Akurasi Kriteria Voltase Elektrokardiografi Hipertrofi Ventrikel Kiri untuk Membedakan Jenis Geometri Hipertrofi Ventrikel Kiri

Abstract

Perbedaan jenis geometri hipertrofi ventrikel kiri dikaitkan dengan risiko penyakit kardiovaskular yang berbeda. Ekokardiografi dengan bantuan kriteria voltase elektrokardiografi (EKG) hipertrofi ventrikel kiri dapat membedakan jenis geometri hipertrofi ventrikel kiri. Tujuan penelitian mengetahui peranan berbagai kriteria voltase EKG hipertrofi ventrikel kiri untuk membedakan jenis geometri hipertrofi ventrikel kiri. Dilakukan penelitian potong lintang periode Juni–November 2015 terhadap 100 pasien di poliklinik dan rawat inap kardiologi RSUP H. Adam Malik Medan. Dilakukan anamnesis, pengukuran indeks massa tubuh, serta pemeriksaan EKG dan ekokardiografi. Jika hasil kriteria EKG hipertrofi ventrikel kiri Sokolow-Lyon tidak dipenuhi maka didapatkan geometri ventrikel kiri normal dengan sensitivitas 60%, spesifisitas 72,22%, dan akurasi 71%. Untuk jenis geometri eksentrik hipertrofi ventrikel kiri didapatkan bila Cornel voltase tidak dipenuhi, sensitivitasnya 25%, spesifisitas 71,88% dan akurasi 55%. Untuk jenis hipertrofi geometri konsentrik bila rasio RV6/V5 >1 dipenuhi, sensitivitasnya 55,56%, spesifisitas 56,36% dan akurasi 56%. Jika rasio RV6/V5 >1 tidak dipenuhi, jenis geometri konsentrik remodeling hipertrofi ditentukan dengan sensitivitas 55,56%, spesifisitas 49,45% dan akurasi 50%. Pada penelitian ini juga didapatkan sensitivitas dan spesifisitas kriteria Sokolow-Lyon untuk hipertrofi ventrikel kiri secara ekokardiografi dengan sensitivitas 72,22% dan spesifisitas 60,00%, kriteria Cornel voltase untuk hipertrofi ventrikel kiri secara ekokardiografi dengan sensitivitas 77,78% dan spesifisitas 70,00%, dan kriteria rasio RV6/V5 untuk hipertrofi ventrikel kiri secara ekokardiografi dengan sensitivitas 51,11% dan spesifisitas 70,00%. Secara keseluruhan, sensitivitas dan spesifisitas termasuk lemah. Simpulan, berbagai kriteria EKG ventrikel kiri dapat membedakan jenis geometri hipertrofi ventrikel kiri. Kriteria EKG hipertrofi kiri voltase, yaitu Sokolow-Lyon dan Cornel voltase sensitivitas dan spesifisitas lebih baik dibanding dengan rasio RV6/V5.

ACCURACY OF CRITERIA VOLTAGE ELECTROCARDIOGRAPHY LEFT VENTRICULAR HYPERTROPHY TO DISTINGUISH TYPES OF LEFT VENTRICULAR HYPERTROPHY GEOMETRY

The different types of left ventricular hypertrophy geometry is associated with different risk of cardiovascular disease. Echocardiography is the gold standard for diagnosis of left ventricular hypertrophy. Electrocardiographic (ECG)left ventricular hypertrophy voltage criteria can distinguish the type of geometry of left ventricular hypertrophy. The purpose of this study to find out the role of various voltage ECG criteria to distinguish the type of geometry of left ventricle hypertrophy. A cross-sectional study doing from June to November 2015 on 100 patients in cardiology clinic and inpatient at Adam Malik Hospital, Medan, through anamnesis, body mass index  measurement, ECG and echocardiography examinations. If the Sokolow-Lyon ECG criteria for left ventricular hypertrophy did not met, normal left ventricular geometry was diagnosed with 60% sensitivity, 72.22% specificity and 71% accuracy. The eccentric left ventricular hypertrophy geometry was diagnosed if Cornel voltage was not fulfilled, with 25% sensitivity, 71.88% specificity and 55% accuracy. The concentric hypertrophy geometry was diagnosed if the RV6/V5 ratio >1, with 55.56% sensitivity, 56.36% specificity and 56% accuracy. If the RV6/V5 ratio >1 are not met, concentric hypertrophic remodeling geometry was diagnosed with a sensitivity of 55.56%, a specificity of 49.45% and an accuracy of 50%. This study also found the sensitivity and specificity for left ventricular hypertrophy in echocardiography of Sokolow-Lyon criteria were 72.22% and 60.00%, the Cornel voltage criteria with a sensitivity of 77.78% and a specificity of 70.00%, and RV6/V5 ratio criteria with a sensitivity of 51.11% and a specificity of 70.00%. The overall sensitivity and specificity was low. In conclusion, various criteria of  ECG left ventricular geometry voltage can differentiate left ventricular hypertrophy geometry types. Sokolow-Lyon and Cornell voltage criteria are more sensitive and specific than the RV6/V5 ratio.