Harmani Kalim
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Myeloperoxidase as a Predictor for Subsequent Cardiovascular Events in Patients with Acute Myocardial Infarction Rampengan, Starry H; Kalim, Harmani; Karo-karo, Santoso; Soerianata, Sunarya; Harimurti, Ganesja
Jurnal Kardiologi Indonesia Vol. 28 NO.4 Juli 2007
Publisher : Indonesian Heart Association

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Background. Inflammation has been linked to all stages of the development of vulnerable plaque which not only causes platelet activation but also proceeded by activation of polymorphonuclear neutrophils (PMNs). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory properties and may contribute directly to tissue injury. Among predictors of major adverse cardiovascular events (MACE) that we have been widely used and known, such as hs-CRP and Troponin T, it still unknown whether MPO also provides prognostic information in patients with acute myocardial infarction (AMI).Objectives. The aim of our study is to search predictive value of MPO and to compare MPO with hs-CRP and Troponin T as a predictor of MACE in patients with AMI.Methods. Cohort-prospective study was done, conducted from April to June 2006 in the emergency department of National Cardiovascular Centre-Harapan Kita, (NCVC-HK), Jakarta. MPO, hs-CRP, and troponin T serum levels were assessed in 93 patients with AMI. It recorded death, reinfarctions, angina, revascularization, and heart failure during 6 months of follow-up.Results. Patients with MPO serum level > 204,9 μg/l have increased risk of cardiovascular events (HR 6.76; 95% CI 3.37-13.56, P < 0.001). In statistical analysis, MPO (sensitivity 83.1%; specificity 82.4%) is a stronger independent predictor for subsequent cardiovascular events than Troponin T (sensitivity 59.8%; specificity 71.6%) and hs-CRP (sensitivity 48.5%; specificity 46.1%).Conclusions. MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events in patients with acute myocardial infarction
Quality of Life Evaluation After Coronary Artery Bypass Graft Surgery in Patient who Underwent Phase III Rehabilitation Program Abdurachim, Kiki; Kalim, Harmani; Radi, Basuni
Jurnal Kardiologi Indonesia Vol.28 No.3 Mei 2007
Publisher : Indonesian Heart Association

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Background. Coronary artery bypass graft surgery (CABG) is one of the management for coronary artery disease. Cardiovascular rehabilitation usually conducted for recovery and improved quality of life. Questionnaire was used to evaluate quality of life. One of the quality of life instrument most commonly used is Questionnaire SF-36. So far there isn’t any studyto evaluate quality of life in patients post CABG who wish to follow rehabilitation program phase III in Indonesia.Methods and results. This is a cross sectional study conducted in the National Cardiovascular Centre (NCC) - Rehabilitation Division to patients post CABG in phase III rehabilitation program during 2004-2005. Subjectwas taken in consecutive sampling manner. Questionnaire SF-36 was handed directly or via mail. Validity and reliability test was done for the questionnaire form in Indonesia language. There were 112 patients, 34 patients did rehabilitation program in hospital and 78 were home-based. The characteristics between two groups were similar. Validity test using rproduct moment from Pearson to every questions in SF-36 showed r =0,53-0.83 > 0,51 (r table) and Cronbach α= 0,855. SF-36 scoring was not significantly different among the two groups (in hospital rehab vs homebased rehab) and also control group (healthy).Conclusions. There were no difference in quality of life and aerobic capacity in patients who performed rehabilitation program phase III in hospitaland home-based.
Trigliseridemia Postprandial Sebagai Faktor Prediksi Kejadian Kardiak Sindroma Koroner Akut Berulang Sungkar, Muhammad A; Kalim, Harmani; Karim, Sjukri
Jurnal Kardiologi Indonesia Vol 29 No 1, Jan-April 2008
Publisher : Indonesian Heart Association

