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PENYULUHAN DENGAN MEDIA AUDIO VISUAL DAN METODE CERAMAH DAPAT MENINGKATKAN PENCEGAHAN TUBERKULOSIS Yanti, Budi; Heriansyah, Teuku; Riyan, Muhammad
Jurnal Ilmu Kesehatan Masyarakat Vol 18 No 3 (2022)
Publisher : Fakultas Kesehatan Masyarakat, Universitas Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19184/ikesma.v18i3.27147

Abstract

Abstrak Tuberkulosis merupakan suatu penyakit menular yang disebabkan oleh Mycobacterium tuberculosis. Provinsi Aceh termasuk kedalam delapan besar angka kejadian tuberkulosis tertinggi di Indonesia. Penyakit ini menjadi ancaman khusus bagi tempat tertentu dengan lingkungan yang padat. Penelitian ini bertujuan untuk menilai perbedaan metode penyuluhan terhadap peningkatan pengetahuan, sikap dan perilaku pencegahan penyakit tuberkulosis. Penelitian ini menggunakan rancangan quasi eksperimen Non Equivalent control group dengan dua kelompok yaitu kelompok perlakuan dan kontrol pada santri laki-laki kelas sepuluh di Dayah Terpadu Inshafuddin Banda Aceh. Perlakuan yang diberikan adalah penyuluhan melalui penyampaian materi dengan media audio visual melalui metode ceramah yang dijelaskan langsung oleh dokter ahli. Waktu yang digunakan untuk penyuluhan ini berlangsung selama 1 jam dengan menggunakan peralatan presentasi seperti proyektor, sementara pada kelompok kontrol penyuluhan hanya menggunakan leaflet. Penelitian ini telah mengumpulkan keseluruhan responden yaitu 60 santri tingkat Sekolah Menengah Atas terdiri dari 30 santri laki-laki pada kelompok perlakuan dan 30 santri laki-laki pada kelompok kontrol dan ditemukan paling banyak usia 15 tahun (85%). Pada kelompok perlakuan didapatkan peningkatan pengetahuan; skor maksimal (18) sebelum perlakuan dan skor maksimal (20) sesudah perlakuan, peningkatan sikap; skor maksimal (63) sebelum perlakuan dan skor maksimal (86) sesudah perlakuan, dan peningkatan perilaku skor maksimal (62) sebelum perlakuan dan skor maksimal (86) sesudah perlakuan. Penelitian ini menunjukkan perbedaan signifikan peningkatan pengetahuan, sikap, dan perilaku setelah diberikan perlakuan (p<0.05). Penyuluhan menggunakan media audio visual melalui metode ceramah dapat meningkatkan pengetahuan, sikap dan perilaku pencegahan TB di lingkungan pesantren sehingga hal ini dapat membantu program pengendalian TB Nasional. Kata Kunci: Penyuluhan, Tuberkulosis, Pengetahuan, Sikap, Perilaku
Correlation between high sensitivity C reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity in post COVID-19 syndrome patients Widasari, Nina; Heriansyah, Teuku; Ridwan, Muhammad; Munirwan, Haris; Kurniawan, Ferry D.
Narra J Vol. 3 No. 2 (2023): August 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i2.183

