Tesis

Hubungan antara Konsentrasi Kalsidiol dengan Ekspresi Nuclear Factor-kappa B dan Kejadian Gagal Jantung Akut pada Pasien Infark Miokard Akut disertai Elevasi Segmen ST yang Menjalani Intervensi Koroner Perkutan Primer = Association between Calcidiol Concentration with Nuclear Factor-kappa B expression and Acute Heart Failure in ST Elevation Myocardial Infarction Patients who underwent Primary Percutaneous Coronary Intervention.

Latar Belakang: Infark miokard akut disertai elevasi segmen ST (IMA-EST) dihubungkan dengan proses inflamasi akut. Kalsidiol merupakan suatu protein yang memiliki potensi peranan anti inflamasi. Nuclear factor-kappa B (NF-B) merupakan faktor transkripsi yang terlibat dalam dimulainya sinyal inflamasi. Pasien IMA-EST dengan derajat inflamasi yang lebih berat dikaitkan dengan luaran klinis yang lebih buruk seperti gagal jantung akut. Tujuan: Mengetahui hubungan antara konsentrasi kalsidiol dengan ekspresi NF-B dan kejadian gagal jantung akut pada pasien IMA-EST yang menjalani intervensi koroner perkutan primer (IKPP). Metode: Studi cross-sectional dilakukan pada 100 pasien IMA-EST yang menjalani IKPP di RS Jantung dan Pembuluh Darah Harapan Kita periode 2 Januari 2018 hingga 31 Desember 2018. Cut-off konsentrasi kalsidiol dan ekspresi NF-B ditentukan menggunakan kurva receiver operating characteristic. Luaran klinis berupa kejadian gagal jantung akut yang didefinisikan sebagai Killip kelas II-IV. Hasil: Uji Spearman mendapatkan korelasi negatif antara konsentrasi kalsidiol dan ekspresi NF-κB pada kelompok konsentrasi kalsidiol < 27,2 ng/mL (r=-0,42, p=0,04). Kejadian gagal jantung akut dihubungkan dengan konsentrasi kalsidiol lebih rendah (median 20,5 ng/mL vs 36,4 ng/mL, p=0,006) dan ekspresi NF-κB lebih tinggi (median 598,0 %/jumlah sel vs 213,2 %/jumlah sel, p=0,04). Pada analisis multivariat, kelompok konsentrasi kalsidiol < 27,2 ng/mL memiliki hubungan dengan kejadian gagal jantung akut (OR =7,80, IK95%=1,12-54,63, p=0,04). Ekspresi NF-b ≥ 388,5 %/jumlah sel memiliki hubungan dengan kejadian gagal jantung akut pada analisis univariat (OR=6,11, IK95%=1,12-33,45, p=0,02), namun tidak ditemukan hubungan pada analisis multivariat (OR=4,64, IK95%=0,63-34,02, p=0,13). Kesimpulan: Pada pasien IMA-EST yang menjalani IKPP, tidak ditemukan hubungan antara konsentrasi kalsidiol dan ekspresi NF-κB pada seluruh populasi sampel, namun ditemukan korelasi negatif antara konsentrasi kalsidiol dan ekspresi NF-κB pada kelompok konsentrasi kalsidiol rendah. Pasien dengan konsentrasi kalsidiol rendah dihubungkan dengan peningkatan risiko kejadian gagal jantung akut.
Kata Kunci: Ekspresi NF-κB, gagal jantung akut, IMA-EST, konsentrasi kalsidiol.


Background: ST Elevation Myocardial Infarction (STEMI) is associated with acute inflammation process. Calcidiol has a potential anti-inflammatory role. Nuclear factorkappa B (NF-B) is a transcription factor which involved in the activation of inflammation signal. STEMI patients with more severe inflammation degree is associated with worse clinical outcome such as acute heart failure. Objective: To evaluate the association between calcidiol concentration and NF-B expression with acute heart failure in STEMI patients who underwent Primary Percutaneous Coronary Intervention (PPCI). Method: A cross sectional study was performed on 100 STEMI patients who underwent PPCI in National Cardiovascular Centre Harapan Kita between January 2 nd st 2018 to 31 December 2018. Calcidiol concentration and NF-B expression cut-off was determined by receiver operating characteristic curve. Clinical outcome was acute heart failure event which was defined as Killip classification II-IV. Result: Spearman analysis showed a negative correlation between calcidiol concentration and NF-B expression in calcidiol concentration group < 27,2 ng/mL (r=-0,42, p=0,04). Acute heart failure event was associated with lower median calcidiol concentration (20,5 ng/mL vs 36,4 ng/mL, p=0,006) and higher median NF-B expression (598,0 %/cell vs 213,2 %/cell, p=0,04). Multivariate logistic regression analysis showed that calcidiol concentration < 27,2 ng/mL was associated with acute heart failure event (OR =7,80, 95% CI=1,12-54,63; p= 0,04). NF-B expression ≥ 388,5 %/cell was associated with acute heart failure event in univariate analysis (OR=6,11, 95% CI=1,12-33,45, p=0,02), that was not found in multivariate analysis (OR=4,64, 95% CI=0,63-34,02, p=0,13). Conclusion: In patients with acute STEMI and underwent PPCI, no correlation was found between calcidiol concentration and NF-B expression in total sample, but there was negative correlation between between calcidiol concentration and NF-B expression in low calcidiol concentration group. Patients who presented with low calcidiol concentration was associated with an increased risk of acute heart failure.
Keywords: NF-κB expresstion, acute heart failure, STEMI, calcidiol concentration.