Tesis

Hubungan antara kadar endotelin-1 dengan tekanan arteri pulmoner pasca operasi pada pasien stenosis mitral yang menjalani pembedahan katup mitral = Correlation between endothelin-1 level and post operative systolic pulmonary artery pressure in mitral stenosis patients who undergo mitral valve surgery

Latar belakang. Stenosis mitral masih menjadi masalah kesehatan di negara berkembang
dengan hipertensi pulmoner sebagai salah satu komplikasinya. Disfungsi endothelium berperan
penting pada hipertensi pulmoner dimana terdapat peningkatan produksi mediator vasoaktif.
Endotelin-1 merupakan vasokonstriktor yang kuat dan berperan penting dalam hipertensi
pulmoner.
Metode. Penelitian ini merupakan studi kohort pada 32 pasien stenosis mitral bermakna dengan
hipertensi pulmoner sedang-berat yang menjalani pembedahan katup mitral di Pusat Jantung
Nasional Harapan Kita dari bulan April hingga November 2014. Dilakukan analisa statistik
untuk mencari hubungan antara kadar endotelin-1 dengan tekanan sistolik arteri pulmoner
pasca operasi.
Hasil. Terdapat korelasi antara kadar endotelin-1 pre operasi dengan tekanan sistolik arteri
pulmoner pasca operasi (r 0,387 dengan p 0,029). Analisa regresi linear antara kadar endotelin1
pre operasi dengan tekanan sistolik arteri pulmoner pasca operasi (adjusted analysis sesuai
usia, jenis kelamin, hipertensi, diabetes melitus, dislipidemia, atrial fibrilasi dan waktu cross
clamp aorta dan penggunaan mesin cardiopulmonay bypass menunjukan nilai koefisien β 11,4
dengan IK 95% 2,9-19,9 dan nilai p 0,011. Analisa regresi linear antara kadar endotelin-1 pasca
operasi dengan tekanan sistolik arteri pulmoner pasca operasi (adjusted analysis)menunjukan
nilai koefisien β 4,3 dengan IK 95% -5,4-13,9 dan nilai p 0,367. Analisa regresi linear antara
perubahan kadar endotelin-1 pre dan pasca operasi dengan tekanan sistolik arteri pulmoner
pasca operasi (adjusted analysis)mendapatkan nilai koefisien β 12,5 dengan IK 95% 0,5-24,4
dan p 0,041.
Kesimpulan. Kadar endotelin-1 pre operasi berhubungan dengan tekanan sistolik arteri
pulmoner pasca operasi mitral pada pasien mitral stenosis dengan hipertensi pulmoner.
Kata kunci:Stenosis mitral, Hipertensi pulmoner, endotelin-1, residual hipertensi


Background. Mitral stenosis is still the major health problem in developing countries with
pulmonary hypertension as one of the complications. Endothelial dysfunction play significant
role in pulmonary hypertension where the production of vasoactive mediators increase.
Endothelin-1 is a very strong vasoconstrictor which play role in pulmonary hypertension.
Methods. A cohort study in 32 patients with significant mitral stenosis complicated with
moderate-severe pulmonary hypertension who underwent mitral valve surgery in National
Cardiovascular Center Harapan Kita from April to November 2014. Statistical analysis is done
to explore the correlation between endothelin-1 level and systolic pulmonary arterial pressure
post surgery.
Results. There was correlation between endothelin-1 pre surgery with systolic pulmonary
arterypressure after surgery (r 0,387 and p value 0,029). Linear regression analysis of the
endothelin-1 level pre surgery with systolic pulmonary artery pressure post surgery (adjusted
analysis to age, sex, hypertension, diabetes mellitus, dyslipidemia atrial fibrillation, aortic cross
clamp time and cardio-pulmonary bypass time) with β coefficient 11,4 with 95% confidence
interval 2,9-19,9 and p 0,011. Linear regression analysis between endothelin-1 level post
surgery with systolic pulmonary artery pressure (adjusted analysis)showed β coefficient 4,3
with 95% confidence interval -5,4-13,9 and p 0,367. Linear regression analysis between the
difference of endothelin-1 level post and pre surgery and systolic pulmonary artery pressure
post surgery (adjusted analysis) showed β coefficient 4,3 with 95% confidence interval 0,524,4
and p 0,041.
Conclusion. Endothelin-1 level pre surgery is correlated with systolic pulmonary artery
pressure post mitral valve surgery in mitral stenosis patients with pulmonary hypertension
Keywords: mitral stenosis, pulmonary hypertension, endothelin-1, residual pulmonary
hypertension