, the occurrence of atherosclerosis in the coronary arteries can also indicate a risk for other vascular diseases. However, screening program targeted for all patients with coronary artery disease (CAD) is highly ineffective and no studies have assessed the risk factors for developing multi-vascular diseases in general. This study constructed a predictive model and scoring system to enable targeted screening for multi-vascular diseases in CAD patients. Methods: This cross-sectional study includes patients with CAD, as diagnosed during coronary angiography or percutaneous coronary intervention from March 2021 to December 2021. Coronary artery stenosis (CAS) and abdominal aortic aneurysm (AAA) were diagnosed using Doppler ultrasound while peripheral artery disease (PAD) was diagnosed based on ABI score. Multivariate logistic regression was conducted to construct the predictive model and risk scores. Validation was conducted using ROC analysis and Hosmer-Lemeshow test. Results: Multivariate analysis showed that ages of >60 years (OR [95% CI] = 1.579 [1.153-2.164]), diabetes mellitus (OR = 1.412 [1.036-1.924]), cerebrovascular disease (OR = 3.656 [2.326-5.747]), and CAD3VD (OR = 1.960 [1.250-3.073]) increased the odds for multi-vascular disease. The model demonstrated good predictive capability (AUC = 0.659) and was well-calibrated (Hosmer-Lemeshow p = 0.379). Targeted screening for high-risk patients reduced the number needed to screen (NNS) from 6 in the general population to 3 and has a high specificity of 96.5% Conclusions: Targeted screening using clinical risk scores was able to decrease NNS with good predictive capability and high specificity.
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Affiliation(s)
- Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | | | - Suci Indriani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Taofan Taofan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Amir Aziz Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Dwiputra B, Santoso A, Purwowiyoto BS, Radi B, Ambari AM, Desandri DR, Fatrin S, Pandhita BAW. Smartphone-Based Cardiac Rehabilitation Program Improves Functional Capacity in Coronary Heart Disease Patients: A Systematic Review and Meta-Analysis. Glob Heart 2023; 18:42. [PMID: 37577291 PMCID: PMC10417941 DOI: 10.5334/gh.1253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Cardiac rehabilitation (CR) reduces mortality and morbidity in coronary heart disease (CHD); however, patients show a lack of adherence to CR. Alternatively, telehealth interventions have shown promising results for improving target outcomes in CR. This study aimed to review the effect of smartphone-based CR on the functional capacity of CHD patients. A literature search was performed using PubMed, MEDLINE, Embase, and Cochrane Library on 21 March, 2022 to find randomised controlled trials on smartphone usage in CR to improve functional capacity. Outcomes included maximal oxygen consumption (VO2 max), a 6-min walk test (6-MWT), quality of life, smoking cessation, and modifiable risk factors. Eleven trials recruiting CHD patients were reviewed. Wearable devices connected to smartphone- or chat-based applications were commonly used for CR delivery. Most trials managed to provide exercise prescriptions, education on medication adherence and controlling risk factors, and psychosocial counselling through the intervention. Functional capacity improved significantly following smartphone-based CR in CHD patients compared to control groups, as measured by VO2 max and 6-MWT; patients were more likely to quit smoking. Compared to traditional care, smartphones that delivered CR to CHD patients demonstrate superior outcomes regarding increasing functional capacity. There is no significant improvement on lipid profile, blood pressure, HbA1C, body mass index, and quality of life. It can be used either alone or as an adjunct. Ultimately, the patients' preferences and circumstances should be considered.
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Affiliation(s)
- Bambang Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
| | - Budhi Setianto Purwowiyoto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
| | - Ade Meidian Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
| | - Dwita Rian Desandri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
| | - Serlie Fatrin
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
| | - Bashar Adi Wahyu Pandhita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Centre, Jakarta, Indonesia
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Soetisna TW, Thamrin AMH, Permadijana D, Ramadhani ANE, Santoso A, Mansyur M. Intramyocardial Stem Cell Transplantation during Coronary Artery Bypass Surgery Safely Improves Cardiac Function: Meta-Analysis of 20 Randomized Clinical Trials. J Clin Med 2023; 12:4430. [PMID: 37445467 DOI: 10.3390/jcm12134430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
IMSC transplantation during CABG is considered one of the most promising methods to effectively deliver stem cells and has been widely studied in many trials. But the results of outcomes and safety of this modality still vary widely. We conducted this meta-analysis of randomized controlled trials (RCTs) to evaluate not only the outcome but also the safety of this promising method. A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, and Cochrane databases. Articles were thoroughly evaluated and analyzed. Twenty publications about IMSC during CABG were included. Primary outcomes were measured using LVEF, LVESV, LVESVI, LVESD, LVEDV, LVEDVI, LVEDD, WMSI, and 6-MWT. Safety measures were depicted by total deaths, MACE, CRD, CVA, myocardial infarction, ventricular arrhythmia, and cardiac-related readmission. IMSC transplantation during CABG significantly improved LVEF (MD = 3.89%; 95% CI = 1.31% to 6.46%; p = 0.003) and WMSI (MD = 0.28; 95% CI = 0.01-0.56; p = 0.04). Most of the other outcomes showed favorable results for the IMSC group but were not statistically significant. The safety analysis also showed no significant risk difference for IMSC transplantation compared to CABG alone. IMSC during CABG can safely improve cardiac function and tend to improve cardiac volumes and dimensions. The analysis and application of influencing factors that increase patients' responses to IMSC transplantation are important to achieve long-term improvement.
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Affiliation(s)
- Tri Wisesa Soetisna
- Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, Jakarta 11420, Indonesia
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Ahmad Muslim Hidayat Thamrin
- Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, Jakarta 11420, Indonesia
- Faculty of Medicine, Syarif Hidayatullah State Islamic University, Haji Hospital, Jakarta 13560, Indonesia
| | - Diajeng Permadijana
- Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, Jakarta 11420, Indonesia
| | - Andi Nurul Erisya Ramadhani
- Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, Jakarta 11420, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Harapan Kita National Cardiovascular Center Hospital, Jakarta 11420, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
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Joseph P, Pais P, Gao P, Teo K, Xavier D, Lopez-Jaramillo P, Yusoff K, Santoso A, Gamra H, Talukder SH, Christou C, Dagenais G, Tyrwhitt J, Bosch J, Dans A, Yusuf S. Vitamin D supplementation and adverse skeletal and non-skeletal outcomes in individuals at increased cardiovascular risk: Results from the International Polycap Study (TIPS)-3 randomized controlled trial. Nutr Metab Cardiovasc Dis 2023; 33:434-440. [PMID: 36604262 DOI: 10.1016/j.numecd.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Vitamin D has mostly been tested in Western populations. We examined the effect of high dose vitamin D in a population drawn predominantly from outside of Western countries. METHODS AND RESULTS This randomized trial tested vitamin D 60,000 IU monthly in 5670 participants without vascular disease but at increased CV risk. The primary outcome was fracture. The secondary outcome was the composite of CV death, myocardial infarction stroke, cancer, fracture or fall. Death was a pre-specified outcome. Mean age was 63.9 years, and 3005 (53.0%) were female. 3034 (53.5%) participants resided in South Asia, 1904 (33.6%) in South East Asia, 480 (8.5%) in South America, and 252 (4.4%) in other regions. Mean follow-up was 4.6 years. A fracture occurred in 20 participants (0.2 per 100 person years) assigned to vitamin D, and 19 (0.1 per 100 person years) assigned to placebo (HR 1.06, 95% CI 0.57-1.99, p-value = 0.86). The secondary outcome occurred in 222 participants (1.8 per 100 person years) assigned to vitamin D, and 198 (1.6 per 100 person years) assigned to placebo (HR 1.13, 95% CI 0.93-1.37, p = 0.22). 172 (1.3 per 100 person years) participants assigned to vitamin D died, compared with 135 (1.0 per 100 person years) assigned to placebo (HR 1.29, 95% CI 1.03-1.61, p = 0.03). CONCLUSION In a population predominantly from South Asia, South East Asia and South America, high-dose vitamin D did not reduce adverse skeletal or non-skeletal outcomes. Higher mortality was observed in the vitamin D group. REGISTRATION NUMBER NCT01646437.
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Affiliation(s)
- P Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - P Pais
- St. John's Medical College, Bangalore, India
| | - P Gao
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - D Xavier
- St. John's Medical College, Bangalore, India
| | - P Lopez-Jaramillo
- Masira Research Institute Medical School, Universidad de Santander, Bucaramanga, Colombia
| | - K Yusoff
- UiTM Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - A Santoso
- Universitas Indonesia, National Cardiovascular Centre, Jakarta, Indonesia
| | - H Gamra
- Fattouma Bourguiba University Hospital and University of Monastir, Tunisia
| | | | - C Christou
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - G Dagenais
- Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - J Tyrwhitt
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - J Bosch
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - A Dans
- University of the Philippines, Manila, Philippines
| | - S Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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10
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Lamy A, Tong W, Joseph P, Gao P, Pais P, Lopez-Jaramillo P, Walli-Attaei M, Dans AL, Xavier D, Talukder S, Santoso A, Gamra H, Yusuf S. The cost implications of a polypill for primary prevention in the TIPS-3 trial. Eur Heart J Qual Care Clin Outcomes 2022; 8:899-908. [PMID: 34962984 DOI: 10.1093/ehjqcco/qcab101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022]
Abstract
AIMS The International Polycap Study 3 (TIPS-3) trial demonstrated that a polypill containing cholesterol- and multiple blood-pressure-lowering drugs reduces cardiovascular events by 20% compared with placebo in people without cardiovascular disease. The polypill plus aspirin led to a 31% relative risk reduction in cardiovascular disease events compared with double placebo. We report regional variations in costs and affordability of a polypill based on the TIPS-3 trial. METHODS AND RESULTS Countries were categorized using World Bank economic groups: lower-middle-income, upper-middle-income, and high-income countries. Country-specific costs were obtained for hospitalization events, procedures, and non-study medications (2019 US dollars). Polypill price was based on the cheapest equivalent substitute (CES) for each component. For the polypill vs. placebo, the difference in cost over the 4.6 years of the trial was $291 [95% confidence interval (CI): $243-339] per participant in lower-middle-income countries, $1068 (95% CI: $992-1144) in upper-middle-income countries, and $48 (95% CI: -$271 to $367) in high-income countries. Results were similar for the polypill plus aspirin vs. a double placebo. In both cases, the polypill was affordable in all groups using monthly household capacity to pay or a threshold of 4% of the gross national income per capita. CONCLUSION The use of a polypill (CES) in TIPS-3 increases costs in lower-middle-income countries and upper-middle-income countries but is affordable in countries at various economic levels and is cost neutral (dominant) in high-income countries.
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Affiliation(s)
- Andre Lamy
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Wesley Tong
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Peggy Gao
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Prem Pais
- St. John's Medical College, Division of Clinical Research and Training, Bangalore, India
| | | | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Antonio L Dans
- Department of Medicine, UP College of Medicine, University of the Philippines Manila, Padre Faura Street, Ermita, Manila, Metro Manila, Phillipines
| | - Denis Xavier
- St. John's Medical College, Division of Clinical Research and Training, Bangalore, India
| | | | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center, Jakarta, Indonesia
| | - Habib Gamra
- Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
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11
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Utomo P, Santoso A, Faza AG, Yudhistira MB. Effect of One Year COVID-19 on Trauma of Lower Extremity at Orthopaedic Service in Prof Soeharso Orthopaedic Hospital, Indonesia: A Cross-sectional Study. Malays Orthop J 2022; 16:11-16. [PMID: 36589366 PMCID: PMC9791887 DOI: 10.5704/moj.2211.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/22/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The World Health Organization announced the COVID-19 outbreak as a global pandemic on March 11, 2020. Despite the fact that orthopaedic departments are not considered first-line department in the war against pandemic, the pandemic has had a big effect on orthopaedic services. A few studies have found the pandemic effect on the orthopaedics field, but none have found the effect of a one-year pandemic, especially in Indonesia. This study aimed to know the effect of one-year COVID-19 on trauma of lower extremity at Orthopaedic Service in Prof Soeharso Top Referral Orthopaedic Hospital, Indonesia. Materials and methods It is a cross-sectional study. The study compared the population group during one year of the COVID-19 pandemic in Indonesia to the same period one year before. This study was conducted in Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia from March 2019-February 2021. The subjects were patients of lower extremity trauma both surgical procedure and outpatient visit. Patients recorded on other orthopaedic service support installations like radiology, laboratory, or physiotherapy were excluded. Results There was a significant reduction (54.9%) in total trauma of lower extremities patients in Prof Dr R Soeharso Orthopaedic Hospital, Surakarta, from 2146 (pre-COVID-19) to 968 (during COVID-19) in the March 2019-February 2021 period. There was also a significant reduction (90.9%) in total cases outpatient visit in pre-COVID-19 compared to during COVID-19 (p<0.05) and surgical procedures (39%) in pre-COVID-19 compare to the COVID-19 period (p<0.05). Conclusion There was a significant reduction on trauma of lower extremities patients both outpatient visits and surgical procedures during pandemic COVID-19 than before the COVID-19 occurred.
