penelitian ketebalan intima-media karotis dengan...
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DAFTAR ISI
Halaman Judul .......................................................................................................... i
Halaman Pengesahan .............................................................................................. ii
Halaman Pernyataan............................................................................................... iii
Kata Pengantar ....................................................................................................... iv
Daftar Isi................................................................................................................. ix
Daftar Gambar ........................................................................................................ xi
Daftar Tabel .......................................................................................................... xii
Daftar Singkatan................................................................................................... xiii
Intisari .................................................................................................................. xiv
Abstract ................................................................................................................. xv
BAB I ...................................................................................................................... 1
I.1 Latar Belakang ............................................................................................... 1
I.2 Rumusan Masalah .......................................................................................... 4
I.3 Pertanyaan Penelitiaan ................................................................................... 5
I.4 Tujuan Penelitiaan .......................................................................................... 5
1.5 Manfaat Penelitian ......................................................................................... 5
1.6. Keaslian Penelitian ....................................................................................... 5
BAB II ..................................................................................................................... 9
II.1 Aterosklerosis ............................................................................................... 9
II.1.1 Patofisiologi Aterosklerosis ................................................................... 9
II.1.2 Aterosklerosis dan Inflamasi ................................................................ 13
II.2 Penyakit Arteri Karotis sebagai Manifestasi Aterosklerosis pada Arteri
Karotis ........................................................................................................ 15
II.3 Pemeriksaan Aterosklerosis dengan KIMK ................................................ 17
II.4 Teknik Pemeriksaan KIMK ........................................................................ 19
II.5 Penyakit Jantung Koroner Stabil ................................................................ 22
II.5.1 Diagnosis Penyakit Jantung Koroner Stabil ......................................... 24
II.5.2 Angiografi Koroner dan Nilai Syntax .................................................. 29
II.6 Kerangka Teori ........................................................................................... 35
II.7 Kerangka Konsep ........................................................................................ 36
II.8 Hipotesis ..................................................................................................... 37
BAB III ................................................................................................................. 37
III.1 Rancangan Penelitian ................................................................................ 37
III.2 Tempat dan Waktu Penelitian ................................................................... 37
III.3 Populasi Penelitian .................................................................................... 38
III.4 Subjek Penelitian ....................................................................................... 38
III.5 Kriteria Subjek Penelitian ......................................................................... 38
III.5.1 Kriteria Inklusi .................................................................................... 38
III.5.2 Kriteria Eksklusi ................................................................................. 39
III.6 Besar Sampel ............................................................................................. 39
III.7 Variabel Penelitian dan Pengukuran ......................................................... 40
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III.7.1 Variabel Bebas .................................................................................... 40
III.7.2 Variabel Tergantung ........................................................................... 40
III.7.3 Variabel Lain ...................................................................................... 40
III.8 Definisi Operasional .................................................................................. 40
III.9 Protokol Penelitian dan Pengumpulan Data .............................................. 43
III.9.1 Protokol Penelitian .............................................................................. 43
III.9.2 Pemeriksaan KIMK ............................................................................ 44
III. 9.3 Pemeriksaan Keparahan Lesi Koroner .............................................. 45
