Indeks Massa Ventrikel Kiri dengan Disfungsi Diastole pada Pasien Konsentrik Penyakit Jantung Hipertensi

Chaerul Achmad, Erwan Martanto, Toni Mustahsani Aprami, Augustine Purnomowati, R. Reni Farenia Soedjana Ningrat, Mega Febrianora

Abstract


Hipertrofi ventrikel kiri ditunjukkan secara objektif dengan peningkatan indeks massa ventrikel kiri (IMVK). Peningkatan massa ventrikel kiri dan dilatasi jantung ruang adalah parameter untuk penyakit jantung hipertensi (PJH). Remodeling jantung ini mengubah fungsi jantung yang mengakibatkan disfungsi diastolik. Penelitian ini bertujuan menemukan korelasi antara IMVK dan disfungsi diastolik pada pasien PJH konsentrik. Terdapat 49 pasien PJH konsentrik. Dari 49 pasien, 43 pasien dilibatkan, 15 laki-laki (35%) dan 28 perempuan (65%) memenuhi kriteria inklusi. Penelitian dilakukan di Cardiac Centre RSUP Dr. Hasan Sadikin Bandung periode 1 Oktober 2014–15 February 2015. Pemeriksaan tinggi dan berat badan menggunakan alat SMIC ZT 120. Pemeriksaan ekokardiografi standar dilakukan dan fungsi diastolik dinilai dengan pemeriksaan E/e' menggunakan mesin ekokardiografi Vivid 7. Usia rata-rata subjek adalah 56,56 tahun dan indeks massa tubuh rata-rata adalah 25,96 kg/m2. Tekanan darah sistole rata-rata 145,51 (SD 21,969) mmHg dan diastole rata-rata 85,13 (SD 10,227) mmHg. Frekuensi denyut jantung rata-rata 74,07 kali/menit. Fraksi ejeksi rata-rata 73,02. Obat yang secara teratur diminum oleh subjek angiotensin-converting enzyme inhibitor pada 17 orang (40%), calcium channel blocker 19 orang (44%), beta-blocker 15 orang (35%), angiotensin II reseptor blocker 9 orang (21%), dan diuretik 4 orang (9%). Nilai IMVK rata-rata 130,36 (SD 21,077) g/m2. Nilai E/e' rata-rata 10,56 (SD 2,761). Hasil penelitian menunjukkan tidak ada hubungan yang signifikan antara IMVK dan derajat disfungsi diastolik (p=0,73). Data IMVK dan derajat tingkat disfungsi diastolik terdistribusi normal. Simpulan, tidak terdapat hubungan antara IMVK dan disfungsi diastolik pada pasien PJH jenis konsentrik.


LEFT VENTICULAR MASS INDEX WITH DIASTOLIC DYSFUNCTION IN HYPERTENSIVE HEART DISEASE PATIENTS

Left ventricular hypertrophy was shown with increased left ventricular mass index (LVMI). Increased left ventricular mass and cardiac chamber dilatation are parameters for hypertensive heart disease (HHD). This cardiac remodeling causes changes in heart function resulting in diastolic dysfunction. This study aimed to find the correlation between LVMI and diastolic dysfunction in patients with concentric HHD. We enrolled 49 patients with concentric HHD in Cardiac Centre RSUP Dr. Hasan Sadikin Bandung during 1 October 2014 to 15 February 2015, whom 43 met the inclusion criteria, 15 males (35%) and 28 females (65%). The subjects of study height and weight measured using SMIC tool ZT 120. The standard echocardiography examination was performed and diastolic function was assessed by examination of the E/e' using echocardiography machine Vivid 7. The average age of the subjects was 56.56 years with body mass index of 25.96 kg/m2. The average of systolic blood pressure and diastolic blood pressure were 145.51 (SD 21.969) and 85.13 (SD 10.227) mmHg respectivelly. The average frequency of heart beats was 74.07 bpm and average ejection fraction was 73.02. Drugs regularly consumed by subjects according to the percentage were: angiotensin-converting enzyme inhibitor {17 (40%)}, calcium channel blocker {19 (44%)}, beta-blocker {15 (35%)}, angiotensin II receptor blocker {9 (21%)}, and diuretics {4 (9%)}. The average value of LVMI was 130.36 (SD 21.077) g/m2 and the average value of E/e' was 10.56 (SD 2.761). The result show that there was no significant correlation between LVMI and the degree of diastolic dysfunction (p=0.73). The data LVMI and the degree of diastolic dysfunction levels were normally distributed. In conclusion, there is no correlation between LVMI and diastolic dysfunction in patients with HHD concentric type.


Keywords


Diastolic dysfunction; disfungsi diastolik; hipertensi; hypertension; hipertrofi ventrikel kiri; hypertensive heart disease; indeks massa ventrikel kiri, left ventricular hypertrophy; LV mass index; penyakit jantung hipertensi

References


Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, dkk.; the National High Blood Pressure Education Program Coordinating Committee. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52.

Levy D, Larson MG, Vasan RS, Kannel WB, Ho KKL. The progression from hypertension to congestive heart failure. JAMA. 1996;275(20):1557–62.

World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, Switzerland: WHO Press; 2011.

Badan Penelitian dan Pengembangan Kesehatan, Kemenkes RI. Riset kesehatan dasar (Riskesdas) 2013. Jakarta: Kemenkes RI; 2013.

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, dkk.; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.

de Simone G, Verdecchia P, Pede S, Gorini M, Maggioni AP. Prognosis of inappropriate left ventricular mass in hypertension: the MAVI Study. Hypertension. 2002;40(4):470–6.