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Affiliation(s)
- P Utomo
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia,Corresponding Author: Pamudji Utomo, Department of Orthopedics and Traumatology, Universitas Sebelas Maret, Jl Ir Sutami No 36, Kentingan, Kec Jebres, Kota Surakarta, Jawa Tengah 57126, Indonesia
| | - A Santoso
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - AG Faza
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - MB Yudhistira
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
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12
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Raharjo SB, Putro AH, Santoso A, Hanafy DA, Hermanto DY, Humaira S, Yuniadi Y. Simple electrocardiography algorithm for localizing accessory pathway in patients with Wolff-Parkinson-White syndrome. Acta Cardiol 2022; 77:729-733. [PMID: 35947135 DOI: 10.1080/00015385.2021.1967623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Existing algorithms to predict the location of an accessory pathway (AP) in Wolff-Parkinson-White Syndrome (WPW) have good sensitivity and specificity but complex with various accuracy and inter-observer agreement rates. A simple algorithm with high accuracy and inter-observer agreement rates is needed. METHODS This was a cross-sectional and retrospective diagnostic study. The data were collected by total population sampling from January 2015 to January 2017. Forty-seven patients were included in the study. Data collected were pre-ablation 12-lead ECGs and ablation reports. These ECGs were evaluated by two independent observers using the simplified algorithm and compared with ablation results. RESULTS The algorithm had a sensitivity of 45% on the left free wall, 80% on septal, 92% on the right free wall, and the specificity of 96% on the left free wall, 69% on the septal, 85% on the right free wall for AP prediction. The positive predictive value was 90% on the left free wall, 55% on the septal, and 67% on the right free wall APs. The negative predictive value was 70% on the left free wall, 88% on the septal, and 97% on right free wall AP. The positive likelihood ratio was 11.23 on the left free wall, 2.23 on septal and 6.57 on right free wall APs, and the negative likelihood ratio was 0.57 on left free wall APs, 0.28 on septal, and 0.09 on the right free wall APs. Algorithm accuracy varied from 73-87%. Inter-observer agreement calculation was kappa 0.93 for left free wall AP, 0.78 for septal AP, and 0.74 for right free wall AP. CONCLUSION This simple algorithm has a remarkable accuracy and inter-observer agreement; therefore, it may prove to be helpful even to non-electrophysiologists and has the potential to be integrated into clinical practice.
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Affiliation(s)
- Sunu Budhi Raharjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dicky Armein Hanafy
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dony Yugo Hermanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Sarah Humaira
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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13
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Intan RE, Alkaff FF, Oktaviono YH, Nugraha RA, Octora TN, Jonatan M, Balti DR, Hasibuan FS, Radi B, Santoso A. Retrospective Study of the Association Between Platelet-to-Lymphocyte Ratio in Patients with Acute Coronary Syndrome on Admission to a Rural Referral Center in East Java, Indonesia, and the Incidence of New Symptomatic Heart Failure at 6 Months. Med Sci Monit 2022; 28:e935002. [PMID: 35232953 PMCID: PMC8900449 DOI: 10.12659/msm.935002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background This was a retrospective study conducted at a rural referral center in East Java, Indonesia, to evaluate the association between the platelet-to-lymphocyte ratio (PLR) on hospital admission and the incidence of new symptomatic heart failure (HF) within 6 months in patients with acute coronary syndrome (ACS). Material/Methods The study population consisted of all ACS patients who were hospitalized between 1 January and 31 December 2018 at a non-percutaneous coronary intervention-capable secondary referral hospital and came for a routine follow-up until 6 months afterwards. The diagnosis of new symptomatic HF was based on International Classification of Diseases 10th revision code I50.9. Results From 126 hospitalized patients, 92 patients were included in the analysis. The incidence rate of new symptomatic HF at 6 months was 70.65%. High PLR upon initial admission was significantly associated with new symptomatic HF incidence (odds ratio=1.70, P<0.001). PLR was also able to discriminate new symptomatic HF incidence at 6 months with area under the curve of 0.83 (P=0.001). Multivariate Cox regression analysis showed that PLR was an independent predictor for new symptomatic HF incidence (hazard ratio=4.5, P=0.001). Conclusions In a rural center in Indonesia, the PLR was independently correlated with the onset of new symptomatic HF in patients with ACS 6 months after hospital admission. The PLR may be a supplementary biomarker for clinical outcomes in patients with ACS for use in resource-limited regions.
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Affiliation(s)
- Ryan Enast Intan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Firas Farisi Alkaff
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Tan Nicko Octora
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Michael Jonatan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Dimas Rio Balti
- Department of Cardiology and Vascular Medicine, Ngimbang General Hospital, Lamongan, Indonesia
| | - Fani Suslina Hasibuan
- Department of Cardiology and Vascular Medicine, Dr. Koesma General Hospital, Tuban, Indonesia
| | - Basuni Radi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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14
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Koh N, Ference BA, Nicholls SJ, Navar AM, Chew DP, Kostner K, He B, Tse HF, Dalal J, Santoso A, Ako J, Tada H, Park JJ, Ong ML, Lim E, Subramaniam T, Li YH, Phrommintikul A, Iyengar SS, Ray S, Park KW, Tan HC, Chunhamaneewat N, Yeo KK, Tan JWC. Asian Pacific Society of Cardiology Consensus Recommendations on Dyslipidaemia. Eur Cardiol 2022; 16:e54. [PMID: 35024056 PMCID: PMC8728885 DOI: 10.15420/ecr.2021.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
The prevalence of dyslipidaemia has been increasing in the Asia-Pacific region and this is attributed to dietary changes and decreasing physical activity. While there has been substantial progress in dyslipidaemia therapy, its management in the region is hindered by limitations in awareness, adherence and healthcare costs. The Asian Pacific Society of Cardiology (APSC) developed these consensus recommendations to address the need for a unified approach to managing dyslipidaemia. These recommendations are intended to guide general cardiologists and internists in the assessment and treatment of dyslipidaemia and are hoped to pave the way for improving screening, early diagnosis and treatment. The APSC expert panel reviewed and appraised the evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. The resulting consensus recommendations tackle contemporary issues in the management of dyslipidaemia, familial hypercholesterolaemia and lipoprotein(a) in the Asia-Pacific region.
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Affiliation(s)
| | | | | | | | - Derek P Chew
- Flinders University of South Australia Australia
| | - Karam Kostner
- Mater Hospital and University of Queensland Australia
| | - Ben He
- Shanghai Chest Hospital China
| | | | - Jamshed Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital Mumbai, India
| | - Anwar Santoso
- National Cardiovascular Centre, Harapan Kita Hospital, Department of Cardiology-Vascular Medicine, Universitas Indonesia Indonesia
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara, Kanagawa, Japan
| | | | - Jin Joo Park
- Seoul National University Bundang Hospital South Korea
| | | | - Eric Lim
- National Heart Centre Singapore Singapore
| | | | - Yi-Heng Li
- National Cheng Kung University Hospital Taiwan
| | | | | | - Saumitra Ray
- Vivekananda Institute of Medical Sciences Kolkata, India
| | | | | | | | | | - Jack Wei Chieh Tan
- National Heart Centre Singapore Singapore.,University of Cambridge UK.,Victorian Heart Institute Melbourne, Australia
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15
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Robin T, Hu J, Jones B, Patton T, Santoso A, Diamond J, Lefkowits C, Corr B, Guntupalli S, Behbakht K, Fisher C. Phase I Dose Escalation Clinical Trial of Stereotactic Body Radiation Therapy (SBRT) for Limited Locoregional Recurrences of Ovarian Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Shiao J, Santoso A, Stuhr K, Bennett S, Holt D, Robin T, Fisher C. Gynecologic Interstitial Brachytherapy Curriculum Using a Low-Cost Phantom With Ultrasound Workshop and a Treatment Planning Workshop is Feasible and Effective. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Ambari AM, Lilihata G, Zuhri E, Ekawati E, Wijaya SA, Dwiputra B, Sukmawan R, Radi B, Haryana SM, Adiarto S, Hanafy DA, Zamroni D, Elen E, Mangkuanom AS, Santoso A. External Counterpulsation Improves Angiogenesis by Preserving Vascular Endothelial Growth Factor-A and Vascular Endothelial Growth Factor Receptor-2 but Not Regulating MicroRNA-92a Expression in Patients With Refractory Angina. Front Cardiovasc Med 2021; 8:761112. [PMID: 34760951 PMCID: PMC8573065 DOI: 10.3389/fcvm.2021.761112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 12/20/2022] Open
Abstract
Objective: External counterpulsation (ECP) provides long-term benefits of improved anginal frequency and exercise tolerance in patients with refractory angina (RA). This is postulated as a result of improved angiogenesis and endothelial function through an increase in shear stress. Angiogenesis is mainly represented by vascular endothelial growth factor-A (VEGF-A) and its receptor, vascular endothelial growth factor receptor-2 (VEGFR-2). The microRNA-92a (miR-92a) is a flow-sensitive miRNA that regulates atherosclerosis and angiogenesis in response to shear stress. Thus, ECP beneficial effect might be achieved through interaction between VEGF-A, VEGFR-2, and miR-92a. This study aims to evaluate the ECP effect on VEGF-A, VEGFR-2, and miR-92a in patients with RA in a sham-controlled manner. Methods: This was a randomized sham-controlled trial, enrolling 50 patients with RA who have coronary artery disease (CAD). Participants were randomized (1:1 ratio) to 35 sessions of either ECP (n = 25) or sham (n = 25), each session lasting for 1 h. Plasma levels of VEGF-A and VEGFR-2 were assayed by the ELISA technique. The quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to measure miR-92a circulating levels in plasma. Result: External counterpulsation significantly preserved VEGF-A and VEGFR-2 level compared to sham [ΔVEGF-A: 1 (-139 to 160) vs.-136 (-237 to 67) pg/ml, p = 0.026; ΔVEGFR-2: -171(-844 to +1,166) vs. -517(-1,549 to +1,407) pg/ml, p = 0.021, respectively]. Circulating miR-92a increased significantly in ECP [5.1 (4.2-6.4) to 5.9 (4.8-6.4), p < 0.001] and sham [5.2 (4.1-9.4) to 5.6 (4.8-6.3), p = 0.008] post-intervention. The fold changes tended to be higher in ECP group, although was not statistically different from sham [fold changes ECP = 4.6 (0.3-36.5) vs. sham 2.8 (0-15), p = 0.33)]. Conclusion: External counterpulsation improved angiogenesis by preserving VEGF-A and VEGFR-2 levels. Both ECP and sham increased miR-92a significantly, yet the changes were not different between the two groups. (Study registered on www.clinicaltrials.gov, no: NCT03991871, August 8, 2019, and received a grant from the National Health Research and Development of Ministry of Health of Indonesia, No: HK.02.02/I/27/2020).