Abstract

Post coronavirus disease 2019 (COVID-19) syndrome is one of the causes of reduced functional capacity and work productivity, in particular for healthcare workers. The pathophysiology of the post COVID-19 syndrome is related to complex and multisystem inflammatory mechanisms, and cardiopulmonary exercise rehabilitation program is one of the efforts to improve the recovery process for patients with post COVID-19 syndrome. The aim of this study was to determine the correlation between the level of high sensitivity C-reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity (VO2max) in individuals with post-COVID-19 syndrome who received moderate- and high-intensity supervised cardiopulmonary exercise. A prospective cohort study was conducted at the Integrated Cardiac Rehabilitation Center of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The supervised cardiopulmonary exercise was conducted for six weeks according to the participant's baseline VO2max. Spearman's and Pearson's correlation tests were used to assess the correlations. A total of 30 individuals (19 and 11 had moderate and high intensity exercise, respectively) were involved in this study. At moderate intensity exercise, the average Hs-CRP and NLR were 3.3 mg/L and 1.99, respectively; while at high intensity, the values were 3.8 mg/L and 1.79, respectively. No significant correlation between Hs-CRP level and functional capacity in both moderate-intensity and high intensity groups. In contrast, NLR was negatively correlated with functional capacity (r=-0.545, p=0.016) in moderate intensity exercise group. In conclusion, NLR value was negatively correlated with functional capacity in individuals with post-COVID-19 syndrome after receiving moderate intensity supervised cardiopulmonary exercise program. Therefore, moderate intensity of cardiopulmonary exercise maybe be used as a program to accelerate the recovery for those with post COVID-19 syndrome.
Association between six-minute walk distance and prognosis of atherosclerotic coronary heart disease post-cardiac rehabilitation Ridwan, Muhammad; Sari, Indah P.; Salawati, Liza; Heriansyah, Teuku; Taufiks, Nasyaruddin H.; Putri, Cut JE.; Nurjani, Nurjani
Narra J Vol. 3 No. 3 (2023): December 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i3.242

Abstract

Plaque accumulation in the coronary arteries is a major cause of coronary heart disease (CHD), a disease infamously known as a contributor for global death burden. Major adverse cardiac events (MACE) pose significant risks for CHD patients, highlighting the urgency of effective management and cardiac rehabilitation in CHD management. Studies have reported the role of the six-minute walk distance (6MWD) test in predicting outcomes for CHD patients; however, none have performed the investigation in Aceh setting. The aim of this study was to investigate the reliability of 6MWD as a prognostic factor for post-cardiac rehabilitation of patients with atherosclerotic CHD. A cross-sectional study was conducted in Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. MACE was determined through in-person interviews, and phone calls with 30 atherosclerotic CHD patients who completed cardiac rehabilitation between August 2018 and September 2020. The association between 6MWD and prognosis, assessed by MACE incidence, was calculated. The results revealed that 6MWD was strongly associated with MACE occurrence during post-cardiac rehabilitation (p=0.029; prevalence ratio 4.5). Furthermore, CHD patients achieving 6MWD of more than 300 meters exhibited a lower incidence of MACE (10.5%) than patients with 6MWD of less than 300 meters (45.5%). In conclusion, the present study sheds light on the importance of improving functional capacity in patients with atherosclerotic CHD post-cardiac rehabilitation due to its significant association with the prognosis.
Association between NT-proBNP level and the number of stents with major advanced cardiovascular events (MACE) in patients with multivessel coronary artery disease treated with percutaneous coronary intervention: A prospective cohort study Subkhan, Muhammad; Heriansyah, Teuku; Munirwan, Haris; Purnawarman, Adi; Dimiati, Herlina
Narra J Vol. 4 No. 1 (2024): April 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i1.710

