Savitri, A. A. Made Berastia Anis and dr. Dyahris Koentartiwi, Sp.A(K) and Dr. dr. Ariani, Sp.A(K), M.Kes (2024) Hubungan antara status gizi dan stunting dengan fungsi dan ketebalan ventrikel kiri pada Pasien Jantung Bawaan asianotik. Magister thesis, Universitas Brawijaya.
Abstract
Insiden Penyakit jantung bawaan (PJB) di negara maju maupun negara berkembang berkisar 6 – 10 kasus per 1000 kelahiran hidup. Angka kejadian PJB di Indonesia adalah 8 tiap 1000 kelahiran hidup dengan angka kematian akibat PJB adalah 81 kasus per 100.000 kelahiran hidup. Salah satu komplikasi serius yang sering dihadapi oleh anak-anak dengan PJB adalah malnutrisi. Malnutrisi merupakan masalah kesehatan dan meningkatkan resiko kematian terutama di negara berkembang. World Health Organization (WHO) tahun 2020 menyatakan bahwa malnutrisi berkontribusi pada 45% mortalitas anak di dunia. Beberapa literatur menyatakan terdapat hubungan antara penurunan fungsi ventrikel kiri dan ketebalan ventrikel kiri pada anak dengan malnutrisi, namun untuk populasi anak di Indonesia belum banyak dilakukan. Penelitian ini merupakan observasional analitik dengan pendekatan potong lintang bertujuan untuk mengetahui hubungan antara fungsi dan ketebalan ventrikel kiri dengan status gizi pada pasien anak dengan PJB asianotik Pemeriksaan fungsi ventrikel kiri merupakan pemeriksaan kuantitatif dasar penting dalam ekokardiografi jantung untuk menilai kontraksi jantung yang bertugas memompa darah ke seluruh tubuh. Penilaian fungsi ventrikel kiri dengan mengukur Ejection fraction (EF) untuk fungsi sistolik ventrikel kiri dan E/A untuk fungsi diastolik ventrikel kiri. Selain pemeriksaan tersebut terdapat penilaian ketebalan dinding ventrikel kiri dengan mengukur Left Ventricular Posterior Wall selama sistolik (LVPWs) dan Left Ventricular Posterior Wall selama diastolik (LVPWd). Sebanyak 181 pasien diikutkan dalam penelitian ini, dengan mayoritas anak berada di usia 3 bulan-5 tahun di poli anak divisi Kardiologi dan di ruang rawat inap anak RSUD Dr. Saiful Anwar Malang. Terdapat 77 subjek dengan diagnosis Atrial septal defect (ASD), 42 subjek dengan Ventricular septal defect (VSD), 36 subjek Patent ductus arteriosus (PDA) dan 26 subjek kombinasi dari ketiga defek tersebut. Sampel penelitian adalah pasien anak usia 3 bulan-18 tahun dengan PJB asianotik dan dilakukan pengukuran antropometri dan KPSP untuk menentukan status gizi dan stunting. Pada penelitian ini didapatkan 29,3% subjek dengan gizi buruk, 16,6% gizi kurang, 52,5% gizi baik, 2,4% dengan obesitas serta dari keseluruhan sampel terdapat 27 subjek (46,6%) dengan stunting. Selanjutnya seluruh sampel penelitian akan diukur EF, FS, E/A, LVPWs dan LVPWd dengan ekokardiografi dan dikategorikan kedalam grup penurunan fungsi ventrikel kiri atau normal dan ketebalan ventrikel kiri yang tipis atau normal, setelah data lengkap maka data dianalisis menggunakan SPSS for windows versi 25.0. Hasil penelitian ini menggunakan uji korelasi Chi-square didapatkan penurunan fungsi sistolik ventrikel kiri terjadi hanya pada gizi buruk sebanyak 5 subjek (2,8%) dari keseluruhan sampel, penurunan fungsi ventrikel tidak didapatkan pada gizi kurang dan obesitas dengan p-value 0,006 dengan p<0,05 yaitu ada hubungan bermakna antara status gizi dengan fungsi ventrikel kiri (r=0,253). Penurunan fungsi ventrikel kiri pada anak PJB dengan stunting didapatkan sebanyak 75% dengan p-value 0,006, dimana p<0,05 yaitu bermakna secara statistik antara stunting dengan fungsi ventrikel kiri (r=0,215). Ketebalan ventrikel kiri didapatkan menipis pada gizi buruk sebanyak 10 subjek (5,5%), gizi kurang 10 subjek (5,5%), gizi baik 6 subjek (3,3%) dengan p value 0,002 (r=0,278). Ketebalan ventrikel juga didapatkan berkurang pada pasien stunting dengan hasil 20 pasien stunting (76,9%) mengalami penipisan ventrikel kiri dibandingkan yang tidak mengalami stunting dengan p-value 0,000, denan p<0,05 berarti terdapat hubungan bermakna antara ketebalan ventrikel kiri dengan status gizi dan stunting (r=0,321). Sehingga dapat disimpulkan status gizi dan stunting dapat digunakan sebagai acuan menentukan prognosis dan kemungkinan adanya penurunan fungsi dan ketebalan ventrikel kiri pada pasien PJB asianotik.