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Affiliation(s)
- Ade Meidian Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Gracia Lilihata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Ervan Zuhri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Elok Ekawati
- Division of Cardiovascular Research and Development, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Shoma Adhi Wijaya
- Division of Cardiovascular Research and Development, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Sofia Mubarika Haryana
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dicky A. Hanafy
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dian Zamroni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Elen Elen
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Arwin S. Mangkuanom
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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18
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Amelinda DA, Santoso A, Fawzy A. 1246 Partial Phalloplasty After Oncologic Resection: A Challenge for Health Centers in Remote Area of Indonesia. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Restoring penile function for urination and sexual activity, and achieving cosmetic result, are the goals of penile reconstruction including in post-malignancy reconstruction. Lack of studies has reported the usage of radial forearm flap on partial phalloplasty.
Case Presentation
A 31-years old male presented with fragile, cauliflower-like mass sizing 6x8 cm. The tumor had covered whole glans until the middle shaft of the penis. Plan of treatment for this patient started with complete excision of the tumor (partial penectomy), continued with phalloplasty. Phalloplasty consisted of using radial forearm flap (RFF) for penile foreskin (including glans), reconstructing corporal bodies using sartorius muscle, reshaping the penile glans, and urethroplasty to correct the hypospadic-looking urethra. Radial forearm flap of the non-dominant arm was implanted on the remaining foreskin of the penis, continued with wound care. On the 7th day postoperatively, no signs of necrotic, wound dehiscence, nor pus were observed, with capillary refill time on the distal fingers shown less than 2 seconds. Further evaluation is scheduled.
Conclusions
Loss of physiologic function usually follows partial penilectomy, which could lead to decrease in psychological quality of life. The main goal of the reconstruction of penile foreskin (including glans) using RFF is to form a newly formed penile glans that would have a cosmetic appearance nearly similar to a normal glans, which could improve its physiologic function and benefit psychologically. A challenge for health care centers in remote is is how to monitor and maintain a viable flap after the reconstruction and to keep a regular evaluation from the patient.
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Affiliation(s)
- D A Amelinda
- Department of Oncologic Surgery, Chasan Boesorie Public Hospital, Ternate, North Moluccas, Indonesia
| | - A Santoso
- Department of Oncologic Surgery, Chasan Boesorie Public Hospital, Ternate, North Moluccas, Indonesia
| | - A Fawzy
- Plastic Surgeon, Faculty of Medicine and Health Science, General Soedirman University, Purwokerto, Jawa Tengah, Indonesia
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Ambari AM, Setianto B, Santoso A, Radi B, Dwiputra B, Susilowati E, Tulrahmi F, Wind A, Cramer MJM, Doevendans P. Randomised controlled trial into the role of ramipril in fibrosis reduction in rheumatic heart disease: the RamiRHeD trial protocol. BMJ Open 2021; 11:e048016. [PMID: 34518254 PMCID: PMC8438922 DOI: 10.1136/bmjopen-2020-048016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Rheumatic heart disease (RHD) is a major burden in developing countries and accounts for 80% of all people living with the disease, where it causes most cardiovascular morbidity and mortality in children and young adults. Chronic inflammation and fibrosis of heart valve tissue due to chronic inflammation in RHD will cause calcification and thickening of the impacted heart valves, especially the mitral valve. This fibrogenesis is enhanced by the production of angiotensin II by increased transforming growth factor β expression and later by the binding of interleukin-33, which is known to have antihypertrophic and antifibrotic effects, to soluble sST2. sST2 binding to this non-natural ligand worsens fibrosis. Therefore, we hypothesise that ACE inhibitors (ACEIs) would improve rheumatic mitral valve stenosis. METHODS AND ANALYSIS This is a single-centre, double-blind, placebo-controlled, randomised clinical trial with a pre-post test design. Patients with rheumatic mitral stenosis and valve dysfunction will be planned for cardiac valve replacement operation and will be given ramipril 5 mg or placebo for a minimum of 12 weeks before the surgery. The expression of ST2 in the mitral valve is considered to be representative of cardiac fibrosis. Mitral valve tissue will be stained by immunohistochemistry to ST2. Plasma ST2 will be measured by ELISA. This study is conducted in the Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiac Center Harapan Kita Hospital, Jakarta, Indonesia, starting on 27 June 2019. ETHICS AND DISSEMINATION The performance and dissemination of this study were approved by the ethics committee of National Cardiovascular Center Harapan Kita with ethical code LB.02.01/VII/286/KEP.009/2018. TRIAL REGISTRATION NUMBER NCT03991910.
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Affiliation(s)
- Ade Meidian Ambari
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, West Jakarta, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West Jakarta, Jakarta, Indonesia
| | - Budhi Setianto
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, West Jakarta, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West Jakarta, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, West Jakarta, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West Jakarta, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, West Jakarta, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West Jakarta, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, West Jakarta, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West Jakarta, Jakarta, Indonesia
| | - Eliana Susilowati
- Research Assistant of Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, West Jakarta, Jakarta, Indonesia
| | - Fadilla Tulrahmi
- Research Assistant of Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, West Jakarta, Jakarta, Indonesia
| | - Annemiek Wind
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Pieter Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Central Military Hospital, Netherlands Heart Institute, Utrecht, The Netherlands
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Ardiana M, Utami E, Pikir B, Santoso A. Preventive effect of Nigella sativa on M1/M2 ratio, reducing risk of endothelial dysfunction in cigarette smoked Wistars. F1000Res 2021; 10:917. [PMID: 36071890 PMCID: PMC9403357 DOI: 10.12688/f1000research.53713.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Smoking is one of the top three causes of cardiovascular disease (CVD). Natural antioxidants including black cumin ( Nigella sativa) may inhibit the pathogenesis of initial process of atherosclerosis. The aim of this study was to determine the effect of black cumin (Nigella sativa) in preventing endothelial dysfunction mainly through macrophage M1/M2 inflammatory response in cigarette smoked male Wistars. Methods: In total, 50 Wistar rats were randomly allocated to five experimental groups: two control groups, namely no intervention (K-) and exposure to smoke of 40 cigarettes each day (K+); and three treatment groups: rats given a dose of 0.3 g (P1), 0.6 g (P2) or 1.2 g (P3) black cumin per kilograms bodyweight/ day, respectively, and exposed to smoke of 40 cigarettes each day. After 28 days of cigarette smoke exposure, macrophage M1/M2 ratio was evaluated by counting total M1 and M2 in ten microscope field of view. Data were analysed by Mann-Whitney test. Results: The M1 / M2 ratio on K (-) was 0.9 7 ± 0.9 8 (<1) which means M2 was dominant, while the M1 / M2 ratio on K (+) was of 4.97 ± 3.42 (> 1) which means M1 dominant. There was no significant difference in the number of M1 count in treatment groups P1, P2, P3 (p value = 0.996; 0.170; 0.884, respectively) when compared with K+. Additionally, P2 group has the lower M1 number with the highest significance value when compared to K+. The number of M1 counts on P1 did not differ significantly when compared to P2 with p = 0.121 and P3 with p = 0.936. Conclusions: In sum, ethanol extract of black cumin prevents endothelial dysfunction by inhibiting increase in macrophages M1 / M2 ratio in rats Wistar exposed to sub-chronic cigarette smoke.
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Affiliation(s)
- Meity Ardiana
- Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- Cardiology and Vascular Medicine, Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Eka Utami
- Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- Cardiology and Vascular Medicine, Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Budi Pikir
- Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- Cardiology and Vascular Medicine, Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Anwar Santoso
- Cardiology and Vascular Medicine, Harapan Kita National Hospital, Jakarta, West Java, Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta, West Java, Indonesia
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21
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Radi B, Ambari AM, Dwiputra B, Intan RE, Triangto K, Santoso A, Setianto B. Determinants and Prediction Equations of Six-Minute Walk Test Distance Immediately After Cardiac Surgery. Front Cardiovasc Med 2021; 8:685673. [PMID: 34490363 PMCID: PMC8416754 DOI: 10.3389/fcvm.2021.685673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To date, there is no reference for a 6-min walk test distance (6-MWD) immediately after cardiac surgery. Therefore, this study aimed to identify the determinants and to generate equations for prediction reference for 6-MWD in patients immediately after cardiac surgery. Methods: This is a cross-sectional study of the 6-min walk test (6-MWT) prior to participation in the cardiac rehabilitation (CR) program of patients after coronary artery bypass surgery (CABG) or valve surgery. The 6-MWT were carried out in a gymnasium prior to the CR program immediately after the cardiac surgery. Available demographic and clinical data of patients were analyzed to identify the clinical determinants of 6-MWD. Results: This study obtained and analyzed the data of 1,509 patients after CABG and 632 patients after valve surgery. The 6-MWD of all patients was 321.5 ± 73.2 m (60–577). The distance was longer in the valve surgery group than that of patients in the CABG group (327.75 ± 70.5 vs. 313.59 ± 75.8 m, p < 0.001). The determinants which significantly influence the 6-MWD in the CABG group were age, gender, diabetes, atrial fibrillation, and body height, whereas in the valve surgery group these were age, gender, and atrial fibrillation. The multivariable regression models generated two formulas using the identified clinical determinants for patients after CABG: 6-MWD (meter) = 212.57 + 30.47 (if male gender) − 1.62 (age in year) + 1.09 (body height in cm) − 12.68 (if with diabetes) − 28.36 (if with atrial fibrillation), and for patients after valve surgery with the formula: 6-MWD (meter) = 371.05 + 37.98 (if male gender) − 1.36 (age in years) − 10.61 (if atrial with fibrillation). Conclusion: This study identified several determinants for the 6-MWD and successively generated two reference equations for predicting 6-MWD in patients after CABG and valve surgery.
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Affiliation(s)
- Basuni Radi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ade Meidian Ambari
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Kevin Triangto
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Budhi Setianto
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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22
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Ardiana M, Susetyo Pikir B, Santoso A, Oky Hermawan H, Jibril Al-Farabi M. The effect of subchronic cigarette smoke exposure on oxidative stress parameters and endothelial nitric oxide synthase in a rat aorta. ARYA Atheroscler 2021; 17:1-7. [PMID: 35685232 PMCID: PMC9137237 DOI: 10.22122/arya.v17i0.2150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The compounds in cigarette smoke are believed to cause oxidative stress, leading to endothelial dysfunction. Understanding the mechanism of endothelial dysfunction due to cigarette smoke is useful for the development of early and preventive therapy for cardiovascular diseases (CVDs) with smoking risk factors. METHODS In this experimental study, a posttest-only control group design was used. 20 Wistar rats were divided into two groups: a smoking group (exposed to 40 cigarettes per day for 4 weeks) and a control group. After the exposure, the animals were sacrificed and aortas were removed for measurement of malondialdehyde (MDA), superoxide dismutase (SOD), endothelial nitric oxide synthase (eNOS), intima-media thickness (IMT), and for histological analysis. RESULTS Exposure to cigarette smoke caused a significant decrease in SOD activity (24.28 ± 4.90; P = 0.027) and eNOS levels (50.81 ± 4.18; P = 0.014), but no significant effect on the level of MDA (17.08 ± 5.78; P = 0.551). Histological analysis showed an increase in IMT (13.27 ± 2.40; P = 0.000) and disorganization and vacuolation of smooth muscle cells in tunica media after exposure to cigarette smoke. The regression analysis showed a significant negative relationship between the eNOS level and IMT (β = -1.012, P = 0.009). CONCLUSION Subchronic exposure to cigarette smoke caused a decrease in SOD activity and eNOS levels, but no significant change in MDA levels. This study also indicated that smoking causes IMT thickening and pathological structural changes in the aorta. Another finding indicated that a decrease in eNOS levels could cause an increase in the IMT of the aorta.
