KADAR ENDOTELIN-1 SEBAGAI PREDIKTOR MORTALITAS DAN GAGAL JANTUNG PADA INFARK MIOKARDIAL AKUT

Agus Widiyatmoko, dr, Prof. dr. Bambang Irawan, Sp.PD-KKV, Sp.JP(K)

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Infark miokardial akut berhubungan dengan perubahan neurohormonal dan metobolik. Perubahan ini berhubungan dengan tingkat keparahan penyakit dan luaran klinis. Sekresi cepat neurohormon oleh sistem neuroendokrin merupakan respon fisiologis terhadap kerusakan miokardial pada penderita infark miokardial akut untuk mempertahankan hemodinamik. Namun demikian respon yang berlebihan dapat berakibat tidak baik untuk penderita seperti katekolamin yang dapat memicu vasokonstriksi dan takikardi. Endotelin (ET) adalah hormon yang terdiri dari 21 asam amino, berperan sebagai vasokonstriktor. Kadar plasma ET-l meningkat pada penderita infark miokardial akut. Kadar plasma ET-l segera meningkat saat terjadi infark dan dapat terjadi pemanjangan meningkatnya kadar ET-l pada penderita dengan gagaI ventrikel kiri. Peningkatan kadar ET-l berhubungan dengan peningkatan mortalitas. Penelitian ini bertujuan untuk mengetahui peranan kadar ET-l plasma terhadap mortalitas dan terjadinya gagaI jantung. Kadar plasma ET-l diukur pada hari ke 3 pada 120 penderita infark miokardial akut serta dicari hubungan dengan mortalitas 30 hari. Kadar ET-1 juga dianalisa untuk memprediksi resiko mortalitas dan terjadinya gagal jantung dengan uji survival Kaplan Meier.

Acute myocardial infarction (AMI) is accompanied by metabolic and neurohormonal changes that may relate to the severity of illness and clinical outcomes. Rapidly advancing secretion of neurohormones by neuroendocrine . systems is a physiologicresponseto myocardialdamage in patientswith AMI in order to maintain a hemodynamic homeostasis. However, the over reactive responses of these hormones, e.g., vasoconstriction and tachycardia, resulted in catecholamine, which might be harmful to the patients. Considerable clinical evidence shows that increased neuroendocrine activity is detrimental to patients with clinical setting of AMI. Endothelin (ET)-l, a 21 amino acid residue peptide made by endothelial cells, is the most potent endogenous vasoconstrictor yet identified. It has been reported that circulating ET-I increases in the early hours after AMI. After AMI, higher and more prolonged elevations of this vasoconstrictor have been discovered in patients with a complicated clinical course and left ventricular failure, and have consequently been closely associated with increased mortality. However, the precise pathophysiologic effects of ET-I in AMI patients remain uncertain. The research aimed to identified plasma endothelin determinatton in myocardial infarction is related to subsequent survival and assessed whether plasma endothelin measurements provide additional prognostic information to that obtained to be associated with high mortality. Plasma endothelin determination was obtained from 120 patients on day 3 after documented myocardial infarction and was related to 30 days mortality. The predictive power of endothelin was analyzed for risk factors of mortality and heart failure after myocardial infarction in a Kaplan Meier Survival model.

Kata Kunci : infark miokardial akut, endotelin-J, gagaljantung, mortalitas