Tesis

Hubungan Antara Penanda Inflamasi Kronik Dengan Progesifitas Stenosis Katup Mitral Pada Penyakit Jantung Rematik Pasca Komisurotomi Mitral Transvena Perkutan = Association Between Chronic Inflammation Marker with Mitral Valve Stenosis Progressivity in Rheumatic Heart Disease after Percutaneous Transvenous Mitral Commissurotomy.

Latar Belakang: Restenosis katup mitral didefinisikan sebagai penurunan mitral valve area (MVA) < 1,5 cm2 atau penurunan MVA > 50% pasca KMTP. Restenosis katup mitral bersifat time-dependent dan dikaitkan dengan major adverse cardiovascular events (MACE), seperti gagal jantung kongestif, kematian, operasi penggantian katup dan KMTP ulangan. Mekanisme penyebab restenosis katup mitral belum diketahui secara pasti tetapi diduga berkaitan dengan proses inflamasi kronik Tujuan: Mengetahui hubungan inflamasi kronik dengan restenosis katup mitral pasca KMTP. Metode: Total 40 pasien stenosis katup mitral yang telah menjalani tindakan KMTP dikelompokkan menjadi kelompok kasus (n=20) dan kelompok kontrol (n=20) berdasarkan matching. Diambil data sekunder dari rekam medis berupa karakteristik pasien, data ekokardiografi pre KMTP (Skor Wilkins dan MVA pre KMTP), dan data ekokardiografi post KMTP (MVA pasca KTMP). Dilakukan pemeriksaan ekokardiografi (MVA follow-up) dan pemeriksaan lab (kadar IL-6 dan TNF ). Kemudian dilakukan analisis statistik untuk mencari hubungan antara kadar penanda inflamasi kronik serta variabel bebas lainnya dengan restenosis katup mitral. Hasil: Terdapat peningkatan kadar TNF α seperti pada pasien PJR stabil atau derajat berat pada umumnya. Kadar IL-6 bervariasi dan terkesan lebih rendah pada restenosis katup mitral dibandingkan dengan PJR stabil atau derajat berat. Nilai rerata kadar TNF α adalah 15,13 ± 3,56 pg/mL. Nilai median kadar IL-6 adalah 2,39 (0,03 – 11,4) pg/mL. Tidak terdapat perbedaan bermakna kadar IL-6 dan TNF α di antara kelompok dengan restenosis katup mitral dan kelompok tidak restenosis katup mitral (nilai p > 0,05). Penurunan MVA pada pasien stenosis katup mitral yang menjalani tindakan KMTP adalah 0,13 (0 – 0,62) cm2/tahun dimana laju penurunan MVA ≥ 0,155 cm2/tahun merupakan prediktor kejadian restenosis katup mitral pasca KMTP (nilai p < 0,001, OR = 46,72, IK 95% 6,69 – 326,19). Kesimpulan: Inflamasi kronik yang dinilai dengan kadar penanda inflamasi kronik (IL-6 dan TNF α) tidak berhubungan dengan kejadian restenosis katup mitral pasca KMTP.
Kata Kunci: Katup mitral, restenosis, KMTP, inflamasi kronik


Background: Mitral valve restenosis is defined as decreased mitral valve area (MVA) < 1 .5 cm2 or decreased MVA > 50% after PTMC. It is time-dependent and associated with major adverse cardiovascular events (MACE), such as congestive heart failure, cardiac death, mitral valve replacement and redo PTMC. The mechanism is not yet known; however, chronic inflammation may have a role. Objective: To know association between chronic inflammation and mitral valve restenosis after PTMC. Methods: A total 40 patients with mitral valve stenosis underwent PTMC were matched and classified into case group (n=20) and control group (n=20). Secondary data was taken from electronic medical record such as patient characteristics, echocardiography data before PTMC (Wilkins score and MVA before PTMC), and echocardiography data after PTMC (MVA after PTMC). Follow-up echocardiography examination (follow-up MVA) and laboratory assessment (IL-6 and TNF α) were done on all patients. Statistical analyses were done to look for association between level of chronic inflammation marker & other independent variables with mitral valve restenosis. Results: Mean TNF α concentration was 15.13 ± 3.56 pg/mL. Median of IL-6 concentration was 2,39 (0,03 – 11,4) pg/mL. There was increased levels of TNF α as found in stabile/severe RHD patients. Levels of IL-6 was varied and lower than stabile/severe RHD patients. There was no statistically significant difference of IL-6 dan TNF α concentration between both groups (p value > 0.05). MVA decrement was 0.13 (0 – 0.62) cm2/year with rate MVA decrement ≥ 0.155 cm2/year was predictor of mitral valve restenosis (p value < 0.001 , OR = 46.72, 95% CI 6.69 – 326.19). Conclusion: Chronic inflammation was not associated with mitral valve restenosis.
Keywords: Mitral valve, restenosis, PTMC, chronic inflammation