[ABSTRAK
Latar Belakang. Kondisi hipoksia kronik pada pasien dengan penyakit jantungbawaan sianotik akan menurunkan oksigenasi jaringan sehingga terjadilahmekanisme adaptasi yaitu eritrositosis sekunder. Besi merupakan substrat yangpenting dalam produksi hemoglobin dan cadangan besi untuk menjaga kadarhemoglobin yang adekuat. Namun 50% pasien dengan kelainan penyakit jantungbawaan sianotik mengalami defisiensi besi dan kondisi ini dikaitkan dengangangguan kapasitas fungsional akibat berkurangnya pengiriman oksigen danefeknya terhadap metabolisme pada otot rangka. Kadar feritin serum merupakanpemeriksaan yang paling awal dan akurat untuk menilai defisiensi besi. Studi inibertujuan untuk mengetahui hubungan antara kadar feritin serum dengan kapasitasfungsional pada pasien Tetralogi Fallot (TF).Metode. Studi potong lintang dilakukan di Departemen Kardiologi danKedokteran Vaskular Fakultas Kedokteran Universitas Indonesia/Rumah SakitJantung dan Pembuluh Darah Harapan Kita, Jakarta pada pasien TF usia 4-8tahun yang belum menjalani operasi paliatif dan atau operasi definitif. Dilakukanpengumpulan karakteristik dasar, kadar feritin serum, ekokardiografi, serta ujijalan 6 menit. Dilakukan uji korelasi dan analisis multivariat menggunakan ujiregresi.Hasil. Diteliti sebanyak 20 pasien TF dengan rentang usia 51 hingga 98 bulan.Nilai tengah kadar feritin serum adalah 39.75 g/L (kadar terendah 5g/L, kadartertinggi 246g/L). Nilai tengah kadar hemoglobin adalah 16.4 g/dL, kadarterendah 12 g/dL dan kadar tertinggi 20 g/dL. Limapuluh persen pasien memilikikadar feritin serum di bawah normal (< 40 g/L). Pada uji korelasi antara kadarferitin serum dengan jarak uji jalan 6 menit didapatkan nilai r = 0.23 dengan nilaip = 0.34. Pada uji regresi linear pada 2 kelompok, ditemukan perbedaan reratajarak uji jalan 6 menit pada kelompok dengan kadar feritin lebih tinggi (> 40g/L, n = 10) sebesar 46,83 m dibandingkan dengan kelompok feritin rendah (<40 g/L, n = 10) dengan koefisien β = 46,83; IK 95 -47,81- 141,47 p = 0,307.Kesimpulan. Secara klinis terdapat kecenderungan pasien TF dengan kadarferitin serum yang lebih tinggi mampu menempuh jarak uji jalan 6 menit yanglebih jauh walaupun secara satistik tidak bermakna.
ABSTRACT
Background. Chronic hypoxia in cyanotic congenital heart disease (CCHD)result in reduced of tissue oxygenation, therefore stimulates adaptive mechanismof secondary erythrocytosis. Iron is a vital substrate for hemoglobin productionand sufficient iron stores are necessary to achieve and maintain adequate levels ofhemoglobin. Unfortunately, 50% of patients with cyanotic CHD are iron-deficientand this condition is associated with exercise intolerance through reduced oxygendelivery and its effect on skeletal muscle cell metabolism Ferritin serum level isthe most accurate test to determine iron deficiency. Aim of this study is toevaluate the association between ferritin serum level and functional capacity inpatient with Tetralogy of Fallot (TOF).Methods. A cross-sectional study was done in Department Cardiology andVascular Medicine, Faculty Medicine Universitas Indonesia / NationalCardiovascular Center Harapan Kita, Jakarta in patients with TOF aged 4-8 yearsold before the palliatif and or definite operation. The data collected from patientsincluding basic characteristic, ferritin serum level and erythocyte index and sixminute walk test result. Statistical analysis was done using correlation test andmultivariat analysis using regression test.Result. Twenty subjects of TF aged 51 to 98 months was collected. Median levelof ferritin serum level was 39.75 g/L (the lowest level 5g/L, the highest level246g/L). Median level of hemoglobin level was (the lowest level 12 g/dL, thehighest level 20 g/dL). Fifty percent of patients had abnormal feritin serum level(< 40 g/dL). There was a correlation coefficient (r) of 0,23 with p value of 0,34found on the correlation between ferritin serum level and six minute walk testdistance. However, on linear regression test between 2 groups of ferritin serum,46,83 m mean difference of six minute walk test distance found between higherlevel of ferritin serum group (> 40 g/d, n = 10), and lower level of ferritin serumgroup (< 40 g/d, n = 10) with β = 46,83; IK 95 -47,81- 141,47 p = 0,307.Conclusion. Clinically in patients with higher level of feritin serum there is atendency able to walk farther on six minute walk test, although statitically notsignificant.;Background. Chronic