Tesis

Prediksi Global Longitudinal Strain, Peak Strain Dispersion, Peak Atrial Longitudinal Strain dan Kombinasi dengan Skor GRACE terhadap Major Adverse Cardiovascular Events pada Pasien Infark Miokard Akut di RS Cipto Mangunkusumo = Prediction of Global Longitudinal Strain, Peak Strain Dispersion, Peak Atrial Longitudinal Strain, and GRACE Score Combination for Major Adverse Cardiovascular Events in Acute Myocardial Infarction Patients at Cipto Mangunkusumo Hospital.

Latar Belakang: Skor GRACE (Global Registry of Acute Coronary Events) direkomendasikan untuk stratifikasi risiko infark miokard akut (IMA) dalam memprediksi major adverse cardiovascular events (MACE) selama perawatan, namun tidak mencakup penilaian disfungsi miokard. Speckle Tracking Echocardiography dapat menilai disfungsi miokard melalui global longitudinal strain (GLS), peak strain dispersion (PSD), dan peak atrial longitudinal strain (PALS) dengan kemampuan prognostik jangka panjang, meski bukti prediksi jangka pendek masih terbatas. Tujuan: Menilai kemampuan diskriminatif GLS, PSD, dan PALS, serta kombinasinya dengan skor GRACE, terhadap kejadian MACE selama rawat inap pada pasien IMA di di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta. Metode: Penelitian ini merupakan studi kohort prospektif pada pasien IMA yang dirawat di Intensive Cardiac Care Unit RSCM selama Maret–Juni 2025, dengan metode pengambilan sampel konsekutif. Pengambilan data meliputi data klinis, skor GRACE saat admisi, dan ekokardiografi dalam 36 jam pertama, serta pemantauan MACE hingga akhir perawatan. Analisis menggunakan kurva ROC untuk menilai AUC dan cut-off optimal serta regresi logistik biner terhadap kombinasi GRACE dengan parameter strain kemudian menilai AUC tiap model. Hasil: Dari 88 pasien IMA, 43,2% mengalami MACE, terutama gagal jantung akut, diikuti syok kardiogenik. Rerata LVEF 44,86 ±12,22%, dengan dominasi kasus IMA-EST (63,6%). PALS menunjukkan AUC tertinggi 0,864 (IK 95%: 0,789– 0,939; cut-off20,5%), diikuti GLS 0,821 (IK 95%: 0,729–0,912; cut-off–10,45%) dan PSD 0,694 (IK 95%: 0,582–0,807; cut-off 74,3 ms). Kombinasi GRACE dan PALS mencapai AUC 0,878 (IK 95%: 0,808–0,948; p < 0,001), sedangkan GRACE dan GLS 0,839 (IK 95%: 0,754–0,924; p < 0,001), sementara GRACE dan PSD 0,735 (IK 95%: 0,631 – 0,840). Simpulan: GLS dan PALS memiliki akurasi baik dalam memprediksi MACE selama perawatan, begitu pula kombinasi GRACE dengan PALS maupun GRACE dengan GLS juga menunjukkan akurasi yang baik pada pasien IMA.
Kata kunci: infark miokard akut, GRACE, GLS, PALS, PSD, MACE


Background: The GRACE (Global Registry of Acute Coronary Events) score is recommended for risk stratification in acute myocardial infarction (AMI) to predict major adverse cardiovascular events (MACE) during hospitalization; however, it does not include myocardial dysfunction assessment. Speckle Tracking Echocardiography can evaluate myocardial dysfunction through global longitudinal strain (GLS), peak strain dispersion (PSD), and peak atrial longitudinal strain (PALS), which have demonstrated long-term prognostic value, though evidence for short-term prediction remains limited. Objective: To evaluate the discriminative accuracy and optimal cut-off values of GLS, PSD, and PALS, as well as their combination with the GRACE score, in predicting in-hospital MACE among AMI patients Methods: A prospective cohort study of 88 AMI patients was conducted in the ICCU ofCipto Mangunkusumo Hospital (RSCM) (March–June 2025), with clinical data, GRACE scores, and echocardiography obtained within the first 36 hours, and MACE monitored until discharge. Analysis included ROC curves for AUC and optimal cut-offs, and binary logistic regression to assess GRACE and strain parameter combinations and the AUC of each model. Results: A total of 43.2% of patients experienced MACE, predominantly acute heart failure, with a mean LVEF of 44.86% ± 12.22 and a predominance of STEMI (63.6%). PALS showed the highest AUC at 0.864 (95% CI: 0.789–0.939; cut-off 20.5%), followed by GLS at 0.821 (95% CI: 0.729–0.912; cut-off –10.45%) and PSD at 0.694 (95% CI: 0.582–0.807; cut-off 74.3 ms). The GRACE–PALS combination demonstrated the highest AUC at 0.878 (95% CI: 0.808–0.948; p < 0.001), followed by GRACE–GLS at 0.839 (95% CI: 0.754–0.924; p < 0.001), and GRACE–PSD at 0.735 (95% CI: 0.631–0.840). Conclusions: GLS and PALS showed good accuracy in predicting MACE, and the combinations of GRACE with PALS or GRACE with GLS also demonstrated good accuracy in AMI patients.
Key words: acute myocardial infarction, GLS, GRACE, MACE, PALS, PSD