Proving the Role of Diabetes Mellitus in Heart Failure Patients, Oliva Saraswati Earns a Doctoral Degree

 

Located in dr. A A. Made Djelantik Lt IV, Udayana University Faculty of Medicine Building, Denpasar, the Doctoral Promotion exam has taken place with promovenda candidate dr. Luh Oliva Saraswati Suastika, Sp.JP(K), FIHA., with the dissertation title "Differences in Levels of HS-Troponin I, Galectin-3, and Cartilage Intermediate Layer Protein-1 Serum in Heart Failure Patients with Decreased Ejection Fraction with Type Diabetes Mellitus 2 Compared Without Type 2 Diabetes Mellitus." (9/5/2023)

 

In heart failure with reduced ejection fraction (HFrEF) cardiomyocyte death and myocardial fibrosis occur which causes a decrease in left ventricular ejection fraction (LVEF). Type 2 diabetes mellitus (DMT2) is thought to exacerbate cardiomyocyte death and myocardial fibrosis, characterized by changes in circulating levels of high sensitive (hs)-troponin I, galectin-3 and cartilage intermediate layer protein-1 (CILP-1). This study aims to determine differences in serum levels of hs-troponin I, galectin-3 and CILP-1 in HFrEF patients with and without T2DM; and the effect of DMT2 on LVEF changes through these three biomarkers in HFrEF patients.

 

This study involved a total of 80 HFrEF patients (43 subjects with DMT2 and 37 subjects without DMT2) who visited the Cardiac Polyclinic at Prof. Hospital. I.G.N.G. Ngoerah, Denpasar, Bali. Galectin-3, CILP-1 and NT-proBNP levels were examined using an enzyme-linked immunosorbent assay (ELISA), hs-troponin I levels were examined with an Abbott automated assay. LVEF examination used a Philips Epiq 7 echocardiography machine. Differences in biomarker levels were analyzed with the Mann-Whitney U test and effect test with the partial least square-structured equation model (PLS-SEM).

 

The levels of hs-troponin I, galectin-3 and CILP-1 did not differ between subjects with and without T2DM. Type 2 diabetes mellitus has a direct effect on NT-proBNP. Meanwhile, NT-proBNP has a direct effect on galectin-3 and CILP-1, and an indirect effect on CILP-1 through galectin-3. Neither DMT2 nor NT-proBNP had any effect on hs-troponin I. Hs-troponin I and CILP-1 had a direct effect on LVEF. The effect of total DMT2 on LVEF was very weak over NT-proBNP, galectin-3 and CILP-1.

 

In HFrEF, there was no difference in hs-troponin I, galectin-3 and CILP-1 levels between patients with and without T2DM. However DMT2 affects LVEF via NT-proBNP, galectin-3 and CILP-1. This study shows that DMT2 does not cause cardiomyocyte death and more severe myocardial fibrosis in HFrEF, but DMT2 affects myocardial fibrosis and left ventricular systolic function through a process of myocardial stretching.

 

The exam was led by the Dean of FK Unud, Dr. dr. Komang Januartha Putra Pinatih, M.Kes., with the testing team:

1. Dr. dr. I Gde Raka Widiana, Sp.PD-KGH) (Promoter)

2. Prof. Dr. dr. I Wayan Wita, Sp.JP (K) (Co-promoter I)

3. Dr. dr. Agung Pranoto, Sp.PD-KEMD., FINASIM., M.Sc (Co-promoter II)

4. Dr. dr. I Made Jawi, M. Kes

5. Prof. Dr. dr. Yudi Her Oktaviono, Sp.JP(K),MM

6. Dr. dr.A.A.Wiradewi Lestari, Sp.PK(K)

7.Dr. dr. Urged Made Wihandani, M.Kes

8.Dr. dr. Dyah Kanya Wati, Sp.A (K)

9.Dr. err. nat. dr. Ni Nyoman Ayu Dewi, M.Sc

10. dr. Ni Nengah Dwi Fatmawati, S.Ked., Sp.MK(K).,Ph.D

 

While academic invitations are:

1.Dr. dr. Luh Made Mas Rusyati, Sp.KK(K)

2.Dr. dr. Yenny Kandarini, Sp.PD-KGH(K)

3.Dr. dr. Ni Wayan Winarti, S.Ked.,Sp.PA

4.Dr. dr. I Wayan Eka Sutyawan, Sp. M(K)

5.Dr. dr. I Made Pande Dwipayana, Sp. PD-KEMD, FINASIM

In this exam, Dr. dr. Luh Oliva Saraswati Suastika, Sp.JP(K), FIHA was declared to have graduated as the 377th Doctor Graduate of the Doctoral Degree in Medical Sciences, Faculty of Medicine, Udayana University with the title of Cumlaude