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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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Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder R, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macias JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. METHODS For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. FINDINGS Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. INTERPRETATION Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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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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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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Lampus N, Ransun T, Ambari AM, Dwiputra B, Radi B. Cardiac rehabilitation results among patients who have undergone cardiac surgery after covid-19 infection. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.108] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Coronavirus disease 2019 (Covid-19) has become a global pandemic. Covid-19 increases morbidity in patients with underlying cardiovascular disease. The six-minute walk test (6MWT) is a simple test for assessing cardiopulmonary fitness and has been applied to assess post-surgical recovery in cardiac populations. Decreased heart rate recovery (HRR) over 1 or 2 minutes after exercise shows autonomic dysfunction and is associated with an increased risk of mortality. We conducted a cross sectional study to determine if Covid-19 affects cardiac rehabilitation parameters, such as 6MWT distance, HRR-1, and HRR-2 among patients who have undergone cardiac surgery.
Methods
This analysis included 155 adults who had elective cardiac surgery at the National Heart Center Harapan Kita (NHCHK) from January to June 2022. Each participant performed a 6MWT and treadmill evaluation in phase II cardiac rehabilitation (CR) program. To analyze the association of 6mwt distances and heart rate recovery among patients with covid-19 and without covid-19 who had undergone elective cardiac surgery using Mann Whitney and Chi-Square tests.
Results
Forty-Seven (30.3%) patients had a history of Covid-19. The mean 6MWT was 339.53 ± 59.90 m in the pre-CR program, increased to 415.37 ± 46.46 m in the post-CR program. The mean HRR1 was 15.16 ± 9.44, and HRR2 was 56.59± 35.47. There were no differences in 6MWT distance, HRR1, and HRR2 among patients with a history of Covid-19 and without a history of Covid-19 (P= 0.48, p=0.56, p=0.12).
Conclusion
The cardiac rehabilitation (CR) program improves the 6MWT distance. Covid-19 does not affect the ability of patients to do six-minute walk tests; neither HRR-1 nor HRR-2 among patients who have undergone cardiac surgery.
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Affiliation(s)
- N Lampus
- Prof. Dr. R. D. Kandou, Hospital, Manado, Indonesia, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sam Ratulangi , manado , Indonesia
| | - T Ransun
- Dr. H. Abdoel Moeloek Hospital, Department of Cardiology and Vascular Medicine , Lampung , Indonesia
| | - A M Ambari
- Harapan Kita Hospital, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia
| | - B Dwiputra
- Harapan Kita Hospital, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia
| | - B Radi
- Harapan Kita Hospital, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia
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Yasmin A, Radi B, Ambari AM, Dwiputra B. The impact of diabetes mellitus on improvement of resting rate pressure product in patients with refractory angina undergone external counter pulsation. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.053] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The management of coronary artery disease (CAD) has developed significantly in the last few decades. One of the therapeutic modalities that could be considered to patients with refractory angina caused by CAD is external counter pulsation (ECP). Rate pressure product (RPP) is a determinant of cardiac oxygen consumption and heart workload. It is a simple parameter that could be calculated easily by multiplying systolic blood pressure and heart rate. Increased resting RPP is associated with higher myocardial oxygen consumption and decreased cardiac efficiency. Studies that discuss factors that influence the decrease of resting RPP due to ECP procedure as a possible mechanism underlying the improvement of clinical symptoms in patients with refractory angina are still very limited.
Purpose
This study aimed to determine the impact of diabetes mellitus (DM) as one of most common risk factors for complex CAD and refractory angina on the decremental of resting RPP in refractory angina patients who have undergone standard 35 sessions of ECP.
Methods
This is a cohort retrospective study that collected data from registry of all patients who have completed 35 sessions of ECP procedures from 2018 until 2021. We compared the improvement of resting RPP after program completion and evaluated the effect of DM and blood glucose levels on the difference in resting RPP. Statistical test was performed by SPSS software for windows.