Abstract

Complex revascularization strategies, particularly complete revascularization, are controversial in coronary artery disease (CAD), and data supporting routine revascularization in stable CAD is lacking. The importance of percutaneous coronary intervention (PCI) in CAD and N-terminal pro-brain natriuretic peptide (NT-proBNP), which has been studied as a predictor of major advanced cardiovascular events (MACE) in CAD patients, still requires further research. The aim of this study was to determine the association between NT-proBNP levels and the number of stents with MACE incidence in CAD cases. A prospective cohort study was conducted in both types of CAD (acute coronary syndrome (ACS) and chronic coronary syndrome (CCS)). The NT-proBNP levels were measured pre- and post-PCI using fluorescence immunoassay, while MACE was assessed three months post-PCI. The Student t-test was used to compare the levels of NT-proBNP between pre- and post-PCI and between those who had MACE and did not; both in patients treated with single or multiple stenting groups. A total of 32 CAD patients were recruited, consisting of 20 ACS cases and 12 CCS cases. NT-proBNP levels post-PCI increased significantly in both ACS and CCS patients compared to pre-PCI either among those treated with single and multiple stentings. MACE occurred in 4 (12.5%) out of a total of 32 patients, all of which occurred in ACS patients treated with multiple stentings. Those who had MACE had higher post-PCI NT-proBNP levels compared to those who did not have MACE (23,703.50 vs 11,600.17 pg/mL, p=0.013). This study highlights the association between elevated NT-proBNP levels and multiple stenting with the presence of MACE in CAD patients, particularly in ACS cases.
Immunoexpression of aortic endothelial P-selectin and serum apolipoprotein A-1 levels after administration of arabica (Coffea arabica) and robusta (Coffea canephora) coffee bean extracts: In vivo study in atherosclerosis rat model Ekawati, Wahyu; Heriansyah, Teuku; Kamarlis, Reno K.; Purnawarman, Adi; Sofyan, Hamny; Enitan, Seyi S.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.794

Abstract

Atherosclerosis is a leading cause of cardiovascular disease-related death worldwide. Some studies suggested that the natural ingredients in coffee may negatively affect cardiovascular diseases, while other studies indicated that coffee contains anti-inflammatory compounds that are beneficial for cardiovascular diseases. The aim of this study was to measure the expression of P-selectin in aortic endothelial cells and the level of serum apolipoprotein A-1 (ApoA-1) in an atherosclerosis rat model after the administration of arabica and robusta coffee bean extracts at mild-moderate and high doses. An experimental study was conducted with a complete randomized design using 36 adult male white rats (Rattus norvegicus) divided into six groups: negative control (NC), positive control (PC), arabica mild-moderate dose (A1), arabica high dose (A2), robusta mild-moderate dose (R1), and robusta high dose (R2). Animals were induced atherosclerosis with atherogenic feed and then were treated with arabica and robusta coffee bean extracts at two different doses for four weeks. The results showed that the expression of P-selectin in the group of rats treated with robusta coffee bean extract was lower than arabica coffee bean extract group. Rats with robusta coffee bean extract mild-moderate dose had the highest ApoA-1 levels compared to other groups significantly (p<0.05). The level of ApoA-1 was higher in both mild-moderate and high dose of robusta coffee groups compared to the negative control group (both with p<0.001). In conclusion, mild-moderate intake of robusta coffee bean extract could reduce aortic P-selectin immunoexpression and increase serum ApoA-1 levels in an atherosclerosis rat model.
Perbandingan Pemberian Dexmedetomidine dengan Fentanyl Intraoperatif terhadap Kedalaman Anestesia dan Kecepatan Pemulihan pada Operasi Bedah Saraf Jasa, Zafrullah Kany; Heriansyah, Teuku; Muttaqin, Muttaqin
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (292.219 KB) | DOI: 10.24244/jni.v11i2.463

