Oleh Admin Kalbe Medical pada February 07, 2017 08:00

Peranan Coenzyme Q10 pada Gagal Jantung

Tatalaksana gagal jantung yang optimal memiliki berbagai tantangan. Terapi standar yang biasa diberikan pada pasien lebih bersifat memblok proses seluler daripada meningkatkannya, di mana beberapa kebutuhan penting miokardium dapat tidak terpenuhi. Di antara berbagai penyebab gagal jantung, mekanisme penting yang berkontribusi adalah kurangnya energi miosit kardiak.

Coenzyme Q10 (CoQ10) adalah antioksidan kuat, larut-lemak, yang juga merupakan komponen sentral redoks rantai transpor elektron serta sintesis dari adenosine triphosphate (ATP). Pada pasien-pasien gagal jantung didapati berkurangnya kandungan CoQ10 pada jaringan miokardial yang berkorelasi dengan keparahan gejala dan derajat disfungsi bilik kiri. Beberapa meta-analisa atas uji-uji klinis acak terkontrol mengindikasikan adanya pengaruh positif CoQ10 terhadap fraksi ejeksi bilik kiri pada gagal jantung, baik dengan maupun tanpa peningkatan dari New York Heart Association (NYHA) functional class.


Mortensen SA, et al, melakukan studi pada pasien-pasien dengan gagal jantung derajat sedang hingga berat yang secara acak diberikan CoQ10 100 mg tiga kali sehari atau plasebo, di samping terapi gagal jantung standar yang didapat, dan diikuti prospektif selama 2 tahun. Tolak ukur jangka panjang yang digunakan yaitu gabungan dari Major Adverse Cardiovascular Events (MACE) yang terdiri dari perawatan inap di rumah sakit akibat perburukan gagal jantung, kematian kardiovaskular, implan alat bantuan mekanis, atau transplantasi jantung darurat. Hasil jangka panjang pada studi ini adalah pada minggu ke-106, terjadi penurunan MACE yang signifikan pada kelompok yang mendapat CoQ10 (N=30,15%) dibandingkan pada kelompok plasebo (N=57,26%), dengan relative reduction sebesar 43% (p = 0,005; Fisher-exact test).


Pada studi yang dilakukan Sander S, et al, didapatkan bahwa CoQ10 meningkatkan fungsi sistolik pada pasien dengan gagal jantung dengan data statistik yang signifikan pada perubahan ejection fracton, cardiac output, dan stroke index jika dibandingkan dengan plasebo. Namun, efek ini akan berkurang jika pemberian CoQ10 bersamaan dengan terapi standar seperti ACE inhibitors.

Dibutuhkan    studi   lebih   lanjut   untuk   mengevaluasi   luaran jangka panjang dan mengonfirmasi efikasi CoQ10 pada pasien-pasien gagal jantung, baik diberikan sebagai terapi ajuvan maupun alternatif.

(JCH)

Image : Ilustrasi
Referensi:    
1.Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure. J Heart Failure 2014;(9):1-9. doi: 10.1016/j.jchf.2014.06.008.
2.Sander S, Coleman CI, Patel AA, Kluger J, White CM. The impact of coenzyme Q10 on systolic function in patients with chronic heart failure. J of Cadiac Heart Failure 2006;12(6):464-72.

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