Results
A total of 16 patients were enrolled in this study with mean age of 65.4 years old. Subjects in this study were predominantly male (87.5%) and most of the subjects (68.8%) were diagnosed with CAD/3-vessels disease (3VD). The main risk factors found in the subjects were hypertension (75%) and DM (62.5%). All subjects underwent random blood sugar examination before starting ECP procedure with mean 122.7 mg/dL. Paired samples T-test analysis found that there was a decrease in resting RPP in subjects after undergoing ECP compared to before the procedure (7046.1 ± 1515.3 vs 8572.5 ± 1915.7; p-value <0.001). Independent samples T-test showed that the presence of DM reduced the mean decrease of resting RPP in study subjects (1034.8 ± 1122.2 vs 2345.7 ± 1167.5; p-value 0.043). Pearson correlation analysis showed that there was no significant correlation between blood sugar levels and decrease in resting RPP after ECP completion in study subjects (correlation coefficient -0.049; p-value: 0.869).
Conclusion
Standard 35 ECP sessions could decrease resting RPP in refractory angina patients. The improvements may contribute to the clinical benefit of ECP. However, the presence of DM can reduce the effectiveness of ECP in improving resting RPP, regardless of the blood sugar levels. These findings were probably related to cardiovascular autonomic neuropathy that were commonly found among diabetics. Further research is needed to elucidate the exact underlying mechanisms of these outcomes.
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Affiliation(s)
- A Yasmin
- Prof. Dr. IGNG Ngoerah General Hospital, Udayana University, Department of Cardiology and Vascular Medicine , Denpasar , Indonesia
| | - B Radi
- National Cardiovascular Center Harapan Kita, University of Indonesia, Department of Cardiology and Vascular Medicine , Jakarta , Indonesia
| | - A M Ambari
- National Cardiovascular Center Harapan Kita, University of Indonesia, Department of Cardiology and Vascular Medicine , Jakarta , Indonesia
| | - B Dwiputra
- National Cardiovascular Center Harapan Kita, University of Indonesia, Department of Cardiology and Vascular Medicine , Jakarta , Indonesia
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8
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Anggraeni VY, Ambari AM, Dwiputra B, Radi B, Hutajulu SH, Hardianti MS, Mumpuni H, Kusumastuti DA, Hartopo AB. Endothelin-1 negatively correlates with functional capacity in patients with breast cancer receiving first line anthracycline-based chemotherapy. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.293] [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: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Endothelial dysfunction caused by anthracycline is one of the key mechanism of chemotherapy induced cardiomyopathy that ultimately resulted in heart remodeling and exercise limitations. An endothelial molecular factor Endothelin-1 (ET-1) is known to be extremely important in vasoconstriction and angiogenesis. Interestingly, ET-1 concentration is also altered in vascular injury following anthracycline administration suggesting a distinct association. Nonetheless, the correlation between ET-1 and functional capacity in chemotherapy induced cardiomyopathy remained largely unknown.
Purpose
To elucidate correlation between ET-1 serum concentration with left ventricular (LV) function and functional capacity using echocardiography and 6 minute walk test (6MWT) following anthracycline-based chemotherapy in patient with breast cancer.
Methods
This is a prospective study that involves 19 female participants diagnosed with breast cancer (stage IIA-IV) receiving first line chemotherapy with 4-8 cycles of anthracycline-based regiments. Baseline pre-chemotherapy characteristics, ET-1 serum concentration, echocardiography and 6MWT, followed by post-chemotherapy evaluation were measured. Additionally, 6MWT were also performed at 6 months and 12 months after completion of chemotherapy.
Results
ET-1 serum significantly increased post-chemotherapy (1.521±0.57 vs 1.817±0.52 pg/mL, p=0.0169) in comparison with baseline. 6MWT distance was decreased after initial pre-chemotherapy measurement (372.5±84.23), 366.8±51.96 and 358.5±51.97 post-chemotherapy and 6 months after chemotherapy completion respectively. Moreover, post-chemotherapy LV ejection fraction (LVEF) was significantly lower in high ET-1 group (≥ 1.817 pg/mL) as compared to patients with low ET-1 (70.39±3.75 vs 65.80±2.49, p=0.0465) regardless comparable baseline LVEF. In addition, Pearson’s correlation test displayed a tendency of negative correlation between post chemotherapy ET-1 with 6MWT distance post-chemotherapy and 6 months after chemotherapy completion (r = -0.264, p=0.2745, 95% CI = -0.64-0.22 and r = -0.172, p=0.4803, 95% CI = -0.58-0.3).
