Nilai Diagnostik Index ST/HR pada Uji Latih Jantung dalam Mendeteksi Keparahan Lesi Koroner pada Pasien yang Terduga Penyakit Jantung Koroner Stabil

DYAH PITALOKA PUTRI, dr. Irsad Andi Arso, MSc., SpPD, SpJP(K)

2016 | Tesis-Spesialis | SP KARDIOLOGI DAN KEDOKTERAN VASKULAR

Latar Belakang : Index ST/HR pada Uji Latih Jantung (ULJ) 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 Index ST/HR dalam mendeteksi keparahan lesi koroner masih menunjukkan hasil yang beragam. Metode Penelitian : Penelitian ini merupakan studi potong lintang di RSUP Dr Sardjito dengan menggunakan data sejak 1 Januari 2012. Pasien dengan ULJ positif, telah dilakukan angiografi koroner dan memenuhi kriteria inklusi dan eksklusi dimasukan ke dalam penelitian. Dilakukan penilaian Index ST/HR berdasarkan hasil ULJ menggunakan alat treadmill dan nilai Syntax berdasarkan hasil angiografi koroner. Dilakukan analisis statistik untuk mengetahui nilai diagnostik Index ST/HR untuk mendeteksi keparahan lesi koroner berdasarkan nilai Syntax. Hasil : Didapatkan 75 pasien dengan rerata usia 56.48 ± 7.32 tahun yang terdiri dari laki-laki sebanyak 52 subyek (69.3%) dan perempuan sebanyak 23 subyek (30.6%), dengan faktor risiko terbanyak adalah hipertensi yaitu 56 subyek (74.6%), diikuti dislipidemia 33 subyek (44%), DM 27 subyek (36%), merokok 24 subyek (32%) dan riwayat keluarga menderita PJK 1 subyek (1.3%). Total subyek yang memiliki Nilai Syntax tinggi sebanyak 30 subyek (40%) dan Nilai Syntax rendah sebanyak 45 subyek (60%) sedangkan total subyek yang memiliki Index ST/HR rendah sebanyak 42 subyek (56%) dan Index ST/HR tinggi sebanyak 33 subyek (44%). Pada penelitian ini nilai diagnostik Index ST/HR berdasarkan tabel 2x2 didapatkan nilai sensitivitas 83%, spesifisitas 82%, nilai duga positif 75%, nilai duga negatif 88% dan akurasi 83% untuk mendeteksi lesi koroner dengan nilai Syntax tinggi. Simpulan : Index ST/HR tinggi berdasarkan nilai batas >3,3 uV/kpm memiliki nilai diagnostik yang baik untuk mendeteksi derajat keparahan lesi koroner pada pasien yang terduga penyakit jantung koroner stabil.

Background: ST/HR Index with a simple method calculation can improve the identification of coronary artery disease (CAD) and had a prognostic value as predicting mortality in patients with stable angina pectoris. However, the diagnostic value ST/HR Index as predicting the coronary lesions severity still show a diversion results. Research Methods: Cross sectional study was performed in Dr Sardjito General Hospital based on data from 1st January 2012. Patients who had positive exercise stress test result, already had coronary angiography and met the inclusion and exclusion criteria, were included in the study. ST/HR Index 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 Index in predicting coronary lesions severity based on Syntax Score. Results: There were 75 patients with average age of 56.48 ± 7.32 year consisting of a 52 male subjects (69.3%) and 23 female subjects (30.6). Hypertension was found to be the most common risk factors in this study, 56 subjects (74.6%), followed by dyslipidaemia in 33 subjects (44%), Diabetes Mellitus in 27 subjects (36%), smoking in 24 subjects (32%) and family history of CAD in 1 subjects (1.3%). Subjects with high Syntax score and the low Syntax score were found in 30 subjects (40%) and 45 subjects (60%) respectively. Subjects with low ST/HR Index were found in 42 subjects (56%) and high Index ST / HR were found in 33 subjects (44%). In this study the ST/HR Index diagnostic value were analyzed based on 2x2 tables. ST/HR Index had sensitivity 83%, specificity 82%, positive predictive value 75%, negative predictive value 88% and accuracy of 83% in predicting the coronary lesions severity based on Syntax Score Conclusions: ST/HR Index with cutt off >3,3 uV/ bpm 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 Index, Syntax score, severity of coronary lesions

Kata Kunci : Kata kunci: Penyakit jantung koroner stabil, Uji latih jantung, Index ST/HR, Nilai Syntax, keparahan lesi koroner.