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0.659
P-Index
Augustine Purnomowati
Departemen Kardiovaskular Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Articles
4
Documents
Perbedaan Kadar Adiponektin, Asimetrik Dimetilarginin Plasma, dan Respons Vasodilatasi Arteri Brakialis antara Dewasa Muda dengan Riwayat Bayi Berat Lahir Rendah dan Normal

Majalah Kedokteran Bandung Vol 44, No 1 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Adiponektin mempunyai efek antiaterogenik, antiinflamasi, sensitizer insulin, dan berperan penting dalam mengatur pertumbuhan janin. Hipoadiponektinemia dapat menyebabkan disfungsi endotel. Risiko penyakit kardiovaskular meningkat pada subjek dengan riwayat bayi berat lahir rendah (BBLR). Penelitian ini bertujuan menganalisis perbedaan kadar adiponektin, asimetrik dimetilarginin (ADMA) plasma dan respons vasodilatasi arteri brakialis melalui tes flow mediated brachial artery (FMBA) antara dewasa muda dengan riwayat BBLR dan bayi berat lahir normal (BBLN), serta korelasi kadar adiponektin dengan fungsi endotel pada BBLR. Penelitian kohor retrospektif dilakukan periode November 2009–Januari 2010 berasal dari Growth Study Cohort Tanjungsari Kabupaten Sumedang. Sebanyak 134 subjek dipilih secara simple random, terdiri atas 67 BBLR dan 67 BBLN yang karakteristik umumnya sama. Analisis multivariat melalui Hotelling’s trace menunjukkan FMBA, kadar ADMA, dan adiponektin berbeda bermakna (p<0,001) antara BBLR dan BBLN. Analisis simultaneous confidence interval menunjukkan kadar adiponektin plasma dan FMBA bermakna lebih rendah (p=0,015 dan p<0,001) pada BBLR dibandingkan dengan BBLN. Korelasi tidak bermakna antara kadar adiponektin dan ADMA (r=-0,16; p=0,176) dan FMBA (r=0,13; p=0,281) BBLR. Kecil peran adiponektin pada disfungsi endotel, mungkin variabel lain berperan, seperti tumor necrosis factor α. Simpulan, terdapat perbedaan kadar adiponektin plasma dan FMBA antara dewasa muda dengan riwayat BBLR dan BBLN, tetapi kecil peran adiponektin pada disfungsi endotel dewasa muda dengan riwayat BBLR. [MKB. 2012;44(1):1–6].Kata kunci: Adiponektin, asimetrik dimetilarginin, BBLR, tes flow mediated brachial arteryDifferences of Plasma Adiponectine, Asymmetric Dimethylarginine and Brachial Artery Vasodilatation Response in Young Adult with Low and Normal Birth Weight HistoryBeside an anti-atherosclerotic, anti-inflammation effect, and a sensitizer insulin, adiponectin also play an important role in fetal growth. Hypoadiponectinemia may lead to endothelial dysfunction. Low birth weight (LBW) has increase risk of cardiovascular disease. The aim of this study was to analyze the differences of plasma adiponectin, asymmetric dimethylarginine (ADMA) level and vasodilatation response of brachial artery by doing flow mediated brachial artery (FMBA) test between young adults with LBW and normal birth weight (NBW), and the role ofadiponectin level in endothelial function of the LBW. This was a retrospective cohort study during November 2009– January 2010, 134 subjects were randomly selected from the Growth Study Cohort of Tanjungsari Sumedang. They consisted of 67 LBW and 67 NBW young adults, with similar basic characteristics. A multivariate analysis via Hotelling’s trace showed that there was a significant difference (p<0.001) for FMBA, ADMA, and adiponectin level, but simultaneous confidence interval measurements indicated that the rate of FMBA and the level of plasma adiponectin were significantly lower (p<0.001, p=0.015, respectively) in LBW compared to NBW. The correlation between adiponectin and ADMA level (r=-0.16, p=0.176), and FMBA (r=0.13, p=0.281) in LBW were not significant, suggesting a small role of plasma adiponectin in endothelial dysfunction of young adults with LBW, other variables could play a role such as tumor necrosis factor α. In conclusions, the level of plasma adiponectin and FMBA are different between LBW and NBW, but the role of adiponectin may be small in endothelial dysfunction in young adults with LBW. [MKB. 2012;44(1):1–6].Key words: Adiponectin, asymmetric dimethylarginine, flow mediated brachial artery, LBW test DOI: http://dx.doi.org/10.15395/mkb.v44n1.72

Hubungan antara QT Variability Index dan Laju Filtrasi Glomerulus pada Penyakit Ginjal Kronik Predialisis

Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penderita penyakit ginjal kronik (PGK) mempunyai risiko yang tinggi untuk mengalami aritmia ventrikel dan kematian mendadak (sudden cardiac death/SCD). Angka kejadian SCD pada penderita PGK meningkat seiring dengan menurunnya laju filtrasi glomerulus (glomerular filtration rate/GFR). Mekanisme patofisiologi yang mendasari SCD pada umumnya aritmia ventrikel yang berhubungan dengan ketidakstabilan repolarisasi miokardium. QT variability index (QTVI), suatu indeks yang menggambarkan ketidakstabilan repolarisasi miokardium, merupakan prediktor yang kuat untuk terjadi aritmia fatal dan SCD. Penelitian ini merupakan studi observasi potong lintang untuk menilai hubungan antara QTVI dan GFR pada penderita PGK predialisis dengan GFR <60 mL/menit. Penelitian ini dilakukan pada penderita PGK yang berobat ke Poliklinik Ginjal Hipertensi Rumah Sakit Dr. Hasan Sadikin Bandung periode Oktober–Desember 2011. Penelitian ini melibatkan 51 subjek. Pemeriksaan elektrokardiografi (EKG) istirahat dilakukan pada semua subjek dan selanjutnya dilakukan penghitungan QTVI. Hampir semua subjek menderita hipertensi atau mendapat antihipertensi (94%). Gambaran EKG dengan hipertrofi ventrikel kiri didapatkan pada 37% subjek dan QTVI rata-rata subjek sebesar 0,16 (SD 0,24). Hubungan antara QTVI dan GFR dianalisis menggunakan Spearman’s rank correlation. QT variability index mempunyai hubungan yang bermakna baik dengan GFR (r=-0,816; p<0,001) maupun dengan estimated glomerular filtration rate (eGFR) (r=-0,460; p<0,001). Simpulan, terdapat hubungan sangat kuat antara QTVI dan GFR pada penderita PGK predialisis, makin rendah GFR makin panjang nilai QTVI. [MKB. 2012;44(4):193–98].Kata kunci: Kematian jantung mendadak, laju filtrasi glomerulus, penyakit ginjal kronik, QT variability indexCorrelation between QT Variability Index and Glomerular Filtration Rate in Predialysis Chronic Kidney DiseaseAbstractChronic kidney disease (CKD) patients are at increased risk for ventricular arrhythmia and sudden cardiac death (SCD). The rate of SCD in CKD patients increased as glomerular filtration rate decreased. Sudden cardiac death is generally mediated by ventricular arrhythmias associated with instability of myocardial repolarization. QT variability index (QTVI) as an index of myocardial repolarization instability is a strong predictor for fatal ventricular arrhythmias and SCD. The aim of this study was to evaluate correlation between QTVI and GFR(< 60 >mL/minute) in predialysis CKD patients. This study was done in Kidney and Hypertension Clinic of Dr. Hasan Sadikin Hospital Bandung, from October to December 2011. A total of 51 subjects were included in this study and had their resting electrocardiography (ECG) recorded and QTVI calculated, 94% had hypertension or received anti hypertension, while only 37% fulfilled the ECG criteria for left ventricular hypertrophy. We determined the correlation between QTVI and GFR using Spearman’s rank, with mean QTVI 0.16 (SD 0.24), we had strong and significant correlation between QTVI and GFR (r=-0.816, p <0.001) and moderate correlation between QTVI and estimated glomerular filtration rate (r=-0.460, p<0.001). In conclusions, there is a strong correlation between QTVI and GFR in predialysis CKD patients, the lower GFR the higher QTVI value. [MKB. 2012;44(4):193–98].Key words: Chronic kidney disease, glomerular filtration rate, QT variability index, sudden cardiac death DOI: http://dx.doi.org/10.15395/mkb.v44n4.214

Hubungan Kadar Apelin dengan Disfungsi Diastol pada Penderita Gagal Jantung dengan Fraksi Ejeksi Normal

Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Apelin merupakan peptida yang berperan dalam mempertahankan performa jantung pada beban tekanan kronik. Penelitian ini bertujuan menilai hubungan antara kadar apelin dan disfungsi diastol pada penderita gagal jantung dengan fraksi ejeksi normal. Analisis statistik korelasi Spearman-Rank. Penelitian dilakukan di Instalasi Rawat Jalan Jantung dan Divisi Diagnostiik Noninvasif Departmen Kardiologi dan Kedokteran Vaskular Rumah Sakit Dr. Hasan Sadikin Bandung periode Januari–April 2014. Hasil penelitian didapatkan 50 penderita laki-laki sebanyak 24 (48%) dan perempuan 26 (52%), usia rata-rata 58,72 (11,02) tahun, durasi hipertensi 1–30 tahun, median 5 tahun. Indeks massa tubuh rata-rata 24,13 kg/m2. Median tekanan darah sistol 130 (120–180) mmHg, median tekanan darah diastol 90 (70–110)mmHg. Fraksi ejeksi median 65 (49–77%), pengobatan dengan Angiotensin converting enzyme inhibitor (ACEI) sebanyak 48%, calcium channel blocker (CCB) 27%, beta bloker 6%, angiotensin receptor blocker (ARB) 3%, dan diuretik 1%. Pengukuran fungsi diastol, tissue doppler imaging (TDI) rata-rata 10,32, deceleration time rata-rata 228,2 detik, median rasio E/A (early/atrial (late) ventricular filling velocities) 0,77 (0,43–1,53), median isovolumic relaxation time (IVRT) 92 (60–177) detik. Median kadar apelin 1080,5 (993,2–1113) pg/mL. Sebagai simpulan, terdapat korelasi positif antara kadar apelin dan disfungsi diastol yang dihitung dengan TDI (R=0,3445, p=0,014). Apelin dapat digunakan untuk menilai gejala dan prognosis pada penderita gagal jantung dengan fraksi ejeksi normal karena kadarnya meningkat pada beban tekanan disertai fibrosis yang  sedikit dan menurun pada beban tekanan disertai fibrosis yang luas.[MKB. 2015;47(2):91–5]Kata kunci: Apelin, disfungsi diastol, fraksi ejeksi normal, gagal jantung, TDICorrelation between Plasma Apelin Level and Diastolic Dysfunction in Heart Failure Patients with Preserved Ejection Fraction AbstractApelin ia a novel multifunction peptide implicated in cardiovascular performance regulation in chronic pressure overload. Plasma apelin level and its correlation to diastolic dysfunction in patient heart failure with preserved ejection fraction were investigated. Hypertensive patients with heart failure but without coronary artery disease, atrial fibrillation, obese, and diabetes mellitus were enrolled in this study. Each patients underwent plasma apelin measurement and echocardiographic assessment of left ventricular diastolic function. Statistical analysis was conducted using Spearman Rank. Fifty patients,  24 males (48%) and 26 females (52%),  met the inclusion criteria.  The mean age of the participants was 58.72 (11.02) years with a duration of hypertension between 1–30 years, median 5 year. Mean body mass index was 24.13 kg/m2. Systolic blood pressure median was 130 (120–180)mmHg while the diastolic blood pressure median was 90 (70–110)mmHg. Left ventricular ejection fraction median was 65 (49–77)%, treatment with Angiotensin converting enzyme inhibitor (ACEI) was 48%, calcium channel blocker (CCB) was 27%, beta blocker was 6%, angiotensin receptor blocker (ARB) was 3%, and diuretic was 1%. Diastolic function assessment with tissue doppler imaging (TDI) resulted in a mean of 10.32, deceleration time mean of 228.2, E/A (early/atrial (late) filling velocities) ratio median of 0.77 (0.43–1.53),and IVRT (isovolumic relaxation time) median of 92 (59–177). Plasma apelin measurement median was 1080.5 (993.2–11) pg/mL. In conclusion, there is a positive correlation between plasma apelin level and diastolic function (TDI) (R=0.3445, p=0.014). There is no significant correlation between plasma apelin level and diastolic function using other criteria. In conclusion, apelin can be used for assessing symptoms and prognosis of heart failure patients with preserved ejection fraction because apelin level is upregulated when pressure overload occurs with less fibrosis and down-regulated when pressure overload occurs with marked fibrosis. [MKB. 2015;47(2):91–5]Key words: Apelin, diastolic dysfunction, heart failure, preserved ejection fraction DOI: 10.15395/mkb.v47n2.459

Endothelial Dysfunction in the Young Adult: a Retrospective Cohort Study on the Effect of Low Birth Weight

Acta Medica Indonesiana Vol 46, No 2 (2014)
Publisher : Indonesian Society of Internal Medicine

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Abstract

Aim: to investigate the effect of low birth weight (LBW) on endothelial function, and to determine the role of plasma adiponectin in endothelial dysfunction by conducting flow mediated brachial artery (FMBA) test or vasodilation response (VR) and by measuring plasma asymmetrical dimethylarginine (ADMA) of young adults born with LBW. Methods: in a retrospective cohort study, subjects were randomly selected from the growth study cohort of Tanjungsari Sumedang district West Java. They consisted of 67 LBW and 67 NBW (Normal Birth Weight) young adults. Dependent variables were plasma adiponectin, plasma ADMA, and VR. The correlation between plasma adiponectin and ADMA level was examined using Pearson’s correlation. Results: the relative risk for LBW to have low brachialis artery vasodilation response was 2.94, (95% CI:1.91- 4.53), and to have low of plasma adiponectin concentration 1.53, (95% CI: 1.07-2.18). There was a statistically significant difference for all variables studied (FMBA, plasma ADMA, and plasma Adiponectin concentrations), while simultaneous confidence interval measurements indicated that the value of FMBA and the concentration of plasma adiponectin were significantly lower, respectively p<0.001, 95% CI: -4.409-(-2.114), and p=0.015, 95% CI: -1.083-(-0.082) in LBW compared to NBW subjects. The correlation between plasma adiponectin concentration and plasma ADMA concentration in LBW subjects was not significant. Conclusion: there is an effect of LBW on endothelial function. LBW compared to NBW subjects have lower VR and plasma adiponectin concentration. There may be a small role of plasma adiponectin in endothelial dysfunction of young adults with LBW. Key words: low birth weight, adiponectin, ADMA, FMBA test