The prevalence of heart failure with preserved ejection fraction (HFpEF) accounts for more than 50% of patients with heart failure (HF) and tends to increase with a prognosis as bad as that of HF with reduced ejection fraction (HFrEF) (1-6). Till date, no therapy has been demonstrated to improve mortality in patients with HFpEF including several large prospective, randomized controlled trial such as angiotensin converting enzyme inhibitor (ACE-I) perindopril (PEP-CHF) (7), angiotensin II receptor blockers (ARBs) candesartan (CHARM-Preserved) (8) and irbesartan (I-PRESERVE) (9), aldosterone receptor blockers spironolactone (TOPCAT (10) and Aldo-DHF (11)), and beta blocker (SENIORS) (12). Recent studies have shown that bioenergetic deficiency is involved in the pathophysiology of HFpEF and that these changes lead to myocardial remodeling and dysfunction (13). Patients with HFpEF show abnormalities in myocardial energetics in the formation of adenosine triphosphate (ATP) and movement between phosphocreatine and ATP through creatine kinase reactions. Phan et al. (14,15) found a significant reduction in the phosphocreatine/ATP ratio of patients with HFpEF compared to that in controls. Summary Heart failure with preserved ejection fraction (HFpEF) is a leading cause of morbidity and mortality without an established treatment. Diastolic dysfunction, the hallmark of HFpEF, is associated with altered myocardial bioenergetics. No previous study has examined the effects of coenzyme Q10 (CoQ10) on left ventricle (LV) diastolic function in patients with HFpEF. We investigated whether CoQ10 could improve LV diastolic function in patients with HFpEF. We performed a randomized controlled trial (RCT) using pretest and posttest control groups of 30 patients with HFpEF. The patients received either CoQ10 100 mg three times a day or no CoQ10 in addition to routine treatment for 30 days. Echocardiographic study was performed at baseline and follow-up. LV diastolic function was evaluated by two dimensional and Doppler echocardiography as follows; average E/e‫,׳‬ septal and lateral e‫׳‬ velocity, and left atrium volume index (LAVI). A total of 28 patients completed the study. A statistically significant improvement was observed in the CoQ10 treatment group in terms of average E/e‫׳‬ (18.9 (3.8) vs. 15.1 (4.3); p < 0.01) and LAVI (32 (9) mL/m 2 vs. 26 (7) mL/m 2 ; p < 0.05) and in the control group (18.4 (3.1) vs. 15.8 (5.6); p < 0.05) and (33 (7) mL/m 2 vs. 30 (8) mL/m 2 ; p < 0.05, respectively). However, there was no difference in change reduction between groups (∆E/e‫׳‬-3.6 vs.-2.4; p = 0.28) and (∆LAVI-5.4 vs.-4.4; p = 0.83). Short term CoQ10 supplementation provided no additional benefits in improving LV diastolic function in patients with HFpEF.

Background: small dense Low Density Lipoprotein (sdLDL) was the most atherogenic lipoprotein. Its influenced by internal and external factors including food consumption. Indonesian people mostly take a diet of high carbohydrate (CH) and fried food that believed to correlate with higher sdLDL level and predisposed to Coronary Heart Disease (CHD). There were 2 types of CH based on the processing ways, refined and non-refined CH.Objectives: The study’s purpose was to prove the correlation between different types of CH and fat intake with the sdlDL level in CHD patients.Methods: cross sectional in CHD patients hospitalized at Dr Kariadi hospital. The sdLDL and others lipid profile examined. The type and amount of CH and fat intakes per-day were collect from an interview using semi-quantitative food frequency questionnaire (SQFFQ) and food models. Pearson and Spearman test used for bivariate analysis. Confounding factors age, gender, physical activity, diabetes mellitus and smoking were analyzed. Variables with p<0,25 was included in multivariate analysis using linear regression test.Results: There were 30 samples with CHD came with acute coronary syndrome (ACS). Mean of total CH intake per day was 267.75 gram. Mean of percentage of CH from total calories per day was 55.93%. This number was higher than advised which is 30-130 gram or <45% of total calorie per day. Mean of refined and non-refined CH intake was 161.80 and 57.81 gr/day. The total CH mostly from refined CH (76%) rather than non-refined. Mean of fat intake was 68 gr/day (32.76% of total energy per day), and the mean of sdLDL level was 26,54 mg/dl. Correlation between refined CH vs non-refined CH with the sdLDL levels (r=0.328; p=0.077 vs r=-0.184;p=0.331). Correlation between fat intake and sdLDL levels (r=0.44;p=0.15). Multivariate analysis was analyzing refined CH fat intake and age with sdLDL level (r=0,28;p=0,13 vs r=0.45;p=0.01 vs r=-0.15;p=0.44). There is significant correlation between fat intake and sdLDL levels with r=0.45Conclusion: There was a significant correlation between fat intake and sdLDL levels in CHD patients. There is no significant correlation between refined and non-refined carbohydrates with sdLDL levels in CHD patients.