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Latar Belakang dan Tujuan: Anestesi bebas opioid merupakan diskusi baru dalam dunia anestesi. Bukti menunjukkan bahwa opioid memiliki efek samping yang tidak diinginkan. Dexmedetomidine merupakan suatu reseptor agonis a2-adrenergik selektif yang memiliki efek sparing opioid serta kecepatan pulih sadar anestesi yang lebih baik. Penelitian ini bertujuan membandingkan efektifitas dexmedetomidine dan fentanyl terhadap kedalaman anestesi dan pemulihan pasca anestesi pada operasi bedah saraf supratentorialSubjek dan Metode: Total 40 sampel penelitian dibagi menjadi 2 grup: A (Dexmedetomidine) dan B (Fentanyl) dengan total sampel 20 pada tiap grup. Kedua grup dilakukan pemasangan alat bispectral index (BIS) selama pembedahan. Kedua grup akan dinilai kecepatan pemulihan pasca anestesi sejak obat anestesi dihentikan.Hasil: Berdasarkan uji statistik didapatkan hasil bahwa penggunaan dexmedetomidine dan fentanyl memiliki efek anestesi optimal, dimana tidak terdapat perbedaan signifikan di antara keduanya dalam hal mencapai level anestesi optimal berdasar indeks BIS. Didapatkan pula hasil waktu pulih pasca anestesi dexmedetomidine lebih cepat dibandingkan pemberian fentanyl, dengan perbedaan waktu 5,10 menit (p0,05), dengan terdapat perbedaan signifikan kecepatan pulih pasca anestesi antara penggunaan dexmedetomidine dan fentanyl.Simpulan: Penggunaan dexmedetomidine pada operasi bedah saraf supratentorial memiliki kecepatan waktu pulih pasca anestesi yang lebih baik dibandingkan fentanylComparison of Dexmedetomidine Administration with Intraoperative Fentanyl to The Depth of Anesthesia and Recovery Speed in NeurosurgeryAbstractBackground and Objective: Opioid free anesthesia is a new discussion in the world of anesthesia. The available evidence suggests that opioids also have unintended effects. Dexmedetomidine is a selective 2-adrenergic receptor (?2-AR) agonist drug, that this drug has an opioid-sparing effect, and a faster recovery rate after anesthesia. To compare the effectiveness of dexmedetomidine and fentanyl on the depth of anesthesia and post-anesthesia recovery in supratentorial neurosurgery operations.Subject and Methods: A total of 40 research samples was divided into 2 groups, namely group A (Dexmedetomidine) and group B (Fentanyl). The number of research samples in each group was 20 people. Both groups of patients will be fitted with a bispectral index (BIS) during surgery. Both groups will measure the post-anesthesia recovery time since the anesthetic drug was discontinuedResults: Based on statistical tests, it was found that the use of dexmedetomidine and fentanyl had an optimal anesthetic effect, where there was no significant difference between these two anesthetic agents in achieving optimal anesthetic levels based on the BIS Index. From statistical analysis was found that post-anesthesia recovery time on dexmedetomidine was faster than the administration of fentanyl, with a difference of 5.10 minutes (p0.05) with statistically significant difference in the speed of post-anesthesia recovery between the use of dexmedetomidine and fentanyl.Conclusion: The use of dexmedetomidine in supratentorial neurosurgical surgery anesthesia has a faster post- anesthesia recovery time than the use of fentanyl.
ACE inhibitors versus angiotensin receptor-neprilysin inhibitors for HFrEF management: A prospective cohort study from Indonesia Heriansyah, Teuku; Lestari, Nova D.; Hadi, Tjut F.; Novia, Rizki; Munawarah, Iffah; Taufiqurrahman, Taufiqurrahman; Yuvhendmindo, Shahcoga L.; Bashori, Ahmad A.
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.978

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Previous studies have reported that angiotensin receptor-neprilysin inhibitors (ARNI) are superior to angiotensin-converting enzyme inhibitors (ACEI) in treating heart failure with reduced ejection fraction (HFrEF). Unfortunately, previously published studies predominantly focused on Western populations, while the data remains insufficient in developing countries. The aim of this study was to compare the efficacies of ARNI and ACEI on patients with HFrEF in Indonesia. A prospective cohort study was conducted among heart failure patients at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Both ACEI and ARNI each consisted of 40 subjects receiving standard treatment for heart failure. Left ventricular ejection fraction (LVEF), quality of life (QoL), suppression of tumorigenicity 2 (ST2), and troponin T were measured upon admission and at the end of the follow-up. In addition, the occurrence of major adverse cardiac events (MACE) was observed during 6 months of follow-up. Paired t-test was used to compare the outcomes of ACEI and ARNI. The results revealed that KKCQ score and LVEF were improved in both ARNI and ACEI groups (each with p<0.001). A higher KCCQ overall score was observed in the ARNI group in contrast to the ACEI group (p=0.01). ARNI demonstrated superior results in improving the ejection fraction as compared with ACEI (p=0.001). Troponin T and ST2 levels exhibited no significant difference between the two groups (p=0.07 and 0.286, respectively). MACE-associated mortality (p=0.696) and rehospitalization (p=0.955) were identical between both groups. In conclusion, ARNI was more efficacious than ACEI in improving the quality of life and left ventricular ejection fraction of patients with HFrEF. However, the efficacy was not significantly different in reducing the risk of MACE.
Non-dominant handgrip strength is associated with higher cardiorespiratory endurance and elevated NT-proBNP concentrations in ambulatory male adult outpatients with stable HFrEF Triangto, Kevin; Radi, Basuni; Siswanto, Bambang B.; Tambunan, Tresia FU.; Heriansyah, Teuku; Harahap, Alida R.; Kekalih, Aria; Katsukawa, Hajime; Santoso, Anwar
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.1278