Conclusion
Collectively, these findings strongly suggest that ET-1 may serve as a novel biomarker to predict compromised functional capacity in cancer patients underwent chemotherapy, arguably requires further investigations.
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Affiliation(s)
- VY Anggraeni
- Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Division of Cardiology, Department of Internal Medicine, Yogyakarta, Indonesia
| | - AM Ambari
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - B Dwiputra
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - B Radi
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - SH Hutajulu
- Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Division of Hematology and Medical Oncology, Department of Internal Medicine, Yogyakarta, Indonesia
| | - MS Hardianti
- Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Division of Hematology and Medical Oncology, Department of Internal Medicine, Yogyakarta, Indonesia
| | - H Mumpuni
- Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Department of Cardiology and Vascular Medicine, Yogyakarta, Indonesia
| | - DA Kusumastuti
- Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Department of Cardiology and Vascular Medicine, Yogyakarta, Indonesia
| | - AB Hartopo
- Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Department of Cardiology and Vascular Medicine, Yogyakarta, Indonesia
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Asmuni M, Soesanto AM, Kurniawati Y, Zahara R, Dwiputra B, Rossimarina V. OR79. Validation of EuroSCORE II, Ambler score and Harapan Kita Score as Predictor of In Hospital Mortality in Patients Underwent Heart Valve Surgery. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab122.078] [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
Aims
Preoperative risk prediction models have important role in heart valve surgery management. Changing in patient characteristics and surgical facilities over time, might affect the predicting value of those scoring system. This study aimed to compare the validation of EuroSCORE II, Ambler score and Harapan Kita score in predicting in hospital mortality at patients underwent heart valve surgery
Methods
Cohort restrospective study was performed at 416 patients who underwent heart valve surgery from November 2018 to December 2019. Data was taken from the medical records by consecutive sampling method. The calibration and discrimination value of EuroSCORE II, Ambler score and Harapan Kita score were obtained.
Results
Observed in hospital mortality was 6.7%. EuroSCORE II, Ambler score and Harapan Kita score have good calibration (Hosmer-Lemeshow test p = 0.065, p = 0.233 and p = 0.314). The discriminative value of these three scores predicting in hospital mortality for EuroScore II AUC 0.763 (95% CI; 0.660-0.867), Ambler score AUC 0.748 (95% CI; 0.655-0.841) and Harapan Kita score AUC 0.694 (95% CI; 0.584-0.804)
Conclusion
EuroSCORE II, Ambler score and Harapan Kita score have fairly good validation. Those scoring system have good calibration with Harapan Kita score calibration relatively better than EuroSCORE and Ambler score, meanwhile Harapan Kita score has less discrimination value than EuroScore II and Ambler score.
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Affiliation(s)
- M Asmuni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - A M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - Y Kurniawati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - R Zahara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - B Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - V Rossimarina
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
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10
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Nugroho BH, Raharjo SB, Andriantoro H, Lelya O, Dwiputra B, Sukmawan R. OR19. Correlation between Circadian Variation of Idiopathic Ventricular Arrhytmia and Left Ventricular Intrinsic Systolic Function assessed by Speckle Tracking Echocardiography. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab122.018] [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: 11/13/2022]
Abstract
Abstract
Aims
To investigate the correlation between circadian variation of idiopathic ventricular arrhytmia (IVA) and left ventricular (LV) intrinsic systolic function.
Methods
This cross sectional study included 67 patients with IVA originated from ventricular outflow tract. All patients underwent 24-hour Holter monitoring and speckle tracking echocardiography examinations. The circadian variation of IVA burden and global longitudinal strain (GLS) were determined and statistical analysis was conducted to evaluate their correlation.
