Penilaian Right Ventricle - Pulmonary Artery Coupling Sebagai Faktor Prediksi Kematian Pada Pasien Defek Septum Atrium Yang Belum Dikoreksi Dengan Hipertensi Pulmonal

Dea Amelia Yolanda, Dr. dr. Lucia Kris Dinarti, Sp.PD(K), Sp.JP(K).; Dr.Med.dr.Putrika Prastuti Ratna Gharini, Sp.JP(K)

2023 | Tesis-Spesialis |

Latar Belakang: Pasien defek septum atrium (DSA) dengan hipertensi pulmonal (HP) mengalami perubahan keseimbangan Right Ventricle-Pulmonary Artery Coupling (RVPAC) akibat peningkatan resistensi pulmonal dan penambahan beban pada RV. Pengukuran RVPAC telah digunakan untuk memprediksi luaran berbagai  kondisi kardiopulmonal. Tujuan Penelitian: Mengetahui peran pengukuran RVPAC dalam memprediksi kematian pasien defek septum atrium yang belum dikoreksi dengan hipertensi pulmonal. Metode Penelitian: Penelitian ini merupakan studi observasional analitik dengan desain kohort retrospektif. Penelitian ini dilakukan pada pasien DSA dengan HP di RSUP Dr. Sardjito Yogyakarta yang terdaftar dalam registri Congenital Heart Disease in Adult and Pulmonary Hypertension (COHARD-PH) periode 2017-2021. Parameter RVPAC diwakili oleh nilai TAPSExPVAccT, TAPSE/TRV dan TAPSE/SPAP yang diukur dengan ekokardiografi. Hasil: Terdapat 124 pasien yang memenuhi kriteria inklusi, 20 pasien diantaranya meninggal. Pasien yang meninggal memiliki rerata TAPSExPVAccT, TAPSE/TRV dan TAPSE/SPAP lebih rendah dibandingkan pasien yang hidup (secara berurutan 1759,8 vs 2295,5 mm.ms; 4,99 vs , 6,47x10 mm.s; 0,30 vs 0,47 mm/mmHg). Nilai cut off  TAPSExPVAccT, TAPSE/TRV  dan  TAPSE/SPAP  adalah  2092,5  mm.ms, 4,3847x10 mm.s dan 0,456 mm/mmHg. Berdasarkan analisis multivariat diketahui parameter TAPSExPVAccT (p=0,245; OR 1,97; IK95%: 0,62-6,22) dan TAPSE/TRV (p=0,998; OR 2,30; IK 95% 0,30-3,23) tidak bermakna secara statistik dalam memprediksi luaran kematian. Parameter TAPSE/SPAP (p=0,042; OR 8,44; IK 95%: 1,08-65,82) memiliki nilai penanda prognostik yang kuat luaran kematian Simpulan: Parameter pengukuran RVPAC berupa rasio TAPSE/SPAP merupakan faktor prediktor independen kematian pada pasien defek septum atrium yang belum dikoreksi dengan hipertensi pulmonal.  Pasien dengan rasio TAPSE/SPAP <0>0.456 mm/mmHg.

Background: Patients with atrial septal defect (ASD) and pulmonary hypertension  (PH) experience changes in the Right Ventricle-Pulmonary Artery Coupling (RVPAC) balance due to increased pulmonary resistance and load increased on the RV. RVPAC measurement has been used to predict the outcome of various cardiopulmonary conditions. Objective: To determine the role of RVPAC measurement in predicting mortality in patients with uncorrected atrial septal defect and pulmonary hypertension. Methods: It was an analytical observational study with a retrospective cohort design. The study was conducted on ASD patients with PH at Dr. Sardjito Yogyakarta Hospital registered in the Congenital Heart Disease in Adult and Pulmonary Hypertension (COHARD-PH) registry from 2017 to 2021. RVPAC parameters were represented by TAPSExPVAccT, TAPSE/TRV, and TAPSE/SPAP measured by echocardiography. Results: There were 124 patients who met the inclusion criteria, 20 of whom died. Patients who died had lower mean TAPSExPVAccT, TAPSE/TRV, and TAPSE/SPAP values compared to surviving patients (1759.8 vs.2295.5 mm.ms; 4.99 vs.6.47x10- 3mm.s;  0.30 vs.0.47mm/mmHg,respectively).The cut-off values for TAPSExPVAccT,TAPSE/TRV, and TAPSE/SPAP were 2092.5 mm.ms, 4.3847x10-3mm.s, and 0.456 mm/mmHg, respectively. Based on multivariate analysis, it was found that the TAPSExPVAccT parameter (p=0.245; OR 1.975; 95% CI: 0.62-6.22) and TAPSE/TRV (p=0.998; OR 2,30; 95% CI: 0.30-3.23) were not statistically significant in predicting mortality outcome. The TAPSE/SPAP parameter (p=0.042; OR 8.44; 95% CI: 1.08-65.82) had a strong prognostic value for mortality outcome. Conclusion: The RVPAC parameter in the form of the TAPSE/SPAP ratio is an independent predictor of mortality in patients with uncorrected atrial septal defects with pulmonary hypertension. Patients with a TAPSE/SPAP ratio <0>0.456 mm/mmHg

Kata Kunci : defek septum atrium, hipertensi pulmonal, Right Ventricle-Pulmonary Artery Coupling, atrial septal defect, pulmonary hypertension, Right Ventricle-Pulmonary Artery Coupling