Effect of enhanced external counterpulsation therapy on myeloperoxidase in lowering cardiovascular events of patients with chronic heart failure.

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.

The reference range of serum, plasma and erythrocyte magnesium.

The interest in the clinical importance of serum magnesium level has just recently begun with the analysis and findings of abnormal magnesium level in cardiovascular, metabolic and neuromuscular disorder. Although the serum level does not reflect the body magnesium level, but currently, only serum magnesium determination is widely used. Erythrocyte magnesium is considered more sensitive than serum magnesium as it reflects intracellular magnesium status. According to NCCLS (National Committee for Clinical Laboratory Standards) every laboratory is recommended to have its own reference range for the tests it performs, including magnesium determination. The reference range obtained is appropriate for the population and affected by the method and technique. This study aimed to find the reference range of serum and plasma magnesium and also intracellular magnesium i.e. erythrocyte magnesium by direct method, and compare the results of serum and plasma magnesium. Blood was taken from 114-blood donor from Unit Transfusi Darah Daerah (UTDD) Budhyarto Palang Merah Indonesia (PMI) DKI Jakarta, consisted of 57 male and 57 female, aged 17 – 65 years, clinically healthy according to PMI donor criteria. Blood was taken from blood set, collected into 4 ml vacuum tube without anticoagulant for serum magnesium determination and 3 ml vacuum tube with lithium heparin for determination of erythrocyte and plasma magnesium Determination of magnesium level was performed with clinical chemistry auto analyzer Hitachi 912 by Xylidil Blue method colorimetrically. This study showed no significant difference between serum and heparinized plasma extra cellular magnesium. The reference range for serum or plasma magnesium was 1.30 – 2.00 mEq/L and for erythrocyte magnesium was 4.46 - 7.10 mEq/L.

The effect of aerobic exercise on blood and plasma viscosity on cardiac health club participants.

AIM: to analyze the effect of SJS aerobic exercise on blood and plasma viscosity. METHODS: the study was performed on 30 subjects with an age span of 40 to 60 years. Subjects participated in SJS aerobic exercise of moderate intensity of 40 to 45 minutes duration, three times a week for 9 to 12 weeks. Five milliliters of blood were collected into K3EDTA container to assess blood and plasma viscosity prior to the program and following the completion of the SJS program. Blood and plasma viscosity was measured using Brookfield LVDV-III viscometer using rotational method principle. RESULTS: this study demonstrated a significant decrease in blood viscosity (2.94%, p = 0.03) and insignificant decrease in plasma viscosity in subjects following SJS aerobic exercise compared to prior exercise. CONCLUSION: this study proved that SJS aerobic exercise of moderate intensity of 40 to 45 minutes duration times a week for 9 to 12 weeks gave the benefit of lowering blood viscosity, which contributes to reducing the risk of coronary heart disease.

Albumin cobalt binding (ACB) test: its role as a novel marker of acute coronary syndrome.

The biochemical marker of myocardial ischemia is detected prior to the development of myocardial necrosis, i.e. a novel biochemical evaluation based on human serum albumin binding to cobalt, a transitional metal. The evaluation is known as Albumin Cobalt Binding (ACB) Test. ACB Test is applied to detect the presence of Ischemia Modified Albumin (IMA), an albumin which has altered binding capacity to bind metal ion such as cobalt (Co), copper (Cu) and nickel (Ni) in N-terminus region. It is produced when the serum albumin convenes with ischemic heart tissues. ACB Test detecting the presence of myocardial ischemia that occurs prior to myocardial necrosis has been studied by some researchers and they found an ACB increase prior to troponin increase. The cut off point of ACB evaluation was 85 U/ml. Provided that the value was greater than 85 U/ml then there was positive myocardial ischemia. But it should be noticed that IMA increase in the plasma may be due to other tissues such as gastrointestinal tissues or skeletal muscles tissues. We should also consider other factors which may affect the evaluation result such as severe hypoalbuminemia that will cause a false-high result. ACB Test may be used as an early marker of myocardial ischemia that occurs prior to myocardial necrosis.

The role of lipid profile as a risk factor indicator for ischemic stroke at Cipto Mangunkusumo Hospital, Jakarta.

AIM: to determine the role of low HDL-cholesterol, and high total cholesterol, LDL-Cholesterol and triglyceride as risk factors for ischemic stroke at Dr. Cipto Mangunkusumo Hospital. METHOD: a study was conducted on 76 patients with an age range of 40-70 years. Subjects consisted of 38 post ischemic stroke patients and 38 control subjects with a diagnosis other than stroke. The study sample consisted of serum for lipid profile assessment. Total cholesterol and triglyceride were assessed using enzymatic method, while HDL-cholesterol and LDL-cholesterol using direct homogenous enzymatic method. Statistical analysis was performed using chi-square and multivariate analysis using logistic regression. RESULTS: low HDL-cholesterol was found in ischemic stroke patients and demonstrated a significant difference compared to control subjects (p<0.05). The results of total cholesterol, triglyceride, LDL-cholesterol did not demonstrate a significant difference. The odds ratio (3.09; CI 95%: 1.04; 8.73) demonstrates that low HDL-cholesterol is a risk factor for ischemic stroke. CONCLUSION: a low HDL-cholesterol level is a risk factor for ischemic stroke, with an odds ratio of 3.09, while total cholesterol, triglyceride and high LDL-cholesterol levels were not risk factors for ischemic stroke.

The role of persistent anticardiolipin antibody as risk factor of ischemic stroke.

AIM: To determine the role of persistent ACA and hyperviscosity as risk factor of ischemic stroke. Methods: A study was conducted on 76 subjects whose age 40 to 70 years. Subjects consisted of 38 patients of post ischemic stroke and 38 controls with diagnosis other than stroke. Fresh blood samples were taken and mixed with EDTA for viscosity examination and serum for ACA IgM and IgG examination. The laboratory examination for persistent ACA IgM and IgG used ELISA method, while viscosity analysis was using viscometer. Statistic analysis used chi-square and multivariate analysis with logistic regression. RESULTS: In this study we found persistent ACA IgG in 25% of case group , and 2.63% in control group. Multivariate analysis showed persistent ACA IgG as risk factor for ischemic stroke with p < 0.05 and OR 14.11 (CI 95%:1.64;121.11). We found persistent ACA IgM in 2.78% of case group and 5.26% in control group. High blood viscosity was found in 15.79% case group and 10.53% in a control group. Statistical analysis showed no significant difference of viscosity (p = 0.740) and persistent ACA IgM (p = 1.000) between case and control group. CONCLUSION: study showed that persistent ACA IgG in stroke ischemic was higher than in control subjects. Blood viscosity examination and persistent ACA IgM did not show significant difference. While persistent ACA IgG with OR 14.11 (CI: 1.64; 121.11) was the risk factor for ischemic stroke. Blood viscosity and persistent ACA IgM were not risk factors for ischemic stroke.