Results
A total 31 patients (46.3%) had impaired LV systolic function by GLS (-15.1% + 1.8% vs -21.3% + 2.0%; p = <0.001) with less variation in circadian PVC distribution (coefficient of variation 6 hourly 26.8% + 15.6 vs 52.0 % + 28.2%; p = <0.00). Impaired LV systolic function was found in 31 patients (46.3%) with less variation in circadian IVA distribution (coefficient of variation/CoV 6 hourly 26.8%+15.6) compared to patients with normal LV systolic function (CoV: 52.0%+28.2%; p = <0.001). Multivariate analysis showed that less variation in circadian PVC distribution [CoV<35%) is correlated with LV dysfunction (OR = 3.89, 95%CI 1.09-13.80, p = 0.036). Other independent factors were episode of non-sustained VT (OR = 14.4, 95%CI=2.36-88.55, p = 0.008), IVA burden >9% (OR = 6.81, 95%CI 1.35-34.41, p = 0.020), and male gender (OR = 14.4, CI 95%=2.02-101.1, p = 0.004).
Conclusion
This study is the first to show that lack of circadian variation of IVA is associated with impaired LV systolic function by GLS. The finding of this study suggested that chronotherapy of antiarrhytmia medication may prevent the development of LV dysfunction.
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Affiliation(s)
- Bhayu Hanggadhi Nugroho
- Department of Cardiology and Vascular Medicne, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia / National Cardiovascular Heart Centre Harapan Kita , Jakarta, Indonesia
| | - Sunu Budhi Raharjo
- Department of Cardiology and Vascular Medicne, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia / National Cardiovascular Heart Centre Harapan Kita , Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicne, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia / National Cardiovascular Heart Centre Harapan Kita , Jakarta, Indonesia
| | - Olfi Lelya
- Department of Cardiology and Vascular Medicne, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia / National Cardiovascular Heart Centre Harapan Kita , Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiology and Vascular Medicne, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia / National Cardiovascular Heart Centre Harapan Kita , Jakarta, Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicne, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia / National Cardiovascular Heart Centre Harapan Kita , Jakarta, Indonesia
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11
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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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12
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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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13
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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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14
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Basuki N, El-Ansary D, Höfer S, Dwiputra B, Nualnim N. The Validity and Reliability of the MacNew Heart Disease Health Related Quality of Life Questionnaire: The Indonesian Version. Acta Med Indones 2021; 53:276-281. [PMID: 34611066] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The MacNew heart disease health related quality of life tool is used widely in the cardiac populations to evaluate the impact of disease and intervention including rehabilitation. In addition to the English version, it is also available for several other languages except the Indonesian language. Therefore, the purpose of this study were 1) to translate the MacNew questionnaire from the English version to the Indonesian language and 2) to estimate the preliminary validity and reliability of the Indonesian MacNew for patients with coronary artery disease. METHODS Forward and backward translation procedure was used to develop the Indonesian MacNew. The Indonesian MacNew was administered to 24 patients after one week of revascularization surgery. Reliability was assessed by internal consistency and test-retest reliability. To evaluate concurrent validity, the correlation of the compatible domain of the Indonesian MacNew and SF-36 was assessed. RESULTS Internal consistency reliability of the Indonesian MacNew was confirmed with Cronbach's α of the global scale and all three subscales exceeding 0.95. Test- retest reliability was acceptable with intraclass correlation coefficient of 0.66 for the global score. Furthermore, an acceptable concurrent validity was established with statistically significant correlation between Indonesian MacNew and SF-36 (pearson correlation ranging from 0.47 to 0.71). CONCLUSION The first results of the Indonesian MacNew indicate acceptable validity and reliability as a measurement tool to assess health related quality of life of Indonesian patients with coronary artery disease.
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Affiliation(s)
- Nur Basuki
- Faculty of Physical Therapy, Mahidol University, Thailand.
