ix

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

xi

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

xii

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

xiii

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