Tesis

Perbaikan Fungsi Intrinsik Longitudinal Ventrikel Kiri Sebelum dan Sesudah Latihan Olahraga pada Pasien Gagal Jantung dengan Fraksi Ejeksi yang Normal = The Improvement of Longitudinal Intrisic Function of Left Ventricle Before and After Exercise Training In Heart Failure with Preserved Ejection Fraction Patient.

Latar Belakang: Lima puluh persen penderita gagal jantung merupakan gagal jantung dengan fraksi ejeksi yang normal (HFPEF). Morbiditas dan mortalitas HFPEF dengan gagal jantung fraksi ejeksi yang rendah hampir sama, namun terapi HFPEF belumlah jelas. Latihan olahraga terbukti memperbaiki kualitas hidup penderita gagal jantung dengan fraksi ejeksi yang rendah dan telah menjadi rekomendasi pertama dalam beberapa panduan klinis, namun belum pada HFPEF. Ekokardiografi strain longitudinal apikal empat ruangan dapat digunakan sebagai nilai prognostik. Namun perbaikan fungsi longitudinal intrinsik ventrikel kiri menggunakan strain longitudinal apikal empat ruangan akibat latihan olahraga belumlah diketahui. Tujuan: Untuk mengetahui adakah perbaikan fungsi intrinsik longitudinal ventrikel kiri sebelum dan sesudah program latihan olahraga pada pasien HFPEF. Metode: Penelitian ini merupakan penelitian kuasi eksperimental. Menggunakan 30 sampel konsekutif HFPEF yang dilakukan program latihan olahraga tersupervisi di Divisi Prevensi dan Rehabilitasi Pusat Jantung Harapan Kita. Program latihan olahraga dilakukan selama 20 kali latihan dalam satu bulan dan dievaluasi tiap 2 minggu. Dilakukan pemeriksaan ekokardiografi sebelum, minggu ke 2 dan minggu ke 4 latihan olahraga. Juga dilakukan pemeriksaan 6MWT serta pengisian kuesioner MLWHF dan WHO sebelum dan sesudah latihan olahraga. Hasil Penelitian: Tidak terdapat perbedaan yang signifikan dalam variabel EF sebelum, minggu ke 2 dan ke 4 latihan olahraga. Variabel E/e’, LAVI dan strain longitudinal global mengalami perbaikan selama latihan olahraga. Terdapat perbedaan yang signifikan dalam 6MWT, nilai skoring MLWHF dan WHO5 sebelum dan sesudah latihan olahraga. Didapatkan nilai strain longitudinal sebesar -16,20% (10,7% sampai dengan -17,81%). Strain longitudinal apikal 4 ruangan mengalami perbaikan pada minggu ke 2 dan ke 4 latihan olahraga (sebelum latihan olahraga LS = -16,20 [-10,70 to -17,81]; minggu ke dua latihan olah raga LS = -18,00±2,69 dan minggu ke 4 latihan olahraga LS = -21,86±1,79) dan terdapat perbedaan yang signifikan (p < 0,001). Kesimpulan: Terdapat perbaikan fungsi intrinsik longitudinal ventrikel kiri sebelum dengan sesudah diberikan program latihan olahraga pada penderita gagal jantung dengan fraksi ejeksi yang normal.
Kata kunci: HFPEF, latihan olahraga,strain longitudinal global



Background: Fifty percent of patients with heart failure are heart failure with preserved ejection fraction (HFPEF). Morbidity and mortality of HFPEF with heart failure low ejection fraction is almost the same, but therapy of HFPEF is unclear. Exercise is proven to improve the quality of life of heart failure with low ejection fraction patients and has become the first recommendation in several clinical guidelines, but not yet in HFPEF. Apical 4 chamber longitudinal strain echocardiography can be used as a prognostic value. But the improvement of longitudinal intrinsic left ventricular function using apical 4 chamber longitudinal strain due to exercise training is not yet known. Aim: To know is there any improvement in intrinsic longitudinal left ventricular function before and after exercise training in HFPEF patients. Method: This is a quasi- experimental study. Using thirty consecutive sample of HFPEF and was performed supervised exercise training in the Division of Prevention and Rehabilitation of Cardiovascular Center Harapan Kita. Exercise training program was conducted for a month with total of 20 times exercise training and evaluated every 2 weeks. Echocardiography was performed before, week 2 and week 4 of exercise training. 6MWT, MLWHF and WHO questionnaire was performed before and after exercise. Result: There was no significant difference in EF before, weeks 2 and 4 of exercise. E/e', LAVI and longitudinal strain has improved during the exercise. There was significant differences in the 6MWT, the value of MLWHF and WHO5 score before and after exercise. Longitudinal strain values obtained by -16.20 % (-10.7% to 17.81%). Four chamber longitudinal strain was improved at weeks 2 and 4 of exercise (before exercise LS = -16.20 [-10.70 to -17.81]; the second week of exercise training LS = -18.00±2,69 and week 4 exercise LS = -21.86 ± 1.79) and there were significant differences (p < 0.001). Conclusion: There was an improvement in the longitudinal intrinsic left ventricular function before and after exercise training in patients with heart failure with preserved ejection fraction.
Keywords: HFPEF, exercise training, longitudinal strain