Background: Left ventricular hypertrophy (LVH) is a preclinical manifestation of cardiovascular disease and a strong predictor of cardiovascular morbidity and mortality. The electrocardiogram (ECG) is an easily available, easy to use and cost effective tool to evaluate LVH. Peguero – Lo Presti criteria is a newcriteria to diagnose LVH from ECG that has higher sensitivity than the other ECG criteria.Aims: To assess the ability of Peguero – Lo Presti criteria to diagnose LVH and obtain new cut-off point criteria to more accurately diagnose LVH in patients with hypertension in Adam Malik Hospital.Methods: A cross sectional study was conducted on patients with hypertension in cardiac centre Adam Malik Hospital Medan. Electrocardiographic examination was performed to obtain Peguero – Lo Presti point in blinded fashion. LVH was assessed using M-mode method with Cube formula. The analysis of Peguero – Lo Presti criteria was based on the calculation of the deepest S wave in any precordial lead (deepest S wave,SD) and S wave in lead V4 (SV4). A SD + SV4 ≥ 28 mm in male and ≥ 23 mm in female subjects were considered positive for LVH. LVH was defined as left ventricular mass index > 115 gr/m2 in male and > 95 gr/m2 in female subjects.Results: Peguero – Lo Presti criteria had 54.8% sensitivity, 97.6% specificity, 55.4% NPV and 97.6% PPV to diagnose LVH. Lowering the cut-off point of Peguero – Lo Presti criteria to 26 mm in male and 22 mm in female subjects improved the sensitivity from 54.8% to 67.1% with 90.5% specificity, 61.3% NPV and 92.5% PPV to diagnose LVH.Conclusion: Peguero – Lo Presti criteria on ECG could be used to diagnose LVH in patients with hypertension in Adam Malik Hospital Medan.
Background: Coronary heart disease (CHD) is still the leading cause of death in the world. There are various risk factors for atherosclerosis leading to CHD. Duke Treadmill Score (DTS) is known to demonstrate prognostic stratification and has a diagnostic value in predicting the number of coronary arteries involved in patient populations with ischemic heart disease. However, DTS does not describe the role of risk factors for coronary heart disease to the complexity of coronary artery lesions. This study aims to add risk factors for coronary heart disease on DTS to detect the complexity of coronary artery lesions with stable angina pectoris.Methods: This study was a cross-sectional study in stable angina pectoris patient who comes to Haji Adam Malik Hospital Medan from January 2017 until February 2018. Patients who have done treadmill test and coronary angiography, and fulfill inclusion and exclusion criteria are included in the study. ECG examination and recording of risk factors for coronary heart disease were done. DTS assessment was performed based on a treadmill test and Syntax score based on coronary angiography results. Diagnostic tests were performed to assess the sensitivity and specificity of the addition of CHD risk factors to detect the complexity of coronary artery lesions.Results: Of the 76 people with stable angina pectoris, 55 people were found with low SYNTAX and 21 people with high Syntax. DTS is divided into 3 groups: mild (> -10), moderate (-10 to - 13.5), and severe (≤-13.6) based on the cut off of the ROC curve. Risk factors for CHD are divided into 3 groups, mild (≤3 CHD risk factors), moderate (4-6 CHD risk factors), and severe (7 CHD risk factors) based on the cut off of the ROC curve, then assessed the relationship with Syntax which has been divided into 2 groups, low Syntax, and high Syntax. Diagnostic test shows the addition of risk factors of CHD to DTS to detect the complexity of coronary artery lesions have greater sensitivity and specificity than DTS without the addition of risk factors of CHD, 95%, and 89%.Conclusion: The addition of risk factors for coronary heart disease on DTS can detect the complexity of coronary artery lesions.
