Korelasi Right Ventricular Outflow Tract Systolic Excursion dengan Forced Expiratoy Volume-1 Pada Pasien Penyakit Paru Obstruktif Kronik

Irwan Meidi Loebis

Sari


Penyakit paru obstruktif kronik (PPOK) merupakan salah satu penyebab morbiditas dan mortalitas terbanyak di dunia dengan prevalensi yang terus meningkat. Manifestasi ekstrapulmonal dari PPOK salah satunya pada sistem kardiovaskular yang terjadi pada 50% penderita PPOK yang dirawat, diantaranya gagal jantung kanan, hipertensi pulmonal, dan penyakit jantung iskemik. Gagal jantung kanan merupakan nilai prognostik yang buruk bagi pasien PPOK dan dianggap sebagai stadium akhir dari penyakit paru. Pemeriksaan spirometri merupakan baku emas untuk menilai fungsi paru, dengan parameter forced expiratory volume-1 (FEV1) untuk menilai derajat obstruksi saluran pernafasan. Pemeriksaan right ventricular outflow tract systolic excursion (RVOT-SE) dengan ekokardiografi merupakan parameter baru untuk menilai fungsi sistolik ventrikel kanan dengan sensitifitas dan spesifisitas 100%. Penelitian ini bertujuan untuk menilai korelasi antara RVOT-SE dengan FEV1 pada penderita PPOK. Dilakukan penelitian observasional dengan rancangan potong lintang, periode Oktober 2013-Januari 2014 di Instalasi Rawat Jalan Paru Rumah Sakit Dr. Hasan Sadikin Bandung. Rumus korelasi digunakan untuk menentukan besar sampel, didapat jumlah sampel minimal sebesar 32 subjek. Pemilihan subjek dengan consecutive sampling sesuai kriteria inklusi dan eksklusi. Subjel dilakukan pemeriksaan spirometri dan ekokardiografi. Uji korelasi Pearson dan korelasi parsial dilakukan dengan menggunakan perangkat lunak statistical product and service solution versi 17. Hasil dari 32 subjek, sebagian besar laki-laki dengan rata-rata usia 66,53±10,08 tahun, rata-rata FEV1 51,42±12,11%, rata-rata RVOT-SE 0,82±0,28 cm, median waktu sejak terdiagnosis PPOK 7,05(27+5) tahun, dan sebagian besar memiliki frekuensi eksaserbasi <2 kali per tahun (78%). Uji korelasi Pearson menunjukkan tidak ada korelasi antara RVOT-SE dengan FEV1 (r=0,228; p=0,209). Uji korelasi parsial dengan menyesuaikan variabel waktu sejak terdiagnosis PPOK menunjukkan korelasi positif bermakna antara RVOT-SE dengan FEV1 (r=0,315; p=0,042). Simpulan, terdapat korelasi positif bermakna antara RVOT-SE dengan FEV1 pada penderita PPOK setelah menyesuaikan variabel waktu sejak terdiagnosis PPOK.

Kata kunci: forced expiratory volume-1, penyakit paru obstruktif kronik, right ventricular outflow tract systolic excursion.

 

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality with increasingly prevelance throughout the world. COPD is associated with significant extrapulmonary effects among which cardiac manifestation is the most common, accounts of 50% of all hospitalization,consists of right heart failure, pulmonary hypertension and ischaemic heart disease. Right heart failure is an important prognostic factor and considered to be an end stage pulmonary disease. Spirometry is the gold standard for accurate and repeatable measurement of lung function, whereas forced expiratory volume-1 (FEV1) represent the severity of airway obstruction. Echocardiography provides a rapid, noninvasive and accurate method to evaluate right heart function. A novel parameter right ventricular outflow tract systolic excursion (RVOT-SE) can identify reduced right ventricular function with 100% sensitivity and 100% specificity.This study aims to analyze the correlation of RVOT-SE and FEV1 in COPD patients. An observational cross-sectional study was done during October 2013- January 2014 at Pulmonology outpatient installation of Dr. Hasan Sadikin Hospital,Bandung. Sample was chosen by consecutive sampling according to the inclusion and exclusion criteria. The selected samples were evaluated by spiromtery and echocardiography. Pearson correlation and partial correlation was analyzed using statistical product and service solution version 17 software.Results of total of 32 samples mostly male with mean age 66,53±10,08 years, mean FEV1 51,42±12,11%, mean RVOT-SE 0,82±0,28 cm, median of time since COPD diagnosis 7,05(275) years, and mostly <2 exacerbation a year (78%).There was no correlation between RVOT-SE and FEV1 (r=0,228; p=0,209) on bivariat analysis. Partial correlation with adjustment of time since COPD diagnosis showed a signifcant positive correlation between RVOT-SE and FEV1 (r=0,315; p=0,042). We conclude that there is a significant positive correlation between RVOT-SE and FEV1 after adjusting the time since COPD diagnosis.

Keywords: forced expiratory volume-1, chronic obstructive pulmonary disease, right ventricular outflow tract systolic excursion.


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