Tesis

Perbedaan Nilai Heart Rate Variability, Neutrophil Lymphocyte Ratio dan Kualitas Hidup Antara Pasien Infark Miokard Akut dengan Gejala Depresi dan Pasien Infark Miokard Akut tanpa Gejala Depresi = Differences in Heart Rate Variability, Neutrophil Lymphocyte Ratio and Quality of Life between Acute Myocardial Infarction Patients with Depressive Symptoms and Acute Myocardial Infarction Patients without Depressive Symptoms.

Latar Belakang: Penyakit jantung koroner masih menjadi penyebab utama morbiditas dan mortalitas di seluruh dunia. Lebih dari 20% pasien jantung koroner memenuhi kriteria depresi mayor dan 2 dari 5 pasien sindrom koroner akut mempunyai gejala depresi yang nyata. Beberapa penelitian memperlihatkan adanya hubungan antara penurunan nilai Heart Rate Variability (HRV), peningkatan Neutrophyl Lymphocyte Ratio (NLR) dengan peningkatan morbiditas dan mortalitas pada pasien infark miokard. Di sisi lain, depresi dapat menyebabkan penurunan nilai HRV, peningkatan NLR dan penurunan kualitas hidup sehingga menjadi penting untuk mengetahui bagaimana sebenarnya perbedaan nilai HRV, NLR dan kualitas hidup antara pasien Infark Miokard Akut (IMA) dengan gejala depresi dan pasien IMA tanpa gejala depresi saat menjalani perawatan di rumah sakit Tujuan: Mengetahui perbedaan nilai HRV, NLR dan kualitas hidup antara pasien IMA dengan gejala depresi dan pasien IMA tanpa gejala depresi Metode: Penelitian ini merupakan studi potong lintang. Dilakukan pengambilan data pasien IMA yang dirawat di Intensive Cardiac Care Unit (ICCU) Rumah Sakit Cipto Mangunkusumo dalam kurun waktu Maret - Juli 2021 secara konsekutif sampai jumlah data terpenuhi. Data dianalisis dengan uji t tidak berpasangan. Hasil: Terdapat total 46 subjek pasien IMA dalam penelitian ini, 10 subjek dengan gejala depresi dan 36 subjek tanpa gejala depresi. Dari analisis didapatkan pasien IMA dengan gejala depresi mempunyai rata-rata standard deviation normal to normal (SDNN) lebih rendah dengan nilai p=0,447, rata-rata low frequency/high frequency (LF/HF) lebih rendah dengan nilai p=0,323 dan rata-rata NLR lebih tinggi dengan nilai p=0,438 dibandingkan pasien IMA tanpa gejala depresi walaupun secara statistik tidak bermakna. Dari analisis juga didapatkan secara bermakna rata-rata skor total SF36 (p=0,000), skor domain fungsi fisik (p=0,000), skor domain energi(p=0,000), skor domain kesehatan mental (p=0,000), skor domain fungsi sosial (p=0,028), skor domain nyeri (p=0,002), dan skor domain kesehatan umum (p=0,002) yang lebih rendah pada pasien IMA dengan gejala depresi. Simpulan: Pada pasien IMA dengan gejala depresi mempunyai rata-rata SDNN dan LF/HF yang lebih rendah serta rata-rata NLR yang lebih tinggi dibanding pasien IMA tanpa depresi walaupun statistik tidak bermakna. Terdapat kualitas hidup yang lebih rendah pada pasien IMA dengan gejala depresi dibandingkan pasien IMA tanpa gejala depresi secara bermakna.
Kata kunci: Depresi, Infark Miokard Akut, Heart Rate Variability, Neutrophil Lymphocyte Ratio, Kualitas Hidup


Background: Coronary heart disease is still a major cause of morbidity and mortality worldwide. More than 20% of coronary heart patients meet the criteria for major depression and 2 out of 5 patients with acute coronary syndrome have significant depressive symptoms. Several studies have shown that reduction of hearth rate variability (HRV) and enhancement of neutrophil lymphocyte ratio (NLR) can cause enhancement of morbidity and mortality in patients with myocardial infarction. On the other hand, depression can cause reduction of HRV, enhancement of NLR and reduction of quality of life, so it is important to know how exactly the differences in HRV, NLR and quality of life between acute myocardial infarction (AMI) patients with depressive symptoms and AMI patients without depressive symptoms in hospital ward. Objective: To determine differences in HRV, NLR and quality of life between AMI patients with depressive symptoms and AMI patients without depressive symptoms. Methods: This research is a cross-sectional study. Data were collected on AMI patients who were treated at Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from March to July 2021. Data were analyzed by unpaired t-test. Results: There were a total of 46 subjects AMI patients in this study, 10 subjects with depressive symptoms and 36 subjects without depressive symptoms. From the analysis, it was found that AMI patients with depressive symptoms had lower standard deviation normal to normal (SDNN) average (p=0.447), lower low frequency/high frequency (LF/HF) average (p=0.323) and higher NLR average (p= 0.438) than AMI patients without depressive symptom although it was not statistically significant. From the analysis, it was also obtained that the mean of SF36 total scores (p=0.000), physical function domain scores (p=0.000), energy domain scores (p=0.000), mental health domain scores (p=0.000), social function domain scores (p=0.028), bodily pain domain scores (p=0.002), and general health domain scores (p=0.002) were lower in AMI patients with depressive symptoms. Conclusion: AMI patients with depressive symptoms had lower SDNN, lower LF/HF and higher NLR than AMI patients without depressive symptoms, although the statistics were not significant. There is a significantly lower quality of life in AMI patients with depressive symptoms than in AMI patients withoud depressive symptoms.
Keywords: Depression, Acute Myocardial Infarction, Heart Rate Variability, Neutrophil Lymphocyte Ratio, Quality of Life