Sally Aman Nasution

The clinical factors' prediction of increased intradialytic QT dispersion on the electrocardiograms of chronic hemodialysis patients.

Ventricular arrhythmias and sudden death are common in patients on maintenance hemodialysis (HD). The increase in QT dispersion (QTd) on the electrocardiogram (ECG) reflects increased tendency for ventricular repolarization that predisposes to arrhythmias. The purpose of the study was to identify the clinical factors that may predict the increased intradialytic QTd and to assess differences in QTd before and after HD. Each of 61 chronic HD patients underwent 12-lead ECG and blood pressure (BP) measurement before and every 1 h during a single HD session. The QT intervals were corrected for heart rate using Bazetts formula. Intradialytic QTd increased in 30 (49%) patients. There was no correlation between the increased QTd and the clinical factors including hypertension, pulse pressure, intradialytic hypotension, left ventricular hypertrophy, old myocardial infarct, diabetes mellitus, and nutritional status. The means of QT interval and QTd increased after HD session (from 382 ± 29 to 444 ± 26 ms, P <0.05; and from 74 ± 21 to 114 ± 53 ms, respectively, P <0.05). We conclude that the increased intradialytic QTd could not be predicted by any of the clinical factors evaluated in this study. There was significant difference in the means of QTd before and after HD session.

Diagnostic Test of Platelet Lymphocyte Ratio for Screening of Complex Coronary Lesion in Different Age Group of Acute Coronary Syndrome

Background: Increasing of ACS case with complex coronary lesion and in increase needs of CABG, we need tools to help in stratification of high risk patient that can be used in daily clinical practice, and even can be used in first line of health care facilities in Indonesia. By doing early stratification of high risk patient, hopefully it can decrease the morbidity and mortality in ACS cases. Aim: Evaluate diagnostic accuracy of PLR in identifying a complex coronary lesion and optimal cut-off point of PLR between ≤ 45 years old group and >45 years old group subjects. Method: This is a cross sectional study which was conducted retrospectively in ACS patients from January 2012 until July 2015. The inclusion criteria are adult ACS patients (age ≥18 years old) diagnosed with ACS and who underwent coronary angiography during hospitalization. The diagnostic accuracy was determined by calculating the sensitivity, specificity, Positive Likelihood Ratio (LR+), and Negative Likelihood Ratio (LR-). The cut-off point was determined using ROC curve. Results: The proportion of complex coronary lesion in this study was 47.2%. The optimal cut-off point in ≤ 45 year’s old group was 111.06 with sensitivity, specificity, LR+, and LR─ respectively 91.3%, 91.9%, 11.27 and 0.09. The optimal cut-off points in >45 years old groups was 104,78 with sensitivity, specificity, LR+, and LR─ respectively 91.7%, 58.6%, 2.21 and 0.14. Conclusion: The optimal cut-off point of ≤ 45 years old groups is 111.06 and for >45 years old group is 104.78 with AUC 93.9% (p<0.001) 77.3% (p<0.001), respectively.