English Abstract
The incidence of congenital heart disease (CHD) in both developed and developing countries ranges between 6–10 cases per 1,000 live births. In Indonesia, the rate of CHD is 8 per 1,000 live births, with 81 deaths per 100,000 live births due to CHD. One serious complication commonly faced by children with CHD is malnutrition. Malnutrition poses a significant health issue, increasing the risk of mortality, especially in developing countries. According to the World Health Organization (WHO) in 2020, malnutrition contributed to 45% of child mortality worldwide. Some studies suggest a relationship between decreased left ventricular function and thickness in children with malnutrition, but few studies have been conducted in the Indonesian pediatric population. This study is an observational analytic study using a cross-sectional approach aimed at examining the relationship between left ventricular function and thickness with nutritional status in pediatric patients with non-cyanotic CHD. The assessment of left ventricular function is an essential quantitative measure in cardiac echocardiography to evaluate the heart’s contraction, which is responsible for pumping blood throughout the body. Left ventricular function is assessed by measuring the ejection fraction (EF) for systolic function and the E/A ratio for diastolic function. In addition to these assessments, the thickness of the left ventricular wall is evaluated by measuring the Left Ventricular Posterior Wall during systole (LVPWs) and diastole (LVPWd). A total of 181 patients participated in this study, with the majority of children aged between 3 months and 5 years, treated at the pediatric cardiology outpatient clinic and pediatric ward at RSUD Dr. Saiful Anwar Malang. The study included 77 subjects diagnosed with atrial septal defect (ASD), 42 with ventricular septal defect (VSD), 36 with patent ductus arteriosus (PDA), and 26 subjects with a combination of these defects. The sample population comprised children aged 3 months to 18 years with non-cyanotic CHD, and anthropometric measurements along with PreDevelopment Screening Questionnair tests were conducted to determine their nutritional status and stunting. The study revealed that 29.3% of the subjects were severely malnourished, 16.6% were undernourished, 52.5% had good nutritional status, and 2.4% were obese, with 27 subjects (46.6%) identified as stunted. All research subjects underwent echocardiography to measure EF, FS, E/A, LVPWs, and LVPWd, and were then categorized into groups with either decreased or normal left ventricular function, as well as groups with either thin or normal left ventricular wall thickness. Once the data was collected, it was analyzed using SPSS for Windows version 25.0. The results of this study, using Chi-square correlation tests, showed that decreased left ventricular systolic function was found in 5 subjects (2.8%) whowere severely malnourished, with no decrease in function observed in undernourished or obese subjects. The p-value was 0.006, indicating a statistically significant relationship between nutritional status and left ventricular function (r=0.253). Additionally, 75% of children with stunting were found to have decreased left ventricular function, with a p-value of 0.006 (p<0.05), demonstrating a statistically significant relationship between stunting and left ventricular function (r=0.215). Thinning of the left ventricular wall was observed in 10 subjects (5.5%) with severe malnutrition, 10 subjects (5.5%) with undernutrition, and 6 subjects (3.3%) with good nutritional status. The p-value for this was 0.002 (r=0.278). Ventricular wall thinning was also more common in stunted patients, with 20 stunted patients (76.9%) experiencing thinning compared to those who were not stunted. The p-value for this finding was 0.000, indicating a statistically significant relationship between left ventricular thickness, nutritional status, and stunting (r=0.321). Thus, it can be concluded that nutritional status and stunting can be used as reference points for determining the prognosis and the likelihood of decreased left ventricular function and thickness in patients with non-cyanotic CHD.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0424060178 |
| Uncontrolled Keywords: | PJB asianotik, malnutrisi, stunting, disfungsi ventrikel kiri, ketebalan ventrikel kiri |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Kesehatan Anak, Fakultas Kedokteran |
| Depositing User: | Unnamed user with username nova |
| Date Deposited: | 28 Feb 2025 02:05 |
| Last Modified: | 28 Feb 2025 02:05 |
| URI: | http://repository.ub.ac.id/id/eprint/237770 |
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