Patients with hypertension are at high risk for development of Left Ventricle Hypertrophy (LVH) and Left Ventricular Systolic Dysfunction (LVSD). These conditions should be identified earlier to prevent cardiac morbidity and mortality. To measured serumlevel of NT-proBNP in hypertensive and mild symptomatic Hypertensive Heart Disease (HHD) patients (NYHA class I-II), to performechocardiography evaluation to all of the patients and associated with serum level of NT-proBNP. A cross sectional study was done at H.Adam Malik Hospital Medan, participants were recruited from consecutive samples of 15 hypertensive and 16 mild symptomatic HHDpatients whose visited cardiovascular and internal medicine out patient clinics. Of these patients, blood samples were taken and a twodimension echo-Doppler study was performed. The patients divided into three groups based on echocardiography studies respectively:Group 1: 9 hypertensive patients with normal echocardiography finding; group 2: 13 patients with LVH and ejection fraction (EF) ≥60%; and group 3: 9 patients with LVH and EF < 60%. Mean NT-proBNP serum level (in pg/mL) for groups 1-3 respectively, were:56.4 ± 34.5, 245.4 ± 339.2 and 852.0 ± 1218.9. Mean NT-proBNP serum level differed among all three groups (p = 0.050), butthe significant difference found between group 1 and group 3 (p < 0.05) only. There were significant correlation between NT-proBNPserum level and the three stages of echocardiography finding (r = 0.488 and p = 0.005). The result suggests that NT-proBNP serumlevel correlated with deterioration of heart function and structure according echocardiography studies. The Significant rise in NT-proBNPserum level happened only when Left Ventricular Systolic Dysfunction (LVSD) develops in hypertension.
Background: Patients diagnosed with hypertension will deteriorate into hypertensive heart disease which is characterized by diastolic dysfunction first followed by systolic dysfunction later in the course of the disease. Diastolic dysfunction of the left ventricle causes an increase in LVEDP as well as in the dimension of the left atrium. P-Wave Terminal Force V1 (PTFV1) which is derived from 12 lead ECG could help diagnose diastolic dysfunction in centers where echocardiography is not available. The purpose of this study was to determine the correlation of PTFV1 on the 12-lead Electrocardiography with diastolic dysfunction in patients diagnosed with hypertension in the outpatient clinic of Cardiac Center Adam Malik General Hospital in Medan. Methods: This is a cross-sectional study conducted from March 2019 until August 2019. Patients with hypertension who met the inclusion criteria were examined electrocardiographically to obtain PTFV1 value. Then echocardiography examination was then performed to assess the grades of diastolic dysfunction and other parameters. Analysis of correlation between PTFV1 values and diastolic dysfunction was then conducted. Results: From the clinical characteristics, there is no difference regarding age, sex , and risk factorsbetween the three diastolic dysfunction groups, while echocardiography characteristic shows more reduced EF in grade III diastolic dysfunction (36.5±7.7). Significant differences in PTFV1 are found among diastolic dysfunction groups. Grade I diastolic dysfunction has PTFV1 value of 23.8 mm.ms, grade II diastolic dysfunction has PTFV1 value of 34.1 mm.ms, and grade III diastolic dysfunction has PTFV1 value of 52.1 mm.ms, Significance of p value is <0.001. There is a strong correlation between PTFV1 and diastolic dysfunction grade (r = 0.63 (P <0.001)). Cut off point of PTFV1 > 29.8 mm.ms can discriminate patients who have increased LAP with a sensitivity of 84% and specificity of 71%. Conclusions: PTFV1 is a simple screening tool which is widely available and correlate well with left ventricular diastolic dysfunction in patients with hypertension, which makes it a good alternative tool especially in areas where echocardiography is not readily available.
Background: Contrast-Induced Nephropathy (CIN) is a serious problem that can be found in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). The development of CIN in hospitalized patients even with coronary revascularization can immediately increase morbidity and mortality both during treatment and long-term outcomes. In a recent study, a CHA2DS2-VASC-HSF score was reported to predict coronary artery severity and major cardiovascular events (MACE) as well as CIN in AMI patients without atrial fibrillation. The purpose of this study was to investigate the CHA2DS2-VASC score as a predictor of CIN in AMI patients undergoing PCI procedures. Methods: This study was an ambispective cohort study of 53 AMI patients who were treated at cardiac care and underwent PCI procedures. The CHA2DS2-VASC-HSF score was calculated for each patient. From this study found 14 cases (26.4%) with a total CIN prevalence of 16.83%. CIN is defined as an increase in serum creatinine> 0.5 mg / dL or an increase in serum creatinine> 25% from baseline within 24 hours post PCI. Results: Through the analysis of the ROC curve, we established the CHA2DS2- VASC-HSF score cut point> 5 as a predictor of CIN with a sensitivity of 78.57% and specificity of 66.6 %% (AUC 0.818, 95%: CI 3.018-6.142, p <0.001). By getting the equation from the linear regression assessment we also found the probability of the occurrence of CIN in accordance with the CHA2DS2-VASC-HSF score. Conclusion: CHA2DS2-VASC score has a positive correlation with CIN. Therefore, this score can be used as a simple scoring system and can predict the incidence of CIN in AMI patients undergoing PCI procedures.
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