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Pravian D, Soesanto AM, Ambari AM, Kuncoro BRMAS, Dwiputra B, Muliawan HS, Sukmawan R. The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial. Int J Cardiovasc Imaging 2021; 37:2483-2490. [PMID: 34037889 DOI: 10.1007/s10554-021-02289-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/15/2021] [Indexed: 01/12/2023]
Abstract
External Counterpulsation (ECP) is one of the therapeutic options in patients with refractory angina inadequately controlled by medical, interventional, or surgical therapy. The 2D Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement. We would like to evaluate any improvement of myocardial intrinsic function using 2D-STE in patients underwent standard ECP protocol (35 sessions). We conducted a double-blind randomized controlled trial. Patients with refractory angina who could not be revascularized conventionally were randomized into two groups: (1) the ECP group (300 mmHg) and (2) the Sham/control group (75 mmHg). ECP standard therapy was given for 35 sessions (1 h/day/session). The 2D-STE data, including longitudinal strain and post systolic index (PSI) were obtained before and after therapy. 43 subjects were analyzed, with 22 subjects in ECP group and 21 control subjects (Sham group). A homogenous baseline strain was found either globally (12.42 ± 4.55 vs 12.00 ± 4.92 [- %]; P = 0.774) or segmentally/regionally (12.63 (0.01-25.16) vs 12.43 (0.01-27.20) [- %]; P = 0.570). There was no statistically significant improvement between groups in the left ventricle longitudinal strain globally (P = 0.535) and segmentally/regionally (P = 0.434). PSI parameters showed improvement in the ECP group (P = 0.049), and segments with PSI ≥ 20% seemed to improve longitudinal strains in the ECP group after therapy (P = 0.042). In conclusion, 35 ECP therapy sessions did not improve either global or segmental/regional left ventricular mechanical function in patients with refractory angina. However, the mechanical function of myocardial segments with PSS tends to improve after ECP therapy.
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Affiliation(s)
- Dexanda Pravian
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
| | - Ade M Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - B R M Ario S Kuncoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/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
| | - Hary S Muliawan
- 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
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Hartopo AB, Islami ZH, Arso IA, Ambari AM, Dwiputra B, Radi B. Exercise-based cardiac rehabilitation adaptation protocol during COVID-19 pandemic achieved similar results as compared to non-pandemic usual practice: a single-center retrospective study. Eur J Prev Cardiol 2021. [PMCID: PMC8136035 DOI: 10.1093/eurjpc/zwab061.339] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Dr. Sardjito Hospital Funding
Background
During the COVID-19 pandemic, exercise-based cardiac rehabilitation (EBCR) faced challenges. Patients could not freely attend EBCR in hospital. In our hospital, cardiac rehabilitation (CR) service adapted to the pandemic condition by reducing to sessions per week.
Purpose
This study aimed to investigate whether the adaptation protocol of EBCR during COVID-19 period influenced the CR result.
Methods
This was a retrospective cohort study. The subjects were patients underwent EBCR program in CR Service of our hospital. We retrieved the CR program registry and divided it into two periods, namely the non-pandemic period (January 2019 – February 2020) and the COVID-19 period (March 2020 – December 2020). During the non-pandemic period, subjects performed EBCR 3 times (@45 min) per week for 10-12 total sessions. During the COVID-19 period, the EBCR session was reduced 2 times (@45 min) per week for 10-12 total sessions. However, patients might modify the sessions provided space availability and acceptable reason. After total sessions were completed, the treadmill test evaluation was performed. We compared the duration and metabolic equivalent (METs) achieved in the treadmill test evaluation.
Results
There was nearly 50% reduction in patients who underwent EBCR during the COVID-19 pandemic (n = 48), compared to during the non-pandemic period (n = 96). Post septal defect closure (42.7% vs. 60.4%) and mitral valve surgery (35.4% vs. 29.2%) predominated subjects registered for EBCR during the non-pandemic and the COVID-19 period, whereas post CABG was the minority (4.2% vs. 4.2%). Among 144 registered subjects, majority completed EBCR sessions and underwent treadmill test evaluation (79 (82.3%) vs. 37 (77.1%) during the non-pandemic and the COVID-19 period). During the COVID-19 period, the most common sessions were 2 times per week (48.6%), followed by 5 times per week (32.4%), whereas during the non-pandemic period, 3 times per week was the most common (77.2%), followed by 5 times per week (19.0%) (p < 0.001). Total sessions did not significantly differ between the non pandemic and the COVID-19 period. Total sessions also did not significantly differ among subjects undergoing 2 times per week, 3 times per week, and 5 times per week sessions. There was no difference in duration (7.1 ± 1.9 min vs. 6.6 ± 1.9 min, p = 0,136) and METs (7.5 ± 1.8 vs. 6.9 ± 1.9, p = 0.192) achieved on treadmill evaluation between subjects on two time periods. There was no significant difference in duration (6.9 ± 1.9 min, 7.0 ± 1.9 min and 6.8 ± 1.8 min)and METs (7.1 ± 1.9, 7.3 ± 1.7 and 7.4 ± 2.1) achieved on treadmill evaluation among subjects who underwent EBCR 2 times per week, 3 times per week and 5 times per week respectively.
