Hubungan antara Indeks Trigliserida Glukosa dengan Disfungsi Diastolik, Disfungsi Sistolik dan Perubahan Struktur Ventrikel Kiri Jantung pada Diabetes Melitus Tipe 2

Saiful Anam, dr. Hemi Sinorita, SpPD, K-EMD.; dr. Hasanah Mumpuni, M.Sc, SpPD, K-KV, SpJP(K)

2025 | Tesis-Subspesialis | SUBSPESIALIS ILMU PENYAKIT DALAM

Latar belakang: Diabetes melitus (DM) penyebab utama gagal jantung. Prevalensi gagal jantung pada pasien DM 22,3%. Resistensi insulin pada DM tipe 2 adalah faktor risiko disfungsi diastolik, disfungsi sistolik dan perubahan struktur ventrikel jantung. Indeks trigliserida-glukosa (Indeks TyG) merupakan alternatif penilaian resistensi insulin yang sederhana dan relatif baru.

Metode: Penelitian potong lintang ini bertujuan untuk mengetahui hubungan indeks TyG dengan disfungsi diastolik, disfungsi sistolik dan perubahan struktur ventrikel kiri jantung. Penelitian dilakukan terhadap 56 pasien DM tipe 2 tidak terkontrol tanpa gejala kardiovaskuler, usia 30-65 tahun di Poliklinik Endokrin RSUP Dr Sardjito Yogyakarta periode 1 Mei 2024 sampai 31 Oktober 2024. Ekokardiografi dilakukan untuk menilai disfungsi dan perubahan struktur ventrikel jantung. Indeks TyG dihitung dengan furmula, Indeks TyG: ln [trigliserida darah puasa (mg/dL) x glukosa darah puasa (mg/dL) /2]. Uji regresi logistik digunakan untuk menilai hubungan variabel bebas dengan keluaran.

Hasil: Sebanyak 56 subyek diikutkan penelitian. Ekokardiografi fungsi diastolic didapatkan 66% normal, 28,6% disfungsi diastolik grade 1; 3,6% disfungsi diastolik grade 2 dan 1,8% disfungsi diastolik grade 3. Ekokardiografi terhadap fungsi sistolik didapatkan median fraksi ejeksi 68% (22-79%), yang meliputi 80,3% fraksi ejeksi normal (EF > 50), 5,4% fraksi ejeksi 41-49, dan 14,3% fraksi ejeksi < 40 xss=removed xss=removed xss=removed xss=removed xss=removed>

Kesimpulan: Terdapat hubungan indeks TyG tinggi dengan perubahan struktur ventrikel kiri pada DM tipe 2. Tidak terdapat hubungan indeks TyG dengan disfungsi diastolik dan sistolik ventrikel kiri pada DM tipe 2.

Background: Diabetes mellitus (DM) is the main cause of heart failure. Prevalence of heart failure in DM patients is 22.3%. Insulin resistance in type 2 DM is risk factor for diastolic dysfunction, systolic dysfunction and left ventricular remodeling. TyG Index is a simple and relatively new for alternative assessing insulin resistance. 

Methods: The aim of this cross-sectional study was to determine association between TyG index with diastolic dysfunction, systolic dysfunction and left ventricular remodeling. This study was conducted on 56 patients with uncontrolled type 2 DM without cardiovascular symptoms, 30-65 years old at Endocrine Polyclinic Sardjito General Hospital Yogyakarta, period May1st to October31st 2024. Echocardiography was performed to assess ventricular dysfunction and left ventricular remodeling. TyG index is calculated with formula, TyG index: ln [fasting blood triglycerides (mg/dL) x fasting blood glucose (mg/dL) /2]. Logistic regression test is used to assess association between independent variables and outcome. 

Results: A total 56 subjects were included in this study. Echocardiography results of diastolic function showed 66.0% normal, 28.6% grade 1 diastolic dysfunction, 3.6% grade 2 diastolic dysfunction and 1.8% grade 3 diastolic dysfunction. Echocardiography results of systolic function were in median ejection fraction of 68% (22-79%), which included 80,3% normal ejection fraction (EF > 50), 5,4% ejection fraction 41-49, and 14.3% ejection fraction < 40 xss=removed xss=removed xss=removed xss=removed xss=removed>

Conclusion: There is association between high TyG index and left ventricular remodeling in type 2 DM. There were no association between TyG index with left ventricular diastolic and systolic dysfunction in type 2 DM patients.

Kata Kunci : Indeks TyG, resistensi insulin, disfungsi ventrikel kiri, perubahan struktur, TyG index, insulin resistance, left ventricular dysfunction, remodeling