Background: Breast cancer is a malignancy originating from breast tissue, where chemotherapy is one of the choice therapy. Doxorubicin, 5-fluorouracil, and cyclophosphamide (FAC) are the most commonly used combination of chemotherapy. One of the side effects of chemotherapy is cardiotoxicity. Multiflora honey prevents cardiotoxic effects through its flavonoids and polyphenols compounds. The aim of this research is to analyze the effectiveness of adding honey in preventing cardiotoxic effects in breast cancer patients receiving FAC chemotherapy. Methods: An experimental study with double-blind randomized pre and post-test with control group design. Ductal invasive breast cancer patients were divided into 2 groups, the control group, who received FAC chemotherapy (n=18) and the treatment group, who received chemotherapy and 90 ml/day honey consumption for 14 days (n=18). The patient's Troponin I and NT-proBNP enzyme levels before and after 14 days of the study were assessed. Results: Post-treatment, there was an increase in Troponin I levels from the treatment group (0.22 ± 0.07 vs. 0.24 ± 0.07) vs. control (0.25 ± 0.11 vs. 0.34 ± 0.20) with a significant difference. (p = 0.031). There was a decrease in NT-proBNP levels in the treatment group (461.0 ± 610.4 vs. 215.6 ± 260.3) and an increase in NT-proBNP levels (275.9 ± 392.4 vs. 315.4 ± 293.9) with a significant difference (p = 0.006). Conclusion: Multiflora honey can prevent cardiotoxic effects in breast cancer patients receiving FAC chemotherapy.

Background: Physical exercise in patients with heart failure maydecrease the level of proinflammatory biomarkers,increase maximal oxygen consumption, improve pulmonary function and quality of life. Circuit training is one of the most advantageous exercise models because it improves cardiorespiratory fitness and muscle strength. Objective: This study was aimed to investigate the effect of circuit training on proinflammatory biomarkers, functional capacity, pulmonary function, and quality of life in patients with chronic heart failure in RSUP Dr. Kariadi Methods: Twenty-six stable chronic heart failure with reduced ejection fraction patients were randomized into exercise group that received circuit training in the rehabilitation center of Kariadi Hospital for a month and control group. TNF- ? levels, maximum oxygen consumption, pulmonary function, and quality of life were taken before and after the exercise period. Data between two groups was analyzed with the Mann-Whitney test. Pre and post data was analyzed with the Wilcoxon test.  Results: Nine-teensubjects completed the study without any significant side effects.There was no significant difference in TNF-? levels before and after treatment between treatment groups and control groups (p=0,513). The treatment group with circuit training showed a greater increase in maximum oxygen consumption (p=0,034), greater increase in Forced Vital Capacity value(p=0,010) and a greater increase in quality of life score(p=0,047)than the control group. Conclusion: Circuit training in patients with chronic heart failure can increase maximal oxygen consumption, lung function, and quality of life, but no changes in inflammatory biomarkers. Keywords: Circuit training, TNF-a, maximal oxygen consumption, FVC, quality of life   Latar belakang: Latihan fisik pada pasien gagal jantung dapat menurunkan kadar biomarker proinflamasi, meningkatkan konsumsi oksigen maksimal, memperbaiki fungsi paru dan meningkatkan kualitas hidup. Latihan sirkuit merupakan salah satu model latihan fisik yang lebih menguntungkan karena mampu memperbaiki kebugaran kardiorespirasi dan kekuatan otot sekaligus. Tujuan:Menganalisispengaruh latihan sirkuit terhadap biomarker inflamasi, kapasitas fungsional, fungsi parudan kualitas hiduppasien gagal jantung kronik di RSUP Dr.Kariadi. Metode:Dua puluh enam pasien gagal jantung kronik stabil dengan penurunan fraksi ejeksi ventrikel kiri dirandomisasi menjadi kelompok yang  mendapatkan latihan sirkuit di bagian rehabilitasi RSUP Kariadi selama 1 bulan dan kelompok kontrol. Kadar TNF-a, nilai konsumsi oksigen maksimal, fungsi paru, dan kualitas hidupdiambil sebelum dan sesudah periode latihan. Analisis data antara dua kelompok menggunakan uji Mann-Whitney.Analisis data pre dan post, menggunakan uji Wilcoxon Hasil: Sembilan belas subjek menyelesaikan studi tanpa ada efek samping.Tidak didapati perubahan kadar TNF-a sesudah latihan sirkuit (p=0,513);Kelompok perlakuan dengan latihan sirkuit menunjukkan peningkatan konsumsi oksigen maksimal yang lebih besar (p=0,034), rerata peningkatan nilai FVC (Forced Vital Capacity) setelah latihan yang lebih besar (p=0,010), sertarerata peningkatan kualitas hidup yang lebih besar (p=0,047) dibandingkan kelompok kontrol. Simpulan: Latihan sirkuit pada pasien gagal jantung kronik dapat meningkatkan konsumsi oksigen maksimal, fungsi paru, dan kualitas hidup, namun tidak menyebabkan perubahan padabiomarker inflamasi. Kata Kunci: Latihan sirkuit, TNF-a, konsumsi oksigen maksimal, FVC, kualitas hidup