PJK ASIMTOMATIK

BUDHI SETIANTO
DE P . KARDI O L OGI DAN KE DO KTERAN V AS KUL AR/PJNHK
J AKART A

European Heart Journal (2013) 34, 29493003

European Heart Journal (2013) 34, 29493003

Testing in asymptomatic patients at risk for stable CAD

European Heart Journal (2013) 34, 29493003

High CVD risk countries

Armenia, Azerbaijan, Belarus, Bulgaria, Georgia,
Kazakhstan, Kyrgyzstan, Latvia,
Lithuania, Macedonia FYR, Moldova, Russia,
Ukraine, and Uzbekistan.

Figure 3 SCORE chart: 10-year risk of fatal

cardiovascular disease (CVD) in countries at
high CVD risk based on the following risk
factors:
age, sex, smoking, systolic blood pressure,
and total cholesterol.

European Heart Journal : Joint ESC Guideline s 2012

doi:10.1093/eurheartj/ehs092

Low CVD countries

are Andorra,
Austria, Belgium, Cyprus, Denmark, Finland,
France, Germany, Greece, Iceland, Ireland,
Israel, Italy,Luxembourg, Malta, Monaco, The
Netherlands, Norway, Portugal, San Marino,
Slovenia, Spain, Sweden, Switzerland, United
Kingdom.

Figure 4 SCORE chart:

10-year risk of
fatal cardiovascular disease (CVD) in countries
at low CVD risk based on the following risk
factors:
age, sex, smoking, systolic blood pressure, and
total cholesterol. Note that the risk of total
(fatal + non-fatal) CVD events will be
approximately three times higher than the
figures given.

European Heart Journal : Joint ESC Guideline s 2012

doi:10.1093/eurheartj/ehs092

ATP III Assessment of CHD Risk

For persons without known CHD, other forms of atherosclerotic disease, or diabetes:
Count the number of risk factors:

Cigarette smoking
Hypertension (BP 140/90 mmHg or on
antihypertensive medication)
Low HDL cholesterol (<40 mg/dL)
Family history of premature CHD
CHD in male first degree relative <55 years
CHD in female first degree relative <65 years
Age (men 45 years; women 55 years)

Use Framingham scoring for persons with 2 risk factors* (or with metabolic syndrome)
to determine the absolute 10-year CHD risk. (downloadable risk algorithms at
www.nhlbi.nih.gov)

Expert Panel on Detection, Evaluation, and Treatment of

High Blood Cholesterol in Adults. JAMA. 2001;285:2486-2497.

2001, Professional Postgraduate Services

www.lipidhealth.org

ATP III Framingham Risk Scoring http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

Step 1: Age
Years
20-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79

Assessing CHD Risk in Men

Points
-9
-4
0
3
6
8
10
11
12
13

Points at
Age 20-39
0
4
7
9
11

Step 3: HDL-Cholesterol
HDL-C
(mg/dL)
60

Points
-1

50-59

40-49

<40

Age
Total cholesterol
HDL-cholesterol
Systolic blood pressure
Smoking status
Point total

Step 4: Systolic Blood Pressure

Systolic BP
(mm Hg)
<120
120-129
130-139
140-159
160

Points
if Untreated
0
0
1
1
2

Points
if Treated
0
1
2
2
3

Step 2: Total Cholesterol

TC
(mg/dL)
<160
160-199
200-239
240-279
280

Step 6: Adding Up the Points

Points at Points at Points at Points at

Age 40-49 Age 50-59 Age 60-69 Age 70-79
0
0
0
0
3
2
1
0
5
3
1
0
6
4
2
1
8
5
3
1

Step 5: Smoking Status

Points at
Age 20-39
Nonsmoker
0
Smoker
8

Step 7: CHD Risk

Point Total 10-Year Risk
<0
<1%
0
1%
1
1%
2
1%
3
1%
4
1%
5
2%
6
2%
7
3%
8
4%
9
5%
10
6%

Point Total 10-Year Risk

11
8%
12
10%
13
12%
14
16%
15
20%
16
25%
17
30%

Points at Points at Points at Points at

Age 40-49 Age 50-59 Age 60-69 Age 70-79
0
0
0
0
5
3
1
1

Note: Risk estimates were derived from the experience of the Framingham Heart Study,
a predominantly Caucasian population in Massachusetts, USA.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
JAMA. 2001;285:2486-2497.