hypoxia in cyanotic congenital heart disease (CCHD)result in reduced of tissue oxygenation, therefore stimulates adaptive mechanismof secondary erythrocytosis. Iron is a vital substrate for hemoglobin productionand sufficient iron stores are necessary to achieve and maintain adequate levels ofhemoglobin. Unfortunately, 50% of patients with cyanotic CHD are iron-deficientand this condition is associated with exercise intolerance through reduced oxygendelivery and its effect on skeletal muscle cell metabolism Ferritin serum level isthe most accurate test to determine iron deficiency. Aim of this study is toevaluate the association between ferritin serum level and functional capacity inpatient with Tetralogy of Fallot (TOF).Methods. A cross-sectional study was done in Department Cardiology andVascular Medicine, Faculty Medicine Universitas Indonesia / NationalCardiovascular Center Harapan Kita, Jakarta in patients with TOF aged 4-8 yearsold before the palliatif and or definite operation. The data collected from patientsincluding basic characteristic, ferritin serum level and erythocyte index and sixminute walk test result. Statistical analysis was done using correlation test andmultivariat analysis using regression test.Result. Twenty subjects of TF aged 51 to 98 months was collected. Median levelof ferritin serum level was 39.75 g/L (the lowest level 5g/L, the highest level246g/L). Median level of hemoglobin level was (the lowest level 12 g/dL, thehighest level 20 g/dL). Fifty percent of patients had abnormal feritin serum level(< 40 g/dL). There was a correlation coefficient (r) of 0,23 with p value of 0,34found on the correlation between ferritin serum level and six minute walk testdistance. However, on linear regression test between 2 groups of ferritin serum,46,83 m mean difference of six minute walk test distance found between higherlevel of ferritin serum group (> 40 g/d, n = 10), and lower level of ferritin serumgroup (< 40 g/d, n = 10) with β = 46,83; IK 95 -47,81- 141,47 p = 0,307.Conclusion. Clinically in patients with higher level of feritin serum there is atendency able to walk farther on six minute walk test, although statitically notsignificant., Background. Chronic hypoxia in cyanotic congenital heart disease (CCHD)result in reduced of tissue oxygenation, therefore stimulates adaptive mechanismof secondary erythrocytosis. Iron is a vital substrate for hemoglobin productionand sufficient iron stores are necessary to achieve and maintain adequate levels ofhemoglobin. Unfortunately, 50% of patients with cyanotic CHD are iron-deficientand this condition is associated with exercise intolerance through reduced oxygendelivery and its effect on skeletal muscle cell metabolism Ferritin serum level isthe most accurate test to determine iron deficiency. Aim of this study is toevaluate the association between ferritin serum level and functional capacity inpatient with Tetralogy of Fallot (TOF).Methods. A cross-sectional study was done in Department Cardiology andVascular Medicine, Faculty Medicine Universitas Indonesia / NationalCardiovascular Center Harapan Kita, Jakarta in patients with TOF aged 4-8 yearsold before the palliatif and or definite operation. The data collected from patientsincluding basic characteristic, ferritin serum level and erythocyte index and sixminute walk test result. Statistical analysis was done using correlation test andmultivariat analysis using regression test.Result. Twenty subjects of TF aged 51 to 98 months was collected. Median levelof ferritin serum level was 39.75 g/L (the lowest level 5g/L, the highest level246g/L). Median level of hemoglobin level was (the lowest level 12 g/dL, thehighest level 20 g/dL). Fifty percent of patients had abnormal feritin serum level(< 40 g/dL). There was a correlation coefficient (r) of 0,23 with p value of 0,34found on the correlation between ferritin serum level and six minute walk testdistance. However, on linear regression test between 2 groups of ferritin serum,46,83 m mean difference of six minute walk test distance found between higherlevel of ferritin serum group (> 40 g/d, n = 10), and lower level of ferritin serumgroup (< 40 g/d, n = 10) with β = 46,83; IK 95 -47,81- 141,47 p = 0,307.Conclusion. Clinically in patients with higher level of feritin serum there is atendency able to walk farther on six minute walk test, although statitically notsignificant.] |
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