Januar Wibawa Martha
Faculty of Medicine, Padjadjaran University, Bandung

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Journal : Majalah Kedokteran Bandung

Hubungan Beberapa Faktor Klinis dan Pengobatan Penyakit Arteri Koroner dengan Pembentukan dan Gradasi Kolateral Arteri Koroner Martha, Januar Wibawa; Purnomowati, Augustine
Majalah Kedokteran Bandung Vol 49, No 4 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (550.29 KB) | DOI: 10.15395/mkb.v49n4.1199

Abstract

Penyakit arteri koroner (PAK) ditandai lesi aterosklerosis yang menyebabkan penurunan suplai oksigen ke miokardium. Sebagian pasien PAK membentuk pembuluh kolateral yang menambah suplai darah ke miokardium. Pembentukan kolateral didasari proses angiogenesis dan dipengaruhi oleh berbagai faktor. Aspirin telah digunakan sebagai pencegahan angiogenesis. Penelitian ini bertujuan mencari pengaruh faktor klinis dan pengobatan terhadap pembentukan kolateral koroner. Penelitian ini menggunakan metode potong lintang pada pasien PAK yang dilakukan angiografi koroner. Klasifikasi kolateral koroner dinilai menggunakan kriteria Rentrop. Subjek penelitian dibagi menjadi kolateral baik dan kolateral buruk, ditentukan berdasar atas penilaian intervensionis. Faktor yang dianalisis adalah keluhan angina, obat-obatan, lesi stenosis, dan faktor risiko kardiovaskular. Analisis statistik menggunakan korelasi Spearman dan regresi logistik. Sebanyak 382 pasien diikutsertakan dalam penelitian. Seluruh subjek penelitian memiliki stenosis koroner di atas 80% pada salah satu arteri koroner. Analisis kolateral koroner mendapatkan 164 pasien kolateral baik dan 158 orang kolateral buruk. Secara bivariat, faktor-faktor yang berpengaruh pada pembentukan kolateral koroner yang buruk adalah: penggunaan inhibitor ACE (p=0,048), penggunaan aspirin (p=0,047), oklusi pada pembuluh left circumflex (p=0,032), tidak ada keluhan angina (p=0,036), dan diabetes (p=0,047). Regresi logistik tidak menunjukkan kemaknaan dari faktor-faktor diatas terhadap pembentukan kolateral koroner (p=0,088). Penelitian ini menyimpulkan bahwa aspirin, inhibitor ACE, oklusi pembuluh left circumflex, tidak ada keluhan angina dan riwayat diabetes memiliki potensi untuk menghambat pembentukan kolateral koroner. [MKB. 2017;49(4):274–80]Kata kunci: Faktor klinis, kolateral koroner, penyakit arteri koroner Relationship between Several Clinical and Treatment Factors in Cad Patients in Coronary Collateral Development and Gradation Coronary artery disease (CAD) involves atherosclerotic plaques that caused reduction of myocardial oxygen supply. Some CAD patients develop collaterals which augment myocardial blood circulation. Angiogenesis is a precursor for collateral development and influenced by multiple factors. Aspirin has been used as an angiogenesis inhibitor. This study was intended to elucidate clinical and treatment factors that may affect collateral development. This study employed cross-sectional methodology. Subjects were CAD patients who underwent coronary angiography. Grading of coronary collaterals was classified using Rentrop criteria. Subjects were categorized into poor collaterals and good collaterals, determined by an interventionist. Factors  analyzed were anginal symptoms, medications, stenotic lesions, and cardiovascular risk factors. Data were examined using Pearson or Spearman correlation and logistic regression. A total of 382 patients were selected. All subjects had 80% or more stenotic lesions in one or more coronary arteries. There were 164 patients assigned as good collaterals and 158 patients was assigned as poor collaterals. Factors that hampered collateral development were: ACE (p=0.048) and aspirin (p=0.047) use, occlusion of left circumflex artery (p=0.032), no anginal symptoms (p=0.036) and diabetics (p=0,047). None of these factors was statistically significant in logistic regression (p=0.088). The study concluded that aspirin has a potential to diminish coronary collateral development. [MKB. 2017;49(4):274–80]Key words: Clinical factors, coronary artery disease, coronary collaterals
HUBUNGAN KADAR LEPTIN SERUM DENGAN KOMPLEKSITAS LESI KORONER BERDASARKAN SKOR SYNTAX PADA PENDERITA PENYAKIT ARTERI KORONER STABIL Ashari, Fajar; Aprami, Toni Mustahsani; Akbar, Muhammad Rizki; Purnomowati, Augustine; Martha, Januar Wibawa; Achmad, Chaerul; Martanto, Erwan
Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (165.975 KB) | DOI: 10.15395/mkb.v48n1.730