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Understanding the significance of handgrip strength is essential for identifying frailty in heart failure patients. The aim of this study was to identify the association between handgrip strength and cardiorespiratory endurance while highlighting the importance of the musculoskeletal system in cardiac rehabilitation for patients with heart failure. An observational cross-sectional study was conducted at Harapan Kita Hospital, Jakarta, Indonesia, from April 2022 to April 2023, among patients with heart failure with reduced ejection fraction (HFrEF) attributed to cardiomyopathy or coronary artery disease. Patients were classified by a 6-minute walk test (6MWT) distance into <400 meters (low endurance) or ≥400 meters (high endurance). The short physical performance battery (SPPB), handgrip strength, ultrasonographic forearm muscle thickness, left ventricle ejection fraction, tricuspid annular plane systolic excursion, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured. Results indicated significant differences in non-dominant handgrip strength, gait speed, and sit-to-stand SPPB scores between patients achieving a 6MWT distance of ≥400 meters and those below this threshold, with values of 31.11±6.88 kg vs 27.66±6.66 kg (p=0.049), 0.52±0.08 m/s vs 0.61±0.13 m/s (p=0.001), and 10.71±2.47 seconds vs 12.85±4.11 seconds (p=0.014), respectively. Stronger non-dominant handgrip strength (>30 kg) was associated with higher endurance (odds ratio (OR): 3.80; 95%CI: 1.35–10.67; p=0.010) and thicker forearm muscles (>1.9 cm) as measured by ultrasonography (AUC: 0.713; 95%CI: 0.585–0.840, p=0.001). In conclusion, a cut-off of ≤30 kg for non-dominant handgrip strength could effectively stratify the male patients into a lower endurance group (6MWT ≤400 meters), which is associated with elevated NT-proBNP levels and reduced forearm muscle thickness.
Protokol Latihan BEST yang Disesuaikan dalam Rehabilitasi Gagal Jantung Triangto, Kevin; Radi, Basuni; Siswanto, Bambang Budi; Tambunan, Tresia Fransiska Ulianna; Heriansyah, Teuku; Harahap, Alida Rosita; Kekalih, Aria; Ambari, Ade Meidian; Dwiputra, Bambang; Desandri, Dwita Rian; Katsukawa, Hajime; Santoso, Anwar
Jurnal Kardiologi Indonesia Vol 45 No 3 (2024): July - September, 2024
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1738