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Latar Belakang. Plasminogen Activator Inhibitor-1 (PAI-1) merupakan faktor hemostatik penting dalam kejadian trombosis, karena menghambat mekanisme fibrinolisis oleh tissue-Plasminogen Activator (t-PA). Beberapa penelitian membuktikan bahwa PAI-1 merupakan prediktor kejadian kardiak berulang pasca Sindroma Koroner Akut (SKA). Disamping itu, PAI-1 juga berhubungan dengan Sindroma Resistensi Insulin yang bermanifestasi : peningkatan kadar Trigliserid (Tg), penurunan kadar High Density Lipoprotein (HDL) kolesterol, hipertensi dan Glukosa Intolerans. Peningkatan kadar Tg baik akut maupun kronik berhubungan dengan peningkatan aktifitas PAI-1.Objektif. Studi ini untuk mengetahui hubungan antara Tg postprandial dengan peningkatan PAI-1 pada pasien SKA, yang dapat berakibat kejadian kardiak berulang.Metoda. Suatu studi kontrol kasus dilakukan pada 54 pasien SKA usia 54-63 tahun dengan atau tanpa elevasi segmen ST, tanpa diabetes mellitus (DM). Pasien dibagi dalam 2 kelompok berdasarkan kadar Tg postprandial dan dibandingkan dengan umur, jenis kelamin, indek massa tubuh, merokok, tekanan darah sistolik, nadi, deviasi segmen ST, kadar CKMB, total kolesterol, low density lipoprotein (LDL), HDL dan PAI-1. Pasien dengan kadar Tg postprandial < 153.5 mg/dL dipakai sebagai control. Pasien diamati selama perawatan dan 1 bulan setelah perawatan. Analisis statistik dilakukan untuk melihat kemaknaan antara variabel-variabel pada kedua kelompok tersebut, dan hubungannya dengan faktor hemostatik serta kejadian utama perburukan kardiak (Major Adverse Cardiac Event/MACE).Hasil. Terdapat peningkatan kadar PAI-1 pada populasi studi (28.89 ± 25.81 ng/dL) dan pada kelompok pasien dengan postprandial hipertrigliseridemia (p=0.004). Namun secara keseluruhan meskipun tidak dijumpai hubungan yang bermakna antara postprandial hipertrigliseridemia dengan MACE didapatkan kebersamaan dan hubungan yang bermakna antara postprandial hipertrigliseridemia dengan obesitas (p=0.037) serta HDL kolesterol yang merupakan komponen Sindroma Metabolik.Kesimpulan: Postprandial hipertrigliseridemia merupakan suatu keadaan yang dapat dijumpai pada gangguan metabolik yang mempengaruhi status koagulasi dan dijumpai suatu korelasi antara postprandial hipertrigliseridemia dengan obesitas PAI-1 merupakan prediktor kejadian berulang pasca Sindroma Koroner Akut namun tidak dijumpai hubungan antara postprandial hipertrigliseridemia dengan kejadian berulang pasca Sindroma Koroner Akut.Kata kunci: Postprandial Triglyceridemia, Recurrent Cardiac Events, Acute Coronary Syndrome
Measurement agreement between Swan-Ganz and Echocardiography in stroke volume, cardiac output and systemic vascular resistance Priyana, Andria; Joesoef, Andang H; Kalim, Harmani; Soesanto, Amiliana M
Jurnal Kardiologi Indonesia Vol 30, No 2 (2009): Mei-Agustus 2009
Publisher : Indonesian Heart Association

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Background: Pulmonary artery catheter (PAC) or Swan-Ganz until now is still considered as gold standard for hemodynamic measurement. It is, however, high cost, has some complications risks, and has shown little benefit/risk ratio. It, therefore, makes many studies assessing correlation or agreement between non-invasive or semi-invasive modalities with PAC for hemodynamic measurement. There were many studies for agreement between TEE and PAC, while only few studies that assessed agreement between TTE and PAC for hemodynamic profiles, especially SVR. Method: This is an analytic cross-sectional study in post CABG patients in ICU whose PAC were performed. Hemodynamic measurement by TTE measuring LVOT diameter, VTI, IVC diameter that can be calculated into SV, CO, and SVR. There were three SVR categories: SVR1 using top limit of estRAp, SVR2 using bottom limit of estRAp, and SVR3 using mean of the estRAp. Statistic analysis used paired t-test for mean comparison. Agreement analysis used Bland-Altman method. Intraobserver and interobserver variability were assessed by intraclass correlation (ICC) and repeatibility coefficient (RC). Percentage error was calculated as follows: twice the SD for the difference between the two methods being compared was divided by the mean value obtained from both methods {2xSD mean difference / [(mean from PAC + mean from TTE) /2] x 100}. Data was analyzed by SPSS 15.0 Results:There were 50 data from 28 samples. As many as 30 data was also measured by second observer for interobserver variability. Bias/mean difference between TEE and PAC were: 0,11 for SV; 0,03 for CO; -15,76 for SVR1; 67,75 for SVR2; 25,99 for SVR3. There were also good agreement between methods with quite narrow limits of agreement (SV -15,22; 15,44, CO -1,30; 1,36, SVR1 -293,18; 261,66, SVR2 -220,10; 355,60, SVR3 -256,23; 308,21. Conclusion: There is good agreement between TTE and PAC for measuring SV, CO, and SVR. Therefore, TTE can be used to evaluate hemodynamic variables. (J Kardiol Indones. 2009;30:46-56) Keywords: Swan-Ganz, echocardiography, hemodynamic measurement
Correlation between NT-proBNP plasma levels with mitral annular Tissue Doppler Velocities in Heart Failure patients Siregar, Raja Adil C.; Kalim, Harmani; Siswanto, Bambang Budi; Soesanto, Amiliana M.
Jurnal Kardiologi Indonesia Vol 31, No 3 (2010): Sept-Des 2010
Publisher : Indonesian Heart Association