Abstract

Leptin memiliki peran penting dalam pembentukan plak ateroskleosis dengan mengaktifkan respons sel imun dan respons inflamasi ataupun peran langsung terhadap dinding pembuluh darah koroner. Penelitian terdahulu mengenai hubungan antara kadar leptin serum dan kompleksitas lesi koroner masih menunjukkan kontroversi. Penelitian ini bertujuan mengetahui hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. Metode penelitian berupa observasional, deskriptif, dan analisis korelasi dengan rancangan potong lintang. Subjek penelitian sebanyak 44 orang penderita penyakit arteri koroner (PAK) stabil yang memenuhi kriteria inklusi, menjalani pemeriksaan angiografi koroner di Rumah Sakit Dr. Hasan Sadikin Bandung selama bulan Januari?Mei 2014. Pengambilan sampel darah untuk pemeriksaan kadar leptin serum dilakukan sebelum tindakan angiografi. Kompleksitas lesi arteri koroner dinilai menggunakan skor SYNTAX. Hasil penelitian didapatkan subjek penelitian 84% laki-laki dengan usia rata-rata 54,68 (+10,24) tahun. Indeks massa tubuh rata-rata 24,71 (+ 3,05) kg/m2. Faktor risiko terbanyak adalah dislipidemia (84%), merokok (72%), hipertensi (38,4%), diabetes melitus (22,7%), dan obesitas (4,5%). Median kadar leptin serum 7.242 (780?36.929) pq/mL, nilai rata-rata skor SYNTAX sebesar 19,52 (+9,93). Analisis menggunakan uji korelasi rank-Spearman tidak didapatkan hubungan (p=0,61; r= 0,078). Perbedaan hasil penelitian ini dengan penelitian sebelumnya disebabkan oleh perbedaan subjek dan kriteria penilaian kompleksitas lesi arteri koroner. Simpulan, tidak terdapat hubungan antara kadar leptin serum dan kompleksitas lesi koroner berdasarkan skor SYNTAX pada penderita penyakit arteri koroner stabil. [MKB. 2016;48(1):26?31]Kata kunci: Kompleksitas lesi koroner, leptin serum, penyakit arteri koroner stabil, skor SYNTAXCorrelation between Serum Leptin Levels and Complexity of Coronary Artery Lesion based on SYNTAX Score in Patients with Stable Coronary Artery DiseaseAbstractLeptin has been shown to play a potential role in the atherosclerotic plaque formation by activating immune and inflammatory cells or directly acting on the vessel wall. Earlier reports of the correlation of serum leptin levels with the degree of coronary lesion stated are still controversial. This study determined the correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease (SCAD). This is an observational cross-sectional study. Data were collected from January to May 2014 in Dr. Hasan Sadikin Central General Hospital Bandung. Blood samples were collected before angiography procedures. The complexity of coronary artery lesion was assessed using SYNTAX score. There were 44 patients who met inclusion criteria, male 84%, median age 54.68 (+10.24) years. Mean body mass index 24.71 (+ 3.05) kg/m2. Dyslipidemia was the most common risk factor (84%), followed by smoking (72%), hypertension (38.4%), diabetes mellitus (22.7%), and obesity (4.5%). Median leptin level was 7,242 (780-36,929) pq/mL. Mean SYNTAX score was 19.52 (+9.93). Leptin level had no correlation with the complexity of coronary artery lesion (p=0.61, r=0.078). The difference between this study from prior studies might be caused by differences in subject selection and criteria used for complexity of coronary artery lesion. In conclusion, there is no correlation between serum leptin levels and complexity of coronary artery lesion in patients with stable coronary artery disease. [MKB. 2016;48(1):26?31]Key words: Complexity of coronary artery lesion, leptin, stable coronary artery disease, SYNTAX score