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Introduction Heart failure with a reduced ejection fraction (HFrEF) significantly contributes to global morbidity and mortality, necessitating effective rehabilitation programs. Exercise-based rehabilitation improves functional capacity and quality of life in HFrEF patients, though responses vary. The tailored BEST (Breathing, Endurance, and Strengthening) exercise protocol addresses both cardiac and extracardiac rehabilitation, benefiting all patients regardless of response status. This study evaluated the protocol's effects on HFrEF patients and classified responses based on VO2max changes. Methods In this etiologic study with prospective cohort design, all participants underwent a three-month cardiac rehabilitation program using the BEST Exercise Protocol. Assessments included the 6-minute walk test (6MWT), short physical performance battery (SPPB), handgrip strength, chest expansion, ultrasonographic measurements, and NT-proBNP levels before and after the intervention, with statistical comparisons made within and between groups. Groupings of responder level will be reliant on 6MWT distance achievement at the end of the program, with ≥6% improvement classified as good responders. Results Out of 107 HFrEF patients (median age 55 years, ejection fraction 29.50±7.34%), 63.56% were good responders and 36.44% were poor responders (<6% improvement). Good responders showed significant improvements in most extracardiac parameters, including a 20% increase in 6MWT distance (470.96±69.21 meters post-rehabilitation), chest expansion, handgrip strength, and SPPB scores (p<0.001 for all). Poor responders also improved in chest expansion, sit-to-stand time, and postural balance, with minor 6MWT gains (407.33±72.50 meters). NT-proBNP levels decreased in both groups but were not statistically significant (p=0.288 and 0.368 for good and poor responders, respectively). Conclusion The tailored BEST Exercise Protocol offers substantial cardiac and extracardiac benefits for HFrEF patients by enhancing functional capacity and muscle strength. Both good and poor responders exhibited significant improvements, indicating the protocol's broad applicability. However, the lack of statistically significant NT-proBNP reduction suggests further studies on cardiac biomarkers are needed. The 6MWT provides accessible rehabilitation insights, though more precise evaluations like Cardiopulmonary Exercise Testing (CPET) can offer clearer insights into cardiopulmonary adaptations.
Exploring the Relationship Between Comprehensive Respiratory Assessment and Intra-Extracardiac Biomarkers in Heart Failure Rehabilitation Triangto, Kevin; Radi, Basuni; Siswanto, Bambang B.; Tambunan, Tresia FU.; Heriansyah, Teuku; Harahap, Alida R.; Kekalih, Aria; Katsukawa, Hajime; Santoso, Anwar
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v8i-.248

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Introduction: Heart failure with reduced ejection fraction (HFrEF) is well-known as a systemic disease that involves cardiac and extracardiac issues, with respiratory function playing on of the key role in rehabilitation prognosis. Biomarkers such as soluble suppression of tumorigenicity 2 (sST2), myostatin, miRNA-133, and NT-proBNP indicate disease progression. Notably, sST2, which is also produced by the lungs, predicts heart failure outcomes. This study examines the relationship between comprehensive respiratory assessments (e.g., diaphragmatic ultrasonography, spirometry) and intra-extracardiac biomarkers to improve rehabilitation strategies. Methods: Sixty-nine HFrEF patients underwent respiratory evaluations, including diaphragmatic ultrasonography, spirometry, chest expansion measurements, and a six-minute walking test (6MWT). Biomarkers assessed were sST2, myostatin, miRNA-133, and NT-proBNP. Associations between respiratory parameters and biomarkers were analyzed using t-tests and correlation analyses. Results: The median age was 56 years, and 33 (47.82%) of the subjects had diaphragmatic dysfunction, resulting in poorer 6MWT performance (378.03±58.15 m vs 409.75±63.65 m, p=0.017) and other parameters. Superior chest expansion negatively correlated with sST2 (r=−0.387, p=0.001) and positively with miRNA-133 (r=0.442, p<0.001). Similar results were found for inferior chest expansion. No significant correlations were observed for other biomarkers. Conclusion: This study highlights strong associations between chest expansion and sST2/miRNA-133, suggesting that incorporating respiratory assessments and training into HFrEF rehabilitation could enhance outcomes by addressing cardiorespiratory insufficiencies. Given sST2's predictive value for heart failure prognosis, these findings support a multi-component rehabilitation strategy incorporating respiratory training, such as aerobic and inspiratory muscle exercises, to enhance cardiopulmonary outcomes. This integrated approach offers promise for future HFrEF rehabilitation protocols.