NILAI DIAGNOSTIK PENAMBAHAN KRITERIA LAJU JANTUNG PEMULIHAN ABNORMAL MENIT PERTAMA SETELAH UJI LATIH TREADMILL PADA DUKE TREADMILL SCORE RISIKO SEDANG UNTUK MENDETEKSI LESI KORONER BERAT PADA PASIEN YANG TERDUGA PENYAKIT JANTUNG KORONER STABIL

NANDA NURKUSUMASARI, dr. Irsad Andi Arso, MSc., SpPD, SpJP(K).; Dr. dr. Budi Yuli Setianto, SpPD(K), SpJP(K).

2017 | Tesis-Spesialis | SP KARDIOLOGI DAN KEDOKTERAN VASKULAR

Latar Belakang: Duke Treadmill Score (DTS) dan laju jantung pemulihan (LJP) abnormal menit pertama setelah uji latih treadmill (ULT) telah diketahui dapat menunjukan stratifikasi prognosis dan memiliki nilai diagnostik dalam memprediksi jumlah arteri koroner yang terlibat pada populasi pasien dengan penyakit jantung iskemik. Namun, belum ada penelitian mengenai penambahan kriteria LJP abnormal menit pertama setelah ULT pada DTS risiko sedang untuk mendeteksi lesi koroner berat pada pasien terduga PJK stabil. Metode Penelitian: Penelitian ini merupakan studi potong lintang di RSUP Dr Sardjito dengan menggunakan data sejak 1 Januari 2012. Pasien dengan ULT positif dengan DTS risiko sedang, telah dilakukan angiografi koroner dan memenuhi kriteria inklusi dan eksklusi dimasukan ke dalam penelitian. Dilakuka n penilaian DTS dan LJP menit pertama berdasarkan hasil uji latih treadmill dan keparahan lesi koroner berdasarkan hasil angiografi koroner. Dilakukan analis is statistik untuk mengetahui nilai diagnostik penambahan kriteria LJP abnormal menit pertama setelah ULT pada DTS risiko sedang untuk mendeteksi lesi koroner berat pada pasien terduga PJK stabil. Hasil: Didapatkan 174 pasien dengan rerata usia 57,37 +- 7,41 tahun yang terdiri dari laki-laki sebanyak 128 subyek (74%) dan perempuan sebanyak 46 subyek (28%) dengan faktor risiko terbanyak adalah hipertensi yaitu 118 subyek (68%), diikuti. Total subyek dengen lesi koroner berat dan LJP abnormal menit pertama sebanyak 62 subyek. Pada penelitian ini didapatkan nilai diagnostik penambahan kriteria LJP abnormal menit pertama setelah ULT pada DTS risiko sedang untuk mendeteksi lesi koroner berat pada pasien terduga PJK stabil dengan nilai sensitivitas sebesar 67%, spesifisitas 55%, nilai duga positif 62,6%, nilai duga negatif 60%, dan akurasi 61,5%. Simpulan: Penambahan kriteria LJP abnormal menit pertama setelah ULT pada DTS risiko sedang untuk mendeteksi lesi koroner berat pada pasien terduga PJK stabil memiliki nilai diagnostik yang lemah, namun penambahan kriteria LJP abnormal menit pertama pada DTS risiko sedang mampu meningkatkan nilai akurasi dalam mendeteksi lesi koroner berat.

Background: Duke Treadmill Score (DTS) and first one minute abnormal heart rate recovery (HRR) after exercise treadmill test have been found to stratific ate prognostic and have diagnostic value in predicting severity of coronary arteries involvement in ischemic heart disease patients. However, there has been no research on additional first one minute abnormal heart rate recovery after exercise treadmill test in moderate risk duke treadmill score to detect severe coronary artery lesion in patient suspected stable coronary artery disease. Methods: This study was a cross sectional study in Dr. Sardjito Hospital using data from January 1 , 2012. Patients with positive moderate risk DTS after treadmill test that was performed coronary angiography and meet inclusion and exclusion st criterias was included in the study. Duke treadmill score and first one minute abnormal HRR assessment based on exercise treadmill test results and severity of coronary lesions is based on the results of coronary angiography. Statistical analysis was performed to determine the diagnostic value of addition first one minute abnormal HRR after exercise treadmill test in moderate risk duke treadmill score to detect severe coronary artery lesion in patient suspected stable coronary artery disease Results: There were 174 patients with mean age 57.37 +- 7.41 years consisting of 128 male subjects (74%) and 46 female subjects (28%) with the highest risk factor is hypertension consist of 118 subjects (68% ). Subjects with severe coronary lesions and first one minute abnormal HRR are 62 subjects. In this study, the diagnostic value of addition first one minute abnormal HRR after exercise treadmill test in moderate risk duke treadmill score to detect severe coronary artery lesion in patient suspected stable coronary heart disease has sensitivity 67%, specificity 55%, positive predictive value 62.6%, negative predictive value 60%, and accuracy of 61.5%. Conclusion: The addition first one minute abnormal HRR criteria after exercise treadmill test in moderate risk duke treadmill score to detect severe coronary artery lesion in patient suspected stable coronary artery disease has weak diagnostic value, but it able to increase the accuracy in detecting coronary lesions.

Kata Kunci : penyakit jantung koroner stabil, uji latih treadmill, Duke Treadmill Score risiko sedang, Laju jantung pemulihan abnormal menit pertama, lesi koroner berat, Stable coronary artery disease, exercise treadmill test, moderate risk Duke Treadmill Score, abn