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Background. N-terminal pro brain natriuretic peptide (NT-proBNP) will release from myocite granules in a condition of increased cardiac wall-stress in heart failure (HF) patients, and its plasma level elevation had been widely used as a parameter of diagnosis, functional class, treatment monitoring and prognostication. Pulsed-wave tissue Doppler velocities of mitral annulus (Tissue Doppler Imaging/TDI) currently known had an ability to detect movement changes of cardiac wall in HF patients. But only few research to see the correlation between them, with various selection of patients and results.Aim. To determine whether plasma NT-proBNP levels correlate with mitral annulus velocities measured by TDI and to search which component had the strongest correlation.Methods. One hundred consecutive patients with HF who came for echocardiography examination in The National Cardiac Center Harapan Kita Jakarta underwent an additional TDI procedure (Sm, Em and E/Em component). Before or after echocardiography, venous blood sample was collected for plasma NT-proBNP examination. We determined the correlation between plasma NT-proBNP level and TDI results, and assessed which component had the strongest correlation.Results. There were 74 men and 26 women of HF patients with mean of age 54 y.o. Functional NYHA Class II were 28 patients, NYHA Class III 42 patients and NYHA Class IV 30 patients. The causes of HF were CAD 49 patients, HHD 19 patients, Valve Disease 23 patients, DCM 8 patients and other 1 patient. There were 64 patients with sinus rhythm and 36 patients with atrial fibrillation. There were 17 diastolic HF patients and 83 systolic HF patients. Fifty patients with significant MR and 50 patients without significant MR. We found the strongest significant negative correlation (r= -0,713, p 0,000) between plasma NT-proBNP level and Em component. Sm also had a significant negative correlation, but Em had a stronger correlation than Sm. E/Em component had a weak significant positive correlation.Conclusion. Elevated plasma NT-proBNP levels correlates strongly with declining velocities of TDI early diastolic Em component in HF patients.(J Kardiol Indones. 2010;31:168-74)Keywords: NT-proBNP, TDI, Tissue Doppler velocity, Heart failure.
Hypoalphalipoproteinemia: Prevalence and the impact of treatment on reaching HDL cholesterol target level in patients with dyslipidemia Kalim, Harmani
Medical Journal of Indonesia Vol 10, No 2 (2001): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (606.281 KB) | DOI: 10.13181/mji.v10i2.13

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A low serum high density lipoprotein cholesterol (HDL-C) level is a potent predictor of coronary heart disease (CHD). It has been estimated that 11% of the Framingham men have isolated low HDL-C levels and about 30% of dyslipidemia patients have HDL-C level of less than 35 mg/dl (hypoalphalipoproteinemia). In addition, there is uncertainty regarding the management of these patients. There is no epidemiological data on the prevalence low HDL-C level in dyslipidemia patients and the results of treatment on HDL-C on a large number of patients in Indonesia. We conducted a survey in 13 cities in Indonesia to evaluate the prevalence of hypoalphalipoproteinemia among dyslipidemic patients and the impact of treatment with lipid modification drugs on achieving target level of HDL-C 35 mg/dl or more in routine clinical practice. A total number of 1420 dyslipidemia patients (mean age 50 years, male 58%) were included and analyzed in this report. The overall prevalence of hypoalphalipoproteinemia in our study was 35.4% and it was correlated with the risk level of the patients; 21.9% among low risk group (patient with < 2 other risk factor), 39.6% in high risk group (≥ 2 other risk factors) and 44.3% in patients with CHD. After 12 week treatment, the prevalence decreased to 12%, 20% and 18% in low risk, high risk and CHD patients respectively. The magnitude of HDL-C changes correlated inversely with base-line HDL-C and it was highest (59%) in the lowest HDL-C group (< 25 mg/dl) and the least change (23%) was found in group with the highest HDL-C level (≥ 45 mg/dl). Only 46% of patients with low HDL-C value at baseline achieved normal HDL-C level after treatment. In conclusion, the prevalence of low HDL-C in dyslipidemia patients was high especially in high risk group and in CHD patients. The majority of patients with low HDL-C at base-line could not reach the target level for HDL-C of 35 mg/dl or more after 12 weeks treatment with lipid modification drugs. (Med J Indones 2001; 10: 98-102)Keywords: hypoalphalipoproteinemia, dyslipidemia, routine practice, anti lipid drugs
Heart rate turbulence in patients after primary percutaneous coronary intervention and fibrinolytic treatment for acute myocardial infarction Firdaus, Isman; Yuniadi, Yoga; Tjahjono, Cholid T.; Kalim, Harmani; Munawar, Muhammad
Medical Journal of Indonesia Vol 16, No 1 (2007): January-March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (180.813 KB) | DOI: 10.13181/mji.v16i1.250