III.10 Alur Penelitian ......................................................................................... 45
III.11 Analisis Statistik ...................................................................................... 46
III.12 Pertimbangan Etik ................................................................................... 46
BAB IV ................................................................................................................. 47
IV.1 Hasil Penelitian ......................................................................................... 47
IV.1.1 Karateristik Dasar Subjek Penelitian .................................................. 47
IV.1.2 Uji Korelasi KIMK dan Nilai Syntax pada Pasien PJK Stabil ........... 49
IV.1.3 Kurva Receiver Operating Charateristic dan Grafik Sensitivitas dan
Spesifisitas pada Pasien PJK Stabil..................................................... 50
IV.1.4 Karakteristik Dasar Subjek Penelitian berdasarkan KIMK ................ 51
IV.1.4 Karakteristik Dasar Subjek Penelitian berdasarkan Syntax ............... 53
IV.1.5 Analisis Multivariat terhadap Nilai Syntax pada Pasien PJK Stabil .. 55
IV.2 Pembahasan ............................................................................................... 56
IV.2.1 Karakteristik Dasar Subjek Penelitian ................................................ 56
IV.2.2 Hubungan nilai KIMK dengan Syntax pada Pasien PJK Stabil ......... 58
IV.2.3 Faktor Perancu KIMK dan Nilai Syntax ............................................ 60
IV.2.4 Keterbatasan Penelitian ...................................................................... 61
BAB V ................................................................................................................... 62
V.1 Simpulan ..................................................................................................... 62
V.2 Saran ........................................................................................................... 62
Daftar Pustaka ....................................................................................................... 63
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DAFTAR GAMBAR
Gambar 1. Gambar skematik dinding arteri.. ........................................................ 10
Gambar 2. Skematik proses aterosklerosis di dinding pembuluh darah. .............. 13
Gambar 3. Sudut-sudut pengukuran KIMK . ........................................................ 20
Gambar 4. Gambaran skematik KIM dan posisi pengukuran . ............................. 22
Gambar 5. Pemeriksaan non-invasif pada pasien dengan kecurigaan PJK dan
PTP intermediate.. ............................................................................. 27
Gambar 6. Dominansi dan penomoran segmen arteri koroner ............................ 33
Gambar 7. Kerangka teori penelitian .................................................................... 36
Gambar 8. Kerangka konsep penelitian ................................................................ 37
Gambar 9. Alur penelitian. .................................................................................... 46
Gambar 10. Alur jumlah subjek penelitian. .......................................................... 49
Gambar 11. Scatter-plot hubungan korelasi positif antara KIMK dan Syntax
pada PJK stabil. ................................................................................. 50
Gambar 12. Kurva ROC nilai KIMK terhadap nilai Syntax tinggi. ..................... 51
Gambar 13. Titik potong kurva sensitivitas dan spesifisitas pada berbagai nilai
KIMK untuk mendeteksi lesi koroner dengan nilai Syntax tinggi
pada pasien yang terduga PJK stabil. ................................................ 51
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DAFTAR TABEL
Tabel 1. Karakteristik pemeriksaan penunjang pada PJK stabil. .......................... 25
Tabel 2. Algoritma Penghitungan Nilai Syntax .................................................... 33
Tabel 3. Skoring karateristik untuk masing-masing lesi ....................................... 33
Tabel 4. Karakteristik dasar pasien PJK stabil. ..................................................... 49
Tabel 5. Perbandingan variabel kelompok KIMK >71 mm dan ≤71 mm pada
pasien PJK stabil. ..................................................................................... 52
Tabel 6. Perbandingan variabel kelompok Syntax tinggi dan Syntax rendah
pada pasien PJK stabil. ............................................................................ 53
Tabel 7. Analisis univariat variabel yang mempengaruhi nilai KIMK dan nilai
Syntax. ..................................................................................................... 54
Tabel 8. Analisis multivariat faktor-faktor yang berpengaruh terhadap nilai
Syntax ...................................................................................................... 55
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DAFTAR SINGKATAN
AII : Angiotensin II
ACC : American College of Cardiology
AHA : American Heart Association
AKI : Arteri karotis interna
AKK : Arteri karotis komunis
ARIC : Atherosclerosis Risk in Communities
EKG : Elektrokardiografi
DTS : Duke Treadmill Score
DM : Diabetes mellitus
HU : Hounsfiled units
IL-6 : Interleukin-6
KIMK : Ketebalan intima media karotis
KIM : Ketebalan intima media
MSCT : Multi slice computed tomography
PJK : Penyakit jantung koroner
RS : Rumah sakit
ULT : Uji latih treadmill
USG : Ultrasonografi
VCAM-1 : Vascular cell adhesion molecule-1
VD : Vessel disease