HUBUNGAN AREA KATUP MITRAL DENGAN HIPERTROFI VENTRIKEL KANAN BERDASARKAN SKOR KRITERIA UTAMA BUTLER-LEGGETT PADA PASIEN STENOSIS MITRAL

FENDY ANDRA FAHREZA, dr. Erika Maharani, Sp.JP (K); dr. Hasanah Mumpuni, Sp.PD, Sp.JP (K)

2017 | Skripsi | S1 PENDIDIKAN DOKTER

Latar Belakang: Stenosis mitral merupakan salah satu penyakit kardiovaskuler yang disebabkan oleh reaksi peradangan akibat bakteri Streptokokus β hemolitikus grup A. Penyempitan katup menyebabkan peningkatan tekanan pada atrium kiri, sirkulasi pulmoner, hingga mencapai ventrikel kanan. Afterload ventrikel kanan meningkat dan kondisi ini dikompensasi dengan hipertrofi ventrikel kanan. Hipertrofi akan mengakibatkan pembesaran ukuran ventrikel kanan dan dapat mengubah gambaran aktivitas kelistrikan jantung. Perubahan ini terdeteksi oleh elektrokardiografi yang merupakan alat diagnostik yang terjangkau, murah, dapat dioperasikan dan diinterpretasikan oleh dokter umum. Salah satu kriteria hipertrofi ventrikel kanan yang dapat digunakan untuk kasus stenosis mitral adalah skor kriteria utama Butler-Leggett. Tujuan: Mengetahui hubungan antara area katup mitral dengan hipertrofi ventrikel kanan berdasarkan skor kriteria utama Butler-Leggett. Hasil: Sampel berjumlah 67 orang, diantaranya terdapat 49 (73,13%) perempuan dan delapan belas (26,87%) laki-laki. Rentang usia subjek penelitian 18-68 tahun dengan rerata 44,4 ± 11,34 tahun. Indeks massa tubuh subjek penelitian memiliki median 20,81 cm2 (RK 95%: 20,66-22,76). Derajat keparahan SM didominasi pada derajat berat (71,64%), diikuti derajat sedang (22,39%) dan ringan (5,97%). Sebesar lima belas pasien (22,39%) memiliki stenosis mitral isolated. Area katup mitral subjek penelitian memiliki median 0,8 cm2 (RK 95%: 0,76-0,92 cm2). Hasil perhitungan skor kriteria utama Butler-Leggett memiliki median 0,7 mV (RK 95%: 0,68-1,13 mV). Hubungan antara kedua variabel memiliki bernilai negatif dengan koefisien korelasi (r) sebesar -0,219 dengan nilai p = 0,037. Koefisien determinasi (R2) variabel independen sebesar 8,3% pada variabel dependen. Kesimpulan: Terdapat hubungan negatif dengan kekuatan lemah dan bermakna secara statistik antara area katup mitral dengan hipertrofi ventrikel kanan berdasarkan skor kriteria utama Butler-Leggett pada pasien stenosis mitral (r = 0,219 dan p = 0,037).

Background: Mitral stenosis is one of cardiovascular disease that is characterized by inflammation at mitral valve induced by Group A Streptococcus infection. Once the valve orrifce becomes stenosed, pressure is accumulated in the left atrium, pulmonary circulation and reaches the right ventricle. Right ventricular afterload will be elevated and is compensated by right ventricular hypertrophy. Hypertrophy will cause ventricular enlargement and it alters electrical activity of the heart. Shifting of electrical activity can be detected using an electrocardiogram (ECG) which is simple, easy to operate, and affordable diagnostic tool, especially in primary health care setting. One of right ventricle hypertrophy signs on ECG is the vectorcardiogram based Butler-Leggett main criteria score in which determines the right ventricle hypertrophy in mitral stenosis patients. Objective: To assess the relationship between mitral valve area with right ventricle hypertrophy based on the Butler-Leggett main criteria score. Methods: Study was conducted at RSUP Dr. Sardjito Yogyakarta between August and October 2016. Selected mitral stenosis patients were examined using TTE (planimetry method) and electrocardiography to assess their mitral valve area and Butler-Legget score. The score is derived from R or S wave on lead V1, V2, V6, and I, then calculation based on Butler-Leggett main criteria was done. Mitral valve area will be correlated with Butler-Leggett main criteria score using Spearman correlation method. Results: Sixty seven patients, forty nine (73,13%) females and eighteen (26,87%) males with age range 18-68 years (mean age 44,4 ± 11,34 years) were included in this study. Body Mass Index median was 20,81 cm2 (CI 95% 20,66-22,76). Most subject were on severe level of mitral stenosis (71,64%), followed by moderate (22,39%) and mild (5,97%). Fifteen subjects have isolated mitral stenosis (22,39%). Mitral valve area median area was 0,8 cm2 (CI 95%: 0,76-0,92 cm2). Butler-Leggett score median was 0,7 mV (CI 95%: 0,68-1,13 mV). Based on Spearman correlation method, there is an inverted and weak correlation with significant p value (r = -0,219 and p = 0,037). Coefficient of determination of independent variable was 8,3% to the dependent variable. Conclusion: There is weak inverted but statistically significant correlation between mitral valve area with right ventricle hypertrophy based on Butler-Leggett main criteria score in mitral stenosis patients (r = -0,219 and p=0,037).

Kata Kunci : stenosis mitral, area katup mitral, skor kriteria utama Butler-Leggett