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Affiliation(s)
- Meity Ardiana
- Lecturer, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
| | - Budi Susetyo Pikir
- Professor, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
| | - Anwar Santoso
- Lecturer, Department of Cardiology, Faculty of Medicine, University of Indonesia; National Cardiovascular Center, Harapan Kita Hospital, Jakarta, Indonesia
| | - Hanestya Oky Hermawan
- Resident, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
| | - Makhyan Jibril Al-Farabi
- Resident, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
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23
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Santoso A, Pranata R, Wibowo A, Al-Farabi MJ, Huang I, Antariksa B. Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis. Am J Emerg Med 2021; 44:352-357. [PMID: 32331955 PMCID: PMC7166308 DOI: 10.1016/j.ajem.2020.04.052] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background In this systematic review and meta-analysis, we aimed to explore the association between cardiac injury and mortality, the need for intensive care unit (ICU) care, acute respiratory distress syndrome (ARDS), and severe coronavirus disease 2019 (COVID-19) in patients with COVID-19 pneumonia. Methods We performed a comprehensive literature search from several databases. Definition of cardiac injury follows that of the included studies, which includes highly sensitive cardiac troponin I (hs-cTnl) >99th percentile.The primary outcome was mortality, and the secondary outcomes were ARDS, the need for ICU care, and severe COVID-19. ARDS and severe COVID-19 were defined per the World Health Organization (WHO) interim guidance of severe acute respiratory infection (SARI) of COVID-19. Results There were a total of 2389 patients from 13 studies. This meta-analysis showed that cardiac injury was associated with higher mortality (RR 7.95 [5.12, 12.34], p < 0.001; I2: 65%). Cardiac injury was associated with higher need for ICU care (RR 7.94 [1.51, 41.78], p = 0.01; I2: 79%), and severe COVID-19 (RR 13.81 [5.52, 34.52], p < 0.001; I2: 0%). The cardiac injury was not significant for increased risk of ARDS (RR 2.57 [0.96, 6.85], p = 0.06; I2: 84%). The level of hs-cTnI was higher in patients with primary + secondary outcome (mean difference 10.38 pg/mL [4.44, 16.32], p = 0.002; I2: 0%). Conclusion Cardiac injury is associated with mortality, need for ICU care, and severity of disease in patients with COVID-19.
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Affiliation(s)
- Anwar Santoso
- Department of Cardiology - Vascular Medicine, Universitas Indonesia, Harapan Kita Hospital - National Cardiovascular Centre, Jalan Letjen S. Parman kav 87, Jakarta 11420, Indonesia.
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, MH Thamrin Boulevard 1100, Tangerang 15811, Indonesia
| | - Arief Wibowo
- Department of Cardiology - Vascular Medicine, Padjadjaran University, Dr. Hasan Sadikin Hospital, Jalan Pasteur No: 38, Bandung 40161, Indonesia
| | - Makhyan Jibril Al-Farabi
- Department of Cardiology - Vascular Medicine, Airlangga University, Soetomo Academic and General Hospital, Jalan Mayjen Moestopo No: 6-8, Surabaya 60286, Indonesia.
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, MH Thamrin Boulevard 1100, Tangerang 15811, Indonesia
| | - Budhi Antariksa
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia, Persahabatan Hospital, Jalan Persahabatan Raya No: 1, Jakarta 13230, Indonesia
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24
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Santoso A, Yulianto Y, Simarmata H, Putra AN, Listiyaningsih E. Effect of PCSK9 E670G and R46L Polymorphisms on Major Adverse Cardio-Cerebrovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Int J Angiol 2021; 30:22-28. [PMID: 34025093 DOI: 10.1055/s-0041-1722875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Major adverse cardio-cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) are still high, although there have been advances in pharmacology and interventional procedures. Proprotein convertase subtilisin/Kexin type 9 ( PCSK9 ) is a serine protease regulating lipid metabolism associated with inflammation in acute coronary syndrome. The MACCE is possibly related to polymorphisms in PCSK9 . A prospective cohort observational study was designed to confirm the association between polymorphism of E670G and R46L in the PCSK9 gene with MACCE in STEMI. The Cox proportional hazards model and Spearman correlation were utilized in the study. The Genotyping of PCSK9 and ELISA was assayed. Sixty-five of 423 STEMI patients experienced MACCE in 6 months. The E670G polymorphism in PCSK9 was associated with MACCE (hazard ratio = 45.40; 95% confidence interval: 5.30-390.30; p = 0.00). There was a significant difference of PCSK9 plasma levels in patients with previous statin consumption (310 [220-1,220] pg/mL) versus those free of any statins (280 [190-1,520] pg/mL) ( p = 0.001). E670G polymorphism of PCSK9 was associated with MACCE in STEMI within a 6-month follow-up. The plasma PCSK9 level was higher in statin users.
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Affiliation(s)
- Anwar Santoso
- Department of Cardiology, Vascular Medicine, Harapan Kita Hospital, National Cardiovascular Centre, Universitas Indonesia, Jakarta, Indonesia
| | - Yulianto Yulianto
- Department of Cardiology, Vascular Medicine, Harapan Kita Hospital, National Cardiovascular Centre, Universitas Indonesia, Jakarta, Indonesia
| | - Hendra Simarmata
- Department of Cardiology, Vascular Medicine, Harapan Kita Hospital, National Cardiovascular Centre, Universitas Indonesia, Jakarta, Indonesia
| | - Abhirama Nofandra Putra
- Department of Cardiology, Vascular Medicine, Gunung Jati Government Hospital, Kesambi - Cirebon, West Java, Indonesia
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25
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Turu' Allo IJ, Santoso A, Findyartini A. Cardiology trainees' attitudes towards clinical supervision: a scale development study. Int J Med Educ 2021; 12:38-44. [PMID: 33772563 DOI: 10.5116/ijme.604a.4964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aims to explore the construct validity, dimensionality, and internal consistency of a new attitude scale for measuring cardiology trainees' attitudes towards clinical supervision. METHODS A multi-centred, cross-sectional study involving 388 Indonesian cardiology trainees from eight universities was conducted using convenience sampling. Twenty-nine items have been generated based on an extensive literature review and conceptual framework of effective clinical supervision. Ten clinical experts reviewed the items to ensure the Cardiology Clinical Supervision Scale (CCSS) adequately represents the construct under study. An exploratory factor analysis using principal axis factoring (PAF) with oblique rotation was run to identify the internal structure of the scale. Items with factor loading <0.50 were deleted. In addition, inter-item correlations and items' communalities were analysed. Each subscale's internal consistency was assessed using Cronbach's alpha score. RESULTS The content validity index provided evidence for CCSS' validity (G-coefficient=0.71). Scrutinising the experts' comments, we finalised the scale to include 27 items. Further, four items were deleted due to low inter-item correlation and communality. PAF analysis resulted in a two-factor model comprising the "Supervisory Interaction and Facilitation" factor (n=10 items) and the "Role Modelling" factor (n=9 items); four items were deleted due to low factor loading. The Cronbach's alpha score for SIF and RM factors were 0.93 and 0.89, respectively. CONCLUSIONS The study's results support the validity, internal structure, and internal consistency of the new clinical supervision scale for cardiology training. Further studies are required to investigate other validity and reliability evidence for CCSS, including its cross-cultural validity.
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Affiliation(s)
| | - Anwar Santoso
- Department of Cardiology-Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Centre-Harapan Kita Hospital, Jakarta, Indonesia
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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26
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Irnidayanti Y, Sutiono DR, Ibrahim N, Wisnuwardhani PH, Santoso A. Potential neuroprotective of trans-resveratrol a promising agent tempeh and soybean seed coats-derived against beta-amyloid neurotoxicity on primary culture of nerve cells induced by 2-methoxyethanol. BRAZ J BIOL 2021; 82:e235781. [PMID: 33787733 DOI: 10.1590/1519-6984.235781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022] Open
Abstract
Resveratrol, a natural polyphenol found in tempeh, has not been investigated especially in vitro as a neuroprotective agent against 2-methoxyethanol (2-ME)-induced beta-amyloid cytotoxicity. Beta amyloid peptides (Aβ) could initiate neurotoxic events and neuron-inflammatory response via microglial activation. However, it remains unknown whether the neurotoxic effect of beta-amyloid and/or associated with the potential of 2-ME to induce neurotoxic effects on primary culture of nerve cells induced by 2-ME. This study investigated potential neuroprotective of trans-resveratrol a promising agent tempeh and soybean seed coats-derived against beta-amyloid cytotoxicity on primary culture of nerve cells induced by 2-methoxyethanol. Biotium and MTT assays were used to analyze neurons, which were isolated from the cerebral cortex of fetal mice at gestation day 19 (GD-19). A standard solution of 2-methoxyethanol was dosed at 10 μL. The cultured cells were randomly divided into the following groups: (1) 2-ME group + resveratrol standard, (2) 2-ME group + resveratrol isolated from tempeh, (3) 2-ME group + resveratrol isolated from soybean seed coats, and (4) the control group, without the addition of either 2-ME or resveratrol. Exposure of the primary cortical neuron cells to beta-amyloid monoclonal antibody pre-incubated for 24 h with 10 µL of 4.2 µg/mL resveratrol and 7.5 mmol/l 2-methoxy-ethanol additions. Here, we report that the addition of 2-ME and resveratrol (standard and isolated from tempeh) of cell culture at concentrations of 1.4, 2.8 and 4.2 µg/mL showed that the majority of neurons grew well. In contrast, after exposure to 2-ME and Beta-amyloid, showed that glial activated. These findings demonstrate a role for resveratrol in neuroprotective-neurorescuing action.
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Affiliation(s)
- Y Irnidayanti
- Universitas Negeri Jakarta, Faculty of Mathematics and Science, Department of Animal Development, Biology, Jakarta, Indonesia
- Jakarta State University, Faculty of Mathematics and Natural Sciences, Research Group of Biology, Jakarta, Indonesia
| | - D R Sutiono
- Jakarta State University, Faculty of Mathematics and Natural Sciences, Research Group of Biology, Jakarta, Indonesia
| | - N Ibrahim
- Universitas Indonesia, Faculty of Medicine, Jakarta, Indonesia
| | - P H Wisnuwardhani
- Indonesian Institute of Sciences - LIPI, Biotechnology, Bogor, Indonesia
| | - A Santoso
- Indonesian Institute of Sciences - LIPI, Biotechnology, Bogor, Indonesia
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27
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Yusuf S, Joseph P, Dans A, Gao P, Teo K, Xavier D, López-Jaramillo P, Yusoff K, Santoso A, Gamra H, Talukder S, Christou C, Girish P, Yeates K, Xavier F, Dagenais G, Rocha C, McCready T, Tyrwhitt J, Bosch J, Pais P. Polypill with or without Aspirin in Persons without Cardiovascular Disease. N Engl J Med 2021; 384:216-228. [PMID: 33186492 PMCID: PMC7116860 DOI: 10.1056/nejmoa2028220] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A polypill comprising statins, multiple blood-pressure-lowering drugs, and aspirin has been proposed to reduce the risk of cardiovascular disease. METHODS Using a 2-by-2-by-2 factorial design, we randomly assigned participants without cardiovascular disease who had an elevated INTERHEART Risk Score to receive a polypill (containing 40 mg of simvastatin, 100 mg of atenolol, 25 mg of hydrochlorothiazide, and 10 mg of ramipril) or placebo daily, aspirin (75 mg) or placebo daily, and vitamin D or placebo monthly. We report here the outcomes for the polypill alone as compared with matching placebo, for aspirin alone as compared with matching placebo, and for the polypill plus aspirin as compared with double placebo. For the polypill-alone and polypill-plus-aspirin comparisons, the primary outcome was death from cardiovascular causes, myocardial infarction, stroke, resuscitated cardiac arrest, heart failure, or revascularization. For the aspirin comparison, the primary outcome was death from cardiovascular causes, myocardial infarction, or stroke. Safety was also assessed. RESULTS A total of 5713 participants underwent randomization, and the mean follow-up was 4.6 years. The low-density lipoprotein cholesterol level was lower by approximately 19 mg per deciliter and systolic blood pressure was lower by approximately 5.8 mm Hg with the polypill and with combination therapy than with placebo. The primary outcome for the polypill comparison occurred in 126 participants (4.4%) in the polypill group and in 157 (5.5%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.63 to 1.00). The primary outcome for the aspirin comparison occurred in 116 participants (4.1%) in the aspirin group and in 134 (4.7%) in the placebo group (hazard ratio, 0.86; 95% CI, 0.67 to 1.10). The primary outcome for the polypill-plus-aspirin comparison occurred in 59 participants (4.1%) in the combined-treatment group and in 83 (5.8%) in the double-placebo group (hazard ratio, 0.69; 95% CI, 0.50 to 0.97). The incidence of hypotension or dizziness was higher in groups that received the polypill than in their respective placebo groups. CONCLUSIONS Combined treatment with a polypill plus aspirin led to a lower incidence of cardiovascular events than did placebo among participants without cardiovascular disease who were at intermediate cardiovascular risk. (Funded by the Wellcome Trust and others; TIPS-3 ClinicalTrials.gov number, NCT01646437.).
