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.

Electrophysiological characteristics and radiofrequency ablation of right atrial flutter.

This study aimed to elaborate the electrophysiology characteristics and radiofrequency ablation (RFA) results of atrial flutter (AFL) which has not been established in Indonesia. Three multipolar catheters were inserted percutaneously and positioned into coronary sinus (CS), His bundle area and around tricuspid annulus. Eight mm ablation catheter was used to make linear ablation at CTI of typical and reverse typical AFL. Bidirectional block was confirmed by conduction time prolongation of more than 90 msec from low lateral to CS ostium and vice versa, and/or by means of differential pacing. Thirty AFL from 27 patients comprised of 19 typical AFL, 5 reverse typical AFL and 6 atypical AFL enrolled the study. Mean tachycardia cycle length (TCL) were 261.8 ± 42.84, 226.5 ± 41.23, and 195.4 ± 9.19 msec, respectively (p = 0.016). CTI conduction time occupied up to 60% of TCL with mean conduction time of 153.0 ± 67.37 msec. CS activation distributed to three categories which comprised of proximal to distal, distal to proximal and fusion activation. Only nine of 27 patients had no structural heart disease. RFA of symptomatic typical and reverse typical AFL demonstrated 96% success and 4.5 % recurrence rate during 13 ± 8 months follow up. Typical AFL is the predominant type of AFL in our population. The majority of AFL cases suffered from structural heart disease. RFA was highly effective to cure typical and reverse typical AFL.

QT dispersion, a simple tool to predict ventricular tachyarrhythmias and/or sudden cardiac death after myocardial infarction.

Recent studies showed contradictive results of the relation between QT dispersion and the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death. In addition, beta adrenoreceptors blocking agents, which are known to decrease the incidence of lethal arrhythmias after myocardial infarction, administered to the majority of patients in those studies population. Since β -blocker as secondary prevention drug was underutilized at National Cardiovascular Center Harapan Kita, this study was performed to find out the relation between QT dispersion and ventricular tachyarrhythmias and/or sudden cardiac death after previous myocardial infarction. The QT interval duration, QT dispersion and clinical variables of 36 postinfarction patients with history of sustained ventricular tachyarrhythmias and/or sudden cardiac death (event group) were compared with 75 postinfarction patients without such events (control group). QT dispersion differed significantly between study groups and was increased in the event group (115 ± 41 msec vs 81 ± 25 msec, p < 0.001). Corrected maximal QT interval duration was also prolonged in the event group (534 ± 56 vs 501 ± 35 msec, p < 0.001). Regression analysis showed that increasing QT dispersion was related to the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death with OR of 3.2, 4, and 5.8 for cut-off point of 80, 90, and 100 msec respectively. The QT dispersion could predict the occurrence of ventricle tachyarrhythmias and/or sudden cardiac death in patient with AMI. This study confirmed that the QTd remain useful in free of beta blocking agents state.

Age, body posture, daity working load, past antihypertensive drugs and risk of hypertension: A rural Indonesian study.

Indonesia has about 210 million inhabitans and most of them live in rural areas, therefore in rural community it is estimated that a big number of hypertensive people can be found. However, few rural community-based studies have been conducted to identify hypertensive risk factors. This study aims to identfy some risk factors related to hypertension in rural areas. The data for this study came from the result of the field study done by the second year medical students of the Faculty of Medicine, University of Indonesia, Jakarta. The study was conducted on July 12, 2000 at 10:00 AM to 1:00 PM in a rural area, the Cijeruk subdistrict in Bogor regency. The subjects were selected randomly using neighborhood cluster. Interviews and blood pressure were taken at the houses of the subjects. The results of this study showed that people aged 40 years or over had an increase risk to suffer hypertension compared to the 17-39 year old group, and the risk was most prominent among the 55-59 year group (adjusted odds ratio = 21.62; 95% confidence intervals (CI) = 4.10-113.97). Compared to the subjects with normal body posture, those who were obese had more than 6.3-folds increase in the risk to be hypertensive (adjusted OR = 6.33: 95% CI = 2.62-15.29). In addition, those who discontinued antihypertensive drugs had almost 12-fold increase in the risk to be hypertensive relative to subjects who never take antihypertensive drugs (adjusted OR = 11.92; 95% CI = 4.61 -30.80). This study concluded that special attention should be taken to the elderly aged 40 years and over, to some one who discontinued antihypertensive drugs, and whom had light daily working load to prevent hypertension.