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Hubungan antara ekskresi albumin urin dan penurunan Global Longitudinal Strain (GLS) dengan Speckle Tracking Echocardiography (STE) pada pasien DM tipe 2

Abstract

Background: Prevalence of type 2 diabetes mellitus (DM) in Indonesia and Bali is quite high. In 2007, Denpasar was the highest prevalence of type 2 DM in the city of Bali province by 2%. Type 2 DM is a chronic disease that can be fatal because type 2 DM patients increase the risk of cardiovascular disease which is the highest cause of death worldwide. Type 2 DM is one of the causes of kidney disorders and kidney failure. The initial sign of diabetic nephropathy is microalbuminuria which in some studies has been proven as a marker of endothelial dysfunction which can cause atherosclerosis and diabetic cardiomyopathy. Global longitudinal strains assessed using speckle tracking echocardiography have the advantage of being able to assess subclinical left ventricular dysfunction.

Method: This study was a cross-sectional study using a sample of 60 patients with type 2 DM taken consecutively during January - April 2019.

Result: Of the 60 patients with type 2 DM the average age was 55.23±8.7 years (27 women and 33 men) with a mean urine creatinine albumin ratio of 55 ug / mg of which 38 patients (63.33%) had microalbuminuria. Patients with microalbuminuria had longer duration of diabetes mellitus (7.34±3.68 with 4.64±2.74 years), higher HbA1c levels (8.64±1.70 with 7.13 ± 0.85%) and lower globallongitudinal strains (20.26±1.81 with 23.05±1.68%). Bivariate analysis showed a significant relationship between microalbuminuria with global longitudinal strains (r -0.577; p <0.001). After adjusting for confounding factors, microalbuminuria remained significantly associated with left ventricular global longitudinal strains (r2 0.574; 95% CI (-)3.987- (-)0.796; p= 0.004).

Conclusion: Higher urinary albumin / creatinine ratio in type 2 DM patients have been shown to correlate with a decrease in the left ventricular Global Longitudinal Strain.


Latar Belakang: Prevalensi DM tipe 2 di Indonesia dan Bali cukup tinggi. Prevalensi DM tipe 2 di provinsi Bali tahun 2007 sebesar 1% tertinggi di kota Denpasar sebesar 2%. DM tipe 2 merupakan penyakit kronik yang dapat berakibat fatal dikarenakan pasien DM tipe 2 meningkatkan resiko terjadinya penyakit kardiovaskular yang merupakan penyabab kematian tertinggi di seluruh dunia. DM tipe 2 adalah salah satu penyebab gangguan ginjal dan gagal ginjal. Tanda awal diabetik nefropathy adalah mikroalbuminuria yang pada beberapa studi terbukti sebagai penanda telah terjadinya disfungsi endotel yang mana dapat menyebabkan terbentuknya atherosklerosis dan diabetik kardiomiopati. Global longitudinal strain yang dinilai dengan menggunakan speckle tracking echocardiography mempunyai kelebihan dapat menilai disfungsi ventrikel kiri subklinis.

Metode: Penelitian ini merupakan penelitian cross-sectional ini menggunakan sampel 60 pasien diabetes mellitus tipe 2 yang diambil secara konsekutif selama bulan Januari – April 2019.

Hasil: Dari 60 pasien dengan DM tipe 2 rerata usia 55,23± 8,7 tahun (27 perempuan dan 33 lelaki) dengan rerata rasio albumin kreatinin urin 55 ug/mg yang mana 38 pasien (63,33%) dengan mikroalbuminuria. Pasien dengan mikroalbuminuria durasi diabetes melitus yang lebih lama (7,34 ± 3,68 dengan 4,64 ± 2,74 tahun), kadar HbA1c lebih tinggi (8,64 ± 1,70 dengan 7,13 ± 0,85%) dan global longitudinal strain yang lebih rendah (20,26 ± 1,81 dengan 23,05 ± 1,68%). Analisis bivariat dengan regresi linier, menunjukkan hubungan yang signifikan antara mikroalbuminuria dengan global longitudinal strain (r -0,577; p<0,001). Setelah dilakukan penyesuaian dengan faktor perancu, mikroalbuminuria tetap berhubungan secara signifikan dengan global longitudinal strain ventrikel kiri (r2 0,574; IK 95% (-)3,987- (-)0,796; p= 0,004).

Kesimpulan: Rasio albumin/kreatinin urin yang lebih tinggi pada pasien DM tipe 2 terbukti berkorelasi dengan penurunan global longitudinal strain ventrikel kiri.


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How to Cite

Diprabawa, I. D. G. A., Nadha, I. K. B., & Gotera, W. (2020). Hubungan antara ekskresi albumin urin dan penurunan Global Longitudinal Strain (GLS) dengan Speckle Tracking Echocardiography (STE) pada pasien DM tipe 2. Medicina, 51(1). https://doi.org/10.15562/medicina.v51i1.879

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