Hubungan antara kadar asam urat serum dan nilai Left Ventricular Ejection Fraction pada penderita ST-Elevation Myocardial Infarction (STEMI)

TAROENO, Suryo Aribowo, dr. Bambang Irawan, SpPD,SpJP(K)

2006 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar belakang : infark miokard akut (IMA) merupakan masalah kesehatan dengan mortalitas tinggi. Pada penelitian akhir-akhir ini diungkap hubungan bermakna kadar asam urat serum yang tinggi dengan mortalitas/kejadian kardiovaskuler pasca IMA. Siklus gagal jantung pasca IMA, hipoksia, aktivasi xantin oksidase (XO), kenaikan kadar asam urat, yang mengakibatkan mechanoenergetic uncoupling, diduga mendasari patogenesis hubungan tersebut. Tujuan : mengetahui apakah kadar asam urat serum pasien STEMI berkorelasi dengan nilai LVEF pasca infark, untuk menguji hipotesis siklus gagal jantung pasca IMA tersebut. Subyek dan metode : penelitian potong lintang terhadap pasien rawat inap di unit jantung intensif, STEMI < 48 jam, tanpa gagal jantung kongestif sebelumnya, tidak menderita artritis gout/insufisiensi ginjal, tidak memakai diuretik/urikosurik/inhibitor XO. Kadar asam urat diperiksa saat masuk RS. Pemeriksaan LVEF dilakukan segera setelah pasien stabil dengan ekokardiografi 2 dimensi, M mode assesment, metode Quinone yang dimodifikasi. Analisis untuk menilai hubungan kadar asam urat serum dan nilai LVEF, dengan Pearson coefficient correlation. Hasil : terdapat 40 pasien memenuhi kriteria, 9 meninggal sebelum dilakukan ekokardiografi. Sebanyak 31 pasien dianalisis. Rerata kadar asam urat serum 6,4 ± 1,4 mg/dl, rerata nilai LVEF 50,5 ± 11,5%. Pada analisis korelasi didapatkan r = - 0,016, p = 0,93. Simpulan : tidak terdapat korelasi bermakna antara kadar asam urat serum dan nilai LVEF pasca infark

Background : acute myocardial infarction (AMI) was one of health problems with high mortality rate. Recent studies showed that high serum uric acid level had significant relationship with cardiac mortality/events in AMI patients. A hypotethical vicious cycle started from failing heart following AMI, hypoxia, xantin oxydase (XO) enzymatic activation, elevation of serum uric acid level, lead to “mechanoenergetic uncoupling” condition, had proposed to explain this relationship. Aim : to determine wheter serum uric acid level in STEMI patients correlate with post infarction LVEF value, further to clarify the hypotethical vicious cycle of heart failure following AMI. Subject and method : cross sectional study was conducted among intensive coronary care unit patients with STEMI below 48 hours since its onset, without knowing diagnoses of congestive heart failure, gouty arthritis, renal insufficiency, and without diuretic/uricosuric/XO inhibitor medications. Serum uric acid level sampling has taken at patients’ arrival. Determination of post infarction LVEF value has performed as soon as the patients reached their clinically stable conditions, with 2 dimension echocardiography, M mode assessment, and modified Quinone method. Statistical analysis to asses this two variables’ correlation was performed with Pearson correlation coefficient Result : there were 40 subject fulfilled study criterias, among them 9 died before echocardiography had performed. All 31 remain patients had included in study analysis. Mean of serum uric acid level was 6,4 ± 1,4 mg/dl, mean of LVEF value was 50,5 ± 11,5 % . Pearson correlation coefficient, r = - 0,016, p = 0,93. Conclusion : there was no significant correlation between serum uric acid level and post infarction LVEF value.

Kata Kunci : Penderita STEMI, Kadar Asam Urat Serum, Nilai LVEF, serum uric acid level - LVEF value - STEMI