Muiesan ML, Salvetti M, Monteduro C, Bonzi B, Paini A, Viola S, dkk. Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients. Hypertension. 2004;43(4):731–8.

Stevens SM, Reinier K, Chugh SS. Increased left ventricular mass as a predictor of sudden cardiac death: is it time to put it to the test? Circ Arrhythm Electrophysiol. 2013;6(1):212–7.

de Simone G, Kitzman DW, Chinali M, Oberman A, Hopkins PN, Rao DC, dkk. Left ventricular concentric geometry is associated with impaired relaxation in hypertension: the HyperGEN study. Eur Heart J. 2005;26(10):1039–45.

Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Battistelli M, Bartoccini C, dkk. Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass. J Am Coll Cardiol. 1995;25(4):871–8.

Mottram PM, Marwick TH. Assessment of diastolic function: what the general cardiologist needs to know. Heart. 2005;91(5):681–91.

Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, dkk. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10(2):165–93.

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, dkk. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.

Baloch DM, Rasheed SZ, Rajput IA, Samad A. Prevalence of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy. Pak Heart J. 2010;43(1–2);20–6.

Almuntaser I, Mahmud A, Brown A, Murphy R, King G, Crean P, dkk. Blood pressure control determines improvement in diastolic dysfunction in early hypertension. Am J Hypertens. 2009;22(11):1227–31.

Masugata H, Senda S, Inukai M, Murao K, Hosomi N, Iwado Y, dkk. Differences in left ventricular diastolic dysfunction between eccentric and concentric left ventricular hypertrophy in hypertensive patients with preserved systolic function. J Int Med Res. 2011;39(3):772–9.

Lee H, Kong YH, Kim KH, Huh J, Kang IS, Song J. Left ventricular hypertrophy and diastolic function in children and adolescents with essential hypertension. Clin Hypertens. 2015;21:21.

Agu NC, McNiece Redwine K, Bell C, Garcia KM, Martin DS, Poffenbarger TS, dkk. Detection of early diastolic alterations by tissue doppler imaging in untreated childhood–onset essential hypertension. J Am Soc Hypertens. 2014;8(5):303–11.

Fagard RH, Celis H, Thijs L, Wouters S. Regression of left ventricular mass by antihypertensive treatment. Hypertension. 2009;54(5):1084–91.

Gaudio C, Ferri FM, Giovannini M, Pannarale G, Puddu PE, Vittore A, dkk. Comparative effects of irbesartan versus amlodipine on left ventricular mass index in hypertensive patients with left ventricular hypertrophy. J Cardiovasc Pharmacol. 2003;42(5):622–8.

Beltman FW, Heesen WF, Smit AJ, May JF, de Graeff PA, Havinga TK, dkk. Effects of amlodipine and lisinopril on left ventricular mass and diastolic function in previously untreated patients with mild to moderate diastolic hypertension. Blood Press. 1998;7(2):109–17.

Terpstra WF, May JF, Smit AJ, de Graeff PA, Havinga TK, van den Veur E, dkk. Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients: the ELVERA trial. J Hypertens. 2001;19(2):303–9.

Bruder O, Christoph JJ, Bell M, Rummel R, Boehm G, Klebs S, dkk. Effects of the combinations of amlodipine/ valsartan versus losartan/hydrochlorothiazide on left ventricular hypertrophy as determined with magnetic resonance imaging in patients with hypertension. J Drug Assess. 2012;1(1):1–10.

Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, dkk. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA. 2004;292(19):2343–9.

Teniente-Valente R, Solorio S, Vargas-Salado E, Aguirre-Vázquez C, Hernández-González MA, Olvera-Lopez JA, dkk. Improvement of diastolic function after regression of left ventricular hypertrophy. Arch Cardiol Mex. 2008;78(4):392–9.

Malmqvist K, Kahan T, Isaksson H, Ostergren J. Regression of left ventricular mass with captopril and metoprolol, and the effects on glucose and lipid metabolism. Blood Press. 2001;10(2):101–10.

Fak AS, Okucu M, Tezcan H, Bodur G, Kotay A. Effects of antihypertensive therapy with amlodipine on left ventricular mass and diastolic function. Arch Turk Soc Cardiol. 1995;23(5):336–42.

Prasquier R, Dufloux MA, Chatellier G, Plouin PF, Ménard D, Corvol P, dkk. Comparison of the effect of captopril and minoxidil on left ventricular mass. Results of a 6-month comparative double-blind test. Arch Mal Coeur Vaiss. 1987;80(6):911–8.

Egan B, Fitzpatrick A, Juni J, Buda AJ, Zweifler A. Importance of overweight in studies of left ventricular hypertrophy and diastolic function in mild systemic hypertension. Am J Cardiol. 1989;64(12):752–5.

Chadha DS, Swamy A, Malani SK, Ganjoo RK, Mathew OP. Impact of body mass index on left ventricular function. Med J Armed Forces India. 2009;65(3):203–7.

Kossaify S, Nicolas N. Impact of overweight and obesity on left ventricular diastolic function and value of tissue doppler echocardiography. Clin Med Insights Cardiol. 2013;7:43–50.

Fenk S, Fischer M, Strack C, Schmitz G, Loew T, Lahmann C, dkk. Successful weight reduction improves left ventricular diastolic function and physical performance in severe obesity. Int Heart J. 2015;56(2):196–202.




DOI: https://doi.org/10.29313/gmhc.v5i1.2194

pISSN 2301-9123 | eISSN 2460-5441


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