Conclusion
The adaptation protocol of EBCR during the COVID-19 period by reducing sessions per week did not influence the duration and METs achieved on treadmill evaluation at the end of CR as compared to usual EBCR practice.
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Affiliation(s)
- AB Hartopo
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Cardiology and Vascular Medicine, Yogyakarta, Indonesia
| | - ZH Islami
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Cardiology and Vascular Medicine, Yogyakarta, Indonesia
| | - IA Arso
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Cardiology and Vascular Medicine, Yogyakarta, Indonesia
| | - AM Ambari
- Faculty of Medicine, Universitas Indonesia - National Cardiovascular Center Harapan Kita , Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - B Dwiputra
- Faculty of Medicine, Universitas Indonesia - National Cardiovascular Center Harapan Kita , Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - B Radi
- Faculty of Medicine, Universitas Indonesia - National Cardiovascular Center Harapan Kita , Cardiology and Vascular Medicine, Jakarta, Indonesia
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Laksono S, Setianto B, Prawara AS, Dwiputra B. Highlighting Exosomes' Function in Cardiovascular Diseases. Curr Cardiol Rev 2021; 18:e241121191159. [PMID: 33563169 DOI: 10.2174/1573403x17666210204153526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022] Open
Abstract
Exosomes as one of the extracellular vesicles' subgroups played an important role in the cell to cell communication. The cargos and surface protein of exosomes have been known to affect the cardiovascular system both positively and negatively in chronic heart failure, ischemic heart disease, and atherosclerosis. There have been several exosomes that emerged as a potential diagnostic and prognostic marker in cardiovascular patients. However, the conditions affecting the patients and the method of isolation should be considered to create a standardized normal value of the exosomes and the components. CPC-derived exosomes, ADSCs-derived exosomes, and telocyte-derived exosomes have been proven to be capable ofacting as a therapeutic agent in myocardial infarction models. Exosomes have the potential to become a diagnostic marker, prognostic marker, and therapeutic agent in cardiovascular diseases.
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Affiliation(s)
- Sidhi Laksono
- Department of Cardiology and Vascular Medicine, RSUD PasarRebo, Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang. Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine, National Cardiac Center Harapan Kita, Faculty of medicine, Universitas Indonesia, Jakarta. Indonesia
| | | | - Bambang Dwiputra
- Department of Cardiology and Vascular Medicine, National Cardiac Center Harapan Kita, Faculty of medicine, Universitas Indonesia, Jakarta. 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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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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Dwiputra B, Santoso A, Poh KK. Targeting pro-protein convertase subtilisin kexin-9 as a novel therapy of hypercholesterolemia. Med J Indones 2017. [DOI: 10.13181/mji.v26i2.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Reducing low density lipoprotein (LDL) cholesterol level is an established primary and secondary prevention strategy for coronary heart disease. However, not all patients are able to achieve their LDL targets as recommended by the guidelines. Over the last 10 years, high plasma LDL level is known to be associated with a higher level of pro-protein convertase subtilisin kexin-9 (PCSK-9). Loss-of-function mutations in the PCSK-9 gene is associated with lower plasma LDL level and cardiovascular risk. Since its discovery in 2003, PCSK-9 has triggered many researchers to design a PCSK-9 inhibitor to reduce LDL cholesterol through competitive inhibition of this molecule. Some phase III clinical trials have showed promising results of PCSK-9 inhibitor efficacy in lowering LDL level and improving clinical outcome. This article aims to discuss the role of PCSK-9 in LDL metabolism and the efficacy of PCSK-9 inhibitor in reducing plasma LDL level.
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