Hubungan antara kadar C-Reactive Protein dengan ejeksi fraksi ventrikel kiri pada ST Elevation Myocardial Infarction anterior

PRIAMBODO, Rosa, dr. Bambang Irawan, SpPD-KKV

2006 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar Belakang: Kadar C-Reactive Protein pada penderita ST elevation myocardial infarction (STEMI) dilaporkan meningkat, baik sebelum maupun setelah STEMI. Peningkatan kadar CRP akan mengaktivasi jalur komplemen yang selanjutnya terjadi inflamasi akibat masuknya sel-sel neutrofil dan makrofag ke dalam miokard yang infark. Infark yang meluas disertai proses remodeling, dapat mengakibatkan terjadinya disfungsi ventrikel kiri dan penurunan ejeksi fraksi (EF) ventrikel kiri. Tujuan: Mengetahui hubungan antara kadar CRP plasma dengan EF pada penderita STEMI anterior. Subyek dan metode: Penelitian dilakukan dengan rancangan potong lintang. Penderita yang masuk kriteria inklusi adalah penderita STEMI anterior baru dengan onset maksimal 48 jam. Penderita dieksklusi dari penelitian apabila terdapat infeksi, penyakit inflamasi, riwayat pembedahan / stroke dalam 3 bulan terakhir, keganasan, gagal jantung kongestif dan STEMI inferior. Terdapat 30 subyek yang ikut dalam penelitian dan diambil sampel CRP maksimal dalam 48 jam onset. Pemeriksaan EF dilakukan selama perawatan. Hubungan antara kadar CRP dengan EF dianalisis dengan Spearman rho test. Hasil: Kadar CRP pada subyek perempuan terkesan lebih tinggi dibandingkan lakilaki [median CRP 23,4 mg/l (5,73 – 61,4 mg/l) vs 12,2 mg/l (5,6 – 66,5 mg/l)], namun tidak berbeda bermakna (P = 0,297). Subyek yang menjalani terapi trombolisis, kadar CRP tampak lebih rendah dibandingkan yang tidak ditrombolisis [10,7 mg/l (5,6 – 44,5 mg/l) vs 14,7 mg/l (8,7 – 66,5 mg/l), P = 0,178]. Hubungan antara kadar CRP dengan EF berupa korelasi negatif yang sangat lemah dan tidak bermakna (r = - 0,100 dengan P = 0,597). Kesimpulan: Tidak ada hubungan antara kadar CRP dengan ejeksi fraksi pada penderita IMA.

Background: C-Reactive Protein levels were found increase in ST Elevation Myocardial Infarction patients, before and after STEMI. Increasing of CRP levels were able to activate complement pathway to induce inflammation by attracting neuthrophil and macrophage to enter to infarcted myocardial. Infarct expansion followed by remodeling process, led to left ventricular dysfunction and decreasing of ejection fraction. The aim: The study was aimed to investigate the correlation between CRP plasma levels and LVEF in anterior STEMI patients. Subject and method: The study was conducted in cross-sectional design. Subjects were new anterior STEMI patients with maximum onset 48 hours. The exclusion criterias were infection evidence, suffering from inflammation, history of surgery or stroke 3 months ago, malignancy, congestive heart failure and inferior STEMI. There were 30 subjects who join the study. CRP blood samples were collected at least 48 hours since onset. LVEF measurement were done during hospitalisation. The correlation between CRP levels and LVEF was analyzed by Spearman rho test. Result: Women had CRP level higher than men [CRP median 23,4 mg/l (5,73 – 61,4 mg/l) vs 12,2 mg/l (5,6 – 66,5 mg/l)], but the difference not significant (P = 0,297). The thrombolysis therapy group had lower CRP levels than non thrombolysis therapy group [10,7 mg/l (5,6 – 44,5 mg/l) vs 14,7 mg/l (8,7 – 66,5 mg/l), but not significant with P = 0,178]. The negative correlation between CRP level and LVEF was very weak and not significant (r = - 0,100 with P = 0,597).

Kata Kunci : Kadar C,Reactive Protein,Penderita STEMI,Ejeksi Fraksi, ST Elevation Myocardial Infarction – C-Reactive Protein – inflammation – Left Ventricular Ejection Fraction