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Affiliation(s)
- Salim Yusuf
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Philip Joseph
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Antonio Dans
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Peggy Gao
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Koon Teo
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Denis Xavier
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Patricio López-Jaramillo
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Khalid Yusoff
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Anwar Santoso
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Habib Gamra
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Shamim Talukder
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Courtney Christou
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Preeti Girish
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Karen Yeates
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Freeda Xavier
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Gilles Dagenais
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Catalina Rocha
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Tara McCready
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Jessica Tyrwhitt
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Jackie Bosch
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
| | - Prem Pais
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., P.J., P. Gao, K.T., C.C., T.M., J.T., J.B.), Queen's University, Kingston, ON (K. Yeates), and Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (G.D.) - all in Canada; the University of the Philippines, Manila (A.D.); St. John's Medical College, Bangalore, India (D.X., P. Girish, F.X., P.P.); Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., C.R.); Universiti Teknologi MARA Selayang, Selangor, and UCSI University, Cheras, Kuala Lumpur - both in Malaysia (K. Yusoff); Universitas Indonesia, National Cardiovascular Center, Jakarta (A.S.); Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia (H.G.); and Eminence, Dhaka, Bangladesh (S.T.)
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Syam H, Sukmawan R, Dharma S, Alaztha G, Giyantini A, Prakoso R, Rudiktyo E, Zamroni D, Rejeki V, Juzar D, Rahardjo S, Adriantoro H, Santoso A. Epigenetic interaction of miRNA-26a and P2Y12 gene DNA methylation on platelet reactivity under clopidogrel and their impact to the coronary flow after primary PCI in STEMI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Epigenetic factors such as miRNA-26A and P2Y12 DNA methylation play role in pathophysiology of cardiovascular disease. Clopidogrel-resistance is associated with worse cardiovascular outcome. The interactions between the expression of platelet miRNA-26a and P2Y12 DNA methylation to clopidogrel resistance and post procedural TIMI flow in STEMI patients undergoing primary PCI is unclear.
Purpose
To define interaction of epigenetic factors micro-RNA (miRNA)-26a expression and P2Y12 gene DNA methylation to the platelet reactivity under clopidogrel therapy, and their impact on the coronary flow after Primary PCI in patients with STEMI.
Methods
We studied STEMI patients who underwent primary PCI, receiving 600 mg loading dose of clopidogrel. Platelet reactivity assessed by VerifyNow P2Y12. Realtime PCR was performed to measure the expression of platelet miR-26a and DNA methylation of P2Y12 gene. Postprocedural epicardial coronary flow was assessed semi quantitatively.
Results
There were 100 patients were recruited. Among them, 59% have high miRNA-26a platelet expression, 60% had no methylation in their P2Y12 gene, and 27% had high platelet reactivity index under clopidogrel therapy. There was association between high miR-26a expression and reduced platelet inhibition under clopidogrel (OR 4.2, p<0.01), but not with DNA methylation of P2Y12 gene. High platelet reactivity index under clopidogrel therapy was associated with suboptimal coronary flow after primary PCI in STEMI patients (OR 3.3, p<0.05).
Conclusions
High miRNA-26a platelet expression, but not DNA methylation of P2Y12 gene, in patients with acute STEMI have significant association with high platelet reactivity under clopidogrel therapy. Furthermore, high platelet reactivity under clopidogrel is associated with suboptimal coronary flow in STEMI patients undergoing primary PCI.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Harapan Kita Honor Research Grant
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Affiliation(s)
- H Syam
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - R Sukmawan
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - S Dharma
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - G Alaztha
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - A Giyantini
- Cipto Mangunkusumo Hospital, Clinical Pathology, Jakarta, Indonesia
| | - R Prakoso
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - E Rudiktyo
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - D Zamroni
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - V.G Rejeki
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - D.A Juzar
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - S.B Rahardjo
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - H Adriantoro
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - A Santoso
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Sarvasti D, Lalenoh I, Oepangat E, Purwowiyoto BS, Santoso A, Romdoni R. Cardiovascular Protection Variables Based on Exercise Intensity in Stable Coronary Heart Disease Patients After Coronary Stenting: A Comparative Study. Vasc Health Risk Manag 2020; 16:257-270. [PMID: 32753874 PMCID: PMC7352377 DOI: 10.2147/vhrm.s259190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Our study aimed at determining and comparing the mechanism of cardiovascular protection variables in moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) in patients with stable coronary heart disease (CHD) after coronary stenting. Participants and Methods This experimental study used the same subject and cross-over design, involving eleven stable CHD patients after coronary stenting. These were randomly divided into two groups; MICT for 29 minutes at 50–60% heart rate reserve and HIIT with 4x4 minute intervals at 60–80% heart rate reserve, each followed by three minutes of active recovery at 40–50% heart rate reserve. These were conducted three times a week for two weeks. The participants’ levels of adrenaline, noradrenaline, endothelial nitric oxide synthase (eNOS), extracellular superoxide dismutase (EC-SOD) activity assayed, and flow-mediated dilatation (FMD) were examined before and after treatments were completed. Results The HIIT significantly increased the levels of noradrenaline and eNOS compared with MICT (p<0.05). Also, HIIT was better in maintaining EC-SOD activity and FMD compared with MICT (p<0.05). Through the noradrenalin pathway, HIIT had a direct and significant effect on eNOS and FMD (p<0.05) but MICT, through the noradrenaline pathways, had a direct and significant effect on eNOS (p<0.05), and through the EC-SOD activity pathways had a direct and significant effect on FMD (p<0.05). MICT reduced EC-SOD activity and also decreased the FMD value. Conclusion HIIT is superior to MICT in increasing cardiovascular protection by increasing the concentrations of noradrenalin and eNOS, maintaining EC-SOD activity, and FMD in stable CHD patients after coronary stenting.
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Affiliation(s)
- Dyana Sarvasti
- Department of Internal Medicine, Faculty of Medicine Widya Mandala Catholic University, Surabaya, Indonesia
| | - Isabella Lalenoh
- Department of Cardiology, Siloam Hospital TB Simatupang, Jakarta, Indonesia
| | - Emanoel Oepangat
- Department of Cardiology, Siloam Hospital TB Simatupang, Jakarta, Indonesia
| | - Budhi Setianto Purwowiyoto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Rochmad Romdoni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Airlangga University - Dr. Soetomo District General Hospital, Surabaya, Indonesia
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30
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Turana Y, Widyantoro B, Situmorang TD, Delliana J, Roesli RMA, Danny SS, Suhardjono, Sofiatin Y, Hermiawaty E, Kuncoro AS, Barack R, Beaney T, Ster AC, Poulter NR, Santoso A. May Measurement Month 2018: an analysis of blood pressure screening results from Indonesia. Eur Heart J Suppl 2020; 22:H66-H69. [PMID: 32884474 PMCID: PMC7455301 DOI: 10.1093/eurheartj/suaa031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Elevated blood pressure (BP) is a significant burden worldwide, leading to high cardio-cerebro-reno-vascular morbidity and mortality. For the second year of the May Measurement Month (MMM) campaign in Indonesia in 2018, we recruited 174 sites in 31 out of 34 provinces in Indonesia and screened through convenience sampling in public areas and rural primary health centres. Hypertension was defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or both, or on the basis of receiving antihypertensive medication. Blood pressure was measured three times followed the standard global MMM protocol, multiple imputation was used to estimate the mean of the 2nd and 3rd BP readings if these were not recorded. A total of 91 222 individuals were screened, and after multiple imputations, 27 331 (30.0%) had hypertension. Of individuals not receiving antihypertensive medication, 14 367 (18.4%) were hypertensive. Among the 47.4% of hypertensive individuals on antihypertensive medication, 10 106 (78.0%) had uncontrolled BP. MMM17 and MMM18 were still the most extensive standardized screening campaigns for BP measurement in Indonesia. Compared to the previous study, the proportion with uncontrolled BP on medication was significantly higher and provided the substantial challenges in managing hypertension in the rural community.
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Affiliation(s)
- Yuda Turana
- Department of Neurology, School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jakarta 14440, Indonesia
| | - Bambang Widyantoro
- Department of Cardiology — Vascular Medicine, Faculty of Medicine, Universitas Indonesia — National Cardiovascular Center Harapan Kita Hospital, Jl. S. Parman Kav 87, Slipi, Jakarta 11420, Indonesia
| | - Tunggul D Situmorang
- Division of Nephrology, Department of Internal Medicine, PGI Cikini Hospital, Jakarta 10330, Indonesia
| | - Juzi Delliana
- Department of Cardiology, Directorate of Non-Communicable Disease, Ministry of Health - Republic of Indonesia, Jalan Percetakan Negara 29, Jakarta 10560, Indonesia
| | - Rully M A Roesli
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung 40161, Indonesia
| | - Siska S Danny
- Department of Cardiology — Vascular Medicine, Faculty of Medicine, Universitas Indonesia — National Cardiovascular Center Harapan Kita Hospital, Jl. S. Parman Kav 87, Slipi, Jakarta 11420, Indonesia
| | - Suhardjono
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia—Cipto Mangunkusumo National General Hospital, Jalan Pangeran Diponegoro No: 71, Jakarta 10430, Indonesia
| | - Yulia Sofiatin
- Department of Public Health, Faculty of Medicine, Padjadjaran University, Jalan Prof. Eijkman 38, Bandung 40161, Indonesia
| | - Eka Hermiawaty
- Department of Neurology, National Cardiovascular Center Harapan Kita Hospital, Jl. S. Parman Kav 87, Slipi, Jakarta 11420, Indonesia
| | - Ario S Kuncoro
- Department of Cardiology — Vascular Medicine, Faculty of Medicine, Universitas Indonesia — National Cardiovascular Center Harapan Kita Hospital, Jl. S. Parman Kav 87, Slipi, Jakarta 11420, Indonesia
| | - Rossana Barack
- Department of Cardiology, MMC Hospital, Jakarta, Indonesia
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, Shepherd's Bush, London W12 7RH, UK
- Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W6 8RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, Shepherd's Bush, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, Shepherd's Bush, London W12 7RH, UK
| | - Anwar Santoso
- Department of Cardiology — Vascular Medicine, Faculty of Medicine, Universitas Indonesia — National Cardiovascular Center Harapan Kita Hospital, Jl. S. Parman Kav 87, Slipi, Jakarta 11420, Indonesia
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Ambari AM, Setianto B, Santoso A, Radi B, Dwiputra B, Susilowati E, Tulrahmi F, Doevendans PA, Cramer MJ. Angiotensin Converting Enzyme Inhibitors (ACEIs) Decrease the Progression of Cardiac Fibrosis in Rheumatic Heart Disease Through the Inhibition of IL-33/sST2. Front Cardiovasc Med 2020; 7:115. [PMID: 32850979 PMCID: PMC7399157 DOI: 10.3389/fcvm.2020.00115] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Rheumatic heart disease (RHD) is common in developing countries and poses a big medical challenge and burden. The pathogenesis of RHD is influenced by the triad of host, agent, and environment. Autoantigens generated from Group A Streptococcus (GAS) infection are captured by the resident dendritic cells (DCs) in the heart's valvular endothelium. DCs differentiate into antigen presenting cells (APC) in the valve interstices. APC induces activation of autoreactive T cells, which triggers inflammation and tissue fibrosis. Cardiac fibrosis is promoted through the activation of Mitogen activated protein kinases (MAPKs) and its downstream signaling, including its interaction with transforming growth factor-β (TGF-β) and Smad proteins. TGF-β-induced phosphorylation of Smad2 complexes with Smad3 and Smad4, and translocates into the nucleus. Angiotensin II enhances the migration, maturation, and presentation of DC. In RHD, Angiotensin II induces fibrosis via the stimulation of TGF-β, which further increases the binding of IL-33 to sST2 but not ST2L, resulting in the upregulation of Angiotensin II and progression of cardiac fibrosis. This cascade of inflammation and valvular fibrosis causes calcification and stiffening of the heart valves in RHD. Angiotensin converting enzyme inhibitors (ACEIs) inhibit Angiotensin II production, which in turn decreases TGF-β expression and the onset of overt inflammatory response. This condition leads to a reduction in the sST2 as the decoy receptor to "steal" IL-33, and IL-33 binds to ST2L and results in cardioprotection against cardiac fibrosis in the pathogenesis of RHD.