2001, Professional Postgraduate Services

www.lipidhealth.org

Table 2. Comparison of a Sample

of Global Coronary and
Cardiovascular Risk Factor

ACCF/AHA Pocket Guideline

Based on the 2010
ACCF/AHA Guideline
Guideline for
Assessment of
Cardiovascular Risk
in Asymptomatic
Adults
November 2010

Table 2.
Comparison of
a Sample of
Global
Coronary and
Cardiovascular
Risk Factor
ACCF/AHA
Pocket
Guideline
Based on the
2010
ACCF/AHA
Guideline
Guideline for
Assessment of
Cardiovascular
Risk
in
Asymptomatic
Adults
November 2010

Testing in asymptomatic patients at risk for stable CAD

European Heart Journal (2013) 34, 29493003

carotid intima media thickness

http://www.lumedx.com/Data/Sites/1/media/workflows/vascular-ultrasound/lgvascularultrasound.jpg
http://www.revespcardiol.org/imatges/255/255v64n05/grande/255v64n05-90003631fig1.jpg

Non-invasive diagnostic of CAD

MSCT / KM RIVA Kalzifizierungen

High CAC Score

Normal Coronary Artery

Ankle Brachial Index

http://www.elsevierimages.com/images/vpv/000/000/029/29138-0550x0475.jpg

http://www.jaaos.org/content/17/4/197/F1.large.jpg

Testing in asymptomatic patients at risk for stable CAD

European Heart Journal (2013) 34, 29493003

EXERCISE STRESS TEST

http://www.novameddiagnostics.com/img/exercise-stress-test.jpg

Stress Echocardiography Dobutamin

http://www.johnsom.com/Dobutamine_Stress_Echo_files/shapeimage_1.png

MYOCARDIAL PERFUSION IMAGING

http://www.boothradiology.com/newimages/IG5L0125.jpg
http://www.isotope.com.au/files/4FG2Q5XXLI/MPS_slices.jpg

STRESS PERFUSSION CARDIAC MRI

http://content.onlinejacc.org/data/Journals/JAC/23062/10074_gr2.jpeg
http://limpeter-mriblog.blogspot.com/2009/09/adenosine-stress-magnetic-

KESIMPULAN
Pada CAD asimtomatik (Rekomendasi)
(+) HT atau (+) DM perlu pemeriksaan Rest. ECG (IIa; C);
SCORE= intermediate risk (nilai 7,5): CIMT, ABI, CT-CAC-Score (IIa; B)
(+) DM (+) 40 th: CT-CAC-Score (IIb; B)
(-) HT atau (-) DM perlu pemeriksaan Rest. ECG (IIb; C);
SCORE= intermediate risk (nilai 7,5): Exer. ECG (IIb; C)
(+) DM/FH kuat; CAC > 400; MPI, str. Echo, perfusi CMR: (+): Adv! (IIb; C)
SCORE= low/inter. Stress imaging test: not indicated (III; C)

Tuhan YME, Allah SWT, God The Father,

Thien, Shang Ti, Ida Sang Hyang Widhi
Wasa, Budha Agung, Yehova, Deo, Theo,
Baba Nanak, Suksma Kawekas, Amata
Dibata Mula Jadi Nabolon. Tuhan YME,
Allah SWT, God T he Father, T hien,
Shang Ti, Ida Sang Hyang Widhi Wasa,
Budha Agung, Yehova, Deo, Theo, Baba
Nanak, Suksma Kawekas, Amata Dibata
Mula Jadi Nabolon. Tuhan YME, Allah
SWT, God The Father, Thien, Shang Ti,
Ida Sang Hyang Widhi Wasa, Budha
Agung, Yehova, Deo, Theo, Baba Nanak,
Suksma Kawekas, Amata Dibata Mula

thank
you
thank you