Electronic Theses and Dissertation

Latar belakang: doksorubisin merupakan agen kemoterapi yang efektif namun memiliki efek samping kardiovaskular signifikan yang dikenal sebagai kardiotoksisitas. efek samping ini merupakan penyebab utama morbiditas dan mortalitas dan dapat bermanifestasi sebagai cancer therapy related cardiac dysfunction (ctrcd) dan gagal jantung. deteksi dini kerusakan miokard subklinis sangat penting sebelum timbulnya gejala. penelitian ini bertujuan untuk mengetahui korelasi kadar troponin-t dan d-dimer terhadap kejadian kardiotoksisitas akibat doksorubisin serta menilai potensi biomarker tersebut sebagai prediktor dini. metode: penelitian analitik observasional prospektif ini melibatkan 26 pasien kanker di gedung onkologi rsudza banda aceh yang menerima regimen doksorubisin. kadar troponin-t dan d-dimer diukur secara serial (sebelum, dan setelah siklus 1, 2, dan 3), dan kardiotoksisitas didefinisikan berdasarkan penurunan left ventricular ejection fraction(lvef) melalui ekokardiografi. analisis data menggunakan uji statistik korelasi bivariat. hasil: kejadian kardiotoksisitas ditemukan pada 23,1% (6 dari 26) subjek penelitian. peningkatan troponin-t terdeteksi pada 42,3% pasien, menunjukkan adanya cedera miokard akut. meskipun peningkatan troponin-t secara statistik tidak memiliki korelasi signifikan (p>0,05) dengan penurunan lvef, tetapi hasil menunjukkan korelasi yang sangat signifikan antara peningkatan kadar d-dimer (p=0,001) dengan kejadian kardiotoksisitas. prevalence ratio (pr) yang tinggi untuk d-dimer mengindikasikan biomarker tersebut sebagai prediktor kuat terhadap kejadian kardiotoksisitas. kesimpulan: peningkatan d-dimer merupakan biomarker yang prediktif dan berkorelasi kuat terhadap kejadian kardiotoksisitas akibat doksorubisin. meskipun troponin-t berfungsi sebagai penanda cedera miokard, kombinasi pemeriksaan serial troponin-t dan d-dimer bersamaan dengan evaluasi lvef sangat direkomendasikan untuk stratifikasi risiko dan intervensi pencegahan dini. kata kunci: kardiotoksisitas, doksorubisin, troponin-t, d-dimer, lvef

CORRELATION BETWEEN TROPONIN-T AND D-DIMER LEVELS AND THE INCIDENCE OF DOXORUBICIN-INDUCED CARDIOTOXICITY IN CANCER PATIENTS AT THE ONCOLOGY CENTER DR. ZAINOEL ABIDIN GENERAL HOSPITAL BANDA ACEH Background: Doxorubicin is an effective chemotherapeutic agent but possesses significant cardiovascular side effects known as cardiotoxicity. This side effect is a major cause of morbidity and mortality and can manifest as Cancer Therapy Related Cardiac Dysfunction (CTRCD) and heart failure. Early detection of subclinical myocardial damage is crucial before the onset of symptoms. This study aimed to determine the correlation of troponin-T and D-dimer levels with the incidence of cardiotoxicity due to doxorubicin and to assess the potential of these biomarkers as early predictors. Methods: This prospective observational analytic study involved 26 cancer patients at the RSUDZA Oncology Building, Banda Aceh, who were receiving a doxorubicin regimen. Levels of Troponin-T and D-dimer were measured serially (before, and after cycles 1, 2, and 3), and cardiotoxicity was defined based on a decrease in Left Ventricular Ejection Fraction (LVEF) measured by echocardiography. Data analysis utilized a bivariate correlation statistical test. Results: The incidence of cardiotoxicity was found in 23.1% (6 out of 26) of the subjects. An increase in Troponin-Twas detected in 42.3% of patients, indicating acute myocardial injury. Although the increase in Troponin-T statistically did not have a significant correlation (p>0.05) with the decrease in LVEF, the results showed a highly significantcorrelation between the increase in D-dimer levels (p=0.001) and the incidence of cardiotoxicity. The high Prevalence Ratio (PR) for D-dimer indicates that this biomarker is a strong predictor of cardiotoxicity incidence. Conclusion: The increase in D-dimer is a predictive biomarker and strongly correlates with the incidence of cardiotoxicity due to doxorubicin. Although Troponin-T serves as a marker of myocardial injury, the combination of serial Troponin-T and D-dimer examination along with LVEF evaluation is highly recommended for risk stratification and early preventive intervention. Keywords: Cardiotoxicity, Doxorubicin, Troponin-T, D-dimer, LVEF.