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Affiliation(s)
- Ade M. Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - Eliana Susilowati
- Research Assistants of Preventive Cardiology, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Fadilla Tulrahmi
- Research Assistants of Preventive Cardiology, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
- Cardiovascular Departement, The Netherlands Heart Institute Utrecht, Utrecht, Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
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Castillo-Carandang NT, Buenaventura RD, Chia YC, Do Van D, Lee C, Duong NL, Ng CH, Robles YR, Santoso A, Sigua HS, Sukonthasarn A, Tan R, Viora E, Zakaria H, Brizuela GE, Ratnasingham P, Thomas M, Majumdar A. Moving Towards Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations from a Review and Multidisciplinary Expert Panel. Risk Manag Healthc Policy 2020; 13:803-819. [PMID: 32765135 PMCID: PMC7371561 DOI: 10.2147/rmhp.s256165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in the Association of Southeast Asian Nations (ASEAN) member states. Progress has been slow despite the World Health Organization action plan for the prevention and control of NCDs in the region. This paper presents recommendations focused on practical strategies for optimizing NCD management in the ASEAN region. Methods A multidisciplinary group of experts from six ASEAN member states convened for two face-to-face meetings to discuss barriers and possible recommendations for optimizing NCD management, focused on cardiovascular diseases and mental disorders, in the region. Multiple approaches, ie, analysis of insights from the meetings and a review of existing literature on NCD programs in the ASEAN region were followed. The proposed recommendations were also based on selected successful interventions in ASEAN member states, thus providing actionable strategies. Results The gaps identified in NCD management for cardiovascular diseases and mental disorders in the ASEAN region were classified into gaps relating to policies and to clinical and public health practice. The proposed solutions addressing policy gaps include fostering multisectoral public–private partnerships, employing “whole-of-government” and “whole-of-society” approaches and promoting “health-in-all policies approach” to manage issues with financing, accessibility, efficiency and quality of health services. Whereas proposed solutions to bridge clinical and public health practice gaps entail strengthening primary care services, building the capacity of trained healthcare workers and employing collaborative care for holistic management of patients. Conclusion The scale of premature and preventable deaths from NCDs in the ASEAN region remains a serious public health concern and requires a “whole-of-system approach”. The interventions proposed in this paper build on regional collaborations and knowledge sharing to help develop a concerted and targeted response to NCDs.
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Affiliation(s)
- Nina T Castillo-Carandang
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Robert D Buenaventura
- Department of Psychiatry, Manila Theological College - College of Medicine, Manila, Philippines
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dung Do Van
- The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Ngoc Long Duong
- Department of Research, Education and Technology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yolanda R Robles
- College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology, Vascular Medicine, National Cardiovascular Centre - Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Helen S Sigua
- University of the Philippines Open University, Laguna, Philippines
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Roger Tan
- Roger Kidney Clinic, Gleneagles Hospital, Singapore
| | - Eka Viora
- Indonesia Psychiatrist Association, Jakarta, Indonesia
| | - Hazli Zakaria
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Grace E Brizuela
- Research, Development and Medical, Pfizer Upjohn, Manila, Philippines
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Santoso A, Maulana R, Alzahra F, Prameswari HS, Ambari AM, Hartopo AB, Arso IA, Radi B. The Effects of Aerobic Exercise on N-terminal Pro-B-type Natriuretic Peptide and Cardiopulmonary Function in Patients With Heart Failure: A Meta-Analysis of Randomised Clinical Trials. Heart Lung Circ 2020; 29:1790-1798. [PMID: 32665172 DOI: 10.1016/j.hlc.2020.05.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/24/2020] [Accepted: 05/11/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Aerobic exercise (AEx) improves outcomes in heart failure (HF). N-terminal pro B-type natriuretic peptide (NT-pro-BNP) is a prognosticator in HF. There are few data on the association of AEx, NT-pro-BNP, and cardiopulmonary function; hence, robust evidence is needed. The aim of this study was to measure the effects of AEx on NT-pro-BNP levels and cardiopulmonary function in HF. METHOD Databases (Pubmed, EMBASE, Medline, Cochrane Central Registry, and Scopus) were systematically searched for randomised controlled trials (RCTs) that assessed the association of AEx with NT-pro-BNP and cardiopulmonary function (VE/VCO2 slope, peak VO2, maximal workload, and left ventricular ejection fraction [LVEF]) in HF. RevMan 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, 2014) was used to produce forest plots, and the random-effect model was applied with the effects measure of weighted mean differences (WMD) and 95% confidence interval (CI). RESULTS Thirteen (13) RCTs recruited 1,503 patients and 1,494 controls. Aerobic exercise was significant in lowering NT-pro-BNP (pg/mL) compared with control group (WMD=-741.69, 95% CI -993.10 to -490.27 [p<0.00001; I2=63%]). VE/VCO2 slope was also significantly reduced (WMD=-3.57, 95% CI -6.48 to -0.67 [p=0.02; I2=97%]). Peak VO2 (mL/kg/min) significantly improved (WMD=3.68, 95% CI 2.39-4.96 [p<0.00001; I2=96%]). Maximal workload (watt) significantly increased following AEx (WMD=22.80, 95% CI 18.44-27.17 [p<0.00001; I2=78%]). Furthermore, there was a significant enhancement of LVEF (%) in the AEx group (WMD=2.42, 95% CI 0.64-4.19 [p=0.008; I2=71%]). CONCLUSIONS Aerobic exercise improves the NT-pro-BNP, ventilatory efficiency, aerobic capacity, maximal workload, and the left ventricular function in patients with HF.
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Affiliation(s)
- Anwar Santoso
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia.
| | - Rido Maulana
- Faculty of Medicine, University of Muhamadiyah, Jakarta, Indonesia
| | - Fatimah Alzahra
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
| | - Hawani Sasmaya Prameswari
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ade Meidian Ambari
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | - Anggoro Budi Hartopo
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, University of Gadjah Mada, Jogyakarta, Indonesia
| | - Irsad Andi Arso
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, University of Gadjah Mada, Jogyakarta, Indonesia
| | - Basuni Radi
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
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Santoso A, Raharjo SB. Combination of Oral Anticoagulants and Single Antiplatelets versus Triple Therapy in Nonvalvular Atrial Fibrillation and Acute Coronary Syndrome: Stroke Prevention among Asians. Int J Angiol 2020; 29:88-97. [PMID: 32499669 DOI: 10.1055/s-0040-1708477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation (AF), the most prevalent arrhythmic disease, tends to foster thrombus formation due to hemodynamic disturbances, leading to severe disabling and even fatal thromboembolic diseases. Meanwhile, patients with AF may also present with acute coronary syndrome (ACS) and coronary artery disease (CAD) requiring stenting, which creates a clinical dilemma considering that majority of such patients will likely receive oral anticoagulants (OACs) for stroke prevention and require additional double antiplatelet treatment (DAPT) to reduce recurrent cardiac events and in-stent thrombosis. In such cases, the gentle balance between bleeding risk and atherothromboembolic events needs to be carefully considered. Studies have shown that congestive heart failure, hypertension, age ≥ 75 years (doubled), diabetes mellitus, and previous stroke or transient ischemic attack (TIA; doubled)-vascular disease, age 65 to 74 years, sex category (female; CHA 2 DS 2 -VASc) scores outperform other scoring systems in Asian populations and that the hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, labile international normalized ratio (INR), elderly (>65 years), drugs/alcohol concomitantly (1 point each; HAS-BLED) score, a simple clinical score that predicts bleeding risk in patients with AF, particularly among Asians, performs better than other bleeding scores. A high HAS-BLED score should not be used to rule out OAC treatment but should instead prompt clinicians to address correctable risk factors. Therefore, the current review attempted to analyze available data from patients with nonvalvular AF who underwent stenting for ACS or CAD and elaborate on the direct-acting oral anticoagulant (DOAC) and antiplatelet management among such patients. For majority of the patients, "triple therapy" comprising OAC, aspirin, and clopidogrel should be considered for 1 to 6 months following ACS. However, the optimal duration for "triple therapy" would depend on the patient's ischemic and bleeding risks, with DOACs being obviously safer than vitamin-K antagonists.
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Affiliation(s)
- Anwar Santoso
- Department of Cardiology-Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | - Sunu B Raharjo
- Department of Cardiology-Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
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Ardiana M, Pikir BS, Santoso A, Hermawan HO, Al-Farabi MJ. Effect of Nigella sativa Supplementation on Oxidative Stress and Antioxidant Parameters: A Meta-Analysis of Randomized Controlled Trials. ScientificWorldJournal 2020; 2020:2390706. [PMID: 32454800 PMCID: PMC7225850 DOI: 10.1155/2020/2390706] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Nigella sativa is a commonly used traditional medicine which has been shown to have antioxidant properties. However, its supplementation in patients of clinical trials showed conflicting results. Materials and Method. Relevant articles were searched through PubMed/Medline, SCOPUS, and Google Scholar databases using "Nigella sativa" or "black seed" or "black caraway" or "thymoquinone" and "oxidative stress" or "antioxidant" and "clinical trial" keywords. Randomized, placebo-controlled human interventions using Nigella sativa were included in this study. The methodological quality of studies was assessed using Jadad's quality scales. RESULTS Five studies using 293 subjects met the inclusion criteria. The overall quality of all included trials was determined based on the low risk of bias and the high quality of reported information (Jadad score ≥ 3). Meta-analysis of 293 eligible subjects showed that treatment with Nigella sativa improved the superoxide dismutase (SOD) level (48.18; 95% CI 30.29 to 66.08; p < 0.01), but there was no significant effect on the malondialdehyde (MDA) level (-5.32; 95% CI -1.19 to 0.128; p=0.114) and total antioxidant capacity (TAC) level (0.219; 95% CI -0.136 to 0.573; p = 0.227). CONCLUSION This meta-analysis suggests that Nigella sativa supplementation in humans may benefit as an antioxidant by increasing SOD levels but has no significant effect on the MDA level and TAC level.