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Heart rate turbulence (HRT) as novel predictor of sudden cardiac death were superior to all other presently available indicators. HRT significantly was improves after successful reperfusion reflecting rapid restoration of baroreceptor response. We investigated turbulence onset (TO) and turbulence slope (TS) values among patients with acute ST-elevation myocardial infarction (STEMI) underwent revascularization by means of primary PCI or fibrinolytic. We hypothesized that the values of TO and TS were different in two kinds of revascularization treatment. The subjects underwent 24 hours ECG recording after revascularization therapy. TO was quantified by the relative change of the first two sinus RR intervals following a ventricular premature beat (VPB) and the last two sinus RR intervals before the VPB. TS was quantified by the maximum positive slope of a regression line assessed over any sequence of five subsequent sinus rhythm RR intervals within the first two sinus rhythm intervals after a VPB. Thirteen patients (mean of age 56 ± 9 years old) who underwent revascularization treatment of acute STEMI were eligible as subject of this study.Ten patients underwent fibrinolytic therapy and three patients underwent primary PCI. TO value was significantly different between PCI group and fibrinolytic group (-3.3 ± 1.7 % vs -0.2 ± 0.9 % ; P=0.03). The Primary PCI group has better outcome on turbulence slope value (TS) than fibrinolytic group but not significance (7.7 ± 4.4 msec/RR interval vs 3.4 ± 2.6 msec/RR interval; P = 0.056). In conclusion, TO was better in acute STEMI patient undergone PCI compare to that undergone fibrinolytic therapy. (Med J Indones 2007; 16:19-24) Keywords: heart rate turbulence, revascularization, myocardial infarction
The risk factors profile of coronary heart disease in dyslipidemic patients : Results from a survey in 13 cities in Indonesia Kalim, Harmani; Kaligis, Rinambaan W.M.
Medical Journal of Indonesia Vol 10, No 1 (2001): January-March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (4764.74 KB) | DOI: 10.13181/mji.v10i1.8

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The incidence of coronary heart disease (CHD) has significantly increased and has been associated to the high mortality rate in Indonesia. One important CHD risk is the abnormal lipid profile or dyslipidemia, but there are other risk factors that has been associated with CHD in Western population. In Indonesia, data on CHD risk factors are very limited and usually only available as hospital-based data. The aim of this study is to analyze the CHD risk profile in the private clinical practice setting and to determine the factors affecting CHD in  dyslipidemic patients in Indonesia. This study is a cross-sectional survey which targeted physicians in 13 cities in Indonesia who regularly treat patients with dyslipidemia. The majority of dyslipidemic patients in clinical practice setting was the CHD high-risk group. Age, Iow HDL-C and hypertension were the most common risk factors. The prevalence of the risk factors and the proportion of dyslipidemic patients which belongs to the high risk group were comparable to the result of US (L-TAP) study. (Med J Indones 2001; 10: 42-7)Keywords : Coronary Heart Disease, risk factors, dyslipidemia, clinical practice
Lipid Treatment Assessment Project (L-TAP) Study : a survey in 13 cities in Indonesia to evaluate the percentages of dyslipidemic patients achieving NCEP LDL-C target goals after treatment Kaligis, Rinambaan W.M.; Kalim, Harmani
Medical Journal of Indonesia Vol 10, No 2 (2001): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (669.084 KB) | DOI: 10.13181/mji.v10i2.17

