Tesis

Hubungan Ketebalan Tunika Intima Media Arteri Karotis dengan Disfungsi Diastolik Ventrikel Kiri pada Pasian Diabetes Melitus Tipe 2 = Relationship between Carotid Artery Intima Media Thickness and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus Patients.

Latar Belakang: Sebanyak 50-75% pasien diabetes meninggal akibat kejadian kardiovaskular dan 47% pasien diabetes melitus tipe 2memiliki disfungsi diastolik. Peningkatan ketebalan tunika intima media arteri karotis diasosiasikan dengan penurunan distensibilitas arteri, yang menyebabkan peningkatan afterload dan disfungsi diastolik. Pada DM, terdapat kondisi resistensi insulin yg berhubungan dengan proses aterosklerosis. CIMT dapat menjadi salah satu marker aterosklerosis. Tujuan: Penelitian ini bertujuan untuk menilai hubungan ketebalan tunika intima media arteri karotis dengan disfungsi diastolik ventrikel kiri pada pasien diabetes melitus tipe 2. Metode: Penelitian potong lintang menggunakan data sekunder dari data penelitian Kohort PTM Bogor. Data dikumpulkan pada bulan Agustus-September 2024 di RSCM/FKUI. Analisis data dilakukan dengan program SPSS 20. Analisis bivariat dilakukan untuk melihat hubungan disfungsi diastolik dengan ketebalan tunika intima media arteri karotis dilakukan dengan uji Chi Square jika terpenuhi atau uji Fisher exact. Variabel perancu dianalisis menggunakan analisis multivariat regresi logistik. Hasil: 113 pasien DM tipe 2 memenuhi kriteria inklusi eksklusi penelitian ini dengan median usia 59 tahun (51 – 65). Mayoritas berjenis kelamin wanita (65,49%) dan komorbid terbanyak adalah hipertensi (44.25%). CIMT abnormal ditemukan pada 9,73% pasien dan 8% pasien mengalami disfungsi diastolik. Secara spesifik, 69,9% memiliki laju e’ anular septal < 7 cm/detik atau laju e’ anular lateral < 10 cm/detik, 7.1% dan 0.9% LAVI > 34 mL/m2. Laju e’ anular septal berkorelasi negatif dengan CIMT (r=-0,288¸ p=0,003) dan rasio E/e’ rata-rata > 14 berkorelasi positif dengan CIMT (r=0,191, p=0,042). Simpulan: Tidak ada hubungan antara ketebalan tunika intima media arteri karotis dan disfungsi diastolik ventrikel kiri pada pasien diabetes mellitus tipe 2.
Kata kunci: CIMT, Disfungsi Diastolik, DM Tipe 2, HFpEF


Background: As many as 50-70% of diabetic patients die from cardiovascular events and 47% of patients with type 2 diabetes mellitus have diastolic dysfunction. Increased CIMT is associated with decreased arterial distensibility, which causes increased afterload and diastolic dysfunction. In DM, there is a condtition of insulin resistance associated with the atherosclerosis proses. CIMT can be one of the markers of atherosclerosis. Objective: This study aims to assess the relationship between carotid artery intima media thickness and left ventricular diastolic dysfunction in type 2 diabetes mellitus patients. Methods: This is a cross-sectional study using secondary data from the Bogor PTM Cohort study data and were collected in August-September 2024 at RSCM/FKUI. Data analysis was performed using the SPSS 20 program. Bivariate analysis was performed to see the relationship between diastolic dysfunction and carotid artery intima media thickness using the Chi Square test if met or the Fisher exact test. Confounding variables be analyzed using multivariate logistic regression analysis. Results: 113 type 2 DM patients met the inclusion and exclusion criteria of this study with a median age of 59 years (51 - 65). The majority were female (65.49%) and the most common comorbidity was hypertension (44.25%). Abnormal CIMT was found in 9.73% of patients and 8% of patients experienced diastolic dysfunction. Specifically, 69.9% had a septal annular e’ rate < 7 cm/sec or a lateral annular e’ rate < 10 cm/sec, mean E/e’ >14 7.1%, and LAVI > 34 mL/m2 0.9%. Septal annular e' rate was negatively correlated with CIMT (r=-0.288¸ p=0.003) and an average E/e' ratio > 14 was positively correlated with CIMT (r=0.191, p=0.042). Conclusions: There was no association between carotid artery intima media thickness and the incidence of left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus.
Key words: CIMT, Diastolic Dysfunction, Type 2 DM, HFpEF