Nilai Diagnostik Pola ST/HR Loop Pada Uji Latih Jantung Dalam Mendeteksi Keparahan Lesi Koroner Pada Pasien Yang Terduga Penyakit Jantung Koroner Stabil
AZ HAFID NASHAR, dr. Irsad Andi Arso, M.Sc. Sp.PD, Sp.JP(K)
2016 | Tesis-Spesialis | SP KARDIOLOGI DAN KEDOKTERAN VASKULARLatar Belakang: Pola ST/HR loop pada Uji Latih Jantung dengan metode perhitungan sederhana dapat berperan untuk meningkatkan identifikasi penyakit jantung koroner (PJK) dan sebagai penanda prognosis mortalitas pada pasien yang terduga penyakit jantung koroner stabil. Namun, penggunaan Pola ST/HR loop dalam mendeteksi keparahan lesi koroner berdasarkan nilai Syntax belum pernah dilaporkan. 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 pola ST/HR loop berdasarkan hasil uji latih jantung menggunakan alat treadmill dan nilai Syntax berdasarkan hasil angiografi koroner. Dilakukan analisis statistik untuk mengetahui nilai diagnostik pola ST/HR loop untuk mendeteksi keparahan lesi koroner berdasarkan nilai Syntax. Hasil: Didapatkan 108 pasien dengan rerata usia 56.77 + 7.83 tahun yang terdiri dari laki-laki sebanyak 87 subyek (80.6%) dan perempuan sebanyak 21 subyek (19.4%), dengan faktor risiko terbanyak adalah hipertensi yaitu 57 subyek (52.8%), diikuti merokok 56 subyek (51.9%), dislipidemia 30 subyek (27.8%), DM 30 subyek (27.8%), dan riwayat keluarga menderita PJK 13 subyek (12%). Total subyek yang memiliki Nilai Syntax tinggi sebanyak 68 subyek (63%) dan Nilai Syntax rendah sebanyak 40 subyek (37%) sedangkan total subyek yang memiliki pola ST/HR Loop Counterclockwise sebanyak 65 subyek (60.2%) dan pola ST/HR Loop Clockwise sebanyak 43 subyek (39.8%). Pada penelitian ini nilai diagnostik pola ST/HR Loop berdasarkan tabel 2x2 didapatkan nilai sensitivitas 83.8%, spesifisitas 80%, nilai duga positif 87.7%, nilai duga negatif 74.4% dan akurasi 82.4% untuk mendeteksi lesi koroner dengan nilai Syntax tinggi. Simpulan: Pola ST/HR Loop Counterclocwise memiliki nilai diagnostik yang baik untuk mendeteksi derajat keparahan lesi koroner pada pasien yang terduga penyakit jantung koroner stabil. Kata kunci: Penyakit jantung koroner stabil, Uji latih jantung, ST/HR loop, Nilai Syntax, keparahan lesi koroner.
Background: ST/HR Loop with a simple method calculation can improve the identification of coronary artery disease (CAD) and had a prognostic value in predicting mortality in patients with stable angina pectoris. However, there is no report about diagnostic value ST/HR Loop in predicting the coronary lesions severity based on Syntax Score. Research Methods: 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. ST/HR Loop was calculated based on the assessment of the treadmill exercise test result and Syntax score was measured from the coronary angiography result. Statistical analysis was performed to determine the diagnostic value of ST/HR Loop in predicting coronary lesions severity based on Syntax Score. Results: There were 108 patients with average age of 56.77 + 7.83 year consisting of a 87 male subjects (80.6%) and 21 female subjects (19.4%). Hypertension was found to be the most common risk factors in this study, 57 subjects (52.8%), followed by smoking in 56 subjects (51.9%), dyslipidaemia in 30 subjects (27.8%), Diabetes Mellitus in 30 subjects (27.8%), and family history of CAD in 13 subjects (12%). Subjects with high Syntax score and the low Syntax score were found in 68 subjects (63%) and 40 subjects (37%) respectively. Subjects with ST/HR loop counterclockwise were found in 65 subjects (%) and ST/HR loop Clockwise were found in 43 subjects (39.8%). In this study the ST/HR loop diagnostic value were analyzed based on 2x2 tables. ST/HR loop had sensitivity 83.8%, specificity 80%, positive predictive value 87.7%, negative predictive value 74.4% and accuracy of 82.4% in predicting the coronary lesions severity based on Syntax Score Conclusions: ST/HR loop counterclockwise have a good diagnostic value in predicting coronary lesions severity based on high Syntax Score, particularly in patients with suspected stable coronary artery diseases. Keywords: Stable coronary artery disease, treadmill exercise test, ST/HR loop, Syntax score, severity of coronary lesions
Kata Kunci : Penyakit jantung koroner stabil, Uji latih jantung, ST/HR loop, Nilai Syntax, keparahan lesi koroner.
