Tesis

Hubungan NT-proBNP dengan Sindrom Curah Jantung Rendah pada Pasien Pediatrik Asianotik Pascabedah Jantung Terbuka = Correlation between NT-proBNP and Low Cardiac Output Syndrome in Acyanotic Congenital Heart Disease Pediatric Patients undergoing Open Heart Surgery.

Penyakit jantung bawaan asianotik yang merupakan sebagian besar dari penyakit jantung bawaan memerlukan operasi bedah jantung terbuka untuk memperbaiki kelainannya. Sindrom curah jantung rendah masih merupakan masalah yang dihadapi pada pasien pediatrik pascabedah jantung terbuka. Deteksi sindrom curah jantung rendah yang ada sekarang menggunakan kriteria klinis dan indikator laboratorik masih belum dirasa cukup, yang terbukti dengan masih adanya angka morbiditas dan mortalitas. Peranan penanda biologis NT-proBNP telah berkembang di gagal jantung dewasa diharapkan dapat digunakan untuk dapat mendeteksi sindrom curah jantung rendah pada pediatrik. Penelitian cross sectional observasional dengan jumlah 38 subjek yang memenuhi kriteria inklusi dan eksklusi yang menjalani operasi jantung bawaan asianotik bulan Oktober-November 2018 di Rumah Sakit Jantung dan Pembuluh darah Nasional Harapan Kita, Indonesia. Data prabedah, intrabedah dan pascabedah termasuk kejadian sindrom curah jantung rendah dicatat. Kadar NT-proBNP akan diambil prabedah, 4 jam, 24 jam dan 72 jam pascabedah. Analisis data menggunakan uji Mann-Whitney. Kadar NT-proBNP prabedah, 4 jam pascabedah dan 24 jam pascabedah berbeda bermakna dengan kejadian sindrom curah jantung rendah (nilai p < 0,05). Kadar NTproBNP prabedah memiliki perbedaan rerata lebih rendah dibandingkan dengan kadar NT-proBNP 4 jam pascabedah yang juga lebih rendah dibandingkan kadar NT-proBNP 24 jam pascabedah dan hal ini berbeda bermakna (p < 0,001). Sedangkan kadar NTproBNP 72 jam pascabedah memiliki rerata lebih rendah dibandingkan dengan kadar NT-proBNP 24 jam pascabedah yang juga berbeda bermakna (p < 0,001). Analisis kadar NT-proBNP dengan variabel lainnya mendapatkan hasil berbeda bermakna dengan variabel usia, jenis kelamin, berat badan, diagnosis PJB, durasi ventilasi mekanik dan durasi ICU. Kadar NT-proBNP berhubungan dengan kejadian sindrom curah jantung rendah. Kadar NT-proBNP yang tinggi menunjukkan adanya kejadian sindrom curah jantung rendah (pada kadar NT-proBNP prabedah, 4 jam dan 24 jam pascabedah).
Kata kunci: penyakit jantung bawaan asianotik, sindrom curah jantung rendah, kadar NT-proBNP


Open heart surgery is essential for the treatment of acyanotic congenital heart disease in pediatrics. Patients undergoing this heart surgery are vulnerable to low cardiac output syndrome. To date, the detection of low cardiac output state has been solely relied from clinical judgement and laboratory assessments. These parameters are thought to be inadequate for the unchanging mortality and morbidity rate after surgery. N-terminal pro-B-type-natriuretic-peptide (NT-proBNP), as known biomarker for heart failure in adults, is expected to be used to detect low cardiac output syndrome in pediatrics. We conducted a cross-sectional trial on 38 subjects who are fulfilled our study criteria. The study was performed at the National Cardiovascular Centre Harapan Kita, Indonesia, in the period of October – November 2018. Perisurgical data including low cardiac output state were recorded. Levels of NT-proBNP were acquired before, 4 hours-, 24 hours-, and 72 hours after surgery. We utilised Mann-Whitney test to analyse the data. Statistically significant was observed in the level of NT-proBNP before, 4 hours- and 24 hours after surgery with low cardiac output syndrome (p < 0.05). Level of pre surgical NT-proBNP was significanly lower than its level 4 hours after surgery which also significantly lower than its level 24 hours after surgery (p < 0.001). On 72 hours after surgery, the level of NT-proBNP were significantly lower than its level 24 hours after surgery (p < 0.001). All statistical analysis of NT-proBNP with other variables including age, sex, body weight, diagnosis, mechanical ventilation, and length of ICU stay were significant. Levels of NT-proBNP were associated with low cardiac output syndrome. High concentration of this biomarker indicates low cardiac output state in this study population.
Keywords: acyanotic congenital heart disease, low cardiac output syndrome, NTproBNP