[ABSTRAK Latar belakang. Angka kejadian akut kardiovaskular diperkirakan akan semakinmeningkat. Pasien dengan Angina APS dapat berkembang menjadi Sindroma Koroner Akut(SKA). Konsep proses inflamasi dan stress oksidatif berperan terhadap patogenesisatherosklerosis. Radikal bebas seperti reactive oxygen atau nitrogen species, dan HOCL(hypochlorous acid) dapat mengakibatkan kerapuhan plak. HOCL merupakan ReactiveOxygen Species (ROS) kuat yang menyebabkan ketidakstabilan plak sehingga mudah ruptur.Plak yang mudah ruptur disebut plak vulnerable. HOCL adalah substrat yang dihasilkan olehmyeloperoxidase (MPO). Studi histopatologi plak vulnerablemenilai ukuran pusat nekrotik adalahprediktor kuat terjadinya ruptur plak (OR 0.35; P <0.05), dan (OR 2.0; P <0.02).CT angiografikoroner adalah suatu modalitas pencitraan non invasif yang mampu memvisualisasimorfologi plak vulnerable salah satunya dengan mengidentifikasi adanya Napkin Ring Sign(NRS). NRS sangat spesifik untuk menilai pusat nekrotik. Studi ini bertujuan melihat hubunganMPO dengan plak vulnerableyang dinilai dengan Napkin Ring Sign pada pasien angina pektorisstabil.Metode. Penelitian ini adalah studi potong lintang yang dilakukan di Pusat Jantung NasionalHarapan Kita dari periode Juni ? November 2014. Studi dilakukan pada 41 subyek, padapasien dengan angina pektoris stabil, jumlah laki ? laki sebanyak 32 orang ( 78%) danperempuan 9 orang (22%), Pengambilan sampel secara konsekutif. Pengukuran kadar MPOdilakukan dengan menggunakan colorimetri assay. Pemeriksaan CT angiografi koronerdilakukan untuk mengidentifikasi NRS.Analisa statistik untuk mencari hubungan antarakadar MPO dengan plak vulnerable yang ditandai dengan NRSpada pemeriksaan CTangiografi koroner.Hasil.Kadar MPO (nmol) pada pasien dengan positif NRS lebih tinggi dibandingkan yangnegatif 124,371 + 15,324 vs 105,206 + 18,335, aktivitas MPO (milliunit/mL) 829,136 +102,157 vs701,371 + 122,235. Analisa bivariat erdapat hubungan yang bermakna antarakadar MPO dengan NRS p 0,002, IK 95%2.3,0 - 39,9. Dari multivariat regresi logistikdidapatkan kadar MPO > 117,2 (median), memiliki OR 9,6 (IK 95% 2,3 -39) dengan p0,002. Setelah dilakukan penyesuaian dengan faktor resiko, pada analisa multivariat regresilogistik, didapatkan OR 20,3 (IK 95% 3,1-31,7) dengan p 0,002.Kesimpulan. Kadar MPO memiliki hubungan yang bermakna dengan plak vulnerable yangditandai dengan temuan NRS pada CT angiografi koroner pada pasien dengan APS.Kata kunci : atherosklerosis, plak vulnerable, myeloperoxidase, napkin ring sign. ABSTRACT Background.Coronary Heart Disease ( CHD) is still the major health problem in worldwide.Atherosclerosis is a chronic inflammatory process where oxidative damage play a role inatherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental andweaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactiveoxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaquevulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase(MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidantscontributes to plaque vulnerability. Coronary Computed Tomography Angiography (CCTA)is a non invasive modality which able to identify morphology of vulnerable plaque. Napkin-Ring Sign (NRS) has been associated with high-risk plaques in several studies.Methods. A cross sectional study in 41 patients stable angina pectoris was done.The subjectswas taken blood sample and underwent CCTA to evaluate NRS in National CardiovascularCenter Harapan Kita from June to November 2014. Statistical analysis is done to explore theassociation between MPO and vulnerable plaque marked with NRS in stable angina pectoris.Results. There was association between MPO level with vulnerable plaque marked withNapkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positifNRS vs non NRS (nmol) 124,371 + 15,324 vs 105,206 + 18,335, activity of MPO(milliunit/mL) 829,136 + 102,157 