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Clinical trials have demonstrated significant benefit from low density lipoprotein cholesterol (LDL-C) lowering for primary and secondary prevention of cardiovascular disease. In the US, it is well recognized that a substantial number of hypercholesterolemic patients were not treated to the LDL-C goals recommended by the National Cholesterol Education Program (NCEP) guidelines. In 1996, the Indonesian Heart Association (PERKI) has issued guidelines recommending goals for screening and lipid treatment in Indonesia adopted from NCEP guidelines; however, the frequency of undertreatment in Indonesia is not known. The objective of this study was to determine the percentage of patients treated with lipid-lowering therapy who reached LDL-C goals as defined by NCEP guidelines in routine clinical practice. This was a cross-sectional survey targeted physicians who regularly treated dyslipidemic patients in 13 cities in Indonesia. Participating doctors were asked on their awareness of NCEP guidelines and to complete the case record form (CRF) of the enrolled patients. One-hundred and eighty-eight (188) out of four hundreds (400) physicians who were invited, have participated in this study. Among the evaluable 1420 CRF, 1082 patients received statins, 301 used fibrates, 14 patients used combination drugs, and 23 others received non-drug treatments only. Success rates on achieving target LDL-C in low-risk, high-risk, and CHD groups were 73.0 %, 43.6 %, and 14.8 %, respectively. Overall success rate in patients using statins was 55.1 %, while in low-risk group, high-risk group, and CHD patients, the success rates with statin were 77.8%, 50.1%, and 18.6 %, respectively. Atorvastatin showed the highest success rate (77.4 %) if compared to other statins. Only 14 % of physicians were knowledgeable about the NCEP goals. Conclusion : A large number of dyslipidemic patients who were on lipid-lowering therapy were not achieving the recommended LDL-C target levels. Success rates were lower in CHD patients and high risk group. Atorvastatin seemed more effective in lowering the LDL-C to target levels. There are still many physicians in Indonesia who do not aware about the NCEP guidelines and LDL-C treatment goals. (Med J lndones 2001; 10: 103-9)Keywords: lipid treatment assessment project (L-TAP), dyslipidemia, coronary heart disease (CHD) risk, routine practice
Effect of enhanced external counterpulsation therapy on myeloperoxidase in lowering cardiovascular events of patients with chronic heart failure Rampengan, Starry H.; Setianto, Budhi; Posangi, Jimmy; Immanuel, Suzanna; Prihartono, Judo; Siagian, Minarma; Kalim, Harmani; Inneke, Sirowanto; Abdullah, Murdani; Waspadji, Sarwono
Medical Journal of Indonesia Vol 22, No 3 (2013): August
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (911.558 KB) | DOI: 10.13181/mji.v22i3.584

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Background: Chronic heart failure (CHF) is a slowly progressive disease with high morbidity and mortality; therefore, the management using pharmacological treatments frequently fails to improve outcome. Enhanced external counterpulsation (EECP), a non-invasive treatment, may serve as alternative treatment for heart failure. This study was aimed to evaluate the influence of EECP on myeloperoxidase (MPO) as inflammatory marker as well as cardiac events outcome.Methods: This was an open randomized controlled clinical trial on 66 CHF patients visiting several cardiovascular clinics in Manado between January-December 2012. The subjects were randomly divided into two groups, i.e. the group who receive EECP therapy and those who did not receive EECP therapy with 33 patients in each group. Myeloperoxidase (MPO) as inflammatory marker was examined at baseline and after 6 months of observation. Cardiovascular events were observed as well after 6 months of observation. Unpaired t-test was use to analyze the difference of MPO between the two groups, and chi-square followed by calculation of relative risk were used for estimation of cardiovascular event outcomes.Results: MPO measurement at baseline and after 6 months in EECP group were 643.16 ± 239.40 pM and 422.31 ± 156.26 pM, respectively (p < 0.001). Whereas in non EECP group, the MPO values were 584.69 ± 281.40 pM and 517.64 ± 189.68 pM, repectively (p = 0.792). MPO reduction was observed in all patients of EECP group and in 13 patients (48%) of non-EECP group (p < 0.001). Cardiovascular events were observed in 7 (21.21%) and 15 (45.45%) of patients in EECP and non-EECP groups, respectively (p = 0.037).Conclusion: EECP therapy significantly decreased the level of MPO as inflammatory marker and this decrease was correlated with the reduction of cardiovascular events in CHF patients. (Med J Indones. 2013;22:152-60. doi: 10.13181/mji.v22i3.584)Keywords: CHF, cardiovascular events, EECP, myeloperoxidase