UJI DIAGNOSTIK ELEKTROKARDIOGRAM UNTUK MENDETEKSI HIPERTROFI VENTRIKEL KIRI PADA PASIEN TALASEMIA MAYOR

Rama Iqbal Mahendra, Prof. dr. Indah Kartika Murni, M.Kes, Ph.D, Sp.A(K), Dr. dr. Sri Mulatsih, M.P.H., Sp.A(K)

2026 | Tesis | S2 Kedokteran Klinik

Latar Belakang: Talasemia mayor memiliki risiko komplikasi jantung berupa hemosiderosis jantung dan perubahan dimensi jantung yang terdeteksi sebagai left ventricular hypertrophy (LVH) melalui mekanisme deposisi besi, kardiomiopati, dan perubahan hemodinamik akibat anemia kronik. LVH paling akurat dinilai menggunakan magnetic resonance imaging (MRI) atau ekokardiografi, maupun dengan penunjang sederhana yaitu elektrokardiogram (EKG). Mengingat keterbatasan akses terhadap MRI T2* dan ekokardiografi di fasilitas daerah, diperlukan evaluasi kemampuan diagnostik EKG menggunakan kriteria spesifik sesuai usia anak untuk mendeteksi LVH pada pasien talasemia mayor.

Tujuan: Menilai kemampuan diagnostik EKG dalam mendeteksi LVH dan menentukan prevalensi LVH pada anak talasemia mayor.

Metode Penelitian: Studi potong lintang dengan jumlah subjek 55 anak talasemia mayor berusia 1-18 tahun di RS Sardjito. Diagnosis LVH pada EKG ditentukan dengan melihat karakteristik gelombang pada EKG dengan referensi sesuai usia. Nilai left ventricular mass index (LVMI) pada ekokardiografi digunakan sebagai referensi standar.

Hasil: Prevalensi LVH pada anak talasemia mayor di RS Sardjito sebesar 50,9% (95%CI 37,1%-64,7%). Analisis EKG dengan minimal satu parameter positif menunjukkan nilai sensitivitas 35,7% (95%CI 18,6%-55,9%), spesifisitas 74,07% (95%CI 53,7%-88,9%), nilai prediksi positif 58,8% (95%CI 38,9%-76,2%), nilai prediksi negatif 52,6% (43,8%-61,3%), dan akurasi 54,55% (95%CI 40,6%-68%), dengan positive likelihood ratio sebesar 1,38 dalam deteksi LVH

Simpulan: Kemampuan diagnostik EKG untuk deteksi LVH cukup terbatas karena sensitivitas dan spesifisitas yang rendah, namun tetap relevan sebagai alat deteksi awal LVH pada fasilitas kesehatan dengan fasilitas terbatas untuk mencegah komplikasi jangka panjang, terlebih dengan tingginya prevalensi LVH pada populasi talasemia mayor di RS Sardjito

Background: Major thalassemia carries a risk of cardiac complications, including cardiac hemosiderosis and alterations in cardiac dimensions that manifest as left ventricular hypertrophy (LVH) through mechanisms involving iron deposition, cardiomyopathy, and hemodynamic changes secondary to chronic anemia. LVH is most accurately assessed using magnetic resonance imaging (MRI) or echocardiography, as well as with simpler modality of electrocardiogram (ECG). Given the limited access to MRI T2* and echocardiography in regional healthcare facilities, evaluation of the diagnostic capability of ECG using age-specific paediatric criteria for detecting LVH in patients with major thalassemia is warranted.

Aim: To evaluate diagnostic capability of ECG in detecting LVH and determine the prevalence of LVH in children with major thalassemia.

Methods: This cross-sectional study involved 55 children with thalassemia major, aged 1–18 years, at Sardjito Hospital. The diagnosis of LVH on ECG was determined by wave characteristics using age-specific reference values. Left ventricular mass index was obtained from echocardiography as the reference standard

Results: The prevalence of LVH in children with major thalassemia at Sardjito Hospital was 50.9% (95% CI 37.1%–64.7%). ECG demonstrated a sensitivity of 35.7% (95% CI 18.6%–55.9%), specificity of 74.07% (95% CI 53.7%–88.9%), positive predictive value of 58.8% (95% CI 38.9%–76.2%), negative predictive value of 52.6% (95% CI 43.8%–61.3%), and accuracy of 54.55% (95% CI 40.6%–68%), with a positive likelihood ratio of 1.38 in detecting LVH.

Conclusion: The diagnostic capability of ECG for detecting LVH is markedly limited due to low sensitivity and specificity, yet it remains relevant as an initial screening tool for LVH in healthcare facilities with limited resources to prevent long-term complications, since a high prevalence of LVH observed in the major thalassemia population at Sardjito Hospital

Kata Kunci : electrocardiogram, echocardiography, major thalassemia, left ventricular hypertrophy, diagnostic study