NILAI DIAGNOSTIK DUKE TREADMILL SCORE UNTUK MENDETEKSI KEPARAHAN LESI KORONER PADA PASIEN YANG TERDUGA PENYAKIT JANTUNG KORONER STABIL

NI MADE ELVA MAYASARI, dr. Irsad Andi Arso, M.Sc, Sp.PD, Sp.JP(K); dr. Erika Maharani, Sp.JP(K)

2015 | Tesis-Spesialis | SP KARDIOLOGI DAN KEDOKTERAN VASKULAR

Latar Belakang: Duke Treadmill Score (DTS) telah diketahui dapat menunjukan stratifikasi prognosis dan memiliki nilai diagnostik yang baik dalam memprediksi jumlah arteri koroner yang terlibat pada populasi pasien dengan penyakit jantung iskemik. Selain itu, DTS juga telah terbukti memiliki korelasi yang kuat dengan keparahan lesi koroner yang dinilai berdasarkan nilai Syntax namun belum ada data mengenai nilai diagnostik DTS dalam memprediksi keparahan lesi koroner berdasarkan nilai Syntax. Metode Penelitian: Penelitian ini merupakan studi potong lintang di RSUP Dr. Sardjito dengan menggunakan data sejak 1 Januari 2012. Pasien dengan ULT positif, telah dilakukan angiografi koroner dan memenuhi kriteria inklusi dan eksklusi dimasukan ke dalam penelitian. Dilakukan penilaian DTS berdasarkan hasil uji latih treadmill dan nilai Syntax berdasarkan hasil angiografi koroner. Dilakukan analisis statistik untuk mengetahui nilai diagnostik DTS untuk mendeteksi keparahan lesi koroner berdasarkan nilai Syntax. Hasil: Didapatkan 76 pasien dengan rerata usia 56.64 +- 7.41 tahun yang terdiri dari laki-laki sebanyak 53 subyek (70%) dan perempuan sebanyak 23 subyek (30%) dengan faktor risiko terbanyak adalah hipertensi yaitu 57 subyek (75%), diikuti dislipidemia 33 subyek (43.3%), DM 27 subyek (35.5%), merokok 24 subyek (31.6%) dan riwayat keluarga menderita PJK 1 subyek (1.3%). Total subyek yang memiliki Nilai Syntax tinggi sebanyak 30 subyek (39.5%) dan Nilai Syntax rendah sebanyak 46 subyek (60.5%). Pada penelitian ini didapatkan nilai diagnostik DTS untuk memprediksi Nilai Syntax tinggi berdasarkan nilai area bawah kurva berdasarkan analisis dengan kurva Receiver Operating Characteristic (ROC) adalah sebesar 92% (95% IK 86%-97%), p = 0.000. Duke Treadmill Score -8.5 memiliki nilai sensitivitas sebesar 83%, spesifisitas sebesar 82%, nilai duga positif sebesar 75%, nilai duga negatif sebesar 88% dan akurasi 83% untuk mendeteksi lesi koroner dengan nilai Syntax tinggi. Simpulan: Duke Treadmill Score (DTS) memiliki nilai diagnostik yang baik untuk mendeteksi derajat keparahan lesi koroner pada pasien yang terduga penyakit jantung koroner stabil. Nilai batas prediksi yang dapat digunakan untuk mendeteksi derajat keparahan lesi koroner adalah DTS -8.5.

Background: Duke Treadmill Score (DTS) is a well known score to stratify prognosis with good diagnostic value in predicting number of diseased coronary arteries in ischemic heart disease patient. DTS has also been shown to have a strong correlation with the severity of coronary lesion based on the Syntax score. However, the diagnostic value of DTS in predicting the coronary lesions severity based on Syntax score has not been well established. Research Method: Cross sectional study was performed in Dr. Sardjito general hospital based on data from 1st January 2012. Patients who had positive exercise test result, already had coronary angiography and met the inclusion and exclusion criteria, were included in the study. DTS was calculated based on the assessment of the exercise test result and Syntax score was measured from the coronary angiography result. Statistical analysis was performed to determine the diagnostic value of DTS in predicting coronary lesions severity based on Syntax Score. Result: There were 76 patients with average age of 56.64 +- 7.41 year old consisting of 53 male subjects (70%) and 23 female subjects (30%). Hypertension was found to be the most common risk factors in this study, 57 subjects (75%), followed by dyslipidaemia in 33 subjects (43.3%), Diabetes Mellitus in 27 subjects (35.5%), smoking in 24 subjects (31.6%) and family history of CHD in 1 subject (1.3%). Subjects with high Syntax score and the low Syntax score were found in 30 subjects (39.5%) and 46 subjects (60.5%) respectively. In this study, the DTS diagnostic value in predicting high Syntax score was determined by the value of area under the curve based on the the Receiver Operating Characteristic (ROC) curve analysis was 92% (95% CI: 86%-97%, p : <0.0001). Moreover, DTS with value -8.5 had sensitivity 83%, specificity 82%, positive predictive value 75%, negative predictive value 88%, and accuracy 83% to predict high Syntax score. Conclusion: DTS has a good diagnostic value in predicting coronary lesions severity, particularly in patients with suspected stable coronary artery diseases. DTS value of -8.5 has shown to have the best cut point in this study.

Kata Kunci : Penyakit jantung koroner stabil, Uji latih treadmill, Duke Treadmill Score, Nilai Syntax, keparahan lesi koroner; Stable coronary artery disease, treadmill exercise testing, Duke Treadmill Score, Syntax score, severity of coronary lesions