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Affiliation(s)
- M. Ardiana
- Medical Doctoral Program Student, Faculty of Medicine, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
| | - B. S. Pikir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
| | - A. Santoso
- Department of Cardiology, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | - H. O. Hermawan
- Postgraduate School of Biomedicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - M. J. Al-Farabi
- Medical Doctoral Program Student, Faculty of Medicine, Surabaya, Indonesia
- Postgraduate School of Management, University College London, Gower St, Bloomsbury, London WC1E 6BT, UK
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Pranata R, Vania R, Tondas AE, Setianto B, Santoso A. A time-to-event analysis on air pollutants with the risk of cardiovascular disease and mortality: A systematic review and meta-analysis of 84 cohort studies. J Evid Based Med 2020; 13:102-115. [PMID: 32167232 DOI: 10.1111/jebm.12380] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/15/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Air pollution is one of the most substantial problems globally. Aerodynamic toxic of particulate matter with <10 mm in diameter (PM10 ), or <2.5 mm (PM2.5 ), as well as nitric dioxide (NO2 ), have been linked with health issues. We aimed to perform a comprehensive analysis of the time-to-event for different types of air pollutants on cardiovascular disease (CVD) events based on cohort studies. METHODS A comprehensive search on topics that assesses air pollution and cardiovascular disease with keywords up until July 2019 was performed. RESULTS There were a total of 28 215 394 subjects from 84 cohorts. Increased PM2.5 was associated with composite CVD [HR 1.10 (1.02, 1.19)], acute coronary events [HR 1.15 (1.12, 1.17)], stroke [HR 1.13 (1.06, 1.19)], and hypertension [HR 1.07 (1.01, 1.14)], all-cause mortality [HR 1.07 (1.04, 1.09)], CVD mortality [HR 1.10 (1.07, 1.12)], and ischemic heart disease (IHD) mortality [HR 1.11 (1.07, 1.16)]. Association with AF became significant after removal of a study. Increased PM10 was associated with heart failure [HR 1.25 (1.04, 1.50)], all-cause mortality [HR 1.16 (1.06, 1.27)], CVD mortality [HR 1.17 (1.04, 1.30)], and IHD mortality [HR 1.03 (1.01, 1.05)]. Increased of NO2 was associated with increased composite CVD [HR 1.15 (1.02, 1.29)], atrial fibrillation [HR 1.01 (1.01, 1.02)], acute coronary events [HR 1.08 (1.02, 1.13)], all-cause mortality [HR 1.23 (1.14, 1.32)], CVD mortality [HR 1.17 (1.10, 1.25)], and IHD mortality [HR 1.05 (1.03, 1.08)]. CONCLUSION Air pollutants are associated with an increased incidence of cardiovascular diseases, all-cause mortality, and CVD mortality.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Alexander Edo Tondas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sriwijaya, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Soetisna TW, Sukmawan R, Setianto B, Mansyur M, Murni TW, Listiyaningsih E, Santoso A. Cover Image: Volume 35 Issue 4. J Card Surg 2020. [DOI: 10.1111/jocs.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tri Wisesa Soetisna
- Department of Cardiothoracic and Vascular SurgeryNational Cardiovascular Center Harapan KitaJakarta Indonesia
- Department of Surgery, Faculty of MedicineUniversitas IndonesiaJakarta Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular MedicineNational Cardiovascular Center Harapan KitaJakarta Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas IndonesiaJakarta Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular MedicineNational Cardiovascular Center Harapan KitaJakarta Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas IndonesiaJakarta Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of MedicineUniversitas IndonesiaJakarta Pusat Indonesia
| | - Tri Wahyu Murni
- Department of Cardiothoracic and Vascular Surgery, Hasan Sadikin HospitalUniversitas PadjadjaranBandung Indonesia
| | - Erlin Listiyaningsih
- Molecular Laboratory & Stem Cell FacilityNational Cardiovascular Center Harapan KitaJakarta Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular MedicineNational Cardiovascular Center Harapan KitaJakarta Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas IndonesiaJakarta Indonesia
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Santoso A, Yoon TR, Park KS, Anwar IB, Utomo P, Soetjahjo B, Sibarani T. The Results of Two-stage Revision for Methicillin-resistant Periprosthetic Joint Infection (PJI) of the Hip. Malays Orthop J 2020; 14:18-23. [PMID: 32296477 PMCID: PMC7156181 DOI: 10.5704/moj.2003.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Periprosthetic joint infection (PJI) of the hip due to methicillin-resistant bacteria is difficult to treat and remain a challenge for arthroplasty surgeon. Material and Methods: Retrospective review was done to the patients who received two-stage revisions with an antibiotic loaded cement-spacer for PJI of the hip between January 2010 to May 2015. We found 65 patients (65 hips) with positive culture findings. Eight patients were lost to follow-up and excluded from the study. Among the rest of the 57 patients, methicillin-resistant infection (MR Group) was found in 28 cases. We also evaluate the 29 other cases that caused by the other pathogen as control group. We compared all of the relevant medical records and the treatment outcomes between the two groups. Results: The mean of follow-up period was 33.7 months in the methicillin-resistant group and 28.4 months in the control group (p = 0.27). The causal pathogens in the methicillin-resistant group were: Methicillin-resistant Staphylococcus aureus (MRSA) in 10 cases, Methicillin-resistant Staphylococcus epidermidis (MRSE) in 16 cases and Methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in two cases. The reimplantation rate was 92.8% and 89.6% in the methicillin-resistant and control group, respectively (p= 0.66). The rates of recurrent infection after reimplantation were 23.1% (6/26) in the methicillin-resistant group and 7.6% (2/26) in the control group (p= 0.12). The overall infection control rate was 71.4% (20/28) and 89.6% (26/29) in the methicillin-resistant and control group, respectively (p = 0.08). Both groups showed comparable baseline data on mean age, BMI, gender distribution, preoperative ESR/CRP/WBC and comorbidities. Conclusions: Two-stage revision procedure resulted in low infection control rate and high infection recurrency rate for the treatment of methicillin-resistant periprosthetic joint infection (PJI) of the hip. Development of the treatment strategy is needed to improve the outcome of methicillin-resistant periprosthetic joint infection (PJI) of the hip.
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Affiliation(s)
- A Santoso
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Solo, Indonesia
| | - T R Yoon
- Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Jeonnam, Republic of Korea
| | - K S Park
- Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Jeonnam, Republic of Korea
| | - I B Anwar
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Solo, Indonesia
| | - P Utomo
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Solo, Indonesia
| | - B Soetjahjo
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Solo, Indonesia
| | - T Sibarani
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Solo, Indonesia
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Soetisna TW, Sukmawan R, Setianto B, Mansyur M, Murni TW, Listiyaningsih E, Santoso A. Combined transepicardial and transseptal implantation of autologous CD 133+ bone marrow cells during bypass grafting improves cardiac function in patients with low ejection fraction. J Card Surg 2020; 35:740-746. [PMID: 32048356 PMCID: PMC7187333 DOI: 10.1111/jocs.14454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Autologous CD133+ bone marrow stem cells may improve cardiac function. This randomized, single-blind clinical trial inquired whether a combined transepicardial and transseptal implantation of CD133+ stem cells during coronary artery bypass grafting (CABG) improve cardiac function with ejection fraction (EF) changes as a primary endpoint in patients with low EF. METHODS Thirty patients with coronary heart disease and EF <35% were randomized to undergo CABG alone or CABG with transseptal and transepicardial implantation of CD133+. Cardiac function was evaluated using cardiac magnetic resonance imaging (MRI) before and 6 months after CABG. RESULTS Preoperative EF was lower in the intervention group (25.88% ± 5.66%) than in the control group (30.18% ± 3.85%; P = .04). The adverse event incidence was similar between both groups. At 6 months, EF changes were significantly higher (8.69% ± 9.49; P = .04) in the CD133+ group than in the CABG-only group. Compared to the control group, significant improvements were seen in the wall motion score index (P = .003) and scar size proportion (P = .047) in the CD133+ group. The quality of life (QOL), assessed by a 6-minute walking test, showed considerable improvement in the CD133+ group compared to that in the control group (P = .03). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale did not show improvement in the intervention group (P = .09, vs control). CONCLUSION Combined transepicardial and transseptal autologous CD133+ BMC implantation during bypass grafting improved cardiac function in low EF coronary artery disease patients.
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Affiliation(s)
- Tri Wisesa Soetisna
- Department of Cardiothoracic and Vascular Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Indonesia
| | - Tri Wahyu Murni
- Department of Cardiothoracic and Vascular Surgery, Hasan Sadikin Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Erlin Listiyaningsih
- Molecular Laboratory & Stem Cell Facility, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Santoso A, Heriansyah T, Rohman MS. Phospholipase A2 is an Inflammatory Predictor in Cardiovascular Diseases: Is there any Spacious Room to Prove the Causation? Curr Cardiol Rev 2020; 16:3-10. [PMID: 31146670 PMCID: PMC7393598 DOI: 10.2174/1573403x15666190531111932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/01/2019] [Accepted: 05/05/2019] [Indexed: 12/17/2022] Open
Abstract
Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme family of phospholipase A2 produced by the inflammatory cell in atherosclerotic plaque. It is transported in the circulation, attached mainly to low-density lipoprotein-cholesterol (LDL-C). It hydrolyzes glycerophospholipids particularly fatty acids at the sn-2 position and produces numerous bioactive lipids; and leads to endothelial dysfunction, atherosclerotic plaque inflammation, and development of the necrotic core in plaques. There are two kinds of phospholipase A2, namely: secretory phospholipase A2 (sPLA2) and Lp- PLA2. They are deemed as evolving predictors of cardiovascular disease (CVD) risk in hospitaland population-based studies, including healthy subjects, acute coronary syndromes (ACS) and patients with CVD. Unfortunately, Lp-PLA2 inhibitor (darapladib) and s-PLA2 inhibitor (varespladib methyl) failed to prove to lower the risk of composite CVD mortality, myocardial infarction and stroke in those with stable CVD and ACS. Herein, we describe the explanation based on the existing data why there is still a discrepancy among them. So, it highlights the opinion that phospholipase A2 is merely the inflammatory biomarkers of CVD and playing an important role in atherosclerosis. Further, there is more spacious room to prove the causation.
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Affiliation(s)
- Anwar Santoso
- Address correspondence to this author at the Department of Cardiology and Vascular Medicine, National Cardiovascular Centre, Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia; Tel: +62 21 5684093;
E-mail:
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Santoso A. Phospholipase A2 is an Inflammatory Predictor in Cardiovascular Diseases: Is there any Spacious Room to Prove the Causation? Curr Cardiol Rev 2020. [DOI: 10.2174/18756557otg2podeztcvy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Santoso A, Nofanda Putra A, Arifa Yuzar DAFSAH. P24 Association between plasma PCSK9 and major cardio-cerebrovascular events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Some STEMI patients still suffers adverse outcomes though they undergo optimal management, including primary PCI. Plasma PCSK9 is deemed to have a role in that residual risk. Our knowledge on the association between plasma PCSK9 level and MACCE in STEMI is still limited.
Purpose
The aim of this study is to evaluate the association between plasma PCSK9 level during admission with MACCE in STEMI who undergo primary PCI.
Methods
This was a prospective observational study, recruited 239 patients with STEMI who were treated with primary PCI and assayed for PCSK9 level using ELISA technique. MACCE and other supportive data were taken from the medical records and telephone follow-up.
Results
There were 28 study participants who experienced MACCE in 30 days. However, survival analysis did not show a significant association between plasma PCSK9 level and MACCE in 30 days. The hazard ratio for MACCE between the third tertile and the second tertile of plasma PCSK9 level was 1.466 (95%CI 0.579-3.714) and between the first tertile and the second tertile was 1.257 (95%CI 0.496-3.185).
Conclusion
Plasma PCSK9 levels was not associated with MACCE in STEMI patients treated with primary PCI.