vs701,371 + 122,235. Logistic regression analysis showedlevel of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. Afteradjustment with confounding factor MPO level ≥ 117,2 nmol (median), OR 20,3 (IK 95%3,1-31,7) , p value 0,002.Conclusion.There was association between Myeloperoxidase level with vulnerable plaquemarked with Napkin Ring Sign;Background.Coronary Heart Disease ( CHD) is still the major health problem in worldwide.Atherosclerosis is a chronic inflammatory process where oxidative damage play a role inatherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental andweaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactiveoxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaquevulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase(MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidantscontributes to plaque vulnerability. Coronary Computed Tomography Angiography (CCTA)is a non invasive modality which able to identify morphology of vulnerable plaque. Napkin-Ring Sign (NRS) has been associated with high-risk plaques in several studies.Methods. A cross sectional study in 41 patients stable angina pectoris was done.The subjectswas taken blood sample and underwent CCTA to evaluate NRS in National CardiovascularCenter Harapan Kita from June to November 2014. Statistical analysis is done to explore theassociation between MPO and vulnerable plaque marked with NRS in stable angina pectoris.Results. There was association between MPO level with vulnerable plaque marked withNapkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positifNRS vs non NRS (nmol) 124,371 + 15,324 vs 105,206 + 18,335, activity of MPO(milliunit/mL) 829,136 + 102,157 vs701,371 + 122,235. Logistic regression analysis showedlevel of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. Afteradjustment with confounding factor MPO level ≥ 117,2 nmol (median), OR 20,3 (IK 95%3,1-31,7) , p value 0,002.Conclusion.There was association between Myeloperoxidase level with vulnerable plaquemarked with Napkin Ring Sign, Background.Coronary Heart Disease ( CHD) is still the major health problem in worldwide.Atherosclerosis is a chronic inflammatory process where oxidative damage play a role inatherosclerosis. Overexpression of Reactive Oxygen Species ( ROS) could be detrimental andweaken the plaque. This type of plaque is often referred to as vulnerable plaque. Reactiveoxygen or nitrogen species, and HOCL (hypochlorous acid) responsible for plaquevulnerability leading to Acute Coronary Syndrome. HOCL is a substrat of Myeloperoxidase(MPO). MPO is a member of the heme peroxidase superfamily, generates reactive oxidantscontributes to plaque vulnerability. Coronary Computed Tomography Angiography (CCTA)is a non invasive modality which able to identify morphology of vulnerable plaque. Napkin-Ring Sign (NRS) has been associated with high-risk plaques in several studies.Methods. A cross sectional study in 41 patients stable angina pectoris was done.The subjectswas taken blood sample and underwent CCTA to evaluate NRS in National CardiovascularCenter Harapan Kita from June to November 2014. Statistical analysis is done to explore theassociation between MPO and vulnerable plaque marked with NRS in stable angina pectoris.Results. There was association between MPO level with vulnerable plaque marked withNapkin Ring Sign, p value 0,002 , CI 95%2.3,0 - 39.9. Level of MPO is higher in positifNRS vs non NRS (nmol) 124,371 + 15,324 vs 105,206 + 18,335, activity of MPO(milliunit/mL) 829,136 + 102,157 vs701,371 + 122,235. Logistic regression analysis showedlevel of MPO ≥ 117,2 nmol (median), OR 9,6 (CI95% 2,3 -39) p value0,002. Afteradjustment with confounding factor MPO level ≥ 117,2 nmol (median), OR 20,3 (IK 95%3,1-31,7) , p value 0,002.Conclusion.There was association between Myeloperoxidase level with vulnerable plaquemarked with Napkin Ring Sign] |