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Affiliation(s)
- A Santoso
- National Cardiovascular Center Harapan Kita, Cardiology - Vascular Medicine; Faculty of Medicine - University of Indonesia, Jakarta, Indonesia
| | - A Nofanda Putra
- National Cardiovascular Center Harapan Kita, Cardiology - Vascular Medicine; Faculty of Medicine - University of Indonesia, Jakarta, Indonesia
| | - D A F S A H Arifa Yuzar
- National Cardiovascular Center Harapan Kita, Cardiology - Vascular Medicine; Faculty of Medicine - University of Indonesia, Jakarta, Indonesia
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Dharma S, Sari NY, Santoso A, Sukmawan R, Rao SV. Association of plasma pentraxin 3 concentration with angiographic and clinical outcomes in patients with acute ST‐segment elevation myocardial infarction treated by primary angioplasty. Catheter Cardiovasc Interv 2019; 96:1233-1239. [DOI: 10.1002/ccd.28626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/26/2019] [Accepted: 11/17/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Novi Y. Sari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Sunil V. Rao
- The Duke Clinical Research Institute Durham North Carolina
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Dharma S, Sari NY, Parlautan A, Sukmawan R, Wijaya S, Ekawati E, Santoso A. The 3q25 rs2305619 Polymorphism Is Associated With Coronary Microvascular Obstruction Following Primary Angioplasty for Acute ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2019; 12:e008228. [PMID: 31766867 DOI: 10.1161/circinterventions.119.008228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia (S.D.)
| | - Novi Yanti Sari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia (N.Y.S, A.P, R.S, A.S)
| | - Andrew Parlautan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia (N.Y.S, A.P, R.S, A.S)
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia (N.Y.S, A.P, R.S, A.S)
| | - Shoma Wijaya
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia (S.W, E.E)
| | - Elok Ekawati
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia (S.W, E.E)
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia (N.Y.S, A.P, R.S, A.S)
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Ambari AM, Setianto B, Santoso A, Dwiputra B, Radi B, Alkatiri AA, Adji AB, Susilowati E, Tulrahmi F, Cramer MJM, Doevendans PA. Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country. Neth Heart J 2019; 27:559-564. [PMID: 31359321 PMCID: PMC6823404 DOI: 10.1007/s12471-019-01315-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Rheumatic mitral stenosis continues to be prevalent in developing countries, notably in endemic areas. Over the last few decades, percutaneous balloon mitral valvuloplasty (PBMV) has been established as a lower-cost alternative treatment for mitral stenosis (MS) in low-to-middle-income countries. PBMV has also been suggested to be an effective and safe alternative treatment modality. This study aims to analyse the survival of rheumatic MS patients treated with PBMV compared with those treated with mitral valve surgery (MVS). Methods This study was a national, single-centre, longitudinal study using a survival analysis method in 329 consecutive patients suffering from rheumatic heart disease with severe MS who underwent PBMV compared with 142 consecutive patients with similar characteristics who underwent MVS between January 2011 and December 2016. Survival analysis and event-free duration were determined over a median follow-up of 24 months in the PBMV group and 27 months in the MVS group. Results The results showed that of the 329 consecutive patients in the PBMV group, 61 patients (18.5) had an event (6 patients died and 55 patients were hospitalised), and of the 142 consecutive patients in the MVS group, 19 patients (13.4%) had an event (5 patients died, and 14 patients were hospitalised). The hazard ratio was 0.631 (95% confidence interval, 0.376–1.058; P = 0.081). Longer short-term survival was found in the MVS group but was not statistically significant. Event-free survival was significantly longer in the MVS group (P = 0.002), by 5 months. Conclusions In this study, the efficacy and safety of PBMV was reconfirmed, as PBMV proved to be non-inferior to MVS in survival prognosis, but sustained event-free duration was significantly better in the MVS group than in the PBMV group.
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Affiliation(s)
- A M Ambari
- Department of Cardiology Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia.
| | - B Setianto
- Department of Cardiology Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - A Santoso
- Department of Cardiology Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - B Dwiputra
- Department of Cardiology Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - B Radi
- Department of Cardiology Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - A A Alkatiri
- Department of Cardiology Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - A B Adji
- Department of Thorax Cardio Vascular Surgery, Faculty of Medicine, National Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta, Indonesia
| | - E Susilowati
- Division of Preventive and Rehabilitative, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - F Tulrahmi
- Division of Preventive and Rehabilitative, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - M J M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Widyantoro B, Situmorang TD, Turana Y, Barack R, Delliana J, Roesli RMA, Erwinanto E, Hermiawaty E, Kuncoro AS, Sofiatin Y, Beaney T, Xia X, Poulter NR, Schlaich MP, Santoso A. May Measurement Month 2017: an analysis of the blood pressure screening campaign results in Indonesia-South-East Asia and Australasia. Eur Heart J Suppl 2019; 21:D63-D65. [PMID: 31043881 PMCID: PMC6479504 DOI: 10.1093/eurheartj/suz057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 11/17/2022]
Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Our previous primary health surveys in 2013 and 2018 show that 25.8% to 34.1% of adults have raised BP, which is associated with cardiovascular, cerebrovascular, and renovascular morbidity and mortality. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. We recruited 292 sites in all 34 provinces in Indonesia, and screened in public areas and offices as well as health centres. A total of 69 307 individuals were screened. After multiple imputation, 23 892 (34.5%) had hypertension. Of individuals not receiving antihypertensive medication, 20.0% were hypertensive. Among individuals receiving antihypertensive medication, 7885 (62.8%) had uncontrolled BP. MMM17 was the largest standardized screening campaign for BP measurement in our country. The proportion of individuals identified with hypertension and the percentage of those with uncontrolled BP on medication provide evidence of the substantial challenges in managing hypertension in the community. These results suggest that opportunistic screening can identify significant numbers of individuals with raised BP.
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Affiliation(s)
- Bambang Widyantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Tunggul D Situmorang
- Division of Nephrology, Department of Internal Medicine, PGI Cikini Hospital, Jakarta, Indonesia
| | - Yuda Turana
- Department of Neurology, Faculty of Medicine, Atmajaya Catholic University, Jakarta, Indonesia
| | - Rossana Barack
- Department of Cardiology, MMC Hospital, Jakarta, Indonesia
| | - Juzi Delliana
- Department of Cardiology, Directorate of Non-Communicable Disease, Ministry of Health - Republic of Indonesia, Jakarta, Indonesia
| | - Rully M A Roesli
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Erwinanto Erwinanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Eka Hermiawaty
- Department of Neurology, National Cardiovascular Centre, Harapan Kita, Jakarta, Indonesia
| | - Ario S Kuncoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Yulia Sofiatin
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK; and
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK; and
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK; and
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
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Santoso A, Purwowiyoto SL, Purwowiyoto BS, Soesanto AM. Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction. Int J Angiol 2019; 28:44-49. [PMID: 30880893 DOI: 10.1055/s-0038-1676836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF). The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients. This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well. Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise ( p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly ( p = 0.001). Quality of life improved significantly during exercise ( p < 0.001). Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.
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Affiliation(s)
- Anwar Santoso
- Department of Cardiology - Vascular Medicine, Faculty of Medicine - Universitas Indonesia, National Cardiovascular Centre - Harapan Kita Hospital, Jakarta, Indonesia
| | | | - Budhi Setianto Purwowiyoto
- Department of Cardiology - Vascular Medicine, Faculty of Medicine - Universitas Indonesia, National Cardiovascular Centre - Harapan Kita Hospital, Jakarta, Indonesia
| | - Amiliana Mardiana Soesanto
- Department of Cardiology - Vascular Medicine, Faculty of Medicine - Universitas Indonesia, National Cardiovascular Centre - Harapan Kita Hospital, Jakarta, Indonesia
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Joseph P, Pais P, Dans AL, Bosch J, Xavier D, Lopez-Jaramillo P, Yusoff K, Santoso A, Talukder S, Gamra H, Yeates K, Lopez PC, Tyrwhitt J, Gao P, Teo K, Yusuf S. The International Polycap Study-3 (TIPS-3): Design, baseline characteristics and challenges in conduct. Am Heart J 2018; 206:72-79. [PMID: 30342297 PMCID: PMC6299262 DOI: 10.1016/j.ahj.2018.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is hypothesized that in individuals without clinical cardiovascular disease (CVD), but at increased CVD risk, a 50% to 60% reduction in CVD risk could be achieved using fixed dose combination (FDC) therapy (usually comprised of multiple blood-pressure agents and a statin [with or without aspirin]) in a single "polypill". However, the impact of a polypill in preventing clinical CV events has not been evaluated in a large randomized controlled trial. METHODS TIPS-3 is a 2x2x2 factorial randomized controlled trial that will examine the effect of a FDC polypill on major CV outcomes in a primary prevention population. This study aims to determine whether the Polycap (comprised of atenolol, ramipril, hydrochlorothiazide, and a statin) reduces CV events in persons without a history of CVD, but who are at least at intermediate CVD risk. Additional interventions in the factorial design of the study will compare the effect of (1) aspirin versus placebo on CV events (and cancer), (2) vitamin D versus placebo on the risk of fractures, and (3) the combined effect of aspirin and the Polycap on CV events. RESULTS The study has randomized 5713 participants across 9 countries. Mean age of the study population is 63.9 years, and 53% are female. Mean INTERHEART risk score is 16.8, which is consistent with a study population at intermediate CVD risk. CONCLUSION Results of the TIP-3 study will be key to determining the appropriateness of FDC therapy as a strategy in the global prevention of CVD.
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Affiliation(s)
- Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Prem Pais
- St. John's Medical College, Bangalore, India
| | - Antonio L Dans
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Patricio Lopez-Jaramillo
- Research Institute and Clinic of Metabolic Syndrome and Diabetes, Fundacion Oftalmologica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colombia
| | - Khalid Yusoff
- UiTM Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Anwar Santoso
- Universitas Indonesia and Department of Cardiology - Vascular Medicine, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | | | - Habib Gamra
- Fattouma Bourguiba University Hospital and University of Monastir, Tunisia
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paul Camacho Lopez
- Research Institute and Clinic of Metabolic Syndrome and Diabetes, Fundacion Oftalmologica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colombia
| | - Jessica Tyrwhitt
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Peggy Gao
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
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Santoso A, Utomo P, Im CJ, Park KS, Yoon TR. Minimally Invasive Total Hip Arthroplasty in a Patient with Hereditary Multiple Exostoses: A Case Report. Malays Orthop J 2018; 12:53-56. [PMID: 30555649 PMCID: PMC6287126 DOI: 10.5704/moj.1811.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hip geometry abnormalities found in patients with hereditary multiple exostoses (HME) could promote premature hip joint degeneration which needs treatment. We report the case of a 45-year old male with right hip arthrosis who underwent two-incision minimally invasive (MIS-2) total hip arthroplasty (THA), with satisfactory outcome. This technique could be an alternative approach for performing THA in patients with hereditary multiple exostoses.
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Affiliation(s)
- A Santoso
- Department of Orthopaedic and Traumatology, Sebelas Maret University, Solo, Indonesia
| | - P Utomo
- Department of Orthopaedic and Traumatology, Sebelas Maret University, Solo, Indonesia
| | - C J Im
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - K S Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - T R Yoon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
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Santoso A, Maulana R, Alzahra F, Fadjri Adda'i M, B Kusmanto V. P2788The effect of aerobic exercise on n-terminal pro-b-type natriuretic peptide expression and cardiopulmonary function in patients with chronic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Santoso
- National Cardiovascular Center Harapan Kita, Cardiology - Vascular Medicine; Faculty of Medicine - University of Indonesia, Jakarta, Indonesia
| | - R Maulana
- University of Muhamadiyah, Faculty of Medicine, Jakarta, Indonesia
| | - F Alzahra
- University of Gadjah Mada, Cardology - Vascular Medicine, Jogyakarta, Indonesia
| | - M Fadjri Adda'i
- University of Gadjah Mada, Cardology - Vascular Medicine, Jogyakarta, Indonesia
| | - V B Kusmanto
- University of Gadjah Mada, Cardology - Vascular Medicine, Jogyakarta, Indonesia
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